diff --git "a/ner-train.jsonl" "b/ner-train.jsonl"
deleted file mode 100644--- "a/ner-train.jsonl"
+++ /dev/null
@@ -1,200 +0,0 @@
-{"full_text":"CASE: A 28-year-old previously healthy man presented with a 6-week history of palpitations.\nThe symptoms occurred during rest, 2\u20133 times per week, lasted up to 30 minutes at a time and were associated with dyspnea.\nExcept for a grade 2\/6 holosystolic tricuspid regurgitation murmur (best heard at the left sternal border with inspiratory accentuation), physical examination yielded unremarkable findings.\nAn electrocardiogram (ECG) revealed normal sinus rhythm and a Wolff\u2013 Parkinson\u2013 White pre-excitation pattern (Fig.1: Top), produced by a right-sided accessory pathway.\nTransthoracic echocardiography demonstrated the presence of Ebstein's anomaly of the tricuspid valve, with apical displacement of the valve and formation of an \u201catrialized\u201d right ventricle (a functional unit between the right atrium and the inlet [inflow] portion of the right ventricle) (Fig.2).\nThe anterior tricuspid valve leaflet was elongated (Fig.2C, arrow), whereas the septal leaflet was rudimentary (Fig.2C, arrowhead).\nContrast echocardiography using saline revealed a patent foramen ovale with right-to-left shunting and bubbles in the left atrium (Fig.2D).\nThe patient underwent an electrophysiologic study with mapping of the accessory pathway, followed by radiofrequency ablation (interruption of the pathway using the heat generated by electromagnetic waves at the tip of an ablation catheter).\nHis post-ablation ECG showed a prolonged PR interval and an odd \u201csecond\u201d QRS complex in leads III, aVF and V2\u2013V4 (Fig.1Bottom), a consequence of abnormal impulse conduction in the \u201catrialized\u201d right ventricle.\nThe patient reported no recurrence of palpitations at follow-up 6 months after the ablation.\n","ner_info":[{"text":"28-year-old","label":"AGE","start":8,"end":19},{"text":"previously healthy","label":"HISTORY","start":20,"end":38},{"text":"man","label":"SEX","start":39,"end":42},{"text":"presented","label":"CLINICAL_EVENT","start":43,"end":52},{"text":"6-week","label":"DURATION","start":60,"end":66},{"text":"palpitations","label":"SIGN_SYMPTOM","start":78,"end":90},{"text":"symptoms","label":"COREFERENCE","start":96,"end":104},{"text":"rest","label":"CLINICAL_EVENT","start":121,"end":125},{"text":"2\u20133 times per week","label":"FREQUENCY","start":127,"end":145},{"text":"up to 30 minutes at a time","label":"DETAILED_DESCRIPTION","start":154,"end":180},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":206,"end":213},{"text":"grade 2\/6","label":"LAB_VALUE","start":228,"end":237},{"text":"holosystolic","label":"DETAILED_DESCRIPTION","start":238,"end":250},{"text":"tricuspid","label":"BIOLOGICAL_STRUCTURE","start":251,"end":260},{"text":"regurgitation murmur","label":"SIGN_SYMPTOM","start":261,"end":281},{"text":"left sternal border","label":"BIOLOGICAL_STRUCTURE","start":301,"end":320},{"text":"inspiratory accentuation","label":"DETAILED_DESCRIPTION","start":326,"end":350},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":353,"end":373},{"text":"unremarkable","label":"LAB_VALUE","start":382,"end":394},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":408,"end":425},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":427,"end":430},{"text":"normal","label":"LAB_VALUE","start":441,"end":447},{"text":"sinus rhythm","label":"DIAGNOSTIC_PROCEDURE","start":448,"end":460},{"text":"Wolff\u2013 Parkinson\u2013 White pre-excitation pattern","label":"SIGN_SYMPTOM","start":467,"end":513},{"text":"right-sided","label":"DETAILED_DESCRIPTION","start":542,"end":553},{"text":"accessory pathway","label":"DISEASE_DISORDER","start":554,"end":571},{"text":"Transthoracic","label":"BIOLOGICAL_STRUCTURE","start":573,"end":586},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":587,"end":603},{"text":"Ebstein's anomaly","label":"DISEASE_DISORDER","start":633,"end":650},{"text":"tricuspid valve","label":"BIOLOGICAL_STRUCTURE","start":658,"end":673},{"text":"apical displacement","label":"SIGN_SYMPTOM","start":680,"end":699},{"text":"valve","label":"COREFERENCE","start":707,"end":712},{"text":"atrialized","label":"DISEASE_DISORDER","start":734,"end":744},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":746,"end":761},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":793,"end":805},{"text":"inlet","label":"BIOLOGICAL_STRUCTURE","start":814,"end":819},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":844,"end":859},{"text":"anterior tricuspid valve leaflet","label":"BIOLOGICAL_STRUCTURE","start":874,"end":906},{"text":"elongated","label":"SIGN_SYMPTOM","start":911,"end":920},{"text":"septal leaflet","label":"BIOLOGICAL_STRUCTURE","start":950,"end":964},{"text":"rudimentary","label":"SIGN_SYMPTOM","start":969,"end":980},{"text":"Contrast","label":"DETAILED_DESCRIPTION","start":1002,"end":1010},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1011,"end":1027},{"text":"using saline","label":"DETAILED_DESCRIPTION","start":1028,"end":1040},{"text":"patent foramen ovale","label":"DISEASE_DISORDER","start":1052,"end":1072},{"text":"right-to-left shunting","label":"SIGN_SYMPTOM","start":1078,"end":1100},{"text":"bubbles","label":"SIGN_SYMPTOM","start":1105,"end":1112},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":1120,"end":1131},{"text":"electrophysiologic study","label":"DIAGNOSTIC_PROCEDURE","start":1167,"end":1191},{"text":"mapping","label":"DIAGNOSTIC_PROCEDURE","start":1197,"end":1204},{"text":"accessory pathway","label":"BIOLOGICAL_STRUCTURE","start":1212,"end":1229},{"text":"radiofrequency","label":"DETAILED_DESCRIPTION","start":1243,"end":1257},{"text":"ablation","label":"THERAPEUTIC_PROCEDURE","start":1258,"end":1266},{"text":"ablation catheter","label":"THERAPEUTIC_PROCEDURE","start":1363,"end":1380},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":1401,"end":1404},{"text":"prolonged","label":"LAB_VALUE","start":1414,"end":1423},{"text":"PR interval","label":"DIAGNOSTIC_PROCEDURE","start":1424,"end":1435},{"text":"odd","label":"LAB_VALUE","start":1443,"end":1446},{"text":"\u201csecond\u201d","label":"LAB_VALUE","start":1447,"end":1455},{"text":"QRS complex","label":"DIAGNOSTIC_PROCEDURE","start":1456,"end":1467},{"text":"leads III, aVF and V2\u2013V4","label":"DETAILED_DESCRIPTION","start":1471,"end":1495},{"text":"abnormal impulse conduction","label":"DISEASE_DISORDER","start":1528,"end":1555},{"text":"atrialized","label":"DISEASE_DISORDER","start":1564,"end":1574},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":1576,"end":1591},{"text":"palpitations","label":"SIGN_SYMPTOM","start":1631,"end":1643},{"text":"follow-up","label":"CLINICAL_EVENT","start":1647,"end":1656},{"text":"6 months after","label":"DATE","start":1657,"end":1671}],"tokens":["CASE: A ","28-year-old"," ","previously healthy"," ","man"," ","presented"," with a ","6-week"," history of ","palpitations",".\nThe ","symptoms"," occurred during ","rest",", ","2\u20133 times per week",", lasted ","up to 30 minutes at a time"," and were associated with ","dyspnea",".\nExcept for a ","grade 2\/6"," ","holosystolic"," ","tricuspid"," ","regurgitation murmur"," (best heard at the ","left sternal border"," with ","inspiratory accentuation","), ","physical examination"," yielded ","unremarkable"," findings.\nAn ","electrocardiogram"," (","ECG",") revealed ","normal"," ","sinus rhythm"," and a ","Wolff\u2013 Parkinson\u2013 White pre-excitation pattern"," (Fig.1: Top), produced by a ","right-sided"," ","accessory pathway",".\n","Transthoracic"," ","echocardiography"," demonstrated the presence of ","Ebstein's anomaly"," of the ","tricuspid valve",", with ","apical displacement"," of the ","valve"," and formation of an \u201c","atrialized","\u201d ","right ventricle"," (a functional unit between the ","right atrium"," and the ","inlet"," [inflow] portion of the ","right ventricle",") (Fig.2).\nThe ","anterior tricuspid valve leaflet"," was ","elongated"," (Fig.2C, arrow), whereas the ","septal leaflet"," was ","rudimentary"," (Fig.2C, arrowhead).\n","Contrast"," ","echocardiography"," ","using saline"," revealed a ","patent foramen ovale"," with ","right-to-left shunting"," and ","bubbles"," in the ","left atrium"," (Fig.2D).\nThe patient underwent an ","electrophysiologic study"," with ","mapping"," of the ","accessory pathway",", followed by ","radiofrequency"," ","ablation"," (interruption of the pathway using the heat generated by electromagnetic waves at the tip of an ","ablation catheter",").\nHis post-ablation ","ECG"," showed a ","prolonged"," ","PR interval"," and an ","odd"," ","\u201csecond\u201d"," ","QRS complex"," in ","leads III, aVF and V2\u2013V4"," (Fig.1Bottom), a consequence of ","abnormal impulse conduction"," in the \u201c","atrialized","\u201d ","right ventricle",".\nThe patient reported no recurrence of ","palpitations"," at ","follow-up"," ","6 months after"," the ablation.\n"],"ner_labels":[0,5,0,39,0,65,0,13,0,32,0,69,0,18,0,13,0,35,0,22,0,69,0,42,0,22,0,12,0,69,0,12,0,22,0,24,0,42,0,24,0,24,0,42,0,24,0,69,0,22,0,26,0,12,0,24,0,26,0,12,0,69,0,18,0,26,0,12,0,12,0,12,0,12,0,12,0,69,0,12,0,69,0,22,0,24,0,22,0,26,0,69,0,69,0,12,0,24,0,24,0,12,0,22,0,75,0,75,0,24,0,42,0,24,0,42,0,42,0,24,0,22,0,26,0,26,0,12,0,69,0,13,0,19,0]}
-{"full_text":"The patient was a 34-yr-old man who presented with complaints of fever and a chronic cough.\nHe was a smoker and had a history of pulmonary tuberculosis that had been treated and cured.\nA computed tomographic (CT) scan revealed multiple tiny nodules in both lungs.\nA thoracoscopic lung biopsy was taken from the right upper lobe.\nThe microscopic examination revealed a typical LCH.\nThe tumor cells had vesicular and grooved nuclei, and they formed small aggregations around the bronchioles (Fig.1).\nThe tumor cells were strongly positive for S-100 protein, vimentin, CD68 and CD1a.\nThere were infiltrations of lymphocytes and eosinophils around the tumor cells.\nWith performing additional radiologic examinations, no other organs were thought to be involved.\nHe quit smoking, but he received no other specific treatment.\nHe was well for the following one year.\nAfter this, a follow-up CT scan was performed and it showed a 4 cm-sized mass in the left lower lobe, in addition to the multiple tiny nodules in both lungs (Fig.2).\nA needle biopsy specimen revealed the possibility of a sarcoma; therefore, a lobectomy was performed.\nGrossly, a 4 cm-sized poorly-circumscribed lobulated gray-white mass was found (Fig.3), and there were a few small satellite nodules around the main mass.\nMicroscopically, the tumor cells were aggregated in large sheets and they showed an infiltrative growth.\nThe cytologic features of some of the tumor cells were similar to those seen in a typical LCH.\nHowever, many tumor cells showed overtly malignant cytologic features such as pleomorphic\/hyperchromatic nuclei and prominent nucleoli (Fig.4), and multinucleated tumor giant cells were also found.\nThere were numerous mitotic figures ranging from 30 to 60 per 10 high power fields, and some of them were abnormal.\nA few foci of typical LCH remained around the main tumor mass.\nImmunohistochemically, the tumor cells were strongly positive for S-100 protein (Fig.5) and vimentin; they were also positive for CD68 (Dako N1577, Clone KPI), and focally positive for CD1a (Fig.6), and they were negative for cytokeratin, epithelial membrane antigen, CD3, CD20 and HMB45.\nThe ultrastructural analysis failed to demonstrate any Birbeck granules in the cytoplasm of the tumor cells.\nNow, at five months after lobectomy, the patient is doing well with no significant change in the radiologic findings.\n","ner_info":[{"text":"34-yr-old","label":"AGE","start":18,"end":27},{"text":"man","label":"SEX","start":28,"end":31},{"text":"presented","label":"CLINICAL_EVENT","start":36,"end":45},{"text":"fever","label":"SIGN_SYMPTOM","start":65,"end":70},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":77,"end":84},{"text":"cough","label":"SIGN_SYMPTOM","start":85,"end":90},{"text":"smoker","label":"HISTORY","start":101,"end":107},{"text":"history of pulmonary tuberculosis","label":"HISTORY","start":118,"end":151},{"text":"treated and cured","label":"LAB_VALUE","start":166,"end":183},{"text":"computed tomographic","label":"DIAGNOSTIC_PROCEDURE","start":187,"end":207},{"text":"(CT)","label":"DIAGNOSTIC_PROCEDURE","start":208,"end":212},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":227,"end":235},{"text":"tiny","label":"DETAILED_DESCRIPTION","start":236,"end":240},{"text":"nodules","label":"SIGN_SYMPTOM","start":241,"end":248},{"text":"both lungs","label":"BIOLOGICAL_STRUCTURE","start":252,"end":262},{"text":"thoracoscopic","label":"DETAILED_DESCRIPTION","start":266,"end":279},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":280,"end":284},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":285,"end":291},{"text":"right upper lobe","label":"BIOLOGICAL_STRUCTURE","start":311,"end":327},{"text":"microscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":333,"end":356},{"text":"LCH","label":"SIGN_SYMPTOM","start":376,"end":379},{"text":"tumor cells","label":"COREFERENCE","start":385,"end":396},{"text":"vesicular","label":"DETAILED_DESCRIPTION","start":401,"end":410},{"text":"grooved","label":"TEXTURE","start":415,"end":422},{"text":"nuclei","label":"BIOLOGICAL_STRUCTURE","start":423,"end":429},{"text":"small","label":"BIOLOGICAL_ATTRIBUTE","start":447,"end":452},{"text":"aggregations","label":"BIOLOGICAL_ATTRIBUTE","start":453,"end":465},{"text":"around the bronchioles","label":"BIOLOGICAL_STRUCTURE","start":466,"end":488},{"text":"tumor cells","label":"COREFERENCE","start":502,"end":513},{"text":"strongly","label":"SEVERITY","start":519,"end":527},{"text":"positive","label":"LAB_VALUE","start":528,"end":536},{"text":"S-100 protein","label":"DIAGNOSTIC_PROCEDURE","start":541,"end":554},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":556,"end":564},{"text":"CD68","label":"DIAGNOSTIC_PROCEDURE","start":566,"end":570},{"text":"CD1a","label":"DIAGNOSTIC_PROCEDURE","start":575,"end":579},{"text":"infiltrations","label":"BIOLOGICAL_STRUCTURE","start":592,"end":605},{"text":"lymphocytes","label":"BIOLOGICAL_STRUCTURE","start":609,"end":620},{"text":"eosinophils","label":"BIOLOGICAL_STRUCTURE","start":625,"end":636},{"text":"tumor cells","label":"COREFERENCE","start":648,"end":659},{"text":"radiologic examinations","label":"DIAGNOSTIC_PROCEDURE","start":688,"end":711},{"text":"no other organs were thought to be involved","label":"SIGN_SYMPTOM","start":713,"end":756},{"text":"quit smoking","label":"ACTIVITY","start":761,"end":773},{"text":"well","label":"SIGN_SYMPTOM","start":827,"end":831},{"text":"for the following one year","label":"DURATION","start":832,"end":858},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":884,"end":891},{"text":"4 cm-sized","label":"SHAPE","start":922,"end":932},{"text":"mass","label":"SIGN_SYMPTOM","start":933,"end":937},{"text":"left lower lobe","label":"BIOLOGICAL_STRUCTURE","start":945,"end":960},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":981,"end":989},{"text":"tiny","label":"DETAILED_DESCRIPTION","start":990,"end":994},{"text":"nodules","label":"SIGN_SYMPTOM","start":995,"end":1002},{"text":"both lungs","label":"BIOLOGICAL_STRUCTURE","start":1006,"end":1016},{"text":"needle","label":"DETAILED_DESCRIPTION","start":1028,"end":1034},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1035,"end":1041},{"text":"possibility of a sarcoma","label":"SIGN_SYMPTOM","start":1064,"end":1088},{"text":"lobectomy","label":"THERAPEUTIC_PROCEDURE","start":1103,"end":1112},{"text":"4 cm-sized","label":"SHAPE","start":1139,"end":1149},{"text":"poorly-circumscribed","label":"DETAILED_DESCRIPTION","start":1150,"end":1170},{"text":"lobulated","label":"DETAILED_DESCRIPTION","start":1171,"end":1180},{"text":"gray-white","label":"COLOR","start":1181,"end":1191},{"text":"mass","label":"SIGN_SYMPTOM","start":1192,"end":1196},{"text":"small","label":"DETAILED_DESCRIPTION","start":1237,"end":1242},{"text":"satellite","label":"DETAILED_DESCRIPTION","start":1243,"end":1252},{"text":"nodules","label":"SIGN_SYMPTOM","start":1253,"end":1260},{"text":"main mass","label":"COREFERENCE","start":1272,"end":1281},{"text":"Microscopically","label":"DIAGNOSTIC_PROCEDURE","start":1283,"end":1298},{"text":"tumor cells","label":"COREFERENCE","start":1304,"end":1315},{"text":"aggregated in large sheets","label":"DETAILED_DESCRIPTION","start":1321,"end":1347},{"text":"infiltrative growth","label":"BIOLOGICAL_STRUCTURE","start":1367,"end":1386},{"text":"cytologic features","label":"BIOLOGICAL_ATTRIBUTE","start":1392,"end":1410},{"text":"tumor cells","label":"COREFERENCE","start":1426,"end":1437},{"text":"similar to those seen in a typical LCH","label":"DETAILED_DESCRIPTION","start":1443,"end":1481},{"text":"tumor cells","label":"COREFERENCE","start":1497,"end":1508},{"text":"cytologic features","label":"BIOLOGICAL_ATTRIBUTE","start":1534,"end":1552},{"text":"pleomorphic\/hyperchromatic","label":"DETAILED_DESCRIPTION","start":1561,"end":1587},{"text":"nuclei","label":"BIOLOGICAL_STRUCTURE","start":1588,"end":1594},{"text":"prominent","label":"DETAILED_DESCRIPTION","start":1599,"end":1608},{"text":"nucleoli","label":"BIOLOGICAL_ATTRIBUTE","start":1609,"end":1617},{"text":"multinucleated","label":"DETAILED_DESCRIPTION","start":1631,"end":1645},{"text":"tumor giant cells","label":"BIOLOGICAL_STRUCTURE","start":1646,"end":1663},{"text":"numerous","label":"DETAILED_DESCRIPTION","start":1692,"end":1700},{"text":"mitotic figures","label":"BIOLOGICAL_STRUCTURE","start":1701,"end":1716},{"text":"30 to 60 per 10 high power fields","label":"LAB_VALUE","start":1730,"end":1763},{"text":"some of them were abnormal","label":"DETAILED_DESCRIPTION","start":1769,"end":1795},{"text":"few foci","label":"DETAILED_DESCRIPTION","start":1799,"end":1807},{"text":"typical LCH","label":"SIGN_SYMPTOM","start":1811,"end":1822},{"text":"around the main tumor mass","label":"DETAILED_DESCRIPTION","start":1832,"end":1858},{"text":"Immunohistochemically","label":"DIAGNOSTIC_PROCEDURE","start":1860,"end":1881},{"text":"strongly","label":"SEVERITY","start":1904,"end":1912},{"text":"positive","label":"LAB_VALUE","start":1913,"end":1921},{"text":"S-100 protein","label":"DIAGNOSTIC_PROCEDURE","start":1926,"end":1939},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":1952,"end":1960},{"text":"positive","label":"LAB_VALUE","start":1977,"end":1985},{"text":"CD68","label":"DIAGNOSTIC_PROCEDURE","start":1990,"end":1994},{"text":"focally","label":"DETAILED_DESCRIPTION","start":2024,"end":2031},{"text":"positive","label":"LAB_VALUE","start":2032,"end":2040},{"text":"CD1a","label":"DIAGNOSTIC_PROCEDURE","start":2045,"end":2049},{"text":"negative","label":"LAB_VALUE","start":2073,"end":2081},{"text":"cytokeratin","label":"DIAGNOSTIC_PROCEDURE","start":2086,"end":2097},{"text":"epithelial membrane antigen","label":"DIAGNOSTIC_PROCEDURE","start":2099,"end":2126},{"text":"CD3","label":"DIAGNOSTIC_PROCEDURE","start":2128,"end":2131},{"text":"CD20","label":"DIAGNOSTIC_PROCEDURE","start":2133,"end":2137},{"text":"HMB45","label":"DIAGNOSTIC_PROCEDURE","start":2142,"end":2147},{"text":"ultrastructural analysis","label":"DIAGNOSTIC_PROCEDURE","start":2153,"end":2177},{"text":"failed to demonstrate any Birbeck granules","label":"SIGN_SYMPTOM","start":2178,"end":2220},{"text":"cytoplasm","label":"BIOLOGICAL_STRUCTURE","start":2228,"end":2237},{"text":"tumor cells","label":"SIGN_SYMPTOM","start":2245,"end":2256},{"text":"five months after","label":"DATE","start":2266,"end":2283},{"text":"lobectomy","label":"COREFERENCE","start":2284,"end":2293},{"text":"doing well","label":"OUTCOME","start":2310,"end":2320},{"text":"no significant change in the radiologic findings","label":"SIGN_SYMPTOM","start":2326,"end":2374}],"tokens":["The patient was a ","34-yr-old"," ","man"," who ","presented"," with complaints of ","fever"," and a ","chronic"," ","cough",".\nHe was a ","smoker"," and had a ","history of pulmonary tuberculosis"," that had been ","treated and cured",".\nA ","computed tomographic"," ","(CT)"," scan revealed ","multiple"," ","tiny"," ","nodules"," in ","both lungs",".\nA ","thoracoscopic"," ","lung"," ","biopsy"," was taken from the ","right upper lobe",".\nThe ","microscopic examination"," revealed a typical ","LCH",".\nThe ","tumor cells"," had ","vesicular"," and ","grooved"," ","nuclei",", and they formed ","small"," ","aggregations"," ","around the bronchioles"," (Fig.1).\nThe ","tumor cells"," were ","strongly"," ","positive"," for ","S-100 protein",", ","vimentin",", ","CD68"," and ","CD1a",".\nThere were ","infiltrations"," of ","lymphocytes"," and ","eosinophils"," around the ","tumor cells",".\nWith performing additional ","radiologic examinations",", ","no other organs were thought to be involved",".\nHe ","quit smoking",", but he received no other specific treatment.\nHe was ","well"," ","for the following one year",".\nAfter this, a follow-up ","CT scan"," was performed and it showed a ","4 cm-sized"," ","mass"," in the ","left lower lobe",", in addition to the ","multiple"," ","tiny"," ","nodules"," in ","both lungs"," (Fig.2).\nA ","needle"," ","biopsy"," specimen revealed the ","possibility of a sarcoma","; therefore, a ","lobectomy"," was performed.\nGrossly, a ","4 cm-sized"," ","poorly-circumscribed"," ","lobulated"," ","gray-white"," ","mass"," was found (Fig.3), and there were a few ","small"," ","satellite"," ","nodules"," around the ","main mass",".\n","Microscopically",", the ","tumor cells"," were ","aggregated in large sheets"," and they showed an ","infiltrative growth",".\nThe ","cytologic features"," of some of the ","tumor cells"," were ","similar to those seen in a typical LCH",".\nHowever, many ","tumor cells"," showed overtly malignant ","cytologic features"," such as ","pleomorphic\/hyperchromatic"," ","nuclei"," and ","prominent"," ","nucleoli"," (Fig.4), and ","multinucleated"," ","tumor giant cells"," were also found.\nThere were ","numerous"," ","mitotic figures"," ranging from ","30 to 60 per 10 high power fields",", and ","some of them were abnormal",".\nA ","few foci"," of ","typical LCH"," remained ","around the main tumor mass",".\n","Immunohistochemically",", the tumor cells were ","strongly"," ","positive"," for ","S-100 protein"," (Fig.5) and ","vimentin","; they were also ","positive"," for ","CD68"," (Dako N1577, Clone KPI), and ","focally"," ","positive"," for ","CD1a"," (Fig.6), and they were ","negative"," for ","cytokeratin",", ","epithelial membrane antigen",", ","CD3",", ","CD20"," and ","HMB45",".\nThe ","ultrastructural analysis"," ","failed to demonstrate any Birbeck granules"," in the ","cytoplasm"," of the ","tumor cells",".\nNow, at ","five months after"," ","lobectomy",", the patient is ","doing well"," with ","no significant change in the radiologic findings",".\n"],"ner_labels":[0,5,0,65,0,13,0,69,0,22,0,69,0,39,0,39,0,42,0,24,0,24,0,22,0,22,0,69,0,12,0,22,0,12,0,24,0,12,0,24,0,69,0,18,0,22,0,73,0,12,0,9,0,9,0,12,0,18,0,63,0,42,0,24,0,24,0,24,0,24,0,12,0,12,0,12,0,18,0,24,0,69,0,1,0,69,0,32,0,24,0,67,0,69,0,12,0,22,0,22,0,69,0,12,0,22,0,24,0,69,0,75,0,67,0,22,0,22,0,15,0,69,0,22,0,22,0,69,0,18,0,24,0,18,0,22,0,12,0,9,0,18,0,22,0,18,0,9,0,22,0,12,0,22,0,9,0,22,0,12,0,22,0,12,0,42,0,22,0,22,0,69,0,22,0,24,0,63,0,42,0,24,0,24,0,42,0,24,0,22,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,69,0,12,0,69,0,19,0,18,0,56,0,69,0]}
-{"full_text":"A 23 year old white male with a 4 year history of Crohn's disease presented with an acute two day history of malaise, fever, abdominal pain, vomiting and stomal diarrhoea.\nHe complained of joint pains affecting the shoulders, elbows, wrists, metacarpophalangeals, knees and ankles.\nThere was also a rash on the elbows, ankles and feet, which began as erythematous macules and evolved to vesico-pustular lesions followed by crusting.\nThere was no history of sexual exposure or any intercurrent infection.\nHe was on no regular medication, but had discontinued Pentasa 4 months earlier.\nOne month earlier he had undergone a laparotomy to excise a complex ileo-cutaneous fistula with blind tracts, and two weeks earlier a defunctioning ileostomy had been created in view of persistent abdominal pain.\nThe cutaneous fistula had been present for a year, but was associated with a terminal ileal stricture and ileo-rectal fistula of at least 2 years duration.\nHis bowel disease had been resistant to immunosuppressive drugs including azathioprine, corticosteroiods and three infusions of Infliximab a year earlier.\nThere had been no extra-intestinal manifestations.\nOn admission to the hospital, he was thin, afebrile with a resting tachycardia of 125\/minute.\nThe rest of the cardio-respiratory examination was normal.\nThe abdomen was minimally tender around the ileostomy without guarding or rebound tenderness.\nExamination of the skin revealed some pustules and crusts around the elbows, ankles and feet (Fig 1 and  2).\nThe buttocks were spared.\nThere were clinical signs of synovitis of the wrists, proximal interphalangeal and metacarpophalangeal joints, and also both ankles.\nResults of the laboratory tests showed a haemoglobin of 13.1 gm\/dl, white blood count 15.8 \u00d7 109\/L, platelets 585 \u00d7 109\/L, C- reactive protein 37.7 mg\/L and erythrocyte sedimentation rate 69 mm\/hr.\nUrea and electrolytes, complement, urine analysis and microscopy were normal.\nRheumatoid factor, antinuclear and antineutrophil cytoplasmic antibodies, cryoglobulins and Hepatitis B and C serology were negative.\nTransthoracic echocardiogram showed no signs of endocarditis, and multiple blood cultures were sterile.\nA skin biopsy from the ankle revealed a perivascular lymphohistiocytic infiltrate with prominent neutrophils and associated fibrinoid necrosis of vessels consistent with 'leukocytoclastic' vasculitis.\nHe was commenced on 60 mg prednisolone per day leading to prompt and complete resolution of all features.\nThe dose of prednisolone was rapidly tapered over the course of one month by the patient, faster than advised but without any recurrence over the following 3 years.\n","ner_info":[{"text":"23 year old","label":"AGE","start":2,"end":13},{"text":"white","label":"PERSONAL_BACKGROUND","start":14,"end":19},{"text":"male","label":"SEX","start":20,"end":24},{"text":"4 year history of Crohn's disease","label":"HISTORY","start":32,"end":65},{"text":"presented","label":"CLINICAL_EVENT","start":66,"end":75},{"text":"two day","label":"DURATION","start":90,"end":97},{"text":"malaise","label":"SIGN_SYMPTOM","start":109,"end":116},{"text":"fever","label":"SIGN_SYMPTOM","start":118,"end":123},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":125,"end":134},{"text":"pain","label":"SIGN_SYMPTOM","start":135,"end":139},{"text":"vomiting","label":"SIGN_SYMPTOM","start":141,"end":149},{"text":"stomal","label":"BIOLOGICAL_STRUCTURE","start":154,"end":160},{"text":"diarrhoea","label":"SIGN_SYMPTOM","start":161,"end":170},{"text":"joint","label":"BIOLOGICAL_STRUCTURE","start":189,"end":194},{"text":"pains","label":"SIGN_SYMPTOM","start":195,"end":200},{"text":"shoulders","label":"BIOLOGICAL_STRUCTURE","start":215,"end":224},{"text":"elbows","label":"BIOLOGICAL_STRUCTURE","start":226,"end":232},{"text":"wrists","label":"BIOLOGICAL_STRUCTURE","start":234,"end":240},{"text":"metacarpophalangeals","label":"BIOLOGICAL_STRUCTURE","start":242,"end":262},{"text":"knees","label":"BIOLOGICAL_STRUCTURE","start":264,"end":269},{"text":"ankles","label":"BIOLOGICAL_STRUCTURE","start":274,"end":280},{"text":"rash","label":"SIGN_SYMPTOM","start":299,"end":303},{"text":"elbows","label":"BIOLOGICAL_STRUCTURE","start":311,"end":317},{"text":"ankles","label":"BIOLOGICAL_STRUCTURE","start":319,"end":325},{"text":"feet","label":"BIOLOGICAL_STRUCTURE","start":330,"end":334},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":351,"end":363},{"text":"macules","label":"SIGN_SYMPTOM","start":364,"end":371},{"text":"vesico-pustular","label":"DETAILED_DESCRIPTION","start":387,"end":402},{"text":"lesions","label":"SIGN_SYMPTOM","start":403,"end":410},{"text":"crusting","label":"SIGN_SYMPTOM","start":423,"end":431},{"text":"no history of sexual exposure","label":"HISTORY","start":443,"end":472},{"text":"infection","label":"SIGN_SYMPTOM","start":493,"end":502},{"text":"no regular medication","label":"MEDICATION","start":514,"end":535},{"text":"Pentasa","label":"MEDICATION","start":558,"end":565},{"text":"4 months earlier","label":"DATE","start":566,"end":582},{"text":"One month earlier","label":"DATE","start":584,"end":601},{"text":"laparotomy","label":"THERAPEUTIC_PROCEDURE","start":621,"end":631},{"text":"complex","label":"DETAILED_DESCRIPTION","start":644,"end":651},{"text":"ileo-cutaneous","label":"DETAILED_DESCRIPTION","start":652,"end":666},{"text":"fistula","label":"SIGN_SYMPTOM","start":667,"end":674},{"text":"blind tracts","label":"DETAILED_DESCRIPTION","start":680,"end":692},{"text":"two weeks earlier","label":"DATE","start":698,"end":715},{"text":"defunctioning","label":"DETAILED_DESCRIPTION","start":718,"end":731},{"text":"ileostomy","label":"THERAPEUTIC_PROCEDURE","start":732,"end":741},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":770,"end":780},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":781,"end":790},{"text":"pain","label":"SIGN_SYMPTOM","start":791,"end":795},{"text":"cutaneous","label":"BIOLOGICAL_STRUCTURE","start":801,"end":810},{"text":"fistula","label":"SIGN_SYMPTOM","start":811,"end":818},{"text":"had been present for a year","label":"DURATION","start":819,"end":846},{"text":"terminal","label":"DETAILED_DESCRIPTION","start":874,"end":882},{"text":"ileal","label":"BIOLOGICAL_STRUCTURE","start":883,"end":888},{"text":"stricture","label":"SIGN_SYMPTOM","start":889,"end":898},{"text":"ileo-rectal","label":"BIOLOGICAL_STRUCTURE","start":903,"end":914},{"text":"fistula","label":"SIGN_SYMPTOM","start":915,"end":922},{"text":"of at least 2 years duration","label":"DURATION","start":923,"end":951},{"text":"bowel disease","label":"COREFERENCE","start":957,"end":970},{"text":"azathioprine","label":"MEDICATION","start":1027,"end":1039},{"text":"corticosteroiods","label":"MEDICATION","start":1041,"end":1057},{"text":"three infusions","label":"DOSAGE","start":1062,"end":1077},{"text":"Infliximab","label":"MEDICATION","start":1081,"end":1091},{"text":"a year earlier","label":"DATE","start":1092,"end":1106},{"text":"no extra-intestinal manifestations","label":"SIGN_SYMPTOM","start":1123,"end":1157},{"text":"admission","label":"CLINICAL_EVENT","start":1162,"end":1171},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1179,"end":1187},{"text":"thin","label":"SIGN_SYMPTOM","start":1196,"end":1200},{"text":"afebrile","label":"SIGN_SYMPTOM","start":1202,"end":1210},{"text":"resting","label":"DETAILED_DESCRIPTION","start":1218,"end":1225},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":1226,"end":1237},{"text":"125\/minute","label":"LAB_VALUE","start":1241,"end":1251},{"text":"cardio-respiratory examination","label":"DIAGNOSTIC_PROCEDURE","start":1269,"end":1299},{"text":"normal","label":"LAB_VALUE","start":1304,"end":1310},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1316,"end":1323},{"text":"minimally","label":"SEVERITY","start":1328,"end":1337},{"text":"tender","label":"SIGN_SYMPTOM","start":1338,"end":1344},{"text":"ileostomy","label":"BIOLOGICAL_STRUCTURE","start":1356,"end":1365},{"text":"without guarding","label":"DETAILED_DESCRIPTION","start":1366,"end":1382},{"text":"Examination of the skin","label":"DIAGNOSTIC_PROCEDURE","start":1406,"end":1429},{"text":"pustules","label":"SIGN_SYMPTOM","start":1444,"end":1452},{"text":"crusts","label":"SIGN_SYMPTOM","start":1457,"end":1463},{"text":"elbows","label":"BIOLOGICAL_STRUCTURE","start":1475,"end":1481},{"text":"ankles","label":"BIOLOGICAL_STRUCTURE","start":1483,"end":1489},{"text":"feet","label":"BIOLOGICAL_STRUCTURE","start":1494,"end":1498},{"text":"The buttocks were spared.","label":"OTHER_EVENT","start":1515,"end":1540},{"text":"synovitis","label":"SIGN_SYMPTOM","start":1570,"end":1579},{"text":"wrists","label":"BIOLOGICAL_STRUCTURE","start":1587,"end":1593},{"text":"proximal interphalangeal","label":"BIOLOGICAL_STRUCTURE","start":1595,"end":1619},{"text":"metacarpophalangeal","label":"BIOLOGICAL_STRUCTURE","start":1624,"end":1643},{"text":"joints","label":"BIOLOGICAL_STRUCTURE","start":1644,"end":1650},{"text":"both ankles","label":"BIOLOGICAL_STRUCTURE","start":1661,"end":1672},{"text":"laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":1689,"end":1705},{"text":"haemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1715,"end":1726},{"text":"13.1 gm\/dl","label":"LAB_VALUE","start":1730,"end":1740},{"text":"white blood count","label":"DIAGNOSTIC_PROCEDURE","start":1742,"end":1759},{"text":"15.8 \u00d7 109\/L","label":"LAB_VALUE","start":1760,"end":1772},{"text":"platelets","label":"DIAGNOSTIC_PROCEDURE","start":1774,"end":1783},{"text":"585 \u00d7 109\/L","label":"LAB_VALUE","start":1784,"end":1795},{"text":"C- reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1797,"end":1816},{"text":"37.7 mg\/L","label":"LAB_VALUE","start":1817,"end":1826},{"text":"erythrocyte sedimentation rate","label":"DIAGNOSTIC_PROCEDURE","start":1831,"end":1861},{"text":"69 mm\/hr","label":"LAB_VALUE","start":1862,"end":1870},{"text":"Urea","label":"DIAGNOSTIC_PROCEDURE","start":1872,"end":1876},{"text":"electrolytes","label":"DIAGNOSTIC_PROCEDURE","start":1881,"end":1893},{"text":"complement","label":"DIAGNOSTIC_PROCEDURE","start":1895,"end":1905},{"text":"urine analysis","label":"DIAGNOSTIC_PROCEDURE","start":1907,"end":1921},{"text":"microscopy","label":"DIAGNOSTIC_PROCEDURE","start":1926,"end":1936},{"text":"normal","label":"LAB_VALUE","start":1942,"end":1948},{"text":"Rheumatoid 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cultures","label":"DIAGNOSTIC_PROCEDURE","start":2150,"end":2173},{"text":"sterile","label":"LAB_VALUE","start":2179,"end":2186},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":2190,"end":2194},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2195,"end":2201},{"text":"perivascular","label":"BIOLOGICAL_STRUCTURE","start":2228,"end":2240},{"text":"lymphohistiocytic","label":"BIOLOGICAL_STRUCTURE","start":2241,"end":2258},{"text":"infiltrate","label":"BIOLOGICAL_STRUCTURE","start":2259,"end":2269},{"text":"neutrophils","label":"BIOLOGICAL_STRUCTURE","start":2285,"end":2296},{"text":"fibrinoid","label":"DETAILED_DESCRIPTION","start":2312,"end":2321},{"text":"necrosis","label":"SIGN_SYMPTOM","start":2322,"end":2330},{"text":"vessels","label":"BIOLOGICAL_STRUCTURE","start":2334,"end":2341},{"text":"leukocytoclastic","label":"DETAILED_DESCRIPTION","start":2359,"end":2375},{"text":"vasculitis","label":"DISEASE_DISORDER","start":2377,"end":2387},{"text":"60 mg","label":"DOSAGE","start":2409,"end":2414},{"text":"prednisolone","label":"MEDICATION","start":2415,"end":2427},{"text":"per day","label":"DOSAGE","start":2428,"end":2435},{"text":"prompt","label":"DETAILED_DESCRIPTION","start":2447,"end":2453},{"text":"complete","label":"DETAILED_DESCRIPTION","start":2458,"end":2466},{"text":"resolution of all features","label":"SIGN_SYMPTOM","start":2467,"end":2493},{"text":"prednisolone","label":"MEDICATION","start":2507,"end":2519},{"text":"tapered","label":"CLINICAL_EVENT","start":2532,"end":2539},{"text":"over the course of one month","label":"DURATION","start":2540,"end":2568},{"text":"without any recurrence","label":"SIGN_SYMPTOM","start":2609,"end":2631},{"text":"over the following 3 years","label":"DURATION","start":2632,"end":2658}],"tokens":["A ","23 year old"," ","white"," ","male"," with a ","4 year history of Crohn's disease"," ","presented"," with an acute ","two day"," history of ","malaise",", ","fever",", ","abdominal"," ","pain",", ","vomiting"," and ","stomal"," ","diarrhoea",".\nHe complained of ","joint"," ","pains"," affecting the ","shoulders",", ","elbows",", ","wrists",", ","metacarpophalangeals",", ","knees"," and ","ankles",".\nThere was also a ","rash"," on the ","elbows",", ","ankles"," and ","feet",", which began as ","erythematous"," ","macules"," and evolved to ","vesico-pustular"," ","lesions"," followed by ","crusting",".\nThere was ","no history of sexual exposure"," or any intercurrent ","infection",".\nHe was on ","no regular medication",", but had discontinued ","Pentasa"," ","4 months earlier",".\n","One month earlier"," he had undergone a ","laparotomy"," to excise a ","complex"," ","ileo-cutaneous"," ","fistula"," with ","blind tracts",", and ","two weeks earlier"," a ","defunctioning"," ","ileostomy"," had been created in view of ","persistent"," ","abdominal"," ","pain",".\nThe ","cutaneous"," ","fistula"," ","had been present for a year",", but was associated with a ","terminal"," ","ileal"," ","stricture"," and ","ileo-rectal"," ","fistula"," ","of at least 2 years duration",".\nHis ","bowel disease"," had been resistant to immunosuppressive drugs including ","azathioprine",", ","corticosteroiods"," and ","three infusions"," of ","Infliximab"," ","a year earlier",".\nThere had been ","no extra-intestinal manifestations",".\nOn ","admission"," to the ","hospital",", he was ","thin",", ","afebrile"," with a ","resting"," ","tachycardia"," of ","125\/minute",".\nThe rest of the ","cardio-respiratory examination"," was ","normal",".\nThe ","abdomen"," was ","minimally"," ","tender"," around the ","ileostomy"," ","without guarding"," or rebound tenderness.\n","Examination of the skin"," revealed some ","pustules"," and ","crusts"," around the ","elbows",", ","ankles"," and ","feet"," (Fig 1 and  2).\n","The buttocks were spared.","\nThere were clinical signs of ","synovitis"," of the ","wrists",", ","proximal interphalangeal"," and 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'","leukocytoclastic","' ","vasculitis",".\nHe was commenced on ","60 mg"," ","prednisolone"," ","per day"," leading to ","prompt"," and ","complete"," ","resolution of all features",".\nThe dose of ","prednisolone"," was rapidly ","tapered"," ","over the course of one month"," by the patient, faster than advised but ","without any recurrence"," ","over the following 3 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-{"full_text":"A 30-year-old female (65 kg) underwent rhinoplasty under general anaesthesia, which was induced using a combination of a bolus of Remifentanyl (0.5 \u03bcg\/kg) and Propofol 2 mg\/kg.\nMuscle paralysis was obtained with Cisatracurium (0.15 \u03bcg\/kg).\nTransoral intubation was performed with a Macintosh blade (No.3) and a size 7 mm diameter reinforced tracheal tube was easily and gently placed in the trachea, on the first attempt and was then fixed to the right corner of the mouth.\nNo problems were encountered during laryngoscopy and intubation.\nThe cuff of the tube was inflated with a pressure \u2264 20 cm H2O.\nNo adjustment of cuff volume was made intra-operatively.\nN2O was not used for inhalation anaesthesia.\nThe throat pack was placed in the pharynx to avoid the passage of blood in the aero-digestive tract.\nGeneral anaesthesia was maintained with Sevofluorane in oxygen\/air and Remifentanyl in continuous infusion 0.25 \u03bcg\/kg\/min.\nModerate arterial hypotension was maintained with a cuff systolic artery pressure of approximately 90 mmHg.\nThe operation was carried out in a semi-supine position with the head slightly inclined forward and laterally and trunk slightly elevated.\nDuration of the operation was 100 minutes.\nThe patient was extubated, after removal of the throat pack without problems.\nThe following day the patient complained of difficulty in swallowing, dysphonia and hoarseness.\nExamination revealed deviation of the tongue to the right side and vocal cord paralysis, expression of hypoglossal and recurrent laryngeal nerve injury without local oedema or haematoma.\nThe movements of the pharynx and soft palate were normal.\nMeticulous neurological examination, including also magnetic resonance imaging (MRN) revealed no other evidence of central or cranial nerve involvement.\nConservative management included steroids, vitamins together with speech and swallowing therapy.\nFull recovery of lingual and laryngeal functions was obtained within four months after surgery.\n","ner_info":[{"text":"30-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"rhinoplasty","label":"THERAPEUTIC_PROCEDURE","start":39,"end":50},{"text":"general anaesthesia","label":"MEDICATION","start":57,"end":76},{"text":"Remifentanyl","label":"MEDICATION","start":130,"end":142},{"text":"0.5 \u03bcg\/kg","label":"DOSAGE","start":144,"end":153},{"text":"Propofol","label":"MEDICATION","start":159,"end":167},{"text":"2 mg\/kg","label":"DOSAGE","start":168,"end":175},{"text":"Muscle paralysis","label":"DISEASE_DISORDER","start":177,"end":193},{"text":"Cisatracurium","label":"MEDICATION","start":212,"end":225},{"text":"0.15 \u03bcg\/kg","label":"DOSAGE","start":227,"end":237},{"text":"Transoral","label":"DETAILED_DESCRIPTION","start":240,"end":249},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":250,"end":260},{"text":"Macintosh 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volume","label":"THERAPEUTIC_PROCEDURE","start":605,"end":630},{"text":"N2O","label":"MEDICATION","start":659,"end":662},{"text":"throat pack","label":"THERAPEUTIC_PROCEDURE","start":708,"end":719},{"text":"pharynx","label":"BIOLOGICAL_STRUCTURE","start":738,"end":745},{"text":"General anaesthesia","label":"MEDICATION","start":805,"end":824},{"text":"Sevofluorane","label":"MEDICATION","start":845,"end":857},{"text":"in oxygen\/air","label":"ADMINISTRATION","start":858,"end":871},{"text":"Remifentanyl","label":"MEDICATION","start":876,"end":888},{"text":"continuous infusion","label":"ADMINISTRATION","start":892,"end":911},{"text":"0.25 \u03bcg\/kg\/min","label":"DOSAGE","start":912,"end":926},{"text":"Moderate","label":"SEVERITY","start":928,"end":936},{"text":"arterial hypotension","label":"SIGN_SYMPTOM","start":937,"end":957},{"text":"systolic artery pressure","label":"DIAGNOSTIC_PROCEDURE","start":985,"end":1009},{"text":"90 mmHg","label":"LAB_VALUE","start":1027,"end":1034},{"text":"semi-supine position","label":"THERAPEUTIC_PROCEDURE","start":1071,"end":1091},{"text":"head slightly inclined forward","label":"DETAILED_DESCRIPTION","start":1101,"end":1131},{"text":"trunk slightly elevated","label":"DETAILED_DESCRIPTION","start":1150,"end":1173},{"text":"operation","label":"THERAPEUTIC_PROCEDURE","start":1191,"end":1200},{"text":"100 minutes","label":"DURATION","start":1205,"end":1216},{"text":"extubated","label":"THERAPEUTIC_PROCEDURE","start":1234,"end":1243},{"text":"throat pack","label":"THERAPEUTIC_PROCEDURE","start":1266,"end":1277},{"text":"problems","label":"DISEASE_DISORDER","start":1286,"end":1294},{"text":"following day","label":"DATE","start":1300,"end":1313},{"text":"difficulty in swallowing","label":"SIGN_SYMPTOM","start":1340,"end":1364},{"text":"dysphonia","label":"SIGN_SYMPTOM","start":1366,"end":1375},{"text":"hoarseness","label":"SIGN_SYMPTOM","start":1380,"end":1390},{"text":"Examination","label":"DIAGNOSTIC_PROCEDURE","start":1392,"end":1403},{"text":"deviation","label":"SIGN_SYMPTOM","start":1413,"end":1422},{"text":"tongue","label":"BIOLOGICAL_STRUCTURE","start":1430,"end":1436},{"text":"right side","label":"DETAILED_DESCRIPTION","start":1444,"end":1454},{"text":"vocal cord","label":"BIOLOGICAL_STRUCTURE","start":1459,"end":1469},{"text":"paralysis","label":"DISEASE_DISORDER","start":1470,"end":1479},{"text":"hypoglossal","label":"BIOLOGICAL_STRUCTURE","start":1495,"end":1506},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":1511,"end":1520},{"text":"laryngeal","label":"BIOLOGICAL_STRUCTURE","start":1521,"end":1530},{"text":"nerve injury","label":"DISEASE_DISORDER","start":1531,"end":1543},{"text":"local","label":"DETAILED_DESCRIPTION","start":1552,"end":1557},{"text":"oedema","label":"SIGN_SYMPTOM","start":1558,"end":1564},{"text":"haematoma","label":"SIGN_SYMPTOM","start":1568,"end":1577},{"text":"movements","label":"DIAGNOSTIC_PROCEDURE","start":1583,"end":1592},{"text":"pharynx","label":"BIOLOGICAL_STRUCTURE","start":1600,"end":1607},{"text":"soft palate","label":"BIOLOGICAL_STRUCTURE","start":1612,"end":1623},{"text":"normal","label":"LAB_VALUE","start":1629,"end":1635},{"text":"neurological examination","label":"DIAGNOSTIC_PROCEDURE","start":1648,"end":1672},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":1689,"end":1715},{"text":"MRN","label":"DIAGNOSTIC_PROCEDURE","start":1717,"end":1720},{"text":"central","label":"BIOLOGICAL_STRUCTURE","start":1752,"end":1759},{"text":"cranial","label":"BIOLOGICAL_STRUCTURE","start":1763,"end":1770},{"text":"nerve involvement","label":"SIGN_SYMPTOM","start":1771,"end":1788},{"text":"steroids","label":"MEDICATION","start":1823,"end":1831},{"text":"vitamins","label":"MEDICATION","start":1833,"end":1841},{"text":"speech","label":"DETAILED_DESCRIPTION","start":1856,"end":1862},{"text":"swallowing","label":"DETAILED_DESCRIPTION","start":1867,"end":1877},{"text":"therapy","label":"THERAPEUTIC_PROCEDURE","start":1878,"end":1885},{"text":"Full recovery","label":"OUTCOME","start":1887,"end":1900},{"text":"lingual","label":"BIOLOGICAL_STRUCTURE","start":1904,"end":1911},{"text":"laryngeal","label":"BIOLOGICAL_STRUCTURE","start":1916,"end":1925},{"text":"functions","label":"DIAGNOSTIC_PROCEDURE","start":1926,"end":1935},{"text":"within four months after","label":"DATE","start":1949,"end":1973}],"tokens":["A ","30-year-old"," ","female"," (65 kg) underwent ","rhinoplasty"," under ","general anaesthesia",", which was induced using a combination of a bolus of ","Remifentanyl"," (","0.5 \u03bcg\/kg",") and ","Propofol"," ","2 mg\/kg",".\n","Muscle paralysis"," was obtained with ","Cisatracurium"," (","0.15 \u03bcg\/kg",").\n","Transoral"," ","intubation"," was performed with a ","Macintosh blade"," (","No.3",") and a size ","7 mm diameter"," ","reinforced"," ","tracheal tube"," was easily and gently placed in the ","trachea",", on the first attempt and was then fixed to the ","right corner of the mouth",".\nNo ","problems"," were encountered during ","laryngoscopy"," and ","intubation",".\nThe cuff of the ","tube"," was inflated with a ","pressure \u2264 20 cm H2O",".\nNo ","adjustment of cuff volume"," was made intra-operatively.\n","N2O"," was not used for inhalation anaesthesia.\nThe ","throat pack"," was placed in the ","pharynx"," to avoid the passage of blood in the aero-digestive tract.\n","General anaesthesia"," was maintained with ","Sevofluorane"," ","in oxygen\/air"," and ","Remifentanyl"," in ","continuous infusion"," ","0.25 \u03bcg\/kg\/min",".\n","Moderate"," ","arterial hypotension"," was maintained with a cuff ","systolic artery pressure"," of approximately ","90 mmHg",".\nThe operation was carried out in a ","semi-supine position"," with the ","head slightly inclined forward"," and laterally and ","trunk slightly elevated",".\nDuration of the ","operation"," was ","100 minutes",".\nThe patient was ","extubated",", after removal of the ","throat pack"," without ","problems",".\nThe ","following day"," the patient complained of ","difficulty in swallowing",", ","dysphonia"," and ","hoarseness",".\n","Examination"," revealed ","deviation"," of the ","tongue"," to the ","right side"," and ","vocal cord"," ","paralysis",", expression of ","hypoglossal"," and ","recurrent"," ","laryngeal"," ","nerve injury"," without ","local"," ","oedema"," or ","haematoma",".\nThe ","movements"," of the ","pharynx"," and ","soft palate"," were ","normal",".\nMeticulous ","neurological examination",", including also ","magnetic resonance imaging"," (","MRN",") revealed no other evidence of ","central"," or ","cranial"," ","nerve involvement",".\nConservative management included ","steroids",", ","vitamins"," together with ","speech"," and ","swallowing"," ","therapy",".\n","Full recovery"," of ","lingual"," and ","laryngeal"," ","functions"," was obtained ","within four months after"," surgery.\n"],"ner_labels":[0,5,0,65,0,75,0,46,0,46,0,29,0,46,0,29,0,26,0,46,0,29,0,22,0,75,0,75,0,22,0,22,0,22,0,75,0,12,0,12,0,26,0,75,0,18,0,18,0,42,0,75,0,46,0,75,0,12,0,46,0,46,0,4,0,46,0,4,0,29,0,63,0,69,0,24,0,42,0,75,0,22,0,22,0,75,0,32,0,75,0,75,0,26,0,19,0,69,0,69,0,69,0,24,0,69,0,12,0,22,0,12,0,26,0,12,0,22,0,12,0,26,0,22,0,69,0,69,0,24,0,12,0,12,0,42,0,24,0,24,0,24,0,12,0,12,0,69,0,46,0,46,0,22,0,22,0,75,0,56,0,12,0,12,0,24,0,19,0]}
-{"full_text":"Here, we describe another case in a 60-year-old man from San Francisco who had consumed raw pork while traveling in the Philippines.\nIn June 2003, this man became ill with fever, diaphoresis, headache, nausea, and anorexia.\nHe had just returned from a 7-month vacation in the Philippines.\nThree days after symptoms onset, his physician prescribed doxycycline.\nSymptoms continued and he was admitted to a local hospital 5 days later with a fever of 38.9\u00b0C, nuchal rigidity, headache, and general malaise.\nThe patient described no recent contact with sick persons; past medical history was unremarkable.\nOn physical examination, he was somnolent but fully oriented, with no focal findings on neurologic examination and only slight nuchal rigidity.\nHe had a leukocyte count of 21,000\/mm3, including 16,400\/mm3 neutrophils.\nCerebrospinal fluid (CSF) showed leukocyte count of 487\/\u03bcL with 80% polymorphonuclear cells and 18% lymphocytes, and glucose and protein levels <20 mg\/dL and <167 mg\/dL, respectively.\nGram stain of CSF showed gram-positive cocci in pairs (Figure).\nEmpiric therapy (ceftriaxone, vancomycin, and ampicillin) for bacterial meningitis was begun.\nComputed tomographic scan of the head showed only sinusitis; findings of chest radiograph and transesophageal echocardiogram were negative.\nOn hospital day 2, blood cultures grew gram-positive cocci in pairs and chains.\nThe organism was catalase-negative, bile esculin-negative, and pyrrolidonyl aminopeptidase-negative, consistent with Streptococcus spp.\nA latex agglutination test did not detect Streptococcus pneumoniae antigen.\nAntimicrobial susceptibility testing showed that the isolate was sensitive to penicillin (MIC = 0.03), ceftriaxone, and vancomycin but resistant to tetracycline and clindamycin.\nAntimicrobial therapy was changed to penicillin G, 24 million units intravenously per day.\nOn hospital day 5, the patient complained of hearing loss in his left ear.\nResults of nasopharyngeal endoscopy were negative.\nBy hospital day 7, the organism was identified by the API 20 Strep System (bioMerieux, Marcy l\u2019Etoile, France), as S. suis serotype 2.\nThe patient subsequently stated that he was a butcher with a culinary preference for partially cooked pork, which he had eaten in the Philippines until the week prior to onset of symptoms.\nOn hospital day 9, a formal audiology evaluation showed severe bilateral sensorineural high-frequency hearing loss (\u201370 dB).\nThe patient completed a 10-day course of parenteral antimicrobial drugs and was discharged on continued oral therapy with close followup.\nTwo months after discharge, the patient reported much improved hearing without other sequelae.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":36,"end":47},{"text":"man","label":"SEX","start":48,"end":51},{"text":"San Francisco","label":"PERSONAL_BACKGROUND","start":57,"end":70},{"text":"consumed raw pork","label":"ACTIVITY","start":79,"end":96},{"text":"traveling","label":"ACTIVITY","start":103,"end":112},{"text":"Philippines","label":"NONBIOLOGICAL_LOCATION","start":120,"end":131},{"text":"June 2003","label":"DATE","start":136,"end":145},{"text":"ill","label":"SIGN_SYMPTOM","start":163,"end":166},{"text":"fever","label":"SIGN_SYMPTOM","start":172,"end":177},{"text":"diaphoresis","label":"SIGN_SYMPTOM","start":179,"end":190},{"text":"headache","label":"SIGN_SYMPTOM","start":192,"end":200},{"text":"nausea","label":"SIGN_SYMPTOM","start":202,"end":208},{"text":"anorexia","label":"SIGN_SYMPTOM","start":214,"end":222},{"text":"returned","label":"ACTIVITY","start":236,"end":244},{"text":"7-month","label":"DURATION","start":252,"end":259},{"text":"vacation","label":"ACTIVITY","start":260,"end":268},{"text":"Philippines","label":"NONBIOLOGICAL_LOCATION","start":276,"end":287},{"text":"Three days after symptoms onset","label":"DATE","start":289,"end":320},{"text":"doxycycline","label":"MEDICATION","start":347,"end":358},{"text":"Symptoms continued","label":"SIGN_SYMPTOM","start":360,"end":378},{"text":"admitted","label":"CLINICAL_EVENT","start":390,"end":398},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":404,"end":418},{"text":"5 days later","label":"DATE","start":419,"end":431},{"text":"fever","label":"SIGN_SYMPTOM","start":439,"end":444},{"text":"38.9\u00b0C","label":"LAB_VALUE","start":448,"end":454},{"text":"nuchal rigidity","label":"SIGN_SYMPTOM","start":456,"end":471},{"text":"headache","label":"SIGN_SYMPTOM","start":473,"end":481},{"text":"malaise","label":"SIGN_SYMPTOM","start":495,"end":502},{"text":"no recent contact with sick persons","label":"HISTORY","start":526,"end":561},{"text":"past medical history was unremarkable","label":"HISTORY","start":563,"end":600},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":605,"end":625},{"text":"somnolent","label":"SIGN_SYMPTOM","start":634,"end":643},{"text":"fully oriented","label":"SIGN_SYMPTOM","start":648,"end":662},{"text":"focal findings","label":"SIGN_SYMPTOM","start":672,"end":686},{"text":"neurologic examination","label":"DIAGNOSTIC_PROCEDURE","start":690,"end":712},{"text":"slight","label":"SEVERITY","start":722,"end":728},{"text":"nuchal rigidity","label":"SIGN_SYMPTOM","start":729,"end":744},{"text":"leukocyte count","label":"DIAGNOSTIC_PROCEDURE","start":755,"end":770},{"text":"21,000\/mm3","label":"LAB_VALUE","start":774,"end":784},{"text":"16,400\/mm3","label":"LAB_VALUE","start":796,"end":806},{"text":"neutrophils","label":"DIAGNOSTIC_PROCEDURE","start":807,"end":818},{"text":"Cerebrospinal fluid","label":"BIOLOGICAL_STRUCTURE","start":820,"end":839},{"text":"CSF","label":"BIOLOGICAL_STRUCTURE","start":841,"end":844},{"text":"leukocyte count","label":"DIAGNOSTIC_PROCEDURE","start":853,"end":868},{"text":"487\/\u03bcL","label":"LAB_VALUE","start":872,"end":878},{"text":"80% polymorphonuclear cells","label":"LAB_VALUE","start":884,"end":911},{"text":"18% lymphocytes","label":"LAB_VALUE","start":916,"end":931},{"text":"glucose","label":"DIAGNOSTIC_PROCEDURE","start":937,"end":944},{"text":"protein","label":"DIAGNOSTIC_PROCEDURE","start":949,"end":956},{"text":"<20 mg\/dL","label":"LAB_VALUE","start":964,"end":973},{"text":"<167 mg\/dL","label":"LAB_VALUE","start":978,"end":988},{"text":"Gram stain","label":"DIAGNOSTIC_PROCEDURE","start":1004,"end":1014},{"text":"CSF","label":"BIOLOGICAL_STRUCTURE","start":1018,"end":1021},{"text":"gram-positive cocci in pairs","label":"SIGN_SYMPTOM","start":1029,"end":1057},{"text":"ceftriaxone","label":"MEDICATION","start":1085,"end":1096},{"text":"vancomycin","label":"MEDICATION","start":1098,"end":1108},{"text":"ampicillin","label":"MEDICATION","start":1114,"end":1124},{"text":"bacterial meningitis","label":"DISEASE_DISORDER","start":1130,"end":1150},{"text":"Computed tomographic scan","label":"DIAGNOSTIC_PROCEDURE","start":1162,"end":1187},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":1195,"end":1199},{"text":"sinusitis","label":"SIGN_SYMPTOM","start":1212,"end":1221},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1235,"end":1240},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":1241,"end":1251},{"text":"transesophageal echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1256,"end":1286},{"text":"negative","label":"LAB_VALUE","start":1292,"end":1300},{"text":"hospital day 2","label":"DATE","start":1305,"end":1319},{"text":"blood cultures","label":"DIAGNOSTIC_PROCEDURE","start":1321,"end":1335},{"text":"gram-positive cocci","label":"SIGN_SYMPTOM","start":1341,"end":1360},{"text":"pairs","label":"DETAILED_DESCRIPTION","start":1364,"end":1369},{"text":"chains","label":"DETAILED_DESCRIPTION","start":1374,"end":1380},{"text":"organism","label":"SIGN_SYMPTOM","start":1386,"end":1394},{"text":"catalase","label":"DIAGNOSTIC_PROCEDURE","start":1399,"end":1407},{"text":"negative","label":"LAB_VALUE","start":1408,"end":1416},{"text":"bile esculin","label":"DIAGNOSTIC_PROCEDURE","start":1418,"end":1430},{"text":"negative","label":"LAB_VALUE","start":1431,"end":1439},{"text":"pyrrolidonyl aminopeptidase","label":"DIAGNOSTIC_PROCEDURE","start":1445,"end":1472},{"text":"negative","label":"LAB_VALUE","start":1473,"end":1481},{"text":"Streptococcus spp","label":"SIGN_SYMPTOM","start":1499,"end":1516},{"text":"latex agglutination test","label":"DIAGNOSTIC_PROCEDURE","start":1520,"end":1544},{"text":"Streptococcus pneumoniae antigen","label":"SIGN_SYMPTOM","start":1560,"end":1592},{"text":"Antimicrobial susceptibility testing","label":"DIAGNOSTIC_PROCEDURE","start":1594,"end":1630},{"text":"isolate","label":"COREFERENCE","start":1647,"end":1654},{"text":"sensitive to penicillin (MIC = 0.03), ceftriaxone, and vancomycin","label":"SIGN_SYMPTOM","start":1659,"end":1724},{"text":"resistant to tetracycline and clindamycin","label":"SIGN_SYMPTOM","start":1729,"end":1770},{"text":"Antimicrobial therapy","label":"MEDICATION","start":1772,"end":1793},{"text":"penicillin G","label":"MEDICATION","start":1809,"end":1821},{"text":"24 million units","label":"DOSAGE","start":1823,"end":1839},{"text":"intravenously","label":"ADMINISTRATION","start":1840,"end":1853},{"text":"per day","label":"FREQUENCY","start":1854,"end":1861},{"text":"hospital day 5","label":"DATE","start":1866,"end":1880},{"text":"hearing loss","label":"SIGN_SYMPTOM","start":1908,"end":1920},{"text":"left ear","label":"BIOLOGICAL_STRUCTURE","start":1928,"end":1936},{"text":"nasopharyngeal endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1949,"end":1973},{"text":"negative","label":"LAB_VALUE","start":1979,"end":1987},{"text":"hospital day 7","label":"DATE","start":1992,"end":2006},{"text":"organism","label":"COREFERENCE","start":2012,"end":2020},{"text":"API 20 Strep System","label":"DIAGNOSTIC_PROCEDURE","start":2043,"end":2062},{"text":"S. suis serotype 2","label":"SIGN_SYMPTOM","start":2104,"end":2122},{"text":"butcher","label":"OCCUPATION","start":2170,"end":2177},{"text":"culinary preference for partially cooked pork,","label":"DETAILED_DESCRIPTION","start":2185,"end":2231},{"text":"eaten","label":"ACTIVITY","start":2245,"end":2250},{"text":"Philippines","label":"NONBIOLOGICAL_LOCATION","start":2258,"end":2269},{"text":"until the week prior to onset of symptoms","label":"DATE","start":2270,"end":2311},{"text":"hospital day 9","label":"DATE","start":2316,"end":2330},{"text":"formal audiology evaluation","label":"DIAGNOSTIC_PROCEDURE","start":2334,"end":2361},{"text":"severe","label":"SEVERITY","start":2369,"end":2375},{"text":"bilateral sensorineural high-frequency hearing loss","label":"SIGN_SYMPTOM","start":2376,"end":2427},{"text":"\u201370 dB","label":"LAB_VALUE","start":2429,"end":2435},{"text":"10-day course","label":"DURATION","start":2462,"end":2475},{"text":"parenteral antimicrobial drugs","label":"MEDICATION","start":2479,"end":2509},{"text":"discharged","label":"CLINICAL_EVENT","start":2518,"end":2528},{"text":"continued","label":"DETAILED_DESCRIPTION","start":2532,"end":2541},{"text":"oral therapy","label":"MEDICATION","start":2542,"end":2554},{"text":"Two months after discharge","label":"DATE","start":2576,"end":2602},{"text":"much improved hearing","label":"SIGN_SYMPTOM","start":2625,"end":2646},{"text":"sequelae","label":"SIGN_SYMPTOM","start":2661,"end":2669}],"tokens":["Here, we describe another case in a ","60-year-old"," ","man"," from ","San Francisco"," who had ","consumed raw pork"," while ","traveling"," in the ","Philippines",".\nIn ","June 2003",", this man became ","ill"," with ","fever",", ","diaphoresis",", ","headache",", ","nausea",", and ","anorexia",".\nHe had just ","returned"," from a ","7-month"," ","vacation"," in the ","Philippines",".\n","Three days after symptoms onset",", his physician prescribed ","doxycycline",".\n","Symptoms continued"," and he was ","admitted"," to a ","local hospital"," ","5 days later"," with a ","fever"," of ","38.9\u00b0C",", ","nuchal rigidity",", ","headache",", and general ","malaise",".\nThe patient described ","no recent contact with sick persons","; ","past medical history was unremarkable",".\nOn ","physical examination",", he was ","somnolent"," but ","fully oriented",", with no ","focal findings"," on ","neurologic examination"," and only ","slight"," ","nuchal rigidity",".\nHe had a ","leukocyte count"," of ","21,000\/mm3",", including ","16,400\/mm3"," ","neutrophils",".\n","Cerebrospinal fluid"," (","CSF",") showed ","leukocyte count"," of ","487\/\u03bcL"," with ","80% polymorphonuclear cells"," and ","18% lymphocytes",", and ","glucose"," and ","protein"," levels ","<20 mg\/dL"," and ","<167 mg\/dL",", respectively.\n","Gram stain"," of ","CSF"," showed ","gram-positive cocci in pairs"," (Figure).\nEmpiric therapy (","ceftriaxone",", ","vancomycin",", and ","ampicillin",") for ","bacterial meningitis"," was begun.\n","Computed tomographic scan"," of the ","head"," showed only ","sinusitis","; findings of ","chest"," ","radiograph"," and ","transesophageal echocardiogram"," were ","negative",".\nOn ","hospital day 2",", ","blood cultures"," grew ","gram-positive cocci"," in ","pairs"," and ","chains",".\nThe ","organism"," was ","catalase","-","negative",", ","bile esculin","-","negative",", and ","pyrrolidonyl aminopeptidase","-","negative",", consistent with ","Streptococcus spp",".\nA ","latex agglutination test"," did not detect ","Streptococcus pneumoniae antigen",".\n","Antimicrobial susceptibility testing"," showed that the ","isolate"," was ","sensitive to penicillin (MIC = 0.03), ceftriaxone, and vancomycin"," but ","resistant to tetracycline and clindamycin",".\n","Antimicrobial therapy"," was changed to ","penicillin G",", ","24 million units"," ","intravenously"," ","per day",".\nOn ","hospital day 5",", the patient complained of ","hearing loss"," in his ","left ear",".\nResults of ","nasopharyngeal endoscopy"," were ","negative",".\nBy ","hospital day 7",", the ","organism"," was identified by the ","API 20 Strep System"," (bioMerieux, Marcy l\u2019Etoile, France), as ","S. suis serotype 2",".\nThe patient subsequently stated that he was a ","butcher"," with a ","culinary preference for partially cooked pork,"," which he had ","eaten"," in the ","Philippines"," ","until the week prior to onset of symptoms",".\nOn ","hospital day 9",", a ","formal audiology evaluation"," showed ","severe"," ","bilateral sensorineural high-frequency hearing loss"," (","\u201370 dB",").\nThe patient completed a ","10-day course"," of ","parenteral antimicrobial drugs"," and was ","discharged"," on ","continued"," ","oral therapy"," with close followup.\n","Two months after discharge",", the patient reported ","much improved hearing"," without other ","sequelae",".\n"],"ner_labels":[0,5,0,65,0,58,0,1,0,1,0,48,0,19,0,69,0,69,0,69,0,69,0,69,0,69,0,1,0,32,0,1,0,48,0,19,0,46,0,69,0,13,0,48,0,19,0,69,0,42,0,69,0,69,0,69,0,39,0,39,0,24,0,69,0,69,0,69,0,24,0,63,0,69,0,24,0,42,0,42,0,24,0,12,0,12,0,24,0,42,0,42,0,42,0,24,0,24,0,42,0,42,0,24,0,12,0,69,0,46,0,46,0,46,0,26,0,24,0,12,0,69,0,12,0,24,0,24,0,42,0,19,0,24,0,69,0,22,0,22,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,69,0,24,0,69,0,24,0,18,0,69,0,69,0,46,0,46,0,29,0,4,0,35,0,19,0,69,0,12,0,24,0,42,0,19,0,18,0,24,0,69,0,50,0,22,0,1,0,48,0,19,0,19,0,24,0,63,0,69,0,42,0,32,0,46,0,13,0,22,0,46,0,19,0,69,0,69,0]}
-{"full_text":"A 74-year-old man was referred to our hospital in November 2000 because of liver dysfunction detected during a medical checkup.\nThe patient had been diagnosed with nephrotic syndrome in 1995.\nLaboratory examinations showed elevated serum hepatobiliary enzymes and IgM, and the presence of antimitochondrial antibodies.\nSerologic markers for Hepatitis B and C viruses were negative.\nHistopathologic examination of a liver biopsy specimen obtained at laparoscopy revealed non-suppurative destructive cholangitis in the portal area (Figure \u200b1).\nThe diagnosis of PBC (Scheuer stage 3) was confirmed and ursodeoxycholic acid, 900 mg daily, was started.\nIn January and June 2002, the patient underwent endoscopic variceal ligation plus endoscopic injection sclerotherapy as well as argon plasma coagulation for worsening esophageal varices.\nIn September 2007, the patient was admitted for the treatment of recurrent esophageal varices.\nThe platelet count had ranged between 52 \u00d7 109\/L and 69 \u00d7 109\/L for several years, but it was noted to decrease from 61 \u00d7 109\/L in June 2007 to 8 \u00d7 109\/L just before admission.\nBefore the deterioration of thrombocytopenia, the patient had no infectious diseases and received no other medication.\nOn admission, the patient had neither purpura nor bleeding episodes.\nTable 1 shows the laboratory data on admission.\nThe platelet-associated IgG level was markedly high.\nBone marrow biopsy revealed normocellular marrow without cellular atypia.\nUltrasonography and magnetic resonance imaging revealed a cirrhotic liver with splenomegaly, ascites, and gallstones.\nThe spleen size had remained unchanged from previous imaging examinations.\nBased on these findings, the association of PBC (decompensated liver cirrhosis) with ITP was diagnosed.\nHuman leukocyte antigen (HLA) genotyping determined by polymerase chain reaction-sequencing-based typing or polymerase chain reaction-sequence specific primers (SRL, Inc., Tokyo, Japan) detected A*02010101, B*400201, C*030401, C*07020101, DPB1*0501, DQA1*0103, DQA1*030101, DQB1*030201, DQB1*060101, DRB1*080201, and DRB1*080302.\nThe 13C urea breath test for H pylori infection was negative.\nFigure \u200b2 shows the clinical course.\nOral prednisolone, 30 mg daily, for ITP was started on day 11, and diuretic therapy combined with albumin infusion for ascites was performed.\nAs the platelet count did not increase notably, pulse therapy with intravenous methylprednisolone, 1 g daily, was added on d 22 to 24.\nHowever, the response was weak and temporary.\nOn d 31, mild melena was identified.\nThe patient was given a trial of intravenous immune gamma globulin therapy, 25 g daily, on d 32 to 36, combined with a second round of intravenous methylprednisolone pulse therapy on d 32 to 34.\nBecause a moderate response was observed, prednisolone was continued, and the platelet count increased slowly.\nThe ascites was relatively well controlled with diuretics at discharge.\nConsidering the decompensated liver cirrhosis and the platelet count, we determined the patient required careful follow-up of esophageal varices without prophylactic endoscopic therapy.\n","ner_info":[{"text":"74-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":38,"end":46},{"text":"November 2000","label":"DATE","start":50,"end":63},{"text":"liver dysfunction","label":"SIGN_SYMPTOM","start":75,"end":92},{"text":"medical checkup","label":"CLINICAL_EVENT","start":111,"end":126},{"text":"nephrotic syndrome","label":"DISEASE_DISORDER","start":164,"end":182},{"text":"1995","label":"DATE","start":186,"end":190},{"text":"Laboratory examinations","label":"DIAGNOSTIC_PROCEDURE","start":192,"end":215},{"text":"elevated","label":"LAB_VALUE","start":223,"end":231},{"text":"serum hepatobiliary enzymes","label":"DIAGNOSTIC_PROCEDURE","start":232,"end":259},{"text":"IgM","label":"DIAGNOSTIC_PROCEDURE","start":264,"end":267},{"text":"presence","label":"LAB_VALUE","start":277,"end":285},{"text":"antimitochondrial antibodies","label":"DIAGNOSTIC_PROCEDURE","start":289,"end":317},{"text":"Serologic markers","label":"DIAGNOSTIC_PROCEDURE","start":319,"end":336},{"text":"Hepatitis B","label":"DIAGNOSTIC_PROCEDURE","start":341,"end":352},{"text":"negative","label":"LAB_VALUE","start":372,"end":380},{"text":"Histopathologic examination","label":"DIAGNOSTIC_PROCEDURE","start":382,"end":409},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":415,"end":420},{"text":"biopsy specimen","label":"DIAGNOSTIC_PROCEDURE","start":421,"end":436},{"text":"laparoscopy","label":"THERAPEUTIC_PROCEDURE","start":449,"end":460},{"text":"non-suppurative","label":"DETAILED_DESCRIPTION","start":470,"end":485},{"text":"destructive","label":"DETAILED_DESCRIPTION","start":486,"end":497},{"text":"cholangitis","label":"DISEASE_DISORDER","start":498,"end":509},{"text":"portal area","label":"BIOLOGICAL_STRUCTURE","start":517,"end":528},{"text":"PBC","label":"DISEASE_DISORDER","start":559,"end":562},{"text":"Scheuer stage 3","label":"DISEASE_DISORDER","start":564,"end":579},{"text":"ursodeoxycholic acid","label":"MEDICATION","start":599,"end":619},{"text":"900 mg","label":"DOSAGE","start":621,"end":627},{"text":"daily","label":"FREQUENCY","start":628,"end":633},{"text":"January and June 2002","label":"DATE","start":651,"end":672},{"text":"endoscopic variceal ligation","label":"THERAPEUTIC_PROCEDURE","start":696,"end":724},{"text":"endoscopic injection sclerotherapy","label":"THERAPEUTIC_PROCEDURE","start":730,"end":764},{"text":"argon plasma coagulation","label":"THERAPEUTIC_PROCEDURE","start":776,"end":800},{"text":"worsening","label":"SEVERITY","start":805,"end":814},{"text":"esophageal varices","label":"SIGN_SYMPTOM","start":815,"end":833},{"text":"September 2007","label":"DATE","start":838,"end":852},{"text":"admitted","label":"CLINICAL_EVENT","start":870,"end":878},{"text":"recurrent","label":"SEVERITY","start":900,"end":909},{"text":"esophageal varices","label":"SIGN_SYMPTOM","start":910,"end":928},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":934,"end":948},{"text":"52 \u00d7 109\/L","label":"LAB_VALUE","start":968,"end":978},{"text":"69 \u00d7 109\/L","label":"LAB_VALUE","start":983,"end":993},{"text":"several years","label":"DURATION","start":998,"end":1011},{"text":"it","label":"COREFERENCE","start":1017,"end":1019},{"text":"decrease","label":"LAB_VALUE","start":1033,"end":1041},{"text":"61 \u00d7 109\/L","label":"LAB_VALUE","start":1047,"end":1057},{"text":"June 2007","label":"DATE","start":1061,"end":1070},{"text":"8 \u00d7 109\/L","label":"LAB_VALUE","start":1074,"end":1083},{"text":"just before admission","label":"DATE","start":1084,"end":1105},{"text":"deterioration","label":"DETAILED_DESCRIPTION","start":1118,"end":1131},{"text":"thrombocytopenia","label":"SIGN_SYMPTOM","start":1135,"end":1151},{"text":"infectious diseases","label":"DISEASE_DISORDER","start":1172,"end":1191},{"text":"medication","label":"MEDICATION","start":1214,"end":1224},{"text":"admission","label":"DATE","start":1229,"end":1238},{"text":"purpura","label":"SIGN_SYMPTOM","start":1264,"end":1271},{"text":"bleeding episodes","label":"SIGN_SYMPTOM","start":1276,"end":1293},{"text":"platelet-associated IgG level","label":"DIAGNOSTIC_PROCEDURE","start":1347,"end":1376},{"text":"markedly","label":"DETAILED_DESCRIPTION","start":1381,"end":1389},{"text":"high","label":"LAB_VALUE","start":1390,"end":1394},{"text":"Bone marrow","label":"BIOLOGICAL_STRUCTURE","start":1396,"end":1407},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1408,"end":1414},{"text":"normocellular marrow","label":"SIGN_SYMPTOM","start":1424,"end":1444},{"text":"cellular atypia","label":"SIGN_SYMPTOM","start":1453,"end":1468},{"text":"Ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":1470,"end":1485},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":1490,"end":1516},{"text":"cirrhotic","label":"SIGN_SYMPTOM","start":1528,"end":1537},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":1538,"end":1543},{"text":"splenomegaly","label":"SIGN_SYMPTOM","start":1549,"end":1561},{"text":"ascites","label":"SIGN_SYMPTOM","start":1563,"end":1570},{"text":"gallstones","label":"SIGN_SYMPTOM","start":1576,"end":1586},{"text":"spleen size","label":"DIAGNOSTIC_PROCEDURE","start":1592,"end":1603},{"text":"unchanged","label":"LAB_VALUE","start":1617,"end":1626},{"text":"previous","label":"DETAILED_DESCRIPTION","start":1632,"end":1640},{"text":"imaging examinations","label":"DIAGNOSTIC_PROCEDURE","start":1641,"end":1661},{"text":"PBC","label":"DISEASE_DISORDER","start":1707,"end":1710},{"text":"decompensated liver cirrhosis","label":"DISEASE_DISORDER","start":1712,"end":1741},{"text":"ITP","label":"DISEASE_DISORDER","start":1748,"end":1751},{"text":"Human leukocyte antigen (HLA) genotyping","label":"DIAGNOSTIC_PROCEDURE","start":1767,"end":1807},{"text":"polymerase chain reaction-sequencing-based typing","label":"DIAGNOSTIC_PROCEDURE","start":1822,"end":1871},{"text":"polymerase chain reaction-sequence specific primers","label":"DIAGNOSTIC_PROCEDURE","start":1875,"end":1926},{"text":"A*02010101","label":"SIGN_SYMPTOM","start":1962,"end":1972},{"text":"B*400201","label":"SIGN_SYMPTOM","start":1974,"end":1982},{"text":"C*030401","label":"SIGN_SYMPTOM","start":1984,"end":1992},{"text":"C*07020101","label":"SIGN_SYMPTOM","start":1994,"end":2004},{"text":"DPB1*0501","label":"SIGN_SYMPTOM","start":2006,"end":2015},{"text":"DQA1*0103","label":"SIGN_SYMPTOM","start":2017,"end":2026},{"text":"DQA1*030101","label":"SIGN_SYMPTOM","start":2028,"end":2039},{"text":"DQB1*030201","label":"SIGN_SYMPTOM","start":2041,"end":2052},{"text":"DQB1*060101","label":"SIGN_SYMPTOM","start":2054,"end":2065},{"text":"DRB1*080201","label":"SIGN_SYMPTOM","start":2067,"end":2078},{"text":"DRB1*080302","label":"SIGN_SYMPTOM","start":2084,"end":2095},{"text":"13C urea breath test","label":"DIAGNOSTIC_PROCEDURE","start":2101,"end":2121},{"text":"H pylori infection","label":"DIAGNOSTIC_PROCEDURE","start":2126,"end":2144},{"text":"negative","label":"LAB_VALUE","start":2149,"end":2157},{"text":"Oral","label":"ADMINISTRATION","start":2196,"end":2200},{"text":"prednisolone","label":"MEDICATION","start":2201,"end":2213},{"text":"30 mg","label":"DOSAGE","start":2215,"end":2220},{"text":"daily","label":"FREQUENCY","start":2221,"end":2226},{"text":"ITP","label":"COREFERENCE","start":2232,"end":2235},{"text":"day 11","label":"DATE","start":2251,"end":2257},{"text":"diuretic therapy","label":"MEDICATION","start":2263,"end":2279},{"text":"albumin infusion","label":"MEDICATION","start":2294,"end":2310},{"text":"ascites","label":"SIGN_SYMPTOM","start":2315,"end":2322},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2345,"end":2359},{"text":"did not increase notably","label":"LAB_VALUE","start":2360,"end":2384},{"text":"pulse therapy","label":"MEDICATION","start":2386,"end":2399},{"text":"intravenous","label":"ADMINISTRATION","start":2405,"end":2416},{"text":"methylprednisolone","label":"MEDICATION","start":2417,"end":2435},{"text":"1 g","label":"DOSAGE","start":2437,"end":2440},{"text":"daily","label":"FREQUENCY","start":2441,"end":2446},{"text":"d 22 to 24","label":"DURATION","start":2461,"end":2471},{"text":"response","label":"COREFERENCE","start":2486,"end":2494},{"text":"weak","label":"LAB_VALUE","start":2499,"end":2503},{"text":"temporary","label":"DETAILED_DESCRIPTION","start":2508,"end":2517},{"text":"d 31","label":"DATE","start":2522,"end":2526},{"text":"mild","label":"SEVERITY","start":2528,"end":2532},{"text":"melena","label":"SIGN_SYMPTOM","start":2533,"end":2539},{"text":"trial","label":"DETAILED_DESCRIPTION","start":2580,"end":2585},{"text":"intravenous","label":"ADMINISTRATION","start":2589,"end":2600},{"text":"immune gamma globulin therapy","label":"MEDICATION","start":2601,"end":2630},{"text":"25 g","label":"DOSAGE","start":2632,"end":2636},{"text":"daily","label":"FREQUENCY","start":2637,"end":2642},{"text":"d 32 to 36","label":"DURATION","start":2647,"end":2657},{"text":"second round","label":"DETAILED_DESCRIPTION","start":2675,"end":2687},{"text":"intravenous","label":"ADMINISTRATION","start":2691,"end":2702},{"text":"methylprednisolone pulse therapy","label":"MEDICATION","start":2703,"end":2735},{"text":"d 32 to 34","label":"DURATION","start":2739,"end":2749},{"text":"moderate","label":"LAB_VALUE","start":2761,"end":2769},{"text":"response","label":"COREFERENCE","start":2770,"end":2778},{"text":"prednisolone","label":"MEDICATION","start":2793,"end":2805},{"text":"continued","label":"CLINICAL_EVENT","start":2810,"end":2819},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2829,"end":2843},{"text":"increased slowly","label":"LAB_VALUE","start":2844,"end":2860},{"text":"ascites was relatively well controlled","label":"SIGN_SYMPTOM","start":2866,"end":2904},{"text":"diuretics","label":"MEDICATION","start":2910,"end":2919},{"text":"discharge","label":"CLINICAL_EVENT","start":2923,"end":2932},{"text":"decompensated liver cirrhosis","label":"DISEASE_DISORDER","start":2950,"end":2979},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2988,"end":3002},{"text":"follow-up","label":"CLINICAL_EVENT","start":3047,"end":3056},{"text":"esophageal varices","label":"SIGN_SYMPTOM","start":3060,"end":3078},{"text":"prophylactic endoscopic therapy","label":"THERAPEUTIC_PROCEDURE","start":3087,"end":3118}],"tokens":["A ","74-year-old"," ","man"," was ","referred"," to our ","hospital"," in ","November 2000"," because of ","liver dysfunction"," detected during a ","medical checkup",".\nThe patient had been diagnosed with ","nephrotic syndrome"," in ","1995",".\n","Laboratory examinations"," showed ","elevated"," ","serum hepatobiliary enzymes"," and ","IgM",", and the ","presence"," of ","antimitochondrial antibodies",".\n","Serologic markers"," for ","Hepatitis B"," and C viruses were ","negative",".\n","Histopathologic examination"," of a ","liver"," ","biopsy specimen"," obtained at ","laparoscopy"," revealed ","non-suppurative"," ","destructive"," ","cholangitis"," in the ","portal area"," (Figure \u200b1).\nThe diagnosis of ","PBC"," (","Scheuer stage 3",") was confirmed and ","ursodeoxycholic acid",", ","900 mg"," ","daily",", was started.\nIn ","January and June 2002",", the patient underwent ","endoscopic variceal ligation"," plus ","endoscopic injection sclerotherapy"," as well as ","argon plasma coagulation"," for ","worsening"," ","esophageal varices",".\nIn ","September 2007",", the patient was ","admitted"," for the treatment of ","recurrent"," ","esophageal varices",".\nThe ","platelet count"," had ranged between ","52 \u00d7 109\/L"," and ","69 \u00d7 109\/L"," for ","several years",", but ","it"," was noted to ","decrease"," from ","61 \u00d7 109\/L"," in ","June 2007"," to ","8 \u00d7 109\/L"," ","just before admission",".\nBefore the ","deterioration"," of ","thrombocytopenia",", the patient had no ","infectious diseases"," and received no other ","medication",".\nOn ","admission",", the patient had neither ","purpura"," nor ","bleeding episodes",".\nTable 1 shows the laboratory data on admission.\nThe ","platelet-associated IgG level"," was ","markedly"," ","high",".\n","Bone marrow"," ","biopsy"," revealed ","normocellular marrow"," without ","cellular atypia",".\n","Ultrasonography"," and ","magnetic resonance imaging"," revealed a ","cirrhotic"," ","liver"," with ","splenomegaly",", ","ascites",", and ","gallstones",".\nThe ","spleen size"," had remained ","unchanged"," from ","previous"," ","imaging examinations",".\nBased on these findings, the association of ","PBC"," (","decompensated liver cirrhosis",") with ","ITP"," was diagnosed.\n","Human leukocyte antigen (HLA) genotyping"," determined by ","polymerase chain reaction-sequencing-based typing"," or ","polymerase chain reaction-sequence specific primers"," (SRL, Inc., Tokyo, Japan) detected ","A*02010101",", ","B*400201",", ","C*030401",", ","C*07020101",", ","DPB1*0501",", ","DQA1*0103",", ","DQA1*030101",", ","DQB1*030201",", ","DQB1*060101",", ","DRB1*080201",", and ","DRB1*080302",".\nThe ","13C urea breath test"," for ","H pylori infection"," was ","negative",".\nFigure \u200b2 shows the clinical course.\n","Oral"," ","prednisolone",", ","30 mg"," ","daily",", for ","ITP"," was started on ","day 11",", and ","diuretic therapy"," combined with ","albumin infusion"," for ","ascites"," was performed.\nAs the ","platelet count"," ","did not increase notably",", ","pulse therapy"," with ","intravenous"," ","methylprednisolone",", ","1 g"," ","daily",", was added on ","d 22 to 24",".\nHowever, the ","response"," was ","weak"," and ","temporary",".\nOn ","d 31",", ","mild"," ","melena"," was identified.\nThe patient was given a ","trial"," of ","intravenous"," ","immune gamma globulin therapy",", ","25 g"," ","daily",", on ","d 32 to 36",", combined with a ","second round"," of ","intravenous"," ","methylprednisolone pulse therapy"," on ","d 32 to 34",".\nBecause a ","moderate"," ","response"," was observed, ","prednisolone"," was ","continued",", and the ","platelet count"," ","increased slowly",".\nThe ","ascites was relatively well controlled"," with ","diuretics"," at ","discharge",".\nConsidering the ","decompensated liver cirrhosis"," and the ","platelet count",", we determined the patient required careful ","follow-up"," of ","esophageal varices"," without ","prophylactic endoscopic therapy",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,19,0,69,0,13,0,26,0,19,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,12,0,24,0,75,0,22,0,22,0,26,0,12,0,26,0,26,0,46,0,29,0,35,0,19,0,75,0,75,0,75,0,63,0,69,0,19,0,13,0,63,0,69,0,24,0,42,0,42,0,32,0,18,0,42,0,42,0,19,0,42,0,19,0,22,0,69,0,26,0,46,0,19,0,69,0,69,0,24,0,22,0,42,0,12,0,24,0,69,0,69,0,24,0,24,0,69,0,12,0,69,0,69,0,69,0,24,0,42,0,22,0,24,0,26,0,26,0,26,0,24,0,24,0,24,0,69,0,69,0,69,0,69,0,69,0,69,0,69,0,69,0,69,0,69,0,69,0,24,0,24,0,42,0,4,0,46,0,29,0,35,0,18,0,19,0,46,0,46,0,69,0,24,0,42,0,46,0,4,0,46,0,29,0,35,0,32,0,18,0,42,0,22,0,19,0,63,0,69,0,22,0,4,0,46,0,29,0,35,0,32,0,22,0,4,0,46,0,32,0,42,0,18,0,46,0,13,0,24,0,42,0,69,0,46,0,13,0,26,0,24,0,13,0,69,0,75,0]}
-{"full_text":"An 18-year-old male was diagnosed with attention-deficit hyperactivity disorder (ADHD) in 2005.\nHe was overweight with a body mass index (BMI) of 40.\nHe was started on quetiapine fumarate (Seroquel\u00ae) 900 mg daily in April 2005 and methylphenidate (Concerta\u00ae) 54 mg daily in September 2005.\nIn the beginning of August 2006 he was admitted to his local hospital with severe dyspnoea, tachypnea, tachycardia, and cyanosis.\nOn admission the blood pressure was 120\/80 mmHg, and the arterial blood gas revealed a pH of 7.45, pCO2 of 3.55 kPa, paO2 of 7.76 kPa, and BE of \u22125.1 mmol\/l.\nC-reactive protein was not elevated.\nThe chest X-ray showed an enlarged heart.\nHe developed hemoptysis and was treated with unfractionated heparin in suspicion of pulmonary embolism.\nHe subsequently developed cardiogenic shock and was treated with vasoactive drugs.\nIn spite of the treatment he became oliguric and his liver enzymes were rising.\nHe was referred to our hospital for further treatment.\nOn admission the blood pressure was 90\/60 mmHg, despite infusion with noradrenaline.\nHis heart rate was 130\/minute and his temperature was 38.4 \u00b0C.\nA thoracic computed tomography scan did not show pulmonary embolism.\nEchocardiography revealed biventricular failure and left ventricular end diastolic diameter was 7 cm.\nThe left ventricle was severely hypokinetic with an ejection fraction (EF) of 20%\u201325%.\nThe left ventricular end diastolic pressure was markedly elevated, and there was a moderate mitral regurgitation.\nIntermittent hemodialysis was initiated.\nHis liver function improved slightly, but despite dialysis the renal function deteriorated with increasing creatinine values.\nAfter three days there was a further worsening of the left ventricular systolic function with an ejection fraction of 10%\u201312% and marked pulmonary hypertension with systolic pulmonary pressure estimated to 30 mmHg.\nThe clinical picture resembled dilated cardiomyopathy with low output failure causing renal and liver failure.\nWe suspected drug-induced cardiomyopathy and methylphenidate and quetiapine fumarate were discontinued.\nScreening for infectious pathogens, immunological markers, and iron or amyloid deposition were all negative.\nAfter three days he was transferred to the National Hospital (Rikshospitalet, Oslo) with ongoing noradrenaline and dobutamine infusions.\nShortly after admission an intraaortic balloon pump (IABP) was inserted and noradrenaline was replaced by nitroprusside.\nCoronary angiography was normal.\nEndomyocardial biopsy from the right ventricle did not reveal any distinct myocardial pathology.\nOn treatment with IABP, nitroprusside, and dialysis, the clinical situation gradually improved and the liver function returned to normal.\nHis renal function also improved with increasing diuresis and creatinine fell from 798 to 98 \u03bcmol\/l.\nHis EF was still markedly reduced (15%).\nBecause of behavioral problems and adipose stature, he was denied a heart transplant.\nHe was treated with IABP for 26 days, and after 28 days he was transferred back to our hospital.\nAt that time his liver and renal functions were normal.\nHe was treated with an angiotensin-converting enzyme (ACE)-inhibitor, a beta-blocker, and diuretics.\nDuring the following two weeks his clinical status improved and he was subsequently discharged to his home.\nThe echocardiography still showed markedly dilated left ventricle with EF of 20%.\nIn March 2007, his clinical status was improved and he was in function class II (New York Heart Association) with an EF estimated by echocardiography to 30%\u201335%.\n","ner_info":[{"text":"18-year-old","label":"AGE","start":3,"end":14},{"text":"male","label":"SEX","start":15,"end":19},{"text":"attention-deficit hyperactivity disorder","label":"DISEASE_DISORDER","start":39,"end":79},{"text":"ADHD","label":"DISEASE_DISORDER","start":81,"end":85},{"text":"2005","label":"DATE","start":90,"end":94},{"text":"overweight","label":"HISTORY","start":103,"end":113},{"text":"body mass index","label":"DIAGNOSTIC_PROCEDURE","start":121,"end":136},{"text":"BMI","label":"DIAGNOSTIC_PROCEDURE","start":138,"end":141},{"text":"40","label":"LAB_VALUE","start":146,"end":148},{"text":"quetiapine fumarate","label":"MEDICATION","start":168,"end":187},{"text":"(Seroquel\u00ae)","label":"MEDICATION","start":188,"end":199},{"text":"900 mg daily","label":"DOSAGE","start":200,"end":212},{"text":"April 2005","label":"DATE","start":216,"end":226},{"text":"methylphenidate","label":"MEDICATION","start":231,"end":246},{"text":"(Concerta\u00ae)","label":"MEDICATION","start":247,"end":258},{"text":"54 mg daily","label":"DOSAGE","start":259,"end":270},{"text":"September 2005","label":"DATE","start":274,"end":288},{"text":"beginning of August 2006","label":"DATE","start":297,"end":321},{"text":"admitted","label":"CLINICAL_EVENT","start":329,"end":337},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":345,"end":359},{"text":"severe","label":"SEVERITY","start":365,"end":371},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":372,"end":380},{"text":"tachypnea","label":"SIGN_SYMPTOM","start":382,"end":391},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":393,"end":404},{"text":"cyanosis","label":"SIGN_SYMPTOM","start":410,"end":418},{"text":"admission","label":"CLINICAL_EVENT","start":423,"end":432},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":437,"end":451},{"text":"120\/80 mmHg","label":"LAB_VALUE","start":456,"end":467},{"text":"arterial blood gas","label":"DIAGNOSTIC_PROCEDURE","start":477,"end":495},{"text":"pH","label":"DIAGNOSTIC_PROCEDURE","start":507,"end":509},{"text":"7.45","label":"LAB_VALUE","start":513,"end":517},{"text":"pCO2","label":"DIAGNOSTIC_PROCEDURE","start":519,"end":523},{"text":"3.55 kPa","label":"LAB_VALUE","start":527,"end":535},{"text":"paO2","label":"DIAGNOSTIC_PROCEDURE","start":537,"end":541},{"text":"7.76 kPa","label":"LAB_VALUE","start":545,"end":553},{"text":"BE","label":"DIAGNOSTIC_PROCEDURE","start":559,"end":561},{"text":"\u22125.1 mmol\/l","label":"LAB_VALUE","start":565,"end":576},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":578,"end":596},{"text":"not elevated","label":"LAB_VALUE","start":601,"end":613},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":619,"end":624},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":625,"end":630},{"text":"enlarged 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home","label":"NONBIOLOGICAL_LOCATION","start":3311,"end":3319},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":3325,"end":3341},{"text":"dilated","label":"LAB_VALUE","start":3364,"end":3371},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":3372,"end":3386},{"text":"EF","label":"DIAGNOSTIC_PROCEDURE","start":3392,"end":3394},{"text":"20%","label":"LAB_VALUE","start":3398,"end":3401},{"text":"March 2007","label":"DATE","start":3406,"end":3416},{"text":"clinical status","label":"DIAGNOSTIC_PROCEDURE","start":3422,"end":3437},{"text":"improved","label":"LAB_VALUE","start":3442,"end":3450},{"text":"function class","label":"DIAGNOSTIC_PROCEDURE","start":3465,"end":3479},{"text":"II","label":"LAB_VALUE","start":3480,"end":3482},{"text":"New York Heart 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","pH"," of ","7.45",", ","pCO2"," of ","3.55 kPa",", ","paO2"," of ","7.76 kPa",", and ","BE"," of ","\u22125.1 mmol\/l",".\n","C-reactive protein"," was ","not elevated",".\nThe ","chest"," ","X-ray"," showed an ","enlarged heart",".\nHe developed ","hemoptysis"," and was treated with ","unfractionated"," ","heparin"," in suspicion of ","pulmonary"," ","embolism",".\nHe subsequently developed ","cardiogenic shock"," and was treated with ","vasoactive drugs",".\nIn spite of the treatment he became ","oliguric"," and his ","liver enzymes"," were ","rising",".\nHe was ","referred"," to our ","hospital"," for further treatment.\nOn ","admission"," the ","blood pressure"," was ","90\/60 mmHg",", despite ","infusion"," with ","noradrenaline",".\nHis ","heart rate"," was ","130\/minute"," and his ","temperature"," was ","38.4 \u00b0C",".\nA ","thoracic"," ","computed tomography scan"," ","did not show pulmonary embolism",".\n","Echocardiography"," revealed ","biventricular failure"," and ","left ventricular end diastolic diameter"," was ","7 cm",".\nThe ","left ventricle"," was ","severely"," ","hypokinetic"," with an ","ejection fraction"," (","EF",") of ","20%\u201325%",".\nThe ","left ventricular end diastolic pressure"," was markedly ","elevated",", and there was a ","moderate"," ","mitral regurgitation",".\n","Intermittent"," ","hemodialysis"," was initiated.\nHis ","liver function"," ","improved"," ","slightly",", but despite ","dialysis"," the ","renal function"," ","deteriorated"," with ","increasing"," ","creatinine values",".\n","After three days"," there was a further ","worsening"," of the ","left ventricular systolic function"," with an ","ejection fraction"," of ","10%\u201312%"," and marked ","pulmonary hypertension"," with ","systolic pulmonary pressure"," estimated to ","30 mmHg",".\nThe clinical picture resembled ","dilated"," ","cardiomyopathy"," with ","low output failure"," causing ","renal"," and ","liver"," ","failure",".\nWe suspected ","drug-induced"," ","cardiomyopathy"," and ","methylphenidate"," and ","quetiapine fumarate"," were discontinued.\n","Screening for infectious pathogens",", ","immunological markers",", and ","iron"," or ","amyloid deposition"," were all ","negative",".\n","After three days"," he was ","transferred"," to the ","National Hospital (Rikshospitalet, Oslo)"," with ongoing ","noradrenaline"," and ","dobutamine"," ","infusions",".\nShortly after ","admission"," an ","intraaortic balloon pump"," (","IABP",") was inserted and ","noradrenaline"," was replaced by ","nitroprusside",".\n","Coronary angiography"," was ","normal",".\n","Endomyocardial"," ","biopsy"," from the ","right ventricle"," did not reveal any distinct ","myocardial pathology",".\nOn treatment with ","IABP",", ","nitroprusside",", and ","dialysis",", the ","clinical situation"," gradually ","improved"," and the ","liver function"," returned to ","normal",".\nHis ","renal function"," also ","improved"," with increasing ","diuresis"," and ","creatinine"," fell from ","798"," to ","98 \u03bcmol\/l",".\nHis ","EF"," was still markedly ","reduced"," (","15%",").\nBecause of ","behavioral problems"," and ","adipose stature",", he was ","denied"," a ","heart transplant",".\nHe was treated with ","IABP"," for ","26 days",", and ","after 28 days"," he was ","transferred"," back to ","our hospital",".\nAt that time his ","liver and renal functions"," were ","normal",".\nHe was treated with an ","angiotensin-converting enzyme (ACE)-inhibitor",", a ","beta-blocker",", and ","diuretics",".\nDuring the following ","two weeks"," his ","clinical status"," ","improved"," and he was subsequently ","discharged"," to ","his home",".\nThe ","echocardiography"," still showed markedly ","dilated"," ","left ventricle"," with ","EF"," of ","20%",".\nIn ","March 2007",", his ","clinical status"," was ","improved"," and he was in ","function class"," ","II"," (","New York Heart Association",") with an ","EF"," estimated by ","echocardiography"," to ","30%\u201335%",".\n"],"ner_labels":[0,5,0,65,0,26,0,26,0,19,0,39,0,24,0,24,0,42,0,46,0,46,0,29,0,19,0,46,0,46,0,29,0,19,0,19,0,13,0,48,0,63,0,69,0,69,0,69,0,69,0,13,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,69,0,22,0,46,0,12,0,69,0,26,0,46,0,69,0,24,0,42,0,13,0,48,0,13,0,24,0,42,0,4,0,46,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,24,0,69,0,24,0,27,0,12,0,63,0,42,0,24,0,24,0,42,0,24,0,42,0,42,0,69,0,22,0,75,0,24,0,42,0,63,0,18,0,24,0,42,0,42,0,24,0,19,0,42,0,24,0,24,0,42,0,69,0,24,0,42,0,22,0,26,0,69,0,12,0,12,0,69,0,22,0,18,0,46,0,46,0,24,0,24,0,24,0,24,0,42,0,19,0,13,0,48,0,46,0,46,0,4,0,13,0,75,0,75,0,18,0,46,0,24,0,42,0,12,0,24,0,12,0,26,0,18,0,18,0,75,0,24,0,42,0,24,0,42,0,24,0,42,0,69,0,24,0,42,0,42,0,24,0,42,0,42,0,69,0,69,0,13,0,75,0,18,0,32,0,32,0,13,0,48,0,24,0,42,0,46,0,46,0,46,0,32,0,24,0,42,0,13,0,48,0,24,0,42,0,12,0,24,0,42,0,19,0,24,0,42,0,24,0,42,0,22,0,24,0,24,0,42,0]}
-{"full_text":"A 19-year-old man presented at the emergency department, 12 h after insertion of a high pressure container with tanning spray into his rectum.\nA plain abdominal radiograph (Figure 1) showed the container in the rectosigmoid region.\nThere were no signs of perforation.\nA flexible sigmoidoscopy was performed under conscious sedation.\nThe object was located just above the rectosigmoid junction.\nThe container could not be extracted by bimanual manipulation.\nAn attempt to remove the object with conventional endoscopic instruments, such as polypectomy snares, was unsuccessful.\nThe sigmoidoscope could be passed alongside the foreign body to its proximal end.\nA guide wire was left behind with the sigmoidoscope removed.\nSubsequently, a 40 mm pneumatic dilatation balloon (Rigiflex\u00ae, Boston Scientific), normally used in achalasia patients, was inserted over the guide wire and inflated just above the container (Figure 2).\nFor safety purposes, the sigmoidoscope was reintroduced alongside the catheter of the balloon to allow endoscopic visual control of the distal end of the container in the rectum.\nGentle traction was exerted on the balloon catheter, and the container was successfully removed under fluoroscopic and endoscopic control (Figure \u200b3).\n","ner_info":[{"text":"19-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":35,"end":55},{"text":"12 h after","label":"TIME","start":57,"end":67},{"text":"insertion","label":"ACTIVITY","start":68,"end":77},{"text":"high pressure container","label":"DETAILED_DESCRIPTION","start":83,"end":106},{"text":"rectum","label":"BIOLOGICAL_STRUCTURE","start":135,"end":141},{"text":"plain","label":"DETAILED_DESCRIPTION","start":145,"end":150},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":151,"end":160},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":161,"end":171},{"text":"container","label":"SIGN_SYMPTOM","start":194,"end":203},{"text":"rectosigmoid region","label":"BIOLOGICAL_STRUCTURE","start":211,"end":230},{"text":"perforation","label":"DISEASE_DISORDER","start":255,"end":266},{"text":"flexible","label":"DETAILED_DESCRIPTION","start":270,"end":278},{"text":"sigmoidoscopy","label":"DIAGNOSTIC_PROCEDURE","start":279,"end":292},{"text":"conscious sedation","label":"MEDICATION","start":313,"end":331},{"text":"object","label":"SIGN_SYMPTOM","start":337,"end":343},{"text":"above the rectosigmoid junction","label":"BIOLOGICAL_STRUCTURE","start":361,"end":392},{"text":"container","label":"COREFERENCE","start":398,"end":407},{"text":"extracted","label":"THERAPEUTIC_PROCEDURE","start":421,"end":430},{"text":"bimanual manipulation","label":"THERAPEUTIC_PROCEDURE","start":434,"end":455},{"text":"remove","label":"THERAPEUTIC_PROCEDURE","start":471,"end":477},{"text":"object","label":"COREFERENCE","start":482,"end":488},{"text":"conventional endoscopic instruments","label":"DETAILED_DESCRIPTION","start":494,"end":529},{"text":"polypectomy snares","label":"DETAILED_DESCRIPTION","start":539,"end":557},{"text":"unsuccessful","label":"LAB_VALUE","start":563,"end":575},{"text":"sigmoidoscope","label":"DIAGNOSTIC_PROCEDURE","start":581,"end":594},{"text":"foreign body","label":"COREFERENCE","start":625,"end":637},{"text":"guide wire","label":"DIAGNOSTIC_PROCEDURE","start":661,"end":671},{"text":"sigmoidoscope","label":"DIAGNOSTIC_PROCEDURE","start":697,"end":710},{"text":"40 mm","label":"DISTANCE","start":736,"end":741},{"text":"pneumatic dilatation balloon","label":"DIAGNOSTIC_PROCEDURE","start":742,"end":770},{"text":"guide wire","label":"DIAGNOSTIC_PROCEDURE","start":862,"end":872},{"text":"container","label":"COREFERENCE","start":901,"end":910},{"text":"sigmoidoscope","label":"DIAGNOSTIC_PROCEDURE","start":948,"end":961},{"text":"balloon","label":"COREFERENCE","start":1009,"end":1016},{"text":"container","label":"COREFERENCE","start":1077,"end":1086},{"text":"rectum","label":"BIOLOGICAL_STRUCTURE","start":1094,"end":1100},{"text":"balloon","label":"COREFERENCE","start":1137,"end":1144},{"text":"container","label":"COREFERENCE","start":1163,"end":1172},{"text":"successfully","label":"LAB_VALUE","start":1177,"end":1189},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":1190,"end":1197},{"text":"fluoroscopic and endoscopic control","label":"DETAILED_DESCRIPTION","start":1204,"end":1239}],"tokens":["A ","19-year-old"," ","man"," ","presented"," at the ","emergency department",", ","12 h after"," ","insertion"," of a ","high pressure container"," with tanning spray into his ","rectum",".\nA ","plain"," ","abdominal"," ","radiograph"," (Figure 1) showed the ","container"," in the ","rectosigmoid region",".\nThere were no signs of ","perforation",".\nA ","flexible"," ","sigmoidoscopy"," was performed under ","conscious sedation",".\nThe ","object"," was located just ","above the rectosigmoid junction",".\nThe ","container"," could not be ","extracted"," by ","bimanual manipulation",".\nAn attempt to ","remove"," the ","object"," with ","conventional endoscopic instruments",", such as ","polypectomy snares",", was ","unsuccessful",".\nThe ","sigmoidoscope"," could be passed alongside the ","foreign body"," to its proximal end.\nA ","guide wire"," was left behind with the ","sigmoidoscope"," removed.\nSubsequently, a ","40 mm"," ","pneumatic dilatation balloon"," (Rigiflex\u00ae, Boston Scientific), normally used in achalasia patients, was inserted over the ","guide wire"," and inflated just above the ","container"," (Figure 2).\nFor safety purposes, the ","sigmoidoscope"," was reintroduced alongside the catheter of the ","balloon"," to allow endoscopic visual control of the distal end of the ","container"," in the ","rectum",".\nGentle traction was exerted on the ","balloon"," catheter, and the ","container"," was ","successfully"," ","removed"," under ","fluoroscopic and endoscopic control"," (Figure \u200b3).\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,78,0,1,0,22,0,12,0,22,0,12,0,24,0,69,0,12,0,26,0,22,0,24,0,46,0,69,0,12,0,18,0,75,0,75,0,75,0,18,0,22,0,22,0,42,0,24,0,18,0,24,0,24,0,27,0,24,0,24,0,18,0,24,0,18,0,18,0,12,0,18,0,18,0,42,0,75,0,22,0]}
-{"full_text":"A 63-year-old woman with no known cardiac history presented with a sudden onset of dyspnea requiring intubation and ventilatory support out of hospital.\nShe denied preceding symptoms of chest discomfort, palpitations, syncope or infection.\nThe patient was afebrile and normotensive, with a sinus tachycardia of 140 beats\/min.\nThe cardiorespiratory examination was remarkable for an elevated jugular venous pressure at the angle of the jaw, a left-sided third heart sound and bibasilar crackles in both lung fields.\nThe complete blood cell count, electrolytes and cardiac biomarkers were within normal limits.\nAn initial electrocardiogram revealed ST depression in leads V2 to V6, suggestive of anterolateral ischemia (Figure 1).\nA chest radiograph demonstrated pulmonary vascular congestion consistent with a diagnosis of pulmonary edema (Figure 2).\nAn echocardiographic examination revealed normal cardiac dimensions, normal wall motion and mild diastolic dysfunction with an early diastolic to late diastolic transmitral ratio of less than 1, prolonged deceleration time (250 ms) and a reduced early diastolic annular velocity of the lateral mitral valve annulus.\nFollowing aggressive diuresis and requiring minimal ventilatory support, the patient was extubated one day following her initial presentation.\nWithin 1 h of extubation, the patient developed recurrent pulmonary edema clinically and radiographically, requiring mechanical ventilation.\nCardiac catheterization was performed and revealed normal coronary arteries.\nOn day 4 of the coronary care unit admission, the patient failed a repeat attempt at extubation.\nA computed tomographic scan revealed a 4 cm \u00d7 9 cm multinodular goiter extending into the mediastinum and suspected associated tracheal stenosis (Figure 3).\nWith a diagnosis of NPPE secondary to an enlarged goiter, the patient underwent surgical intervention for a thyroidectomy.\nIntraoperative bronchoscopy revealed tracheal stenosis of greater than 50%.\nThe postoperative course was uncomplicated, and three months following discharge, the patient returned to her previous activity level without subjective dyspnea.\n","ner_info":[{"text":"63-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"no known cardiac history","label":"HISTORY","start":25,"end":49},{"text":"presented","label":"CLINICAL_EVENT","start":50,"end":59},{"text":"sudden onset","label":"DETAILED_DESCRIPTION","start":67,"end":79},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":83,"end":90},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":101,"end":111},{"text":"ventilatory support","label":"THERAPEUTIC_PROCEDURE","start":116,"end":135},{"text":"out of hospital","label":"NONBIOLOGICAL_LOCATION","start":136,"end":151},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":186,"end":191},{"text":"discomfort","label":"SIGN_SYMPTOM","start":192,"end":202},{"text":"palpitations","label":"SIGN_SYMPTOM","start":204,"end":216},{"text":"syncope","label":"SIGN_SYMPTOM","start":218,"end":225},{"text":"infection","label":"DISEASE_DISORDER","start":229,"end":238},{"text":"afebrile","label":"SIGN_SYMPTOM","start":256,"end":264},{"text":"normotensive","label":"SIGN_SYMPTOM","start":269,"end":281},{"text":"sinus","label":"DETAILED_DESCRIPTION","start":290,"end":295},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":296,"end":307},{"text":"140 beats\/min","label":"LAB_VALUE","start":311,"end":324},{"text":"cardiorespiratory examination","label":"DIAGNOSTIC_PROCEDURE","start":330,"end":359},{"text":"elevated","label":"LAB_VALUE","start":382,"end":390},{"text":"jugular venous 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to V6","label":"DIAGNOSTIC_PROCEDURE","start":664,"end":678},{"text":"anterolateral ischemia","label":"DISEASE_DISORDER","start":694,"end":716},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":731,"end":736},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":737,"end":747},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":761,"end":770},{"text":"vascular congestion","label":"SIGN_SYMPTOM","start":771,"end":790},{"text":"pulmonary edema","label":"DISEASE_DISORDER","start":822,"end":837},{"text":"echocardiographic examination","label":"DIAGNOSTIC_PROCEDURE","start":853,"end":882},{"text":"normal","label":"LAB_VALUE","start":892,"end":898},{"text":"cardiac dimensions","label":"DIAGNOSTIC_PROCEDURE","start":899,"end":917},{"text":"normal","label":"LAB_VALUE","start":919,"end":925},{"text":"wall motion","label":"DIAGNOSTIC_PROCEDURE","start":926,"end":937},{"text":"mild","label":"SEVERITY","start":942,"end":946},{"text":"diastolic dysfunction","label":"DISEASE_DISORDER","start":947,"end":968},{"text":"early diastolic to late diastolic transmitral ratio","label":"DIAGNOSTIC_PROCEDURE","start":977,"end":1028},{"text":"less than 1","label":"LAB_VALUE","start":1032,"end":1043},{"text":"prolonged","label":"LAB_VALUE","start":1045,"end":1054},{"text":"deceleration time","label":"DIAGNOSTIC_PROCEDURE","start":1055,"end":1072},{"text":"250 ms","label":"LAB_VALUE","start":1074,"end":1080},{"text":"reduced","label":"LAB_VALUE","start":1088,"end":1095},{"text":"early diastolic annular velocity","label":"DIAGNOSTIC_PROCEDURE","start":1096,"end":1128},{"text":"lateral mitral valve annulus","label":"BIOLOGICAL_STRUCTURE","start":1136,"end":1164},{"text":"aggressive","label":"LAB_VALUE","start":1176,"end":1186},{"text":"diuresis","label":"SIGN_SYMPTOM","start":1187,"end":1195},{"text":"minimal","label":"LAB_VALUE","start":1210,"end":1217},{"text":"ventilatory 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cm","label":"AREA","start":1663,"end":1674},{"text":"multinodular","label":"DETAILED_DESCRIPTION","start":1675,"end":1687},{"text":"goiter","label":"DISEASE_DISORDER","start":1688,"end":1694},{"text":"mediastinum","label":"BIOLOGICAL_STRUCTURE","start":1714,"end":1725},{"text":"tracheal","label":"BIOLOGICAL_STRUCTURE","start":1751,"end":1759},{"text":"stenosis","label":"SIGN_SYMPTOM","start":1760,"end":1768},{"text":"NPPE","label":"DISEASE_DISORDER","start":1801,"end":1805},{"text":"enlarged","label":"SEVERITY","start":1822,"end":1830},{"text":"goiter","label":"DISEASE_DISORDER","start":1831,"end":1837},{"text":"surgical 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level","label":"DETAILED_DESCRIPTION","start":2090,"end":2113},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2133,"end":2140}],"tokens":["A ","63-year-old"," ","woman"," with ","no known cardiac history"," ","presented"," with a ","sudden onset"," of ","dyspnea"," requiring ","intubation"," and ","ventilatory support"," ","out of hospital",".\nShe denied preceding symptoms of ","chest"," ","discomfort",", ","palpitations",", ","syncope"," or ","infection",".\nThe patient was ","afebrile"," and ","normotensive",", with a ","sinus"," ","tachycardia"," of ","140 beats\/min",".\nThe ","cardiorespiratory examination"," was remarkable for an ","elevated"," ","jugular venous pressure"," at the ","angle of the jaw",", a ","left-sided"," ","third heart sound"," and ","bibasilar"," ","crackles"," in ","both lung"," fields.\nThe ","complete blood cell count",", ","electrolytes"," and ","cardiac biomarkers"," were ","within normal limits",".\nAn initial ","electrocardiogram"," revealed ","ST depression"," in ","leads V2 to V6",", suggestive of ","anterolateral ischemia"," (Figure 1).\nA ","chest"," ","radiograph"," demonstrated ","pulmonary"," ","vascular congestion"," consistent with a diagnosis of ","pulmonary edema"," (Figure 2).\nAn ","echocardiographic examination"," revealed ","normal"," ","cardiac dimensions",", ","normal"," ","wall motion"," and ","mild"," ","diastolic dysfunction"," with an ","early diastolic to late diastolic transmitral ratio"," of ","less than 1",", ","prolonged"," ","deceleration time"," (","250 ms",") and a ","reduced"," ","early diastolic annular velocity"," of the ","lateral mitral valve annulus",".\nFollowing ","aggressive"," ","diuresis"," and requiring ","minimal"," ","ventilatory support",", the patient was ","extubated"," ","one day following"," her initial presentation.\n","Within 1 h"," of ","extubation",", the patient developed ","recurrent"," ","pulmonary edema"," clinically and ","radiographically",", requiring ","mechanical ventilation",".\n","Cardiac catheterization"," was performed and revealed ","normal"," ","coronary arteries",".\n","On day 4"," of the ","coronary care unit"," ","admission",", the patient ","failed"," a repeat attempt at ","extubation",".\nA ","computed tomographic"," scan revealed a ","4 cm \u00d7 9 cm"," ","multinodular"," ","goiter"," extending into the ","mediastinum"," and suspected associated ","tracheal"," ","stenosis"," (Figure 3).\nWith a diagnosis of ","NPPE"," secondary to an ","enlarged"," ","goiter",", the patient underwent ","surgical intervention"," for a ","thyroidectomy",".\n","Intraoperative"," ","bronchoscopy"," revealed ","tracheal"," ","stenosis"," of ","greater than 50%",".\nThe ","postoperative course"," was ","uncomplicated",", and ","three months following"," ","discharge",", the patient ","returned"," to her ","previous activity level"," without subjective ","dyspnea",".\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,22,0,69,0,75,0,75,0,48,0,12,0,69,0,69,0,69,0,26,0,69,0,69,0,22,0,69,0,42,0,24,0,42,0,24,0,12,0,22,0,69,0,22,0,69,0,12,0,24,0,24,0,24,0,42,0,24,0,69,0,24,0,26,0,12,0,24,0,12,0,69,0,26,0,24,0,42,0,24,0,42,0,24,0,63,0,26,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,12,0,42,0,69,0,42,0,75,0,75,0,19,0,78,0,18,0,22,0,26,0,24,0,75,0,24,0,42,0,12,0,19,0,48,0,13,0,13,0,75,0,24,0,8,0,22,0,26,0,12,0,12,0,69,0,26,0,63,0,26,0,75,0,75,0,22,0,24,0,12,0,69,0,42,0,24,0,42,0,19,0,13,0,56,0,22,0,69,0]}
-{"full_text":"A 28-year-old woman was referred with a 4-week history of continuous, moderate right upper quadrant pain associated with jaundice, as well as weight loss (10 kg over 3 months) and a liver mass identified by ultrasonography.\nThe pain sensation seemed different from previous colicky attacks the patient had experienced before she underwent laparoscopic cholecystectomy 7 years previously.\nOn physical examination, she was obese (body mass index 37.8), with icterus noted over the conjunctivae, oral mucosa and skin.\nImaging modalities included computed tomography (CT), positron emission tomography (PET) and endoscopic cholangiopancreatography (ERCP) (Fig.1).\nThe patient underwent exploratory laparotomy.\nIntraoperative ultrasonography revealed a cystic lesion measuring 3.5 2.5 cm within the central portion of the liver, anterior to the porta hepatis.\nIntraoperative cholangiography demonstrated an extensive stricture obliterating the left hepatic duct, with partial occlusion of the right hepatic duct.\nAn extended left lobectomy was done en bloc with the biliary confluence.\nOn frozen-section examination, all margins of the excised specimen were free of malignant cells.\nReconstruction was performed with a Roux-en-Y cholangiojejunostomy to 3 second bile duct radicals in the right side.\nIntraoperatively, radiotherapy was applied to the surgical margins.\nAfter this, the patient underwent 6 weeks of image-guided external beam radiation centred on the resection field labelled at surgery.\nThe final pathology described this tumour as an infiltrating, moderately differentiated squamous cell carcinoma associated with severe dysplasia of the bile-duct epithelium (Fig.2).\nThe patient recovered without complications and was doing well 18 months after the initial surgical procedure, with an unremarkable CT scan.\n","ner_info":[{"text":"28-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"referred","label":"CLINICAL_EVENT","start":24,"end":32},{"text":"4-week","label":"DURATION","start":40,"end":46},{"text":"continuous","label":"DETAILED_DESCRIPTION","start":58,"end":68},{"text":"moderate","label":"SEVERITY","start":70,"end":78},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":79,"end":99},{"text":"pain","label":"SIGN_SYMPTOM","start":100,"end":104},{"text":"jaundice","label":"SIGN_SYMPTOM","start":121,"end":129},{"text":"weight loss","label":"SIGN_SYMPTOM","start":142,"end":153},{"text":"10 kg","label":"LAB_VALUE","start":155,"end":160},{"text":"3 months","label":"DURATION","start":166,"end":174},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":182,"end":187},{"text":"mass","label":"SIGN_SYMPTOM","start":188,"end":192},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":207,"end":222},{"text":"pain sensation","label":"COREFERENCE","start":228,"end":242},{"text":"different","label":"LAB_VALUE","start":250,"end":259},{"text":"colicky attacks","label":"SIGN_SYMPTOM","start":274,"end":289},{"text":"laparoscopic","label":"DETAILED_DESCRIPTION","start":339,"end":351},{"text":"cholecystectomy","label":"THERAPEUTIC_PROCEDURE","start":352,"end":367},{"text":"7 years previously","label":"DATE","start":368,"end":386},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":391,"end":411},{"text":"obese","label":"SIGN_SYMPTOM","start":421,"end":426},{"text":"body mass index","label":"DIAGNOSTIC_PROCEDURE","start":428,"end":443},{"text":"37.8","label":"LAB_VALUE","start":444,"end":448},{"text":"icterus","label":"SIGN_SYMPTOM","start":456,"end":463},{"text":"conjunctivae","label":"BIOLOGICAL_STRUCTURE","start":479,"end":491},{"text":"oral mucosa","label":"BIOLOGICAL_STRUCTURE","start":493,"end":504},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":509,"end":513},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":543,"end":562},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":564,"end":566},{"text":"positron emission tomography","label":"DIAGNOSTIC_PROCEDURE","start":569,"end":597},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":599,"end":602},{"text":"endoscopic cholangiopancreatography","label":"DIAGNOSTIC_PROCEDURE","start":608,"end":643},{"text":"ERCP","label":"DIAGNOSTIC_PROCEDURE","start":645,"end":649},{"text":"exploratory","label":"DETAILED_DESCRIPTION","start":682,"end":693},{"text":"laparotomy","label":"DIAGNOSTIC_PROCEDURE","start":694,"end":704},{"text":"Intraoperative","label":"DETAILED_DESCRIPTION","start":706,"end":720},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":721,"end":736},{"text":"cystic","label":"DETAILED_DESCRIPTION","start":748,"end":754},{"text":"lesion","label":"SIGN_SYMPTOM","start":755,"end":761},{"text":"3.5 2.5 cm","label":"AREA","start":772,"end":782},{"text":"central portion of the liver","label":"BIOLOGICAL_STRUCTURE","start":794,"end":822},{"text":"anterior to the porta hepatis","label":"BIOLOGICAL_STRUCTURE","start":824,"end":853},{"text":"Intraoperative","label":"DETAILED_DESCRIPTION","start":855,"end":869},{"text":"cholangiography","label":"DIAGNOSTIC_PROCEDURE","start":870,"end":885},{"text":"extensive","label":"SEVERITY","start":902,"end":911},{"text":"stricture","label":"SIGN_SYMPTOM","start":912,"end":921},{"text":"left hepatic duct","label":"BIOLOGICAL_STRUCTURE","start":939,"end":956},{"text":"partial","label":"SEVERITY","start":963,"end":970},{"text":"occlusion","label":"SIGN_SYMPTOM","start":971,"end":980},{"text":"right hepatic duct","label":"BIOLOGICAL_STRUCTURE","start":988,"end":1006},{"text":"extended","label":"DETAILED_DESCRIPTION","start":1011,"end":1019},{"text":"left","label":"DETAILED_DESCRIPTION","start":1020,"end":1024},{"text":"lobectomy","label":"THERAPEUTIC_PROCEDURE","start":1025,"end":1034},{"text":"en bloc with the biliary confluence","label":"DETAILED_DESCRIPTION","start":1044,"end":1079},{"text":"frozen-section examination","label":"DIAGNOSTIC_PROCEDURE","start":1084,"end":1110},{"text":"margins of the excised specimen","label":"DIAGNOSTIC_PROCEDURE","start":1116,"end":1147},{"text":"free of malignant cells","label":"LAB_VALUE","start":1153,"end":1176},{"text":"Reconstruction","label":"THERAPEUTIC_PROCEDURE","start":1178,"end":1192},{"text":"Roux-en-Y","label":"DETAILED_DESCRIPTION","start":1214,"end":1223},{"text":"cholangiojejunostomy","label":"THERAPEUTIC_PROCEDURE","start":1224,"end":1244},{"text":"3 second bile duct radicals","label":"BIOLOGICAL_STRUCTURE","start":1248,"end":1275},{"text":"right side","label":"DETAILED_DESCRIPTION","start":1283,"end":1293},{"text":"radiotherapy","label":"THERAPEUTIC_PROCEDURE","start":1313,"end":1325},{"text":"surgical margins","label":"BIOLOGICAL_STRUCTURE","start":1345,"end":1361},{"text":"6 weeks","label":"DURATION","start":1397,"end":1404},{"text":"image-guided","label":"DETAILED_DESCRIPTION","start":1408,"end":1420},{"text":"external beam","label":"DETAILED_DESCRIPTION","start":1421,"end":1434},{"text":"radiation","label":"THERAPEUTIC_PROCEDURE","start":1435,"end":1444},{"text":"resection field","label":"BIOLOGICAL_STRUCTURE","start":1460,"end":1475},{"text":"infiltrating","label":"DETAILED_DESCRIPTION","start":1545,"end":1557},{"text":"moderately","label":"LAB_VALUE","start":1559,"end":1569},{"text":"differentiated","label":"DETAILED_DESCRIPTION","start":1570,"end":1584},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":1585,"end":1608},{"text":"severe","label":"SEVERITY","start":1625,"end":1631},{"text":"dysplasia","label":"DISEASE_DISORDER","start":1632,"end":1641},{"text":"bile-duct epithelium","label":"BIOLOGICAL_STRUCTURE","start":1649,"end":1669},{"text":"recovered","label":"SIGN_SYMPTOM","start":1691,"end":1700},{"text":"complications","label":"SIGN_SYMPTOM","start":1709,"end":1722},{"text":"doing well","label":"SIGN_SYMPTOM","start":1731,"end":1741},{"text":"18 months after","label":"DATE","start":1742,"end":1757},{"text":"unremarkable","label":"LAB_VALUE","start":1798,"end":1810},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":1811,"end":1818}],"tokens":["A ","28-year-old"," ","woman"," was ","referred"," with a ","4-week"," history of ","continuous",", ","moderate"," ","right upper quadrant"," ","pain"," associated with ","jaundice",", as well as ","weight loss"," (","10 kg"," over ","3 months",") and a ","liver"," ","mass"," identified by ","ultrasonography",".\nThe ","pain sensation"," seemed ","different"," from previous ","colicky attacks"," the patient had experienced before she underwent ","laparoscopic"," ","cholecystectomy"," ","7 years previously",".\nOn ","physical examination",", she was ","obese"," (","body mass index"," ","37.8","), with ","icterus"," noted over the ","conjunctivae",", ","oral mucosa"," and ","skin",".\nImaging modalities included ","computed tomography"," (","CT","), ","positron emission tomography"," (","PET",") and ","endoscopic cholangiopancreatography"," (","ERCP",") (Fig.1).\nThe patient underwent ","exploratory"," ","laparotomy",".\n","Intraoperative"," ","ultrasonography"," revealed a ","cystic"," ","lesion"," measuring ","3.5 2.5 cm"," within the ","central portion of the liver",", ","anterior to the porta hepatis",".\n","Intraoperative"," ","cholangiography"," demonstrated an ","extensive"," ","stricture"," obliterating the ","left hepatic duct",", with ","partial"," ","occlusion"," of the ","right hepatic duct",".\nAn ","extended"," ","left"," ","lobectomy"," was done ","en bloc with the biliary confluence",".\nOn ","frozen-section examination",", all ","margins of the excised specimen"," were ","free of malignant cells",".\n","Reconstruction"," was performed with a ","Roux-en-Y"," ","cholangiojejunostomy"," to ","3 second bile duct radicals"," in the ","right side",".\nIntraoperatively, ","radiotherapy"," was applied to the ","surgical margins",".\nAfter this, the patient underwent ","6 weeks"," of ","image-guided"," ","external beam"," ","radiation"," centred on the ","resection field"," labelled at surgery.\nThe final pathology described this tumour as an ","infiltrating",", ","moderately"," ","differentiated"," ","squamous cell carcinoma"," associated with ","severe"," ","dysplasia"," of the ","bile-duct epithelium"," (Fig.2).\nThe patient ","recovered"," without ","complications"," and was ","doing well"," ","18 months after"," the initial surgical procedure, with an ","unremarkable"," ","CT scan",".\n"],"ner_labels":[0,5,0,65,0,13,0,32,0,22,0,63,0,12,0,69,0,69,0,69,0,42,0,32,0,12,0,69,0,24,0,18,0,42,0,69,0,22,0,75,0,19,0,24,0,69,0,24,0,42,0,69,0,12,0,12,0,12,0,24,0,24,0,24,0,24,0,24,0,24,0,22,0,24,0,22,0,24,0,22,0,69,0,8,0,12,0,12,0,22,0,24,0,63,0,69,0,12,0,63,0,69,0,12,0,22,0,22,0,75,0,22,0,24,0,24,0,42,0,75,0,22,0,75,0,12,0,22,0,75,0,12,0,32,0,22,0,22,0,75,0,12,0,22,0,42,0,22,0,26,0,63,0,26,0,12,0,69,0,69,0,69,0,19,0,42,0,24,0]}
-{"full_text":"A 49-year-old woman was admitted to the Department of Radiology of the Second Affiliated Hospital of Zhejiang University in October 2004 with right upper quadrant pain and weight loss.\nShe was a hepatitis B virus carrier.\nHer \u03b1-fetoprotein level was 1185.3 ng\/mL.\nUltrasonography and computed tomography (CT) revealed a 10-cm mass in the posterior segments of the right liver lobe.\nA 1.5-cm mass was also found in the left lateral segment.\nThese clinical signs indicated that the patient had inoperable HCC and Child-Pugh class A cirrhosis.\nTACE was offered to the patient.\nAngiogram demonstrated no obvious hepatic arterio-venous shunt, but multiple smaller masses in both lobes of the liver.\nAn emulsion of oxaliplatin, pirarubicin, hydroxycamptothecin and lipiodol were prepared, 35 mL and 3 mL of the mixture were administered intra-arterially to the right and left hepatic artery, respectively.\nThe patient experienced right upper quadrant pain after TACE and had an uneventful recovery.\nOne month later, a second TACE procedure was performed via the right hepatic artery and 40 mL of the mixture was administered.\nOn the next day, she experienced sudden acute dyspnoea and the peripheral oxygen saturation decreased to 90%.\nThe chest X-ray showed some increased reticular shadows in the left lung, especially in the lower zones, and a chest CT scan revealed multiple iodized oil-like high-density materials in parenchyma of the lung (Figure \u200b1).\nAfter 10 mg dexamethasone i.v. and other supportive therapies were administered, the respiratory symptom was attenuated.\nTwo days later, the patient suffered from a serious headache and transient consciousness loss, accompanying nausea and vomiting followed by confusion, lower extremity weakness.\nNon-contrast enhanced CT scanning showed multiple disseminated hyper-intense lesions in the brain, consistent with deposition of iodized oil (Figure \u200b2).\nOne week later, her respiratory and neurologic symptoms disappeared completely, and she was discharged.\nThe patient also consequently completed the other three TACE procedures, during which no similar symptoms occurred.\n","ner_info":[{"text":"49-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"admitted","label":"CLINICAL_EVENT","start":24,"end":32},{"text":"Department of Radiology","label":"NONBIOLOGICAL_LOCATION","start":40,"end":63},{"text":"Second Affiliated Hospital of Zhejiang University","label":"NONBIOLOGICAL_LOCATION","start":71,"end":120},{"text":"October 2004","label":"DATE","start":124,"end":136},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":142,"end":162},{"text":"pain","label":"SIGN_SYMPTOM","start":163,"end":167},{"text":"weight loss","label":"SIGN_SYMPTOM","start":172,"end":183},{"text":"hepatitis B virus carrier","label":"HISTORY","start":195,"end":220},{"text":"\u03b1-fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":226,"end":239},{"text":"1185.3 ng\/mL","label":"LAB_VALUE","start":250,"end":262},{"text":"Ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":264,"end":279},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":284,"end":303},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":305,"end":307},{"text":"10-cm","label":"DISTANCE","start":320,"end":325},{"text":"mass","label":"SIGN_SYMPTOM","start":326,"end":330},{"text":"posterior segments","label":"BIOLOGICAL_STRUCTURE","start":338,"end":356},{"text":"right liver lobe","label":"BIOLOGICAL_STRUCTURE","start":364,"end":380},{"text":"1.5-cm","label":"DISTANCE","start":384,"end":390},{"text":"mass","label":"SIGN_SYMPTOM","start":391,"end":395},{"text":"left lateral segment","label":"BIOLOGICAL_STRUCTURE","start":418,"end":438},{"text":"inoperable","label":"DETAILED_DESCRIPTION","start":492,"end":502},{"text":"HCC","label":"DISEASE_DISORDER","start":503,"end":506},{"text":"Child-Pugh class A","label":"DETAILED_DESCRIPTION","start":511,"end":529},{"text":"cirrhosis","label":"DISEASE_DISORDER","start":530,"end":539},{"text":"TACE","label":"THERAPEUTIC_PROCEDURE","start":541,"end":545},{"text":"Angiogram","label":"DIAGNOSTIC_PROCEDURE","start":574,"end":583},{"text":"hepatic","label":"BIOLOGICAL_STRUCTURE","start":608,"end":615},{"text":"arterio-venous shunt","label":"SIGN_SYMPTOM","start":616,"end":636},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":642,"end":650},{"text":"smaller","label":"DETAILED_DESCRIPTION","start":651,"end":658},{"text":"masses","label":"SIGN_SYMPTOM","start":659,"end":665},{"text":"both lobes of the liver","label":"BIOLOGICAL_STRUCTURE","start":669,"end":692},{"text":"emulsion","label":"ADMINISTRATION","start":697,"end":705},{"text":"oxaliplatin","label":"MEDICATION","start":709,"end":720},{"text":"pirarubicin","label":"MEDICATION","start":722,"end":733},{"text":"hydroxycamptothecin","label":"MEDICATION","start":735,"end":754},{"text":"lipiodol","label":"MEDICATION","start":759,"end":767},{"text":"35 mL","label":"DOSAGE","start":783,"end":788},{"text":"3 mL","label":"DOSAGE","start":793,"end":797},{"text":"mixture","label":"MEDICATION","start":805,"end":812},{"text":"intra-arterially","label":"ADMINISTRATION","start":831,"end":847},{"text":"right and left hepatic artery","label":"BIOLOGICAL_STRUCTURE","start":855,"end":884},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":924,"end":944},{"text":"pain","label":"SIGN_SYMPTOM","start":945,"end":949},{"text":"uneventful","label":"LAB_VALUE","start":972,"end":982},{"text":"recovery","label":"DIAGNOSTIC_PROCEDURE","start":983,"end":991},{"text":"One month later","label":"DATE","start":993,"end":1008},{"text":"second","label":"DETAILED_DESCRIPTION","start":1012,"end":1018},{"text":"TACE","label":"THERAPEUTIC_PROCEDURE","start":1019,"end":1023},{"text":"right hepatic artery","label":"BIOLOGICAL_STRUCTURE","start":1056,"end":1076},{"text":"40 mL","label":"DOSAGE","start":1081,"end":1086},{"text":"mixture","label":"COREFERENCE","start":1094,"end":1101},{"text":"next day","label":"DATE","start":1127,"end":1135},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":1153,"end":1159},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1160,"end":1165},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":1166,"end":1174},{"text":"peripheral oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":1183,"end":1211},{"text":"decreased","label":"LAB_VALUE","start":1212,"end":1221},{"text":"90%","label":"LAB_VALUE","start":1225,"end":1228},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1234,"end":1239},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":1240,"end":1245},{"text":"increased","label":"DETAILED_DESCRIPTION","start":1258,"end":1267},{"text":"reticular","label":"DETAILED_DESCRIPTION","start":1268,"end":1277},{"text":"shadows","label":"SIGN_SYMPTOM","start":1278,"end":1285},{"text":"left lung","label":"BIOLOGICAL_STRUCTURE","start":1293,"end":1302},{"text":"lower zones","label":"BIOLOGICAL_STRUCTURE","start":1322,"end":1333},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1341,"end":1346},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1347,"end":1349},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1364,"end":1372},{"text":"iodized","label":"DETAILED_DESCRIPTION","start":1373,"end":1380},{"text":"oil-like","label":"DETAILED_DESCRIPTION","start":1381,"end":1389},{"text":"high-density","label":"DETAILED_DESCRIPTION","start":1390,"end":1402},{"text":"materials","label":"SIGN_SYMPTOM","start":1403,"end":1412},{"text":"parenchyma of the lung","label":"BIOLOGICAL_STRUCTURE","start":1416,"end":1438},{"text":"10 mg","label":"DOSAGE","start":1458,"end":1463},{"text":"dexamethasone","label":"MEDICATION","start":1464,"end":1477},{"text":"i.v.","label":"ADMINISTRATION","start":1478,"end":1482},{"text":"supportive therapies","label":"THERAPEUTIC_PROCEDURE","start":1493,"end":1513},{"text":"respiratory symptom","label":"COREFERENCE","start":1537,"end":1556},{"text":"Two days later","label":"DATE","start":1573,"end":1587},{"text":"serious","label":"SEVERITY","start":1617,"end":1624},{"text":"headache","label":"SIGN_SYMPTOM","start":1625,"end":1633},{"text":"transient","label":"DETAILED_DESCRIPTION","start":1638,"end":1647},{"text":"consciousness loss","label":"SIGN_SYMPTOM","start":1648,"end":1666},{"text":"nausea","label":"SIGN_SYMPTOM","start":1681,"end":1687},{"text":"vomiting","label":"SIGN_SYMPTOM","start":1692,"end":1700},{"text":"confusion","label":"SIGN_SYMPTOM","start":1713,"end":1722},{"text":"lower extremity","label":"BIOLOGICAL_STRUCTURE","start":1724,"end":1739},{"text":"weakness","label":"SIGN_SYMPTOM","start":1740,"end":1748},{"text":"Non-contrast enhanced","label":"DETAILED_DESCRIPTION","start":1750,"end":1771},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1772,"end":1774},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1791,"end":1799},{"text":"disseminated","label":"DETAILED_DESCRIPTION","start":1800,"end":1812},{"text":"hyper-intense","label":"DETAILED_DESCRIPTION","start":1813,"end":1826},{"text":"lesions","label":"SIGN_SYMPTOM","start":1827,"end":1834},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":1842,"end":1847},{"text":"deposition","label":"SIGN_SYMPTOM","start":1865,"end":1875},{"text":"iodized oil","label":"DETAILED_DESCRIPTION","start":1879,"end":1890},{"text":"One week later","label":"DATE","start":1904,"end":1918},{"text":"respiratory","label":"BIOLOGICAL_STRUCTURE","start":1924,"end":1935},{"text":"neurologic","label":"BIOLOGICAL_STRUCTURE","start":1940,"end":1950},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1951,"end":1959},{"text":"discharged","label":"CLINICAL_EVENT","start":1996,"end":2006},{"text":"other three","label":"DETAILED_DESCRIPTION","start":2052,"end":2063},{"text":"TACE","label":"THERAPEUTIC_PROCEDURE","start":2064,"end":2068},{"text":"similar","label":"DETAILED_DESCRIPTION","start":2097,"end":2104},{"text":"symptoms","label":"SIGN_SYMPTOM","start":2105,"end":2113}],"tokens":["A ","49-year-old"," ","woman"," was ","admitted"," to the ","Department of Radiology"," of the ","Second Affiliated Hospital of Zhejiang University"," in ","October 2004"," with ","right upper quadrant"," ","pain"," and ","weight loss",".\nShe was a ","hepatitis B virus carrier",".\nHer ","\u03b1-fetoprotein"," level was ","1185.3 ng\/mL",".\n","Ultrasonography"," and ","computed tomography"," (","CT",") revealed a ","10-cm"," ","mass"," in the ","posterior segments"," of the ","right liver lobe",".\nA ","1.5-cm"," ","mass"," was also found in the ","left lateral segment",".\nThese clinical signs indicated that the patient had ","inoperable"," ","HCC"," and ","Child-Pugh class A"," ","cirrhosis",".\n","TACE"," was offered to the patient.\n","Angiogram"," demonstrated no obvious ","hepatic"," ","arterio-venous shunt",", but ","multiple"," ","smaller"," ","masses"," in ","both lobes of the liver",".\nAn ","emulsion"," of ","oxaliplatin",", ","pirarubicin",", ","hydroxycamptothecin"," and ","lipiodol"," were prepared, ","35 mL"," and ","3 mL"," of the ","mixture"," were administered ","intra-arterially"," to the ","right and left hepatic artery",", respectively.\nThe patient experienced ","right upper quadrant"," ","pain"," after TACE and had an ","uneventful"," ","recovery",".\n","One month later",", a ","second"," ","TACE"," procedure was performed via the ","right hepatic artery"," and ","40 mL"," of the ","mixture"," was administered.\nOn the ","next day",", she experienced ","sudden"," ","acute"," ","dyspnoea"," and the ","peripheral oxygen saturation"," ","decreased"," to ","90%",".\nThe ","chest"," ","X-ray"," showed some ","increased"," ","reticular"," ","shadows"," in the ","left lung",", especially in the ","lower zones",", and a ","chest"," ","CT"," scan revealed ","multiple"," ","iodized"," ","oil-like"," ","high-density"," ","materials"," in ","parenchyma of the lung"," (Figure \u200b1).\nAfter ","10 mg"," ","dexamethasone"," ","i.v."," and other ","supportive therapies"," were administered, the ","respiratory symptom"," was attenuated.\n","Two days later",", the patient suffered from a ","serious"," ","headache"," and ","transient"," ","consciousness loss",", accompanying ","nausea"," and ","vomiting"," followed by ","confusion",", ","lower extremity"," ","weakness",".\n","Non-contrast enhanced"," ","CT"," scanning showed ","multiple"," ","disseminated"," ","hyper-intense"," ","lesions"," in the ","brain",", consistent with ","deposition"," of ","iodized oil"," (Figure \u200b2).\n","One week later",", her ","respiratory"," and ","neurologic"," ","symptoms"," disappeared completely, and she was ","discharged",".\nThe patient also consequently completed the ","other three"," ","TACE"," procedures, during which no ","similar"," ","symptoms"," occurred.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,48,0,19,0,12,0,69,0,69,0,39,0,24,0,42,0,24,0,24,0,24,0,27,0,69,0,12,0,12,0,27,0,69,0,12,0,22,0,26,0,22,0,26,0,75,0,24,0,12,0,69,0,22,0,22,0,69,0,12,0,4,0,46,0,46,0,46,0,46,0,29,0,29,0,46,0,4,0,12,0,12,0,69,0,42,0,24,0,19,0,22,0,75,0,12,0,29,0,18,0,19,0,22,0,22,0,69,0,24,0,42,0,42,0,12,0,24,0,22,0,22,0,69,0,12,0,12,0,12,0,24,0,22,0,22,0,22,0,22,0,69,0,12,0,29,0,46,0,4,0,75,0,18,0,19,0,63,0,69,0,22,0,69,0,69,0,69,0,69,0,12,0,69,0,22,0,24,0,22,0,22,0,22,0,69,0,12,0,69,0,22,0,19,0,12,0,12,0,69,0,13,0,22,0,75,0,22,0,69,0]}
-{"full_text":"A 71-year-old woman with known diastolic congestive heart failure (CHF) presented to the ER with exacerbation of CHF and a decreased level of consciousness.\nBrachial blood pressure (BP) was measured at 55\/40 mmHg.\nThe patient had four recent admissions with exacerbation of CHF.\nHer medical history was also significant for autoimmune hepatitis, but preserved liver function; esophageal varices with a bleeding episode; and long-term corticosteroid therapy complicated by adrenal insufficiency, type 2 diabetes mellitus and osteoporosis.\nRecent echocardiography had revealed moderate concentric left ventricular hypertrophy with diastolic dysfunction, and mild to moderate mitral regurgitation.\nCardiac catheterization in a recent admission demonstrated 50% stenosis in the second diagonal artery, with mild diffuse disease in the other coronary arteries.\nRight ventricular endomyocardial biopsy had ruled out myocarditis and infiltrative cardiomyopathies, but healing ischemic microinfarcts with atheroemboli were observed.\nPrevious BP values were also low; systolic BP was between 60 mmHg and 65 mmHg, and diastolic BP was between 40 mmHg and 45 mmHg.\nFollowing intubation, dopamine was started for hypotension management and was later replaced with noradrenaline.\nThe patient developed atrial flutter but successfully converted to sinus rhythm with two direct current electric shocks.\nCardiology consultation resulted in admission to the coronary care unit (CCU).\nOn admission to the CCU, BP was measured at 56\/36 mmHg in the left arm but was not detectable in the right arm.\nAn arterial line was inserted via the femoral artery, and BP was measured at 191\/92 mmHg.\nBP values were consistently much higher through the femoral arterial line than the cuff on the arms, and was higher in the left arm than in the right arm.\nFor instance, on the first day post-CCU admission, BP at one point was measured at 170\/80 mmHg through the arterial line, while cuff readings on the arms were 83\/74 mmHg on the left and 60\/39 mmHg on the right arm.\nTo investigate the inconsistency between brachial and femoral BP values, a computed tomography (CT) scan of the thorax was obtained using 1.25 mm slices, both before and after intravenous contrast injection with sagittal and coronal planar reformatting of maximum-intensity projection images.\nAnalysis of the initial unenhanced CT images showed densely calcified plaque or thrombus at the origins of both subclavian arteries and the right common carotid artery.\nThe CT angiogram showed absence of flow in the right subclavian artery, a very tight stenosis at the origin of the left subclavian artery and a tight stenosis at the origin of the right common carotid artery.\nBoth vertebral arteries showed normal calibre and flow (Figure 1).\nFurther management following the insertion of the femoral arterial line was based on femoral BP readings with diuretics and BP-lowering agents.\nThe patient was eventually discharged in stable condition.\nShe remained stable during the eight months between discharge and the time the present report was written, without further exacerbation of CHF or related ER visits.\n","ner_info":[{"text":"71-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"diastolic","label":"DETAILED_DESCRIPTION","start":31,"end":40},{"text":"congestive heart failure","label":"DISEASE_DISORDER","start":41,"end":65},{"text":"(CHF)","label":"DISEASE_DISORDER","start":66,"end":71},{"text":"ER","label":"NONBIOLOGICAL_LOCATION","start":89,"end":91},{"text":"exacerbation","label":"DETAILED_DESCRIPTION","start":97,"end":109},{"text":"CHF","label":"DISEASE_DISORDER","start":113,"end":116},{"text":"decreased","label":"LAB_VALUE","start":123,"end":132},{"text":"level of consciousness","label":"SIGN_SYMPTOM","start":133,"end":155},{"text":"Brachial","label":"BIOLOGICAL_STRUCTURE","start":157,"end":165},{"text":"blood pressure","label":"SIGN_SYMPTOM","start":166,"end":180},{"text":"(BP)","label":"SIGN_SYMPTOM","start":181,"end":185},{"text":"55\/40 mmHg","label":"LAB_VALUE","start":202,"end":212},{"text":"four","label":"LAB_VALUE","start":230,"end":234},{"text":"recent","label":"DETAILED_DESCRIPTION","start":235,"end":241},{"text":"admissions","label":"CLINICAL_EVENT","start":242,"end":252},{"text":"exacerbation","label":"DETAILED_DESCRIPTION","start":258,"end":270},{"text":"CHF","label":"DISEASE_DISORDER","start":274,"end":277},{"text":"medical history was also significant for autoimmune hepatitis, but preserved liver function","label":"HISTORY","start":283,"end":374},{"text":"esophageal varices with a bleeding episode","label":"HISTORY","start":376,"end":418},{"text":"long-term","label":"DETAILED_DESCRIPTION","start":424,"end":433},{"text":"corticosteroid therapy","label":"MEDICATION","start":434,"end":456},{"text":"adrenal insufficiency","label":"DISEASE_DISORDER","start":472,"end":493},{"text":"type 2 diabetes mellitus","label":"DISEASE_DISORDER","start":495,"end":519},{"text":"osteoporosis","label":"DISEASE_DISORDER","start":524,"end":536},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":545,"end":561},{"text":"moderate","label":"SEVERITY","start":575,"end":583},{"text":"concentric","label":"DETAILED_DESCRIPTION","start":584,"end":594},{"text":"left ventricular","label":"BIOLOGICAL_STRUCTURE","start":595,"end":611},{"text":"hypertrophy","label":"DISEASE_DISORDER","start":612,"end":623},{"text":"diastolic dysfunction","label":"DETAILED_DESCRIPTION","start":629,"end":650},{"text":"mild","label":"SEVERITY","start":656,"end":660},{"text":"moderate","label":"SEVERITY","start":664,"end":672},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":673,"end":693},{"text":"Cardiac catheterization","label":"DIAGNOSTIC_PROCEDURE","start":695,"end":718},{"text":"admission","label":"CLINICAL_EVENT","start":731,"end":740},{"text":"50%","label":"LAB_VALUE","start":754,"end":757},{"text":"stenosis","label":"DISEASE_DISORDER","start":758,"end":766},{"text":"second diagonal artery","label":"BIOLOGICAL_STRUCTURE","start":774,"end":796},{"text":"mild","label":"SEVERITY","start":803,"end":807},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":808,"end":815},{"text":"disease","label":"COREFERENCE","start":816,"end":823},{"text":"other coronary arteries","label":"BIOLOGICAL_STRUCTURE","start":831,"end":854},{"text":"Right ventricular endomyocardial","label":"DETAILED_DESCRIPTION","start":856,"end":888},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":889,"end":895},{"text":"myocarditis","label":"DISEASE_DISORDER","start":910,"end":921},{"text":"infiltrative","label":"DETAILED_DESCRIPTION","start":926,"end":938},{"text":"cardiomyopathies","label":"DISEASE_DISORDER","start":939,"end":955},{"text":"healing","label":"DETAILED_DESCRIPTION","start":961,"end":968},{"text":"ischemic microinfarcts","label":"DISEASE_DISORDER","start":969,"end":991},{"text":"atheroemboli","label":"DISEASE_DISORDER","start":997,"end":1009},{"text":"BP values","label":"SIGN_SYMPTOM","start":1034,"end":1043},{"text":"low","label":"LAB_VALUE","start":1054,"end":1057},{"text":"systolic BP","label":"SIGN_SYMPTOM","start":1059,"end":1070},{"text":"60 mmHg","label":"LAB_VALUE","start":1083,"end":1090},{"text":"65 mmHg","label":"LAB_VALUE","start":1095,"end":1102},{"text":"diastolic BP","label":"SIGN_SYMPTOM","start":1108,"end":1120},{"text":"40 mmHg","label":"LAB_VALUE","start":1133,"end":1140},{"text":"45 mmHg","label":"LAB_VALUE","start":1145,"end":1152},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":1164,"end":1174},{"text":"dopamine","label":"MEDICATION","start":1176,"end":1184},{"text":"hypotension management","label":"THERAPEUTIC_PROCEDURE","start":1201,"end":1223},{"text":"replaced","label":"CLINICAL_EVENT","start":1238,"end":1246},{"text":"noradrenaline","label":"MEDICATION","start":1252,"end":1265},{"text":"atrial flutter","label":"DISEASE_DISORDER","start":1289,"end":1303},{"text":"converted","label":"CLINICAL_EVENT","start":1321,"end":1330},{"text":"sinus rhythm","label":"SIGN_SYMPTOM","start":1334,"end":1346},{"text":"two","label":"LAB_VALUE","start":1352,"end":1355},{"text":"direct current","label":"DETAILED_DESCRIPTION","start":1356,"end":1370},{"text":"electric shocks","label":"THERAPEUTIC_PROCEDURE","start":1371,"end":1386},{"text":"Cardiology consultation","label":"DIAGNOSTIC_PROCEDURE","start":1388,"end":1411},{"text":"admission","label":"CLINICAL_EVENT","start":1424,"end":1433},{"text":"coronary care unit","label":"NONBIOLOGICAL_LOCATION","start":1441,"end":1459},{"text":"(CCU)","label":"NONBIOLOGICAL_LOCATION","start":1460,"end":1465},{"text":"admission","label":"COREFERENCE","start":1470,"end":1479},{"text":"CCU","label":"BIOLOGICAL_STRUCTURE","start":1487,"end":1490},{"text":"BP","label":"SIGN_SYMPTOM","start":1492,"end":1494},{"text":"56\/36 mmHg","label":"LAB_VALUE","start":1511,"end":1521},{"text":"left arm","label":"BIOLOGICAL_STRUCTURE","start":1529,"end":1537},{"text":"not detectable","label":"LAB_VALUE","start":1546,"end":1560},{"text":"right arm","label":"BIOLOGICAL_STRUCTURE","start":1568,"end":1577},{"text":"arterial line","label":"DIAGNOSTIC_PROCEDURE","start":1582,"end":1595},{"text":"femoral artery","label":"BIOLOGICAL_STRUCTURE","start":1617,"end":1631},{"text":"BP","label":"SIGN_SYMPTOM","start":1637,"end":1639},{"text":"191\/92 mmHg","label":"LAB_VALUE","start":1656,"end":1667},{"text":"BP values","label":"SIGN_SYMPTOM","start":1669,"end":1678},{"text":"consistently","label":"DETAILED_DESCRIPTION","start":1684,"end":1696},{"text":"much","label":"SEVERITY","start":1697,"end":1701},{"text":"higher","label":"LAB_VALUE","start":1702,"end":1708},{"text":"through the femoral arterial line than the cuff on the arms","label":"DETAILED_DESCRIPTION","start":1709,"end":1768},{"text":"higher","label":"LAB_VALUE","start":1778,"end":1784},{"text":"in the left arm than in the right arm","label":"DETAILED_DESCRIPTION","start":1785,"end":1822},{"text":"on the first day post-CCU admission","label":"DATE","start":1838,"end":1873},{"text":"BP","label":"SIGN_SYMPTOM","start":1875,"end":1877},{"text":"at one point","label":"TIME","start":1878,"end":1890},{"text":"170\/80 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angiogram","label":"DIAGNOSTIC_PROCEDURE","start":2505,"end":2517},{"text":"flow","label":"SIGN_SYMPTOM","start":2536,"end":2540},{"text":"right subclavian artery","label":"COREFERENCE","start":2548,"end":2571},{"text":"very","label":"SEVERITY","start":2575,"end":2579},{"text":"tight","label":"DETAILED_DESCRIPTION","start":2580,"end":2585},{"text":"stenosis","label":"DISEASE_DISORDER","start":2586,"end":2594},{"text":"origin of the left subclavian artery","label":"COREFERENCE","start":2602,"end":2638},{"text":"tight","label":"DETAILED_DESCRIPTION","start":2645,"end":2650},{"text":"stenosis","label":"DISEASE_DISORDER","start":2651,"end":2659},{"text":"origin of the right common carotid artery","label":"COREFERENCE","start":2667,"end":2708},{"text":"Both vertebral arteries","label":"COREFERENCE","start":2710,"end":2733},{"text":"normal","label":"LAB_VALUE","start":2741,"end":2747},{"text":"calibre","label":"SIGN_SYMPTOM","start":2748,"end":2755},{"text":"flow","label":"SIGN_SYMPTOM","start":2760,"end":2764},{"text":"Further management","label":"THERAPEUTIC_PROCEDURE","start":2777,"end":2795},{"text":"femoral arterial line","label":"DIAGNOSTIC_PROCEDURE","start":2827,"end":2848},{"text":"femoral","label":"DETAILED_DESCRIPTION","start":2862,"end":2869},{"text":"BP readings","label":"DIAGNOSTIC_PROCEDURE","start":2870,"end":2881},{"text":"diuretics","label":"MEDICATION","start":2887,"end":2896},{"text":"BP-lowering agents","label":"MEDICATION","start":2901,"end":2919},{"text":"discharged","label":"CLINICAL_EVENT","start":2948,"end":2958},{"text":"stable","label":"LAB_VALUE","start":2962,"end":2968},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":2969,"end":2978},{"text":"remained stable","label":"CLINICAL_EVENT","start":2984,"end":2999},{"text":"during the eight months between discharge and the time the present report was written","label":"DURATION","start":3000,"end":3085},{"text":"further exacerbation","label":"DETAILED_DESCRIPTION","start":3095,"end":3115},{"text":"CHF","label":"DISEASE_DISORDER","start":3119,"end":3122},{"text":"ER visits","label":"CLINICAL_EVENT","start":3134,"end":3143}],"tokens":["A ","71-year-old"," ","woman"," with known ","diastolic"," ","congestive heart failure"," ","(CHF)"," presented to the ","ER"," with ","exacerbation"," of ","CHF"," and a ","decreased"," ","level of consciousness",".\n","Brachial"," ","blood pressure"," ","(BP)"," was measured at ","55\/40 mmHg",".\nThe patient had ","four"," ","recent"," ","admissions"," with ","exacerbation"," of ","CHF",".\nHer ","medical history was also significant for autoimmune hepatitis, but preserved liver function","; ","esophageal varices with a bleeding episode","; and ","long-term"," ","corticosteroid therapy"," complicated by ","adrenal insufficiency",", ","type 2 diabetes mellitus"," and ","osteoporosis",".\nRecent ","echocardiography"," had revealed ","moderate"," ","concentric"," ","left ventricular"," ","hypertrophy"," with ","diastolic dysfunction",", and ","mild"," to ","moderate"," ","mitral regurgitation",".\n","Cardiac catheterization"," in a recent ","admission"," demonstrated ","50%"," ","stenosis"," in the ","second diagonal artery",", with ","mild"," ","diffuse"," ","disease"," in the ","other coronary arteries",".\n","Right ventricular endomyocardial"," ","biopsy"," had ruled out ","myocarditis"," and ","infiltrative"," ","cardiomyopathies",", but ","healing"," ","ischemic microinfarcts"," with ","atheroemboli"," were observed.\nPrevious ","BP values"," were also ","low","; ","systolic BP"," was between ","60 mmHg"," and ","65 mmHg",", and ","diastolic BP"," was between ","40 mmHg"," and ","45 mmHg",".\nFollowing ","intubation",", ","dopamine"," was started for ","hypotension management"," and was later ","replaced"," with ","noradrenaline",".\nThe patient developed ","atrial flutter"," but successfully ","converted"," to ","sinus rhythm"," with ","two"," ","direct current"," ","electric shocks",".\n","Cardiology consultation"," resulted in ","admission"," to the ","coronary care unit"," ","(CCU)",".\nOn ","admission"," to the ","CCU",", ","BP"," was measured at ","56\/36 mmHg"," in the ","left arm"," but was ","not detectable"," in the ","right arm",".\nAn ","arterial line"," was inserted via the ","femoral artery",", and ","BP"," was measured at ","191\/92 mmHg",".\n","BP values"," were ","consistently"," ","much"," ","higher"," ","through the femoral arterial line than the cuff on the arms",", and was ","higher"," ","in the left arm than in the right arm",".\nFor instance, ","on the first day post-CCU admission",", ","BP"," ","at one point"," was measured at ","170\/80 mmHg"," through the ","arterial line",", while ","cuff readings"," on ","the arms"," were ","83\/74 mmHg"," on the left and ","60\/39 mmHg"," on the ","right arm",".\nTo investigate the inconsistency between ","brachial"," and ","femoral"," ","BP values",", a computed tomography ","(CT) scan"," of the ","thorax"," was obtained using ","1.25 mm"," ","slices",", both before and after ","intravenous"," ","contrast injection"," with ","sagittal and coronal planar reformatting"," of ","maximum-intensity projection images",".\nAnalysis of the ","initial"," ","unenhanced"," ","CT images"," showed ","densely"," ","calcified"," ","plaque"," or ","thrombus"," at the origins of both subclavian arteries and the right common carotid artery.\nThe ","CT angiogram"," showed absence of ","flow"," in the ","right subclavian artery",", a ","very"," ","tight"," ","stenosis"," at the ","origin of the left subclavian artery"," and a ","tight"," ","stenosis"," at the ","origin of the right common carotid artery",".\n","Both vertebral arteries"," showed ","normal"," ","calibre"," and ","flow"," (Figure 1).\n","Further management"," following the insertion of the ","femoral arterial line"," was based on ","femoral"," ","BP readings"," with ","diuretics"," and ","BP-lowering agents",".\nThe patient was eventually ","discharged"," in ","stable"," ","condition",".\nShe ","remained stable"," ","during the eight months between discharge and the time the present report was written",", without ","further exacerbation"," of ","CHF"," or related ","ER 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-{"full_text":"A newborn boy of healthy nonconsanguineous parents was delivered at 37 weeks\u2019 gestation by cesarean section.\nHis mother (primipara, 32 years old) had been admitted to our hospital 2 weeks previously because of reduced fetal intrauterine movements and polyhydramnios.\nThe child\u2019s birthweight was 2,330 g (<10th percentile), length 47 cm, and head circumference 33.2 cm (25th percentile).\nHe had low-set ears and bilateral clubfoot.\nApgar scores were 2, 6, and 7 at 1, 5, and 10 minutes.\nThe child presented with severe hypotonia and generalized muscle weakness, requiring ventilatory assistance and total parenteral nutrition.\nWeaning failed because of inadequate pulmonary ventilation and respiratory acidosis.\nHearing loss was detected by auditory evoked potentials, while cranial MRI showed mildly enlarged ventricles and liquor spaces.\nTwo days after birth, the infant presented with severe abdominal distension with a hypoactive bowel.\nMRI revealed marked intestinal dilation without mechanical obstruction.\nLaboratory investigations showed hypoglycemia (27 mg\/dL), hypomagnesemia (0.58 mmol\/L), and hypokalemia (2.4 mmol\/L).\nBlood lactate was normal (1.3 mmol\/L, normal range 0.5\u20132.2 mmol\/L) and liver enzymes were unremarkable.\nA skeletal muscle biopsy was performed and showed scattered, hypertrophic cytochrome c oxidase (COX)-deficient and succinate dehydrogenase\u2013positive muscle fibers (figure), suggesting a mitochondrial disorder.\nMolecular genetic studies revealed marked mtDNA depletion in muscle (93% decrease as compared to age-matched controls), while a screen for mtDNA rearrangements within individual COX-positive and COX-deficient fibers4 was negative.\nWe sequenced the entire coding region and intron-exon boundaries of the POLG1 gene, identifying two reported heterozygous missense mutations in compound c.679C>T predicting p.R227W and c.2542G>A predicting p.G848S.\nSequencing of parental samples confirmed recessive inheritance.\nThe infant died at 20 days of respiratory failure.\nAt autopsy, the brain did not show remarkable changes on gross examination.\nHistology was not informative due to poor preservation of tissue; there was no evidence of neuronal damage in the spinal cord.\nThe liver showed diffuse cholestasis, consistent with total parenteral nutrition; hepatocyte steatosis, necrosis, or liver fibrosis were not observed.\nThe testicles were undescended, while remaining visceral organs were normal except for a marked dilation and thinning of the bowel wall.\nDespite normal histology, analysis of stomach, ileum, and colon homogenates revealed severe mtDNA depletion (up to 94% decrease; table e-1 on the Neurology\u00ae Web site at www.neurology.org).\nLaser capture microdissection analysis5 revealed that the mtDNA depletion was confined to the muscularis propria, being most prominent in its external layer (figure).\nGanglion cells from the myenteric plexus showed milder mtDNA depletion, restricted to the small intestine (figure).\nThere was no mtDNA depletion in liver (not shown).\n","ner_info":[{"text":"newborn","label":"AGE","start":2,"end":9},{"text":"boy","label":"SEX","start":10,"end":13},{"text":"healthy nonconsanguineous parents","label":"FAMILY_HISTORY","start":17,"end":50},{"text":"delivered","label":"CLINICAL_EVENT","start":55,"end":64},{"text":"37 weeks\u2019 gestation","label":"DATE","start":68,"end":87},{"text":"cesarean section","label":"THERAPEUTIC_PROCEDURE","start":91,"end":107},{"text":"mother","label":"SUBJECT","start":113,"end":119},{"text":"primipara","label":"FAMILY_HISTORY","start":121,"end":130},{"text":"32 years old","label":"FAMILY_HISTORY","start":132,"end":144},{"text":"admitted","label":"CLINICAL_EVENT","start":155,"end":163},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":171,"end":179},{"text":"2 weeks previously","label":"DATE","start":180,"end":198},{"text":"reduced","label":"LAB_VALUE","start":210,"end":217},{"text":"fetal intrauterine movements","label":"SIGN_SYMPTOM","start":218,"end":246},{"text":"polyhydramnios","label":"SIGN_SYMPTOM","start":251,"end":265},{"text":"birthweight","label":"DIAGNOSTIC_PROCEDURE","start":279,"end":290},{"text":"2,330 g","label":"LAB_VALUE","start":295,"end":302},{"text":"<10th percentile","label":"LAB_VALUE","start":304,"end":320},{"text":"length","label":"DIAGNOSTIC_PROCEDURE","start":323,"end":329},{"text":"47 cm","label":"LAB_VALUE","start":330,"end":335},{"text":"head circumference","label":"DIAGNOSTIC_PROCEDURE","start":341,"end":359},{"text":"33.2 cm","label":"LAB_VALUE","start":360,"end":367},{"text":"low-set ears","label":"SIGN_SYMPTOM","start":394,"end":406},{"text":"bilateral clubfoot","label":"SIGN_SYMPTOM","start":411,"end":429},{"text":"Apgar scores","label":"DIAGNOSTIC_PROCEDURE","start":431,"end":443},{"text":"2","label":"LAB_VALUE","start":449,"end":450},{"text":"6","label":"LAB_VALUE","start":452,"end":453},{"text":"7","label":"LAB_VALUE","start":459,"end":460},{"text":"1, 5, and 10 minutes","label":"DETAILED_DESCRIPTION","start":464,"end":484},{"text":"presented","label":"CLINICAL_EVENT","start":496,"end":505},{"text":"severe","label":"SEVERITY","start":511,"end":517},{"text":"hypotonia","label":"SIGN_SYMPTOM","start":518,"end":527},{"text":"generalized muscle weakness","label":"SIGN_SYMPTOM","start":532,"end":559},{"text":"ventilatory assistance","label":"THERAPEUTIC_PROCEDURE","start":571,"end":593},{"text":"total parenteral nutrition","label":"THERAPEUTIC_PROCEDURE","start":598,"end":624},{"text":"respiratory acidosis","label":"DISEASE_DISORDER","start":689,"end":709},{"text":"Hearing loss","label":"SIGN_SYMPTOM","start":711,"end":723},{"text":"auditory evoked potentials","label":"DIAGNOSTIC_PROCEDURE","start":740,"end":766},{"text":"cranial","label":"BIOLOGICAL_STRUCTURE","start":774,"end":781},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":782,"end":785},{"text":"mildly enlarged","label":"LAB_VALUE","start":793,"end":808},{"text":"ventricles","label":"BIOLOGICAL_STRUCTURE","start":809,"end":819},{"text":"liquor spaces","label":"BIOLOGICAL_STRUCTURE","start":824,"end":837},{"text":"Two days after birth","label":"DATE","start":839,"end":859},{"text":"severe","label":"SEVERITY","start":887,"end":893},{"text":"abdominal distension","label":"SIGN_SYMPTOM","start":894,"end":914},{"text":"hypoactive bowel","label":"SIGN_SYMPTOM","start":922,"end":938},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":940,"end":943},{"text":"marked","label":"SEVERITY","start":953,"end":959},{"text":"intestinal dilation","label":"SIGN_SYMPTOM","start":960,"end":979},{"text":"mechanical obstruction","label":"SIGN_SYMPTOM","start":988,"end":1010},{"text":"Laboratory investigations","label":"DIAGNOSTIC_PROCEDURE","start":1012,"end":1037},{"text":"hypoglycemia","label":"SIGN_SYMPTOM","start":1045,"end":1057},{"text":"27 mg\/dL","label":"LAB_VALUE","start":1059,"end":1067},{"text":"hypomagnesemia","label":"SIGN_SYMPTOM","start":1070,"end":1084},{"text":"0.58 mmol\/L","label":"LAB_VALUE","start":1086,"end":1097},{"text":"hypokalemia","label":"SIGN_SYMPTOM","start":1104,"end":1115},{"text":"2.4 mmol\/L","label":"LAB_VALUE","start":1117,"end":1127},{"text":"Blood lactate","label":"DIAGNOSTIC_PROCEDURE","start":1130,"end":1143},{"text":"normal","label":"LAB_VALUE","start":1148,"end":1154},{"text":"1.3 mmol\/L","label":"LAB_VALUE","start":1156,"end":1166},{"text":"normal range 0.5\u20132.2 mmol\/L","label":"DETAILED_DESCRIPTION","start":1168,"end":1195},{"text":"liver enzymes","label":"DIAGNOSTIC_PROCEDURE","start":1201,"end":1214},{"text":"unremarkable","label":"LAB_VALUE","start":1220,"end":1232},{"text":"skeletal muscle","label":"BIOLOGICAL_STRUCTURE","start":1236,"end":1251},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1252,"end":1258},{"text":"scattered","label":"DETAILED_DESCRIPTION","start":1284,"end":1293},{"text":"hypertrophic","label":"DETAILED_DESCRIPTION","start":1295,"end":1307},{"text":"cytochrome c oxidase","label":"DIAGNOSTIC_PROCEDURE","start":1308,"end":1328},{"text":"COX","label":"DIAGNOSTIC_PROCEDURE","start":1330,"end":1333},{"text":"deficient","label":"LAB_VALUE","start":1335,"end":1344},{"text":"succinate dehydrogenase","label":"DIAGNOSTIC_PROCEDURE","start":1349,"end":1372},{"text":"positive","label":"LAB_VALUE","start":1373,"end":1381},{"text":"muscle fibers","label":"BIOLOGICAL_STRUCTURE","start":1382,"end":1395},{"text":"mitochondrial disorder","label":"DISEASE_DISORDER","start":1419,"end":1441},{"text":"Molecular genetic studies","label":"DIAGNOSTIC_PROCEDURE","start":1443,"end":1468},{"text":"marked","label":"SEVERITY","start":1478,"end":1484},{"text":"mtDNA depletion","label":"SIGN_SYMPTOM","start":1485,"end":1500},{"text":"93% decrease","label":"LAB_VALUE","start":1512,"end":1524},{"text":"compared to age-matched controls","label":"DETAILED_DESCRIPTION","start":1528,"end":1560},{"text":"screen for mtDNA rearrangements","label":"DIAGNOSTIC_PROCEDURE","start":1571,"end":1602},{"text":"COX-deficient fibers","label":"BIOLOGICAL_STRUCTURE","start":1638,"end":1658},{"text":"negative","label":"LAB_VALUE","start":1664,"end":1672},{"text":"sequenced","label":"DIAGNOSTIC_PROCEDURE","start":1677,"end":1686},{"text":"entire coding region and intron-exon boundaries","label":"DETAILED_DESCRIPTION","start":1691,"end":1738},{"text":"POLG1 gene","label":"BIOLOGICAL_STRUCTURE","start":1746,"end":1756},{"text":"two","label":"LAB_VALUE","start":1770,"end":1773},{"text":"heterozygous missense mutations","label":"SIGN_SYMPTOM","start":1783,"end":1814},{"text":"c.679C>T predicting p.R227W","label":"SIGN_SYMPTOM","start":1827,"end":1854},{"text":"c.2542G>A predicting p.G848S","label":"SIGN_SYMPTOM","start":1859,"end":1887},{"text":"Sequencing of parental samples","label":"DIAGNOSTIC_PROCEDURE","start":1889,"end":1919},{"text":"recessive inheritance","label":"SIGN_SYMPTOM","start":1930,"end":1951},{"text":"died","label":"OUTCOME","start":1964,"end":1968},{"text":"20 days","label":"DATE","start":1972,"end":1979},{"text":"respiratory failure","label":"DISEASE_DISORDER","start":1983,"end":2002},{"text":"autopsy","label":"DIAGNOSTIC_PROCEDURE","start":2007,"end":2014},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":2020,"end":2025},{"text":"remarkable changes","label":"SIGN_SYMPTOM","start":2039,"end":2057},{"text":"gross examination","label":"DIAGNOSTIC_PROCEDURE","start":2061,"end":2078},{"text":"Histology","label":"DIAGNOSTIC_PROCEDURE","start":2080,"end":2089},{"text":"not informative","label":"LAB_VALUE","start":2094,"end":2109},{"text":"neuronal damage","label":"SIGN_SYMPTOM","start":2171,"end":2186},{"text":"spinal cord","label":"BIOLOGICAL_STRUCTURE","start":2194,"end":2205},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2211,"end":2216},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2224,"end":2231},{"text":"cholestasis","label":"SIGN_SYMPTOM","start":2232,"end":2243},{"text":"total parenteral nutrition","label":"THERAPEUTIC_PROCEDURE","start":2261,"end":2287},{"text":"hepatocyte","label":"BIOLOGICAL_STRUCTURE","start":2289,"end":2299},{"text":"steatosis","label":"SIGN_SYMPTOM","start":2300,"end":2309},{"text":"necrosis","label":"SIGN_SYMPTOM","start":2311,"end":2319},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2324,"end":2329},{"text":"fibrosis","label":"SIGN_SYMPTOM","start":2330,"end":2338},{"text":"testicles","label":"BIOLOGICAL_STRUCTURE","start":2362,"end":2371},{"text":"undescended","label":"SIGN_SYMPTOM","start":2377,"end":2388},{"text":"visceral organs","label":"BIOLOGICAL_STRUCTURE","start":2406,"end":2421},{"text":"normal","label":"SIGN_SYMPTOM","start":2427,"end":2433},{"text":"dilation","label":"SIGN_SYMPTOM","start":2454,"end":2462},{"text":"thinning","label":"SIGN_SYMPTOM","start":2467,"end":2475},{"text":"bowel wall","label":"BIOLOGICAL_STRUCTURE","start":2483,"end":2493},{"text":"normal","label":"LAB_VALUE","start":2503,"end":2509},{"text":"histology","label":"DIAGNOSTIC_PROCEDURE","start":2510,"end":2519},{"text":"stomach","label":"BIOLOGICAL_STRUCTURE","start":2533,"end":2540},{"text":"ileum","label":"BIOLOGICAL_STRUCTURE","start":2542,"end":2547},{"text":"colon","label":"BIOLOGICAL_STRUCTURE","start":2553,"end":2558},{"text":"severe","label":"SEVERITY","start":2580,"end":2586},{"text":"mtDNA depletion","label":"SIGN_SYMPTOM","start":2587,"end":2602},{"text":"up to 94% decrease","label":"LAB_VALUE","start":2604,"end":2622},{"text":"Laser capture microdissection analysis","label":"DIAGNOSTIC_PROCEDURE","start":2684,"end":2722},{"text":"mtDNA depletion","label":"COREFERENCE","start":2742,"end":2757},{"text":"muscularis propria","label":"BIOLOGICAL_STRUCTURE","start":2778,"end":2796},{"text":"external layer","label":"DETAILED_DESCRIPTION","start":2826,"end":2840},{"text":"Ganglion cells","label":"BIOLOGICAL_STRUCTURE","start":2851,"end":2865},{"text":"myenteric plexus","label":"BIOLOGICAL_STRUCTURE","start":2875,"end":2891},{"text":"milder","label":"SEVERITY","start":2899,"end":2905},{"text":"mtDNA depletion","label":"COREFERENCE","start":2906,"end":2921},{"text":"small intestine","label":"BIOLOGICAL_STRUCTURE","start":2941,"end":2956},{"text":"mtDNA depletion","label":"SIGN_SYMPTOM","start":2980,"end":2995},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2999,"end":3004}],"tokens":["A ","newborn"," ","boy"," of ","healthy nonconsanguineous parents"," was ","delivered"," at ","37 weeks\u2019 gestation"," by ","cesarean section",".\nHis ","mother"," (","primipara",", ","32 years old",") had been ","admitted"," to our ","hospital"," ","2 weeks previously"," because of ","reduced"," ","fetal intrauterine movements"," and ","polyhydramnios",".\nThe child\u2019s ","birthweight"," was ","2,330 g"," (","<10th percentile","), ","length"," ","47 cm",", and ","head circumference"," ","33.2 cm"," (25th percentile).\nHe had ","low-set ears"," and ","bilateral clubfoot",".\n","Apgar scores"," were ","2",", ","6",", and ","7"," at ","1, 5, and 10 minutes",".\nThe child ","presented"," with ","severe"," ","hypotonia"," and ","generalized muscle weakness",", requiring ","ventilatory assistance"," and ","total parenteral nutrition",".\nWeaning failed because of inadequate pulmonary ventilation and ","respiratory acidosis",".\n","Hearing loss"," was detected by ","auditory evoked potentials",", while ","cranial"," ","MRI"," showed ","mildly enlarged"," ","ventricles"," and ","liquor spaces",".\n","Two days after birth",", the infant presented with ","severe"," ","abdominal distension"," with a ","hypoactive bowel",".\n","MRI"," revealed ","marked"," ","intestinal dilation"," without ","mechanical obstruction",".\n","Laboratory investigations"," showed ","hypoglycemia"," (","27 mg\/dL","), ","hypomagnesemia"," (","0.58 mmol\/L","), and ","hypokalemia"," (","2.4 mmol\/L",").\n","Blood lactate"," was ","normal"," (","1.3 mmol\/L",", ","normal range 0.5\u20132.2 mmol\/L",") and ","liver enzymes"," were ","unremarkable",".\nA ","skeletal muscle"," ","biopsy"," was performed and showed ","scattered",", ","hypertrophic"," ","cytochrome c oxidase"," (","COX",")-","deficient"," and ","succinate dehydrogenase","\u2013","positive"," ","muscle fibers"," (figure), suggesting a ","mitochondrial disorder",".\n","Molecular genetic studies"," revealed ","marked"," ","mtDNA depletion"," in muscle (","93% decrease"," as ","compared to age-matched controls","), while a ","screen for mtDNA rearrangements"," within individual COX-positive and ","COX-deficient fibers","4 was ","negative",".\nWe ","sequenced"," the ","entire coding region and intron-exon boundaries"," of the ","POLG1 gene",", identifying ","two"," reported ","heterozygous missense mutations"," in compound ","c.679C>T predicting p.R227W"," and ","c.2542G>A predicting p.G848S",".\n","Sequencing of parental samples"," confirmed ","recessive inheritance",".\nThe infant ","died"," at ","20 days"," of ","respiratory failure",".\nAt ","autopsy",", the ","brain"," did not show ","remarkable changes"," on ","gross examination",".\n","Histology"," was ","not informative"," due to poor preservation of tissue; there was no evidence of ","neuronal damage"," in the ","spinal cord",".\nThe ","liver"," showed ","diffuse"," ","cholestasis",", consistent with ","total parenteral nutrition","; ","hepatocyte"," ","steatosis",", ","necrosis",", or ","liver"," ","fibrosis"," were not observed.\nThe ","testicles"," were ","undescended",", while remaining ","visceral organs"," were ","normal"," except for a marked ","dilation"," and ","thinning"," of the ","bowel wall",".\nDespite ","normal"," ","histology",", analysis of ","stomach",", ","ileum",", and ","colon"," homogenates revealed ","severe"," ","mtDNA depletion"," (","up to 94% decrease","; table e-1 on the Neurology\u00ae Web site at www.neurology.org).\n","Laser capture microdissection analysis","5 revealed that the ","mtDNA depletion"," was confined to the ","muscularis propria",", being most prominent in its ","external layer"," (figure).\n","Ganglion cells"," from the ","myenteric plexus"," showed ","milder"," ","mtDNA depletion",", restricted to the ","small intestine"," (figure).\nThere was no ","mtDNA depletion"," in ","liver"," (not shown).\n"],"ner_labels":[0,5,0,65,0,34,0,13,0,19,0,75,0,71,0,34,0,34,0,13,0,48,0,19,0,42,0,69,0,69,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,69,0,69,0,24,0,42,0,42,0,42,0,22,0,13,0,63,0,69,0,69,0,75,0,75,0,26,0,69,0,24,0,12,0,24,0,42,0,12,0,12,0,19,0,63,0,69,0,69,0,24,0,63,0,69,0,69,0,24,0,69,0,42,0,69,0,42,0,69,0,42,0,24,0,42,0,42,0,22,0,24,0,42,0,12,0,24,0,22,0,22,0,24,0,24,0,42,0,24,0,42,0,12,0,26,0,24,0,63,0,69,0,42,0,22,0,24,0,12,0,42,0,24,0,22,0,12,0,42,0,69,0,69,0,69,0,24,0,69,0,56,0,19,0,26,0,24,0,12,0,69,0,24,0,24,0,42,0,69,0,12,0,12,0,22,0,69,0,75,0,12,0,69,0,69,0,12,0,69,0,12,0,69,0,12,0,69,0,69,0,69,0,12,0,42,0,24,0,12,0,12,0,12,0,63,0,69,0,42,0,24,0,18,0,12,0,22,0,12,0,12,0,63,0,18,0,12,0,69,0,12,0]}
-{"full_text":"A 46-year-old woman presented with severe acute pain in the right iliac fossa and periumbilical region.\nUltrasound and a computed tomography scan revealed a mucocele in the vermiform appendix, with a well defined lesion located at the mid zone of the appendix.\nThe patient underwent right hemicolectomy, and her postoperative clinical course was uneventful.\nGross examination of the surgical specimen showed an enlarged appendix, which was filled with thick mucinous material.\nA distinct lesion which involved the appendiceal wall, and measured 1.5 cm maximally, was identified in the mid-portion of the appendix.\nThere was no evidence of perforation, extravasation of mucin into the periappendiceal tissue, or pseudomyxoma peritonei during surgery.\nHistopathological examination showed combined GCC and MCA of the vermiform appendix (Figure \u200b1A).\nThe appendiceal lumen was dilated and lined by mucin-containing columnar epithelial cells (Figure 1B).\nThere was no significant cytologic atypia, and no mitotic figures were identified.\nFocal papillary configurations of the lining epithelium, and mild epithelial pseudostratification were present.\nIn addition, the appendiceal wall was infiltrated by glandular structures of various sizes which were arranged in nests and tubules.\nThese glandular structures comprised 2 distinct types of cells: (1) small to intermediate sized monotonous neuroendocrine cells with a small amount of finely granular eosinophilic cytoplasm, and mild cytonuclear atypia (Figure \u200b(Figure1C);1C); (2) mucin-filled intermediate sized cells (goblet cells), with peripherally located small, crescent-like hyperchromatic nuclei, and indistinct nucleoli (Figure \u200b(Figure1D).1D).\nScattered infiltrating single goblet neoplastic cells were focally present.\nAs previously described[1] the tumor nests appeared to arise from the basiglandular region of the intestinal crypts in close proximity to the MCA (Figure \u200b(Figure1E).1E).\nThere was no lymphovascular invasion, although perineural and intraneural invasion was present.\nThe tumor infiltrated the full thickness of the appendiceal wall and extended to the mesoappendix.\nTen lymph nodes were histologically identified, of which all were negative for malignancy.\nImmunohistochemically (Table \u200b1), the tumor cells of the GCC were positive for chromogranin, synaptophysin, and serotonin, which are neuroendocrine markers.\nDiffuse staining for cytokeratin (CK) 20 (Figure \u200b2), CK19, and CD99 was also present.\nThe Ki67 proliferating index revealed nuclear staining in approximately 15% of the tumor cells.\nThere was no staining for CK7.\n","ner_info":[{"text":"46-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"severe","label":"SEVERITY","start":35,"end":41},{"text":"acute","label":"DETAILED_DESCRIPTION","start":42,"end":47},{"text":"pain","label":"SIGN_SYMPTOM","start":48,"end":52},{"text":"right iliac fossa","label":"BIOLOGICAL_STRUCTURE","start":60,"end":77},{"text":"periumbilical region","label":"BIOLOGICAL_STRUCTURE","start":82,"end":102},{"text":"Ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":104,"end":114},{"text":"computed tomography scan","label":"DIAGNOSTIC_PROCEDURE","start":121,"end":145},{"text":"mucocele","label":"SIGN_SYMPTOM","start":157,"end":165},{"text":"vermiform appendix","label":"BIOLOGICAL_STRUCTURE","start":173,"end":191},{"text":"well defined","label":"DETAILED_DESCRIPTION","start":200,"end":212},{"text":"lesion","label":"SIGN_SYMPTOM","start":213,"end":219},{"text":"mid zone of the appendix","label":"BIOLOGICAL_STRUCTURE","start":235,"end":259},{"text":"right hemicolectomy","label":"THERAPEUTIC_PROCEDURE","start":283,"end":302},{"text":"postoperative clinical course","label":"DIAGNOSTIC_PROCEDURE","start":312,"end":341},{"text":"uneventful","label":"LAB_VALUE","start":346,"end":356},{"text":"Gross examination","label":"DIAGNOSTIC_PROCEDURE","start":358,"end":375},{"text":"surgical specimen","label":"BIOLOGICAL_STRUCTURE","start":383,"end":400},{"text":"enlarged","label":"LAB_VALUE","start":411,"end":419},{"text":"appendix","label":"BIOLOGICAL_STRUCTURE","start":420,"end":428},{"text":"thick","label":"TEXTURE","start":452,"end":457},{"text":"mucinous material","label":"SIGN_SYMPTOM","start":458,"end":475},{"text":"distinct","label":"DETAILED_DESCRIPTION","start":479,"end":487},{"text":"lesion","label":"COREFERENCE","start":488,"end":494},{"text":"appendiceal wall","label":"BIOLOGICAL_STRUCTURE","start":514,"end":530},{"text":"1.5 cm","label":"DISTANCE","start":545,"end":551},{"text":"mid-portion of the appendix","label":"BIOLOGICAL_STRUCTURE","start":585,"end":612},{"text":"perforation","label":"SIGN_SYMPTOM","start":639,"end":650},{"text":"extravasation","label":"SIGN_SYMPTOM","start":652,"end":665},{"text":"mucin","label":"BIOLOGICAL_STRUCTURE","start":669,"end":674},{"text":"periappendiceal tissue","label":"BIOLOGICAL_STRUCTURE","start":684,"end":706},{"text":"pseudomyxoma peritonei","label":"DISEASE_DISORDER","start":711,"end":733},{"text":"Histopathological examination","label":"DIAGNOSTIC_PROCEDURE","start":750,"end":779},{"text":"GCC","label":"DISEASE_DISORDER","start":796,"end":799},{"text":"MCA","label":"DISEASE_DISORDER","start":804,"end":807},{"text":"vermiform appendix","label":"BIOLOGICAL_STRUCTURE","start":815,"end":833},{"text":"appendiceal lumen","label":"BIOLOGICAL_STRUCTURE","start":852,"end":869},{"text":"dilated","label":"SIGN_SYMPTOM","start":874,"end":881},{"text":"mucin-containing","label":"SIGN_SYMPTOM","start":895,"end":911},{"text":"columnar epithelial cells","label":"BIOLOGICAL_STRUCTURE","start":912,"end":937},{"text":"cytologic atypia","label":"SIGN_SYMPTOM","start":976,"end":992},{"text":"mitotic figures","label":"SIGN_SYMPTOM","start":1001,"end":1016},{"text":"Focal papillary configurations","label":"SIGN_SYMPTOM","start":1034,"end":1064},{"text":"lining epithelium","label":"BIOLOGICAL_STRUCTURE","start":1072,"end":1089},{"text":"mild","label":"SEVERITY","start":1095,"end":1099},{"text":"epithelial pseudostratification","label":"SIGN_SYMPTOM","start":1100,"end":1131},{"text":"appendiceal wall","label":"BIOLOGICAL_STRUCTURE","start":1163,"end":1179},{"text":"glandular structures","label":"SIGN_SYMPTOM","start":1199,"end":1219},{"text":"various sizes","label":"AREA","start":1223,"end":1236},{"text":"nests","label":"SHAPE","start":1260,"end":1265},{"text":"tubules","label":"SHAPE","start":1270,"end":1277},{"text":"glandular structures","label":"COREFERENCE","start":1285,"end":1305},{"text":"small to intermediate sized","label":"AREA","start":1347,"end":1374},{"text":"monotonous","label":"DETAILED_DESCRIPTION","start":1375,"end":1385},{"text":"neuroendocrine cells","label":"BIOLOGICAL_STRUCTURE","start":1386,"end":1406},{"text":"small amount of finely granular eosinophilic cytoplasm","label":"DETAILED_DESCRIPTION","start":1414,"end":1468},{"text":"mild","label":"SEVERITY","start":1474,"end":1478},{"text":"cytonuclear atypia","label":"SIGN_SYMPTOM","start":1479,"end":1497},{"text":"mucin-filled","label":"DETAILED_DESCRIPTION","start":1527,"end":1539},{"text":"intermediate sized","label":"AREA","start":1540,"end":1558},{"text":"goblet cells","label":"BIOLOGICAL_STRUCTURE","start":1566,"end":1578},{"text":"peripherally located","label":"DETAILED_DESCRIPTION","start":1586,"end":1606},{"text":"small","label":"AREA","start":1607,"end":1612},{"text":"crescent-like","label":"SHAPE","start":1614,"end":1627},{"text":"hyperchromatic nuclei","label":"SIGN_SYMPTOM","start":1628,"end":1649},{"text":"indistinct","label":"DETAILED_DESCRIPTION","start":1655,"end":1665},{"text":"nucleoli","label":"BIOLOGICAL_STRUCTURE","start":1666,"end":1674},{"text":"Scattered","label":"TEXTURE","start":1700,"end":1709},{"text":"infiltrating","label":"DETAILED_DESCRIPTION","start":1710,"end":1722},{"text":"single","label":"DETAILED_DESCRIPTION","start":1723,"end":1729},{"text":"goblet neoplastic cells","label":"BIOLOGICAL_STRUCTURE","start":1730,"end":1753},{"text":"focally present","label":"SIGN_SYMPTOM","start":1759,"end":1774},{"text":"tumor nests","label":"SIGN_SYMPTOM","start":1807,"end":1818},{"text":"basiglandular region","label":"BIOLOGICAL_STRUCTURE","start":1846,"end":1866},{"text":"intestinal crypts","label":"BIOLOGICAL_STRUCTURE","start":1874,"end":1891},{"text":"close proximity to the","label":"DETAILED_DESCRIPTION","start":1895,"end":1917},{"text":"MCA","label":"DISEASE_DISORDER","start":1918,"end":1921},{"text":"lymphovascular","label":"DETAILED_DESCRIPTION","start":1960,"end":1974},{"text":"invasion","label":"SIGN_SYMPTOM","start":1975,"end":1983},{"text":"perineural","label":"DETAILED_DESCRIPTION","start":1994,"end":2004},{"text":"intraneural","label":"DETAILED_DESCRIPTION","start":2009,"end":2020},{"text":"invasion","label":"SIGN_SYMPTOM","start":2021,"end":2029},{"text":"tumor","label":"COREFERENCE","start":2047,"end":2052},{"text":"full thickness","label":"BIOLOGICAL_STRUCTURE","start":2069,"end":2083},{"text":"appendiceal wall","label":"BIOLOGICAL_STRUCTURE","start":2091,"end":2107},{"text":"mesoappendix","label":"BIOLOGICAL_STRUCTURE","start":2128,"end":2140},{"text":"Ten","label":"QUANTITATIVE_CONCEPT","start":2142,"end":2145},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":2146,"end":2157},{"text":"histologically identified","label":"DIAGNOSTIC_PROCEDURE","start":2163,"end":2188},{"text":"malignancy","label":"DISEASE_DISORDER","start":2221,"end":2231},{"text":"Immunohistochemically","label":"DIAGNOSTIC_PROCEDURE","start":2233,"end":2254},{"text":"tumor cells","label":"SIGN_SYMPTOM","start":2271,"end":2282},{"text":"GCC","label":"DISEASE_DISORDER","start":2290,"end":2293},{"text":"positive","label":"LAB_VALUE","start":2299,"end":2307},{"text":"chromogranin","label":"DIAGNOSTIC_PROCEDURE","start":2312,"end":2324},{"text":"synaptophysin","label":"DIAGNOSTIC_PROCEDURE","start":2326,"end":2339},{"text":"serotonin","label":"DIAGNOSTIC_PROCEDURE","start":2345,"end":2354},{"text":"neuroendocrine markers","label":"DETAILED_DESCRIPTION","start":2366,"end":2388},{"text":"Diffuse staining","label":"LAB_VALUE","start":2390,"end":2406},{"text":"cytokeratin","label":"DIAGNOSTIC_PROCEDURE","start":2411,"end":2422},{"text":"CK19,","label":"DIAGNOSTIC_PROCEDURE","start":2444,"end":2449},{"text":"CD99","label":"DIAGNOSTIC_PROCEDURE","start":2454,"end":2458},{"text":"Ki67 proliferating index","label":"DIAGNOSTIC_PROCEDURE","start":2481,"end":2505},{"text":"nuclear staining","label":"SIGN_SYMPTOM","start":2515,"end":2531},{"text":"15%","label":"LAB_VALUE","start":2549,"end":2552},{"text":"tumor cells","label":"SIGN_SYMPTOM","start":2560,"end":2571},{"text":"no staining","label":"LAB_VALUE","start":2583,"end":2594},{"text":"CK7.","label":"DIAGNOSTIC_PROCEDURE","start":2599,"end":2603}],"tokens":["A ","46-year-old"," ","woman"," ","presented"," with ","severe"," ","acute"," ","pain"," in the ","right iliac fossa"," and ","periumbilical region",".\n","Ultrasound"," and a ","computed tomography scan"," revealed a ","mucocele"," in the ","vermiform appendix",", with a ","well defined"," ","lesion"," located at the ","mid zone of the appendix",".\nThe patient underwent ","right hemicolectomy",", and her ","postoperative clinical course"," was ","uneventful",".\n","Gross examination"," of the ","surgical specimen"," showed an ","enlarged"," ","appendix",", which was filled with ","thick"," ","mucinous material",".\nA ","distinct"," ","lesion"," which involved the ","appendiceal wall",", and measured ","1.5 cm"," maximally, was identified in the ","mid-portion of the appendix",".\nThere was no evidence of ","perforation",", ","extravasation"," of ","mucin"," into the ","periappendiceal tissue",", or ","pseudomyxoma peritonei"," during surgery.\n","Histopathological examination"," showed combined ","GCC"," and ","MCA"," of the ","vermiform appendix"," (Figure \u200b1A).\nThe ","appendiceal lumen"," was ","dilated"," and lined by ","mucin-containing"," ","columnar epithelial cells"," (Figure 1B).\nThere was no significant ","cytologic atypia",", and no ","mitotic figures"," were identified.\n","Focal papillary configurations"," of the ","lining epithelium",", and ","mild"," ","epithelial pseudostratification"," were present.\nIn addition, the ","appendiceal wall"," was infiltrated by ","glandular structures"," of ","various sizes"," which were arranged in ","nests"," and ","tubules",".\nThese ","glandular structures"," comprised 2 distinct types of cells: (1) ","small to intermediate sized"," ","monotonous"," ","neuroendocrine cells"," with a ","small amount of finely granular eosinophilic cytoplasm",", and ","mild"," ","cytonuclear atypia"," (Figure \u200b(Figure1C);1C); (2) ","mucin-filled"," ","intermediate sized"," cells (","goblet cells","), with ","peripherally located"," ","small",", ","crescent-like"," ","hyperchromatic nuclei",", and ","indistinct"," ","nucleoli"," (Figure \u200b(Figure1D).1D).\n","Scattered"," ","infiltrating"," ","single"," ","goblet neoplastic cells"," were ","focally present",".\nAs previously described[1] the ","tumor nests"," appeared to arise from the ","basiglandular region"," of the ","intestinal crypts"," in ","close proximity to the"," ","MCA"," (Figure \u200b(Figure1E).1E).\nThere was no ","lymphovascular"," ","invasion",", although ","perineural"," and ","intraneural"," ","invasion"," was present.\nThe ","tumor"," infiltrated the ","full thickness"," of the ","appendiceal wall"," and extended to the ","mesoappendix",".\n","Ten"," ","lymph nodes"," were ","histologically identified",", of which all were negative for ","malignancy",".\n","Immunohistochemically"," (Table \u200b1), the ","tumor cells"," of the ","GCC"," were ","positive"," for ","chromogranin",", ","synaptophysin",", and ","serotonin",", which are ","neuroendocrine markers",".\n","Diffuse staining"," for ","cytokeratin"," (CK) 20 (Figure \u200b2), ","CK19,"," and ","CD99"," was also present.\nThe ","Ki67 proliferating index"," revealed ","nuclear staining"," in approximately ","15%"," of the ","tumor cells",".\nThere was ","no staining"," for ","CK7.","\n"],"ner_labels":[0,5,0,65,0,13,0,63,0,22,0,69,0,12,0,12,0,24,0,24,0,69,0,12,0,22,0,69,0,12,0,75,0,24,0,42,0,24,0,12,0,42,0,12,0,73,0,69,0,22,0,18,0,12,0,27,0,12,0,69,0,69,0,12,0,12,0,26,0,24,0,26,0,26,0,12,0,12,0,69,0,69,0,12,0,69,0,69,0,69,0,12,0,63,0,69,0,12,0,69,0,8,0,67,0,67,0,18,0,8,0,22,0,12,0,22,0,63,0,69,0,22,0,8,0,12,0,22,0,8,0,67,0,69,0,22,0,12,0,73,0,22,0,22,0,12,0,69,0,69,0,12,0,12,0,22,0,26,0,22,0,69,0,22,0,22,0,69,0,18,0,12,0,12,0,12,0,62,0,12,0,24,0,26,0,24,0,69,0,26,0,42,0,24,0,24,0,24,0,22,0,42,0,24,0,24,0,24,0,24,0,69,0,42,0,69,0,42,0,24,0]}
-{"full_text":"A 60-year-old man who underwent colonoscopy was found to have a 2 cm sessile polyp that was located 10 cm from the anal verge and successfully removed.\nThe polyp was a tubulovillous adenoma with focal high-grade dysplasia.\nA flexible sigmoidoscopy performed three months later, as well as a repeat colonoscopy one year after the initial colonoscopy, were both negative for recurrence.\nA colonoscopy performed three years after the initial colonoscopy revealed a sessile polyp, 3 cm in size, at 10 cm from the anal verge.\nBiopsies were taken and reported to be fragments of a villous adenoma with low-grade dysplasia.\nDue to the previous high-grade dysplasia, relatively rapid recurrence and concern that a cancer may have been missed by sampling error, a pelvic magnetic resonance imaging (MRI) scan and an endoscopic ultrasound (EUS) were performed before definitive excision.\nThe MRI revealed an invasive rectal mass involving the muscularis propria but without breach of the adventitia, consistent with a T2 rectal carcinoma (Figure 1).\nNo pelvic lymphadenopathy was detected.\nThe EUS revealed a rectal mass involving the mucosa and submucosa, with no involvement of the muscularis propria (Figure 2).\nThe results of the MRI and EUS, as well as the surgical versus endoscopic resection treatment options, were discussed with the patient, who opted for a surgical resection.\nThe patient underwent a low anterior resection and end-to-end anastomosis with loop ileostomy.\nPathology review of the resected rectosigmoid revealed a villous adenoma with low-grade dyplasia.\nThere was no evidence of muscularis propria invasion, and a total of five pericolic and two mesorectal lymph nodes were excised and deemed benign.\nThe patient underwent ileostomy reversal five months later.\nHe remains asymptomatic with no recurrence of tumours.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":32,"end":43},{"text":"2 cm","label":"DISTANCE","start":64,"end":68},{"text":"sessile polyp","label":"SIGN_SYMPTOM","start":69,"end":82},{"text":"10 cm","label":"DISTANCE","start":100,"end":105},{"text":"anal verge","label":"BIOLOGICAL_STRUCTURE","start":115,"end":125},{"text":"successfully removed","label":"THERAPEUTIC_PROCEDURE","start":130,"end":150},{"text":"polyp","label":"COREFERENCE","start":156,"end":161},{"text":"tubulovillous adenoma","label":"DISEASE_DISORDER","start":168,"end":189},{"text":"high-grade dysplasia","label":"SIGN_SYMPTOM","start":201,"end":221},{"text":"flexible sigmoidoscopy","label":"DIAGNOSTIC_PROCEDURE","start":225,"end":247},{"text":"three months later","label":"DATE","start":258,"end":276},{"text":"repeat","label":"DETAILED_DESCRIPTION","start":291,"end":297},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":298,"end":309},{"text":"one year after the initial colonoscopy","label":"DATE","start":310,"end":348},{"text":"negative","label":"LAB_VALUE","start":360,"end":368},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":387,"end":398},{"text":"three years after the initial colonoscopy","label":"DATE","start":409,"end":450},{"text":"sessile polyp","label":"SIGN_SYMPTOM","start":462,"end":475},{"text":"3 cm","label":"DISTANCE","start":477,"end":481},{"text":"10 cm","label":"DISTANCE","start":494,"end":499},{"text":"anal verge","label":"BIOLOGICAL_STRUCTURE","start":509,"end":519},{"text":"Biopsies","label":"DIAGNOSTIC_PROCEDURE","start":521,"end":529},{"text":"villous adenoma","label":"DISEASE_DISORDER","start":575,"end":590},{"text":"low-grade dysplasia","label":"SIGN_SYMPTOM","start":596,"end":615},{"text":"high-grade","label":"SEVERITY","start":637,"end":647},{"text":"dysplasia","label":"SIGN_SYMPTOM","start":648,"end":657},{"text":"relatively rapid","label":"SEVERITY","start":659,"end":675},{"text":"recurrence","label":"SIGN_SYMPTOM","start":676,"end":686},{"text":"cancer","label":"DISEASE_DISORDER","start":706,"end":712},{"text":"pelvic","label":"BIOLOGICAL_STRUCTURE","start":755,"end":761},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":762,"end":788},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":790,"end":793},{"text":"endoscopic ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":807,"end":828},{"text":"EUS","label":"DIAGNOSTIC_PROCEDURE","start":830,"end":833},{"text":"MRI","label":"COREFERENCE","start":882,"end":885},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":898,"end":906},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":907,"end":913},{"text":"mass","label":"SIGN_SYMPTOM","start":914,"end":918},{"text":"muscularis propria","label":"BIOLOGICAL_STRUCTURE","start":933,"end":951},{"text":"breach","label":"SIGN_SYMPTOM","start":964,"end":970},{"text":"adventitia","label":"BIOLOGICAL_STRUCTURE","start":978,"end":988},{"text":"T2","label":"DETAILED_DESCRIPTION","start":1008,"end":1010},{"text":"rectal carcinoma","label":"DISEASE_DISORDER","start":1011,"end":1027},{"text":"pelvic","label":"BIOLOGICAL_STRUCTURE","start":1043,"end":1049},{"text":"lymphadenopathy","label":"SIGN_SYMPTOM","start":1050,"end":1065},{"text":"EUS","label":"COREFERENCE","start":1084,"end":1087},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":1099,"end":1105},{"text":"mass","label":"SIGN_SYMPTOM","start":1106,"end":1110},{"text":"mucosa","label":"BIOLOGICAL_STRUCTURE","start":1125,"end":1131},{"text":"submucosa","label":"BIOLOGICAL_STRUCTURE","start":1136,"end":1145},{"text":"involvement","label":"SIGN_SYMPTOM","start":1155,"end":1166},{"text":"muscularis propria","label":"BIOLOGICAL_STRUCTURE","start":1174,"end":1192},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1224,"end":1227},{"text":"EUS","label":"DIAGNOSTIC_PROCEDURE","start":1232,"end":1235},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":1357,"end":1375},{"text":"low anterior resection","label":"THERAPEUTIC_PROCEDURE","start":1401,"end":1423},{"text":"end-to-end anastomosis","label":"THERAPEUTIC_PROCEDURE","start":1428,"end":1450},{"text":"loop ileostomy","label":"THERAPEUTIC_PROCEDURE","start":1456,"end":1470},{"text":"Pathology review","label":"DIAGNOSTIC_PROCEDURE","start":1472,"end":1488},{"text":"resected rectosigmoid","label":"BIOLOGICAL_STRUCTURE","start":1496,"end":1517},{"text":"villous adenoma","label":"DISEASE_DISORDER","start":1529,"end":1544},{"text":"low-grade dyplasia","label":"SIGN_SYMPTOM","start":1550,"end":1568},{"text":"muscularis propria","label":"BIOLOGICAL_STRUCTURE","start":1595,"end":1613},{"text":"invasion","label":"SIGN_SYMPTOM","start":1614,"end":1622},{"text":"five pericolic and two mesorectal","label":"DETAILED_DESCRIPTION","start":1639,"end":1672},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1673,"end":1684},{"text":"excised","label":"THERAPEUTIC_PROCEDURE","start":1690,"end":1697},{"text":"benign","label":"SIGN_SYMPTOM","start":1709,"end":1715},{"text":"ileostomy reversal","label":"THERAPEUTIC_PROCEDURE","start":1739,"end":1757},{"text":"five months later","label":"DATE","start":1758,"end":1775},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":1788,"end":1800},{"text":"recurrence of tumours","label":"SIGN_SYMPTOM","start":1809,"end":1830}],"tokens":["A ","60-year-old"," ","man"," who underwent ","colonoscopy"," was found to have a ","2 cm"," ","sessile polyp"," that was located ","10 cm"," from the ","anal verge"," and ","successfully removed",".\nThe ","polyp"," was a ","tubulovillous adenoma"," with focal ","high-grade dysplasia",".\nA ","flexible sigmoidoscopy"," performed ","three months later",", as well as a ","repeat"," ","colonoscopy"," ","one year after the initial colonoscopy",", were both ","negative"," for recurrence.\nA ","colonoscopy"," performed ","three years after the initial colonoscopy"," revealed a ","sessile polyp",", ","3 cm"," in size, at ","10 cm"," from the ","anal verge",".\n","Biopsies"," were taken and reported to be fragments of a ","villous adenoma"," with ","low-grade dysplasia",".\nDue to the previous ","high-grade"," ","dysplasia",", ","relatively rapid"," ","recurrence"," and concern that a ","cancer"," may have been missed by sampling error, a ","pelvic"," ","magnetic resonance imaging"," (","MRI",") scan and an ","endoscopic ultrasound"," (","EUS",") were performed before definitive excision.\nThe ","MRI"," revealed an ","invasive"," ","rectal"," ","mass"," involving the ","muscularis propria"," but without ","breach"," of the ","adventitia",", consistent with a ","T2"," ","rectal carcinoma"," (Figure 1).\nNo ","pelvic"," ","lymphadenopathy"," was detected.\nThe ","EUS"," revealed a ","rectal"," ","mass"," involving the ","mucosa"," and ","submucosa",", with no ","involvement"," of the ","muscularis propria"," (Figure 2).\nThe results of the ","MRI"," and ","EUS",", as well as the surgical versus endoscopic resection treatment options, were discussed with the patient, who opted for a ","surgical resection",".\nThe patient underwent a ","low anterior resection"," and ","end-to-end anastomosis"," with ","loop ileostomy",".\n","Pathology review"," of the ","resected rectosigmoid"," revealed a ","villous adenoma"," with ","low-grade dyplasia",".\nThere was no evidence of ","muscularis propria"," ","invasion",", and a total of ","five pericolic and two mesorectal"," ","lymph nodes"," were ","excised"," and deemed ","benign",".\nThe patient underwent ","ileostomy reversal"," ","five months later",".\nHe remains ","asymptomatic"," with no ","recurrence of tumours",".\n"],"ner_labels":[0,5,0,65,0,24,0,27,0,69,0,27,0,12,0,75,0,18,0,26,0,69,0,24,0,19,0,22,0,24,0,19,0,42,0,24,0,19,0,69,0,27,0,27,0,12,0,24,0,26,0,69,0,63,0,69,0,63,0,69,0,26,0,12,0,24,0,24,0,24,0,24,0,18,0,22,0,12,0,69,0,12,0,69,0,12,0,22,0,26,0,12,0,69,0,18,0,12,0,69,0,12,0,12,0,69,0,12,0,24,0,24,0,75,0,75,0,75,0,75,0,24,0,12,0,26,0,69,0,12,0,69,0,22,0,12,0,75,0,69,0,75,0,19,0,69,0,69,0]}
-{"full_text":"A 72-year-old woman underwent RF ablation for the treatment of a metachronous solitary liver metastasis from rectal adenocarcinoma, which had been treated 18 mo before with preoperative chemoradiotherapy and anterior resection.\nThe lesion was located in segment VIII.\nThe procedure went well and the patient was initially haemodynamically stable.\nOne hour later her condition suddenly worsened.\nShe was clinically dizzy and had fatigue and pallor.\nWe detected hypotension and tachycardia.\nEmergency blood tests showed a haemoglobin level of < 7 g\/dL and markedly elevated transaminase levels.\nA computed tomography examination revealed an accumulation of intraperitoneal fluid in the pelvis and two liver haematomas.\nThe images showed two liver lacerations, one following the path of the needle (Figure \u200b(Figure1A1A-\u200b-C)C) and another, unexplained laceration leading away from the first (Figure \u200b(Figure2).2).\nThe patient had no serious coughing or hiccupping after the RF treatment, or any other complications that might have caused increased abdominal pressure and tumour rupture.\nSubsequently, the patient received a blood transfusion and close monitoring.\nShe was haemodynamically stable after the second blood transfusion and completely recovered 24 h later.\nThe patient remained in bed for 1 wk.\nNo surgical intervention was required.\n","ner_info":[{"text":"72-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"RF ablation","label":"THERAPEUTIC_PROCEDURE","start":30,"end":41},{"text":"metachronous","label":"DETAILED_DESCRIPTION","start":65,"end":77},{"text":"solitary","label":"DETAILED_DESCRIPTION","start":78,"end":86},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":87,"end":92},{"text":"metastasis","label":"DISEASE_DISORDER","start":93,"end":103},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":109,"end":115},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":116,"end":130},{"text":"treated","label":"CLINICAL_EVENT","start":147,"end":154},{"text":"18 mo before","label":"DATE","start":155,"end":167},{"text":"preoperative","label":"DETAILED_DESCRIPTION","start":173,"end":185},{"text":"chemoradiotherapy","label":"MEDICATION","start":186,"end":203},{"text":"anterior resection","label":"THERAPEUTIC_PROCEDURE","start":208,"end":226},{"text":"lesion","label":"COREFERENCE","start":232,"end":238},{"text":"segment VIII","label":"BIOLOGICAL_STRUCTURE","start":254,"end":266},{"text":"procedure","label":"COREFERENCE","start":272,"end":281},{"text":"well","label":"LAB_VALUE","start":287,"end":291},{"text":"haemodynamically","label":"DIAGNOSTIC_PROCEDURE","start":322,"end":338},{"text":"stable","label":"LAB_VALUE","start":339,"end":345},{"text":"One hour later","label":"TIME","start":347,"end":361},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":366,"end":375},{"text":"suddenly worsened","label":"SEVERITY","start":376,"end":393},{"text":"dizzy","label":"SIGN_SYMPTOM","start":414,"end":419},{"text":"fatigue","label":"SIGN_SYMPTOM","start":428,"end":435},{"text":"pallor","label":"SIGN_SYMPTOM","start":440,"end":446},{"text":"hypotension","label":"SIGN_SYMPTOM","start":460,"end":471},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":476,"end":487},{"text":"blood tests","label":"DIAGNOSTIC_PROCEDURE","start":499,"end":510},{"text":"haemoglobin level","label":"DIAGNOSTIC_PROCEDURE","start":520,"end":537},{"text":"< 7 g\/dL","label":"LAB_VALUE","start":541,"end":549},{"text":"elevated","label":"LAB_VALUE","start":563,"end":571},{"text":"transaminase levels","label":"DIAGNOSTIC_PROCEDURE","start":572,"end":591},{"text":"computed tomography examination","label":"DIAGNOSTIC_PROCEDURE","start":595,"end":626},{"text":"intraperitoneal fluid","label":"BIOLOGICAL_STRUCTURE","start":655,"end":676},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":684,"end":690},{"text":"two","label":"LAB_VALUE","start":695,"end":698},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":699,"end":704},{"text":"haematomas","label":"DISEASE_DISORDER","start":705,"end":715},{"text":"images","label":"COREFERENCE","start":721,"end":727},{"text":"two","label":"LAB_VALUE","start":735,"end":738},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":739,"end":744},{"text":"lacerations","label":"SIGN_SYMPTOM","start":745,"end":756},{"text":"one following the path of the needle","label":"DETAILED_DESCRIPTION","start":758,"end":794},{"text":"unexplained laceration leading away from the first","label":"DETAILED_DESCRIPTION","start":836,"end":886},{"text":"coughing","label":"SIGN_SYMPTOM","start":937,"end":945},{"text":"hiccupping","label":"SIGN_SYMPTOM","start":949,"end":959},{"text":"RF treatment","label":"COREFERENCE","start":970,"end":982},{"text":"blood transfusion","label":"THERAPEUTIC_PROCEDURE","start":1120,"end":1137},{"text":"close monitoring","label":"DIAGNOSTIC_PROCEDURE","start":1142,"end":1158},{"text":"haemodynamically","label":"DIAGNOSTIC_PROCEDURE","start":1168,"end":1184},{"text":"stable","label":"LAB_VALUE","start":1185,"end":1191},{"text":"second","label":"LAB_VALUE","start":1202,"end":1208},{"text":"blood transfusion","label":"THERAPEUTIC_PROCEDURE","start":1209,"end":1226},{"text":"completely recovered","label":"SIGN_SYMPTOM","start":1231,"end":1251},{"text":"24 h later","label":"TIME","start":1252,"end":1262},{"text":"remained in bed","label":"ACTIVITY","start":1276,"end":1291},{"text":"1 wk","label":"DURATION","start":1296,"end":1300},{"text":"surgical intervention","label":"THERAPEUTIC_PROCEDURE","start":1305,"end":1326}],"tokens":["A ","72-year-old"," ","woman"," underwent ","RF ablation"," for the treatment of a ","metachronous"," ","solitary"," ","liver"," ","metastasis"," from ","rectal"," ","adenocarcinoma",", which had been ","treated"," ","18 mo before"," with ","preoperative"," ","chemoradiotherapy"," and ","anterior resection",".\nThe ","lesion"," was located in ","segment VIII",".\nThe ","procedure"," went ","well"," and the patient was initially ","haemodynamically"," ","stable",".\n","One hour later"," her ","condition"," ","suddenly worsened",".\nShe was clinically ","dizzy"," and had ","fatigue"," and ","pallor",".\nWe detected ","hypotension"," and ","tachycardia",".\nEmergency ","blood tests"," showed a ","haemoglobin level"," of ","< 7 g\/dL"," and markedly ","elevated"," ","transaminase levels",".\nA ","computed tomography examination"," revealed an accumulation of ","intraperitoneal fluid"," in the ","pelvis"," and ","two"," ","liver"," ","haematomas",".\nThe ","images"," showed ","two"," ","liver"," ","lacerations",", ","one following the path of the needle"," (Figure \u200b(Figure1A1A-\u200b-C)C) and another, ","unexplained laceration leading away from the first"," (Figure \u200b(Figure2).2).\nThe patient had no serious ","coughing"," or ","hiccupping"," after the ","RF treatment",", or any other complications that might have caused increased abdominal pressure and tumour rupture.\nSubsequently, the patient received a ","blood transfusion"," and ","close monitoring",".\nShe was ","haemodynamically"," ","stable"," after the ","second"," ","blood transfusion"," and ","completely recovered"," ","24 h later",".\nThe patient ","remained in bed"," for ","1 wk",".\nNo ","surgical intervention"," was required.\n"],"ner_labels":[0,5,0,65,0,75,0,22,0,22,0,12,0,26,0,12,0,26,0,13,0,19,0,22,0,46,0,75,0,18,0,12,0,18,0,42,0,24,0,42,0,78,0,24,0,63,0,69,0,69,0,69,0,69,0,69,0,24,0,24,0,42,0,42,0,24,0,24,0,12,0,12,0,42,0,12,0,26,0,18,0,42,0,12,0,69,0,22,0,22,0,69,0,69,0,18,0,75,0,24,0,24,0,42,0,42,0,75,0,69,0,78,0,1,0,32,0,75,0]}
-{"full_text":"A 70-year-old man was referred to our hospital for gastric cancer that was detected during screening by esophagogastroduodenoscopy (EGD).\nNo significant medical history was identified, except dysuria caused by bladder contraction.\nInitial laboratory data showed a serum level of AFP of 32.3 ng\/mL (normal range: 0-15 ng\/mL), but no other abnormality, which included other tumor markers, such as, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9).\nEGD revealed a 5-cm ulcerofungating mass that was comprised of three septate ulcers in the greater curvature of the gastric antrum.\nA pathological examination of endoscopic biopsy tissues confirmed the presence of moderately differentiated tubular adenocarcinoma.\nSubsequent abdominopelvic computed tomography visualized a gastric mass with deep ulceration in the gastric antrum with perigastric lymph node enlargement.\nNo metastatic lesions were observed in the liver, lung or peritoneum, and chest radiography showed no significant findings.\nRadical subtotal gastrectomy with D2 lymph node dissection and Billroth II gastrojejunostomy were performed.\nGrossly, the resected specimen contained double lesions: the first was a 5.8 cm \u00d7 3.2 cm ulcerofungating mass in the antrum, with extensive hemorrhage and light gray fibrosis; and the second was a nearby 2.5 cm \u00d7 2.0 cm ulcerative lesion (Figure \u200b1).\nMicroscopically, massive numbers of pleomorphic, bizarre tumor cells with hemorrhage (syncytiotrophoblasts and cytotrophoblasts) were observed in the first lesion.\nHematoxylin and eosin (HE)-stained tissues revealed a bubbly purple cytoplasm and giant nuclei at a magnification of 40 \u00d7 (Figure \u200b2A) and 100 \u00d7 (Figure \u200b2B).\nThe tumor involved the proper muscle layer (T2a) and metastasis was found in four of 56 regional lymph nodes (N1).\nImmunohistochemical staining showed positive immunoreactivity for \u03b2-human chorionic gonadotropin (HCG) (Figure \u200b3A) and focal positivity for AFP (Figure \u200b3B).\nThese findings confirmed the presence of gastric choriocarcinoma that contained small foci of an AFP-producing adenocarcinoma.\nThe second lesion was moderately differentiated tubular adenocarcinoma, which extended to the submucosal layer (T1b).\nIt was close to, but distinct from the first lesion, which was negative by immunohistochemical staining for \u03b2-HCG and AFP.\nThe patient had an uneventful postoperative course and was discharged on postoperative day 9.\nTwo weeks later, his HCG level was 176 mIU\/mL (normal range: 0-10 mIU\/mL) and his AFP level was 10.0 ng\/mL.\nSix cycles of adjuvant chemotherapy with capecitabine (Xeloda; Hoffmann-La Roche Inc., Nutley, NJ, USA) was started at 2500 mg\/m2 per day for 14 d\/cycle.\nAfter two cycles, his \u03b2-HCG level had declined to < 3 mIU\/mL, and has since remained at this level.\nNo recurrence or distant metastasis had occurred at his 4-year postoperative follow-up.\n","ner_info":[{"text":"70-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":38,"end":46},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":51,"end":58},{"text":"cancer","label":"DISEASE_DISORDER","start":59,"end":65},{"text":"esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":104,"end":130},{"text":"(EGD)","label":"DIAGNOSTIC_PROCEDURE","start":131,"end":136},{"text":"No significant medical history","label":"HISTORY","start":138,"end":168},{"text":"dysuria","label":"SIGN_SYMPTOM","start":192,"end":199},{"text":"caused by bladder contraction","label":"DETAILED_DESCRIPTION","start":200,"end":229},{"text":"laboratory","label":"DIAGNOSTIC_PROCEDURE","start":239,"end":249},{"text":"serum level of AFP","label":"DIAGNOSTIC_PROCEDURE","start":264,"end":282},{"text":"32.3 ng\/mL","label":"LAB_VALUE","start":286,"end":296},{"text":"no other abnormality","label":"LAB_VALUE","start":329,"end":349},{"text":"carcinoembryonic antigen","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":420},{"text":"(CEA)","label":"DIAGNOSTIC_PROCEDURE","start":421,"end":426},{"text":"carbohydrate antigen 19-9","label":"DIAGNOSTIC_PROCEDURE","start":431,"end":456},{"text":"(CA19-9)","label":"DIAGNOSTIC_PROCEDURE","start":457,"end":465},{"text":"EGD","label":"COREFERENCE","start":467,"end":470},{"text":"5-cm","label":"DISTANCE","start":482,"end":486},{"text":"ulcerofungating","label":"DETAILED_DESCRIPTION","start":487,"end":502},{"text":"mass","label":"SIGN_SYMPTOM","start":503,"end":507},{"text":"comprised of three septate ulcers","label":"DETAILED_DESCRIPTION","start":517,"end":550},{"text":"in the greater curvature of the gastric antrum","label":"BIOLOGICAL_STRUCTURE","start":551,"end":597},{"text":"pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":601,"end":625},{"text":"endoscopic biopsy tissues","label":"BIOLOGICAL_STRUCTURE","start":629,"end":654},{"text":"moderately differentiated","label":"DETAILED_DESCRIPTION","start":681,"end":706},{"text":"tubular","label":"DETAILED_DESCRIPTION","start":707,"end":714},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":715,"end":729},{"text":"abdominopelvic","label":"BIOLOGICAL_STRUCTURE","start":742,"end":756},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":757,"end":776},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":790,"end":797},{"text":"mass","label":"SIGN_SYMPTOM","start":798,"end":802},{"text":"with deep ulceration","label":"DETAILED_DESCRIPTION","start":803,"end":823},{"text":"in the gastric antrum","label":"BIOLOGICAL_STRUCTURE","start":824,"end":845},{"text":"with perigastric lymph node enlargement","label":"DETAILED_DESCRIPTION","start":846,"end":885},{"text":"metastatic lesions","label":"SIGN_SYMPTOM","start":890,"end":908},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":930,"end":935},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":937,"end":941},{"text":"peritoneum","label":"BIOLOGICAL_STRUCTURE","start":945,"end":955},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":961,"end":966},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":967,"end":978},{"text":"no significant findings","label":"SIGN_SYMPTOM","start":986,"end":1009},{"text":"Radical","label":"DETAILED_DESCRIPTION","start":1011,"end":1018},{"text":"subtotal","label":"DETAILED_DESCRIPTION","start":1019,"end":1027},{"text":"gastrectomy","label":"THERAPEUTIC_PROCEDURE","start":1028,"end":1039},{"text":"D2 lymph node","label":"BIOLOGICAL_STRUCTURE","start":1045,"end":1058},{"text":"dissection","label":"THERAPEUTIC_PROCEDURE","start":1059,"end":1069},{"text":"Billroth II","label":"DETAILED_DESCRIPTION","start":1074,"end":1085},{"text":"gastrojejunostomy","label":"THERAPEUTIC_PROCEDURE","start":1086,"end":1103},{"text":"resected specimen","label":"BIOLOGICAL_STRUCTURE","start":1133,"end":1150},{"text":"double","label":"LAB_VALUE","start":1161,"end":1167},{"text":"lesions","label":"SIGN_SYMPTOM","start":1168,"end":1175},{"text":"a 5.8 cm \u00d7 3.2 cm ulcerofungating mass in the antrum","label":"DETAILED_DESCRIPTION","start":1191,"end":1243},{"text":"extensive hemorrhage","label":"DETAILED_DESCRIPTION","start":1250,"end":1270},{"text":"light gray","label":"COLOR","start":1275,"end":1285},{"text":"fibrosis","label":"DETAILED_DESCRIPTION","start":1286,"end":1294},{"text":"a nearby 2.5 cm \u00d7 2.0 cm ulcerative lesion","label":"DETAILED_DESCRIPTION","start":1315,"end":1357},{"text":"massive numbers","label":"LAB_VALUE","start":1388,"end":1403},{"text":"pleomorphic","label":"DETAILED_DESCRIPTION","start":1407,"end":1418},{"text":"bizarre","label":"DETAILED_DESCRIPTION","start":1420,"end":1427},{"text":"tumor cells","label":"SIGN_SYMPTOM","start":1428,"end":1439},{"text":"hemorrhage (syncytiotrophoblasts and cytotrophoblasts)","label":"DETAILED_DESCRIPTION","start":1445,"end":1499},{"text":"Hematoxylin and eosin (HE)-stained tissues","label":"DIAGNOSTIC_PROCEDURE","start":1535,"end":1577},{"text":"bubbly","label":"SHAPE","start":1589,"end":1595},{"text":"purple","label":"COLOR","start":1596,"end":1602},{"text":"cytoplasm","label":"BIOLOGICAL_STRUCTURE","start":1603,"end":1612},{"text":"giant","label":"LAB_VALUE","start":1617,"end":1622},{"text":"nuclei","label":"BIOLOGICAL_STRUCTURE","start":1623,"end":1629},{"text":"magnification of 40 \u00d7","label":"DETAILED_DESCRIPTION","start":1635,"end":1656},{"text":"100 \u00d7","label":"DETAILED_DESCRIPTION","start":1674,"end":1679},{"text":"tumor","label":"COREFERENCE","start":1698,"end":1703},{"text":"proper muscle layer (T2a)","label":"BIOLOGICAL_STRUCTURE","start":1717,"end":1742},{"text":"metastasis","label":"SIGN_SYMPTOM","start":1747,"end":1757},{"text":"in four of 56 regional lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1768,"end":1802},{"text":"Immunohistochemical staining","label":"DIAGNOSTIC_PROCEDURE","start":1809,"end":1837},{"text":"positive immunoreactivity","label":"LAB_VALUE","start":1845,"end":1870},{"text":"\u03b2-human chorionic gonadotropin","label":"DIAGNOSTIC_PROCEDURE","start":1875,"end":1905},{"text":"focal positivity","label":"LAB_VALUE","start":1929,"end":1945},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":1950,"end":1953},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":2009,"end":2016},{"text":"choriocarcinoma","label":"DISEASE_DISORDER","start":2017,"end":2032},{"text":"AFP-producing","label":"DETAILED_DESCRIPTION","start":2065,"end":2078},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":2079,"end":2093},{"text":"tubular","label":"BIOLOGICAL_STRUCTURE","start":2143,"end":2150},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":2151,"end":2165},{"text":"extended to the submucosal layer","label":"BIOLOGICAL_STRUCTURE","start":2173,"end":2205},{"text":"uneventful","label":"LAB_VALUE","start":2355,"end":2365},{"text":"postoperative course","label":"THERAPEUTIC_PROCEDURE","start":2366,"end":2386},{"text":"discharged","label":"CLINICAL_EVENT","start":2395,"end":2405},{"text":"postoperative day 9","label":"DATE","start":2409,"end":2428},{"text":"Two weeks later","label":"DATE","start":2430,"end":2445},{"text":"HCG level","label":"DIAGNOSTIC_PROCEDURE","start":2451,"end":2460},{"text":"176 mIU\/mL","label":"LAB_VALUE","start":2465,"end":2475},{"text":"AFP level","label":"DIAGNOSTIC_PROCEDURE","start":2512,"end":2521},{"text":"10.0 ng\/mL","label":"LAB_VALUE","start":2526,"end":2536},{"text":"Six cycles","label":"FREQUENCY","start":2538,"end":2548},{"text":"adjuvant chemotherapy","label":"MEDICATION","start":2552,"end":2573},{"text":"capecitabine","label":"MEDICATION","start":2579,"end":2591},{"text":"2500 mg\/m2 per day for 14 d\/cycle","label":"DOSAGE","start":2657,"end":2690},{"text":"After two cycles","label":"DATE","start":2692,"end":2708},{"text":"\u03b2-HCG level","label":"DIAGNOSTIC_PROCEDURE","start":2714,"end":2725},{"text":"declined","label":"LAB_VALUE","start":2730,"end":2738},{"text":"< 3 mIU\/mL","label":"LAB_VALUE","start":2742,"end":2752},{"text":"recurrence","label":"SIGN_SYMPTOM","start":2795,"end":2805},{"text":"distant metastasis","label":"SIGN_SYMPTOM","start":2809,"end":2827},{"text":"4-year","label":"DATE","start":2848,"end":2854},{"text":"postoperative follow-up","label":"CLINICAL_EVENT","start":2855,"end":2878}],"tokens":["A ","70-year-old"," ","man"," was ","referred"," to our ","hospital"," for ","gastric"," ","cancer"," that was detected during screening by ","esophagogastroduodenoscopy"," ","(EGD)",".\n","No significant medical history"," was identified, except ","dysuria"," ","caused by bladder contraction",".\nInitial ","laboratory"," data showed a ","serum level of AFP"," of ","32.3 ng\/mL"," (normal range: 0-15 ng\/mL), but ","no other abnormality",", which included other tumor markers, such as, ","carcinoembryonic antigen"," ","(CEA)"," and ","carbohydrate antigen 19-9"," ","(CA19-9)",".\n","EGD"," revealed a ","5-cm"," ","ulcerofungating"," ","mass"," that was ","comprised of three septate ulcers"," ","in the greater curvature of the gastric antrum",".\nA ","pathological examination"," of ","endoscopic biopsy tissues"," confirmed the presence of ","moderately differentiated"," ","tubular"," ","adenocarcinoma",".\nSubsequent ","abdominopelvic"," ","computed tomography"," visualized a ","gastric"," ","mass"," ","with deep ulceration"," ","in the gastric antrum"," ","with perigastric lymph node enlargement",".\nNo ","metastatic lesions"," were observed in the ","liver",", ","lung"," or ","peritoneum",", and ","chest"," ","radiography"," showed ","no significant findings",".\n","Radical"," ","subtotal"," ","gastrectomy"," with ","D2 lymph node"," ","dissection"," and ","Billroth II"," ","gastrojejunostomy"," were performed.\nGrossly, the ","resected specimen"," contained ","double"," ","lesions",": the first was ","a 5.8 cm \u00d7 3.2 cm ulcerofungating mass in the antrum",", with ","extensive hemorrhage"," and ","light gray"," ","fibrosis","; and the second was ","a nearby 2.5 cm \u00d7 2.0 cm ulcerative lesion"," (Figure \u200b1).\nMicroscopically, ","massive numbers"," of ","pleomorphic",", ","bizarre"," ","tumor cells"," with ","hemorrhage (syncytiotrophoblasts and cytotrophoblasts)"," were observed in the first lesion.\n","Hematoxylin and eosin (HE)-stained tissues"," revealed a ","bubbly"," ","purple"," ","cytoplasm"," and ","giant"," ","nuclei"," at a ","magnification of 40 \u00d7"," (Figure \u200b2A) and ","100 \u00d7"," (Figure \u200b2B).\nThe ","tumor"," involved the ","proper muscle layer (T2a)"," and ","metastasis"," was found ","in four of 56 regional lymph nodes"," (N1).\n","Immunohistochemical staining"," showed ","positive immunoreactivity"," for ","\u03b2-human chorionic gonadotropin"," (HCG) (Figure \u200b3A) and ","focal positivity"," for ","AFP"," (Figure \u200b3B).\nThese findings confirmed the presence of ","gastric"," ","choriocarcinoma"," that contained small foci of an ","AFP-producing"," ","adenocarcinoma",".\nThe second lesion was moderately differentiated ","tubular"," ","adenocarcinoma",", which ","extended to the submucosal layer"," (T1b).\nIt was close to, but distinct from the first lesion, which was negative by immunohistochemical staining for \u03b2-HCG and AFP.\nThe patient had an ","uneventful"," ","postoperative course"," and was ","discharged"," on ","postoperative day 9",".\n","Two weeks later",", his ","HCG level"," was ","176 mIU\/mL"," (normal range: 0-10 mIU\/mL) and his ","AFP level"," was ","10.0 ng\/mL",".\n","Six cycles"," of ","adjuvant chemotherapy"," with ","capecitabine"," (Xeloda; Hoffmann-La Roche Inc., Nutley, NJ, USA) was started at ","2500 mg\/m2 per day for 14 d\/cycle",".\n","After two cycles",", his ","\u03b2-HCG level"," had ","declined"," to ","< 3 mIU\/mL",", and has since remained at this level.\nNo ","recurrence"," or ","distant metastasis"," had occurred at his ","4-year"," ","postoperative follow-up",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,12,0,26,0,24,0,24,0,39,0,69,0,22,0,24,0,24,0,42,0,42,0,24,0,24,0,24,0,24,0,18,0,27,0,22,0,69,0,22,0,12,0,24,0,12,0,22,0,22,0,26,0,12,0,24,0,12,0,69,0,22,0,12,0,22,0,69,0,12,0,12,0,12,0,12,0,24,0,69,0,22,0,22,0,75,0,12,0,75,0,22,0,75,0,12,0,42,0,69,0,22,0,22,0,15,0,22,0,22,0,42,0,22,0,22,0,69,0,22,0,24,0,67,0,15,0,12,0,42,0,12,0,22,0,22,0,18,0,12,0,69,0,12,0,24,0,42,0,24,0,42,0,24,0,12,0,26,0,22,0,26,0,12,0,26,0,12,0,42,0,75,0,13,0,19,0,19,0,24,0,42,0,24,0,42,0,35,0,46,0,46,0,29,0,19,0,24,0,42,0,42,0,69,0,69,0,19,0,13,0]}
-{"full_text":"Our 24-year-old non-smoking male patient presented with repeated hemoptysis in May 2008 with 4 days of concomitant right thoracic pain which intensified while breathing.\nDuring holidays in his home country, this Cuban patient suffered from a cold with fever and a strong cough.\nThe strong dry cough persisted after recovery from the cold.\nThe patient did not report any loss of weight.\nThe initial CT scan of the thorax showed a 12 \u00d7 4 cm solid mass paravertebral right in the lower thorax without any signs of metastases (Figure 1).\nThe bronchoscopy (Figure \u200b2) with non-bleeding biopsy revealed a mass of the lower right bronchus which histologically and immunohistologically provided evidence of a granular cell or Abrikossoff tumor [1].\nThe bronchial lavage which followed was negative for malignant cells.\nThe patient was discharged and surgical intervention was planned.\nFour days after discharge a spontaneous hemothorax developed.\nThe patient needed to be readmitted and the hemothorax was drained.\nNo malignant cells were detected in the cytological examination of the drained liquid.\nAfter an uneventful course and decreasing of the hematoma, the tumor was excised by performing a lower right lobectomy 6 months after the initial admission.\nThe final histological examination confirmed a peribronchial and infiltrating S100 positive tumor supporting the Schwann cell origin theory with very low growth rate of 2% and a size of 15 mm (Figure \u200b3).\n","ner_info":[{"text":"24-year-old","label":"AGE","start":4,"end":15},{"text":"non-smoking","label":"HISTORY","start":16,"end":27},{"text":"male","label":"SEX","start":28,"end":32},{"text":"presented","label":"CLINICAL_EVENT","start":41,"end":50},{"text":"repeated","label":"DETAILED_DESCRIPTION","start":56,"end":64},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":65,"end":75},{"text":"May 2008","label":"DATE","start":79,"end":87},{"text":"4 days","label":"DURATION","start":93,"end":99},{"text":"concomitant","label":"DETAILED_DESCRIPTION","start":103,"end":114},{"text":"right thoracic","label":"BIOLOGICAL_STRUCTURE","start":115,"end":129},{"text":"pain","label":"SIGN_SYMPTOM","start":130,"end":134},{"text":"which intensified while breathing","label":"DETAILED_DESCRIPTION","start":135,"end":168},{"text":"holidays in his home country","label":"HISTORY","start":177,"end":205},{"text":"Cuban","label":"PERSONAL_BACKGROUND","start":212,"end":217},{"text":"cold","label":"SIGN_SYMPTOM","start":242,"end":246},{"text":"fever","label":"SIGN_SYMPTOM","start":252,"end":257},{"text":"strong","label":"SEVERITY","start":264,"end":270},{"text":"cough","label":"SIGN_SYMPTOM","start":271,"end":276},{"text":"strong","label":"SEVERITY","start":282,"end":288},{"text":"dry","label":"TEXTURE","start":289,"end":292},{"text":"cough","label":"COREFERENCE","start":293,"end":298},{"text":"persisted","label":"DETAILED_DESCRIPTION","start":299,"end":308},{"text":"after recovery from the cold.","label":"DATE","start":309,"end":338},{"text":"loss of weight","label":"SIGN_SYMPTOM","start":370,"end":384},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":398,"end":405},{"text":"thorax","label":"BIOLOGICAL_STRUCTURE","start":413,"end":419},{"text":"12 \u00d7 4 cm","label":"AREA","start":429,"end":438},{"text":"solid","label":"DETAILED_DESCRIPTION","start":439,"end":444},{"text":"mass","label":"SIGN_SYMPTOM","start":445,"end":449},{"text":"paravertebral right","label":"BIOLOGICAL_STRUCTURE","start":450,"end":469},{"text":"lower thorax","label":"BIOLOGICAL_STRUCTURE","start":477,"end":489},{"text":"metastases","label":"SIGN_SYMPTOM","start":511,"end":521},{"text":"bronchoscopy","label":"DIAGNOSTIC_PROCEDURE","start":538,"end":550},{"text":"non-bleeding","label":"DETAILED_DESCRIPTION","start":568,"end":580},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":581,"end":587},{"text":"mass","label":"COREFERENCE","start":599,"end":603},{"text":"lower right bronchus","label":"BIOLOGICAL_STRUCTURE","start":611,"end":631},{"text":"histologically","label":"DIAGNOSTIC_PROCEDURE","start":638,"end":652},{"text":"immunohistologically","label":"DIAGNOSTIC_PROCEDURE","start":657,"end":677},{"text":"Abrikossoff tumor","label":"DISEASE_DISORDER","start":718,"end":735},{"text":"bronchial lavage","label":"DIAGNOSTIC_PROCEDURE","start":745,"end":761},{"text":"negative","label":"LAB_VALUE","start":781,"end":789},{"text":"malignant cells","label":"BIOLOGICAL_STRUCTURE","start":794,"end":809},{"text":"discharged","label":"CLINICAL_EVENT","start":827,"end":837},{"text":"Four days after discharge","label":"DATE","start":877,"end":902},{"text":"spontaneous","label":"DETAILED_DESCRIPTION","start":905,"end":916},{"text":"hemothorax","label":"SIGN_SYMPTOM","start":917,"end":927},{"text":"readmitted","label":"CLINICAL_EVENT","start":964,"end":974},{"text":"hemothorax","label":"COREFERENCE","start":983,"end":993},{"text":"drained","label":"THERAPEUTIC_PROCEDURE","start":998,"end":1005},{"text":"malignant cells","label":"SIGN_SYMPTOM","start":1010,"end":1025},{"text":"cytological examination","label":"DIAGNOSTIC_PROCEDURE","start":1047,"end":1070},{"text":"drained liquid","label":"BIOLOGICAL_STRUCTURE","start":1078,"end":1092},{"text":"decreasing","label":"LAB_VALUE","start":1125,"end":1135},{"text":"hematoma","label":"SIGN_SYMPTOM","start":1143,"end":1151},{"text":"tumor","label":"SIGN_SYMPTOM","start":1157,"end":1162},{"text":"excised","label":"THERAPEUTIC_PROCEDURE","start":1167,"end":1174},{"text":"lower right lobectomy","label":"THERAPEUTIC_PROCEDURE","start":1191,"end":1212},{"text":"6 months after the initial admission.","label":"DATE","start":1213,"end":1250},{"text":"histological examination","label":"DIAGNOSTIC_PROCEDURE","start":1261,"end":1285},{"text":"peribronchial","label":"BIOLOGICAL_STRUCTURE","start":1298,"end":1311},{"text":"infiltrating","label":"DETAILED_DESCRIPTION","start":1316,"end":1328},{"text":"S100","label":"DIAGNOSTIC_PROCEDURE","start":1329,"end":1333},{"text":"positive","label":"LAB_VALUE","start":1334,"end":1342},{"text":"tumor","label":"COREFERENCE","start":1343,"end":1348},{"text":"very low","label":"LAB_VALUE","start":1396,"end":1404},{"text":"growth rate","label":"DIAGNOSTIC_PROCEDURE","start":1405,"end":1416},{"text":"2%","label":"LAB_VALUE","start":1420,"end":1422},{"text":"size","label":"DIAGNOSTIC_PROCEDURE","start":1429,"end":1433},{"text":"15 mm","label":"DISTANCE","start":1437,"end":1442}],"tokens":["Our ","24-year-old"," ","non-smoking"," ","male"," patient ","presented"," with ","repeated"," ","hemoptysis"," in ","May 2008"," with ","4 days"," of ","concomitant"," ","right thoracic"," ","pain"," ","which intensified while breathing",".\nDuring ","holidays in his home country",", this ","Cuban"," patient suffered from a ","cold"," with ","fever"," and a ","strong"," ","cough",".\nThe ","strong"," ","dry"," ","cough"," ","persisted"," ","after recovery from the cold.","\nThe patient did not report any ","loss of weight",".\nThe initial ","CT scan"," of the ","thorax"," showed a ","12 \u00d7 4 cm"," ","solid"," ","mass"," ","paravertebral right"," in the ","lower thorax"," without any signs of ","metastases"," (Figure 1).\nThe ","bronchoscopy"," (Figure \u200b2) with ","non-bleeding"," ","biopsy"," revealed a ","mass"," of the ","lower right bronchus"," which ","histologically"," and ","immunohistologically"," provided evidence of a granular cell or ","Abrikossoff tumor"," [1].\nThe ","bronchial lavage"," which followed was ","negative"," for ","malignant cells",".\nThe patient was ","discharged"," and surgical intervention was planned.\n","Four days after discharge"," a ","spontaneous"," ","hemothorax"," developed.\nThe patient needed to be ","readmitted"," and the ","hemothorax"," was ","drained",".\nNo ","malignant cells"," were detected in the ","cytological examination"," of the ","drained liquid",".\nAfter an uneventful course and ","decreasing"," of the ","hematoma",", the ","tumor"," was ","excised"," by performing a ","lower right lobectomy"," ","6 months after the initial admission.","\nThe final ","histological examination"," confirmed a ","peribronchial"," and ","infiltrating"," ","S100"," ","positive"," ","tumor"," supporting the Schwann cell origin theory with ","very low"," ","growth rate"," of ","2%"," and a ","size"," of ","15 mm"," (Figure \u200b3).\n"],"ner_labels":[0,5,0,39,0,65,0,13,0,22,0,69,0,19,0,32,0,22,0,12,0,69,0,22,0,39,0,58,0,69,0,69,0,63,0,69,0,63,0,73,0,18,0,22,0,19,0,69,0,24,0,12,0,8,0,22,0,69,0,12,0,12,0,69,0,24,0,22,0,24,0,18,0,12,0,24,0,24,0,26,0,24,0,42,0,12,0,13,0,19,0,22,0,69,0,13,0,18,0,75,0,69,0,24,0,12,0,42,0,69,0,69,0,75,0,75,0,19,0,24,0,12,0,22,0,24,0,42,0,18,0,42,0,24,0,42,0,24,0,27,0]}
-{"full_text":"A 54-year-old woman with stage IV NSCLC was treated with carboplatin and paclitaxel without disease response.\nMolecular analysis of tumor tissue was unavailable at that time.\nHowever, her demographic profile (Asian, minimal smoking history, non-small cell histology) predicted her disease would harbor EGFR TKI sensitive cells [2].\nTherefore, she then initiated standard daily dosing of erlotinib (150 mg) and her disease responded.\nTwenty-eight months later, she acquired resistance to erlotinib with progression of disease systemically.\nFollowing further progression through an experimental angiogenesis inhibitor, she initiated pemetrexed and resumed standard dose erlotinib.\nAfter initial response, 11 months later, her disease again progressed.\nDNA was extracted from biopsy of a progressing lung lesion and examined using established techniques for analysis of EGFR mutations [5].\nDirect sequencing of exons 18\u201321 encoding the kinase domain of EGFR revealed the L858R mutation associated with EGFR TKI sensitivity (Fig.1) [2].\nIt also demonstrated the T790M mutation associated with acquired EGFR TKI resistance (Fig.1) [2].\nShe also developed headaches and there was a high clinical suspicion of CNS metastases despite negative imaging (not shown).\nShe refused a lumbar puncture.\nShe initiated empiric temozolomide plus standard dose erlotinib (150 mg daily) for presumed CNS disease, but after one cycle her headaches worsened, and she developed nausea and vomiting concerning for CNS metastases with associated raised intracranial pressure.\nMagnetic resonance imaging (MRI) of the brain now demonstrated LM (Fig.2) confirmed by CSF cytology (not shown).\nBy direct sequencing, DNA from CSF cells harbored L858R predicting EGFR TKI sensitivity (Fig.3, left panel) but not the T790M resistance mutation (data not shown).\nBecause the result for T790M was negative in this sample, we performed a more sensitive fluorescence detection PCR-based assay that takes advantage of a PCR restriction fragment length polymorphism generated by the specific missense mutation (Fig.3, right panel, arrow, positive control) [6].\nThat result was also negative, as only the wild type peak was detected (Fig.3, right panel, bottom).\nTherefore, we hypothesized that the LM remained sensitive to an EGFR TKI if sufficiently high concentrations of drug could be achieved in the CSF.\nThe erlotinib concentration required to inhibit growth of cell lines harboring L858R by 50% (IC50) is 100 nM (nM) [2].\nStandard dose erlotinib (150 mg daily) achieves 3000 nM in plasma [7], but CSF concentrations of EGFR TKIs are as low as 1% plasma levels below the IC50 [3, 8].\nIncreasing the daily dose of gefitinib to enhance CSF penetration has been an effective strategy [3], but gefitinib is no longer available in the United States following failure in phase III NSCLC trials.\nAn analogous increase of the daily erlotinib dose above 150\u2013200 mg daily induces unacceptable toxicity.\nHowever, weekly high-dose erlotinib up to 2000 mg is tolerable [4].\nPharmacokinetic analysis of CSF from another patient with NSCLC LM (not shown) treated with 1500 mg erlotinib weekly demonstrated a peak plasma concentration of 11,300 nM with a concurrent CSF concentration of 130 nM.\nTherefore, such high dose weekly administration of erlotinib achieved a CSF concentration exceeding the IC50.\nTherefore, to increase CSF penetrance over standard daily erlotinib dosing in this patient, we initiated high-dose weekly erlotinib at 1000 mg then 1200 mg; persistent nausea precluded higher doses.\nPharmacokinetic analysis was not undertaken in this patient.\nAfter 1 month there was a partial radiographic response of LM on brain MRI (Fig.2b) and after 2 months in the cauda equina (not shown).\nHowever, hydrocephalus and persistent symptoms referable to increased intracranial pressure led to a VP shunt and whole-brain radiation therapy, after which she resumed treatment with 1500 mg weekly erlotinib.\nOne month later, progressive intra-thoracic disease led to initiation of cetixumab and erlotinib was continued but changed to low dose (100 mg) daily.\nShe survived 14 months following the diagnosis of CNS disease.\n","ner_info":[{"text":"54-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"stage IV","label":"DETAILED_DESCRIPTION","start":25,"end":33},{"text":"NSCLC","label":"DISEASE_DISORDER","start":34,"end":39},{"text":"carboplatin","label":"MEDICATION","start":57,"end":68},{"text":"paclitaxel","label":"MEDICATION","start":73,"end":83},{"text":"without disease response","label":"DETAILED_DESCRIPTION","start":84,"end":108},{"text":"Molecular analysis","label":"DIAGNOSTIC_PROCEDURE","start":110,"end":128},{"text":"tumor 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disease","label":"COREFERENCE","start":410,"end":421},{"text":"responded","label":"DETAILED_DESCRIPTION","start":422,"end":431},{"text":"Twenty-eight months later","label":"DATE","start":433,"end":458},{"text":"resistance","label":"OTHER_EVENT","start":473,"end":483},{"text":"erlotinib","label":"MEDICATION","start":487,"end":496},{"text":"progression","label":"DETAILED_DESCRIPTION","start":502,"end":513},{"text":"disease","label":"COREFERENCE","start":517,"end":524},{"text":"systemically","label":"DETAILED_DESCRIPTION","start":525,"end":537},{"text":"experimental","label":"DETAILED_DESCRIPTION","start":580,"end":592},{"text":"angiogenesis inhibitor","label":"MEDICATION","start":593,"end":615},{"text":"pemetrexed","label":"MEDICATION","start":631,"end":641},{"text":"standard dose erlotinib","label":"COREFERENCE","start":654,"end":677},{"text":"11 months later","label":"DATE","start":703,"end":718},{"text":"her disease","label":"COREFERENCE","start":720,"end":731},{"text":"progressed","label":"DETAILED_DESCRIPTION","start":738,"end":748},{"text":"DNA","label":"BIOLOGICAL_STRUCTURE","start":750,"end":753},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":773,"end":779},{"text":"progressing","label":"DETAILED_DESCRIPTION","start":785,"end":796},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":797,"end":801},{"text":"lesion","label":"DISEASE_DISORDER","start":802,"end":808},{"text":"EGFR mutations","label":"DIAGNOSTIC_PROCEDURE","start":867,"end":881},{"text":"Direct sequencing","label":"DIAGNOSTIC_PROCEDURE","start":887,"end":904},{"text":"exons 18\u201321","label":"DETAILED_DESCRIPTION","start":908,"end":919},{"text":"kinase domain","label":"DETAILED_DESCRIPTION","start":933,"end":946},{"text":"EGFR","label":"DIAGNOSTIC_PROCEDURE","start":950,"end":954},{"text":"L858R mutation","label":"DIAGNOSTIC_PROCEDURE","start":968,"end":982},{"text":"EGFR TKI 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imaging","label":"DIAGNOSTIC_PROCEDURE","start":1550,"end":1576},{"text":"(MRI)","label":"DIAGNOSTIC_PROCEDURE","start":1577,"end":1582},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":1590,"end":1595},{"text":"LM","label":"DISEASE_DISORDER","start":1613,"end":1615},{"text":"CSF cytology","label":"DIAGNOSTIC_PROCEDURE","start":1637,"end":1649},{"text":"direct","label":"DETAILED_DESCRIPTION","start":1666,"end":1672},{"text":"sequencing","label":"DIAGNOSTIC_PROCEDURE","start":1673,"end":1683},{"text":"DNA","label":"BIOLOGICAL_STRUCTURE","start":1685,"end":1688},{"text":"CSF cells","label":"DIAGNOSTIC_PROCEDURE","start":1694,"end":1703},{"text":"L858R","label":"DIAGNOSTIC_PROCEDURE","start":1713,"end":1718},{"text":"EGFR TKI sensitivity","label":"DIAGNOSTIC_PROCEDURE","start":1730,"end":1750},{"text":"T790M resistance mutation","label":"DIAGNOSTIC_PROCEDURE","start":1783,"end":1808},{"text":"T790M","label":"DIAGNOSTIC_PROCEDURE","start":1850,"end":1855},{"text":"negative","label":"LAB_VALUE","start":1860,"end":1868},{"text":"this sample","label":"COREFERENCE","start":1872,"end":1883},{"text":"more sensitive","label":"LAB_VALUE","start":1900,"end":1914},{"text":"fluorescence detection","label":"DETAILED_DESCRIPTION","start":1915,"end":1937},{"text":"PCR-based","label":"DETAILED_DESCRIPTION","start":1938,"end":1947},{"text":"assay","label":"DIAGNOSTIC_PROCEDURE","start":1948,"end":1953},{"text":"PCR restriction fragment length polymorphism","label":"DIAGNOSTIC_PROCEDURE","start":1980,"end":2024},{"text":"the specific missense mutation","label":"COREFERENCE","start":2038,"end":2068},{"text":"That result","label":"COREFERENCE","start":2120,"end":2131},{"text":"negative","label":"LAB_VALUE","start":2141,"end":2149},{"text":"wild type peak","label":"DIAGNOSTIC_PROCEDURE","start":2163,"end":2177},{"text":"Pharmacokinetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":3025,"end":3049},{"text":"CSF","label":"BIOLOGICAL_STRUCTURE","start":3053,"end":3056},{"text":"another patient","label":"SUBJECT","start":3062,"end":3077},{"text":"NSCLC","label":"DISEASE_DISORDER","start":3083,"end":3088},{"text":"LM","label":"DISEASE_DISORDER","start":3089,"end":3091},{"text":"erlotinib","label":"MEDICATION","start":3125,"end":3134},{"text":"peak plasma concentration","label":"DIAGNOSTIC_PROCEDURE","start":3157,"end":3182},{"text":"11,300 nM","label":"LAB_VALUE","start":3186,"end":3195},{"text":"CSF concentration","label":"DIAGNOSTIC_PROCEDURE","start":3214,"end":3231},{"text":"130 nM","label":"LAB_VALUE","start":3235,"end":3241},{"text":"exceeding the IC50","label":"DETAILED_DESCRIPTION","start":3333,"end":3351},{"text":"high-dose weekly","label":"DOSAGE","start":3458,"end":3474},{"text":"erlotinib","label":"MEDICATION","start":3475,"end":3484},{"text":"1000 mg","label":"LAB_VALUE","start":3488,"end":3495},{"text":"1200 mg","label":"LAB_VALUE","start":3501,"end":3508},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":3510,"end":3520},{"text":"nausea","label":"SIGN_SYMPTOM","start":3521,"end":3527},{"text":"Pharmacokinetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":3552,"end":3576},{"text":"After 1 month","label":"DATE","start":3613,"end":3626},{"text":"partial radiographic response","label":"DIAGNOSTIC_PROCEDURE","start":3639,"end":3668},{"text":"LM","label":"DISEASE_DISORDER","start":3672,"end":3674},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":3678,"end":3683},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":3684,"end":3687},{"text":"after 2 months","label":"DATE","start":3701,"end":3715},{"text":"cauda equina","label":"BIOLOGICAL_STRUCTURE","start":3723,"end":3735},{"text":"hydrocephalus","label":"DISEASE_DISORDER","start":3758,"end":3771},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":3776,"end":3786},{"text":"symptoms","label":"SIGN_SYMPTOM","start":3787,"end":3795},{"text":"increased","label":"LAB_VALUE","start":3809,"end":3818},{"text":"intracranial pressure","label":"DIAGNOSTIC_PROCEDURE","start":3819,"end":3840},{"text":"VP shunt","label":"THERAPEUTIC_PROCEDURE","start":3850,"end":3858},{"text":"whole-brain","label":"BIOLOGICAL_STRUCTURE","start":3863,"end":3874},{"text":"radiation therapy","label":"THERAPEUTIC_PROCEDURE","start":3875,"end":3892},{"text":"1500 mg weekly","label":"DOSAGE","start":3933,"end":3947},{"text":"erlotinib","label":"MEDICATION","start":3948,"end":3957},{"text":"One month later","label":"DATE","start":3959,"end":3974},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":3976,"end":3987},{"text":"intra-thoracic disease","label":"DISEASE_DISORDER","start":3988,"end":4010},{"text":"cetixumab","label":"MEDICATION","start":4032,"end":4041},{"text":"erlotinib","label":"MEDICATION","start":4046,"end":4055},{"text":"100 mg","label":"LAB_VALUE","start":4095,"end":4101},{"text":"survived","label":"SIGN_SYMPTOM","start":4114,"end":4122},{"text":"14 months following the diagnosis of CNS disease","label":"DATE","start":4123,"end":4171}],"tokens":["A ","54-year-old"," ","woman"," with ","stage IV"," ","NSCLC"," was treated with ","carboplatin"," and ","paclitaxel"," ","without disease response",".\n","Molecular analysis"," of ","tumor tissue"," was ","unavailable"," at that time.\nHowever, her demographic profile (","Asian",", ","minimal"," ","smoking history",", ","non-small cell"," ","histology",") predicted ","her disease"," would harbor ","EGFR TKI sensitive cells"," [2].\nTherefore, she then initiated ","standard"," ","daily dosing"," of ","erlotinib"," (","150 mg",") and ","her disease"," ","responded",".\n","Twenty-eight months later",", she acquired ","resistance"," to ","erlotinib"," with ","progression"," of ","disease"," ","systemically",".\nFollowing further progression through an ","experimental"," ","angiogenesis inhibitor",", she initiated ","pemetrexed"," and resumed ","standard dose erlotinib",".\nAfter initial response, ","11 months later",", ","her disease"," again ","progressed",".\n","DNA"," was extracted from ","biopsy"," of a ","progressing"," ","lung"," ","lesion"," and examined using established techniques for analysis of ","EGFR mutations"," [5].\n","Direct sequencing"," of ","exons 18\u201321"," encoding the ","kinase domain"," of ","EGFR"," revealed the ","L858R mutation"," associated with ","EGFR TKI sensitivity"," (Fig.1) [2].\n","It"," also demonstrated the ","T790M mutation"," associated with ","acquired EGFR TKI resistance"," (Fig.1) [2].\nShe also developed ","headaches"," and there was a high clinical suspicion of ","CNS"," ","metastases"," despite ","negative"," ","imaging"," (not shown).\nShe refused a ","lumbar puncture",".\nShe initiated ","empiric"," ","temozolomide"," plus ","standard dose"," ","erlotinib"," (","150 mg daily",") for presumed ","CNS disease",", but ","after one cycle"," her ","headaches"," ","worsened",", and she developed ","nausea"," and ","vomiting"," concerning for ","CNS metastases"," with associated ","raised"," ","intracranial pressure",".\n","Magnetic resonance imaging"," ","(MRI)"," of the ","brain"," now demonstrated ","LM"," (Fig.2) confirmed by ","CSF cytology"," (not shown).\nBy ","direct"," ","sequencing",", ","DNA"," from ","CSF cells"," harbored ","L858R"," predicting ","EGFR TKI sensitivity"," (Fig.3, left panel) but not the ","T790M resistance mutation"," (data not shown).\nBecause the result for ","T790M"," was ","negative"," in ","this sample",", we performed a ","more sensitive"," ","fluorescence detection"," ","PCR-based"," ","assay"," that takes advantage of a ","PCR restriction fragment length polymorphism"," generated by ","the specific missense mutation"," (Fig.3, right panel, arrow, positive control) [6].\n","That result"," was also ","negative",", as only the ","wild type peak"," was detected (Fig.3, right panel, bottom).\nTherefore, we hypothesized that the LM remained sensitive to an EGFR TKI if sufficiently high concentrations of drug could be achieved in the CSF.\nThe erlotinib concentration required to inhibit growth of cell lines harboring L858R by 50% (IC50) is 100 nM (nM) [2].\nStandard dose erlotinib (150 mg daily) achieves 3000 nM in plasma [7], but CSF concentrations of EGFR TKIs are as low as 1% plasma levels below the IC50 [3, 8].\nIncreasing the daily dose of gefitinib to enhance CSF penetration has been an effective strategy [3], but gefitinib is no longer available in the United States following failure in phase III NSCLC trials.\nAn analogous increase of the daily erlotinib dose above 150\u2013200 mg daily induces unacceptable toxicity.\nHowever, weekly high-dose erlotinib up to 2000 mg is tolerable [4].\n","Pharmacokinetic analysis"," of ","CSF"," from ","another patient"," with ","NSCLC"," ","LM"," (not shown) treated with 1500 mg ","erlotinib"," weekly demonstrated a ","peak plasma concentration"," of ","11,300 nM"," with a concurrent ","CSF concentration"," of ","130 nM",".\nTherefore, such high dose weekly administration of erlotinib achieved a CSF concentration ","exceeding the IC50",".\nTherefore, to increase CSF penetrance over standard daily erlotinib dosing in this patient, we initiated ","high-dose weekly"," ","erlotinib"," at ","1000 mg"," then ","1200 mg","; ","persistent"," ","nausea"," precluded higher doses.\n","Pharmacokinetic analysis"," was not undertaken in this patient.\n","After 1 month"," there was a ","partial radiographic response"," of ","LM"," on ","brain"," ","MRI"," (Fig.2b) and ","after 2 months"," in the ","cauda equina"," (not shown).\nHowever, ","hydrocephalus"," and ","persistent"," ","symptoms"," referable to ","increased"," ","intracranial pressure"," led to a ","VP shunt"," and ","whole-brain"," ","radiation therapy",", after which she resumed treatment with ","1500 mg weekly"," ","erlotinib",".\n","One month later",", ","progressive"," ","intra-thoracic disease"," led to initiation of ","cetixumab"," and ","erlotinib"," was continued but changed to low dose (","100 mg",") daily.\nShe ","survived"," ","14 months following the diagnosis of CNS disease",".\n"],"ner_labels":[0,5,0,65,0,22,0,26,0,46,0,46,0,22,0,24,0,24,0,22,0,58,0,63,0,39,0,22,0,24,0,18,0,24,0,22,0,29,0,46,0,42,0,18,0,22,0,19,0,53,0,46,0,22,0,18,0,22,0,22,0,46,0,46,0,18,0,19,0,18,0,22,0,12,0,24,0,22,0,12,0,26,0,24,0,24,0,22,0,22,0,24,0,24,0,22,0,18,0,24,0,22,0,69,0,12,0,26,0,42,0,24,0,75,0,22,0,46,0,22,0,46,0,29,0,26,0,78,0,69,0,42,0,69,0,69,0,26,0,42,0,24,0,24,0,24,0,12,0,26,0,24,0,22,0,24,0,12,0,24,0,24,0,24,0,24,0,24,0,42,0,18,0,42,0,22,0,22,0,24,0,24,0,18,0,18,0,42,0,24,0,24,0,12,0,71,0,26,0,26,0,46,0,24,0,42,0,24,0,42,0,22,0,29,0,46,0,42,0,42,0,22,0,69,0,24,0,19,0,24,0,26,0,12,0,24,0,19,0,12,0,26,0,22,0,69,0,42,0,24,0,75,0,12,0,75,0,29,0,46,0,19,0,22,0,26,0,46,0,46,0,42,0,69,0,19,0]}
-{"full_text":"A 21-year-old male presented with a 2-year history of progressive shortness of breath on exertion and dry cough.\nAt physical examination, auscultation of the lungs has revealed random wheezes and coarse crackles.\nCardiac auscultation was normal, and no cyanosis or peripheral edema was observed.\nThere was no history of smoking or previous known pulmonary disease.\nOn routine blood examination, blood counts and serum chemistries were found to be normal.\nArterial blood gas analysis and echocardiography showed no important abnormalities.\nPulmonary function tests (PFT) showed a mild restrictive ventilatory defect, with a reduced total lung capacity of 79% (5.94\u2009L), forced vital capacity of 80% (4.18\u2009L) and a forced expiratory volume in one second of 83% (3.72\u2009L).\nThe sputum was negative for acid-alcohol resistant bacillus and human immunodeficiency virus testing was negative as well.\nThe chest plain films revealed a diffuse symmetric dense bilateral micronodular pattern (Figure 1).\nBased on this finding, HRCT scan was obtained, revealing diffuse ground glass attenuation and septal thickening, more pronounced in lower pulmonary regions, with calcifications along the interlobar septa and subpleural regions.\nSubpleural cysts were also noticed (Figure 2).\nThe patient underwent a fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy.\nThe lavage fluid was negative for tuberculosis or fungi.\nMicroliths were not found.\nHistology revealed round, concentrically laminated microliths in the alveoli associated with slightly thickened interstitial septa, consistent with the diagnosis of PAM.\n","ner_info":[{"text":"21-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"presented","label":"CLINICAL_EVENT","start":19,"end":28},{"text":"2-year","label":"DURATION","start":36,"end":42},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":54,"end":65},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":66,"end":85},{"text":"exertion","label":"DETAILED_DESCRIPTION","start":89,"end":97},{"text":"dry cough","label":"SIGN_SYMPTOM","start":102,"end":111},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":116,"end":136},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":138,"end":150},{"text":"lungs","label":"BIOLOGICAL_STRUCTURE","start":158,"end":163},{"text":"random","label":"DETAILED_DESCRIPTION","start":177,"end":183},{"text":"wheezes","label":"SIGN_SYMPTOM","start":184,"end":191},{"text":"coarse crackles","label":"SIGN_SYMPTOM","start":196,"end":211},{"text":"Cardiac","label":"BIOLOGICAL_STRUCTURE","start":213,"end":220},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":221,"end":233},{"text":"cyanosis","label":"SIGN_SYMPTOM","start":253,"end":261},{"text":"peripheral edema","label":"SIGN_SYMPTOM","start":265,"end":281},{"text":"no history of smoking","label":"HISTORY","start":306,"end":327},{"text":"pulmonary disease","label":"DISEASE_DISORDER","start":346,"end":363},{"text":"routine","label":"DETAILED_DESCRIPTION","start":368,"end":375},{"text":"blood examination","label":"DIAGNOSTIC_PROCEDURE","start":376,"end":393},{"text":"blood counts","label":"DIAGNOSTIC_PROCEDURE","start":395,"end":407},{"text":"serum chemistries","label":"DIAGNOSTIC_PROCEDURE","start":412,"end":429},{"text":"normal","label":"LAB_VALUE","start":447,"end":453},{"text":"Arterial blood gas analysis","label":"DIAGNOSTIC_PROCEDURE","start":455,"end":482},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":487,"end":503},{"text":"no important abnormalities","label":"LAB_VALUE","start":511,"end":537},{"text":"Pulmonary function tests","label":"DIAGNOSTIC_PROCEDURE","start":539,"end":563},{"text":"PFT","label":"DIAGNOSTIC_PROCEDURE","start":565,"end":568},{"text":"mild","label":"SEVERITY","start":579,"end":583},{"text":"restrictive ventilatory defect","label":"SIGN_SYMPTOM","start":584,"end":614},{"text":"reduced","label":"LAB_VALUE","start":623,"end":630},{"text":"total lung capacity","label":"DIAGNOSTIC_PROCEDURE","start":631,"end":650},{"text":"79%","label":"LAB_VALUE","start":654,"end":657},{"text":"5.94\u2009L","label":"LAB_VALUE","start":659,"end":665},{"text":"forced vital capacity","label":"DIAGNOSTIC_PROCEDURE","start":668,"end":689},{"text":"80%","label":"LAB_VALUE","start":693,"end":696},{"text":"4.18\u2009L","label":"LAB_VALUE","start":698,"end":704},{"text":"forced expiratory volume in one second","label":"DIAGNOSTIC_PROCEDURE","start":712,"end":750},{"text":"83%","label":"LAB_VALUE","start":754,"end":757},{"text":"3.72\u2009L","label":"LAB_VALUE","start":759,"end":765},{"text":"sputum","label":"BIOLOGICAL_STRUCTURE","start":772,"end":778},{"text":"negative","label":"LAB_VALUE","start":783,"end":791},{"text":"acid-alcohol resistant bacillus","label":"DIAGNOSTIC_PROCEDURE","start":796,"end":827},{"text":"human immunodeficiency virus testing","label":"DIAGNOSTIC_PROCEDURE","start":832,"end":868},{"text":"negative","label":"LAB_VALUE","start":873,"end":881},{"text":"chest plain films","label":"DIAGNOSTIC_PROCEDURE","start":895,"end":912},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":924,"end":931},{"text":"symmetric","label":"DETAILED_DESCRIPTION","start":932,"end":941},{"text":"dense","label":"TEXTURE","start":942,"end":947},{"text":"bilateral","label":"BIOLOGICAL_STRUCTURE","start":948,"end":957},{"text":"micronodular pattern","label":"SIGN_SYMPTOM","start":958,"end":978},{"text":"HRCT scan","label":"DIAGNOSTIC_PROCEDURE","start":1014,"end":1023},{"text":"ground glass attenuation","label":"SIGN_SYMPTOM","start":1056,"end":1080},{"text":"septal thickening","label":"SIGN_SYMPTOM","start":1085,"end":1102},{"text":"lower pulmonary regions","label":"BIOLOGICAL_STRUCTURE","start":1123,"end":1146},{"text":"calcifications","label":"SIGN_SYMPTOM","start":1153,"end":1167},{"text":"interlobar septa","label":"BIOLOGICAL_STRUCTURE","start":1178,"end":1194},{"text":"subpleural regions","label":"BIOLOGICAL_STRUCTURE","start":1199,"end":1217},{"text":"Subpleural","label":"BIOLOGICAL_STRUCTURE","start":1219,"end":1229},{"text":"cysts","label":"SIGN_SYMPTOM","start":1230,"end":1235},{"text":"fiberoptic bronchoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1290,"end":1313},{"text":"bronchoalveolar lavage","label":"DIAGNOSTIC_PROCEDURE","start":1319,"end":1341},{"text":"transbronchial","label":"BIOLOGICAL_STRUCTURE","start":1346,"end":1360},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":1361,"end":1365},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1366,"end":1372},{"text":"lavage fluid","label":"BIOLOGICAL_STRUCTURE","start":1378,"end":1390},{"text":"negative","label":"LAB_VALUE","start":1395,"end":1403},{"text":"tuberculosis","label":"DIAGNOSTIC_PROCEDURE","start":1408,"end":1420},{"text":"fungi","label":"DIAGNOSTIC_PROCEDURE","start":1424,"end":1429},{"text":"Microliths","label":"SIGN_SYMPTOM","start":1431,"end":1441},{"text":"Histology","label":"DIAGNOSTIC_PROCEDURE","start":1458,"end":1467},{"text":"round","label":"SHAPE","start":1477,"end":1482},{"text":"concentrically laminated","label":"DETAILED_DESCRIPTION","start":1484,"end":1508},{"text":"microliths","label":"SIGN_SYMPTOM","start":1509,"end":1519},{"text":"alveoli","label":"BIOLOGICAL_STRUCTURE","start":1527,"end":1534},{"text":"slightly","label":"SEVERITY","start":1551,"end":1559},{"text":"thickened interstitial septa","label":"SIGN_SYMPTOM","start":1560,"end":1588},{"text":"PAM","label":"DISEASE_DISORDER","start":1623,"end":1626}],"tokens":["A ","21-year-old"," ","male"," ","presented"," with a ","2-year"," history of ","progressive"," ","shortness of breath"," on ","exertion"," and ","dry cough",".\nAt ","physical examination",", ","auscultation"," of the ","lungs"," has revealed ","random"," ","wheezes"," and ","coarse crackles",".\n","Cardiac"," ","auscultation"," was normal, and no ","cyanosis"," or ","peripheral edema"," was observed.\nThere was ","no history of smoking"," or previous known ","pulmonary disease",".\nOn ","routine"," ","blood examination",", ","blood counts"," and ","serum chemistries"," were found to be ","normal",".\n","Arterial blood gas analysis"," and ","echocardiography"," showed ","no important abnormalities",".\n","Pulmonary function tests"," (","PFT",") showed a ","mild"," ","restrictive ventilatory defect",", with a ","reduced"," ","total lung capacity"," of ","79%"," (","5.94\u2009L","), ","forced vital capacity"," of ","80%"," (","4.18\u2009L",") and a ","forced expiratory volume in one second"," of ","83%"," (","3.72\u2009L",").\nThe ","sputum"," was ","negative"," for ","acid-alcohol resistant bacillus"," and ","human immunodeficiency virus testing"," was ","negative"," as well.\nThe ","chest plain films"," revealed a ","diffuse"," ","symmetric"," ","dense"," ","bilateral"," ","micronodular pattern"," (Figure 1).\nBased on this finding, ","HRCT scan"," was obtained, revealing diffuse ","ground glass attenuation"," and ","septal thickening",", more pronounced in ","lower pulmonary regions",", with ","calcifications"," along the ","interlobar septa"," and ","subpleural regions",".\n","Subpleural"," ","cysts"," were also noticed (Figure 2).\nThe patient underwent a ","fiberoptic bronchoscopy"," with ","bronchoalveolar lavage"," and ","transbronchial"," ","lung"," ","biopsy",".\nThe ","lavage fluid"," was ","negative"," for ","tuberculosis"," or ","fungi",".\n","Microliths"," were not found.\n","Histology"," revealed ","round",", ","concentrically laminated"," ","microliths"," in the ","alveoli"," associated with ","slightly"," ","thickened interstitial septa",", consistent with the diagnosis of ","PAM",".\n"],"ner_labels":[0,5,0,65,0,13,0,32,0,22,0,69,0,22,0,69,0,24,0,24,0,12,0,22,0,69,0,69,0,12,0,24,0,69,0,69,0,39,0,26,0,22,0,24,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,63,0,69,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,12,0,42,0,24,0,24,0,42,0,24,0,22,0,22,0,73,0,12,0,69,0,24,0,69,0,69,0,12,0,69,0,12,0,12,0,12,0,69,0,24,0,24,0,12,0,12,0,24,0,12,0,42,0,24,0,24,0,69,0,24,0,67,0,22,0,69,0,12,0,63,0,69,0,26,0]}
-{"full_text":"A 48-year-old man presented at our hospital complaining of intracranial bruits.\nThe cranial nerve and laboratory examinations were normal.\nA DVAF was considered, conventional digital subtraction angiography was performed, which showed a Cognard II DVAF in the location of right hypoglossal canal (HC).\nThe DVAF was fed by the meningeal branches of the bilateral ascending pharyngeal arteries, and the right anterior condylar veins within the hypoglossal canal that was the fistulous point mainly drained into the jugular vein.\nEndovascular treatment was insisted upon by the patient because of the associated intolerable intracranial bruit.\nTreatment was performed by transarterial approach under general anesthesia using a biplane angiographic unit.\nStandard coaxial techniques were used.\nThe guide catheter was navigated into the left ascendingtrawt pharyngeal artery.\nMarathon flow directed catheter (eV3) was subsequently navigated over a Mirage.008 microwire (eV3) to reach as near as possible to the fistula.\nThe microcatheter was flushed with 10 mL of normal saline.\nThe dead space of the microcatheter was subsequently filled with dimethyl sulfoxide (DMSO).\nOnyx-18 was then injected over two minutes to fill the microcatheter and to replace the DMSO in the dead space.\nThe injection was stopped until unwanted flow into branches of the right ascending pharyngeal artery was observed.\nThe follow-up angiogram showed no residual shunt (Figure \u200b1).\nThe intracranial bruits disappeared immediately after the operation.\nFor the toxicity of DMSO, 10 mg dexamethasone was intravenously injected for three days.\nOn the second day after endovascular treatment, the patient complainted of difficulty moving his tongue to the left.\nCranial nerve examination was only significant for a right hypoglossal nerve palsy.\nThe patient was discharged from our hospital four days after treatment without continuative pharmacotherapy.\nAt two months follow-up, the patient's main complaint were difficulty swallowing (dysphagia) and slurred speech (dysarthria).\nIn addition, his tongue deviated toward the right during tongue protrusion, and marked right-sided hemiatrophy was observed (Figure \u200b2).\nThe cranial nerve examation showed right hypoglossal nerve palsy persisted.\nWe telephone the patient at three months follow-up and requested a vocal cord evaluation by an ENT specialist in a local hospital.\nVocal cord paralysis was not found, and there was no evidence of vagus nerve dysfunction.\nOral Vitamin B12 was used and his prognosis was still at a long follow-up.\n","ner_info":[{"text":"48-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":35,"end":43},{"text":"intracranial","label":"BIOLOGICAL_STRUCTURE","start":59,"end":71},{"text":"bruits","label":"SIGN_SYMPTOM","start":72,"end":78},{"text":"cranial nerve","label":"DIAGNOSTIC_PROCEDURE","start":84,"end":97},{"text":"laboratory examinations","label":"DIAGNOSTIC_PROCEDURE","start":102,"end":125},{"text":"normal","label":"LAB_VALUE","start":131,"end":137},{"text":"DVAF","label":"DISEASE_DISORDER","start":141,"end":145},{"text":"conventional digital subtraction angiography","label":"DIAGNOSTIC_PROCEDURE","start":162,"end":206},{"text":"Cognard II DVAF","label":"DISEASE_DISORDER","start":237,"end":252},{"text":"right hypoglossal canal","label":"BIOLOGICAL_STRUCTURE","start":272,"end":295},{"text":"HC","label":"BIOLOGICAL_STRUCTURE","start":297,"end":299},{"text":"DVAF","label":"COREFERENCE","start":306,"end":310},{"text":"meningeal branches","label":"BIOLOGICAL_STRUCTURE","start":326,"end":344},{"text":"bilateral ascending pharyngeal arteries","label":"BIOLOGICAL_STRUCTURE","start":352,"end":391},{"text":"right anterior condylar veins","label":"BIOLOGICAL_STRUCTURE","start":401,"end":430},{"text":"hypoglossal canal","label":"BIOLOGICAL_STRUCTURE","start":442,"end":459},{"text":"fistulous point","label":"SIGN_SYMPTOM","start":473,"end":488},{"text":"drained into the jugular vein","label":"DETAILED_DESCRIPTION","start":496,"end":525},{"text":"Endovascular 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navigated","label":"THERAPEUTIC_PROCEDURE","start":871,"end":935},{"text":"fistula","label":"SIGN_SYMPTOM","start":1006,"end":1013},{"text":"microcatheter was flushed","label":"THERAPEUTIC_PROCEDURE","start":1019,"end":1044},{"text":"10 mL","label":"VOLUME","start":1050,"end":1055},{"text":"normal saline","label":"BIOLOGICAL_STRUCTURE","start":1059,"end":1072},{"text":"microcatheter was subsequently filled","label":"THERAPEUTIC_PROCEDURE","start":1096,"end":1133},{"text":"dimethyl sulfoxide","label":"MEDICATION","start":1139,"end":1157},{"text":"Onyx-18","label":"MEDICATION","start":1166,"end":1173},{"text":"injected","label":"THERAPEUTIC_PROCEDURE","start":1183,"end":1191},{"text":"two minutes","label":"DURATION","start":1197,"end":1208},{"text":"injection was stopped","label":"THERAPEUTIC_PROCEDURE","start":1282,"end":1303},{"text":"follow-up","label":"DETAILED_DESCRIPTION","start":1397,"end":1406},{"text":"angiogram","label":"DIAGNOSTIC_PROCEDURE","start":1407,"end":1416},{"text":"residual shunt","label":"SIGN_SYMPTOM","start":1427,"end":1441},{"text":"intracranial","label":"BIOLOGICAL_STRUCTURE","start":1459,"end":1471},{"text":"bruits","label":"SIGN_SYMPTOM","start":1472,"end":1478},{"text":"10 mg","label":"DOSAGE","start":1550,"end":1555},{"text":"dexamethasone","label":"MEDICATION","start":1556,"end":1569},{"text":"intravenously injected","label":"ADMINISTRATION","start":1574,"end":1596},{"text":"three days","label":"DURATION","start":1601,"end":1611},{"text":"second day after endovascular treatment","label":"DATE","start":1620,"end":1659},{"text":"difficulty moving his tongue","label":"SIGN_SYMPTOM","start":1688,"end":1716},{"text":"Cranial nerve","label":"BIOLOGICAL_STRUCTURE","start":1730,"end":1743},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":1744,"end":1755},{"text":"right hypoglossal nerve palsy","label":"SIGN_SYMPTOM","start":1783,"end":1812},{"text":"discharged","label":"CLINICAL_EVENT","start":1830,"end":1840},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1850,"end":1858},{"text":"four days after treatment","label":"DATE","start":1859,"end":1884},{"text":"continuative pharmacotherapy","label":"MEDICATION","start":1893,"end":1921},{"text":"two months follow-up","label":"DATE","start":1926,"end":1946},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":2005,"end":2014},{"text":"dysarthria","label":"SIGN_SYMPTOM","start":2036,"end":2046},{"text":"tongue deviated toward the right","label":"LAB_VALUE","start":2066,"end":2098},{"text":"tongue protrusion","label":"DIAGNOSTIC_PROCEDURE","start":2106,"end":2123},{"text":"marked","label":"DETAILED_DESCRIPTION","start":2129,"end":2135},{"text":"right-sided","label":"DETAILED_DESCRIPTION","start":2136,"end":2147},{"text":"hemiatrophy","label":"SIGN_SYMPTOM","start":2148,"end":2159},{"text":"cranial nerve","label":"BIOLOGICAL_STRUCTURE","start":2190,"end":2203},{"text":"examation","label":"DIAGNOSTIC_PROCEDURE","start":2204,"end":2213},{"text":"right hypoglossal nerve palsy","label":"COREFERENCE","start":2221,"end":2250},{"text":"three months follow-up","label":"DATE","start":2290,"end":2312},{"text":"vocal cord evaluation","label":"DIAGNOSTIC_PROCEDURE","start":2329,"end":2350},{"text":"ENT specialist","label":"SUBJECT","start":2357,"end":2371},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":2377,"end":2391},{"text":"Vocal cord","label":"BIOLOGICAL_STRUCTURE","start":2393,"end":2403},{"text":"paralysis","label":"SIGN_SYMPTOM","start":2404,"end":2413},{"text":"vagus nerve","label":"BIOLOGICAL_STRUCTURE","start":2458,"end":2469},{"text":"dysfunction","label":"SIGN_SYMPTOM","start":2470,"end":2481},{"text":"Oral Vitamin B12","label":"MEDICATION","start":2483,"end":2499},{"text":"follow-up","label":"CLINICAL_EVENT","start":2547,"end":2556}],"tokens":["A ","48-year-old"," ","man"," ","presented"," at our ","hospital"," complaining of ","intracranial"," ","bruits",".\nThe ","cranial nerve"," and ","laboratory examinations"," were ","normal",".\nA ","DVAF"," was considered, ","conventional digital subtraction angiography"," was performed, which showed a ","Cognard II DVAF"," in the location of ","right hypoglossal canal"," (","HC",").\nThe ","DVAF"," was fed by the ","meningeal branches"," of the ","bilateral ascending pharyngeal arteries",", and the ","right anterior condylar veins"," within the ","hypoglossal canal"," that was the ","fistulous point"," mainly ","drained into the jugular vein",".\n","Endovascular treatment"," was insisted upon by the patient because of the associated ","intolerable"," ","intracranial"," ","bruit",".\nTreatment was performed by ","transarterial approach"," under ","general anesthesia"," using a ","biplane angiographic unit",".\n","Standard coaxial techniques"," were used.\nThe ","guide catheter was navigated"," into the ","left ascendingtrawt pharyngeal artery",".\n","Marathon flow directed catheter (eV3) was subsequently navigated"," over a Mirage.008 microwire (eV3) to reach as near as possible to the ","fistula",".\nThe ","microcatheter was flushed"," with ","10 mL"," of ","normal saline",".\nThe dead space of the ","microcatheter was subsequently filled"," with ","dimethyl sulfoxide"," (DMSO).\n","Onyx-18"," was then ","injected"," over ","two minutes"," to fill the microcatheter and to replace the DMSO in the dead space.\nThe ","injection was stopped"," until unwanted flow into branches of the right ascending pharyngeal artery was observed.\nThe ","follow-up"," ","angiogram"," showed no ","residual shunt"," (Figure \u200b1).\nThe ","intracranial"," ","bruits"," disappeared immediately after the operation.\nFor the toxicity of DMSO, ","10 mg"," ","dexamethasone"," was ","intravenously injected"," for ","three days",".\nOn the ","second day after endovascular treatment",", the patient complainted of ","difficulty moving his tongue"," to the left.\n","Cranial nerve"," ","examination"," was only significant for a ","right hypoglossal nerve palsy",".\nThe patient was ","discharged"," from our ","hospital"," ","four days after treatment"," without ","continuative pharmacotherapy",".\nAt ","two months follow-up",", the patient's main complaint were difficulty swallowing (","dysphagia",") and slurred speech (","dysarthria",").\nIn addition, his ","tongue deviated toward the right"," during ","tongue protrusion",", and ","marked"," ","right-sided"," ","hemiatrophy"," was observed (Figure \u200b2).\nThe ","cranial nerve"," ","examation"," showed ","right hypoglossal nerve palsy"," persisted.\nWe telephone the patient at ","three months follow-up"," and requested a ","vocal cord evaluation"," by an ","ENT specialist"," in a ","local hospital",".\n","Vocal cord"," ","paralysis"," was not found, and there was no evidence of ","vagus nerve"," ","dysfunction",".\n","Oral Vitamin B12"," was used and his prognosis was still at a long ","follow-up",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,12,0,69,0,24,0,24,0,42,0,26,0,24,0,26,0,12,0,12,0,18,0,12,0,12,0,12,0,12,0,69,0,22,0,75,0,22,0,12,0,18,0,75,0,46,0,75,0,75,0,75,0,12,0,75,0,69,0,75,0,79,0,12,0,75,0,46,0,46,0,75,0,32,0,75,0,22,0,24,0,69,0,12,0,69,0,29,0,46,0,4,0,32,0,19,0,69,0,12,0,24,0,69,0,13,0,48,0,19,0,46,0,19,0,69,0,69,0,42,0,24,0,22,0,22,0,69,0,12,0,24,0,18,0,19,0,24,0,71,0,48,0,12,0,69,0,12,0,69,0,46,0,13,0]}
-{"full_text":"A 41-year-old man with weight loss, nausea, vomiting, and abdominal pain was referred for an abdominal CT scan to rule out intraabdominal pathology.\nA dedicated CT of the abdomen was performed at our institution according to our standard venous phase protocol.\nFollowing ingestion of positive oral contrast material (barium sulfate suspension 2.1% w\/v, Mallinckrodt) and injection of 125\u2009ml of iopromide, 300\u2009mg\u2009I\/mL (Ultravist, Bayer HealthCare), helical CT was obtained with a 65-s delays using a 64-slice GE Lightspeed VCT scanner (GE Medical Systems; Milwaukee, WI).\nAxial sections of the abdomen showed a large (18\u00d722\u00d722 cm) heterogeneous retroperitoneal mass probably arising from the left adrenal gland containing multiple areas of macroscopic fat (Fig.1).\nThe patient had no documented clinical or laboratory evidence of adrenal hormonal excess.\nOn the basis of the clinical history and CT findings, the patient underwent surgical resection of the left adrenal mass, which was found on pathologic examination to represent a low-grade adrenocortical carcinoma.\n","ner_info":[{"text":"41-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"weight loss","label":"SIGN_SYMPTOM","start":23,"end":34},{"text":"nausea","label":"SIGN_SYMPTOM","start":36,"end":42},{"text":"vomiting","label":"SIGN_SYMPTOM","start":44,"end":52},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":58,"end":67},{"text":"pain","label":"SIGN_SYMPTOM","start":68,"end":72},{"text":"referred","label":"CLINICAL_EVENT","start":77,"end":85},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":93,"end":102},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":103,"end":110},{"text":"intraabdominal pathology","label":"DISEASE_DISORDER","start":123,"end":147},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":161,"end":163},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":171,"end":178},{"text":"institution","label":"NONBIOLOGICAL_LOCATION","start":200,"end":211},{"text":"standard venous phase protocol","label":"DETAILED_DESCRIPTION","start":229,"end":259},{"text":"ingestion","label":"ADMINISTRATION","start":271,"end":280},{"text":"positive oral contrast","label":"DIAGNOSTIC_PROCEDURE","start":284,"end":306},{"text":"barium sulfate suspension","label":"MEDICATION","start":317,"end":342},{"text":"2.1% w\/v","label":"DOSAGE","start":343,"end":351},{"text":"Mallinckrodt","label":"DETAILED_DESCRIPTION","start":353,"end":365},{"text":"injection","label":"ADMINISTRATION","start":371,"end":380},{"text":"125\u2009ml","label":"DOSAGE","start":384,"end":390},{"text":"iopromide","label":"MEDICATION","start":394,"end":403},{"text":"300\u2009mg\u2009I\/mL","label":"DOSAGE","start":405,"end":416},{"text":"Ultravist, Bayer HealthCare","label":"DETAILED_DESCRIPTION","start":418,"end":445},{"text":"helical","label":"DETAILED_DESCRIPTION","start":448,"end":455},{"text":"CT","label":"COREFERENCE","start":456,"end":458},{"text":"65-s delay","label":"DETAILED_DESCRIPTION","start":479,"end":489},{"text":"64-slice GE Lightspeed VCT scanner","label":"DETAILED_DESCRIPTION","start":499,"end":533},{"text":"GE Medical Systems; Milwaukee, WI","label":"DETAILED_DESCRIPTION","start":535,"end":568},{"text":"Axial sections","label":"DIAGNOSTIC_PROCEDURE","start":571,"end":585},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":593,"end":600},{"text":"large","label":"LAB_VALUE","start":610,"end":615},{"text":"18\u00d722\u00d722 cm","label":"VOLUME","start":617,"end":628},{"text":"heterogeneous","label":"DETAILED_DESCRIPTION","start":630,"end":643},{"text":"retroperitoneal","label":"BIOLOGICAL_STRUCTURE","start":644,"end":659},{"text":"mass","label":"SIGN_SYMPTOM","start":660,"end":664},{"text":"left adrenal gland","label":"BIOLOGICAL_STRUCTURE","start":691,"end":709},{"text":"multiple areas of macroscopic fat","label":"DETAILED_DESCRIPTION","start":721,"end":754},{"text":"no documented clinical or laboratory evidence of adrenal hormonal excess","label":"HISTORY","start":780,"end":852},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":930,"end":948},{"text":"left adrenal","label":"BIOLOGICAL_STRUCTURE","start":956,"end":968},{"text":"mass","label":"SIGN_SYMPTOM","start":969,"end":973},{"text":"pathologic examination","label":"DIAGNOSTIC_PROCEDURE","start":994,"end":1016},{"text":"low-grade","label":"SEVERITY","start":1032,"end":1041},{"text":"adrenocortical carcinoma","label":"DISEASE_DISORDER","start":1042,"end":1066}],"tokens":["A ","41-year-old"," ","man"," with ","weight loss",", ","nausea",", ","vomiting",", and ","abdominal"," ","pain"," was ","referred"," for an ","abdominal"," ","CT scan"," to rule out ","intraabdominal pathology",".\nA dedicated ","CT"," of the ","abdomen"," was performed at our ","institution"," according to our ","standard venous phase protocol",".\nFollowing ","ingestion"," of ","positive oral contrast"," material (","barium sulfate suspension"," ","2.1% w\/v",", ","Mallinckrodt",") and ","injection"," of ","125\u2009ml"," of ","iopromide",", ","300\u2009mg\u2009I\/mL"," (","Ultravist, Bayer HealthCare","), ","helical"," ","CT"," was obtained with a ","65-s delay","s using a ","64-slice GE Lightspeed VCT scanner"," (","GE Medical Systems; Milwaukee, WI",").\n","Axial sections"," of the ","abdomen"," showed a ","large"," (","18\u00d722\u00d722 cm",") ","heterogeneous"," ","retroperitoneal"," ","mass"," probably arising from the ","left adrenal gland"," containing ","multiple areas of macroscopic fat"," (Fig.1).\nThe patient had ","no documented clinical or laboratory evidence of adrenal hormonal excess",".\nOn the basis of the clinical history and CT findings, the patient underwent ","surgical resection"," of the ","left adrenal"," ","mass",", which was found on ","pathologic examination"," to represent a ","low-grade"," ","adrenocortical carcinoma",".\n"],"ner_labels":[0,5,0,65,0,69,0,69,0,69,0,12,0,69,0,13,0,12,0,24,0,26,0,24,0,12,0,48,0,22,0,4,0,24,0,46,0,29,0,22,0,4,0,29,0,46,0,29,0,22,0,22,0,18,0,22,0,22,0,22,0,24,0,12,0,42,0,79,0,22,0,12,0,69,0,12,0,22,0,39,0,75,0,12,0,69,0,24,0,63,0,26,0]}
-{"full_text":"A 48 year-old female presented with vaginal bleeding and abnormal Pap smears.\nUpon diagnosis of invasive non-keratinizing SCC of the cervix, she underwent a radical hysterectomy with salpingo-oophorectomy which demonstrated positive spread to the pelvic lymph nodes and the parametrium.\nPathological examination revealed that the tumour also extensively involved the lower uterine segment.\n5 months after this surgery, the woman underwent external beam radiotherapy and intracavitary brachytherapy.\nTwo years later, the patient presented with a three-month history of a productive cough, shortness of breath, and a 2-3 week history of progressive exertional dyspnea.\nX-rays of the chest demonstrated a reticular nodular pattern, and CT scans revealed multiple bilateral patchy areas of ground glass opacity scarring with focal areas of subsegmental atelectasis within both lungs.\nA differential diagnosis included interstitial pneumonia versus non-cardiogenic edema.\nThe woman underwent a bronchoscopy, left thoracoscopy, and an open wedge left lung biopsy.\nPathological examination of the left lung biopsy confirmed the presence of neoplastic sheets of cells classically distributed along the septal vessels, perivascular, peribronchial, and subpleural lymphatics.\nSubpleural nodules were also identified with the presence of neoplastic cells distending the subpleural lymphatics confirming LC (Figures 1A, 1B, 1C).\nOn immunohistochemical analysis, the lesional cells were strongly positive to p16 (Figure 1D), high and low molecular weight keratins (Figure 1E), cytokeratin-7 (CK7) (Figure 1F), CK19, and pan keratin, and negative to CK20, p63, and EGFR.\nBased on these findings, she was diagnosed to have lymphangitic carcinomatosis in the lung metastatic from SCC of the cervix.\nShe was started on chemotherapy (Carbo\/Taxol) with corticosteroids while in the hospital, and was discharged ten days later.\nPost-treatment improvement of clinical symptoms was paralleled by radiographic imaging that showed marked interval improvement of the nodular opacifications and the interstitial thickening that had previously been noted.\nDespite this improvement, she subsequently died 13 months after the initial diagnosis.\n","ner_info":[{"text":"48 year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":21,"end":30},{"text":"vaginal","label":"BIOLOGICAL_STRUCTURE","start":36,"end":43},{"text":"bleeding","label":"SIGN_SYMPTOM","start":44,"end":52},{"text":"abnormal","label":"LAB_VALUE","start":57,"end":65},{"text":"Pap smears","label":"DIAGNOSTIC_PROCEDURE","start":66,"end":76},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":96,"end":104},{"text":"non-keratinizing","label":"DETAILED_DESCRIPTION","start":105,"end":121},{"text":"SCC","label":"DISEASE_DISORDER","start":122,"end":125},{"text":"cervix","label":"BIOLOGICAL_STRUCTURE","start":133,"end":139},{"text":"radical","label":"DETAILED_DESCRIPTION","start":157,"end":164},{"text":"hysterectomy","label":"THERAPEUTIC_PROCEDURE","start":165,"end":177},{"text":"salpingo-oophorectomy","label":"THERAPEUTIC_PROCEDURE","start":183,"end":204},{"text":"positive spread","label":"SIGN_SYMPTOM","start":224,"end":239},{"text":"pelvic lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":247,"end":265},{"text":"parametrium","label":"BIOLOGICAL_STRUCTURE","start":274,"end":285},{"text":"Pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":287,"end":311},{"text":"tumour","label":"COREFERENCE","start":330,"end":336},{"text":"lower uterine segment","label":"BIOLOGICAL_STRUCTURE","start":367,"end":388},{"text":"5 months after this surgery","label":"DATE","start":390,"end":417},{"text":"external beam","label":"DETAILED_DESCRIPTION","start":439,"end":452},{"text":"radiotherapy","label":"THERAPEUTIC_PROCEDURE","start":453,"end":465},{"text":"intracavitary","label":"DETAILED_DESCRIPTION","start":470,"end":483},{"text":"brachytherapy","label":"THERAPEUTIC_PROCEDURE","start":484,"end":497},{"text":"Two years later","label":"DATE","start":499,"end":514},{"text":"three-month","label":"DURATION","start":545,"end":556},{"text":"productive","label":"DETAILED_DESCRIPTION","start":570,"end":580},{"text":"cough","label":"SIGN_SYMPTOM","start":581,"end":586},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":588,"end":607},{"text":"2-3 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lungs","label":"BIOLOGICAL_STRUCTURE","start":868,"end":878},{"text":"interstitial","label":"DETAILED_DESCRIPTION","start":914,"end":926},{"text":"pneumonia","label":"DISEASE_DISORDER","start":927,"end":936},{"text":"non-cardiogenic","label":"DETAILED_DESCRIPTION","start":944,"end":959},{"text":"edema","label":"SIGN_SYMPTOM","start":960,"end":965},{"text":"bronchoscopy","label":"DIAGNOSTIC_PROCEDURE","start":989,"end":1001},{"text":"left","label":"DETAILED_DESCRIPTION","start":1003,"end":1007},{"text":"thoracoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1008,"end":1020},{"text":"open wedge","label":"DETAILED_DESCRIPTION","start":1029,"end":1039},{"text":"left lung","label":"BIOLOGICAL_STRUCTURE","start":1040,"end":1049},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1050,"end":1056},{"text":"Pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":1058,"end":1082},{"text":"left lung","label":"BIOLOGICAL_STRUCTURE","start":1090,"end":1099},{"text":"biopsy","label":"COREFERENCE","start":1100,"end":1106},{"text":"neoplastic sheets of cells","label":"SIGN_SYMPTOM","start":1133,"end":1159},{"text":"along the septal vessels","label":"BIOLOGICAL_STRUCTURE","start":1184,"end":1208},{"text":"perivascular","label":"BIOLOGICAL_STRUCTURE","start":1210,"end":1222},{"text":"peribronchial","label":"BIOLOGICAL_STRUCTURE","start":1224,"end":1237},{"text":"subpleural","label":"BIOLOGICAL_STRUCTURE","start":1243,"end":1253},{"text":"lymphatics","label":"BIOLOGICAL_STRUCTURE","start":1254,"end":1264},{"text":"Subpleural","label":"BIOLOGICAL_STRUCTURE","start":1266,"end":1276},{"text":"nodules","label":"SIGN_SYMPTOM","start":1277,"end":1284},{"text":"neoplastic cells","label":"COREFERENCE","start":1327,"end":1343},{"text":"subpleural lymphatics","label":"BIOLOGICAL_STRUCTURE","start":1359,"end":1380},{"text":"LC","label":"DISEASE_DISORDER","start":1392,"end":1394},{"text":"immunohistochemical analysis","label":"DIAGNOSTIC_PROCEDURE","start":1420,"end":1448},{"text":"lesional cells","label":"COREFERENCE","start":1454,"end":1468},{"text":"positive","label":"LAB_VALUE","start":1483,"end":1491},{"text":"p16","label":"DIAGNOSTIC_PROCEDURE","start":1495,"end":1498},{"text":"high and low molecular weight keratins","label":"DIAGNOSTIC_PROCEDURE","start":1512,"end":1550},{"text":"cytokeratin-7","label":"DIAGNOSTIC_PROCEDURE","start":1564,"end":1577},{"text":"CK7","label":"DIAGNOSTIC_PROCEDURE","start":1579,"end":1582},{"text":"CK19","label":"DIAGNOSTIC_PROCEDURE","start":1597,"end":1601},{"text":"pan keratin","label":"DIAGNOSTIC_PROCEDURE","start":1607,"end":1618},{"text":"negative","label":"LAB_VALUE","start":1624,"end":1632},{"text":"CK20","label":"DIAGNOSTIC_PROCEDURE","start":1636,"end":1640},{"text":"p63","label":"DIAGNOSTIC_PROCEDURE","start":1642,"end":1645},{"text":"EGFR","label":"DIAGNOSTIC_PROCEDURE","start":1651,"end":1655},{"text":"lymphangitic carcinomatosis","label":"DISEASE_DISORDER","start":1708,"end":1735},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":1743,"end":1747},{"text":"metastatic","label":"SIGN_SYMPTOM","start":1748,"end":1758},{"text":"SCC","label":"DISEASE_DISORDER","start":1764,"end":1767},{"text":"cervix","label":"BIOLOGICAL_STRUCTURE","start":1775,"end":1781},{"text":"chemotherapy","label":"MEDICATION","start":1802,"end":1814},{"text":"Carbo","label":"MEDICATION","start":1816,"end":1821},{"text":"Taxol","label":"MEDICATION","start":1822,"end":1827},{"text":"corticosteroids","label":"MEDICATION","start":1834,"end":1849},{"text":"discharged","label":"CLINICAL_EVENT","start":1881,"end":1891},{"text":"ten days later","label":"DATE","start":1892,"end":1906},{"text":"improvement","label":"LAB_VALUE","start":1923,"end":1934},{"text":"clinical symptoms","label":"SIGN_SYMPTOM","start":1938,"end":1955},{"text":"radiographic imaging","label":"DIAGNOSTIC_PROCEDURE","start":1974,"end":1994},{"text":"improvement","label":"LAB_VALUE","start":2023,"end":2034},{"text":"nodular opacifications","label":"SIGN_SYMPTOM","start":2042,"end":2064},{"text":"interstitial thickening","label":"SIGN_SYMPTOM","start":2073,"end":2096},{"text":"died","label":"OUTCOME","start":2172,"end":2176},{"text":"13 months after the initial diagnosis","label":"DATE","start":2177,"end":2214}],"tokens":["A ","48 year-old"," ","female"," ","presented"," with ","vaginal"," ","bleeding"," and ","abnormal"," ","Pap smears",".\nUpon diagnosis of ","invasive"," ","non-keratinizing"," ","SCC"," of the ","cervix",", she underwent a ","radical"," ","hysterectomy"," with ","salpingo-oophorectomy"," which demonstrated ","positive spread"," to the ","pelvic lymph nodes"," and the ","parametrium",".\n","Pathological examination"," revealed that the ","tumour"," also extensively involved the ","lower uterine segment",".\n","5 months after this surgery",", the woman underwent ","external beam"," ","radiotherapy"," and ","intracavitary"," ","brachytherapy",".\n","Two years later",", the patient presented with a ","three-month"," history of a ","productive"," ","cough",", ","shortness of breath",", and a ","2-3 week"," history of ","progressive"," ","exertional"," ","dyspnea",".\n","X-rays"," of the ","chest"," demonstrated a ","reticular nodular pattern",", and ","CT scans"," revealed multiple ","bilateral patchy areas"," of ","ground glass opacity"," ","scarring"," with focal areas of ","subsegmental"," ","atelectasis"," within ","both lungs",".\nA differential diagnosis included ","interstitial"," ","pneumonia"," versus ","non-cardiogenic"," ","edema",".\nThe woman underwent a ","bronchoscopy",", ","left"," ","thoracoscopy",", and an ","open wedge"," ","left lung"," ","biopsy",".\n","Pathological examination"," of the ","left lung"," ","biopsy"," confirmed the presence of ","neoplastic sheets of cells"," classically distributed ","along the septal vessels",", ","perivascular",", ","peribronchial",", and ","subpleural"," ","lymphatics",".\n","Subpleural"," ","nodules"," were also identified with the presence of ","neoplastic cells"," distending the ","subpleural lymphatics"," confirming ","LC"," (Figures 1A, 1B, 1C).\nOn ","immunohistochemical analysis",", the ","lesional cells"," were strongly ","positive"," to ","p16"," (Figure 1D), ","high and low molecular weight keratins"," (Figure 1E), ","cytokeratin-7"," (","CK7",") (Figure 1F), ","CK19",", and ","pan keratin",", and ","negative"," to ","CK20",", ","p63",", and ","EGFR",".\nBased on these findings, she was diagnosed to have ","lymphangitic carcinomatosis"," in the ","lung"," ","metastatic"," from ","SCC"," of the ","cervix",".\nShe was started on ","chemotherapy"," (","Carbo","\/","Taxol",") with ","corticosteroids"," while in the hospital, and was ","discharged"," ","ten days later",".\nPost-treatment ","improvement"," of ","clinical symptoms"," was paralleled by ","radiographic imaging"," that showed marked interval ","improvement"," of the ","nodular opacifications"," and the ","interstitial thickening"," that had previously been noted.\nDespite this improvement, she subsequently ","died"," ","13 months after the initial diagnosis",".\n"],"ner_labels":[0,5,0,65,0,13,0,12,0,69,0,42,0,24,0,22,0,22,0,26,0,12,0,22,0,75,0,75,0,69,0,12,0,12,0,24,0,18,0,12,0,19,0,22,0,75,0,22,0,75,0,19,0,32,0,22,0,69,0,69,0,32,0,22,0,22,0,69,0,24,0,12,0,42,0,24,0,22,0,73,0,69,0,22,0,69,0,12,0,22,0,26,0,22,0,69,0,24,0,22,0,24,0,22,0,12,0,24,0,24,0,12,0,18,0,69,0,12,0,12,0,12,0,12,0,12,0,12,0,69,0,18,0,12,0,26,0,24,0,18,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,26,0,12,0,69,0,26,0,12,0,46,0,46,0,46,0,46,0,13,0,19,0,42,0,69,0,24,0,42,0,69,0,69,0,56,0,19,0]}
-{"full_text":"A 27 years old, male, right handed, was admitted for a 2 years history of very frequent gelastic seizures.\nThe patient described aura\u2013like symptoms: especially warmth throughout the face and dizziness that preceded the seizure and he denied any affective connotation.\nSome of the seizures consisted only of a brief period of laughter without any motor involvement, but a typical seizure would consist of sudden laughter accompanied by simple motor partial seizures in both arms, more often being involved his left arm, without impairment of his consciousness state, which lasted less than 1 minute.\nHe had no previous past medical or social history other than being a smoker: 10\u201315 cigarettes per day.\nThe frequency of the seizures was initially low, but increased progressively over time to about 8\u201310 seizures\/day, despite anti\u2013epileptic treatment \u2013 at the time of admission he was taking Keppra \u2013 Levetiracetam 3 x 250 mg\/day and Phenytoin 3 x 100 mg\/day.\nWith the Neurology Electrophysiology Department assistance we have been able to record a couple of seizures on the Video\u2013EEG His neurological examination was normal.\nDiagnosis was made on native CT scan: minimal hypodense frontal right paramedian lesion (Figure 1A), cerebral MRI (Figure 1 B\u2013F) showed a small right parenchymal homogeneous lesion 16\/22\/15mm, well delimited, involving gyrus cinguli, without perilesional edema and mass effect, hyperintense both on T1 and T2 MR sequences, non\u2013enhancing after Gadolinium.\nThe cerebral lesion was also documented on EEG and video\u2013EEG recordings: 3 seizures with medio\u2013frontal origin and rare interictal epileptiform elements were recorded (Figure 1I)\nUsing an interhemispheric microsurgical approach, above the corpus callosum and the right pericallosal artery, at the level of gyrus cinguli, a yellow\u2013gray, infiltrative tumour, having a moderate vascularisation had been identified and totally removed.\nThe anatomo\u2013pathological analysis revealed a grade \u2161 astrocytoma.\nThe patient recovered very well, without deficits, no gelastic seizures or epileptic manifestations; three months after operation he is still free of seizures.\nA control postop CT revealed no tumor (1 G, H)\n","ner_info":[{"text":"27 years old","label":"AGE","start":2,"end":14},{"text":"male","label":"SEX","start":16,"end":20},{"text":"right handed","label":"HISTORY","start":22,"end":34},{"text":"admitted","label":"CLINICAL_EVENT","start":40,"end":48},{"text":"2 years","label":"DURATION","start":55,"end":62},{"text":"very frequent gelastic seizures","label":"HISTORY","start":74,"end":105},{"text":"aura\u2013like symptoms","label":"SIGN_SYMPTOM","start":129,"end":147},{"text":"warmth","label":"SIGN_SYMPTOM","start":160,"end":166},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":182,"end":186},{"text":"dizziness","label":"SIGN_SYMPTOM","start":191,"end":200},{"text":"seizure","label":"SIGN_SYMPTOM","start":219,"end":226},{"text":"affective connotation","label":"SIGN_SYMPTOM","start":245,"end":266},{"text":"Some","label":"DETAILED_DESCRIPTION","start":268,"end":272},{"text":"seizures","label":"SIGN_SYMPTOM","start":280,"end":288},{"text":"brief","label":"DETAILED_DESCRIPTION","start":309,"end":314},{"text":"laughter","label":"SIGN_SYMPTOM","start":325,"end":333},{"text":"motor involvement","label":"SIGN_SYMPTOM","start":346,"end":363},{"text":"seizure","label":"SIGN_SYMPTOM","start":379,"end":386},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":404,"end":410},{"text":"laughter","label":"SIGN_SYMPTOM","start":411,"end":419},{"text":"simple motor partial seizures","label":"SIGN_SYMPTOM","start":435,"end":464},{"text":"both arms","label":"BIOLOGICAL_STRUCTURE","start":468,"end":477},{"text":"left arm","label":"BIOLOGICAL_STRUCTURE","start":509,"end":517},{"text":"impairment of his consciousness state","label":"SIGN_SYMPTOM","start":527,"end":564},{"text":"less than 1 minute","label":"DETAILED_DESCRIPTION","start":579,"end":597},{"text":"no previous past medical or social history","label":"HISTORY","start":606,"end":648},{"text":"smoker","label":"HISTORY","start":668,"end":674},{"text":"10\u201315 cigarettes per day","label":"QUANTITATIVE_CONCEPT","start":676,"end":700},{"text":"seizures","label":"SIGN_SYMPTOM","start":723,"end":731},{"text":"initially","label":"DETAILED_DESCRIPTION","start":736,"end":745},{"text":"low","label":"FREQUENCY","start":746,"end":749},{"text":"increased progressively over time","label":"DETAILED_DESCRIPTION","start":755,"end":788},{"text":"8\u201310 seizures\/day","label":"FREQUENCY","start":798,"end":815},{"text":"anti\u2013epileptic treatment","label":"THERAPEUTIC_PROCEDURE","start":825,"end":849},{"text":"admission","label":"CLINICAL_EVENT","start":867,"end":876},{"text":"Keppra","label":"MEDICATION","start":891,"end":897},{"text":"Levetiracetam","label":"MEDICATION","start":900,"end":913},{"text":"3 x 250 mg\/day","label":"DOSAGE","start":914,"end":928},{"text":"Phenytoin","label":"MEDICATION","start":933,"end":942},{"text":"3 x 100 mg\/day","label":"DOSAGE","start":943,"end":957},{"text":"Neurology Electrophysiology Department","label":"NONBIOLOGICAL_LOCATION","start":968,"end":1006},{"text":"assistance","label":"CLINICAL_EVENT","start":1007,"end":1017},{"text":"seizures","label":"SIGN_SYMPTOM","start":1058,"end":1066},{"text":"Video\u2013EEG","label":"DIAGNOSTIC_PROCEDURE","start":1074,"end":1083},{"text":"neurological examination","label":"DIAGNOSTIC_PROCEDURE","start":1088,"end":1112},{"text":"normal","label":"LAB_VALUE","start":1117,"end":1123},{"text":"native","label":"DETAILED_DESCRIPTION","start":1147,"end":1153},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":1154,"end":1161},{"text":"minimal","label":"DETAILED_DESCRIPTION","start":1163,"end":1170},{"text":"hypodense","label":"DETAILED_DESCRIPTION","start":1171,"end":1180},{"text":"frontal right paramedian","label":"BIOLOGICAL_STRUCTURE","start":1181,"end":1205},{"text":"lesion","label":"SIGN_SYMPTOM","start":1206,"end":1212},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":1226,"end":1234},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1235,"end":1238},{"text":"small","label":"DETAILED_DESCRIPTION","start":1263,"end":1268},{"text":"right parenchymal","label":"DETAILED_DESCRIPTION","start":1269,"end":1286},{"text":"homogeneous","label":"DETAILED_DESCRIPTION","start":1287,"end":1298},{"text":"lesion","label":"SIGN_SYMPTOM","start":1299,"end":1305},{"text":"16\/22\/15mm","label":"VOLUME","start":1306,"end":1316},{"text":"well delimited","label":"DETAILED_DESCRIPTION","start":1318,"end":1332},{"text":"gyrus cinguli","label":"BIOLOGICAL_STRUCTURE","start":1344,"end":1357},{"text":"perilesional","label":"DETAILED_DESCRIPTION","start":1367,"end":1379},{"text":"edema","label":"SIGN_SYMPTOM","start":1380,"end":1385},{"text":"mass effect","label":"SIGN_SYMPTOM","start":1390,"end":1401},{"text":"hyperintense both on T1 and T2 MR sequences","label":"DETAILED_DESCRIPTION","start":1403,"end":1446},{"text":"non\u2013enhancing after Gadolinium","label":"DETAILED_DESCRIPTION","start":1448,"end":1478},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":1484,"end":1492},{"text":"lesion","label":"SIGN_SYMPTOM","start":1493,"end":1499},{"text":"EEG","label":"DIAGNOSTIC_PROCEDURE","start":1523,"end":1526},{"text":"video\u2013EEG","label":"DIAGNOSTIC_PROCEDURE","start":1531,"end":1540},{"text":"3","label":"LAB_VALUE","start":1553,"end":1554},{"text":"seizures","label":"SIGN_SYMPTOM","start":1555,"end":1563},{"text":"medio\u2013frontal origin","label":"DETAILED_DESCRIPTION","start":1569,"end":1589},{"text":"rare interictal epileptiform elements","label":"DETAILED_DESCRIPTION","start":1594,"end":1631},{"text":"interhemispheric","label":"BIOLOGICAL_STRUCTURE","start":1667,"end":1683},{"text":"microsurgical approach","label":"THERAPEUTIC_PROCEDURE","start":1684,"end":1706},{"text":"above the corpus callosum","label":"BIOLOGICAL_STRUCTURE","start":1708,"end":1733},{"text":"right pericallosal artery","label":"BIOLOGICAL_STRUCTURE","start":1742,"end":1767},{"text":"gyrus cinguli","label":"BIOLOGICAL_STRUCTURE","start":1785,"end":1798},{"text":"yellow\u2013gray","label":"COLOR","start":1802,"end":1813},{"text":"infiltrative","label":"DETAILED_DESCRIPTION","start":1815,"end":1827},{"text":"tumour","label":"SIGN_SYMPTOM","start":1828,"end":1834},{"text":"moderate","label":"SEVERITY","start":1845,"end":1853},{"text":"vascularisation","label":"DETAILED_DESCRIPTION","start":1854,"end":1869},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":1902,"end":1909},{"text":"anatomo\u2013pathological analysis","label":"DIAGNOSTIC_PROCEDURE","start":1915,"end":1944},{"text":"grade \u2161","label":"LAB_VALUE","start":1956,"end":1963},{"text":"astrocytoma","label":"DISEASE_DISORDER","start":1964,"end":1975},{"text":"recovered","label":"SIGN_SYMPTOM","start":1989,"end":1998},{"text":"deficits","label":"SIGN_SYMPTOM","start":2018,"end":2026},{"text":"gelastic seizures","label":"DISEASE_DISORDER","start":2031,"end":2048},{"text":"epileptic manifestations","label":"SIGN_SYMPTOM","start":2052,"end":2076},{"text":"three months after operation","label":"DATE","start":2078,"end":2106},{"text":"seizures","label":"SIGN_SYMPTOM","start":2127,"end":2135},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2154,"end":2156},{"text":"tumor","label":"SIGN_SYMPTOM","start":2169,"end":2174}],"tokens":["A ","27 years old",", ","male",", ","right handed",", was ","admitted"," for a ","2 years"," history of ","very frequent gelastic seizures",".\nThe patient described ","aura\u2013like symptoms",": especially ","warmth"," throughout the ","face"," and ","dizziness"," that preceded the ","seizure"," and he denied any ","affective connotation",".\n","Some"," of the ","seizures"," consisted only of a ","brief"," period of ","laughter"," without any ","motor involvement",", but a typical ","seizure"," would consist of ","sudden"," ","laughter"," accompanied by ","simple motor partial seizures"," in ","both arms",", more often being involved his ","left arm",", without ","impairment of his consciousness state",", which lasted ","less than 1 minute",".\nHe had ","no previous past medical or social history"," other than being a ","smoker",": ","10\u201315 cigarettes per day",".\nThe frequency of the ","seizures"," was ","initially"," ","low",", but ","increased progressively over time"," to about ","8\u201310 seizures\/day",", despite ","anti\u2013epileptic treatment"," \u2013 at the time of ","admission"," he was taking ","Keppra"," \u2013 ","Levetiracetam"," ","3 x 250 mg\/day"," and ","Phenytoin"," ","3 x 100 mg\/day",".\nWith the ","Neurology Electrophysiology Department"," ","assistance"," we have been able to record a couple of ","seizures"," on the ","Video\u2013EEG"," His ","neurological examination"," was ","normal",".\nDiagnosis was made on ","native"," ","CT scan",": ","minimal"," ","hypodense"," ","frontal right paramedian"," ","lesion"," (Figure 1A), ","cerebral"," ","MRI"," (Figure 1 B\u2013F) showed a ","small"," ","right parenchymal"," ","homogeneous"," ","lesion"," ","16\/22\/15mm",", ","well delimited",", involving ","gyrus cinguli",", without ","perilesional"," ","edema"," and ","mass effect",", ","hyperintense both on T1 and T2 MR sequences",", ","non\u2013enhancing after Gadolinium",".\nThe ","cerebral"," ","lesion"," was also documented on ","EEG"," and ","video\u2013EEG"," recordings: ","3"," ","seizures"," with ","medio\u2013frontal origin"," and ","rare interictal epileptiform elements"," were recorded (Figure 1I)\nUsing an ","interhemispheric"," ","microsurgical approach",", ","above the corpus callosum"," and the ","right pericallosal artery",", at the level of ","gyrus cinguli",", a ","yellow\u2013gray",", ","infiltrative"," ","tumour",", having a ","moderate"," ","vascularisation"," had been identified and totally ","removed",".\nThe ","anatomo\u2013pathological analysis"," revealed a ","grade \u2161"," ","astrocytoma",".\nThe patient ","recovered"," very well, without ","deficits",", no ","gelastic seizures"," or ","epileptic manifestations","; ","three months after operation"," he is still free of ","seizures",".\nA control postop ","CT"," revealed no ","tumor"," (1 G, H)\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,32,0,39,0,69,0,69,0,12,0,69,0,69,0,69,0,22,0,69,0,22,0,69,0,69,0,69,0,22,0,69,0,69,0,12,0,12,0,69,0,22,0,39,0,39,0,62,0,69,0,22,0,35,0,22,0,35,0,75,0,13,0,46,0,46,0,29,0,46,0,29,0,48,0,13,0,69,0,24,0,24,0,42,0,22,0,24,0,22,0,22,0,12,0,69,0,12,0,24,0,22,0,22,0,22,0,69,0,79,0,22,0,12,0,22,0,69,0,69,0,22,0,22,0,12,0,69,0,24,0,24,0,42,0,69,0,22,0,22,0,12,0,75,0,12,0,12,0,12,0,15,0,22,0,69,0,63,0,22,0,75,0,24,0,42,0,26,0,69,0,69,0,26,0,69,0,19,0,69,0,24,0,69,0]}
-{"full_text":"The patient was a 3-year-old girl with the following features of VACTERL association: absent C1 vertebra, supernumerary lumbar vertebrae, hypoplastic sacrum\/coccyx, fatty filum terminale with tethered spinal cord, and three fused ribs; an anorectal malformation including a cloaca consisting of a common urogenital sinus and a duplex vagina with midline septum; type C TE fistula; right renal agenesis with moderate left hydronephrosis and vesicoureteral reflux.\nShe had no cardiac or limb malformations, and no other major organ anomalies.\nBoth she and her father were additionally clinically diagnosed with hypermobile type Ehlers\u2013Danlos syndrome, but family history was otherwise noncontributory.\nThe diagnosis of hypermobile type Ehlers\u2013Danlos was based on the patient\u2019s hypermobility (9\/9 on the Beighton hypermobility scale), very soft, fragile skin with unusual scarring, and poor skin healing.\nSkin biopsy was not performed, but testing on peripheral blood did not reveal mutations associated with other forms of Ehlers\u2013Danlos syndrome.\nMicroarray analysis initially showed a maternally-inherited deletion at 4q35.1 detected with one clone and confirmed by FISH (RP11-173M11).\nSubsequent performance of an 180K custom oligonucleotide microarray (Baylor College of Medicine Medical Genetics Laboratories) refined the deleted region deletion to a maximum size of 1.37 Mb, with karyotype revised to 46,XX,arr cgh 4q35.1q35.2 (187,321-768-188,694-589) 3 1.\nGenes in the deleted region, which contains a number of much smaller copy number variations (CNVs) identified in normal controls, include CYP4V2, KLKB2, F11, MTRNR1A, and FAT1, none of which can be clearly related to her phenotype, especially as her mother, from whom the deletion was inherited, is unaffected.\nEvidence for mitochondrial dysfunction began at 13 months of age with progressive muscle weakness, autonomic dysregulation, hypoglycemic episodes, exocrine pancreatic dysfunction, and decline of gastrointestinal function, eventually leading to total parenteral nutrition dependency due to visceral hyperalgesia, dysmotility, and malabsorption.\nMuscle biopsy showed a mild increase in fiber size variability but no other findings consistent with mitochondrial disease, including via electron microscopy.\nHowever, analysis of electron transport chain (ETC) activity showed normal activity of complexes I, II, and III, but complex IV, or cytochrome c oxidase, activity was 45.4 lmol\/min\/g weight, well below the control range (148.9 +\/\u2212 67.2 lmol\/min\/g weight).\nRepeat ETC analysis in isolated mitochondria confirmed a profound and reproducible complex IV deficiency.\nCitrate synthase activity and content in both ETC analyses were normal, confirming good sample quality and normal mitochondrial content.\nWhole mitochondrial genome sequencing, and sequencing of DNA Polymerase Gamma 1 and 2 (POLG1 and POLG2) and Thymidine Phosphorylase did not reveal abnormalities.\n","ner_info":[{"text":"3-year-old","label":"AGE","start":18,"end":28},{"text":"girl","label":"SEX","start":29,"end":33},{"text":"VACTERL association","label":"DIAGNOSTIC_PROCEDURE","start":65,"end":84},{"text":"absent","label":"DETAILED_DESCRIPTION","start":86,"end":92},{"text":"C1 vertebra","label":"BIOLOGICAL_STRUCTURE","start":93,"end":104},{"text":"supernumerary","label":"DETAILED_DESCRIPTION","start":106,"end":119},{"text":"lumbar vertebrae","label":"BIOLOGICAL_STRUCTURE","start":120,"end":136},{"text":"hypoplastic","label":"DETAILED_DESCRIPTION","start":138,"end":149},{"text":"sacrum","label":"BIOLOGICAL_STRUCTURE","start":150,"end":156},{"text":"coccyx","label":"BIOLOGICAL_STRUCTURE","start":157,"end":163},{"text":"fatty","label":"DETAILED_DESCRIPTION","start":165,"end":170},{"text":"filum terminale","label":"BIOLOGICAL_STRUCTURE","start":171,"end":186},{"text":"tethered","label":"DETAILED_DESCRIPTION","start":192,"end":200},{"text":"spinal cord","label":"BIOLOGICAL_STRUCTURE","start":201,"end":212},{"text":"three","label":"LAB_VALUE","start":218,"end":223},{"text":"fused","label":"DETAILED_DESCRIPTION","start":224,"end":229},{"text":"ribs","label":"BIOLOGICAL_STRUCTURE","start":230,"end":234},{"text":"anorectal malformation","label":"DISEASE_DISORDER","start":239,"end":261},{"text":"cloaca","label":"BIOLOGICAL_STRUCTURE","start":274,"end":280},{"text":"common","label":"DETAILED_DESCRIPTION","start":297,"end":303},{"text":"urogenital sinus","label":"BIOLOGICAL_STRUCTURE","start":304,"end":320},{"text":"duplex","label":"DETAILED_DESCRIPTION","start":327,"end":333},{"text":"vagina","label":"BIOLOGICAL_STRUCTURE","start":334,"end":340},{"text":"midline septum","label":"DETAILED_DESCRIPTION","start":346,"end":360},{"text":"type C","label":"DETAILED_DESCRIPTION","start":362,"end":368},{"text":"TE fistula","label":"DISEASE_DISORDER","start":369,"end":379},{"text":"right 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analysis","label":"DIAGNOSTIC_PROCEDURE","start":2538,"end":2550},{"text":"isolated","label":"DETAILED_DESCRIPTION","start":2554,"end":2562},{"text":"mitochondria","label":"BIOLOGICAL_STRUCTURE","start":2563,"end":2575},{"text":"profound","label":"SEVERITY","start":2588,"end":2596},{"text":"reproducible","label":"DETAILED_DESCRIPTION","start":2601,"end":2613},{"text":"complex IV deficiency","label":"DISEASE_DISORDER","start":2614,"end":2635},{"text":"Citrate synthase activity","label":"DIAGNOSTIC_PROCEDURE","start":2637,"end":2662},{"text":"both ETC analyses","label":"COREFERENCE","start":2678,"end":2695},{"text":"normal","label":"LAB_VALUE","start":2701,"end":2707},{"text":"good","label":"LAB_VALUE","start":2720,"end":2724},{"text":"sample quality","label":"DIAGNOSTIC_PROCEDURE","start":2725,"end":2739},{"text":"normal","label":"LAB_VALUE","start":2744,"end":2750},{"text":"mitochondrial content","label":"DIAGNOSTIC_PROCEDURE","start":2751,"end":2772},{"text":"Whole","label":"DETAILED_DESCRIPTION","start":2774,"end":2779},{"text":"mitochondrial","label":"BIOLOGICAL_STRUCTURE","start":2780,"end":2793},{"text":"genome sequencing","label":"DIAGNOSTIC_PROCEDURE","start":2794,"end":2811},{"text":"sequencing","label":"DIAGNOSTIC_PROCEDURE","start":2817,"end":2827},{"text":"DNA Polymerase Gamma 1","label":"DIAGNOSTIC_PROCEDURE","start":2831,"end":2853},{"text":"POLG1","label":"DIAGNOSTIC_PROCEDURE","start":2861,"end":2866},{"text":"POLG2","label":"DIAGNOSTIC_PROCEDURE","start":2871,"end":2876},{"text":"Thymidine Phosphorylase","label":"DIAGNOSTIC_PROCEDURE","start":2882,"end":2905}],"tokens":["The patient was a ","3-year-old"," ","girl"," with the following features of ","VACTERL association",": ","absent"," ","C1 vertebra",", ","supernumerary"," ","lumbar vertebrae",", ","hypoplastic"," ","sacrum","\/","coccyx",", ","fatty"," ","filum terminale"," with ","tethered"," ","spinal cord",", and ","three"," ","fused"," ","ribs","; an ","anorectal malformation"," including a ","cloaca"," consisting of a ","common"," ","urogenital sinus"," and a ","duplex"," ","vagina"," with ","midline septum","; ","type C"," ","TE fistula","; ","right renal"," ","agenesis"," with ","moderate"," ","left"," ","hydronephrosis"," and ","vesicoureteral reflux",".\nShe had no cardiac or ","limb malformations",", and no ","other major organ anomalies",".\nBoth ","she"," and ","her father"," were additionally clinically diagnosed with ","hypermobile type"," ","Ehlers\u2013Danlos syndrome",", but family history was otherwise noncontributory.\nThe diagnosis of ","hypermobile type"," ","Ehlers\u2013Danlos"," was based on the patient\u2019s ","hypermobility"," (","9\/9"," on the ","Beighton hypermobility scale","), ","very"," ","soft",", ","fragile"," ","skin"," with ","unusual scarring",", and ","poor"," ","skin healing",".\n","Skin"," ","biopsy"," was not performed, but ","testing"," on ","peripheral blood"," did not reveal ","mutations"," associated with ","other forms"," of ","Ehlers\u2013Danlos syndrome",".\n","Microarray analysis"," initially showed a ","maternally-inherited"," ","deletion"," at ","4q35.1"," detected with ","one clone"," and confirmed by ","FISH"," ","(RP11-173M11)",".\nSubsequent performance of an ","180K custom oligonucleotide microarray"," (","Baylor College of Medicine Medical Genetics Laboratories",") refined the ","deleted region deletion"," to a ","maximum size of 1.37 Mb",", with ","karyotype"," revised to ","46,XX,arr cgh 4q35.1q35.2 (187,321-768-188,694-589) 3 1",".\n","Genes"," in the ","deleted region",", which contains a number of much smaller copy number variations (CNVs) identified in normal controls, include ","CYP4V2",", ","KLKB2",", ","F11",", ","MTRNR1A",", and ","FAT1",", none of which can be clearly related to her phenotype, especially as ","her mother",", ","from whom the deletion was inherited",", is ","unaffected",".\nEvidence for ","mitochondrial dysfunction"," began at ","13 months of age"," with ","progressive"," ","muscle weakness",", ","autonomic dysregulation",", ","hypoglycemic episodes",", ","exocrine pancreatic dysfunction",", and ","decline"," of ","gastrointestinal function",", eventually leading to ","total"," ","parenteral"," ","nutrition dependency"," due to ","visceral"," ","hyperalgesia",", ","dysmotility",", and ","malabsorption",".\n","Muscle"," ","biopsy"," showed a ","mild"," ","increase"," in ","fiber size variability"," but no ","other findings"," ","consistent with mitochondrial disease",", including via ","electron microscopy",".\nHowever, analysis of electron transport chain ","(ETC) activity"," showed ","normal"," activity of ","complexes I",", II, and III, but ","complex IV",", or ","cytochrome c oxidase",", activity was ","45.4 lmol\/min\/g weight",", ","well below the control range"," (148.9 +\/\u2212 67.2 lmol\/min\/g weight).\n","Repeat"," ","ETC analysis"," in ","isolated"," ","mitochondria"," confirmed a ","profound"," and ","reproducible"," ","complex IV deficiency",".\n","Citrate synthase activity"," and content in ","both ETC analyses"," were ","normal",", confirming ","good"," ","sample quality"," and ","normal"," ","mitochondrial content",".\n","Whole"," ","mitochondrial"," ","genome sequencing",", and ","sequencing"," of ","DNA Polymerase Gamma 1"," and 2 (","POLG1"," and ","POLG2",") and ","Thymidine Phosphorylase"," did not reveal abnormalities.\n"],"ner_labels":[0,5,0,65,0,24,0,22,0,12,0,22,0,12,0,22,0,12,0,12,0,22,0,12,0,22,0,12,0,42,0,22,0,12,0,26,0,12,0,22,0,12,0,22,0,12,0,22,0,22,0,26,0,12,0,26,0,63,0,22,0,26,0,26,0,26,0,26,0,51,0,71,0,22,0,26,0,22,0,26,0,26,0,42,0,24,0,42,0,73,0,73,0,12,0,22,0,42,0,22,0,12,0,24,0,24,0,12,0,24,0,22,0,26,0,24,0,22,0,24,0,12,0,24,0,24,0,24,0,24,0,48,0,24,0,42,0,24,0,22,0,24,0,22,0,24,0,24,0,24,0,24,0,24,0,71,0,22,0,26,0,26,0,5,0,22,0,69,0,26,0,26,0,26,0,22,0,24,0,63,0,22,0,26,0,12,0,26,0,26,0,26,0,12,0,24,0,63,0,42,0,24,0,24,0,22,0,24,0,24,0,42,0,24,0,24,0,24,0,42,0,22,0,22,0,24,0,22,0,12,0,63,0,22,0,26,0,24,0,18,0,42,0,42,0,24,0,42,0,24,0,22,0,12,0,24,0,24,0,24,0,24,0,24,0,24,0]}
-{"full_text":"A 52-year-old man (body surface area: 1.3 m2) known to have dilated cardiomyopathy (DCM), was admitted for worsening heart failure (NYHA class IV).\nHe presented with a 5-month history of cough, progressive dyspnoea, orthopnea and recurrent upper abdominal pain started from 2 months ago.\nOn examination his vital signs were body temperature 37\u00b0C, blood pressure 80\/40 mmHg, respiratory rate 24 breaths per minute, and electrocardiogram showed atrial fibrillation with heart rate 50 beats per minute.\nPhysical examination revealed the jugular venous distension, significant tender hepatomegaly and bilateral pitting edema at lower limbs.\nLaboratory tests showed elevated pro-NT brain natriuretic peptide of 22145 pg\/ml (normal 0 to 227 pg\/ml) and unremarkable D-dimer.\nX-ray and computed tomography of the chest demonstrated consolidation of bilateral lower lobes with pleural effusion, while his venous Doppler of lower extremities was normal.\nBased on his clinical condition, echocardiography was immediately inserted.\nThere were severe dilated cardiac chambers, especially enlargement of the left ventricle (LV) (58 mm\/m2) with spherical shape, decreased wall thickness, impaired ejection fraction 22% and severe mitral regurgitation on two-dimensional transthoracic echocardiography (2DTTE).\nParasternal short axis and subxyphoid view (Figure \u200b1) showed the mobile right atrial mass highly suspicious of a thrombus traversing the right atrial cavity during the cardiac cycle accompanying with free-floating small parts of the thrombi.\nReal-time three dimensional transthoracic echocardiography (RT-3DTTE) was performed to further confirm the nature of mass.\nIt showed a highly mobile thrombus, irregular in contour, measured 2.6 \u00d7 1.0 cm which floating around the orifice of inferior vena cava and protruding into the right atrial cavity (Figure \u200b2).\nIn addition, RT-3DTTE evaluated right ventricle (RV) systolic dysfunction with ejection fraction 15.7% (Figure \u200b3).\nHe was maintained on digoxin, spironolactone, furosemide, sotalol and dopamine.\nAt the same time therapeutic anticoagulation was started with low-molecular-weight heparin and warfarin.\nThe patient had an uneventful hospital course and one week follow-up echocardiography confirmed adequate removal of the thrombus (Figures 4A and \u200b4B).\n","ner_info":[{"text":"52-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"body surface area: 1.3 m2","label":"HISTORY","start":19,"end":44},{"text":"dilated cardiomyopathy","label":"DISEASE_DISORDER","start":60,"end":82},{"text":"DCM","label":"DISEASE_DISORDER","start":84,"end":87},{"text":"admitted","label":"CLINICAL_EVENT","start":94,"end":102},{"text":"heart failure","label":"DISEASE_DISORDER","start":117,"end":130},{"text":"NYHA class 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pressure","label":"DIAGNOSTIC_PROCEDURE","start":347,"end":361},{"text":"80\/40 mmHg","label":"LAB_VALUE","start":362,"end":372},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":374,"end":390},{"text":"24 breaths per minute","label":"LAB_VALUE","start":391,"end":412},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":418,"end":435},{"text":"atrial fibrillation","label":"DISEASE_DISORDER","start":443,"end":462},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":468,"end":478},{"text":"50 beats per minute","label":"LAB_VALUE","start":479,"end":498},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":500,"end":520},{"text":"jugular venous","label":"BIOLOGICAL_STRUCTURE","start":534,"end":548},{"text":"distension","label":"SIGN_SYMPTOM","start":549,"end":559},{"text":"significant","label":"SEVERITY","start":561,"end":572},{"text":"tender","label":"DETAILED_DESCRIPTION","start":573,"end":579},{"text":"hepatomegaly","label":"SIGN_SYMPTOM","start":580,"end":592},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":597,"end":606},{"text":"pitting","label":"DETAILED_DESCRIPTION","start":607,"end":614},{"text":"edema","label":"SIGN_SYMPTOM","start":615,"end":620},{"text":"lower limbs","label":"BIOLOGICAL_STRUCTURE","start":624,"end":635},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":637,"end":653},{"text":"elevated","label":"LAB_VALUE","start":661,"end":669},{"text":"pro-NT brain natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":670,"end":702},{"text":"22145 pg\/ml","label":"LAB_VALUE","start":706,"end":717},{"text":"unremarkable","label":"LAB_VALUE","start":746,"end":758},{"text":"D-dimer","label":"DIAGNOSTIC_PROCEDURE","start":759,"end":766},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":768,"end":773},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":778,"end":797},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":805,"end":810},{"text":"consolidation","label":"SIGN_SYMPTOM","start":824,"end":837},{"text":"bilateral lower lobes","label":"BIOLOGICAL_STRUCTURE","start":841,"end":862},{"text":"pleural effusion","label":"SIGN_SYMPTOM","start":868,"end":884},{"text":"venous","label":"BIOLOGICAL_STRUCTURE","start":896,"end":902},{"text":"Doppler","label":"DIAGNOSTIC_PROCEDURE","start":903,"end":910},{"text":"lower extremities","label":"BIOLOGICAL_STRUCTURE","start":914,"end":931},{"text":"normal","label":"LAB_VALUE","start":936,"end":942},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":977,"end":993},{"text":"severe","label":"SEVERITY","start":1031,"end":1037},{"text":"dilated cardiac chambers","label":"SIGN_SYMPTOM","start":1038,"end":1062},{"text":"enlargement","label":"SIGN_SYMPTOM","start":1075,"end":1086},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":1094,"end":1108},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":1110,"end":1112},{"text":"58 mm\/m2","label":"LAB_VALUE","start":1115,"end":1123},{"text":"spherical shape","label":"SIGN_SYMPTOM","start":1130,"end":1145},{"text":"decreased wall thickness","label":"SIGN_SYMPTOM","start":1147,"end":1171},{"text":"impaired","label":"LAB_VALUE","start":1173,"end":1181},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1182,"end":1199},{"text":"22%","label":"LAB_VALUE","start":1200,"end":1203},{"text":"severe","label":"SEVERITY","start":1208,"end":1214},{"text":"mitral regurgitation","label":"SIGN_SYMPTOM","start":1215,"end":1235},{"text":"two-dimensional transthoracic echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1239,"end":1285},{"text":"2DTTE","label":"DIAGNOSTIC_PROCEDURE","start":1287,"end":1292},{"text":"mobile","label":"DETAILED_DESCRIPTION","start":1361,"end":1367},{"text":"right atrial","label":"BIOLOGICAL_STRUCTURE","start":1368,"end":1380},{"text":"mass","label":"SIGN_SYMPTOM","start":1381,"end":1385},{"text":"thrombus","label":"DISEASE_DISORDER","start":1409,"end":1417},{"text":"right atrial cavity","label":"BIOLOGICAL_STRUCTURE","start":1433,"end":1452},{"text":"free-floating","label":"DETAILED_DESCRIPTION","start":1496,"end":1509},{"text":"small parts","label":"DETAILED_DESCRIPTION","start":1510,"end":1521},{"text":"thrombi","label":"DISEASE_DISORDER","start":1529,"end":1536},{"text":"Real-time three dimensional transthoracic echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1538,"end":1596},{"text":"RT-3DTTE","label":"DIAGNOSTIC_PROCEDURE","start":1598,"end":1606},{"text":"mass","label":"SIGN_SYMPTOM","start":1655,"end":1659},{"text":"It","label":"COREFERENCE","start":1661,"end":1663},{"text":"highly mobile","label":"DETAILED_DESCRIPTION","start":1673,"end":1686},{"text":"thrombus","label":"DISEASE_DISORDER","start":1687,"end":1695},{"text":"irregular in contour","label":"SHAPE","start":1697,"end":1717},{"text":"2.6 \u00d7 1.0 cm","label":"AREA","start":1728,"end":1740},{"text":"orifice of inferior vena cava","label":"BIOLOGICAL_STRUCTURE","start":1767,"end":1796},{"text":"protruding into the right atrial cavity","label":"BIOLOGICAL_STRUCTURE","start":1801,"end":1840},{"text":"RT-3DTTE","label":"DIAGNOSTIC_PROCEDURE","start":1867,"end":1875},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":1886,"end":1901},{"text":"RV","label":"BIOLOGICAL_STRUCTURE","start":1903,"end":1905},{"text":"systolic dysfunction","label":"SIGN_SYMPTOM","start":1907,"end":1927},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1933,"end":1950},{"text":"15.7%","label":"LAB_VALUE","start":1951,"end":1956},{"text":"digoxin","label":"MEDICATION","start":1991,"end":1998},{"text":"spironolactone","label":"MEDICATION","start":2000,"end":2014},{"text":"furosemide","label":"MEDICATION","start":2016,"end":2026},{"text":"sotalol","label":"MEDICATION","start":2028,"end":2035},{"text":"dopamine","label":"MEDICATION","start":2040,"end":2048},{"text":"therapeutic anticoagulation","label":"THERAPEUTIC_PROCEDURE","start":2067,"end":2094},{"text":"low-molecular-weight","label":"DETAILED_DESCRIPTION","start":2112,"end":2132},{"text":"heparin","label":"MEDICATION","start":2133,"end":2140},{"text":"warfarin","label":"MEDICATION","start":2145,"end":2153},{"text":"uneventful","label":"LAB_VALUE","start":2174,"end":2184},{"text":"hospital course","label":"THERAPEUTIC_PROCEDURE","start":2185,"end":2200},{"text":"one week","label":"DATE","start":2205,"end":2213},{"text":"follow-up","label":"CLINICAL_EVENT","start":2214,"end":2223},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":2224,"end":2240},{"text":"thrombus","label":"DISEASE_DISORDER","start":2275,"end":2283}],"tokens":["A ","52-year-old"," ","man"," (","body surface area: 1.3 m2",") known to have ","dilated cardiomyopathy"," (","DCM","), was ","admitted"," for worsening ","heart failure"," (","NYHA class IV",").\nHe presented with a ","5-month"," history of ","cough",", ","progressive"," ","dyspnoea",", ","orthopnea"," and ","recurrent"," ","upper abdominal"," ","pain"," started ","from 2 months ago",".\nOn ","examination"," his ","vital signs"," were ","body temperature"," ","37\u00b0C",", ","blood pressure"," ","80\/40 mmHg",", ","respiratory rate"," ","24 breaths per minute",", and ","electrocardiogram"," showed ","atrial fibrillation"," with ","heart rate"," ","50 beats per minute",".\n","Physical examination"," revealed the ","jugular venous"," ","distension",", ","significant"," ","tender"," ","hepatomegaly"," and ","bilateral"," ","pitting"," ","edema"," at ","lower limbs",".\n","Laboratory tests"," showed ","elevated"," ","pro-NT brain natriuretic peptide"," of ","22145 pg\/ml"," (normal 0 to 227 pg\/ml) and ","unremarkable"," ","D-dimer",".\n","X-ray"," and ","computed tomography"," of the ","chest"," demonstrated ","consolidation"," of ","bilateral lower lobes"," with ","pleural effusion",", while his ","venous"," ","Doppler"," of ","lower extremities"," was ","normal",".\nBased on his clinical condition, ","echocardiography"," was immediately inserted.\nThere were ","severe"," ","dilated cardiac chambers",", especially ","enlargement"," of the ","left ventricle"," (","LV",") (","58 mm\/m2",") with ","spherical shape",", ","decreased wall thickness",", ","impaired"," ","ejection fraction"," ","22%"," and ","severe"," ","mitral regurgitation"," on ","two-dimensional transthoracic echocardiography"," (","2DTTE",").\nParasternal short axis and subxyphoid view (Figure \u200b1) showed the ","mobile"," ","right atrial"," ","mass"," highly suspicious of a ","thrombus"," traversing the ","right atrial cavity"," during the cardiac cycle accompanying with ","free-floating"," ","small parts"," of the ","thrombi",".\n","Real-time three dimensional transthoracic echocardiography"," (","RT-3DTTE",") was performed to further confirm the nature of ","mass",".\n","It"," showed a ","highly mobile"," ","thrombus",", ","irregular in contour",", measured ","2.6 \u00d7 1.0 cm"," which floating around the ","orifice of inferior vena cava"," and ","protruding into the right atrial cavity"," (Figure \u200b2).\nIn addition, ","RT-3DTTE"," evaluated ","right ventricle"," (","RV",") ","systolic dysfunction"," with ","ejection fraction"," ","15.7%"," (Figure \u200b3).\nHe was maintained on ","digoxin",", ","spironolactone",", ","furosemide",", ","sotalol"," and ","dopamine",".\nAt the same time ","therapeutic anticoagulation"," was started with ","low-molecular-weight"," ","heparin"," and ","warfarin",".\nThe patient had an ","uneventful"," ","hospital course"," and ","one week"," ","follow-up"," ","echocardiography"," confirmed adequate removal of the ","thrombus"," (Figures 4A and \u200b4B).\n"],"ner_labels":[0,5,0,65,0,39,0,26,0,26,0,13,0,26,0,42,0,32,0,69,0,22,0,69,0,69,0,22,0,12,0,69,0,32,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,26,0,24,0,42,0,24,0,12,0,69,0,63,0,22,0,69,0,22,0,22,0,69,0,12,0,24,0,42,0,24,0,42,0,42,0,24,0,24,0,24,0,12,0,69,0,12,0,69,0,12,0,24,0,12,0,42,0,24,0,63,0,69,0,69,0,12,0,12,0,42,0,69,0,69,0,42,0,24,0,42,0,63,0,69,0,24,0,24,0,22,0,12,0,69,0,26,0,12,0,22,0,22,0,26,0,24,0,24,0,69,0,18,0,22,0,26,0,67,0,8,0,12,0,12,0,24,0,12,0,12,0,69,0,24,0,42,0,46,0,46,0,46,0,46,0,46,0,75,0,22,0,46,0,46,0,42,0,75,0,19,0,13,0,24,0,26,0]}
-{"full_text":"A 75\u2013year\u2013old female presented in the Emergency Department of Ilfov Clinical Hospital, Bucharest, Romania, with dyspnea, orthopnea, lower extremities swelling, palpitations.\nShe had a 3 years history of atrial fibrillation diagnosed by her family doctor and one-year history of cardiac failure NYHA (New York Heart Association) class \u2161.\nPhysical examination revealed an irregular pulse 80 beats\/min, blood pressure of 100\/60 mmHg, bi\u2013basal crackles on chest auscultation, lower extremities swelling.\nHeart sounds examination revealed a IVth degree pansystolic murmur at the left border of the stern.\nThe jugular veins were dilated.\nThe patient complained of pain in the upper right abdominal region, enhanced by palpation.\nThe liver margin was tender, round, of 6 cm below the costal rib, with a smooth liver surface.\nThe spleen could not be felt.\nEKG: atrial fibrillation of 80\/min, right bundle branch block, infero-lateral ischemia.\nTransabdominal ultrasound showed a homogenous, enlarged liver.\nThe suprahepatic veins were dilated, as well as the inferior vena cava (30 mm, without respiratory variations).\nTransthoracic echocardiography revealed a dilated right atrium of 74,2 mm (Figure 1), dilated left atrium of 55,2 mm, dilated left ventricle of 64\/72,3 mm, dilated right ventricle of 44,4 mm.\nAtrial septal defect ostium secundum type, of 6 cm (Figure 2), with left\u2013to\u2013right shunt.\nSevere tricuspid insufficiency with maximum gradient of 55,4 mm Hg.\n4th degree mitral insufficiency.\nSevere pulmonary hypertension of 75 mm Hg.\nThe ejection fraction of 29%.\nAtrial fibrillation.\nInterventricular sept with paradoxical motion.\nFlattening of the interventricular septum (Figure 3).\nThe diagnosis was IVth degree chronic heart failure NYHA.\nAtrial septal defect ostium secundum type with left\u2013to\u2013right shunt.\nSevere tricuspid insufficiency.\n4th degree mitral insufficiency.\nSevere pulmonary hypertension of 75 mm Hg.\nChronic atrial fibrillation.\nRight bundle branch block.\n","ner_info":[{"text":"75\u2013year\u2013old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":21,"end":30},{"text":"Emergency Department of Ilfov Clinical Hospital, Bucharest, Romania","label":"NONBIOLOGICAL_LOCATION","start":38,"end":105},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":112,"end":119},{"text":"orthopnea","label":"SIGN_SYMPTOM","start":121,"end":130},{"text":"lower extremities","label":"BIOLOGICAL_STRUCTURE","start":132,"end":149},{"text":"swelling","label":"SIGN_SYMPTOM","start":150,"end":158},{"text":"palpitations","label":"SIGN_SYMPTOM","start":160,"end":172},{"text":"3 years","label":"DURATION","start":184,"end":191},{"text":"atrial fibrillation","label":"SIGN_SYMPTOM","start":203,"end":222},{"text":"family doctor","label":"SUBJECT","start":240,"end":253},{"text":"one-year","label":"DURATION","start":258,"end":266},{"text":"cardiac failure","label":"DISEASE_DISORDER","start":278,"end":293},{"text":"NYHA (New York Heart Association) class \u2161","label":"LAB_VALUE","start":294,"end":335},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":337,"end":357},{"text":"irregular pulse","label":"SIGN_SYMPTOM","start":370,"end":385},{"text":"80 beats\/min","label":"LAB_VALUE","start":386,"end":398},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":400,"end":414},{"text":"100\/60 mmHg","label":"LAB_VALUE","start":418,"end":429},{"text":"bi\u2013basal crackles","label":"SIGN_SYMPTOM","start":431,"end":448},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":452,"end":457},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":458,"end":470},{"text":"lower extremities","label":"BIOLOGICAL_STRUCTURE","start":472,"end":489},{"text":"swelling","label":"COREFERENCE","start":490,"end":498},{"text":"Heart sounds examination","label":"DIAGNOSTIC_PROCEDURE","start":500,"end":524},{"text":"IVth degree","label":"LAB_VALUE","start":536,"end":547},{"text":"pansystolic murmur","label":"SIGN_SYMPTOM","start":548,"end":566},{"text":"left border of the stern","label":"BIOLOGICAL_STRUCTURE","start":574,"end":598},{"text":"jugular veins","label":"BIOLOGICAL_STRUCTURE","start":604,"end":617},{"text":"dilated","label":"SIGN_SYMPTOM","start":623,"end":630},{"text":"pain","label":"SIGN_SYMPTOM","start":658,"end":662},{"text":"upper right abdominal region","label":"BIOLOGICAL_STRUCTURE","start":670,"end":698},{"text":"enhanced by palpation","label":"DETAILED_DESCRIPTION","start":700,"end":721},{"text":"liver margin","label":"DIAGNOSTIC_PROCEDURE","start":727,"end":739},{"text":"tender","label":"TEXTURE","start":744,"end":750},{"text":"round","label":"SHAPE","start":752,"end":757},{"text":"6 cm below the costal rib","label":"DISTANCE","start":762,"end":787},{"text":"smooth","label":"TEXTURE","start":796,"end":802},{"text":"liver surface","label":"DIAGNOSTIC_PROCEDURE","start":803,"end":816},{"text":"EKG","label":"DIAGNOSTIC_PROCEDURE","start":848,"end":851},{"text":"atrial fibrillation","label":"SIGN_SYMPTOM","start":853,"end":872},{"text":"80\/min","label":"LAB_VALUE","start":876,"end":882},{"text":"right bundle branch block","label":"SIGN_SYMPTOM","start":884,"end":909},{"text":"infero-lateral","label":"BIOLOGICAL_STRUCTURE","start":911,"end":925},{"text":"ischemia","label":"SIGN_SYMPTOM","start":926,"end":934},{"text":"Transabdominal","label":"BIOLOGICAL_STRUCTURE","start":936,"end":950},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":951,"end":961},{"text":"homogenous","label":"DETAILED_DESCRIPTION","start":971,"end":981},{"text":"enlarged liver","label":"SIGN_SYMPTOM","start":983,"end":997},{"text":"suprahepatic veins","label":"BIOLOGICAL_STRUCTURE","start":1003,"end":1021},{"text":"dilated","label":"SIGN_SYMPTOM","start":1027,"end":1034},{"text":"inferior vena cava","label":"BIOLOGICAL_STRUCTURE","start":1051,"end":1069},{"text":"30 mm","label":"LAB_VALUE","start":1071,"end":1076},{"text":"Transthoracic echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1111,"end":1141},{"text":"dilated","label":"SIGN_SYMPTOM","start":1153,"end":1160},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":1161,"end":1173},{"text":"74,2 mm","label":"LAB_VALUE","start":1177,"end":1184},{"text":"dilated","label":"SIGN_SYMPTOM","start":1197,"end":1204},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":1205,"end":1216},{"text":"55,2 mm","label":"LAB_VALUE","start":1220,"end":1227},{"text":"dilated","label":"SIGN_SYMPTOM","start":1229,"end":1236},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":1237,"end":1251},{"text":"64\/72,3 mm","label":"LAB_VALUE","start":1255,"end":1265},{"text":"dilated","label":"SIGN_SYMPTOM","start":1267,"end":1274},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":1275,"end":1290},{"text":"44,4 mm","label":"LAB_VALUE","start":1294,"end":1301},{"text":"Atrial septal defect","label":"DISEASE_DISORDER","start":1303,"end":1323},{"text":"ostium secundum type","label":"DETAILED_DESCRIPTION","start":1324,"end":1344},{"text":"6 cm","label":"DISTANCE","start":1349,"end":1353},{"text":"left\u2013to\u2013right shunt","label":"SIGN_SYMPTOM","start":1371,"end":1390},{"text":"Severe","label":"SEVERITY","start":1392,"end":1398},{"text":"tricuspid insufficiency","label":"DISEASE_DISORDER","start":1399,"end":1422},{"text":"55,4 mm Hg","label":"LAB_VALUE","start":1448,"end":1458},{"text":"4th degree","label":"LAB_VALUE","start":1460,"end":1470},{"text":"mitral insufficiency","label":"DISEASE_DISORDER","start":1471,"end":1491},{"text":"Severe","label":"SEVERITY","start":1493,"end":1499},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1500,"end":1509},{"text":"hypertension","label":"SIGN_SYMPTOM","start":1510,"end":1522},{"text":"75 mm Hg","label":"LAB_VALUE","start":1526,"end":1534},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1540,"end":1557},{"text":"29%","label":"LAB_VALUE","start":1561,"end":1564},{"text":"Atrial fibrillation","label":"SIGN_SYMPTOM","start":1566,"end":1585},{"text":"Interventricular sept","label":"BIOLOGICAL_STRUCTURE","start":1587,"end":1608},{"text":"paradoxical motion","label":"SIGN_SYMPTOM","start":1614,"end":1632},{"text":"Flattening","label":"SIGN_SYMPTOM","start":1634,"end":1644},{"text":"interventricular septum","label":"BIOLOGICAL_STRUCTURE","start":1652,"end":1675},{"text":"IVth degree","label":"LAB_VALUE","start":1706,"end":1717},{"text":"chronic heart failure","label":"DISEASE_DISORDER","start":1718,"end":1739}],"tokens":["A ","75\u2013year\u2013old"," ","female"," ","presented"," in the ","Emergency Department of Ilfov Clinical Hospital, Bucharest, Romania",", with ","dyspnea",", ","orthopnea",", ","lower extremities"," ","swelling",", ","palpitations",".\nShe had a ","3 years"," history of ","atrial fibrillation"," diagnosed by her ","family doctor"," and ","one-year"," history of ","cardiac failure"," ","NYHA (New York Heart Association) class \u2161",".\n","Physical examination"," revealed an ","irregular pulse"," ","80 beats\/min",", ","blood pressure"," of ","100\/60 mmHg",", ","bi\u2013basal crackles"," on ","chest"," ","auscultation",", ","lower extremities"," ","swelling",".\n","Heart sounds examination"," revealed a ","IVth degree"," ","pansystolic murmur"," at the ","left border of the stern",".\nThe ","jugular veins"," were ","dilated",".\nThe patient complained of ","pain"," in the ","upper right abdominal region",", ","enhanced by palpation",".\nThe ","liver margin"," was ","tender",", ","round",", of ","6 cm below the costal rib",", with a ","smooth"," ","liver surface",".\nThe spleen could not be felt.\n","EKG",": ","atrial fibrillation"," of ","80\/min",", ","right bundle branch block",", ","infero-lateral"," ","ischemia",".\n","Transabdominal"," ","ultrasound"," showed a ","homogenous",", ","enlarged liver",".\nThe ","suprahepatic veins"," were ","dilated",", as well as the ","inferior vena cava"," (","30 mm",", without respiratory variations).\n","Transthoracic echocardiography"," revealed a ","dilated"," ","right atrium"," of ","74,2 mm"," (Figure 1), ","dilated"," ","left atrium"," of ","55,2 mm",", ","dilated"," ","left ventricle"," of ","64\/72,3 mm",", ","dilated"," ","right ventricle"," of ","44,4 mm",".\n","Atrial septal defect"," ","ostium secundum type",", of ","6 cm"," (Figure 2), with ","left\u2013to\u2013right shunt",".\n","Severe"," ","tricuspid insufficiency"," with maximum gradient of ","55,4 mm Hg",".\n","4th degree"," ","mitral insufficiency",".\n","Severe"," ","pulmonary"," ","hypertension"," of ","75 mm Hg",".\nThe ","ejection fraction"," of ","29%",".\n","Atrial fibrillation",".\n","Interventricular sept"," with ","paradoxical motion",".\n","Flattening"," of the ","interventricular septum"," (Figure 3).\nThe diagnosis was ","IVth degree"," ","chronic heart failure"," NYHA.\nAtrial septal defect ostium secundum type with left\u2013to\u2013right shunt.\nSevere tricuspid insufficiency.\n4th degree mitral insufficiency.\nSevere pulmonary hypertension of 75 mm Hg.\nChronic atrial fibrillation.\nRight bundle branch block.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,69,0,12,0,69,0,69,0,32,0,69,0,71,0,32,0,26,0,42,0,24,0,69,0,42,0,24,0,42,0,69,0,12,0,24,0,12,0,18,0,24,0,42,0,69,0,12,0,12,0,69,0,69,0,12,0,22,0,24,0,73,0,67,0,27,0,73,0,24,0,24,0,69,0,42,0,69,0,12,0,69,0,12,0,24,0,22,0,69,0,12,0,69,0,12,0,42,0,24,0,69,0,12,0,42,0,69,0,12,0,42,0,69,0,12,0,42,0,69,0,12,0,42,0,26,0,22,0,27,0,69,0,63,0,26,0,42,0,42,0,26,0,63,0,12,0,69,0,42,0,24,0,42,0,69,0,12,0,69,0,69,0,12,0,42,0,26,0]}
-{"full_text":"An 81-year-old female with hypertension and gout was admitted to Taichung Veterans General Hospital due to abdominal pain and hematemesis.\nShe began to suffer from intermittent epigastralgia more than 10 years ago, and a 4 cm gastric tumor was found.\nThe abdominal pain got worse 2 years before admission, and she went to a local hospital where abdominal CT scan revealed a gastric tumor about 6 cm in length with well-circumscribed calcification(figure \u200b1).\nSurgical intervention was suggested, but she declined.\nAbout 10 days before admission, tarry stool passage was noted, and bloody vomitus was found 1 day later.\nUGI scope revealed submucosal gastric tumor with central ulceration and she was then transferred to our hospital.\nPhysical examination showed upper abdominal tenderness with mild muscle guarding.\nThe plain radiography showed an irregular shape calcification over upper abdomen.\nUGI scope revealed deep gastric ulcer with foreign body.\nCT scan showed an irregularly shaped space-occupying lesion in front of the stomach with plate calcifications and localized free air (figures 2 and 3).\nUnder the impression of perforated gastric tumor, emergent laparotomy was performed.\nAn infiltrative mass between the stomach and transverse colon was noted during operation.\nA sharp, bone-like and thick calcified plate penetrating into the gastric mucosa and pericolic soft tissue was observed.\nA submucosal tumor about 2.3 cm in size adherent to the calcified plate was also noted (figures \u200b4 and 5).\nDistal subtotal gastrectomy and partial colectomy were performed.\nThe patient was discharged 13 days after operation uneventfully.\nMicroscopically, spindle-shaped tumor cells with low mitotic frequency (4\/50 HPF) were found.\nImmunohistochemical staining of the tumor demonstrated diffusely strong positive reactivity for CD 117, positive reactivity for CD34, but negative reactivity for S100 protein and desmin.\nThe diagnosis of the tumor was established as GIST.\nDue to the small size and the paucity of mitotic figures of the tumor located in the stomach, it was classified as very low risk[4].\nSporadic GIST was impressed due to no family history of GIST nor other GIST presented in this patient.\n","ner_info":[{"text":"81-year-old","label":"AGE","start":3,"end":14},{"text":"female","label":"SEX","start":15,"end":21},{"text":"hypertension","label":"SIGN_SYMPTOM","start":27,"end":39},{"text":"gout","label":"DISEASE_DISORDER","start":44,"end":48},{"text":"admitted","label":"CLINICAL_EVENT","start":53,"end":61},{"text":"Taichung Veterans General Hospita","label":"NONBIOLOGICAL_LOCATION","start":65,"end":98},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":107,"end":116},{"text":"pain","label":"SIGN_SYMPTOM","start":117,"end":121},{"text":"hematemesis","label":"SIGN_SYMPTOM","start":126,"end":137},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":164,"end":176},{"text":"epigastralgia","label":"SIGN_SYMPTOM","start":177,"end":190},{"text":"more than 10 years ago","label":"DATE","start":191,"end":213},{"text":"4 cm","label":"DISTANCE","start":221,"end":225},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":226,"end":233},{"text":"tumor","label":"SIGN_SYMPTOM","start":234,"end":239},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":255,"end":264},{"text":"pain","label":"SIGN_SYMPTOM","start":265,"end":269},{"text":"got worse","label":"LAB_VALUE","start":270,"end":279},{"text":"2 years before","label":"DATE","start":280,"end":294},{"text":"went","label":"CLINICAL_EVENT","start":314,"end":318},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":324,"end":338},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":345,"end":354},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":355,"end":357},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":374,"end":381},{"text":"tumor","label":"SIGN_SYMPTOM","start":382,"end":387},{"text":"6 cm","label":"DISTANCE","start":394,"end":398},{"text":"well-circumscribed calcification","label":"DETAILED_DESCRIPTION","start":414,"end":446},{"text":"Surgical intervention","label":"THERAPEUTIC_PROCEDURE","start":459,"end":480},{"text":"10 days before","label":"DATE","start":520,"end":534},{"text":"tarry stool","label":"SIGN_SYMPTOM","start":546,"end":557},{"text":"bloody vomitus","label":"SIGN_SYMPTOM","start":581,"end":595},{"text":"1 day later","label":"DATE","start":606,"end":617},{"text":"UGI scope","label":"DIAGNOSTIC_PROCEDURE","start":619,"end":628},{"text":"submucosal","label":"BIOLOGICAL_STRUCTURE","start":638,"end":648},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":649,"end":656},{"text":"tumor","label":"SIGN_SYMPTOM","start":657,"end":662},{"text":"central ulceration","label":"DETAILED_DESCRIPTION","start":668,"end":686},{"text":"transferred","label":"CLINICAL_EVENT","start":704,"end":715},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":723,"end":731},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":733,"end":753},{"text":"upper abdominal","label":"BIOLOGICAL_STRUCTURE","start":761,"end":776},{"text":"tenderness","label":"SIGN_SYMPTOM","start":777,"end":787},{"text":"mild","label":"SEVERITY","start":793,"end":797},{"text":"muscle","label":"BIOLOGICAL_STRUCTURE","start":798,"end":804},{"text":"guarding","label":"SIGN_SYMPTOM","start":805,"end":813},{"text":"plain","label":"DETAILED_DESCRIPTION","start":819,"end":824},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":825,"end":836},{"text":"irregular shape","label":"SHAPE","start":847,"end":862},{"text":"calcification","label":"SIGN_SYMPTOM","start":863,"end":876},{"text":"upper abdomen","label":"BIOLOGICAL_STRUCTURE","start":882,"end":895},{"text":"UGI scope","label":"DIAGNOSTIC_PROCEDURE","start":897,"end":906},{"text":"deep gastric","label":"BIOLOGICAL_STRUCTURE","start":916,"end":928},{"text":"ulcer","label":"SIGN_SYMPTOM","start":929,"end":934},{"text":"foreign body","label":"SIGN_SYMPTOM","start":940,"end":952},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":954,"end":956},{"text":"irregularly shaped","label":"SHAPE","start":972,"end":990},{"text":"space-occupying","label":"DETAILED_DESCRIPTION","start":991,"end":1006},{"text":"lesion","label":"SIGN_SYMPTOM","start":1007,"end":1013},{"text":"stomach","label":"BIOLOGICAL_STRUCTURE","start":1030,"end":1037},{"text":"plate calcifications","label":"DETAILED_DESCRIPTION","start":1043,"end":1063},{"text":"localized","label":"DETAILED_DESCRIPTION","start":1068,"end":1077},{"text":"free 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tissue","label":"BIOLOGICAL_STRUCTURE","start":1366,"end":1387},{"text":"submucosal","label":"BIOLOGICAL_STRUCTURE","start":1404,"end":1414},{"text":"tumor","label":"SIGN_SYMPTOM","start":1415,"end":1420},{"text":"2.3 cm","label":"DISTANCE","start":1427,"end":1433},{"text":"calcified plate","label":"COREFERENCE","start":1458,"end":1473},{"text":"Distal","label":"DETAILED_DESCRIPTION","start":1509,"end":1515},{"text":"subtotal","label":"DETAILED_DESCRIPTION","start":1516,"end":1524},{"text":"gastrectomy","label":"THERAPEUTIC_PROCEDURE","start":1525,"end":1536},{"text":"partial","label":"DETAILED_DESCRIPTION","start":1541,"end":1548},{"text":"colectomy","label":"THERAPEUTIC_PROCEDURE","start":1549,"end":1558},{"text":"discharged","label":"CLINICAL_EVENT","start":1591,"end":1601},{"text":"13 days 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protein","label":"DIAGNOSTIC_PROCEDURE","start":1896,"end":1908},{"text":"desmin","label":"DIAGNOSTIC_PROCEDURE","start":1913,"end":1919},{"text":"GIST","label":"DISEASE_DISORDER","start":1967,"end":1971},{"text":"very low risk","label":"LAB_VALUE","start":2088,"end":2101},{"text":"no family history of GIST","label":"FAMILY_HISTORY","start":2141,"end":2166}],"tokens":["An ","81-year-old"," ","female"," with ","hypertension"," and ","gout"," was ","admitted"," to ","Taichung Veterans General Hospita","l due to ","abdominal"," ","pain"," and ","hematemesis",".\nShe began to suffer from ","intermittent"," ","epigastralgia"," ","more than 10 years ago",", and a ","4 cm"," ","gastric"," ","tumor"," was found.\nThe ","abdominal"," ","pain"," ","got worse"," ","2 years before"," admission, and she ","went"," to a ","local hospital"," where ","abdominal"," ","CT"," scan revealed a ","gastric"," ","tumor"," about ","6 cm"," in length with ","well-circumscribed calcification","(figure \u200b1).\n","Surgical intervention"," was suggested, but she declined.\nAbout ","10 days before"," admission, ","tarry stool"," passage was noted, and ","bloody vomitus"," was found ","1 day later",".\n","UGI scope"," revealed ","submucosal"," ","gastric"," ","tumor"," with ","central ulceration"," and she was then ","transferred"," to our ","hospital",".\n","Physical examination"," showed ","upper abdominal"," ","tenderness"," with ","mild"," ","muscle"," ","guarding",".\nThe ","plain"," ","radiography"," showed an ","irregular shape"," ","calcification"," over ","upper abdomen",".\n","UGI scope"," revealed ","deep gastric"," ","ulcer"," with ","foreign body",".\n","CT"," scan showed an ","irregularly shaped"," ","space-occupying"," ","lesion"," in front of the ","stomach"," with ","plate calcifications"," and ","localized"," ","free air"," (figures 2 and 3).\nUnder the impression of perforated gastric tumor, ","emergent"," ","laparotomy"," was performed.\nAn ","infiltrative"," ","mass"," between the ","stomach"," and ","transverse colon"," was noted during operation.\nA ","sharp",", ","bone-like"," and ","thick"," ","calcified plate"," penetrating into the ","gastric mucosa"," and ","pericolic soft tissue"," was observed.\nA ","submucosal"," ","tumor"," about ","2.3 cm"," in size adherent to the ","calcified plate"," was also noted (figures \u200b4 and 5).\n","Distal"," ","subtotal"," ","gastrectomy"," and ","partial"," ","colectomy"," were performed.\nThe patient was ","discharged"," ","13 days after"," operation uneventfully.\n","Microscopically",", ","spindle-shaped"," ","tumor cells"," with ","low"," ","mitotic frequency"," (","4\/50 HPF",") were found.\n","Immunohistochemical staining"," of the ","tumor"," demonstrated ","diffusely strong positive"," reactivity for ","CD 117",", ","positive"," reactivity for ","CD34",", but ","negative"," reactivity for ","S100 protein"," and ","desmin",".\nThe diagnosis of the tumor was established as ","GIST",".\nDue to the small size and the paucity of mitotic figures of the tumor located in the stomach, it was classified as ","very low risk","[4].\nSporadic GIST was impressed due to ","no family history of GIST"," nor other GIST presented in this patient.\n"],"ner_labels":[0,5,0,65,0,69,0,26,0,13,0,48,0,12,0,69,0,69,0,22,0,69,0,19,0,27,0,12,0,69,0,12,0,69,0,42,0,19,0,13,0,48,0,12,0,24,0,12,0,69,0,27,0,22,0,75,0,19,0,69,0,69,0,19,0,24,0,12,0,12,0,69,0,22,0,13,0,48,0,24,0,12,0,69,0,63,0,12,0,69,0,22,0,24,0,67,0,69,0,12,0,24,0,12,0,69,0,69,0,24,0,67,0,22,0,69,0,12,0,22,0,22,0,69,0,22,0,24,0,22,0,69,0,12,0,12,0,22,0,22,0,22,0,69,0,12,0,12,0,12,0,69,0,27,0,18,0,22,0,22,0,75,0,22,0,75,0,13,0,19,0,24,0,67,0,69,0,42,0,24,0,42,0,24,0,18,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,26,0,42,0,34,0]}
-{"full_text":"A 33 - year old woman presented to our cardiology service with signs and symptoms of congestive heart failure.\nHer medical history was unremarkable, however a year ago and soon after her third child delivery, she had been admitted in another hospital for acute pulmonary oedema after labor.\nCor triatriatum with obstructive behavior causing pulmonary hypertension had bee diagnosed, while the left ventricle was structurally and functionally intact.\nThe patient at that time denied surgey and had been discharged on medical therapy.\nAt present admission the patient presented with NYHA functional class III, symptoms of heart failure and palpittions as a result of persistent atrial flutter.\nOn physical examination a loud pulmonary component of the 2nd heart sound and a diastolic murmur was heard in the mitral area.\nSigns of right-sided heart failure were absent.\nA transthoracic echocardiography revealed a moderately dilated left ventricle (LV), globally hypokinetic, with severely impaired systolic function (EF estimated \u226530%).\nLeft atrium (LA) was dilated, with a mobile, membrane-like echogenic structure into it.\nTransesophageal echocardiogram (TEE) documented a fibromuscular membrane across the LA, dividing it into two compartments, a proximal one receiving the pulmonary venous flow and a distal one containing the left atrial appendage (LAA).\nThe two chambers communicated via a non-restrictive orifice, but the membrane prolapsed towards the mitral valve inflow causing severe obstruction.\nMitral valve appeared normal, with mild regurgitation.\nPatent foramen ovale (PFO), atrial septal defect (ASD) and anomalous venous connections were ruled out and the diagnosis of cor triatriatum was reconfirmed.\nMagnetic resonance imaging ( MRI) of the heart also revealed the fibromuscular septum into the left atrium and the low left ventricular ejection fraction [(LVEF) 30%, cardiac index 1,6 L\/min\/m2, cardiac output 2,7 L\/min] (figure \u200b1).\nCoronary angiography showed normal coronary arteries.\nWith these findings the patient was scheduled for surgery.\nAnesthetic induction was achieved with standard technique including administration of sodium pentothal, sevofluorane, fentanyl and muscle relaxant.\nInvasive monitoring included the use of right radial arterial lines, a pulmonary artery catheter and a foley catheter with temperature probe to measure bladder temperature as an indicator of core body temperature.\nTransesophageal echocardiography (TEE) was also instituted.\nSurgery was performed through a median sternotomy.\nConnection to cardiopulmonary bypass (CPB) was achieved by standard ascending aorta and bicaval cannulation.\nMildly hypothermic (32\u00b0C) CPB was established.\nCold blood cardioplegia was administered in an antegrade fashion through the aortic root after clamping the aorta.\nThe interatrial groove was developed and the common pulmonary venous chamber of the left atrium was opened through a vertical incision anterior to the right pulmonary veins, exactly as for mitral valve surgery.\nAfter insertion of a self-retaining retractor to facilitate exposure, the diaphragm was exposed and the central hole in it was identified.\nA preliminary incision out from the hole improved exposure for the definitive excision.\nOrifices of the pulmonary veins on both sides were located.\nPosition of the atrial septum was also identified by a small opening in the right atrium and by inserting a curved clamp to displace the septum into the common pulmonary venous chamber of the left atrium.\nThere was no atrial septal defect or patent foramen ovale.\nThe diaphragm was then easily completely excised exposing the mitral valve (figure \u200b2).\nThe left atrial appendage was closed from inside the left atrium using a running 3-0 polypropylene suture to prevent future thrombus formation.\nThe atriotomy incisions were closed, the heart having been filled with blood before the last few sutures were placed.\nThe patient was rewarmed, the aortic cross-clamp was removed and additional de-airing was carried out in the usual manner.\nCPB was terminated with minimal inotropic support, involving milrinone and levophed with good hemodynamics.\nThe postoperative course was uneventful and the patient was extubated after 12 hours and discharged from the hospital on the fifth postoperative day.\nAt 3 months follow-up, the patient was asymptomatic (NYHA class I), in sinus rhythm.\nTTE and MRI revealed a mildly dilated LV with great improvement in systolic function and an estimated LVEF of 50%.\n","ner_info":[{"text":"33 - year old","label":"AGE","start":2,"end":15},{"text":"woman","label":"SEX","start":16,"end":21},{"text":"presented","label":"CLINICAL_EVENT","start":22,"end":31},{"text":"cardiology service","label":"NONBIOLOGICAL_LOCATION","start":39,"end":57},{"text":"congestive heart failure","label":"DISEASE_DISORDER","start":85,"end":109},{"text":"medical 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","congestive heart failure",".\nHer ","medical history"," was ","unremarkable",", however ","a year ago"," and soon after her ","third"," ","child delivery",", she had been ","admitted"," in another ","hospital"," for ","acute pulmonary oedema"," after ","labor",".\n","Cor triatriatum"," with obstructive behavior causing ","pulmonary hypertension"," had bee ","diagnosed",", while the ","left ventricle"," was ","structurally"," and ","functionally"," ","intact",".\nThe patient at that time denied ","surgey"," and had been ","discharged"," on ","medical"," ","therapy",".\nAt present admission the patient ","presented"," with ","NYHA functional class"," ","III",", symptoms of ","heart failure and palpittions"," as a result of ","persistent atrial flutter",".\nOn ","physical examination"," a ","loud pulmonary component of the 2nd heart sound"," and a ","diastolic"," ","murmur"," was heard in the ","mitral area",".\nSigns of ","right-sided"," ","heart failure"," were absent.\nA ","transthoracic echocardiography"," revealed a ","moderately"," ","dilated"," ","left ventricle"," (","LV","), ","globally"," ","hypokinetic",", with ","severely impaired"," ","systolic function"," (","EF"," estimated \u2265","30%",").\n","Left atrium"," (","LA",") was ","dilated",", with a ","mobile, membrane-like"," ","echogenic structure"," into it.\n","Transesophageal echocardiogram"," (","TEE",") documented a ","fibromuscular membrane"," across the ","LA",", dividing it into two ","compartments",", a ","proximal one receiving the pulmonary venous flow"," and a ","distal one"," containing the ","left atrial appendage"," (","LAA",").\nThe two ","chambers"," communicated via a ","non-restrictive"," ","orifice",", but the ","membrane"," ","prolapsed"," towards the ","mitral valve"," inflow causing ","severe"," ","obstruction",".\n","Mitral valve"," ","appeared"," ","normal",", with ","mild"," ","regurgitation",".\n","Patent foramen ovale"," (","PFO","), ","atrial septal defect"," (","ASD",") and ","anomalous"," ","venous connections"," were ruled out and the diagnosis of ","cor triatriatum"," was reconfirmed.\n","Magnetic resonance imaging"," ( ","MRI",") of the heart also revealed the ","fibromuscular septum"," into the ","left atrium"," and the ","low"," ","left ventricular ejection fraction"," [(","LVEF",") ","30%",", ","cardiac index"," ","1,6 L\/min\/m2",", ","cardiac outpu","t ","2,7 L\/min","] (figure \u200b1).\n","Coronary angiography"," showed ","normal"," ","coronary arteries",".\nWith these findings the patient was ","scheduled"," for ","surgery",".\n","Anesthetic"," induction was achieved with standard technique including administration of ","sodium pentothal",", ","sevofluorane",", ","fentanyl"," and ","muscle relaxant",".\n","Invasive monitoring"," included the use of ","right radial arterial lines",", a ","pulmonary artery catheter"," and a ","foley catheter"," with ","temperature probe"," to measure ","bladder temperature"," as an indicator of ","core body temperature",".\n","Transesophageal echocardiography"," (","TEE",") was also instituted.\nSurgery was performed through a ","median sternotomy",".\nConnection to ","cardiopulmonary bypass"," (","CPB",") was achieved by standard ","ascending aorta"," and ","bicaval"," ","cannulation",".\n","Mildly"," ","hypothermic"," (","32\u00b0C",") ","CPB"," was established.\n","Cold blood"," ","cardioplegia"," was administered in an ","antegrade"," fashion through the ","aortic root"," after ","clamping"," the ","aorta",".\nThe ","interatrial groove"," was developed and the ","common pulmonary venous chamber of the left atrium"," was ","opened"," through a ","vertical incision"," ","anterior to the right pulmonary veins",", exactly as for ","mitral valve surgery",".\nAfter insertion of a ","self-retaining"," ","retractor"," to facilitate ","exposure",", the ","diaphragm"," was ","exposed"," and the ","central"," ","hole"," in it was identified.\nA ","preliminary"," ","incision"," out from the ","hole"," ","improved"," ","exposure"," for the ","definitive"," ","excision",".\n","Orifices"," of the ","pulmonary veins"," on both sides were ","located",".\nPosition of the ","atrial septum"," was also ","identified"," by a ","small"," ","opening"," in the ","right atrium"," and by inserting a ","curved clamp"," to ","displace"," the ","septum"," into the ","common pulmonary venous chamber"," of the ","left atrium",".\nThere was no ","atrial septal defect"," or ","patent foramen ovale",".\nThe ","diaphragm"," was then easily ","completely"," ","excised"," ","exposing"," the ","mitral valve"," (figure \u200b2).\nThe ","left atrial appendage"," was ","closed"," from inside the ","left atrium"," using a ","running 3-0 polypropylene suture"," to prevent future ","thrombus formation",".\nThe ","atriotomy incisions"," were ","closed",", the ","heart"," having been ","filled"," with ","blood"," before the last few ","sutures"," were placed.\nThe patient was ","rewarmed",", the ","aortic"," ","cross-clamp"," was removed and additional ","de-airing"," was carried out in the usual manner.\n","CPB"," was terminated with ","minimal"," ","inotropic support",", involving ","milrinone"," and ","levophed"," with ","good"," ","hemodynamics",".\nThe ","postoperative course"," was ","uneventful"," and the patient was ","extubated"," ","after 12 hours"," and ","discharged"," from the hospital on the ","fifth postoperative day",".\nAt ","3 months"," ","follow-up",", the patient was ","asymptomatic"," (","NYHA class"," ","I","), in ","sinus"," ","rhythm",".\n","TTE"," and ","MRI"," revealed a ","mildly"," ","dilated"," ","LV"," with great ","improvement"," in ","systolic function"," and an estimated ","LVEF"," of ","50%",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,26,0,39,0,22,0,39,0,62,0,53,0,13,0,48,0,26,0,53,0,26,0,69,0,13,0,12,0,24,0,24,0,42,0,13,0,13,0,22,0,75,0,13,0,24,0,42,0,69,0,69,0,24,0,69,0,22,0,69,0,12,0,22,0,26,0,24,0,63,0,69,0,12,0,12,0,22,0,26,0,42,0,24,0,24,0,42,0,12,0,12,0,69,0,22,0,69,0,24,0,24,0,69,0,18,0,69,0,22,0,22,0,12,0,12,0,18,0,22,0,12,0,12,0,69,0,12,0,63,0,69,0,12,0,24,0,42,0,63,0,69,0,26,0,26,0,26,0,26,0,69,0,12,0,26,0,24,0,24,0,69,0,12,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,13,0,75,0,46,0,46,0,46,0,46,0,46,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,75,0,75,0,75,0,12,0,12,0,75,0,63,0,69,0,42,0,75,0,22,0,75,0,22,0,12,0,75,0,12,0,12,0,12,0,75,0,22,0,12,0,75,0,22,0,75,0,75,0,12,0,75,0,22,0,69,0,22,0,75,0,69,0,59,0,75,0,22,0,75,0,12,0,12,0,24,0,12,0,24,0,59,0,75,0,12,0,51,0,75,0,12,0,12,0,12,0,26,0,26,0,12,0,22,0,75,0,75,0,12,0,12,0,75,0,12,0,22,0,69,0,75,0,75,0,12,0,53,0,12,0,75,0,75,0,12,0,75,0,75,0,75,0,22,0,46,0,46,0,46,0,42,0,24,0,24,0,42,0,75,0,32,0,13,0,19,0,19,0,13,0,56,0,24,0,42,0,42,0,24,0,24,0,24,0,63,0,69,0,12,0,42,0,24,0,24,0,42,0]}
-{"full_text":"In February 2010, a 77-year-old man with a history of stroke and peripheral vascular disease presented at our emergency department in florid pulmonary edema.\nHe had a 6-month history of worsening dyspnea on exertion, paroxysmal nocturnal dyspnea, and leg edema.\nUpon physical examination, he had diffuse rales and a murmur of aortic stenosis.\nA 2-dimensional Doppler transthoracic echocardiogram revealed severe aortic valve stenosis with a peak gradient of 70 mmHg and a mean gradient of 45 mmHg, a calculated aortic valve area of 0.7 cm2, severe mitral regurgitation, and a severely dilated left ventricle (LV) with an ejection fraction of 0.20.\nAfter the pulmonary edema had resolved, cardiac catheterization confirmed the echocardiographic findings and showed nonobstructive coronary artery disease.\nGiven these findings and the patient's comorbidities, we decided on a minimally invasive surgical approach.\nThe patient was placed in the supine position and underwent anesthetic induction and intubation with a single-lumen endotracheal tube and a bronchial blocker.\nIntraoperative transesophageal echocardiography (TEE) confirmed the previous findings, also showing that the mitral valve leaflets were free of significant disease and that the mitral regurgitation originated in the A2\u2013P2 portion of the mitral valve (Fig.1).\nThe mitral regurgitation was thought to be functional, caused by mitral annular dilation and tethering of the papillary muscles by the severely dilated LV.\nWe decided to perform edge-to-edge repair of the mitral valve from a transaortic approach.\nA femoral platform was used to establish cardiopulmonary bypass.\nA 2- to 3-cm incision was made in the left inguinal crease.\nA 5\u20130 Prolene purse-string suture (Ethicon Inc., a Johnson & Johnson company; Somerville, NJ) was placed in the femoral artery and vein.\nThe left femoral artery was cannulated with a 16F\u201318F arterial cannula.\nThe left femoral vein was cannulated with a 25F Bio-Medicus\u00ae femoral venous cannula (Medtronic, Inc.; Minneapolis, Minn), which was placed in the superior vena cava with the aid of TEE.\nWe then made a 4- to 5-cm transverse parasternal incision over the 3rd intercostal space and transected the 4th costochondral cartilage to enable adequate exposure of the aorta.\nThis interspace was chosen in the event that the left atrium needed to be entered.\nThe pericardium was opened above the phrenic nerve and over the aorta to facilitate exposure.\nA retrograde coronary sinus catheter was inserted directly through the incision, and a purse-string suture was placed in the right atrium.\nA LV vent was inserted via a purse-string suture in the right superior pulmonary vein.\nA transverse aortotomy was performed to expose the aortic valve, which was removed under direct vision.\nThe A2 and P2 segments of the mitral valve were identified, and an edge-to-edge repair was carried out with a 5\u20130 Prolene mattress suture that was reinforced with pericardial pledgets on the ventricular side of the mitral valve (Fig.2).\nNext, a 27-mm Hancock\u00ae II bioprosthetic aortic valve (Medtronic) was implanted by use of standard techniques.\nThe aortotomy was closed in 2-layer fashion, and the patient was weaned from cardiopulmonary bypass.\nThe transected rib was reattached to the sternum with a 1-cm metal plate (Synthes, Inc.; West Chester, Pa), and a fiber wire was placed in figure-8 fashion.\nA single chest tube was left in the pleural space.\nThe thoracotomy was closed in routine fashion.\nPostoperative TEE showed no mitral regurgitation (Fig.3); \u201celbowing\u201d of the anterior leaflet during mid-diastole due to tethering of the anterior leaflet to the posterior leaflet (Fig.4); and the double-orifice mitral valve that resulted from the edge-to-edge repair (Fig.5).\nAfter surgery, the patient did well.\nHis shortness of breath resolved, and he was discharged from the hospital on postoperative day 6.\nUpon follow-up evaluation in March 2011, he was asymptomatic, and echocardiography showed grade 1+ mitral regurgitation.\n","ner_info":[{"text":"February 2010","label":"DATE","start":3,"end":16},{"text":"77-year-old","label":"AGE","start":20,"end":31},{"text":"man","label":"SEX","start":32,"end":35},{"text":"stroke","label":"DISEASE_DISORDER","start":54,"end":60},{"text":"peripheral vascular disease","label":"DISEASE_DISORDER","start":65,"end":92},{"text":"presented","label":"CLINICAL_EVENT","start":93,"end":102},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":110,"end":130},{"text":"florid","label":"DETAILED_DESCRIPTION","start":134,"end":140},{"text":"pulmonary edema","label":"DISEASE_DISORDER","start":141,"end":156},{"text":"6-month history","label":"DURATION","start":167,"end":182},{"text":"worsening dyspnea on exertion","label":"HISTORY","start":186,"end":215},{"text":"paroxysmal","label":"DETAILED_DESCRIPTION","start":217,"end":227},{"text":"nocturnal","label":"DETAILED_DESCRIPTION","start":228,"end":237},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":238,"end":245},{"text":"leg","label":"BIOLOGICAL_STRUCTURE","start":251,"end":254},{"text":"edema","label":"SIGN_SYMPTOM","start":255,"end":260},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":267,"end":287},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":296,"end":303},{"text":"rales","label":"SIGN_SYMPTOM","start":304,"end":309},{"text":"murmur of aortic stenosis","label":"SIGN_SYMPTOM","start":316,"end":341},{"text":"2-dimensional Doppler","label":"DETAILED_DESCRIPTION","start":345,"end":366},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":367,"end":380},{"text":"echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":381,"end":395},{"text":"severe","label":"SEVERITY","start":405,"end":411},{"text":"aortic valve stenosis","label":"DISEASE_DISORDER","start":412,"end":433},{"text":"peak gradient","label":"DIAGNOSTIC_PROCEDURE","start":441,"end":454},{"text":"70 mmHg","label":"LAB_VALUE","start":458,"end":465},{"text":"mean gradient","label":"DIAGNOSTIC_PROCEDURE","start":472,"end":485},{"text":"45 mmHg","label":"LAB_VALUE","start":489,"end":496},{"text":"calculated aortic valve area","label":"DIAGNOSTIC_PROCEDURE","start":500,"end":528},{"text":"0.7 cm2","label":"LAB_VALUE","start":532,"end":539},{"text":"severe","label":"SEVERITY","start":541,"end":547},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":548,"end":568},{"text":"severely","label":"SEVERITY","start":576,"end":584},{"text":"dilated","label":"SIGN_SYMPTOM","start":585,"end":592},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":593,"end":607},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":609,"end":611},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":621,"end":638},{"text":"0.20","label":"LAB_VALUE","start":642,"end":646},{"text":"pulmonary edema","label":"DISEASE_DISORDER","start":658,"end":673},{"text":"cardiac catheterization","label":"DIAGNOSTIC_PROCEDURE","start":688,"end":711},{"text":"echocardiographic findings","label":"COREFERENCE","start":726,"end":752},{"text":"nonobstructive","label":"DETAILED_DESCRIPTION","start":764,"end":778},{"text":"coronary artery disease","label":"DISEASE_DISORDER","start":779,"end":802},{"text":"minimally invasive","label":"DETAILED_DESCRIPTION","start":874,"end":892},{"text":"surgical approach","label":"THERAPEUTIC_PROCEDURE","start":893,"end":910},{"text":"supine position","label":"THERAPEUTIC_PROCEDURE","start":942,"end":957},{"text":"anesthetic","label":"MEDICATION","start":972,"end":982},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":997,"end":1007},{"text":"single-lumen endotracheal tube","label":"DETAILED_DESCRIPTION","start":1015,"end":1045},{"text":"bronchial blocker","label":"DETAILED_DESCRIPTION","start":1052,"end":1069},{"text":"transesophageal echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1086,"end":1118},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":1120,"end":1123},{"text":"mitral valve leaflets","label":"BIOLOGICAL_STRUCTURE","start":1180,"end":1201},{"text":"significant disease","label":"DISEASE_DISORDER","start":1215,"end":1234},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":1248,"end":1268},{"text":"A2\u2013P2 portion","label":"BIOLOGICAL_STRUCTURE","start":1287,"end":1300},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":1308,"end":1320},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":1334,"end":1354},{"text":"functional","label":"DETAILED_DESCRIPTION","start":1373,"end":1383},{"text":"mitral annular dilation","label":"SIGN_SYMPTOM","start":1395,"end":1418},{"text":"tethering","label":"SIGN_SYMPTOM","start":1423,"end":1432},{"text":"papillary muscles","label":"BIOLOGICAL_STRUCTURE","start":1440,"end":1457},{"text":"severely","label":"SEVERITY","start":1465,"end":1473},{"text":"dilated","label":"SIGN_SYMPTOM","start":1474,"end":1481},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":1482,"end":1484},{"text":"edge-to-edge","label":"DETAILED_DESCRIPTION","start":1508,"end":1520},{"text":"repair","label":"THERAPEUTIC_PROCEDURE","start":1521,"end":1527},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":1535,"end":1547},{"text":"transaortic approach","label":"DETAILED_DESCRIPTION","start":1555,"end":1575},{"text":"femoral 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cannula","label":"DETAILED_DESCRIPTION","start":1885,"end":1909},{"text":"left femoral vein","label":"BIOLOGICAL_STRUCTURE","start":1915,"end":1932},{"text":"cannulated","label":"THERAPEUTIC_PROCEDURE","start":1937,"end":1947},{"text":"25F Bio-Medicus\u00ae femoral venous cannula","label":"DETAILED_DESCRIPTION","start":1955,"end":1994},{"text":"Medtronic, Inc.; Minneapolis, Minn","label":"DETAILED_DESCRIPTION","start":1996,"end":2030},{"text":"superior vena cava","label":"BIOLOGICAL_STRUCTURE","start":2057,"end":2075},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":2092,"end":2095},{"text":"4- to 5-cm","label":"DISTANCE","start":2112,"end":2122},{"text":"transverse parasternal","label":"DETAILED_DESCRIPTION","start":2123,"end":2145},{"text":"incision","label":"THERAPEUTIC_PROCEDURE","start":2146,"end":2154},{"text":"3rd intercostal space","label":"BIOLOGICAL_STRUCTURE","start":2164,"end":2185},{"text":"4th costochondral cartilage","label":"BIOLOGICAL_STRUCTURE","start":2205,"end":2232},{"text":"exposure","label":"THERAPEUTIC_PROCEDURE","start":2252,"end":2260},{"text":"aorta","label":"BIOLOGICAL_STRUCTURE","start":2268,"end":2273},{"text":"pericardium","label":"BIOLOGICAL_STRUCTURE","start":2362,"end":2373},{"text":"opened","label":"THERAPEUTIC_PROCEDURE","start":2378,"end":2384},{"text":"above the phrenic nerve","label":"BIOLOGICAL_STRUCTURE","start":2385,"end":2408},{"text":"over the aorta","label":"BIOLOGICAL_STRUCTURE","start":2413,"end":2427},{"text":"exposure","label":"THERAPEUTIC_PROCEDURE","start":2442,"end":2450},{"text":"retrograde","label":"DETAILED_DESCRIPTION","start":2454,"end":2464},{"text":"coronary sinus","label":"BIOLOGICAL_STRUCTURE","start":2465,"end":2479},{"text":"catheter","label":"THERAPEUTIC_PROCEDURE","start":2480,"end":2488},{"text":"incision","label":"THERAPEUTIC_PROCEDURE","start":2523,"end":2531},{"text":"purse-string","label":"DETAILED_DESCRIPTION","start":2539,"end":2551},{"text":"suture","label":"THERAPEUTIC_PROCEDURE","start":2552,"end":2558},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":2577,"end":2589},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":2593,"end":2595},{"text":"vent","label":"THERAPEUTIC_PROCEDURE","start":2596,"end":2600},{"text":"purse-string","label":"DETAILED_DESCRIPTION","start":2620,"end":2632},{"text":"suture","label":"THERAPEUTIC_PROCEDURE","start":2633,"end":2639},{"text":"right superior pulmonary vein","label":"BIOLOGICAL_STRUCTURE","start":2647,"end":2676},{"text":"transverse","label":"DETAILED_DESCRIPTION","start":2680,"end":2690},{"text":"aortotomy","label":"THERAPEUTIC_PROCEDURE","start":2691,"end":2700},{"text":"expose","label":"THERAPEUTIC_PROCEDURE","start":2718,"end":2724},{"text":"aortic valve","label":"BIOLOGICAL_STRUCTURE","start":2729,"end":2741},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":2753,"end":2760},{"text":"direct vision","label":"DIAGNOSTIC_PROCEDURE","start":2767,"end":2780},{"text":"A2 and P2 segments","label":"BIOLOGICAL_STRUCTURE","start":2786,"end":2804},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":2812,"end":2824},{"text":"identified","label":"DIAGNOSTIC_PROCEDURE","start":2830,"end":2840},{"text":"edge-to-edge","label":"DETAILED_DESCRIPTION","start":2849,"end":2861},{"text":"repair","label":"THERAPEUTIC_PROCEDURE","start":2862,"end":2868},{"text":"5\u20130 Prolene mattress","label":"DETAILED_DESCRIPTION","start":2892,"end":2912},{"text":"suture","label":"THERAPEUTIC_PROCEDURE","start":2913,"end":2919},{"text":"reinforced with pericardial pledgets","label":"DETAILED_DESCRIPTION","start":2929,"end":2965},{"text":"ventricular side","label":"BIOLOGICAL_STRUCTURE","start":2973,"end":2989},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":2997,"end":3009},{"text":"27-mm Hancock\u00ae II","label":"DETAILED_DESCRIPTION","start":3027,"end":3044},{"text":"bioprosthetic aortic valve","label":"THERAPEUTIC_PROCEDURE","start":3045,"end":3071},{"text":"Medtronic","label":"DETAILED_DESCRIPTION","start":3073,"end":3082},{"text":"implanted","label":"THERAPEUTIC_PROCEDURE","start":3088,"end":3097},{"text":"standard techniques","label":"DETAILED_DESCRIPTION","start":3108,"end":3127},{"text":"aortotomy","label":"THERAPEUTIC_PROCEDURE","start":3133,"end":3142},{"text":"closed","label":"THERAPEUTIC_PROCEDURE","start":3147,"end":3153},{"text":"2-layer fashion","label":"DETAILED_DESCRIPTION","start":3157,"end":3172},{"text":"cardiopulmonary bypass","label":"THERAPEUTIC_PROCEDURE","start":3206,"end":3228},{"text":"rib","label":"BIOLOGICAL_STRUCTURE","start":3245,"end":3248},{"text":"reattached","label":"THERAPEUTIC_PROCEDURE","start":3253,"end":3263},{"text":"sternum","label":"BIOLOGICAL_STRUCTURE","start":3271,"end":3278},{"text":"1-cm metal plate","label":"DETAILED_DESCRIPTION","start":3286,"end":3302},{"text":"Synthes, Inc.; West Chester, Pa","label":"DETAILED_DESCRIPTION","start":3304,"end":3335},{"text":"fiber wire","label":"DETAILED_DESCRIPTION","start":3344,"end":3354},{"text":"placed","label":"THERAPEUTIC_PROCEDURE","start":3359,"end":3365},{"text":"figure-8 fashion","label":"DETAILED_DESCRIPTION","start":3369,"end":3385},{"text":"single","label":"QUANTITATIVE_CONCEPT","start":3389,"end":3395},{"text":"chest tube","label":"DETAILED_DESCRIPTION","start":3396,"end":3406},{"text":"left","label":"THERAPEUTIC_PROCEDURE","start":3411,"end":3415},{"text":"pleural space","label":"BIOLOGICAL_STRUCTURE","start":3423,"end":3436},{"text":"thoracotomy","label":"THERAPEUTIC_PROCEDURE","start":3442,"end":3453},{"text":"closed","label":"THERAPEUTIC_PROCEDURE","start":3458,"end":3464},{"text":"routine fashion","label":"DETAILED_DESCRIPTION","start":3468,"end":3483},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":3499,"end":3502},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":3513,"end":3533},{"text":"elbowing","label":"SIGN_SYMPTOM","start":3544,"end":3552},{"text":"anterior leaflet","label":"BIOLOGICAL_STRUCTURE","start":3561,"end":3577},{"text":"tethering","label":"SIGN_SYMPTOM","start":3605,"end":3614},{"text":"anterior leaflet","label":"BIOLOGICAL_STRUCTURE","start":3622,"end":3638},{"text":"posterior leaflet","label":"BIOLOGICAL_STRUCTURE","start":3646,"end":3663},{"text":"double-orifice","label":"SIGN_SYMPTOM","start":3681,"end":3695},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":3696,"end":3708},{"text":"edge-to-edge","label":"DETAILED_DESCRIPTION","start":3732,"end":3744},{"text":"repair","label":"THERAPEUTIC_PROCEDURE","start":3745,"end":3751},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":3767,"end":3774},{"text":"did well","label":"SIGN_SYMPTOM","start":3788,"end":3796},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":3802,"end":3821},{"text":"discharged","label":"CLINICAL_EVENT","start":3843,"end":3853},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":3863,"end":3871},{"text":"postoperative day 6","label":"DATE","start":3875,"end":3894},{"text":"follow-up","label":"CLINICAL_EVENT","start":3901,"end":3910},{"text":"March 2011","label":"DATE","start":3925,"end":3935},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":3944,"end":3956},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":3962,"end":3978},{"text":"grade 1+","label":"LAB_VALUE","start":3986,"end":3994},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":3995,"end":4015}],"tokens":["In ","February 2010",", a ","77-year-old"," ","man"," with a history of ","stroke"," and ","peripheral vascular disease"," ","presented"," at our ","emergency department"," in ","florid"," ","pulmonary edema",".\nHe had a ","6-month history"," of ","worsening dyspnea on exertion",", ","paroxysmal"," ","nocturnal"," ","dyspnea",", and ","leg"," ","edema",".\nUpon ","physical examination",", he had ","diffuse"," ","rales"," and a ","murmur of aortic stenosis",".\nA ","2-dimensional Doppler"," ","transthoracic"," ","echocardiogram"," revealed ","severe"," ","aortic valve stenosis"," with a ","peak gradient"," of ","70 mmHg"," and a ","mean gradient"," of ","45 mmHg",", a ","calculated aortic valve area"," of ","0.7 cm2",", ","severe"," ","mitral regurgitation",", and a ","severely"," ","dilated"," ","left ventricle"," (","LV",") with an ","ejection fraction"," of ","0.20",".\nAfter the ","pulmonary edema"," had resolved, ","cardiac catheterization"," confirmed the ","echocardiographic findings"," and showed ","nonobstructive"," ","coronary artery disease",".\nGiven these findings and the patient's comorbidities, we decided on a ","minimally invasive"," ","surgical approach",".\nThe patient was placed in the ","supine position"," and underwent ","anesthetic"," induction and ","intubation"," with a ","single-lumen endotracheal tube"," and a ","bronchial blocker",".\nIntraoperative ","transesophageal echocardiography"," (","TEE",") confirmed the previous findings, also showing that the ","mitral valve leaflets"," were free of ","significant disease"," and that the ","mitral regurgitation"," originated in the ","A2\u2013P2 portion"," of the ","mitral valve"," (Fig.1).\nThe ","mitral regurgitation"," was thought to be ","functional",", caused by ","mitral annular dilation"," and ","tethering"," of the ","papillary muscles"," by the ","severely"," ","dilated"," ","LV",".\nWe decided to perform ","edge-to-edge"," ","repair"," of the ","mitral valve"," from a ","transaortic approach",".\nA ","femoral platform"," was used to establish ","cardiopulmonary bypass",".\nA ","2- to 3-cm"," ","incision"," was made in the ","left inguinal crease",".\nA ","5\u20130 Prolene purse-string"," ","suture"," (","Ethicon Inc., a Johnson & Johnson company; Somerville, NJ",") was placed in the ","femoral artery and vein",".\nThe ","left femoral artery"," was ","cannulated"," with a ","16F\u201318F arterial cannula",".\nThe ","left femoral vein"," was ","cannulated"," with a ","25F Bio-Medicus\u00ae femoral venous cannula"," (","Medtronic, Inc.; Minneapolis, Minn","), which was placed in the ","superior vena cava"," with the aid of ","TEE",".\nWe then made a ","4- to 5-cm"," ","transverse parasternal"," ","incision"," over the ","3rd intercostal space"," and transected the ","4th costochondral cartilage"," to enable adequate ","exposure"," of the ","aorta",".\nThis interspace was chosen in the event that the left atrium needed to be entered.\nThe ","pericardium"," was ","opened"," ","above the phrenic nerve"," and ","over the aorta"," to facilitate ","exposure",".\nA ","retrograde"," ","coronary sinus"," ","catheter"," was inserted directly through the ","incision",", and a ","purse-string"," ","suture"," was placed in the ","right atrium",".\nA ","LV"," ","vent"," was inserted via a ","purse-string"," ","suture"," in the ","right superior pulmonary vein",".\nA ","transverse"," ","aortotomy"," was performed to ","expose"," the ","aortic valve",", which was ","removed"," under ","direct vision",".\nThe ","A2 and P2 segments"," of the ","mitral valve"," were ","identified",", and an ","edge-to-edge"," ","repair"," was carried out with a ","5\u20130 Prolene mattress"," ","suture"," that was ","reinforced with pericardial pledgets"," on the ","ventricular side"," of the ","mitral valve"," (Fig.2).\nNext, a ","27-mm Hancock\u00ae II"," ","bioprosthetic aortic valve"," (","Medtronic",") was ","implanted"," by use of ","standard techniques",".\nThe ","aortotomy"," was ","closed"," in ","2-layer fashion",", and the patient was weaned from ","cardiopulmonary bypass",".\nThe transected ","rib"," was ","reattached"," to the ","sternum"," with a ","1-cm metal plate"," (","Synthes, Inc.; West Chester, Pa","), and a ","fiber wire"," was ","placed"," in ","figure-8 fashion",".\nA ","single"," ","chest tube"," was ","left"," in the ","pleural space",".\nThe ","thoracotomy"," was ","closed"," in ","routine fashion",".\nPostoperative ","TEE"," showed no ","mitral regurgitation"," (Fig.3); \u201c","elbowing","\u201d of the ","anterior leaflet"," during mid-diastole due to ","tethering"," of the ","anterior leaflet"," to the ","posterior leaflet"," (Fig.4); and the ","double-orifice"," ","mitral valve"," that resulted from the ","edge-to-edge"," ","repair"," (Fig.5).\nAfter ","surgery",", the patient ","did well",".\nHis ","shortness of breath"," resolved, and he was ","discharged"," from the ","hospital"," on ","postoperative day 6",".\nUpon ","follow-up"," evaluation in ","March 2011",", he was ","asymptomatic",", and ","echocardiography"," showed ","grade 1+"," ","mitral regurgitation",".\n"],"ner_labels":[0,19,0,5,0,65,0,26,0,26,0,13,0,48,0,22,0,26,0,32,0,39,0,22,0,22,0,69,0,12,0,69,0,24,0,22,0,69,0,69,0,22,0,12,0,24,0,63,0,26,0,24,0,42,0,24,0,42,0,24,0,42,0,63,0,26,0,63,0,69,0,12,0,12,0,24,0,42,0,26,0,24,0,18,0,22,0,26,0,22,0,75,0,75,0,46,0,75,0,22,0,22,0,24,0,24,0,12,0,26,0,26,0,12,0,12,0,26,0,22,0,69,0,69,0,12,0,63,0,69,0,12,0,22,0,75,0,12,0,22,0,75,0,75,0,27,0,75,0,12,0,22,0,75,0,22,0,12,0,12,0,75,0,22,0,12,0,75,0,22,0,22,0,12,0,24,0,27,0,22,0,75,0,12,0,12,0,75,0,12,0,12,0,75,0,12,0,12,0,75,0,22,0,12,0,75,0,75,0,22,0,75,0,12,0,12,0,75,0,22,0,75,0,12,0,22,0,75,0,75,0,12,0,75,0,24,0,12,0,12,0,24,0,22,0,75,0,22,0,75,0,22,0,12,0,12,0,22,0,75,0,22,0,75,0,22,0,75,0,75,0,22,0,75,0,12,0,75,0,12,0,22,0,22,0,22,0,75,0,22,0,62,0,22,0,75,0,12,0,75,0,75,0,22,0,24,0,26,0,69,0,12,0,69,0,12,0,12,0,69,0,12,0,22,0,75,0,75,0,69,0,69,0,13,0,48,0,19,0,13,0,19,0,69,0,24,0,42,0,26,0]}
-{"full_text":"A 59-year-old man was referred to the general surgery department of our hospital for a one-month history of progressive dysphagia for solids, which was not associated with malnutrition or significant weight loss.\nThe patient had recently undergone esophagogastroduodenoscopy in another hospital, which revealed a bleeding, ulcerative lesion in the middle third of the esophagus, but no biopsy had been collected.\nThe medical past history included COPD diagnosed in 1999 and a myocardial infarction in 2002.\nThe patient had smoked approximately 25 cigarettes per day for several years.\nPhysical examination was unremarkable.\nComputed tomography (CT) of the chest and abdomen revealed stenosis involving a 5-cm segment of the middle third of the esophagus with no other lesions in the thoracic or abdominal organs.\nBarium studies disclosed a swelling in the esophageal wall 7 cm above the cardia with an ulcerative pattern, which reduced the diameter of the lumen to 5 mm.\nAn endoscopic biopsy of the oesophageal mass demonstrated poorly differentiated (G3) squamous cell carcinoma.\nMid-distal esophagectomy was performed with oesophagogastric anastomosis and gastric tube reconstruction.\nPathological examination of the surgical specimen confirmed the biopsy diagnosis of poorly differentiated (G3) SCC.\nThe tumor, which measured 3 cm of length, had infiltrated the oesophageal wall and the surrounding paraesophageal fat.\nSurgical margins were tumor-free, as the seven perigastric limph-nodes dissected (pT3 N0).\nThe postoperative period was quite unremarkable, and a contrast enhanced x-ray obtained on the 9th POD showed normal esophageal and gastric transit.\nOn the 14th POD, the patient was discharged with an oncology referral for routine medical follow-up.\nNine months after the operation, CT and esophagogastroduodenoscopy were repeated.\nThe imaging study revealed mild splenomegaly with multiple nonspecific nodules within the organ (Figure \u200b1).\nThe patient was virtually asymptomatic with the exception of a vague sensation of mild discomfort in the left upper quadrant of the abdomen.\nFNAC of the spleen revealed a pattern of numerous inflammatory cells admixed with large cells displaying immunohistochemical positivity for several cytokeratins (Figure 2).\nThe specimen was Gram stain-negative.\nA bone-marrow biopsy was negative for metastatic involvement.\nThe diagnosis was isolated metastases of the spleen with inflammatory and necrotic alterations.\nThe patient was referred to our centre for splenectomy, which was performed as a routine procedure to role out, also, a spontaneous rupture of the spleen.\nOn 12th December 2007, the patient had transabdominal total splenectomy with splenic and celiac artery lymph node dissection.\nThe postoperative course was uneventful.\nOn the 7th postoperative day, Doppler ultrasonography revealed portal-tree patency with no signs of thrombosis.\nTen days later, the patient was discharged with a stable platelet count (780,000\/mm3), Hb 10.9 g\/dL, and a WBC count of 16,500\/mm3.\nPathological examination of the spleen described multiple nodules containing medium to large-sized cells, some of which were keratinized.\nThe nodules were mostly solid with areas of central necrosis (Figure \u200b3).\nThe findings were consistent with metastases of SCC.\nThereafter, the patient was referred to the oncology department of our hospital, where he received two 3-day cycles (separated by a 3-week interval) of systemic chemotherapy based on 5-fluorouracil (800 mg\/day IV) and cisplatin (20 mg\/day).\nThree months after the splenectomy, multiple liver metastases were seen on the CT scan, and cutaneous metastases were also present.\nThe patient died 9 months later.\n","ner_info":[{"text":"59-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"general surgery department","label":"NONBIOLOGICAL_LOCATION","start":38,"end":64},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":72,"end":80},{"text":"one-month history","label":"DURATION","start":87,"end":104},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":108,"end":119},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":120,"end":129},{"text":"solids","label":"DETAILED_DESCRIPTION","start":134,"end":140},{"text":"malnutrition","label":"DISEASE_DISORDER","start":172,"end":184},{"text":"weight loss","label":"SIGN_SYMPTOM","start":200,"end":211},{"text":"esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":248,"end":274},{"text":"another hospital","label":"NONBIOLOGICAL_LOCATION","start":278,"end":294},{"text":"bleeding","label":"DETAILED_DESCRIPTION","start":313,"end":321},{"text":"ulcerative","label":"DETAILED_DESCRIPTION","start":323,"end":333},{"text":"lesion","label":"SIGN_SYMPTOM","start":334,"end":340},{"text":"middle third","label":"DETAILED_DESCRIPTION","start":348,"end":360},{"text":"esophagus","label":"BIOLOGICAL_STRUCTURE","start":368,"end":377},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":386,"end":392},{"text":"COPD","label":"DISEASE_DISORDER","start":447,"end":451},{"text":"1999","label":"DATE","start":465,"end":469},{"text":"myocardial infarction","label":"DISEASE_DISORDER","start":476,"end":497},{"text":"2002","label":"DATE","start":501,"end":505},{"text":"smoked","label":"ACTIVITY","start":523,"end":529},{"text":"25 cigarettes per day","label":"DETAILED_DESCRIPTION","start":544,"end":565},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":585,"end":605},{"text":"unremarkable","label":"LAB_VALUE","start":610,"end":622},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":624,"end":643},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":645,"end":647},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":656,"end":661},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":666,"end":673},{"text":"stenosis","label":"SIGN_SYMPTOM","start":683,"end":691},{"text":"5-cm","label":"DISTANCE","start":704,"end":708},{"text":"segment of the middle third","label":"DETAILED_DESCRIPTION","start":709,"end":736},{"text":"esophagus","label":"BIOLOGICAL_STRUCTURE","start":744,"end":753},{"text":"lesions","label":"SIGN_SYMPTOM","start":768,"end":775},{"text":"thoracic or abdominal organs","label":"BIOLOGICAL_STRUCTURE","start":783,"end":811},{"text":"Barium studies","label":"DIAGNOSTIC_PROCEDURE","start":813,"end":827},{"text":"swelling","label":"SIGN_SYMPTOM","start":840,"end":848},{"text":"esophageal wall","label":"BIOLOGICAL_STRUCTURE","start":856,"end":871},{"text":"7 cm","label":"DISTANCE","start":872,"end":876},{"text":"above the cardia","label":"BIOLOGICAL_STRUCTURE","start":877,"end":893},{"text":"ulcerative pattern","label":"DETAILED_DESCRIPTION","start":902,"end":920},{"text":"reduced","label":"LAB_VALUE","start":928,"end":935},{"text":"diameter","label":"DIAGNOSTIC_PROCEDURE","start":940,"end":948},{"text":"lumen","label":"BIOLOGICAL_STRUCTURE","start":956,"end":961},{"text":"5 mm","label":"LAB_VALUE","start":965,"end":969},{"text":"endoscopic","label":"DETAILED_DESCRIPTION","start":974,"end":984},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":985,"end":991},{"text":"oesophageal","label":"BIOLOGICAL_STRUCTURE","start":999,"end":1010},{"text":"mass","label":"SIGN_SYMPTOM","start":1011,"end":1015},{"text":"poorly differentiated","label":"DETAILED_DESCRIPTION","start":1029,"end":1050},{"text":"G3","label":"LAB_VALUE","start":1052,"end":1054},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":1056,"end":1079},{"text":"Mid-distal","label":"DETAILED_DESCRIPTION","start":1081,"end":1091},{"text":"esophagectomy","label":"THERAPEUTIC_PROCEDURE","start":1092,"end":1105},{"text":"oesophagogastric anastomosis","label":"THERAPEUTIC_PROCEDURE","start":1125,"end":1153},{"text":"gastric tube","label":"BIOLOGICAL_STRUCTURE","start":1158,"end":1170},{"text":"reconstruction","label":"THERAPEUTIC_PROCEDURE","start":1171,"end":1185},{"text":"Pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":1187,"end":1211},{"text":"surgical specimen","label":"COREFERENCE","start":1219,"end":1236},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1251,"end":1257},{"text":"poorly differentiated","label":"DETAILED_DESCRIPTION","start":1271,"end":1292},{"text":"G3","label":"LAB_VALUE","start":1294,"end":1296},{"text":"SCC","label":"DISEASE_DISORDER","start":1298,"end":1301},{"text":"tumor","label":"COREFERENCE","start":1307,"end":1312},{"text":"3 cm of length","label":"DISTANCE","start":1329,"end":1343},{"text":"infiltrated","label":"SIGN_SYMPTOM","start":1349,"end":1360},{"text":"oesophageal wall","label":"BIOLOGICAL_STRUCTURE","start":1365,"end":1381},{"text":"paraesophageal fat","label":"BIOLOGICAL_STRUCTURE","start":1402,"end":1420},{"text":"Surgical margins","label":"DIAGNOSTIC_PROCEDURE","start":1422,"end":1438},{"text":"tumor-free","label":"LAB_VALUE","start":1444,"end":1454},{"text":"seven","label":"QUANTITATIVE_CONCEPT","start":1463,"end":1468},{"text":"perigastric limph-nodes","label":"BIOLOGICAL_STRUCTURE","start":1469,"end":1492},{"text":"dissected","label":"DIAGNOSTIC_PROCEDURE","start":1493,"end":1502},{"text":"pT3 N0","label":"LAB_VALUE","start":1504,"end":1510},{"text":"postoperative period","label":"DIAGNOSTIC_PROCEDURE","start":1517,"end":1537},{"text":"unremarkable","label":"LAB_VALUE","start":1548,"end":1560},{"text":"contrast enhanced","label":"DETAILED_DESCRIPTION","start":1568,"end":1585},{"text":"x-ray","label":"DIAGNOSTIC_PROCEDURE","start":1586,"end":1591},{"text":"9th POD","label":"DATE","start":1608,"end":1615},{"text":"normal","label":"LAB_VALUE","start":1623,"end":1629},{"text":"esophageal and gastric transit","label":"DIAGNOSTIC_PROCEDURE","start":1630,"end":1660},{"text":"14th POD","label":"DATE","start":1669,"end":1677},{"text":"discharged","label":"CLINICAL_EVENT","start":1695,"end":1705},{"text":"oncology","label":"NONBIOLOGICAL_LOCATION","start":1714,"end":1722},{"text":"referral","label":"CLINICAL_EVENT","start":1723,"end":1731},{"text":"follow-up","label":"CLINICAL_EVENT","start":1752,"end":1761},{"text":"Nine months 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","referred"," to the ","general surgery department"," of our ","hospital"," for a ","one-month history"," of ","progressive"," ","dysphagia"," for ","solids",", which was not associated with ","malnutrition"," or significant ","weight loss",".\nThe patient had recently undergone ","esophagogastroduodenoscopy"," in ","another hospital",", which revealed a ","bleeding",", ","ulcerative"," ","lesion"," in the ","middle third"," of the ","esophagus",", but no ","biopsy"," had been collected.\nThe medical past history included ","COPD"," diagnosed in ","1999"," and a ","myocardial infarction"," in ","2002",".\nThe patient had ","smoked"," approximately ","25 cigarettes per day"," for several years.\n","Physical examination"," was ","unremarkable",".\n","Computed tomography"," (","CT",") of the ","chest"," and ","abdomen"," revealed ","stenosis"," involving a ","5-cm"," ","segment of the middle third"," of the ","esophagus"," with no other ","lesions"," in the ","thoracic or abdominal organs",".\n","Barium studies"," disclosed a ","swelling"," in the ","esophageal wall"," ","7 cm"," ","above the cardia"," with an ","ulcerative pattern",", which ","reduced"," the ","diameter"," of the ","lumen"," to ","5 mm",".\nAn ","endoscopic"," ","biopsy"," of the ","oesophageal"," ","mass"," demonstrated ","poorly differentiated"," (","G3",") ","squamous cell carcinoma",".\n","Mid-distal"," ","esophagectomy"," was performed with ","oesophagogastric anastomosis"," and ","gastric tube"," ","reconstruction",".\n","Pathological examination"," of the ","surgical specimen"," confirmed the ","biopsy"," diagnosis of ","poorly differentiated"," (","G3",") ","SCC",".\nThe ","tumor",", which measured ","3 cm of length",", had ","infiltrated"," the ","oesophageal wall"," and the surrounding ","paraesophageal fat",".\n","Surgical margins"," were ","tumor-free",", as the ","seven"," ","perigastric limph-nodes"," ","dissected"," (","pT3 N0",").\nThe ","postoperative period"," was quite ","unremarkable",", and a ","contrast enhanced"," ","x-ray"," obtained on the ","9th POD"," showed ","normal"," ","esophageal and gastric transit",".\nOn the ","14th POD",", the patient was ","discharged"," with an ","oncology"," ","referral"," for routine medical ","follow-up",".\n","Nine months after"," the operation, ","CT"," and ","esophagogastroduodenoscopy"," were repeated.\nThe ","imaging study"," revealed ","mild"," ","splenomegaly"," with ","multiple"," nonspecific ","nodules"," within the ","organ"," (Figure \u200b1).\nThe patient was virtually ","asymptomatic"," with the exception of a vague sensation of ","mild"," ","discomfort"," in the ","left upper quadrant of the abdomen",".\n","FNAC"," of the ","spleen"," revealed a pattern of numerous ","inflammatory cells admixed with large cells"," displaying immunohistochemical ","positivity"," for several ","cytokeratins"," (Figure 2).\nThe specimen was ","Gram stain","-","negative",".\nA ","bone-marrow"," ","biopsy"," was ","negative"," for ","metastatic involvement",".\nThe diagnosis was isolated ","metastases"," of the ","spleen"," with ","inflammatory"," and ","necrotic"," ","alterations",".\nThe patient was ","referred"," to our ","centre"," for ","splenectomy",", which was performed as a routine procedure to role out, also, a ","spontaneous"," ","rupture"," of the ","spleen",".\nOn ","12th December 2007",", the patient had ","transabdominal"," ","total"," ","splenectomy"," with ","splenic"," and ","celiac artery"," ","lymph node dissection",".\nThe ","postoperative course"," was ","uneventful",".\nOn the ","7th postoperative day",", ","Doppler"," ","ultrasonography"," revealed ","portal-tree"," ","patency"," with no signs of ","thrombosis",".\n","Ten days later",", the patient was ","discharged"," with a ","stable"," ","platelet count"," (","780,000\/mm3","), ","Hb"," ","10.9 g\/dL",", and a ","WBC count"," of ","16,500\/mm3",".\n","Pathological examination"," of the ","spleen"," described ","multiple"," ","nodules"," containing ","medium to large-sized cells",", ","some of which were keratinized",".\nThe ","nodules"," were ","mostly solid"," with ","areas of central necrosis"," (Figure \u200b3).\nThe findings were consistent with ","metastases"," of ","SCC",".\nThereafter, the patient was ","referred"," to the ","oncology department"," of our ","hospital",", where he received ","two 3-day cycles"," (","separated by a 3-week interval",") of ","systemic"," ","chemotherapy"," based on ","5-fluorouracil"," (","800 mg\/day"," ","IV",") and ","cisplatin"," (","20 mg\/day",").\n","Three months after"," the ","splenectomy",", ","multiple"," ","liver"," ","metastases"," were seen on the ","CT"," scan, and ","cutaneous"," ","metastases"," were also present.\nThe patient ","died"," ","9 months later",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,48,0,32,0,22,0,69,0,22,0,26,0,69,0,24,0,48,0,22,0,22,0,69,0,22,0,12,0,24,0,26,0,19,0,26,0,19,0,1,0,22,0,24,0,42,0,24,0,24,0,12,0,12,0,69,0,27,0,22,0,12,0,69,0,12,0,24,0,69,0,12,0,27,0,12,0,22,0,42,0,24,0,12,0,42,0,22,0,24,0,12,0,69,0,22,0,42,0,26,0,22,0,75,0,75,0,12,0,75,0,24,0,18,0,24,0,22,0,42,0,26,0,18,0,27,0,69,0,12,0,12,0,24,0,42,0,62,0,12,0,24,0,42,0,24,0,42,0,22,0,24,0,19,0,42,0,24,0,19,0,13,0,48,0,13,0,13,0,19,0,24,0,24,0,24,0,63,0,69,0,62,0,69,0,12,0,69,0,63,0,69,0,12,0,24,0,12,0,69,0,42,0,24,0,24,0,42,0,12,0,24,0,42,0,24,0,26,0,12,0,22,0,22,0,69,0,13,0,48,0,75,0,22,0,69,0,12,0,19,0,22,0,22,0,75,0,12,0,12,0,75,0,24,0,42,0,19,0,22,0,24,0,22,0,69,0,26,0,19,0,13,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,12,0,62,0,69,0,22,0,22,0,69,0,73,0,22,0,26,0,26,0,13,0,48,0,48,0,29,0,22,0,22,0,46,0,46,0,29,0,4,0,46,0,29,0,19,0,75,0,62,0,12,0,26,0,24,0,12,0,26,0,56,0,19,0]}
-{"full_text":"A 26-year-old man of Portuguese descent with no significant past medical history presents with subacute onset of right-sided hemiparesis and aphasia, with marked expressive aphasia, word-finding difficulty, and rare paraphrasic errors.\nExamination demonstrated right central facial weakness, 2\u20133\/5 strength in the right arm and leg, and dysmetria in the right upper and lower extremities.\nReflexes were hyperactive on the right with a right-sided Babinski response.\nMRI of the brain showed multiple bilateral concentric ring-like structures in the centrum semiovale and the corona radiata on T2 imaging (figure,A), consistent with the pattern of Balo concentric sclerosis.\nThere was associated restricted diffusion in 3 lesions and incomplete ring enhancement in 1 lesion.\nCSF analysis showed 30 leukocytes (79% lymphocytes, 4% monocytes), erythrocyte count was 850, and oligoclonal bands were absent.\nHe was treated with 1 g of IV methylprednisolone daily for 5 days, with little improvement.\nHe then underwent 5 plasmapheresis exchanges, with significant improvement of motor, sensory, speech deficits, and gait.\nForty-five days after discharge, his examination showed 4+\/5 strength in the right intrinsic muscles of the hand and a right-sided positional tremor.\nGait and tandem gait were normal.\nHe was placed on \u03b2-interferon-1a 44 \u03bcg subcutaneously 3 times a week, for treatment of presumed clinically isolated syndrome, with good response.\nOne year later, his neurologic examination was essentially normal.\nThere was no family history of demyelinating or autoimmune disorders.\nHis mother has a significant history of headaches and early-onset strokes, and was found to be a carrier of the Notch3 mutation consistent with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).\nHis sister had a stroke in her 30s, and a history of migraine headaches, but has not undergone medical evaluation.\nTesting for CADASIL in the patient showed the Notch3 mutation associated with CADASIL (transition C>T, nucleotide position 1750, codon 558).\nSkin biopsy showed electron-dense extracellular material in close apposition to the smooth muscle of the vascular media1 (figure, B).\n","ner_info":[{"text":"26-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"Portuguese descent","label":"PERSONAL_BACKGROUND","start":21,"end":39},{"text":"no significant past medical history","label":"HISTORY","start":45,"end":80},{"text":"presents","label":"CLINICAL_EVENT","start":81,"end":89},{"text":"right-sided","label":"DETAILED_DESCRIPTION","start":113,"end":124},{"text":"hemiparesis","label":"SIGN_SYMPTOM","start":125,"end":136},{"text":"aphasia","label":"DISEASE_DISORDER","start":141,"end":148},{"text":"marked","label":"SEVERITY","start":155,"end":161},{"text":"expressive","label":"DETAILED_DESCRIPTION","start":162,"end":172},{"text":"aphasia","label":"DISEASE_DISORDER","start":173,"end":180},{"text":"word-finding difficulty","label":"SIGN_SYMPTOM","start":182,"end":205},{"text":"rare","label":"FREQUENCY","start":211,"end":215},{"text":"paraphrasic errors","label":"SIGN_SYMPTOM","start":216,"end":234},{"text":"Examination","label":"DIAGNOSTIC_PROCEDURE","start":236,"end":247},{"text":"right central facial","label":"BIOLOGICAL_STRUCTURE","start":261,"end":281},{"text":"weakness","label":"SIGN_SYMPTOM","start":282,"end":290},{"text":"2\u20133\/5","label":"LAB_VALUE","start":292,"end":297},{"text":"strength","label":"DIAGNOSTIC_PROCEDURE","start":298,"end":306},{"text":"right","label":"DETAILED_DESCRIPTION","start":314,"end":319},{"text":"arm","label":"BIOLOGICAL_STRUCTURE","start":320,"end":323},{"text":"leg","label":"BIOLOGICAL_STRUCTURE","start":328,"end":331},{"text":"dysmetria","label":"SIGN_SYMPTOM","start":337,"end":346},{"text":"right","label":"DETAILED_DESCRIPTION","start":354,"end":359},{"text":"upper","label":"DETAILED_DESCRIPTION","start":360,"end":365},{"text":"lower","label":"DETAILED_DESCRIPTION","start":370,"end":375},{"text":"extremities","label":"BIOLOGICAL_STRUCTURE","start":376,"end":387},{"text":"Reflexes","label":"DIAGNOSTIC_PROCEDURE","start":389,"end":397},{"text":"hyperactive","label":"LAB_VALUE","start":403,"end":414},{"text":"right","label":"DETAILED_DESCRIPTION","start":422,"end":427},{"text":"right-sided","label":"LAB_VALUE","start":435,"end":446},{"text":"Babinski response","label":"DIAGNOSTIC_PROCEDURE","start":447,"end":464},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":466,"end":469},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":477,"end":482},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":490,"end":498},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":499,"end":508},{"text":"concentric","label":"DETAILED_DESCRIPTION","start":509,"end":519},{"text":"ring-like","label":"SHAPE","start":520,"end":529},{"text":"structures","label":"SIGN_SYMPTOM","start":530,"end":540},{"text":"centrum semiovale","label":"BIOLOGICAL_STRUCTURE","start":548,"end":565},{"text":"corona radiata","label":"BIOLOGICAL_STRUCTURE","start":574,"end":588},{"text":"T2 imaging","label":"DIAGNOSTIC_PROCEDURE","start":592,"end":602},{"text":"Balo concentric sclerosis","label":"DISEASE_DISORDER","start":646,"end":671},{"text":"associated restricted diffusion","label":"DETAILED_DESCRIPTION","start":683,"end":714},{"text":"3","label":"LAB_VALUE","start":718,"end":719},{"text":"lesions","label":"SIGN_SYMPTOM","start":720,"end":727},{"text":"incomplete ring enhancement","label":"DETAILED_DESCRIPTION","start":732,"end":759},{"text":"1","label":"LAB_VALUE","start":763,"end":764},{"text":"lesion","label":"SIGN_SYMPTOM","start":765,"end":771},{"text":"CSF analysis","label":"DIAGNOSTIC_PROCEDURE","start":773,"end":785},{"text":"30","label":"LAB_VALUE","start":793,"end":795},{"text":"leukocytes","label":"DIAGNOSTIC_PROCEDURE","start":796,"end":806},{"text":"79%","label":"LAB_VALUE","start":808,"end":811},{"text":"lymphocytes","label":"DIAGNOSTIC_PROCEDURE","start":812,"end":823},{"text":"4%","label":"LAB_VALUE","start":825,"end":827},{"text":"monocytes","label":"DIAGNOSTIC_PROCEDURE","start":828,"end":837},{"text":"erythrocyte","label":"DIAGNOSTIC_PROCEDURE","start":840,"end":851},{"text":"850","label":"LAB_VALUE","start":862,"end":865},{"text":"oligoclonal bands","label":"DIAGNOSTIC_PROCEDURE","start":871,"end":888},{"text":"absent","label":"LAB_VALUE","start":894,"end":900},{"text":"1 g","label":"DOSAGE","start":922,"end":925},{"text":"IV","label":"ADMINISTRATION","start":929,"end":931},{"text":"methylprednisolone","label":"MEDICATION","start":932,"end":950},{"text":"daily","label":"DOSAGE","start":951,"end":956},{"text":"5 days","label":"DURATION","start":961,"end":967},{"text":"5","label":"LAB_VALUE","start":1012,"end":1013},{"text":"plasmapheresis exchanges","label":"THERAPEUTIC_PROCEDURE","start":1014,"end":1038},{"text":"significant improvement","label":"LAB_VALUE","start":1045,"end":1068},{"text":"motor","label":"DIAGNOSTIC_PROCEDURE","start":1072,"end":1077},{"text":"sensory","label":"DIAGNOSTIC_PROCEDURE","start":1079,"end":1086},{"text":"speech deficits","label":"DISEASE_DISORDER","start":1088,"end":1103},{"text":"gait","label":"DIAGNOSTIC_PROCEDURE","start":1109,"end":1113},{"text":"Forty-five days after","label":"DATE","start":1115,"end":1136},{"text":"discharge","label":"CLINICAL_EVENT","start":1137,"end":1146},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":1152,"end":1163},{"text":"4+\/5","label":"LAB_VALUE","start":1171,"end":1175},{"text":"strength","label":"DIAGNOSTIC_PROCEDURE","start":1176,"end":1184},{"text":"right intrinsic muscles of the hand","label":"BIOLOGICAL_STRUCTURE","start":1192,"end":1227},{"text":"right-sided","label":"DETAILED_DESCRIPTION","start":1234,"end":1245},{"text":"positional tremor","label":"SIGN_SYMPTOM","start":1246,"end":1263},{"text":"Gait","label":"DIAGNOSTIC_PROCEDURE","start":1265,"end":1269},{"text":"tandem","label":"DETAILED_DESCRIPTION","start":1274,"end":1280},{"text":"gait","label":"DIAGNOSTIC_PROCEDURE","start":1281,"end":1285},{"text":"normal","label":"LAB_VALUE","start":1291,"end":1297},{"text":"\u03b2-interferon-1a","label":"MEDICATION","start":1316,"end":1331},{"text":"44 \u03bcg","label":"DOSAGE","start":1332,"end":1337},{"text":"subcutaneously","label":"ADMINISTRATION","start":1338,"end":1352},{"text":"3 times a week","label":"DOSAGE","start":1353,"end":1367},{"text":"clinically isolated syndrome","label":"DISEASE_DISORDER","start":1395,"end":1423},{"text":"good","label":"LAB_VALUE","start":1430,"end":1434},{"text":"response","label":"DIAGNOSTIC_PROCEDURE","start":1435,"end":1443},{"text":"One year later","label":"DATE","start":1445,"end":1459},{"text":"neurologic examination","label":"DIAGNOSTIC_PROCEDURE","start":1465,"end":1487},{"text":"essentially normal","label":"LAB_VALUE","start":1492,"end":1510},{"text":"no family history of demyelinating or autoimmune disorders","label":"FAMILY_HISTORY","start":1522,"end":1580},{"text":"mother","label":"SUBJECT","start":1586,"end":1592},{"text":"headaches","label":"FAMILY_HISTORY","start":1622,"end":1631},{"text":"early-onset strokes","label":"FAMILY_HISTORY","start":1636,"end":1655},{"text":"carrier of the Notch3 mutation","label":"FAMILY_HISTORY","start":1679,"end":1709},{"text":"cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy","label":"FAMILY_HISTORY","start":1726,"end":1816},{"text":"CADASIL","label":"FAMILY_HISTORY","start":1818,"end":1825},{"text":"sister","label":"SUBJECT","start":1832,"end":1838},{"text":"stroke in her 30s","label":"FAMILY_HISTORY","start":1845,"end":1862},{"text":"migraine headaches","label":"FAMILY_HISTORY","start":1881,"end":1899},{"text":"not undergone medical evaluation","label":"FAMILY_HISTORY","start":1909,"end":1941},{"text":"Testing for CADASIL","label":"DIAGNOSTIC_PROCEDURE","start":1943,"end":1962},{"text":"showed","label":"LAB_VALUE","start":1978,"end":1984},{"text":"Notch3 mutation","label":"DIAGNOSTIC_PROCEDURE","start":1989,"end":2004},{"text":"associated with CADASIL","label":"DETAILED_DESCRIPTION","start":2005,"end":2028},{"text":"transition C>T, nucleotide position 1750, codon 558","label":"DETAILED_DESCRIPTION","start":2030,"end":2081},{"text":"Skin","label":"BIOLOGICAL_STRUCTURE","start":2084,"end":2088},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2089,"end":2095},{"text":"electron-dense","label":"DETAILED_DESCRIPTION","start":2103,"end":2117},{"text":"extracellular","label":"DETAILED_DESCRIPTION","start":2118,"end":2131},{"text":"material","label":"SIGN_SYMPTOM","start":2132,"end":2140},{"text":"smooth muscle of the vascular media","label":"BIOLOGICAL_STRUCTURE","start":2168,"end":2203}],"tokens":["A ","26-year-old"," ","man"," of ","Portuguese descent"," with ","no significant past medical history"," ","presents"," with subacute onset of ","right-sided"," ","hemiparesis"," and ","aphasia",", with ","marked"," ","expressive"," ","aphasia",", ","word-finding difficulty",", and ","rare"," ","paraphrasic errors",".\n","Examination"," demonstrated ","right central facial"," ","weakness",", ","2\u20133\/5"," ","strength"," in the ","right"," ","arm"," and ","leg",", and ","dysmetria"," in the ","right"," ","upper"," and ","lower"," ","extremities",".\n","Reflexes"," were ","hyperactive"," on the ","right"," with a ","right-sided"," ","Babinski response",".\n","MRI"," of the ","brain"," showed ","multiple"," ","bilateral"," ","concentric"," ","ring-like"," ","structures"," in the ","centrum semiovale"," and the ","corona radiata"," on ","T2 imaging"," (figure,A), consistent with the pattern of ","Balo concentric sclerosis",".\nThere was ","associated restricted diffusion"," in ","3"," ","lesions"," and ","incomplete ring enhancement"," in ","1"," ","lesion",".\n","CSF analysis"," showed ","30"," ","leukocytes"," (","79%"," ","lymphocytes",", ","4%"," ","monocytes","), ","erythrocyte"," count was ","850",", and ","oligoclonal bands"," were ","absent",".\nHe was treated with ","1 g"," of ","IV"," ","methylprednisolone"," ","daily"," for ","5 days",", with little improvement.\nHe then underwent ","5"," ","plasmapheresis exchanges",", with ","significant improvement"," of ","motor",", ","sensory",", ","speech deficits",", and ","gait",".\n","Forty-five days after"," ","discharge",", his ","examination"," showed ","4+\/5"," ","strength"," in the ","right intrinsic muscles of the hand"," and a ","right-sided"," ","positional tremor",".\n","Gait"," and ","tandem"," ","gait"," were ","normal",".\nHe was placed on ","\u03b2-interferon-1a"," ","44 \u03bcg"," ","subcutaneously"," ","3 times a week",", for treatment of presumed ","clinically isolated syndrome",", with ","good"," ","response",".\n","One year later",", his ","neurologic examination"," was ","essentially normal",".\nThere was ","no family history of demyelinating or autoimmune disorders",".\nHis ","mother"," has a significant history of ","headaches"," and ","early-onset strokes",", and was found to be a ","carrier of the Notch3 mutation"," consistent with ","cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy"," (","CADASIL",").\nHis ","sister"," had a ","stroke in her 30s",", and a history of ","migraine headaches",", but has ","not undergone medical evaluation",".\n","Testing for CADASIL"," in the patient ","showed"," the ","Notch3 mutation"," ","associated with CADASIL"," (","transition C>T, nucleotide position 1750, codon 558",").\n","Skin"," ","biopsy"," showed ","electron-dense"," ","extracellular"," ","material"," in close apposition to the ","smooth muscle of the vascular media","1 (figure, B).\n"],"ner_labels":[0,5,0,65,0,58,0,39,0,13,0,22,0,69,0,26,0,63,0,22,0,26,0,69,0,35,0,69,0,24,0,12,0,69,0,42,0,24,0,22,0,12,0,12,0,69,0,22,0,22,0,22,0,12,0,24,0,42,0,22,0,42,0,24,0,24,0,12,0,22,0,22,0,22,0,67,0,69,0,12,0,12,0,24,0,26,0,22,0,42,0,69,0,22,0,42,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,29,0,4,0,46,0,29,0,32,0,42,0,75,0,42,0,24,0,24,0,26,0,24,0,19,0,13,0,24,0,42,0,24,0,12,0,22,0,69,0,24,0,22,0,24,0,42,0,46,0,29,0,4,0,29,0,26,0,42,0,24,0,19,0,24,0,42,0,34,0,71,0,34,0,34,0,34,0,34,0,34,0,71,0,34,0,34,0,34,0,24,0,42,0,24,0,22,0,22,0,12,0,24,0,22,0,22,0,69,0,12,0]}
-{"full_text":"A 70\u2013year\u2013old female presented to the Emergency Department with palpitations, dyspnea and anterior epistaxis.\nShe had a 3 years history of atrial fibrillation and chronic heart failure NYHA class III.\nShe was treated with aspirin 100 mg\/day.\nPhysical examination revealed an irregular pulse of 148 beats\/min, blood pressure of 130\/100 mmHg, pansystolic mitral murmur of 2\/6 grade, murmur of tricuspid regurgitation of 3\/6 grade, lower extremities swelling.\nThe oto-rhino-laryngology exam conclusion was of anterior epistaxis.\nThe 12\u2013lead electrocardiogram revealed atrial fibrillation, inferior ischemia.\nHer International Normalized Ratio (INR) was of 1,24.\nThe two\u2013dimensional transthoracic echocardiography showed the thickening of the mitral valves with a moderate mitral insufficiency and a mobile round mass in the left atrium, heterogeneous, inhomogeneous, of 18 mm in size, attached with a narrow stalk to the interatrial septum.\nIt showed a tumor\u2013like movement with a cardiac cycle, reaching the mitral annular plane (Figure 1,Figure 2).\nAlso, echocardiography showed tricuspid insufficiency with a maximum gradient of 30 mmHg, intact interatrial septum, akinesia of two thirds of basal inferior wall, ejection fraction of 42%.\nThere was no mass in the left atrial appendage.\nThe two\u2013dimensional transesophageal echocardiography confirmed the presence of the intraatrial mass.\nEpistaxis was considered to be due to heart failure and the increased venous pressure.\nThe patient was referred to the cardiovascular surgery clinic, but she refused surgery.\nAnticoagulation with fraxiparine of 0,6 ml\/day was started and continued for 3 weeks, after cessation of epistaxis by nasal tamponament.\nAfter 3 weeks the echocardiography was repeated, with no remnant mass in the left atrium.\nThe conclusion was that the mass must have been a thrombus that has melted away.\nIn this particular case, the left intraatrial thrombus may have been due to the presence of atrial fibrillation.\n","ner_info":[{"text":"70\u2013year\u2013old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":21,"end":30},{"text":"Emergency Department","label":"NONBIOLOGICAL_LOCATION","start":38,"end":58},{"text":"palpitations","label":"SIGN_SYMPTOM","start":64,"end":76},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":78,"end":85},{"text":"anterior","label":"DETAILED_DESCRIPTION","start":90,"end":98},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":99,"end":108},{"text":"3 years history of atrial fibrillation and chronic heart failure NYHA class III","label":"HISTORY","start":120,"end":199},{"text":"aspirin","label":"MEDICATION","start":222,"end":229},{"text":"100 mg\/day","label":"DOSAGE","start":230,"end":240},{"text":"Physical 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extremities","label":"BIOLOGICAL_STRUCTURE","start":429,"end":446},{"text":"swelling","label":"SIGN_SYMPTOM","start":447,"end":455},{"text":"oto-rhino-laryngology exam","label":"DIAGNOSTIC_PROCEDURE","start":461,"end":487},{"text":"anterior","label":"DETAILED_DESCRIPTION","start":506,"end":514},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":515,"end":524},{"text":"12\u2013lead","label":"DETAILED_DESCRIPTION","start":530,"end":537},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":538,"end":555},{"text":"atrial fibrillation","label":"DISEASE_DISORDER","start":565,"end":584},{"text":"inferior","label":"DETAILED_DESCRIPTION","start":586,"end":594},{"text":"ischemia","label":"SIGN_SYMPTOM","start":595,"end":603},{"text":"International Normalized Ratio","label":"DIAGNOSTIC_PROCEDURE","start":609,"end":639},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":641,"end":644},{"text":"1,24","label":"LAB_VALUE","start":653,"end":657},{"text":"two\u2013dimensional","label":"DETAILED_DESCRIPTION","start":663,"end":678},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":679,"end":692},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":693,"end":709},{"text":"thickening of the mitral valves","label":"SIGN_SYMPTOM","start":721,"end":752},{"text":"moderate","label":"SEVERITY","start":760,"end":768},{"text":"mitral insufficiency","label":"SIGN_SYMPTOM","start":769,"end":789},{"text":"mobile","label":"DETAILED_DESCRIPTION","start":796,"end":802},{"text":"round","label":"SHAPE","start":803,"end":808},{"text":"mass","label":"SIGN_SYMPTOM","start":809,"end":813},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":821,"end":832},{"text":"heterogeneous","label":"DETAILED_DESCRIPTION","start":834,"end":847},{"text":"inhomogeneous","label":"DETAILED_DESCRIPTION","start":849,"end":862},{"text":"18 mm","label":"DISTANCE","start":867,"end":872},{"text":"attached with a narrow stalk","label":"DETAILED_DESCRIPTION","start":882,"end":910},{"text":"interatrial septum","label":"BIOLOGICAL_STRUCTURE","start":918,"end":936},{"text":"It","label":"COREFERENCE","start":938,"end":940},{"text":"tumor\u2013like movement with a cardiac cycle","label":"DETAILED_DESCRIPTION","start":950,"end":990},{"text":"mitral annular plane","label":"BIOLOGICAL_STRUCTURE","start":1005,"end":1025},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1053,"end":1069},{"text":"tricuspid insufficiency","label":"SIGN_SYMPTOM","start":1077,"end":1100},{"text":"maximum gradient","label":"DIAGNOSTIC_PROCEDURE","start":1108,"end":1124},{"text":"30 mmHg","label":"LAB_VALUE","start":1128,"end":1135},{"text":"intact interatrial septum","label":"SIGN_SYMPTOM","start":1137,"end":1162},{"text":"akinesia","label":"SIGN_SYMPTOM","start":1164,"end":1172},{"text":"two thirds of basal inferior wall","label":"BIOLOGICAL_STRUCTURE","start":1176,"end":1209},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1211,"end":1228},{"text":"42%","label":"LAB_VALUE","start":1232,"end":1235},{"text":"mass","label":"SIGN_SYMPTOM","start":1250,"end":1254},{"text":"left atrial appendage","label":"BIOLOGICAL_STRUCTURE","start":1262,"end":1283},{"text":"two\u2013dimensional","label":"DETAILED_DESCRIPTION","start":1289,"end":1304},{"text":"transesophageal","label":"BIOLOGICAL_STRUCTURE","start":1305,"end":1320},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1321,"end":1337},{"text":"intraatrial","label":"BIOLOGICAL_STRUCTURE","start":1368,"end":1379},{"text":"mass","label":"SIGN_SYMPTOM","start":1380,"end":1384},{"text":"Epistaxis","label":"SIGN_SYMPTOM","start":1386,"end":1395},{"text":"heart failure","label":"DISEASE_DISORDER","start":1424,"end":1437},{"text":"increased","label":"LAB_VALUE","start":1446,"end":1455},{"text":"venous pressure","label":"SIGN_SYMPTOM","start":1456,"end":1471},{"text":"referred","label":"CLINICAL_EVENT","start":1489,"end":1497},{"text":"cardiovascular surgery clinic","label":"NONBIOLOGICAL_LOCATION","start":1505,"end":1534},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":1552,"end":1559},{"text":"Anticoagulation","label":"THERAPEUTIC_PROCEDURE","start":1561,"end":1576},{"text":"fraxiparine","label":"MEDICATION","start":1582,"end":1593},{"text":"0,6 ml\/day","label":"DOSAGE","start":1597,"end":1607},{"text":"for 3 weeks","label":"DURATION","start":1634,"end":1645},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":1666,"end":1675},{"text":"nasal tamponament","label":"THERAPEUTIC_PROCEDURE","start":1679,"end":1696},{"text":"After 3 weeks","label":"DATE","start":1698,"end":1711},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1716,"end":1732},{"text":"mass","label":"SIGN_SYMPTOM","start":1763,"end":1767},{"text":"thrombus","label":"SIGN_SYMPTOM","start":1838,"end":1846}],"tokens":["A ","70\u2013year\u2013old"," ","female"," ","presented"," to the ","Emergency Department"," with ","palpitations",", ","dyspnea"," and ","anterior"," ","epistaxis",".\nShe had a ","3 years history of atrial fibrillation and chronic heart failure NYHA class III",".\nShe was treated with ","aspirin"," ","100 mg\/day",".\n","Physical examination"," revealed an ","irregular"," ","pulse"," of ","148 beats\/min",", ","blood pressure"," of ","130\/100 mmHg",", ","pansystolic"," ","mitral"," ","murmur"," of ","2\/6 grade",", ","murmur"," of ","tricuspid"," ","regurgitation"," of ","3\/6 grade",", ","lower extremities"," ","swelling",".\nThe ","oto-rhino-laryngology exam"," conclusion was of ","anterior"," ","epistaxis",".\nThe ","12\u2013lead"," ","electrocardiogram"," revealed ","atrial fibrillation",", ","inferior"," ","ischemia",".\nHer ","International Normalized Ratio"," (","INR",") was of ","1,24",".\nThe ","two\u2013dimensional"," ","transthoracic"," ","echocardiography"," showed the ","thickening of the mitral valves"," with a ","moderate"," ","mitral insufficiency"," and a ","mobile"," ","round"," ","mass"," in the ","left atrium",", ","heterogeneous",", ","inhomogeneous",", of ","18 mm"," in size, ","attached with a narrow stalk"," to the ","interatrial septum",".\n","It"," showed a ","tumor\u2013like movement with a cardiac cycle",", reaching the ","mitral annular plane"," (Figure 1,Figure 2).\nAlso, ","echocardiography"," showed ","tricuspid insufficiency"," with a ","maximum gradient"," of ","30 mmHg",", ","intact interatrial septum",", ","akinesia"," of ","two thirds of basal inferior wall",", ","ejection fraction"," of ","42%",".\nThere was no ","mass"," in the ","left atrial appendage",".\nThe ","two\u2013dimensional"," ","transesophageal"," ","echocardiography"," confirmed the presence of the ","intraatrial"," ","mass",".\n","Epistaxis"," was considered to be due to ","heart failure"," and the ","increased"," ","venous pressure",".\nThe patient was ","referred"," to the ","cardiovascular surgery clinic",", but she refused ","surgery",".\n","Anticoagulation"," with ","fraxiparine"," of ","0,6 ml\/day"," was started and continued ","for 3 weeks",", after cessation of ","epistaxis"," by ","nasal tamponament",".\n","After 3 weeks"," the ","echocardiography"," was repeated, with no remnant ","mass"," in the left atrium.\nThe conclusion was that the mass must have been a ","thrombus"," that has melted away.\nIn this particular case, the left intraatrial thrombus may have been due to the presence of atrial fibrillation.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,69,0,22,0,69,0,39,0,46,0,29,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,12,0,69,0,42,0,69,0,12,0,22,0,42,0,12,0,69,0,24,0,22,0,69,0,22,0,24,0,26,0,22,0,69,0,24,0,24,0,42,0,22,0,12,0,24,0,69,0,63,0,69,0,22,0,67,0,69,0,12,0,22,0,22,0,27,0,22,0,12,0,18,0,22,0,12,0,24,0,69,0,24,0,42,0,69,0,69,0,12,0,24,0,42,0,69,0,12,0,22,0,12,0,24,0,12,0,69,0,69,0,26,0,42,0,69,0,13,0,48,0,75,0,75,0,46,0,29,0,32,0,69,0,75,0,19,0,24,0,69,0,69,0]}
-{"full_text":"A 53 year old female without significant past medical history developed severe viral pneumonia, with rapid, progressive deterioration in her respiratory status.\nShe developed ARDS and mechanical ventilatory management using ARDS protocol were unable to maintain adequate oxygenation.\nAs a result, bedside VV-ECMO was planned.\nTransesophageal echocardiography (TEE) was performed to visualize proper positioning of the guidewire and cannula.\nUsing the Seldinger technique, the right internal jugular vein was accessed and a guide wire was placed.\nPlacement of the guidewire into the IVC proved difficult due to repeated migration of the guidewire into the right ventricle.\nAfter multiple attempts, the guidewire was visualized to course properly from the SVC to the IVC.\nAfter a bolus dose of 5000 units of intravenous heparin was given, the right internal jugular venous access site was dilated.\nJust as the final dilatation was completed and upon dilator exchange with simultaneous advancement of the 23 French Avalon cannula, TEE lost visualization of the guidewire.\nMultiple premature ventricular beats were noted and immediately, a new, rapidly enlarging pericardial effusion was detected (Figure \u200b(Figure2).2).\nEmergent preparations were made for bedside surgical decompression of the pericardial space.\nQuickly the patient lost blood pressure from acute cardiac tamponade.\nThe Avalon cannula was immediately clamped at the end but not removed.\nA emergent subxiphoid pericardial window was performed, resulting in drainage of venous blood and restoration of blood pressure.\nTransfusion was initiated and the patient was emergently transported to the operating room for surgical exploration.\nThe Avalon cannula was found to have perforated the apex of the right ventricle.\nThe injury was repaired primarily and the Avalon cannula was repositioned toward the IVC again by TEE with additional direct manipulation.\nVV-ECMO was initiated and the oxygenation improved.\nDue to excessive coagulopathies, the sternum was left open but was closed on postoperative day 2.\nFrom that point, she remained free from any cardiac or infectious complications and her pulmonary condition slowly improved.\nShe was successfully weaned from VV-ECMO on postoperative day 9 and was discharged home on postoperative day 24 without the need for home oxygen.\nShe regained full physical functions at home and recovered normal pulmonary function by 3 months following discharge from the hospital.\n","ner_info":[{"text":"53 year old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"without significant past medical history","label":"HISTORY","start":21,"end":61},{"text":"severe","label":"SEVERITY","start":72,"end":78},{"text":"viral","label":"DETAILED_DESCRIPTION","start":79,"end":84},{"text":"pneumonia","label":"DISEASE_DISORDER","start":85,"end":94},{"text":"rapid","label":"DETAILED_DESCRIPTION","start":101,"end":106},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":108,"end":119},{"text":"deterioration","label":"LAB_VALUE","start":120,"end":133},{"text":"respiratory status","label":"DIAGNOSTIC_PROCEDURE","start":141,"end":159},{"text":"ARDS","label":"DISEASE_DISORDER","start":175,"end":179},{"text":"mechanical ventilatory management","label":"THERAPEUTIC_PROCEDURE","start":184,"end":217},{"text":"ARDS protocol","label":"DETAILED_DESCRIPTION","start":224,"end":237},{"text":"unable to maintain adequate","label":"LAB_VALUE","start":243,"end":270},{"text":"oxygenation","label":"DIAGNOSTIC_PROCEDURE","start":271,"end":282},{"text":"bedside","label":"DETAILED_DESCRIPTION","start":297,"end":304},{"text":"VV","label":"DETAILED_DESCRIPTION","start":305,"end":307},{"text":"ECMO","label":"THERAPEUTIC_PROCEDURE","start":308,"end":312},{"text":"Transesophageal echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":326,"end":358},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":360,"end":363},{"text":"positioning of the guidewire","label":"THERAPEUTIC_PROCEDURE","start":399,"end":427},{"text":"cannula","label":"THERAPEUTIC_PROCEDURE","start":432,"end":439},{"text":"Seldinger technique","label":"DETAILED_DESCRIPTION","start":451,"end":470},{"text":"right internal jugular vein","label":"BIOLOGICAL_STRUCTURE","start":476,"end":503},{"text":"guide wire was placed","label":"COREFERENCE","start":523,"end":544},{"text":"Placement of the guidewire","label":"COREFERENCE","start":546,"end":572},{"text":"IVC","label":"COREFERENCE","start":582,"end":585},{"text":"migration of the guidewire","label":"DETAILED_DESCRIPTION","start":619,"end":645},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":655,"end":670},{"text":"bolus","label":"DETAILED_DESCRIPTION","start":778,"end":783},{"text":"5000 units","label":"DOSAGE","start":792,"end":802},{"text":"intravenous","label":"ADMINISTRATION","start":806,"end":817},{"text":"heparin","label":"MEDICATION","start":818,"end":825},{"text":"right internal jugular venous","label":"BIOLOGICAL_STRUCTURE","start":841,"end":870},{"text":"dilated","label":"THERAPEUTIC_PROCEDURE","start":887,"end":894},{"text":"dilator exchange","label":"THERAPEUTIC_PROCEDURE","start":948,"end":964},{"text":"23 French Avalon","label":"DETAILED_DESCRIPTION","start":1002,"end":1018},{"text":"cannula","label":"COREFERENCE","start":1019,"end":1026},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":1028,"end":1031},{"text":"lost visualization of the guidewire","label":"LAB_VALUE","start":1032,"end":1067},{"text":"Multiple","label":"DETAILED_DESCRIPTION","start":1069,"end":1077},{"text":"premature ventricular beats","label":"SIGN_SYMPTOM","start":1078,"end":1105},{"text":"rapidly enlarging","label":"DETAILED_DESCRIPTION","start":1141,"end":1158},{"text":"pericardial effusion","label":"DISEASE_DISORDER","start":1159,"end":1179},{"text":"surgical decompression","label":"THERAPEUTIC_PROCEDURE","start":1260,"end":1282},{"text":"pericardial space","label":"BIOLOGICAL_STRUCTURE","start":1290,"end":1307},{"text":"lost","label":"LAB_VALUE","start":1329,"end":1333},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1334,"end":1348},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1354,"end":1359},{"text":"cardiac tamponade","label":"DISEASE_DISORDER","start":1360,"end":1377},{"text":"Avalon","label":"DETAILED_DESCRIPTION","start":1383,"end":1389},{"text":"cannula","label":"COREFERENCE","start":1390,"end":1397},{"text":"clamped at the end but not removed","label":"DETAILED_DESCRIPTION","start":1414,"end":1448},{"text":"subxiphoid","label":"BIOLOGICAL_STRUCTURE","start":1461,"end":1471},{"text":"pericardial window","label":"THERAPEUTIC_PROCEDURE","start":1472,"end":1490},{"text":"drainage","label":"SIGN_SYMPTOM","start":1519,"end":1527},{"text":"venous blood","label":"BIOLOGICAL_STRUCTURE","start":1531,"end":1543},{"text":"restoration","label":"LAB_VALUE","start":1548,"end":1559},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1563,"end":1577},{"text":"Transfusion","label":"THERAPEUTIC_PROCEDURE","start":1579,"end":1590},{"text":"transported","label":"CLINICAL_EVENT","start":1636,"end":1647},{"text":"operating room","label":"NONBIOLOGICAL_LOCATION","start":1655,"end":1669},{"text":"surgical exploration","label":"DIAGNOSTIC_PROCEDURE","start":1674,"end":1694},{"text":"Avalon","label":"DETAILED_DESCRIPTION","start":1700,"end":1706},{"text":"cannula","label":"COREFERENCE","start":1707,"end":1714},{"text":"perforated","label":"DISEASE_DISORDER","start":1733,"end":1743},{"text":"apex of the right ventricle","label":"BIOLOGICAL_STRUCTURE","start":1748,"end":1775},{"text":"injury","label":"COREFERENCE","start":1781,"end":1787},{"text":"repaired","label":"THERAPEUTIC_PROCEDURE","start":1792,"end":1800},{"text":"Avalon","label":"DETAILED_DESCRIPTION","start":1819,"end":1825},{"text":"cannula","label":"COREFERENCE","start":1826,"end":1833},{"text":"IVC","label":"BIOLOGICAL_STRUCTURE","start":1862,"end":1865},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":1875,"end":1878},{"text":"additional direct manipulation","label":"DETAILED_DESCRIPTION","start":1884,"end":1914},{"text":"VV","label":"DETAILED_DESCRIPTION","start":1916,"end":1918},{"text":"ECMO","label":"THERAPEUTIC_PROCEDURE","start":1919,"end":1923},{"text":"oxygenation","label":"DIAGNOSTIC_PROCEDURE","start":1946,"end":1957},{"text":"improved","label":"LAB_VALUE","start":1958,"end":1966},{"text":"coagulopathies","label":"DISEASE_DISORDER","start":1985,"end":1999},{"text":"sternum","label":"BIOLOGICAL_STRUCTURE","start":2005,"end":2012},{"text":"left open","label":"THERAPEUTIC_PROCEDURE","start":2017,"end":2026},{"text":"closed","label":"THERAPEUTIC_PROCEDURE","start":2035,"end":2041},{"text":"day 2","label":"DATE","start":2059,"end":2064},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2110,"end":2117},{"text":"infectious","label":"DETAILED_DESCRIPTION","start":2121,"end":2131},{"text":"complications","label":"SIGN_SYMPTOM","start":2132,"end":2145},{"text":"pulmonary condition","label":"DIAGNOSTIC_PROCEDURE","start":2154,"end":2173},{"text":"slowly improved","label":"LAB_VALUE","start":2174,"end":2189},{"text":"VV","label":"DETAILED_DESCRIPTION","start":2224,"end":2226},{"text":"ECMO","label":"THERAPEUTIC_PROCEDURE","start":2227,"end":2231},{"text":"day 9","label":"DATE","start":2249,"end":2254},{"text":"discharged","label":"CLINICAL_EVENT","start":2263,"end":2273},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":2274,"end":2278},{"text":"day 24","label":"DATE","start":2296,"end":2302},{"text":"home oxygen","label":"THERAPEUTIC_PROCEDURE","start":2324,"end":2335},{"text":"full","label":"LAB_VALUE","start":2350,"end":2354},{"text":"physical functions","label":"DIAGNOSTIC_PROCEDURE","start":2355,"end":2373},{"text":"normal","label":"LAB_VALUE","start":2396,"end":2402},{"text":"pulmonary function","label":"DIAGNOSTIC_PROCEDURE","start":2403,"end":2421},{"text":"3 months","label":"DATE","start":2425,"end":2433},{"text":"discharge","label":"CLINICAL_EVENT","start":2444,"end":2453},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":2463,"end":2471}],"tokens":["A ","53 year old"," ","female"," ","without significant past medical history"," developed ","severe"," ","viral"," ","pneumonia",", with ","rapid",", ","progressive"," ","deterioration"," in her ","respiratory status",".\nShe developed ","ARDS"," and ","mechanical ventilatory management"," using ","ARDS protocol"," were ","unable to maintain adequate"," ","oxygenation",".\nAs a result, ","bedside"," ","VV","-","ECMO"," was planned.\n","Transesophageal echocardiography"," (","TEE",") was performed to visualize proper ","positioning of the guidewire"," and ","cannula",".\nUsing the ","Seldinger technique",", the ","right internal jugular vein"," was accessed and a ","guide wire was placed",".\n","Placement of the guidewire"," into the ","IVC"," proved difficult due to repeated ","migration of the guidewire"," into the ","right ventricle",".\nAfter multiple attempts, the guidewire was visualized to course properly from the SVC to the IVC.\nAfter a ","bolus"," dose of ","5000 units"," of ","intravenous"," ","heparin"," was given, the ","right internal jugular venous"," access site was ","dilated",".\nJust as the final dilatation was completed and upon ","dilator exchange"," with simultaneous advancement of the ","23 French Avalon"," ","cannula",", ","TEE"," ","lost visualization of the guidewire",".\n","Multiple"," ","premature ventricular beats"," were noted and immediately, a new, ","rapidly enlarging"," ","pericardial effusion"," was detected (Figure \u200b(Figure2).2).\nEmergent preparations were made for bedside ","surgical decompression"," of the ","pericardial space",".\nQuickly the patient ","lost"," ","blood pressure"," from ","acute"," ","cardiac tamponade",".\nThe ","Avalon"," ","cannula"," was immediately ","clamped at the end but not removed",".\nA emergent ","subxiphoid"," ","pericardial window"," was performed, resulting in ","drainage"," of ","venous blood"," and ","restoration"," of ","blood pressure",".\n","Transfusion"," was initiated and the patient was emergently ","transported"," to the ","operating room"," for ","surgical exploration",".\nThe ","Avalon"," ","cannula"," was found to have ","perforated"," the ","apex of the right ventricle",".\nThe ","injury"," was ","repaired"," primarily and the ","Avalon"," ","cannula"," was repositioned toward the ","IVC"," again by ","TEE"," with ","additional direct manipulation",".\n","VV","-","ECMO"," was initiated and the ","oxygenation"," ","improved",".\nDue to excessive ","coagulopathies",", the ","sternum"," was ","left open"," but was ","closed"," on postoperative ","day 2",".\nFrom that point, she remained free from any ","cardiac"," or ","infectious"," ","complications"," and her ","pulmonary condition"," ","slowly improved",".\nShe was successfully weaned from ","VV","-","ECMO"," on postoperative ","day 9"," and was ","discharged"," ","home"," on postoperative ","day 24"," without the need for ","home oxygen",".\nShe regained ","full"," ","physical functions"," at home and recovered ","normal"," ","pulmonary function"," by ","3 months"," following ","discharge"," from the ","hospital",".\n"],"ner_labels":[0,5,0,65,0,39,0,63,0,22,0,26,0,22,0,22,0,42,0,24,0,26,0,75,0,22,0,42,0,24,0,22,0,22,0,75,0,24,0,24,0,75,0,75,0,22,0,12,0,18,0,18,0,18,0,22,0,12,0,22,0,29,0,4,0,46,0,12,0,75,0,75,0,22,0,18,0,24,0,42,0,22,0,69,0,22,0,26,0,75,0,12,0,42,0,24,0,22,0,26,0,22,0,18,0,22,0,12,0,75,0,69,0,12,0,42,0,24,0,75,0,13,0,48,0,24,0,22,0,18,0,26,0,12,0,18,0,75,0,22,0,18,0,12,0,24,0,22,0,22,0,75,0,24,0,42,0,26,0,12,0,75,0,75,0,19,0,12,0,22,0,69,0,24,0,42,0,22,0,75,0,19,0,13,0,48,0,19,0,75,0,42,0,24,0,42,0,24,0,19,0,13,0,48,0]}
-{"full_text":"A 60-year-old male patient had previously undergone a radical resection of a T2bN0M0G3 Stage III retroperitoneal sarcoma, including right nephrectomy and cholecystectomy, in 2002.\nPathologic evaluation demonstrated a 25\u2009cm high-grade liposarcoma with different histologic components, including myxoid, round cell, well-differentiated, sclerosing and pleomorphic patterns.\nSurgical margins were negative as the tumor did not invade the kidney, and since the renal vein and ureter were free of tumor as well.\nThe patient did not undergo any additional therapy.\nSurveillance magnetic resonance imaging in 2007 revealed an isolated tumor recurrence in the retroperitoneum.\nAn exploratory celiotomy revealed tumor involvement of the duodenum, head of the pancreas, superior mesenteric vein, vena cava and left renal vein with severe adhesive changes, leading to the intraoperative assessment of unresectable disease.\nSubsequently, the patient underwent stereotactic body radiation to the retroperitoneal tumor in five fractions for a total dose of 30\u2009Gy, without complication.\nPostradiation imaging revealed near complete resolution of the retroperitoneal mass.\nOne year later, the patient presented with weight loss, postprandial abdominal pain, nausea and vomiting.\nCross-sectional imaging revealed a 7\u2009cm mass with involvement of the third portion of the duodenum (Figure \u200b1).\nHowever, there was no obvious involvement of the pancreatic head or the other structures that were noted to be involved during the previous laparotomy.\nWe elected to perform another resection attempt, including a possible pancreatoduodenectomy or retroperitoneal vascular resection if necessary.\nAt exploration, the residual tumor was an entirely intraduodenal, pedunculated mass at the posterior duodenal wall distal to the ampulla that filled the entire duodenal lumen.\nThe patient underwent a duodenotomy and stalk transection of the polypoid mass, followed by partial duodenal resection with hand-sewn duodenojejunal anastomosis (Figure 2).\nSurgical pathology examination revealed a 9.5\u2009cm recurrent high-grade liposarcoma with polypoid intraluminal growth containing myxoid, round cell, well-differentiated, sclerosing and focally pleomorphic areas.\nSurgical margins were negative as the tumor came within 0.1\u2009cm of the stalk margin and there was no evidence of additional neoplastic components within the remaining resected duodenum.\nThe postoperative course was uncomplicated, and the patient has demonstrated no recurrence up to 30\u2009months from this resection.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"radical","label":"DETAILED_DESCRIPTION","start":54,"end":61},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":62,"end":71},{"text":"T2bN0M0G3 Stage III","label":"DETAILED_DESCRIPTION","start":77,"end":96},{"text":"retroperitoneal sarcoma","label":"DISEASE_DISORDER","start":97,"end":120},{"text":"right","label":"DETAILED_DESCRIPTION","start":132,"end":137},{"text":"nephrectomy","label":"THERAPEUTIC_PROCEDURE","start":138,"end":149},{"text":"cholecystectomy","label":"THERAPEUTIC_PROCEDURE","start":154,"end":169},{"text":"2002","label":"DATE","start":174,"end":178},{"text":"Pathologic evaluation","label":"DIAGNOSTIC_PROCEDURE","start":180,"end":201},{"text":"25\u2009cm","label":"DISTANCE","start":217,"end":222},{"text":"high-grade","label":"SEVERITY","start":223,"end":233},{"text":"liposarcoma","label":"DISEASE_DISORDER","start":234,"end":245},{"text":"different histologic components","label":"DETAILED_DESCRIPTION","start":251,"end":282},{"text":"myxoid","label":"DETAILED_DESCRIPTION","start":294,"end":300},{"text":"round cell","label":"DETAILED_DESCRIPTION","start":302,"end":312},{"text":"well-differentiated","label":"DETAILED_DESCRIPTION","start":314,"end":333},{"text":"sclerosing","label":"DETAILED_DESCRIPTION","start":335,"end":345},{"text":"pleomorphic patterns","label":"DETAILED_DESCRIPTION","start":350,"end":370},{"text":"Surgical margins","label":"DIAGNOSTIC_PROCEDURE","start":372,"end":388},{"text":"negative","label":"LAB_VALUE","start":394,"end":402},{"text":"tumor","label":"SIGN_SYMPTOM","start":410,"end":415},{"text":"invade","label":"SIGN_SYMPTOM","start":424,"end":430},{"text":"kidney","label":"BIOLOGICAL_STRUCTURE","start":435,"end":441},{"text":"renal vein","label":"BIOLOGICAL_STRUCTURE","start":457,"end":467},{"text":"ureter","label":"BIOLOGICAL_STRUCTURE","start":472,"end":478},{"text":"tumor","label":"SIGN_SYMPTOM","start":492,"end":497},{"text":"additional therapy","label":"THERAPEUTIC_PROCEDURE","start":539,"end":557},{"text":"Surveillance","label":"DETAILED_DESCRIPTION","start":559,"end":571},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":572,"end":598},{"text":"2007","label":"DATE","start":602,"end":606},{"text":"isolated","label":"DETAILED_DESCRIPTION","start":619,"end":627},{"text":"tumor recurrence","label":"SIGN_SYMPTOM","start":628,"end":644},{"text":"retroperitoneum","label":"BIOLOGICAL_STRUCTURE","start":652,"end":667},{"text":"exploratory","label":"DETAILED_DESCRIPTION","start":672,"end":683},{"text":"celiotomy","label":"DIAGNOSTIC_PROCEDURE","start":684,"end":693},{"text":"tumor involvement","label":"SIGN_SYMPTOM","start":703,"end":720},{"text":"duodenum","label":"BIOLOGICAL_STRUCTURE","start":728,"end":736},{"text":"head of the pancreas","label":"BIOLOGICAL_STRUCTURE","start":738,"end":758},{"text":"superior mesenteric vein","label":"BIOLOGICAL_STRUCTURE","start":760,"end":784},{"text":"vena cava","label":"BIOLOGICAL_STRUCTURE","start":786,"end":795},{"text":"left renal vein","label":"BIOLOGICAL_STRUCTURE","start":800,"end":815},{"text":"severe","label":"SEVERITY","start":821,"end":827},{"text":"adhesive changes","label":"DETAILED_DESCRIPTION","start":828,"end":844},{"text":"unresectable disease","label":"DISEASE_DISORDER","start":890,"end":910},{"text":"stereotactic body","label":"DETAILED_DESCRIPTION","start":948,"end":965},{"text":"radiation","label":"THERAPEUTIC_PROCEDURE","start":966,"end":975},{"text":"retroperitoneal","label":"BIOLOGICAL_STRUCTURE","start":983,"end":998},{"text":"tumor","label":"SIGN_SYMPTOM","start":999,"end":1004},{"text":"five fractions","label":"DOSAGE","start":1008,"end":1022},{"text":"total dose of 30\u2009Gy","label":"DOSAGE","start":1029,"end":1048},{"text":"complication","label":"SIGN_SYMPTOM","start":1058,"end":1070},{"text":"imaging","label":"DIAGNOSTIC_PROCEDURE","start":1086,"end":1093},{"text":"retroperitoneal","label":"BIOLOGICAL_STRUCTURE","start":1135,"end":1150},{"text":"mass","label":"SIGN_SYMPTOM","start":1151,"end":1155},{"text":"One year later","label":"DATE","start":1157,"end":1171},{"text":"presented","label":"CLINICAL_EVENT","start":1185,"end":1194},{"text":"weight loss","label":"SIGN_SYMPTOM","start":1200,"end":1211},{"text":"postprandial","label":"DETAILED_DESCRIPTION","start":1213,"end":1225},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1226,"end":1235},{"text":"pain","label":"SIGN_SYMPTOM","start":1236,"end":1240},{"text":"nausea","label":"SIGN_SYMPTOM","start":1242,"end":1248},{"text":"vomiting","label":"SIGN_SYMPTOM","start":1253,"end":1261},{"text":"Cross-sectional imaging","label":"DIAGNOSTIC_PROCEDURE","start":1263,"end":1286},{"text":"7\u2009cm","label":"DISTANCE","start":1298,"end":1302},{"text":"mass","label":"SIGN_SYMPTOM","start":1303,"end":1307},{"text":"third portion of the duodenum","label":"BIOLOGICAL_STRUCTURE","start":1332,"end":1361},{"text":"involvement","label":"SIGN_SYMPTOM","start":1405,"end":1416},{"text":"pancreatic head","label":"BIOLOGICAL_STRUCTURE","start":1424,"end":1439},{"text":"other structures","label":"BIOLOGICAL_STRUCTURE","start":1447,"end":1463},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1557,"end":1566},{"text":"pancreatoduodenectomy","label":"THERAPEUTIC_PROCEDURE","start":1597,"end":1618},{"text":"retroperitoneal vascular","label":"BIOLOGICAL_STRUCTURE","start":1622,"end":1646},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1647,"end":1656},{"text":"exploration","label":"DIAGNOSTIC_PROCEDURE","start":1674,"end":1685},{"text":"tumor","label":"SIGN_SYMPTOM","start":1700,"end":1705},{"text":"intraduodenal","label":"BIOLOGICAL_STRUCTURE","start":1722,"end":1735},{"text":"pedunculated","label":"DETAILED_DESCRIPTION","start":1737,"end":1749},{"text":"mass","label":"COREFERENCE","start":1750,"end":1754},{"text":"posterior duodenal wall","label":"BIOLOGICAL_STRUCTURE","start":1762,"end":1785},{"text":"ampulla","label":"BIOLOGICAL_STRUCTURE","start":1800,"end":1807},{"text":"duodenal lumen","label":"BIOLOGICAL_STRUCTURE","start":1831,"end":1845},{"text":"duodenotomy","label":"THERAPEUTIC_PROCEDURE","start":1871,"end":1882},{"text":"stalk transection","label":"THERAPEUTIC_PROCEDURE","start":1887,"end":1904},{"text":"polypoid","label":"DETAILED_DESCRIPTION","start":1912,"end":1920},{"text":"mass","label":"SIGN_SYMPTOM","start":1921,"end":1925},{"text":"partial","label":"DETAILED_DESCRIPTION","start":1939,"end":1946},{"text":"duodenal","label":"BIOLOGICAL_STRUCTURE","start":1947,"end":1955},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1956,"end":1965},{"text":"hand-sewn","label":"DETAILED_DESCRIPTION","start":1971,"end":1980},{"text":"duodenojejunal","label":"BIOLOGICAL_STRUCTURE","start":1981,"end":1995},{"text":"anastomosis","label":"THERAPEUTIC_PROCEDURE","start":1996,"end":2007},{"text":"Surgical pathology examination","label":"DIAGNOSTIC_PROCEDURE","start":2020,"end":2050},{"text":"9.5\u2009cm","label":"DISTANCE","start":2062,"end":2068},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":2069,"end":2078},{"text":"high-grade","label":"SEVERITY","start":2079,"end":2089},{"text":"liposarcoma","label":"DISEASE_DISORDER","start":2090,"end":2101},{"text":"polypoid intraluminal growth","label":"DETAILED_DESCRIPTION","start":2107,"end":2135},{"text":"myxoid","label":"DETAILED_DESCRIPTION","start":2147,"end":2153},{"text":"round cell","label":"DETAILED_DESCRIPTION","start":2155,"end":2165},{"text":"well-differentiated","label":"DETAILED_DESCRIPTION","start":2167,"end":2186},{"text":"sclerosing","label":"DETAILED_DESCRIPTION","start":2188,"end":2198},{"text":"focally pleomorphic areas","label":"DETAILED_DESCRIPTION","start":2203,"end":2228},{"text":"Surgical margins","label":"DIAGNOSTIC_PROCEDURE","start":2230,"end":2246},{"text":"negative","label":"LAB_VALUE","start":2252,"end":2260},{"text":"tumor","label":"SIGN_SYMPTOM","start":2268,"end":2273},{"text":"within 0.1\u2009cm","label":"DISTANCE","start":2279,"end":2292},{"text":"stalk margin","label":"BIOLOGICAL_STRUCTURE","start":2300,"end":2312},{"text":"neoplastic components","label":"SIGN_SYMPTOM","start":2353,"end":2374},{"text":"duodenum","label":"BIOLOGICAL_STRUCTURE","start":2405,"end":2413},{"text":"postoperative course","label":"DIAGNOSTIC_PROCEDURE","start":2419,"end":2439},{"text":"uncomplicated","label":"LAB_VALUE","start":2444,"end":2457},{"text":"recurrence","label":"SIGN_SYMPTOM","start":2495,"end":2505},{"text":"30\u2009months from","label":"DATE","start":2512,"end":2526}],"tokens":["A ","60-year-old"," ","male"," patient had previously undergone a ","radical"," ","resection"," of a ","T2bN0M0G3 Stage III"," ","retroperitoneal sarcoma",", including ","right"," ","nephrectomy"," and ","cholecystectomy",", in ","2002",".\n","Pathologic evaluation"," demonstrated a ","25\u2009cm"," ","high-grade"," ","liposarcoma"," with ","different histologic components",", including ","myxoid",", ","round cell",", ","well-differentiated",", ","sclerosing"," and ","pleomorphic patterns",".\n","Surgical margins"," were ","negative"," as the ","tumor"," did not ","invade"," the ","kidney",", and since the ","renal vein"," and ","ureter"," were free of ","tumor"," as well.\nThe patient did not undergo any ","additional therapy",".\n","Surveillance"," ","magnetic resonance imaging"," in ","2007"," revealed an ","isolated"," ","tumor recurrence"," in the ","retroperitoneum",".\nAn ","exploratory"," ","celiotomy"," revealed ","tumor involvement"," of the ","duodenum",", ","head of the pancreas",", ","superior mesenteric vein",", ","vena cava"," and ","left renal vein"," with ","severe"," ","adhesive changes",", leading to the intraoperative assessment of ","unresectable disease",".\nSubsequently, the patient underwent ","stereotactic body"," ","radiation"," to the ","retroperitoneal"," ","tumor"," in ","five fractions"," for a ","total dose of 30\u2009Gy",", without ","complication",".\nPostradiation ","imaging"," revealed near complete resolution of the ","retroperitoneal"," ","mass",".\n","One year later",", the patient ","presented"," with ","weight loss",", ","postprandial"," ","abdominal"," ","pain",", ","nausea"," and ","vomiting",".\n","Cross-sectional imaging"," revealed a ","7\u2009cm"," ","mass"," with involvement of the ","third portion of the duodenum"," (Figure \u200b1).\nHowever, there was no obvious ","involvement"," of the ","pancreatic head"," or the ","other structures"," that were noted to be involved during the previous laparotomy.\nWe elected to perform another ","resection"," attempt, including a possible ","pancreatoduodenectomy"," or ","retroperitoneal vascular"," ","resection"," if necessary.\nAt ","exploration",", the residual ","tumor"," was an entirely ","intraduodenal",", ","pedunculated"," ","mass"," at the ","posterior duodenal wall"," distal to the ","ampulla"," that filled the entire ","duodenal lumen",".\nThe patient underwent a ","duodenotomy"," and ","stalk transection"," of the ","polypoid"," ","mass",", followed by ","partial"," ","duodenal"," ","resection"," with ","hand-sewn"," ","duodenojejunal"," ","anastomosis"," (Figure 2).\n","Surgical pathology examination"," revealed a ","9.5\u2009cm"," ","recurrent"," ","high-grade"," ","liposarcoma"," with ","polypoid intraluminal growth"," containing ","myxoid",", ","round cell",", ","well-differentiated",", ","sclerosing"," and ","focally pleomorphic areas",".\n","Surgical margins"," were ","negative"," as the ","tumor"," came ","within 0.1\u2009cm"," of the ","stalk margin"," and there was no evidence of additional ","neoplastic components"," within the remaining resected ","duodenum",".\nThe ","postoperative course"," was ","uncomplicated",", and the patient has demonstrated no ","recurrence"," up to ","30\u2009months from"," this resection.\n"],"ner_labels":[0,5,0,65,0,22,0,75,0,22,0,26,0,22,0,75,0,75,0,19,0,24,0,27,0,63,0,26,0,22,0,22,0,22,0,22,0,22,0,22,0,24,0,42,0,69,0,69,0,12,0,12,0,12,0,69,0,75,0,22,0,24,0,19,0,22,0,69,0,12,0,22,0,24,0,69,0,12,0,12,0,12,0,12,0,12,0,63,0,22,0,26,0,22,0,75,0,12,0,69,0,29,0,29,0,69,0,24,0,12,0,69,0,19,0,13,0,69,0,22,0,12,0,69,0,69,0,69,0,24,0,27,0,69,0,12,0,69,0,12,0,12,0,75,0,75,0,12,0,75,0,24,0,69,0,12,0,22,0,18,0,12,0,12,0,12,0,75,0,75,0,22,0,69,0,22,0,12,0,75,0,22,0,12,0,75,0,24,0,27,0,22,0,63,0,26,0,22,0,22,0,22,0,22,0,22,0,22,0,24,0,42,0,69,0,27,0,12,0,69,0,12,0,24,0,42,0,69,0,19,0]}
-{"full_text":"A 5-year-old Caucasian male presented to the Children\u2019s Emergency Department with epistaxis, bleeding from the dental extraction site and a widespread purpuric rash, secondary to acute idiopathic thrombocytopenia.\nTwo days prior to this, he developed a generalised chickenpox rash.\nWhile in the department it was noted that his heart rate ranged between 50 and 60 beats per min, he was otherwise haemo-dynamically stable with a normal blood pressure and oxygen saturations in air.\nHe had a short systolic murmur grade 2\/6 at the left sternal border.\nHe had no clinical evidence of myocarditis or heart failure.\nHe had extensive generalised petechiae and purpuric rash (figure 1) secondary to acute thrombocytopenia presumed to be due to varicella infection.\nApparently he was healthy prior to this admission.\nThere was no history of maternal lupus.\nAn ECG was performed which showed complete heart block (figure 2).\nHe was admitted to the high dependency unit for close overnight monitoring.\nThe presumed diagnosis was complete heart block secondary to varicella infection.1 2 The initial investigation showed normal electrolytes, calcium, phosphate, glucose and magnesium levels.\nThe full blood count showed a normal haemoglobin and white cell count.\nBut the platelet count was low that is, 13\u00d7109\/l.\nThe platelet count normalised within 10 days without any intervention.\nThe antinuclear antibody titres and the autoimmune screen were negative.\nMaternal autoimmune screen was negative.\nThe echocardiogram showed a structurally normal heart and follow-up 24 h tape showed persistence of complete heart block.\nFollowing these investigations a diagnosis of congenital complete heart block was made.\nOn follow-up after 6 months his heart rate remains between 50 and 60 beats per min, but he remains asymptomatic without any intervention.\nThe need for a pacemaker is being considered on follow-up.\nThe incidental finding of complete heart block was congenital in aetiology with no association with varicella infection or acute thrombocytopenia.\nThis case highlights that asymptomatic late-presenting congenital complete heart block must be considered as a differential diagnosis in children presenting with asymptomatic bradycardia to the emergency department.\n","ner_info":[{"text":"5-year-old","label":"AGE","start":2,"end":12},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":13,"end":22},{"text":"male","label":"AGE","start":23,"end":27},{"text":"presented","label":"CLINICAL_EVENT","start":28,"end":37},{"text":"Children\u2019s Emergency Department","label":"NONBIOLOGICAL_LOCATION","start":45,"end":76},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":82,"end":91},{"text":"bleeding","label":"SIGN_SYMPTOM","start":93,"end":101},{"text":"dental 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min","label":"LAB_VALUE","start":1748,"end":1779},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":1796,"end":1808},{"text":"intervention","label":"THERAPEUTIC_PROCEDURE","start":1821,"end":1833},{"text":"pacemaker","label":"THERAPEUTIC_PROCEDURE","start":1850,"end":1859},{"text":"follow-up","label":"CLINICAL_EVENT","start":1883,"end":1892}],"tokens":["A ","5-year-old"," ","Caucasian"," ","male"," ","presented"," to the ","Children\u2019s Emergency Department"," with ","epistaxis",", ","bleeding"," from the ","dental extraction"," ","site"," and a ","widespread"," ","purpuric"," ","rash",", secondary to ","acute"," ","idiopathic"," ","thrombocytopenia",".\n","Two days prior"," to this, he developed a ","generalised"," ","chickenpox rash",".\nWhile in the department it was noted that his ","heart rate"," ranged ","between 50 and 60 beats per min",", he was otherwise ","haemo-dynamically stable"," with a ","normal"," ","blood pressure"," and ","oxygen saturations"," in ","air",".\nHe had a ","short"," ","systolic"," ","murmur"," ","grade 2\/6"," at the ","left sternal border",".\nHe had no clinical evidence of ","myocarditis"," or ","heart failure",".\nHe had ","extensive"," ","generalised"," ","petechiae"," and ","purpuric"," ","rash"," (figure 1) secondary to ","acute"," ","thrombocytopenia"," presumed to be due to ","varicella infection",".\nApparently he was ","healthy"," prior to this admission.\nThere was ","no history of maternal lupus",".\nAn ","ECG"," was performed which showed ","complete"," ","heart block"," (figure 2).\nHe was ","admitted"," to the ","high dependency unit"," for ","close"," ","overnight"," ","monitoring",".\nThe presumed diagnosis was complete ","heart block"," secondary to ","varicella infection",".1 2 The initial investigation showed ","normal"," ","electrolytes",", ","calcium",", ","phosphate",", ","glucose"," and ","magnesium"," levels.\nThe ","full blood count"," showed a ","normal"," ","haemoglobin"," and ","white cell count",".\nBut the ","platelet count"," was ","low"," that is, ","13\u00d7109\/l",".\nThe ","platelet count"," ","normalised"," ","within 10 days"," without any ","intervention",".\nThe ","antinuclear antibody"," titres and the ","autoimmune screen"," were ","negative",".\n","Maternal"," ","autoimmune screen was negative",".\nThe ","echocardiogram"," showed a ","structurally normal"," ","heart"," and ","follow-up"," ","24 h"," tape showed persistence of ","complete"," ","heart block",".\nFollowing these investigations a diagnosis of ","congenital"," ","complete"," ","heart block"," was made.\nOn ","follow-up"," ","after 6 months"," his ","heart rate"," remains ","between 50 and 60 beats per min",", but he remains ","asymptomatic"," without any ","intervention",".\nThe need for a ","pacemaker"," is being considered on ","follow-up",".\nThe incidental finding of complete heart block was congenital in aetiology with no association with varicella infection or acute thrombocytopenia.\nThis case highlights that asymptomatic late-presenting congenital complete heart block must be considered as a differential diagnosis in children presenting with asymptomatic bradycardia to the emergency department.\n"],"ner_labels":[0,5,0,58,0,5,0,13,0,48,0,69,0,69,0,75,0,12,0,22,0,22,0,69,0,22,0,22,0,69,0,19,0,22,0,69,0,24,0,42,0,69,0,42,0,24,0,24,0,22,0,22,0,22,0,69,0,42,0,12,0,26,0,26,0,63,0,22,0,69,0,22,0,69,0,22,0,69,0,26,0,69,0,34,0,24,0,63,0,26,0,13,0,48,0,22,0,32,0,75,0,26,0,26,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,19,0,75,0,24,0,24,0,42,0,71,0,22,0,24,0,69,0,12,0,13,0,19,0,63,0,26,0,22,0,63,0,26,0,13,0,19,0,24,0,42,0,69,0,75,0,75,0,13,0]}
-{"full_text":"In January 2009, a 57-year-old woman emergently presented with acute shortness of breath.\nShe had a 1-month history of progressive shortness of breath and a gradual decrease in exercise capacity secondary to mild dyspnea.\nShe reported no additional symptoms.\nAt age 40, she had been diagnosed with a stage IIA, T1bN1, left-sided breast cancer.\nInitial treatment had included a lumpectomy and axillary node dissection.\nShe subsequently underwent 4 cycles of DOX therapy (75 mg\/m2), followed by 8 cycles of cyclophosphamide, methotrexate, and 5-fluorouracil.\nMultigated acquisition scans before and after chemotherapy showed normal cardiac function.\nAfter chemotherapy, she underwent left whole-breast radiation with an axillary boost.\nBecause the tumor had been estrogen receptor-positive, her subsequent medical regimen consisted only of anti-estrogen therapy.\nShe took tamoxifen for 5 years, and, ever since, the aromatase inhibitor letrozole.\nIn the 17 years after chemotherapy, she had been active and in relatively good health.\nIn addition to her other symptoms, she now presented with tachycardia, tachypnea, and hypertension.\nShe had marked jugular venous distention, an S3, pulmonary rales, and trace peripheral edema.\nInitial laboratory values were within normal limits except for an elevated level of N-terminal pro-brain natriuretic peptide (>2,000 pg\/mL).\nResults of investigation into the new-onset cardiomyopathy included normal cardiac enzyme levels, an electrocardiogram (ECG) that revealed no ischemic changes, and a coronary angiogram of normal appearance.\nThe ECG showed sinus tachycardia with frequent premature ventricular complexes, left-axis deviation, left atrial enlargement, and low-voltage QRS complexes with nonspecific ST changes (Fig.1).\nA 2-dimensional echocardiogram revealed a left ventricular ejection fraction (LVEF) of 0.20, severe diffuse left ventricular (LV) hypokinesis, and a mildly dilated left atrium.\nTo better define the cause of the LV systolic dysfunction, cardiovascular magnetic resonance (CMR) was performed.\nIt confirmed the LVEF of 0.20.\nThe T2-weighted sequence showed slow flow secondary to LV dysfunction, and no myocardial edema (Fig.2A).\nLate gadolinium enhancement disclosed diffuse myocardial thinning and no scarring (Fig.2B).\nThe patient was treated medically.\nHer symptoms progressively improved during therapy, which consisted of a \u03b2-blocker, an angiotensin-converting enzyme inhibitor, digoxin, and a diuretic.\nThe therapy was slowly tapered, and her LVEF increased from 0.20 to 0.55 during an 8-month period.\nAll medications except for low-dose metoprolol were discontinued after 1 year, and she remained asymptomatic.\n","ner_info":[{"text":"January 2009","label":"DATE","start":3,"end":15},{"text":"57-year-old","label":"AGE","start":19,"end":30},{"text":"woman","label":"SEX","start":31,"end":36},{"text":"presented","label":"CLINICAL_EVENT","start":48,"end":57},{"text":"acute","label":"DETAILED_DESCRIPTION","start":63,"end":68},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":69,"end":88},{"text":"1-month","label":"DURATION","start":100,"end":107},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":119,"end":130},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":131,"end":150},{"text":"gradual decrease","label":"LAB_VALUE","start":157,"end":173},{"text":"exercise capacity","label":"DIAGNOSTIC_PROCEDURE","start":177,"end":194},{"text":"mild","label":"SEVERITY","start":208,"end":212},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":213,"end":220},{"text":"additional symptoms","label":"SIGN_SYMPTOM","start":238,"end":257},{"text":"age 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ventricular","label":"BIOLOGICAL_STRUCTURE","start":1875,"end":1891},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":1893,"end":1895},{"text":"hypokinesis","label":"SIGN_SYMPTOM","start":1897,"end":1908},{"text":"mildly","label":"SEVERITY","start":1916,"end":1922},{"text":"dilated","label":"SIGN_SYMPTOM","start":1923,"end":1930},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":1931,"end":1942},{"text":"cardiovascular magnetic resonance","label":"DIAGNOSTIC_PROCEDURE","start":2003,"end":2036},{"text":"CMR","label":"DIAGNOSTIC_PROCEDURE","start":2038,"end":2041},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":2075,"end":2079},{"text":"0.20","label":"LAB_VALUE","start":2083,"end":2087},{"text":"T2-weighted 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","node dissection",".\nShe subsequently underwent ","4 cycles"," of ","DOX therapy"," (","75 mg\/m2","), followed by ","8 cycles"," of ","cyclophosphamide",", ","methotrexate",", and ","5-fluorouracil",".\n","Multigated acquisition scans"," before and after ","chemotherapy"," showed ","normal"," ","cardiac function",".\nAfter ","chemotherapy",", she underwent ","left whole-breast"," ","radiation"," with an ","axillary boost",".\nBecause the ","tumor"," had been ","estrogen receptor-positive",", her subsequent medical regimen consisted only of ","anti-estrogen therapy",".\nShe took ","tamoxifen"," for ","5 years",", and, ever since, the aromatase inhibitor ","letrozole",".\nIn the ","17 years after"," chemotherapy, she had been ","active"," and in ","relatively good"," ","health",".\nIn addition to her other symptoms, she now presented with ","tachycardia",", ","tachypnea",", and ","hypertension",".\nShe had marked ","jugular venous"," ","distention",", an ","S3",", ","pulmonary rales",", and ","trace"," ","peripheral"," ","edema",".\nInitial ","laboratory values"," were ","within normal limits"," except for an ","elevated"," level of ","N-terminal pro-brain natriuretic peptide"," (",">2,000 pg\/mL",").\nResults of investigation into the new-onset ","cardiomyopathy"," included ","normal"," ","cardiac enzyme"," levels, an ","electrocardiogram"," (","ECG",") that revealed no ","ischemic changes",", and a ","coronary"," ","angiogram"," of ","normal"," appearance.\nThe ","ECG"," showed ","sinus"," ","tachycardia"," with ","frequent"," ","premature ventricular complexes",", ","left-axis deviation",", ","left atrial"," ","enlargement",", and ","low-voltage"," ","QRS complexes"," with ","nonspecific"," ","ST changes"," (Fig.1).\nA ","2-dimensional"," ","echocardiogram"," revealed a ","left ventricular ejection fraction"," (","LVEF",") of ","0.20",", ","severe"," ","diffuse"," ","left ventricular"," (","LV",") ","hypokinesis",", and a ","mildly"," ","dilated"," ","left atrium",".\nTo better define the cause of the LV systolic dysfunction, ","cardiovascular magnetic resonance"," (","CMR",") was performed.\nIt confirmed the ","LVEF"," of ","0.20",".\nThe ","T2-weighted sequence"," showed ","slow"," ","flow"," secondary to ","LV"," ","dysfunction",", and no ","myocardial"," ","edema"," (Fig.2A).\n","Late"," ","gadolinium enhancement"," disclosed ","diffuse"," ","myocardial"," ","thinning"," and no ","scarring"," (Fig.2B).\nThe patient was ","treated medically",".\nHer ","symptoms"," progressively ","improved"," during ","therapy",", which consisted of a ","\u03b2-blocker",", an ","angiotensin-converting enzyme inhibitor",", ","digoxin",", and a ","diuretic",".\nThe ","therapy"," was slowly ","tapered",", and her ","LVEF"," ","increased"," from ","0.20"," to ","0.55"," during an ","8-month period",".\nAll ","medications"," except for ","low-dose"," ","metoprolol"," were ","discontinued"," ","after 1 year",", and she remained ","asymptomatic",".\n"],"ner_labels":[0,19,0,5,0,65,0,13,0,22,0,69,0,32,0,22,0,69,0,42,0,24,0,63,0,69,0,69,0,19,0,13,0,42,0,42,0,22,0,26,0,75,0,12,0,75,0,29,0,46,0,29,0,29,0,46,0,46,0,46,0,24,0,46,0,42,0,24,0,46,0,12,0,75,0,22,0,69,0,22,0,46,0,46,0,32,0,46,0,32,0,69,0,42,0,24,0,69,0,69,0,69,0,12,0,69,0,69,0,69,0,63,0,22,0,69,0,24,0,42,0,42,0,24,0,42,0,26,0,42,0,24,0,24,0,24,0,69,0,12,0,24,0,42,0,24,0,22,0,69,0,35,0,69,0,69,0,12,0,69,0,22,0,69,0,22,0,69,0,22,0,24,0,24,0,24,0,42,0,63,0,22,0,12,0,12,0,69,0,63,0,69,0,12,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,12,0,26,0,12,0,69,0,22,0,24,0,22,0,12,0,69,0,69,0,75,0,69,0,42,0,75,0,46,0,46,0,46,0,46,0,18,0,42,0,24,0,42,0,42,0,42,0,32,0,46,0,29,0,46,0,42,0,19,0,69,0]}
-{"full_text":"This 16-year-old boy was the first child to non-consanguineous parents.\nHis parents and two younger siblings were healthy.\nHe was well until starting school at 7 years of age when he was found to be short in height, slightly myopic, astigmatic and to have subnormal visual acuity.\nEndocrinological investigations were performed that initially revealed borderline values for growth hormone (GH) deficiency and he was therefore treated for a period with GH without any beneficiary effect on his growth.\nAt age 16 years, height and weight was \u22123 SD below the mean compared with a standardized Swedish growth chart.\nOphthalmological investigations at 10 years of age showed pigmentary retinopathy and optic atrophy.\nAn electroretinogram was performed and showed a severe rod cone dystrophy.\nHe had decreased visual acuity, visual fields, color vision, and dark adaption.\nNystagmus has been noted since 14 years of age.\nA year later, photophobia and bilateral cataracts were developed.\nThe cataracts were operated on at 16 years of age.\nHe is now blind.\nAt 14 years of age, he was referred for neurological investigations.\nA clinical examination showed mild ataxia with tremor, dysmetria and gait instability together with mild to moderate muscle weakness, weak to absent tendon reflexes in the lower extremities, and exercise intolerance.\nAudiometric investigations revealed a mild bilateral sensorineural hearing impairment.\nAt 15 years of age, he had an unprovoked epileptic seizure and he has since then been treated with levetiracetam.\nDecreased renal function was identified at 15 years of age, with increased serum creatinine to 145\u2009\u03bcmol\/l (reference interval 30\u201390\u2009\u03bcmol\/l), proteinuria with urine albumine at 244\u2013538\u2009mg\/l (reference interval<20\u2009mg\/l), and urine albumine\/creatinine ratio at 44\u201359\u2009g\/mol (reference interval <3\u2009g\/mol).\nA renal scintigraphy demonstrated reduced kidney size.\nCr51-EDTA clearance showed a decreased glomerular filtration rate of 42% of normal.\nThe filtration rate decreased over time to 29% of normal at 16 years of age.\nSince 14 years of age, cardiac investigations have demonstrated hypertrophy of the walls of the left ventricle (+3 SD compared with normal) with normal systolic and diastolic function and without obstruction of the outflow.\nMitochondrial investigations were performed at 14 years of age.\nBlood levels of lactate and pyruvate were 1.6 and 0.096\u2009mmol\/l, respectively, leading to a ratio of 33 (reference interval <20), while cerebrospinal fluid (CSF) levels of lactate and pyruvate were 3.6 and 0.137\u2009mmol\/l, respectively, leading to a lactate to pyruvate ratio of 26.\nThe urinary lactate excretion was normal.\nThe CSF albumin was increased to 258\u2009mg\/l (reference level <225\u2009mg\/l) and he also had an increased CSF\/plasma albumin ratio of 7.4 (reference level <5).\nThe serum acyl carnitine profile and muscle carnitine levels were normal.\nThe serum creatine kinase activity was mildly increased to 5.4\u2009\u03bckat\/l (reference interval <3.5\u2009\u03bckat\/l).\n","ner_info":[{"text":"16-year-old","label":"AGE","start":5,"end":16},{"text":"boy","label":"SEX","start":17,"end":20},{"text":"non-consanguineous parents","label":"FAMILY_HISTORY","start":44,"end":70},{"text":"His parents and two younger siblings were healthy","label":"FAMILY_HISTORY","start":72,"end":121},{"text":"7 years of age","label":"DATE","start":160,"end":174},{"text":"short in height","label":"SIGN_SYMPTOM","start":199,"end":214},{"text":"slightly myopic","label":"SIGN_SYMPTOM","start":216,"end":231},{"text":"astigmatic","label":"SIGN_SYMPTOM","start":233,"end":243},{"text":"subnormal visual acuity","label":"SIGN_SYMPTOM","start":256,"end":279},{"text":"Endocrinological investigations","label":"DIAGNOSTIC_PROCEDURE","start":281,"end":312},{"text":"borderline values","label":"LAB_VALUE","start":352,"end":369},{"text":"growth hormone (GH) deficiency","label":"SIGN_SYMPTOM","start":374,"end":404},{"text":"treated","label":"CLINICAL_EVENT","start":426,"end":433},{"text":"GH","label":"MEDICATION","start":452,"end":454},{"text":"beneficiary effect on his growth","label":"SIGN_SYMPTOM","start":467,"end":499},{"text":"16 years","label":"DATE","start":508,"end":516},{"text":"height and weight was \u22123 SD below the mean","label":"SIGN_SYMPTOM","start":518,"end":560},{"text":"Ophthalmological investigations","label":"DIAGNOSTIC_PROCEDURE","start":612,"end":643},{"text":"10 years of age","label":"DATE","start":647,"end":662},{"text":"pigmentary retinopathy","label":"SIGN_SYMPTOM","start":670,"end":692},{"text":"optic atrophy","label":"SIGN_SYMPTOM","start":697,"end":710},{"text":"electroretinogram","label":"DIAGNOSTIC_PROCEDURE","start":715,"end":732},{"text":"severe","label":"SEVERITY","start":760,"end":766},{"text":"rod cone dystrophy","label":"SIGN_SYMPTOM","start":767,"end":785},{"text":"decreased","label":"LAB_VALUE","start":794,"end":803},{"text":"visual acuity","label":"SIGN_SYMPTOM","start":804,"end":817},{"text":"visual fields","label":"SIGN_SYMPTOM","start":819,"end":832},{"text":"color vision","label":"SIGN_SYMPTOM","start":834,"end":846},{"text":"dark adaption","label":"SIGN_SYMPTOM","start":852,"end":865},{"text":"Nystagmus","label":"SIGN_SYMPTOM","start":867,"end":876},{"text":"14 years of age","label":"DATE","start":898,"end":913},{"text":"A year later","label":"DATE","start":915,"end":927},{"text":"photophobia","label":"SIGN_SYMPTOM","start":929,"end":940},{"text":"bilateral cataracts","label":"SIGN_SYMPTOM","start":945,"end":964},{"text":"cataracts were operated on","label":"THERAPEUTIC_PROCEDURE","start":985,"end":1011},{"text":"16 years of age","label":"DATE","start":1015,"end":1030},{"text":"now","label":"DATE","start":1038,"end":1041},{"text":"blind","label":"SIGN_SYMPTOM","start":1042,"end":1047},{"text":"14 years of age","label":"DATE","start":1052,"end":1067},{"text":"neurological investigations","label":"DIAGNOSTIC_PROCEDURE","start":1089,"end":1116},{"text":"clinical examination","label":"DIAGNOSTIC_PROCEDURE","start":1120,"end":1140},{"text":"mild","label":"SEVERITY","start":1148,"end":1152},{"text":"ataxia with tremor","label":"SIGN_SYMPTOM","start":1153,"end":1171},{"text":"dysmetria","label":"SIGN_SYMPTOM","start":1173,"end":1182},{"text":"gait instability","label":"SIGN_SYMPTOM","start":1187,"end":1203},{"text":"mild to moderate","label":"SEVERITY","start":1218,"end":1234},{"text":"muscle weakness","label":"SIGN_SYMPTOM","start":1235,"end":1250},{"text":"weak to absent","label":"SEVERITY","start":1252,"end":1266},{"text":"tendon reflexes","label":"SIGN_SYMPTOM","start":1267,"end":1282},{"text":"lower extremities","label":"BIOLOGICAL_STRUCTURE","start":1290,"end":1307},{"text":"exercise intolerance","label":"SIGN_SYMPTOM","start":1313,"end":1333},{"text":"Audiometric investigations","label":"DIAGNOSTIC_PROCEDURE","start":1335,"end":1361},{"text":"mild","label":"SEVERITY","start":1373,"end":1377},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1378,"end":1387},{"text":"sensorineural hearing impairment","label":"SIGN_SYMPTOM","start":1388,"end":1420},{"text":"15 years of age","label":"DATE","start":1425,"end":1440},{"text":"unprovoked","label":"DETAILED_DESCRIPTION","start":1452,"end":1462},{"text":"epileptic seizure","label":"SIGN_SYMPTOM","start":1463,"end":1480},{"text":"treated","label":"CLINICAL_EVENT","start":1508,"end":1515},{"text":"levetiracetam","label":"MEDICATION","start":1521,"end":1534},{"text":"Decreased renal function","label":"SIGN_SYMPTOM","start":1536,"end":1560},{"text":"15 years of age","label":"DATE","start":1579,"end":1594},{"text":"increased","label":"LAB_VALUE","start":1601,"end":1610},{"text":"serum creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1611,"end":1627},{"text":"145\u2009\u03bcmol\/l","label":"LAB_VALUE","start":1631,"end":1641},{"text":"proteinuria","label":"SIGN_SYMPTOM","start":1677,"end":1688},{"text":"urine albumine","label":"DIAGNOSTIC_PROCEDURE","start":1694,"end":1708},{"text":"244\u2013538\u2009mg\/l","label":"LAB_VALUE","start":1712,"end":1724},{"text":"urine albumine\/creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1759,"end":1784},{"text":"44\u201359\u2009g\/mol","label":"LAB_VALUE","start":1794,"end":1805},{"text":"renal","label":"BIOLOGICAL_STRUCTURE","start":1839,"end":1844},{"text":"scintigraphy","label":"DIAGNOSTIC_PROCEDURE","start":1845,"end":1857},{"text":"reduced kidney size","label":"SIGN_SYMPTOM","start":1871,"end":1890},{"text":"Cr51-EDTA clearance","label":"DIAGNOSTIC_PROCEDURE","start":1892,"end":1911},{"text":"decreased","label":"LAB_VALUE","start":1921,"end":1930},{"text":"glomerular filtration rate","label":"DIAGNOSTIC_PROCEDURE","start":1931,"end":1957},{"text":"42% of normal.","label":"LAB_VALUE","start":1961,"end":1975},{"text":"filtration rate","label":"COREFERENCE","start":1980,"end":1995},{"text":"decreased","label":"LAB_VALUE","start":1996,"end":2005},{"text":"29% of normal","label":"LAB_VALUE","start":2019,"end":2032},{"text":"16 years of age","label":"DATE","start":2036,"end":2051},{"text":"14 years of age","label":"DATE","start":2059,"end":2074},{"text":"cardiac investigations","label":"DIAGNOSTIC_PROCEDURE","start":2076,"end":2098},{"text":"hypertrophy","label":"SIGN_SYMPTOM","start":2117,"end":2128},{"text":"walls of the left ventricle","label":"BIOLOGICAL_STRUCTURE","start":2136,"end":2163},{"text":"normal","label":"SEVERITY","start":2198,"end":2204},{"text":"systolic and diastolic function","label":"SIGN_SYMPTOM","start":2205,"end":2236},{"text":"obstruction of the outflow","label":"SIGN_SYMPTOM","start":2249,"end":2275},{"text":"Mitochondrial investigations","label":"DIAGNOSTIC_PROCEDURE","start":2277,"end":2305},{"text":"14 years of age","label":"DATE","start":2324,"end":2339},{"text":"Blood levels","label":"DIAGNOSTIC_PROCEDURE","start":2341,"end":2353},{"text":"lactate","label":"DIAGNOSTIC_PROCEDURE","start":2357,"end":2364},{"text":"pyruvate","label":"DIAGNOSTIC_PROCEDURE","start":2369,"end":2377},{"text":"1.6","label":"LAB_VALUE","start":2383,"end":2386},{"text":"0.096\u2009mmol\/l","label":"LAB_VALUE","start":2391,"end":2403},{"text":"ratio","label":"DIAGNOSTIC_PROCEDURE","start":2432,"end":2437},{"text":"33","label":"LAB_VALUE","start":2441,"end":2443},{"text":"cerebrospinal fluid","label":"DIAGNOSTIC_PROCEDURE","start":2476,"end":2495},{"text":"CSF","label":"DIAGNOSTIC_PROCEDURE","start":2497,"end":2500},{"text":"lactate","label":"DIAGNOSTIC_PROCEDURE","start":2512,"end":2519},{"text":"pyruvate","label":"DIAGNOSTIC_PROCEDURE","start":2524,"end":2532},{"text":"3.6","label":"LAB_VALUE","start":2538,"end":2541},{"text":"0.137\u2009mmol\/l,","label":"LAB_VALUE","start":2546,"end":2559},{"text":"lactate to pyruvate ratio","label":"DIAGNOSTIC_PROCEDURE","start":2587,"end":2612},{"text":"26","label":"LAB_VALUE","start":2616,"end":2618},{"text":"urinary lactate excretion","label":"DIAGNOSTIC_PROCEDURE","start":2624,"end":2649},{"text":"normal","label":"LAB_VALUE","start":2654,"end":2660},{"text":"CSF albumin","label":"DIAGNOSTIC_PROCEDURE","start":2666,"end":2677},{"text":"increased","label":"LAB_VALUE","start":2682,"end":2691},{"text":"258\u2009mg\/l","label":"LAB_VALUE","start":2695,"end":2703},{"text":"increased","label":"LAB_VALUE","start":2751,"end":2760},{"text":"CSF\/plasma albumin ratio","label":"DIAGNOSTIC_PROCEDURE","start":2761,"end":2785},{"text":"7.4","label":"LAB_VALUE","start":2789,"end":2792},{"text":"serum acyl carnitine profile","label":"DIAGNOSTIC_PROCEDURE","start":2819,"end":2847},{"text":"muscle carnitine levels","label":"DIAGNOSTIC_PROCEDURE","start":2852,"end":2875},{"text":"normal","label":"LAB_VALUE","start":2881,"end":2887},{"text":"serum creatine kinase activity","label":"DIAGNOSTIC_PROCEDURE","start":2893,"end":2923},{"text":"mildly increased","label":"LAB_VALUE","start":2928,"end":2944},{"text":"5.4\u2009\u03bckat\/l","label":"LAB_VALUE","start":2948,"end":2958}],"tokens":["This ","16-year-old"," ","boy"," was the first child to ","non-consanguineous parents",".\n","His parents and two younger siblings were healthy",".\nHe was well until starting school at ","7 years of age"," when he was found to be ","short in height",", ","slightly myopic",", ","astigmatic"," and to have ","subnormal visual acuity",".\n","Endocrinological investigations"," were performed that initially revealed ","borderline values"," for ","growth hormone (GH) deficiency"," and he was therefore ","treated"," for a period with ","GH"," without any ","beneficiary effect on his growth",".\nAt age ","16 years",", ","height and weight was \u22123 SD below the mean"," compared with a standardized Swedish growth chart.\n","Ophthalmological investigations"," at ","10 years of age"," showed ","pigmentary retinopathy"," and ","optic atrophy",".\nAn ","electroretinogram"," was performed and showed a ","severe"," ","rod cone dystrophy",".\nHe had ","decreased"," ","visual acuity",", ","visual fields",", ","color vision",", and ","dark adaption",".\n","Nystagmus"," has been noted since ","14 years of age",".\n","A year later",", ","photophobia"," and ","bilateral cataracts"," were developed.\nThe ","cataracts were operated on"," at ","16 years of age",".\nHe is ","now"," ","blind",".\nAt ","14 years of age",", he was referred for ","neurological investigations",".\nA ","clinical examination"," showed ","mild"," ","ataxia with tremor",", ","dysmetria"," and ","gait instability"," together with ","mild to moderate"," ","muscle weakness",", ","weak to absent"," ","tendon reflexes"," in the ","lower extremities",", and ","exercise intolerance",".\n","Audiometric investigations"," revealed a ","mild"," ","bilateral"," ","sensorineural hearing impairment",".\nAt ","15 years of age",", he had an ","unprovoked"," ","epileptic seizure"," and he has since then been ","treated"," with ","levetiracetam",".\n","Decreased renal function"," was identified at ","15 years of age",", with ","increased"," ","serum creatinine"," to ","145\u2009\u03bcmol\/l"," (reference interval 30\u201390\u2009\u03bcmol\/l), ","proteinuria"," with ","urine albumine"," at ","244\u2013538\u2009mg\/l"," (reference interval<20\u2009mg\/l), and ","urine albumine\/creatinine"," ratio at ","44\u201359\u2009g\/mol"," (reference interval <3\u2009g\/mol).\nA ","renal"," ","scintigraphy"," demonstrated ","reduced kidney size",".\n","Cr51-EDTA clearance"," showed a ","decreased"," ","glomerular filtration rate"," of ","42% of normal.","\nThe ","filtration rate"," ","decreased"," over time to ","29% of normal"," at ","16 years of age",".\nSince ","14 years of age",", ","cardiac investigations"," have demonstrated ","hypertrophy"," of the ","walls of the left ventricle"," (+3 SD compared with normal) with ","normal"," ","systolic and diastolic function"," and without ","obstruction of the outflow",".\n","Mitochondrial investigations"," were performed at ","14 years of age",".\n","Blood levels"," of ","lactate"," and ","pyruvate"," were ","1.6"," and ","0.096\u2009mmol\/l",", 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<3.5\u2009\u03bckat\/l).\n"],"ner_labels":[0,5,0,65,0,34,0,34,0,19,0,69,0,69,0,69,0,69,0,24,0,42,0,69,0,13,0,46,0,69,0,19,0,69,0,24,0,19,0,69,0,69,0,24,0,63,0,69,0,42,0,69,0,69,0,69,0,69,0,69,0,19,0,19,0,69,0,69,0,75,0,19,0,19,0,69,0,19,0,24,0,24,0,63,0,69,0,69,0,69,0,63,0,69,0,63,0,69,0,12,0,69,0,24,0,63,0,22,0,69,0,19,0,22,0,69,0,13,0,46,0,69,0,19,0,42,0,24,0,42,0,69,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,24,0,42,0,24,0,42,0,18,0,42,0,42,0,19,0,19,0,24,0,69,0,12,0,63,0,69,0,69,0,24,0,19,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,42,0]}
-{"full_text":"A 51-year-old man was referred to our hospital due to severe congestive heart failure and ventricular arrhythmias in March 2008.\nHe had been suffering from heart failure and ventricular tachycardia for years despite receiving the conventional treatment (ie, furosemide, lisinopril hydrate, pimobendan, warfarin potassium, carvedilol, metildigoxin and amiodarone hydrochloride).\nHis height was 161 cm and body weight was 83 kg.\nBlood pressure was 110\/60 mm Hg.\nThe fasting blood glucose was 107 mg\/dl and HbA1c was 6.3%.\nThe chest x-ray showed cardiomegaly with a cardiothoracic ratio of 0.67 (figure 1A).\nECG, as shown in video 1, revealed a diffused hypokinetic left ventricle with markedly dilated left ventricle dimension (end-diastole: 95 mm) and reduced EF (0.11).\nThe coronary angiogram was normal.\nA myocardial biopsy revealed that over 50% of cardiomyocytes were replaced by fibrosis (figure 2).\nAn implantable cardioverter-defibrillator was implanted.\nDue to the typical facial appearance and thickening of hands, he was referred to the endocrinology department.\nThe plasma level of GH was 8.2 ng\/ml and IGF-1 was 504 ng\/ml.\nMRI demonstrated a macroadenoma in the pituitary.\nThus, he was diagnosed as acromegaly.\nHe was treated with octreotide long-acting-release (LAR) for 8 months.\nThereafter, he underwent trans-sphenoidal surgery in January 2009 (figure 3).\nThe plasma levels of GH and IGF-1 were decreased with octreotide LAR, but basal plasma levels of GH were always more than 4 ng\/ml and plasma IGF-1 levels were above the appropriate age range (figure 3).\nAfter surgery, both plasma levels of GH and IGF-1 further decreased.\nBasal plasma levels of GH were mostly less than 0.5 ng\/ml and IGF-1 levels were within normal ranges (figure 3).\nWith the treatment of LAR, the cardiac function improved partially (cardiothoracic ratio=0.58; EF=0.20 in September 2008).\nAfter surgery, the cardiac function improved drastically (cardiothoracic ratio=0.47; EF=0.55 in April 2009; figures 1B and \u200band2B).2B).\nFrequency of ventricular arrhythmias decreased and pimobendan was tapered off.\n","ner_info":[{"text":"51-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"hospital","label":"BIOLOGICAL_STRUCTURE","start":38,"end":46},{"text":"severe","label":"SEVERITY","start":54,"end":60},{"text":"congestive","label":"DETAILED_DESCRIPTION","start":61,"end":71},{"text":"heart failure","label":"DISEASE_DISORDER","start":72,"end":85},{"text":"ventricular","label":"BIOLOGICAL_STRUCTURE","start":90,"end":101},{"text":"arrhythmias","label":"DISEASE_DISORDER","start":102,"end":113},{"text":"March 2008","label":"DATE","start":117,"end":127},{"text":"heart 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years"," despite receiving the ","conventional treatment"," (ie, ","furosemide",", ","lisinopril hydrate",", ","pimobendan",", ","warfarin potassium",", ","carvedilol",", ","metildigoxin"," and ","amiodarone hydrochloride",").\nHis height was ","161 cm"," and body weight was ","83 kg",".\n","Blood pressure"," was ","110\/60 mm Hg",".\nThe ","fasting blood glucose"," was ","107 mg\/dl"," and ","HbA1c"," was ","6.3%",".\nThe ","chest"," ","x-ray"," showed ","cardiomegaly"," with a ","cardiothoracic ratio"," of ","0.67"," (figure 1A).\n","ECG",", as shown in video 1, revealed a ","diffused"," ","hypokinetic left ventricle"," with ","markedly dilated"," ","left ventricle dimension"," (","end-diastole",": ","95 mm",") and ","reduced"," ","EF"," (","0.11",").\nThe ","coronary"," ","angiogram"," was ","normal",".\nA ","myocardial"," ","biopsy"," revealed that ","over 50% of cardiomyocytes"," were replaced by ","fibrosis"," (figure 2).\nAn ","implantable"," ","cardioverter-defibrillator"," was implanted.\nDue to the ","typical"," ","facial appearance"," and ","thickening of hands",", he was ","referred"," to the ","endocrinology department",".\nThe ","plasma level of GH"," was ","8.2 ng\/ml"," and ","IGF-1"," was ","504 ng\/ml",".\n","MRI"," demonstrated a ","macroadenoma"," in the ","pituitary",".\nThus, he was diagnosed as ","acromegaly",".\nHe was treated with ","octreotide"," ","long-acting-release"," (","LAR",") for ","8 months",".\nThereafter, he underwent ","trans-sphenoidal surgery"," in ","January 2009"," (figure 3).\nThe ","plasma levels of GH"," and ","IGF-1"," were ","decreased"," with ","octreotide"," ","LAR",", but ","basal plasma levels of GH"," were always ","more than 4 ng\/ml"," and ","plasma IGF-1 levels"," were ","above the appropriate age range"," (figure 3).\nAfter ","surgery",", both ","plasma levels of GH"," and ","IGF-1"," ","further decreased",".\n","Basal plasma levels of GH"," were ","mostly less than 0.5 ng\/ml"," and ","IGF-1"," levels were 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-{"full_text":"A 26-year-old woman was seen in the emergency department (ED) for chest pain and hypertension.\nShe was found to have a urinary tract infection and was sent home with an antibiotic and thiazide diuretic.\nTwo days later, she returned with epigastric pain, nausea, emesis and myalgias.\nThe patient had no significant medical history and denied cardio-respiratory symptoms; however, she complained of a low exercise tolerance for the last year.\nThere was no family history of cardiac or pulmonary disease or of sudden cardiac death.\nShe was born in the USA and had neither travelled recently nor had any sick contacts.\nOn examination, she was hypertensive (170\/105\u2005mm\u2005Hg), tachycardic (125\u2005bpm), had dry mucous membranes and appeared ill looking.\nShe was found to have an elevated serum creatinine of 160\u2005\u03bcmol\/l (normal 60\u2013110\u2005\u03bcmol\/l).\nAfter receiving 1.5\u2005l of intravenous fluids for presumed volume depletion and prerenal azotaemia she became short of breath.\nCrackles were noted on auscultation of her chest and a portable chest film demonstrated hazy infiltrates that likely represented pulmonary oedema.\nShe then developed hypotension with systolic pressures in the 90s.\nNon-invasive positive pressure ventilation was initiated.\nAn ECG demonstrated sinus tachycardia with a rate of 130\u2005bpm and minimal ST depression on the precordial leads.\nIn consultation with a cardiologist, the patient received 40\u2005mg of intravenous furosemide.\nAn echocardiogram demonstrated global hypokinesis with a left-ventricular ejection fraction <10% (see figure 1).\nThe patient was transferred to the intensive care unit where she became more anxious and tachycardic to 170\u2005bpm.\nShe was intubated and sedated.\nDespite the placement of a Foley catheter and administration of intravenous loop diuretics, she remained anuric for the first 12\u2005h of hospitalisation.\nShe developed signs of acute kidney injury with a creatinine that increased to 350\u2005\u03bcmol\/l within the first 24\u2005h of hospitalisation.\nShe received norepinephrine and milrinone to improve cardiac output.\nOn the second day of hospitalisation, she was evaluated by a cardiologist and cardiothoracic surgeon for emergent circulatory support as she had developed signs of poor tissue perfusion with a lactic acidosis (8.4\u2005mmol\/l; normal <2.2\u2005mmol\/l) and transaminitis with aspartate aminotransferase\/alanine transaminase  >150\u2005IU\/l (normal <40\u2005U\/l).\nShe was taken to the cardiac catheterisation laboratory for emergent right heart catheterisation and biopsy to exclude acute myocarditis.\nOver the next few days, she was gently fluid resuscitated (guided by bioreactance non-invasive cardiac output), the pressors were gradually weaned off and she became non-oliguric.\nShe slowly regained renal function and organ perfusion improved with resolution of the lactic acidosis and a decrease in liver transaminases.\nOn hospital day 5 she was transferred to the medical ward and was eventually discharged home on non-selective \u03b2 blockade, an ACE inhibitor and nitrate with planned follow-up at the heart-failure clinic.\nThe patient returned to the ED 4\u2005days later with an elevated blood pressure, nausea and abdominal pain.\nA contrast scan of her abdomen revealed pancreatitis and an adrenal mass.\nDuring her treatment for pancreatitis she began to have paroxysms of headaches, nausea, emesis and abdominal pain with corresponding hypertension to the 220s systolic and tachycardia to 120s with a baseline systolic pressure of 90\u2013110\u2005mm\u2005Hg (see figure 2).\nHer urinary and plasma catecholamines were elevated and confirmed on repeat testing.\nShe was given aggressive fluid rehydration and \u03b1 and \u03b2 blockade for a planned adrenalectomy.\nPrior to surgery her left-ventricular ejection fraction had improved to 55% on medical management (see figure 1).\nPathology of her adrenal gland was consistent with a non-malignant pheochromocytoma (see figure 3).\n","ner_info":[{"text":"26-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"seen","label":"CLINICAL_EVENT","start":24,"end":28},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":36,"end":56},{"text":"ED","label":"NONBIOLOGICAL_LOCATION","start":58,"end":60},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":66,"end":71},{"text":"pain","label":"SIGN_SYMPTOM","start":72,"end":76},{"text":"hypertension","label":"SIGN_SYMPTOM","start":81,"end":93},{"text":"urinary tract","label":"BIOLOGICAL_STRUCTURE","start":119,"end":132},{"text":"infection","label":"DISEASE_DISORDER","start":133,"end":142},{"text":"antibiotic","label":"MEDICATION","start":169,"end":179},{"text":"thiazide","label":"MEDICATION","start":184,"end":192},{"text":"diuretic","label":"MEDICATION","start":193,"end":201},{"text":"Two days 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","myalgias",".\nThe patient had ","no significant medical history"," and denied ","cardio-respiratory symptoms","; however, she complained of a ","low exercise tolerance"," for the ","last year",".\nThere was ","no family history of cardiac or pulmonary disease or of sudden cardiac death",".\nShe was ","born in the USA"," and had ","neither travelled recently nor had any sick contacts",".\nOn examination, she was ","hypertensive"," (","170\/105\u2005mm\u2005Hg","), ","tachycardic"," (","125\u2005bpm","), had ","dry"," ","mucous membranes"," and ","appeared"," ","ill"," looking.\nShe was found to have an ","elevated"," ","serum creatinine"," of ","160\u2005\u03bcmol\/l"," (normal 60\u2013110\u2005\u03bcmol\/l).\nAfter receiving ","1.5\u2005","l of ","intravenous"," ","fluids"," for presumed ","volume depletion"," and ","prerenal"," ","azotaemia"," she became ","short of breath",".\n","Crackles"," were noted on ","auscultation"," of her ","chest"," and a ","portable"," ","chest"," ","film"," demonstrated ","hazy"," ","infiltrates"," that likely represented ","pulmonary oedema",".\nShe then developed ","hypotension"," with ","systolic pressures"," in the ","90s",".\n","Non-invasive"," ","positive pressure"," ","ventilation"," was initiated.\nAn ","ECG"," demonstrated ","sinus tachycardia"," with a ","rate"," of ","130\u2005bpm"," and ","minimal"," ","ST depression"," on the ","precordial leads",".\nIn ","consultation"," with a ","cardiologist",", the patient received ","40\u2005mg"," of ","intravenous"," ","furosemide",".\nAn ","echocardiogram"," demonstrated ","global"," ","hypokinesis"," with a ","left-ventricular ejection fraction"," ","<10%"," (see figure 1).\nThe patient was ","transferred"," to the ","intensive care unit"," where she became more ","anxious"," and ","tachycardic"," to ","170\u2005bpm",".\nShe was ","intubated"," and ","sedated",".\nDespite the placement of a ","Foley"," ","catheter"," and administration of ","intravenous loop"," ","diuretics",", she remained ","anuric"," for the ","first 12\u2005h"," of ","hospitalisation",".\nShe developed signs of ","acute"," ","kidney injury"," with a ","creatinine"," that ","increased"," to ","350\u2005\u03bcmol\/l"," ","within the first 24\u2005h"," of ","hospitalisation",".\nShe received ","norepinephrine"," and ","milrinone"," to ","improve"," ","cardiac output",".\nOn the ","second day"," of ","hospitalisation",", she was ","evaluated"," by a ","cardiologist"," and ","cardiothoracic surgeon"," for ","emergent"," ","circulatory support"," as she had developed signs of ","poor tissue perfusion"," with a ","lactic acidosis"," (","8.4\u2005mmol\/l","; normal <2.2\u2005mmol\/l) and ","transaminitis"," with ","aspartate aminotransferase\/alanine transaminase","  ",">150\u2005IU\/l"," (normal <40\u2005U\/l).\nShe was ","taken"," to the ","cardiac catheterisation laboratory"," for ","emergent"," ","right"," ","heart catheterisation"," and ","biopsy"," to exclude ","acute"," ","myocarditis",".\n","Over the next few days",", she was ","gently"," ","fluid resuscitated"," (","guided by bioreactance non-invasive cardiac output","), the ","pressors"," were gradually weaned off and she became ","non-oliguric",".\nShe ","slowly regained"," ","renal function"," and ","organ perfusion"," ","improved"," with resolution of the ","lactic acidosis"," and a ","decrease"," in ","liver transaminases",".\nOn hospital ","day 5"," she was ","transferred"," to the ","medical ward"," and was eventually ","discharged"," ","home"," on ","non-selective"," ","\u03b2 blockade",", an ","ACE inhibitor"," and ","nitrate"," with planned ","follow-up"," at the ","heart-failure clinic",".\nThe patient ","returned"," to the ","ED"," ","4\u2005days later"," with an ","elevated"," ","blood pressure",", ","nausea"," and ","abdominal"," ","pain",".\nA ","contrast scan"," of her ","abdomen"," revealed ","pancreatitis"," and an ","adrenal"," ","mass",".\nDuring her ","treatment"," for ","pancreatitis"," she began to have ","paroxysms"," of ","headaches",", ","nausea",", ","emesis"," and ","abdominal"," ","pain"," with corresponding ","hypertension"," to the ","220s"," ","systolic"," and ","tachycardia"," to ","120s"," with a baseline ","systolic pressure"," of ","90\u2013110\u2005mm\u2005Hg"," (see figure 2).\nHer ","urinary"," and ","plasma"," ","catecholamines"," were ","elevated"," and confirmed on repeat testing.\nShe was given ","aggressive"," ","fluid rehydration"," and ","\u03b1 and \u03b2 blockade"," for a planned ","adrenalectomy",".\nPrior to ","surgery"," her ","left-ventricular ejection fraction"," had ","improved"," to ","55%"," on ","medical management"," (see figure 1).\n","Pathology"," of her ","adrenal gland"," was consistent with a ","non-malignant"," ","pheochromocytoma"," (see figure 3).\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,48,0,12,0,69,0,69,0,12,0,26,0,46,0,46,0,46,0,19,0,12,0,69,0,69,0,69,0,69,0,39,0,69,0,69,0,32,0,34,0,58,0,39,0,69,0,42,0,69,0,42,0,69,0,12,0,24,0,42,0,42,0,24,0,42,0,79,0,4,0,46,0,26,0,22,0,69,0,69,0,69,0,24,0,12,0,22,0,12,0,24,0,73,0,69,0,26,0,69,0,24,0,42,0,22,0,22,0,75,0,24,0,69,0,24,0,42,0,63,0,69,0,24,0,13,0,71,0,29,0,4,0,46,0,24,0,22,0,69,0,24,0,42,0,13,0,48,0,69,0,69,0,42,0,75,0,46,0,22,0,75,0,4,0,46,0,69,0,32,0,13,0,22,0,26,0,24,0,42,0,42,0,78,0,13,0,46,0,46,0,42,0,24,0,19,0,13,0,24,0,71,0,71,0,22,0,75,0,69,0,69,0,42,0,69,0,24,0,42,0,13,0,48,0,22,0,22,0,75,0,24,0,22,0,26,0,32,0,22,0,75,0,22,0,46,0,69,0,42,0,24,0,24,0,42,0,69,0,42,0,24,0,19,0,13,0,48,0,13,0,48,0,22,0,46,0,46,0,46,0,13,0,48,0,13,0,48,0,19,0,42,0,24,0,69,0,12,0,69,0,24,0,12,0,26,0,12,0,69,0,75,0,26,0,69,0,69,0,69,0,69,0,12,0,69,0,69,0,42,0,22,0,69,0,42,0,24,0,42,0,22,0,22,0,24,0,42,0,22,0,75,0,46,0,75,0,18,0,24,0,42,0,42,0,75,0,24,0,12,0,22,0,26,0]}
-{"full_text":"The 31-year-old white primipara with twin pregnancy was admitted to hospital in the 38th week of gestation with elevated blood pressure (150\/100 mmHg).\nAfter receiving antihypertensive treatment blood pressure was 120\/80.\nAll laboratory variables, including plasma proteins, were within their respective reference intervals.\nFew hours after admission to the hospital the contractions started, and the caesarean section was performed because of vertex-transverse presentation of twins.\nLiveborn female and male were delivered.\nThe postoperative course was initially inconspicuous.\nFour hours postpartum she experienced sudden epigastric pain.\nThe blood pressure rose to 190\/130.\nLaboratory findings showed haemolysis, thrombocytopenia, and an increase in serum creatinine and aminotransferases (Table I).\nIntravenous magnesium sulphate was administered.\nAbdominal ultrasound disclosed an empty uterine cavity without placenta residue.\nFive hours postpartum, the patient was transferred to the intensive care unit because of poor urine output, drowsiness, and suspicion of DIC.\nOn examination she was sleepy and disoriented.\nThe combination of haemolysis, thrombocytopenia, and elevated liver enzymes suggested a postpartum HELLP syndrome, complicated by DIC.\nThe patient was rehydrated, and treatment was instituted with fresh frozen plasma, red cell transfusion, fresh platelets, and kybernin P (antithrombin III).\nHigh serum urea, creatinine, and persistent anuria were compatible with acute renal failure.\nA high dose of furosemide failed to increase diuresis.\nSixteen hours postpartum her blood pressure was 60\/40 and oxygen saturation 70%.\nFew minutes later the patient had acute cardiac arrest, and resuscitation started.\nResuscitation was successful, and normal heart action was re-established; blood pressure rose to 150\/110, and oxygen saturation was 90%.\nLaboratory findings were deteriorated, and development of acute renal failure indicated the necessity of urgent dialysis.\nFollowing dialysis, the patient was stable, oxygen saturation 98%.\nTwenty hours postpartum patient developed again cardiopulmonary arrest.\nDespite resuscitation attempts the outcome was lethal.\nDue to the fact that death occurred in the hospital a short time after a surgical intervention, a medico-legal autopsy was ordered.\nAn autopsy revealed oedema of the brain and lungs as well as dilatation of right and left ventricles.\nHydrothorax (900 mL), hydroperitoneum (2500 mL), and hydropericardium (200 mL) were present.\nThe field of operation of the caesarean section was unremarkable.\nPetechial and suffusional haemorrhages were observed under the pleura, endocardium, in the mucosae of the renal pelvis, and peritoneum of the small and large bowel.\nHistology revealed periportal hepatocellular necrosis, bloodless glomeruli with swollen and vacuolated intracapillary cells, as well as confluent haemorrhages in kidneys, liver, and spleen.\nDeath was attributed to multiple organ failure due to DIC as a consequence of HELLP syndrome.\n","ner_info":[{"text":"31-year-old","label":"AGE","start":4,"end":15},{"text":"white","label":"PERSONAL_BACKGROUND","start":16,"end":21},{"text":"primipara with twin pregnancy","label":"HISTORY","start":22,"end":51},{"text":"admitted","label":"CLINICAL_EVENT","start":56,"end":64},{"text":"38th week of gestation","label":"DATE","start":84,"end":106},{"text":"elevated blood pressure","label":"SIGN_SYMPTOM","start":112,"end":135},{"text":"150\/100 mmHg","label":"LAB_VALUE","start":137,"end":149},{"text":"antihypertensive treatment","label":"MEDICATION","start":168,"end":194},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":195,"end":209},{"text":"120\/80","label":"LAB_VALUE","start":214,"end":220},{"text":"laboratory variables, including plasma proteins","label":"DIAGNOSTIC_PROCEDURE","start":226,"end":273},{"text":"within their respective reference intervals","label":"LAB_VALUE","start":280,"end":323},{"text":"Few hours after admission to the hospital","label":"TIME","start":325,"end":366},{"text":"contractions started","label":"SIGN_SYMPTOM","start":371,"end":391},{"text":"caesarean section","label":"THERAPEUTIC_PROCEDURE","start":401,"end":418},{"text":"vertex-transverse presentation of twins","label":"SIGN_SYMPTOM","start":444,"end":483},{"text":"Liveborn female and male","label":"SUBJECT","start":485,"end":509},{"text":"delivered","label":"THERAPEUTIC_PROCEDURE","start":515,"end":524},{"text":"postoperative course","label":"DETAILED_DESCRIPTION","start":530,"end":550},{"text":"inconspicuous","label":"SIGN_SYMPTOM","start":565,"end":578},{"text":"Four hours postpartum","label":"TIME","start":580,"end":601},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":618,"end":624},{"text":"epigastric pain","label":"SIGN_SYMPTOM","start":625,"end":640},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":646,"end":660},{"text":"190\/130","label":"LAB_VALUE","start":669,"end":676},{"text":"Laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":678,"end":697},{"text":"haemolysis","label":"SIGN_SYMPTOM","start":705,"end":715},{"text":"thrombocytopenia","label":"SIGN_SYMPTOM","start":717,"end":733},{"text":"increase","label":"LAB_VALUE","start":742,"end":750},{"text":"serum creatinine","label":"DIAGNOSTIC_PROCEDURE","start":754,"end":770},{"text":"aminotransferases","label":"DIAGNOSTIC_PROCEDURE","start":775,"end":792},{"text":"Intravenous","label":"ADMINISTRATION","start":804,"end":815},{"text":"magnesium sulphate","label":"MEDICATION","start":816,"end":834},{"text":"Abdominal ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":853,"end":873},{"text":"empty","label":"DETAILED_DESCRIPTION","start":887,"end":892},{"text":"uterine cavity","label":"BIOLOGICAL_STRUCTURE","start":893,"end":907},{"text":"placenta residue","label":"SIGN_SYMPTOM","start":916,"end":932},{"text":"Five hours postpartum","label":"TIME","start":934,"end":955},{"text":"transferred","label":"CLINICAL_EVENT","start":973,"end":984},{"text":"intensive care unit","label":"NONBIOLOGICAL_LOCATION","start":992,"end":1011},{"text":"poor urine output","label":"SIGN_SYMPTOM","start":1023,"end":1040},{"text":"drowsiness","label":"SIGN_SYMPTOM","start":1042,"end":1052},{"text":"suspicion","label":"DETAILED_DESCRIPTION","start":1058,"end":1067},{"text":"DIC","label":"DISEASE_DISORDER","start":1071,"end":1074},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":1079,"end":1090},{"text":"sleepy","label":"SIGN_SYMPTOM","start":1099,"end":1105},{"text":"disoriented","label":"SIGN_SYMPTOM","start":1110,"end":1121},{"text":"haemolysis","label":"COREFERENCE","start":1142,"end":1152},{"text":"thrombocytopenia","label":"COREFERENCE","start":1154,"end":1170},{"text":"elevated liver enzymes","label":"COREFERENCE","start":1176,"end":1198},{"text":"postpartum HELLP syndrome","label":"DISEASE_DISORDER","start":1211,"end":1236},{"text":"DIC","label":"COREFERENCE","start":1253,"end":1256},{"text":"rehydrated","label":"THERAPEUTIC_PROCEDURE","start":1274,"end":1284},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":1290,"end":1299},{"text":"fresh","label":"DETAILED_DESCRIPTION","start":1320,"end":1325},{"text":"frozen","label":"DETAILED_DESCRIPTION","start":1326,"end":1332},{"text":"plasma","label":"THERAPEUTIC_PROCEDURE","start":1333,"end":1339},{"text":"red cell","label":"BIOLOGICAL_STRUCTURE","start":1341,"end":1349},{"text":"transfusion","label":"THERAPEUTIC_PROCEDURE","start":1350,"end":1361},{"text":"fresh","label":"DETAILED_DESCRIPTION","start":1363,"end":1368},{"text":"platelets","label":"THERAPEUTIC_PROCEDURE","start":1369,"end":1378},{"text":"kybernin P","label":"THERAPEUTIC_PROCEDURE","start":1384,"end":1394},{"text":"antithrombin III","label":"COREFERENCE","start":1396,"end":1412},{"text":"High","label":"LAB_VALUE","start":1415,"end":1419},{"text":"serum urea","label":"DIAGNOSTIC_PROCEDURE","start":1420,"end":1430},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1432,"end":1442},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":1448,"end":1458},{"text":"anuria","label":"SIGN_SYMPTOM","start":1459,"end":1465},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1487,"end":1492},{"text":"renal failure","label":"DISEASE_DISORDER","start":1493,"end":1506},{"text":"high dose","label":"DOSAGE","start":1510,"end":1519},{"text":"furosemide","label":"MEDICATION","start":1523,"end":1533},{"text":"increase diuresis","label":"THERAPEUTIC_PROCEDURE","start":1544,"end":1561},{"text":"Sixteen hours postpartum","label":"TIME","start":1563,"end":1587},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1592,"end":1606},{"text":"60\/40","label":"LAB_VALUE","start":1611,"end":1616},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":1621,"end":1638},{"text":"70%","label":"LAB_VALUE","start":1639,"end":1642},{"text":"Few minutes later","label":"TIME","start":1644,"end":1661},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1678,"end":1683},{"text":"cardiac arrest","label":"DISEASE_DISORDER","start":1684,"end":1698},{"text":"resuscitation","label":"THERAPEUTIC_PROCEDURE","start":1704,"end":1717},{"text":"Resuscitation","label":"COREFERENCE","start":1727,"end":1740},{"text":"successful","label":"DETAILED_DESCRIPTION","start":1745,"end":1755},{"text":"normal heart action","label":"SIGN_SYMPTOM","start":1761,"end":1780},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1801,"end":1815},{"text":"150\/110","label":"LAB_VALUE","start":1824,"end":1831},{"text":"oxygen 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ventricles","label":"BIOLOGICAL_STRUCTURE","start":2388,"end":2412},{"text":"Hydrothorax","label":"SIGN_SYMPTOM","start":2414,"end":2425},{"text":"900 mL","label":"LAB_VALUE","start":2427,"end":2433},{"text":"hydroperitoneum","label":"SIGN_SYMPTOM","start":2436,"end":2451},{"text":"2500 mL","label":"LAB_VALUE","start":2453,"end":2460},{"text":"hydropericardium","label":"SIGN_SYMPTOM","start":2467,"end":2483},{"text":"200 mL","label":"LAB_VALUE","start":2485,"end":2491},{"text":"caesarean section","label":"THERAPEUTIC_PROCEDURE","start":2537,"end":2554},{"text":"unremarkable","label":"SIGN_SYMPTOM","start":2559,"end":2571},{"text":"Petechial and suffusional haemorrhages","label":"SIGN_SYMPTOM","start":2573,"end":2611},{"text":"pleura","label":"BIOLOGICAL_STRUCTURE","start":2636,"end":2642},{"text":"endocardium","label":"BIOLOGICAL_STRUCTURE","start":2644,"end":2655},{"text":"mucosae","label":"BIOLOGICAL_STRUCTURE","start":2664,"end":2671},{"text":"renal pelvis","label":"BIOLOGICAL_STRUCTURE","start":2679,"end":2691},{"text":"peritoneum","label":"BIOLOGICAL_STRUCTURE","start":2697,"end":2707},{"text":"small and large bowel","label":"BIOLOGICAL_STRUCTURE","start":2715,"end":2736},{"text":"Histology","label":"DIAGNOSTIC_PROCEDURE","start":2738,"end":2747},{"text":"periportal","label":"DETAILED_DESCRIPTION","start":2757,"end":2767},{"text":"hepatocellular","label":"BIOLOGICAL_STRUCTURE","start":2768,"end":2782},{"text":"necrosis","label":"SIGN_SYMPTOM","start":2783,"end":2791},{"text":"bloodless","label":"DETAILED_DESCRIPTION","start":2793,"end":2802},{"text":"glomeruli","label":"BIOLOGICAL_STRUCTURE","start":2803,"end":2812},{"text":"swollen","label":"DETAILED_DESCRIPTION","start":2818,"end":2825},{"text":"vacuolated","label":"DETAILED_DESCRIPTION","start":2830,"end":2840},{"text":"intracapillary cells","label":"BIOLOGICAL_STRUCTURE","start":2841,"end":2861},{"text":"confluent","label":"DETAILED_DESCRIPTION","start":2874,"end":2883},{"text":"haemorrhages","label":"SIGN_SYMPTOM","start":2884,"end":2896},{"text":"kidneys","label":"BIOLOGICAL_STRUCTURE","start":2900,"end":2907},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2909,"end":2914},{"text":"spleen","label":"BIOLOGICAL_STRUCTURE","start":2920,"end":2926},{"text":"Death","label":"OUTCOME","start":2928,"end":2933},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":2952,"end":2960},{"text":"organ failure","label":"DISEASE_DISORDER","start":2961,"end":2974},{"text":"DIC","label":"DISEASE_DISORDER","start":2982,"end":2985},{"text":"HELLP syndrome","label":"DISEASE_DISORDER","start":3006,"end":3020}],"tokens":["The ","31-year-old"," ","white"," ","primipara with twin pregnancy"," was ","admitted"," to hospital in the ","38th week of gestation"," with ","elevated blood pressure"," (","150\/100 mmHg",").\nAfter receiving ","antihypertensive treatment"," ","blood pressure"," was ","120\/80",".\nAll ","laboratory variables, including plasma proteins",", were ","within their respective reference intervals",".\n","Few hours after admission to the hospital"," the ","contractions started",", and the ","caesarean section"," was performed because of ","vertex-transverse presentation of twins",".\n","Liveborn female and male"," were ","delivered",".\nThe ","postoperative course"," was initially ","inconspicuous",".\n","Four hours postpartum"," she experienced ","sudden"," ","epigastric pain",".\nThe ","blood pressure"," rose to ","190\/130",".\n","Laboratory findings"," showed ","haemolysis",", ","thrombocytopenia",", and an ","increase"," in ","serum creatinine"," and ","aminotransferases"," (Table I).\n","Intravenous"," ","magnesium sulphate"," was administered.\n","Abdominal ultrasound"," disclosed an ","empty"," ","uterine cavity"," without ","placenta residue",".\n","Five hours postpartum",", the patient was ","transferred"," to the ","intensive care unit"," because of ","poor urine output",", ","drowsiness",", and ","suspicion"," of ","DIC",".\nOn ","examination"," she was ","sleepy"," and ","disoriented",".\nThe combination of ","haemolysis",", ","thrombocytopenia",", and ","elevated liver enzymes"," suggested a ","postpartum HELLP syndrome",", complicated by ","DIC",".\nThe patient was ","rehydrated",", and ","treatment"," was instituted with ","fresh"," ","frozen"," ","plasma",", ","red cell"," ","transfusion",", ","fresh"," ","platelets",", and ","kybernin P"," (","antithrombin III",").\n","High"," ","serum urea",", ","creatinine",", and ","persistent"," ","anuria"," were compatible with ","acute"," ","renal failure",".\nA ","high dose"," of ","furosemide"," failed to ","increase diuresis",".\n","Sixteen hours postpartum"," her ","blood pressure"," was ","60\/40"," and ","oxygen saturation"," ","70%",".\n","Few minutes later"," the patient had ","acute"," ","cardiac arrest",", and ","resuscitation"," started.\n","Resuscitation"," was ","successful",", and ","normal heart action"," was re-established; ","blood pressure"," rose to ","150\/110",", and ","oxygen saturation"," was ","90%",".\n","Laboratory findings"," were ","deteriorated",", and development of ","acute"," ","renal failure"," indicated the necessity of ","urgent"," ","dialysis",".\n","Following dialysis",", the patient was ","stable",", ","oxygen saturation"," ","98%",".\n","Twenty hours postpartum"," patient developed again ","cardiopulmonary arrest",".\nDespite ","resuscitation attempts"," the outcome was ","lethal",".\nDue to the fact that ","death"," occurred in the ","hospital"," a ","short time after a surgical intervention",", a ","medico-legal autopsy"," was ","ordered",".\nAn ","autopsy"," revealed ","oedema"," of the ","brain"," and ","lungs"," as well as ","dilatation"," of r","ight and left ventricles",".\n","Hydrothorax"," (","900 mL","), ","hydroperitoneum"," (","2500 mL","), and ","hydropericardium"," (","200 mL",") were present.\nThe field of operation of the ","caesarean section"," was ","unremarkable",".\n","Petechial and suffusional haemorrhages"," were observed under the ","pleura",", ","endocardium",", in the ","mucosae"," of the ","renal pelvis",", and ","peritoneum"," of the ","small and large bowel",".\n","Histology"," revealed ","periportal"," ","hepatocellular"," ","necrosis",", ","bloodless"," ","glomeruli"," with ","swollen"," and ","vacuolated"," ","intracapillary cells",", as well as ","confluent"," ","haemorrhages"," in ","kidneys",", ","liver",", and ","spleen",".\n","Death"," was attributed to ","multiple"," ","organ failure"," due to ","DIC"," as a consequence of ","HELLP syndrome",".\n"],"ner_labels":[0,5,0,58,0,39,0,13,0,19,0,69,0,42,0,46,0,24,0,42,0,24,0,42,0,78,0,69,0,75,0,69,0,71,0,75,0,22,0,69,0,78,0,22,0,69,0,24,0,42,0,24,0,69,0,69,0,42,0,24,0,24,0,4,0,46,0,24,0,22,0,12,0,69,0,78,0,13,0,48,0,69,0,69,0,22,0,26,0,24,0,69,0,69,0,18,0,18,0,18,0,26,0,18,0,75,0,75,0,22,0,22,0,75,0,12,0,75,0,22,0,75,0,75,0,18,0,42,0,24,0,24,0,22,0,69,0,22,0,26,0,29,0,46,0,75,0,78,0,24,0,42,0,24,0,42,0,78,0,22,0,26,0,75,0,18,0,22,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,26,0,22,0,75,0,78,0,69,0,24,0,42,0,78,0,26,0,75,0,56,0,18,0,48,0,78,0,24,0,13,0,18,0,69,0,12,0,12,0,69,0,12,0,69,0,42,0,69,0,42,0,69,0,42,0,75,0,69,0,69,0,12,0,12,0,12,0,12,0,12,0,12,0,24,0,22,0,12,0,69,0,22,0,12,0,22,0,22,0,12,0,22,0,69,0,12,0,12,0,12,0,56,0,22,0,26,0,26,0,26,0]}
-{"full_text":"A 37-year-old Caucasian man was referred to our department from an external hospital because of severe abdominal pain of unclear aetiology.\nThe patient suffered from Friedreich's ataxia.1 2 His most recent transthoracic echocardiography, performed on the day of admission, showed a dilated cardiomyopathy, impaired left ventricular function with an ejection fraction of 30% and a pulmonary artery pressure of 55\u2005mm\u2005Hg; all findings were unchanged from previous examinations.\nAt that time, he lived alone in a residential home and was mobile using a wheelchair.\nOn arrival at our emergency department, the patient was somnolent and disoriented.\nHis axillary body temperature was 35.7\u2005\u00b0C and his arterial blood pressure 125\/89\u2005mm\u2005Hg, with a pulse rate of 84 rhythmic beats\/min.\nHe complained of an increasing, diffuse abdominal pain during the whole day, combined with absence of appetite and vomiting on a single occasion.\nHis daily medication was perindopril 2.5\u2005mg, torasemide 7.5\u2005mg and esomeprazole 40\u2005mg.\nOn physical examination, we found a tender abdomen with painful epigastric palpation.\nNormal bowel sounds were auscultated in the upper right and lower left quadrants.\nThe renal bed was free of pain on palpation.\nOn cardiac auscultation, a 2\/6 systolic murmur was audible.\nLung auscultation showed normal respiration.\nLaboratory findings were slightly elevated C reactive protein (CRP) of 16\u2005mg\/l (normal: <5\u2005mg\/l), elevated troponin-T-hs of 0.070\u2005\u00b5g\/l (normal: <0.014\u2005\u00b5g\/l) and highly elevated pro-B-type natriuretic peptide of 7382\u2005pg\/ml (normal: <63\u2005pg\/ml).\nKidney function parameters were in the upper normal range, with creatinine of 100 \u00b5mol\/l and a calculated glomerular filtration rate of 73\u2005ml\/min.\nBlood count revealed leucocytosis of 15.6\u00d7109\/litre.\nRegarding thyroid function, thyroid-stimulating hormone, f-T3 and f-T4 were in the reference range.\nUrine analysis showed no pathology.\nIn abdominal sonography, all organs were normal, especially the kidneys.\nNo free fluid was detected (figure 1).\nAs the severe pain persisted all night, despite analgesia with paracetamol 1\u2005g, metamizole 1\u2005g and pethidine 75\u2005\u00b5g, a contrast-enhanced abdominal CT was performed revealing infarction of the right kidney, which appeared as a hypodense area although kidney arteries and veins were assessed as open (figures 2 and \u200b3).\nCardiac dysfunction is the most frequent cause of death in patients affected by Friedreich's ataxia, most commonly from congestive heart failure or arrhythmia.\nRenal artery embolism is not a rare event in these patients.\nHowever, other non-abdominal viscous causes of severe diffuse abdominal pain such as porphyria, familial Mediterranean fever, diabetic ketoacidosis, tocopherol deficiency also had to be excluded.\nThe negative cardiolipin test excluded tabetic crises.\nNo evidence for pre-existing porphyria was encountered for example, quantitative determination of \u03b4-aminolevulinic acid, porphobilinogen and porphyrin in 24-h urine was negative.\nFurther genetic diagnosis regarding, for example, clotting disorder, was also not conclusive.\nHypovitaminosis was not present.\nThe patient had no endocrinopathies, for example, no diabetes and no evidence for hypothyreosis or hyperthyreosis.\nThe patient was hospitalised without delay at the department of nephrology.\nImmediate anticoagulation with heparin was initiated and later replaced by lifelong oral anticoagulation with phenprocoumon.\nDuring 11\u2005days of hospitalisation, no complications occurred.\nKidney function parameters remained normal.\nTransoesophageal echocardiography on the fifth day showed no cardiac thrombus and no patent foramen ovale.\nDeep vein thrombosis was excluded with duplex sonography.\nAnticardiolipin antibody testing and genetic testing regarding clotting disorders were both negative.\nUrine tests revealed no evidence of porphyria.\nDuring hospitalisation the patient remained stable regarding cardiological function, while diuretics were adjusted according to the fluid balance.\nThe patient had already been treated with levofloxacin for pneumonic infection prior to hospitalisation.\nThe antibiotic treatment was continued because of increasing inflammatory parameters in the further course of disease.\nA CRP increase of up to 200\u2005mg\/l was interpreted as an inflammatory response to renal infarction.\nBy discharge, laboratory parameters were significantly decreased.\n","ner_info":[{"text":"37-year-old","label":"AGE","start":2,"end":13},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":14,"end":23},{"text":"man","label":"SEX","start":24,"end":27},{"text":"referred","label":"CLINICAL_EVENT","start":32,"end":40},{"text":"department","label":"NONBIOLOGICAL_LOCATION","start":48,"end":58},{"text":"from an external hospital","label":"NONBIOLOGICAL_LOCATION","start":59,"end":84},{"text":"severe","label":"SEVERITY","start":96,"end":102},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":103,"end":112},{"text":"pain","label":"SIGN_SYMPTOM","start":113,"end":117},{"text":"unclear aetiology","label":"QUALITATIVE_CONCEPT","start":121,"end":138},{"text":"Friedreich's ataxia","label":"DISEASE_DISORDER","start":166,"end":185},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":206,"end":219},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":220,"end":236},{"text":"day of admission","label":"DATE","start":255,"end":271},{"text":"dilated","label":"DETAILED_DESCRIPTION","start":282,"end":289},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":290,"end":304},{"text":"impaired","label":"LAB_VALUE","start":306,"end":314},{"text":"left ventricular function","label":"DIAGNOSTIC_PROCEDURE","start":315,"end":340},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":349,"end":366},{"text":"30%","label":"LAB_VALUE","start":370,"end":373},{"text":"pulmonary artery pressure","label":"DIAGNOSTIC_PROCEDURE","start":380,"end":405},{"text":"55\u2005mm\u2005Hg","label":"LAB_VALUE","start":409,"end":417},{"text":"lived alone in a residential home","label":"HISTORY","start":492,"end":525},{"text":"mobile using a wheelchair","label":"HISTORY","start":534,"end":559},{"text":"arrival","label":"CLINICAL_EVENT","start":564,"end":571},{"text":"emergency department","label":"BIOLOGICAL_STRUCTURE","start":579,"end":599},{"text":"somnolent","label":"SIGN_SYMPTOM","start":617,"end":626},{"text":"disoriented","label":"SIGN_SYMPTOM","start":631,"end":642},{"text":"axillary","label":"BIOLOGICAL_STRUCTURE","start":648,"end":656},{"text":"body 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bed","label":"BIOLOGICAL_STRUCTURE","start":1181,"end":1190},{"text":"pain","label":"SIGN_SYMPTOM","start":1203,"end":1207},{"text":"palpation","label":"DIAGNOSTIC_PROCEDURE","start":1211,"end":1220},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":1225,"end":1232},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":1233,"end":1245},{"text":"2\/6","label":"LAB_VALUE","start":1249,"end":1252},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":1253,"end":1261},{"text":"murmur","label":"SIGN_SYMPTOM","start":1262,"end":1268},{"text":"Lung","label":"BIOLOGICAL_STRUCTURE","start":1282,"end":1286},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":1287,"end":1299},{"text":"normal","label":"LAB_VALUE","start":1307,"end":1313},{"text":"respiration","label":"DIAGNOSTIC_PROCEDURE","start":1314,"end":1325},{"text":"Laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":1327,"end":1346},{"text":"slightly elevated","label":"LAB_VALUE","start":1352,"end":1369},{"text":"C reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1370,"end":1388},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":1390,"end":1393},{"text":"16\u2005mg\/l","label":"LAB_VALUE","start":1398,"end":1405},{"text":"elevated","label":"LAB_VALUE","start":1425,"end":1433},{"text":"troponin-T-hs","label":"DIAGNOSTIC_PROCEDURE","start":1434,"end":1447},{"text":"0.070\u2005\u00b5g\/l","label":"LAB_VALUE","start":1451,"end":1461},{"text":"highly elevated","label":"LAB_VALUE","start":1488,"end":1503},{"text":"pro-B-type natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":1504,"end":1534},{"text":"7382\u2005pg\/ml","label":"LAB_VALUE","start":1538,"end":1548},{"text":"Kidney function parameters","label":"DIAGNOSTIC_PROCEDURE","start":1570,"end":1596},{"text":"upper normal range","label":"LAB_VALUE","start":1609,"end":1627},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1634,"end":1644},{"text":"100 \u00b5mol\/l","label":"LAB_VALUE","start":1648,"end":1658},{"text":"calculated glomerular filtration rate","label":"DIAGNOSTIC_PROCEDURE","start":1665,"end":1702},{"text":"73\u2005ml\/min","label":"LAB_VALUE","start":1706,"end":1715},{"text":"Blood count","label":"DIAGNOSTIC_PROCEDURE","start":1717,"end":1728},{"text":"leucocytosis","label":"SIGN_SYMPTOM","start":1738,"end":1750},{"text":"15.6\u00d7109\/litre","label":"LAB_VALUE","start":1754,"end":1768},{"text":"thyroid function","label":"DIAGNOSTIC_PROCEDURE","start":1780,"end":1796},{"text":"thyroid-stimulating hormone","label":"DIAGNOSTIC_PROCEDURE","start":1798,"end":1825},{"text":"f-T3","label":"DIAGNOSTIC_PROCEDURE","start":1827,"end":1831},{"text":"f-T4","label":"DIAGNOSTIC_PROCEDURE","start":1836,"end":1840},{"text":"in the reference range","label":"LAB_VALUE","start":1846,"end":1868},{"text":"Urine 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and veins","label":"BIOLOGICAL_STRUCTURE","start":2267,"end":2292},{"text":"open","label":"SIGN_SYMPTOM","start":2310,"end":2314},{"text":"Cardiac dysfunction","label":"DISEASE_DISORDER","start":2335,"end":2354},{"text":"death","label":"OUTCOME","start":2385,"end":2390},{"text":"Friedreich's ataxia","label":"DISEASE_DISORDER","start":2415,"end":2434},{"text":"congestive","label":"DETAILED_DESCRIPTION","start":2455,"end":2465},{"text":"heart failure","label":"DISEASE_DISORDER","start":2466,"end":2479},{"text":"arrhythmia","label":"DISEASE_DISORDER","start":2483,"end":2493},{"text":"Renal 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nephrology","label":"NONBIOLOGICAL_LOCATION","start":3278,"end":3302},{"text":"anticoagulation","label":"MEDICATION","start":3314,"end":3329},{"text":"heparin","label":"MEDICATION","start":3335,"end":3342},{"text":"lifelong","label":"DURATION","start":3379,"end":3387},{"text":"oral","label":"ADMINISTRATION","start":3388,"end":3392},{"text":"anticoagulation","label":"MEDICATION","start":3393,"end":3408},{"text":"phenprocoumon","label":"MEDICATION","start":3414,"end":3427},{"text":"11\u2005days","label":"DURATION","start":3436,"end":3443},{"text":"hospitalisation","label":"CLINICAL_EVENT","start":3447,"end":3462},{"text":"complications","label":"DISEASE_DISORDER","start":3467,"end":3480},{"text":"Kidney function 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decreased","label":"LAB_VALUE","start":4359,"end":4382}],"tokens":["A ","37-year-old"," ","Caucasian"," ","man"," was ","referred"," to our ","department"," ","from an external hospital"," because of ","severe"," ","abdominal"," ","pain"," of ","unclear aetiology",".\nThe patient suffered from ","Friedreich's ataxia",".1 2 His most recent ","transthoracic"," ","echocardiography",", performed on the ","day of admission",", showed a ","dilated"," ","cardiomyopathy",", ","impaired"," ","left ventricular function"," with an ","ejection fraction"," of ","30%"," and a ","pulmonary artery pressure"," of ","55\u2005mm\u2005Hg","; all findings were unchanged from previous examinations.\nAt that time, he ","lived alone in a residential home"," and was ","mobile using a wheelchair",".\nOn ","arrival"," at our ","emergency department",", the patient was ","somnolent"," and ","disoriented",".\nHis ","axillary"," ","body temperature"," was ","35.7\u2005\u00b0C"," and his ","arterial"," ","blood pressure"," ","125\/89\u2005mm\u2005Hg",", with a ","pulse rate"," of ","84 rhythmic beats\/min",".\nHe complained of an ","increasing",", ","diffuse"," ","abdominal"," ","pain"," ","during the whole day",", combined with ","absence of appetite"," and ","vomiting"," on a ","single occasion",".\nHis ","daily"," ","medication"," was ","perindopril"," ","2.5\u2005mg",", ","torasemide"," ","7.5\u2005mg"," and ","esomeprazole"," ","40\u2005mg",".\nOn ","physical examination",", we found a ","tender"," ","abdomen"," with ","painful"," ","epigastric"," ","palpation",".\n","Normal"," ","bowel sounds"," were ","auscultated"," in the ","upper right and lower left quadrants",".\nThe ","renal bed"," was free of ","pain"," on ","palpation",".\nOn ","cardiac"," ","auscultation",", a ","2\/6"," ","systolic"," ","murmur"," was audible.\n","Lung"," ","auscultation"," showed ","normal"," ","respiration",".\n","Laboratory findings"," were ","slightly elevated"," ","C reactive protein"," (","CRP",") of ","16\u2005mg\/l"," (normal: <5\u2005mg\/l), ","elevated"," ","troponin-T-hs"," of ","0.070\u2005\u00b5g\/l"," (normal: <0.014\u2005\u00b5g\/l) and ","highly elevated"," ","pro-B-type natriuretic peptide"," of ","7382\u2005pg\/ml"," (normal: <63\u2005pg\/ml).\n","Kidney function parameters"," were in the ","upper normal range",", with ","creatinine"," of ","100 \u00b5mol\/l"," and a ","calculated glomerular filtration rate"," of ","73\u2005ml\/min",".\n","Blood count"," revealed ","leucocytosis"," of ","15.6\u00d7109\/litre",".\nRegarding ","thyroid function",", ","thyroid-stimulating hormone",", ","f-T3"," and ","f-T4"," were ","in the reference range",".\n","Urine analysis"," showed no ","pathology",".\nIn ","abdominal"," ","sonography",", all organs were ","normal",", especially the ","kidneys",".\nNo ","free fluid"," was detected (figure 1).\nAs the ","severe"," ","pain"," persisted ","all night",", despite ","analgesia"," with ","paracetamol"," ","1\u2005g",", ","metamizole"," ","1\u2005g"," and ","pethidine"," ","75\u2005\u00b5g",", a ","contrast-enhanced"," ","abdominal"," ","CT"," was performed revealing ","infarction"," of the ","right kidney",", which appeared as a ","hypodense area"," although ","kidney arteries and veins"," were assessed as ","open"," (figures 2 and \u200b3).\n","Cardiac dysfunction"," is the most frequent cause of ","death"," in patients affected by ","Friedreich's ataxia",", most commonly from ","congestive"," ","heart failure"," or ","arrhythmia",".\n","Renal artery"," ","embolism"," is not a rare event in these patients.\nHowever, other non-abdominal viscous causes of ","severe"," ","diffuse"," ","abdominal"," ","pain"," such as ","porphyria",", familial ","Mediterranean fever",", ","diabetic ketoacidosis",", ","tocopherol deficiency"," also had to be excluded.\nThe ","negative"," ","cardiolipin test"," excluded ","tabetic crises",".\nNo evidence for ","pre-existing"," ","porphyria"," was encountered for example, quantitative determination of ","\u03b4-aminolevulinic acid",", ","porphobilinogen"," and ","porphyrin"," in ","24-h urine"," was ","negative",".\nFurther ","genetic diagnosis"," regarding, for example, ","clotting disorder",", was also ","not conclusive",".\n","Hypovitaminosis"," was not present.\nThe patient had no ","endocrinopathies",", for example, no ","diabetes"," and no evidence for ","hypothyreosis"," or ","hyperthyreosis",".\nThe patient was ","hospitalised"," without delay at the ","department of nephrology",".\nImmediate ","anticoagulation"," with ","heparin"," was initiated and later replaced by ","lifelong"," ","oral"," ","anticoagulation"," with ","phenprocoumon",".\nDuring ","11\u2005days"," of ","hospitalisation",", no ","complications"," occurred.\n","Kidney function parameters"," remained ","normal",".\n","Transoesophageal"," ","echocardiography"," on the ","fifth day"," showed no ","cardiac"," ","thrombus"," and no ","patent foramen ovale",".\n","Deep vein thrombosis"," was excluded with ","duplex"," ","sonography",".\n","Anticardiolipin antibody testing"," and ","genetic testing"," regarding ","clotting disorders"," were both ","negative",".\n","Urine tests"," revealed no evidence of ","porphyria",".\nDuring ","hospitalisation"," the patient remained ","stable"," regarding ","cardiological function",", while ","diuretics"," were ","adjusted according to the fluid balance",".\nThe patient had already been treated with ","levofloxacin"," for ","pneumonic"," ","infection"," prior to ","hospitalisation",".\nThe ","antibiotic treatment"," was continued because of ","increasing"," ","inflammatory parameters"," in the further course of disease.\nA ","CRP"," ","increase"," of up to ","200\u2005mg\/l"," was interpreted as an inflammatory response to renal infarction.\nBy ","discharge",", ","laboratory parameters"," were ","significantly decreased",".\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,48,0,48,0,63,0,12,0,69,0,59,0,26,0,12,0,24,0,19,0,22,0,26,0,42,0,24,0,24,0,42,0,24,0,42,0,39,0,39,0,13,0,12,0,69,0,69,0,12,0,24,0,42,0,12,0,24,0,42,0,24,0,42,0,22,0,22,0,12,0,69,0,22,0,69,0,69,0,35,0,29,0,46,0,46,0,29,0,46,0,29,0,46,0,29,0,24,0,69,0,12,0,69,0,12,0,24,0,42,0,24,0,24,0,12,0,12,0,69,0,24,0,12,0,24,0,42,0,22,0,69,0,12,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,69,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,26,0,12,0,24,0,42,0,12,0,69,0,63,0,69,0,32,0,75,0,46,0,29,0,46,0,29,0,46,0,29,0,22,0,12,0,24,0,26,0,12,0,69,0,12,0,69,0,26,0,56,0,26,0,22,0,26,0,26,0,12,0,26,0,63,0,22,0,12,0,69,0,26,0,26,0,26,0,26,0,42,0,24,0,26,0,22,0,26,0,24,0,24,0,24,0,22,0,42,0,24,0,26,0,42,0,26,0,26,0,26,0,26,0,26,0,13,0,48,0,46,0,46,0,32,0,4,0,46,0,46,0,32,0,13,0,26,0,24,0,42,0,12,0,24,0,19,0,12,0,26,0,26,0,26,0,22,0,24,0,24,0,24,0,22,0,42,0,24,0,26,0,13,0,42,0,24,0,46,0,22,0,46,0,12,0,26,0,13,0,18,0,42,0,24,0,24,0,42,0,42,0,13,0,24,0,42,0]}
-{"full_text":"A 45-year-old lady sought dermatology consultation for severely tender erythematous vesicles and bullae over back, chest and arms.\nThese were sudden in onset associated with fever, nausea and malaise.\nAlong with this she also complained of pain in upper abdomen.\nThere was no history of receiving any drugs prior to the onset of lesions.\nShe did not report any significant weight loss or loss of appetite.\nOn physical examination, her temperature was 38\u00b0C, pulse rate was 100\/min and blood pressure was 126\/72\u2005mm\u2005Hg.\nThere were multiple coalescing vesicles and bullae over upper back, chest and arms distributed symmetrically showing areas of pustulation and necrosis.\nSurrounding them were multiple pseudovesicular satellite papule (figure 1A,B).\nOn per abdominal examination mild tenderness was present in the right hypochondrium.\nPatient's initial laboratory investigations showed a total leucocyte count of 12\u2005000 cells\/mm3 with 75% neutrophils.\nThe haemoglobin level was 14.3\u2005gm% and erythrocyte sedimentation rate was 30\u2005mm\/h.\nLiver function test, kidney function test and C reactive protein levels were within normal limits.\nGram stain from purulent exudates showed only neutrophils without any organisms and culture did not show any growth after 72\u2005h of incubation.\nA lesional skin biopsy taken from the satellite papule showed neutrophilic infiltration in dermis with papillary dermal oedema and spongiosis (figure 2A,B).\nAbdominal ultrasonography revealed intraluminal gall bladder mass suggestive of malignancy.\nOn the basis of these findings a final diagnosis of SS associated with gall bladder malignancy was made.\nShe was started on oral prednisolone in dose of 40\u2005mg daily along with symptomatic treatment.\nHer cutaneous lesions responded dramatically and subsided completely after 1\u2005week of treatment (figure 3A,B).\nDose of prednisolone was tapered and an open cholecystectomy was performed.\nHistopathology of excised tissue confirmed it to be well-differentiated gall bladder adenocarcinoma forming glands and papillae infiltrating the muscularis propria superficially.\nCystic duct cut margins were free of tumour (figure 2C,D).\nPatient's postoperative period was uneventful and she was discharged on tapering doses of prednisolone with advice to follow-up periodically.\n","ner_info":[{"text":"45-year-old","label":"AGE","start":2,"end":13},{"text":"lady","label":"SEX","start":14,"end":18},{"text":"dermatology consultation","label":"CLINICAL_EVENT","start":26,"end":50},{"text":"severely tender","label":"TEXTURE","start":55,"end":70},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":71,"end":83},{"text":"vesicles","label":"SIGN_SYMPTOM","start":84,"end":92},{"text":"bullae","label":"SIGN_SYMPTOM","start":97,"end":103},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":109,"end":113},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":115,"end":120},{"text":"arms","label":"BIOLOGICAL_STRUCTURE","start":125,"end":129},{"text":"These","label":"COREFERENCE","start":131,"end":136},{"text":"sudden in onset","label":"DETAILED_DESCRIPTION","start":142,"end":157},{"text":"fever","label":"SIGN_SYMPTOM","start":174,"end":179},{"text":"nausea","label":"SIGN_SYMPTOM","start":181,"end":187},{"text":"malaise","label":"SIGN_SYMPTOM","start":192,"end":199},{"text":"pain","label":"SIGN_SYMPTOM","start":240,"end":244},{"text":"upper abdomen","label":"BIOLOGICAL_STRUCTURE","start":248,"end":261},{"text":"no history of receiving any drugs prior to the onset of lesions","label":"HISTORY","start":273,"end":336},{"text":"significant","label":"DETAILED_DESCRIPTION","start":361,"end":372},{"text":"weight loss","label":"SIGN_SYMPTOM","start":373,"end":384},{"text":"loss of appetite","label":"SIGN_SYMPTOM","start":388,"end":404},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":409,"end":429},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":435,"end":446},{"text":"38\u00b0C","label":"LAB_VALUE","start":451,"end":455},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":457,"end":467},{"text":"100\/min","label":"LAB_VALUE","start":472,"end":479},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":484,"end":498},{"text":"126\/72\u2005mm\u2005Hg","label":"LAB_VALUE","start":503,"end":515},{"text":"multiple","label":"LAB_VALUE","start":528,"end":536},{"text":"coalescing","label":"DETAILED_DESCRIPTION","start":537,"end":547},{"text":"vesicles","label":"COREFERENCE","start":548,"end":556},{"text":"bullae","label":"COREFERENCE","start":561,"end":567},{"text":"upper back","label":"BIOLOGICAL_STRUCTURE","start":573,"end":583},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":585,"end":590},{"text":"arms","label":"BIOLOGICAL_STRUCTURE","start":595,"end":599},{"text":"distributed symmetrically","label":"DETAILED_DESCRIPTION","start":600,"end":625},{"text":"pustulation","label":"SIGN_SYMPTOM","start":643,"end":654},{"text":"necrosis","label":"SIGN_SYMPTOM","start":659,"end":667},{"text":"Surrounding","label":"OTHER_ENTITY","start":669,"end":680},{"text":"them","label":"COREFERENCE","start":681,"end":685},{"text":"multiple","label":"LAB_VALUE","start":691,"end":699},{"text":"pseudovesicular","label":"DETAILED_DESCRIPTION","start":700,"end":715},{"text":"satellite","label":"DETAILED_DESCRIPTION","start":716,"end":725},{"text":"papule","label":"SIGN_SYMPTOM","start":726,"end":732},{"text":"abdominal examination","label":"DIAGNOSTIC_PROCEDURE","start":755,"end":776},{"text":"mild","label":"SEVERITY","start":777,"end":781},{"text":"tenderness","label":"SIGN_SYMPTOM","start":782,"end":792},{"text":"right hypochondrium","label":"BIOLOGICAL_STRUCTURE","start":812,"end":831},{"text":"laboratory investigations","label":"DIAGNOSTIC_PROCEDURE","start":851,"end":876},{"text":"total leucocyte count","label":"DIAGNOSTIC_PROCEDURE","start":886,"end":907},{"text":"12\u2005000 cells\/mm3","label":"LAB_VALUE","start":911,"end":927},{"text":"75% neutrophils","label":"LAB_VALUE","start":933,"end":948},{"text":"haemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":954,"end":965},{"text":"14.3\u2005gm%","label":"LAB_VALUE","start":976,"end":984},{"text":"erythrocyte sedimentation rate","label":"DIAGNOSTIC_PROCEDURE","start":989,"end":1019},{"text":"30\u2005mm\/h","label":"LAB_VALUE","start":1024,"end":1031},{"text":"Liver function test","label":"DIAGNOSTIC_PROCEDURE","start":1033,"end":1052},{"text":"kidney function test","label":"DIAGNOSTIC_PROCEDURE","start":1054,"end":1074},{"text":"C reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1079,"end":1097},{"text":"normal","label":"LAB_VALUE","start":1117,"end":1123},{"text":"Gram stain","label":"DIAGNOSTIC_PROCEDURE","start":1132,"end":1142},{"text":"purulent exudates","label":"DIAGNOSTIC_PROCEDURE","start":1148,"end":1165},{"text":"neutrophils","label":"BIOLOGICAL_STRUCTURE","start":1178,"end":1189},{"text":"organisms","label":"SIGN_SYMPTOM","start":1202,"end":1211},{"text":"culture","label":"DIAGNOSTIC_PROCEDURE","start":1216,"end":1223},{"text":"growth","label":"SIGN_SYMPTOM","start":1241,"end":1247},{"text":"72\u2005h of incubation","label":"DURATION","start":1254,"end":1272},{"text":"lesional","label":"DETAILED_DESCRIPTION","start":1276,"end":1284},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":1285,"end":1289},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1290,"end":1296},{"text":"satellite","label":"DETAILED_DESCRIPTION","start":1312,"end":1321},{"text":"papule","label":"COREFERENCE","start":1322,"end":1328},{"text":"neutrophilic infiltration","label":"SIGN_SYMPTOM","start":1336,"end":1361},{"text":"dermis","label":"BIOLOGICAL_STRUCTURE","start":1365,"end":1371},{"text":"papillary dermal oedema","label":"SIGN_SYMPTOM","start":1377,"end":1400},{"text":"spongiosis","label":"SIGN_SYMPTOM","start":1405,"end":1415},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":1431,"end":1440},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":1441,"end":1456},{"text":"intraluminal","label":"DETAILED_DESCRIPTION","start":1466,"end":1478},{"text":"gall bladder","label":"BIOLOGICAL_STRUCTURE","start":1479,"end":1491},{"text":"mass","label":"SIGN_SYMPTOM","start":1492,"end":1496},{"text":"malignancy","label":"SIGN_SYMPTOM","start":1511,"end":1521},{"text":"SS","label":"DISEASE_DISORDER","start":1575,"end":1577},{"text":"gall bladder","label":"COREFERENCE","start":1594,"end":1606},{"text":"malignancy","label":"COREFERENCE","start":1607,"end":1617},{"text":"oral","label":"ADMINISTRATION","start":1647,"end":1651},{"text":"prednisolone","label":"MEDICATION","start":1652,"end":1664},{"text":"40\u2005mg","label":"DOSAGE","start":1676,"end":1681},{"text":"daily","label":"FREQUENCY","start":1682,"end":1687},{"text":"symptomatic","label":"DETAILED_DESCRIPTION","start":1699,"end":1710},{"text":"treatment","label":"MEDICATION","start":1711,"end":1720},{"text":"cutaneous","label":"DETAILED_DESCRIPTION","start":1726,"end":1735},{"text":"lesions","label":"SIGN_SYMPTOM","start":1736,"end":1743},{"text":"subsided completely","label":"DETAILED_DESCRIPTION","start":1771,"end":1790},{"text":"1\u2005week","label":"DURATION","start":1797,"end":1803},{"text":"treatment","label":"MEDICATION","start":1807,"end":1816},{"text":"prednisolone","label":"COREFERENCE","start":1840,"end":1852},{"text":"tapered","label":"CLINICAL_EVENT","start":1857,"end":1864},{"text":"open","label":"DETAILED_DESCRIPTION","start":1872,"end":1876},{"text":"cholecystectomy","label":"THERAPEUTIC_PROCEDURE","start":1877,"end":1892},{"text":"Histopathology","label":"DIAGNOSTIC_PROCEDURE","start":1908,"end":1922},{"text":"excised tissue","label":"BIOLOGICAL_STRUCTURE","start":1926,"end":1940},{"text":"well-differentiated","label":"DETAILED_DESCRIPTION","start":1960,"end":1979},{"text":"gall bladder","label":"BIOLOGICAL_STRUCTURE","start":1980,"end":1992},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":1993,"end":2007},{"text":"glands","label":"BIOLOGICAL_STRUCTURE","start":2016,"end":2022},{"text":"papillae","label":"BIOLOGICAL_STRUCTURE","start":2027,"end":2035},{"text":"infiltrating","label":"SIGN_SYMPTOM","start":2036,"end":2048},{"text":"muscularis propria","label":"BIOLOGICAL_STRUCTURE","start":2053,"end":2071},{"text":"superficially","label":"DETAILED_DESCRIPTION","start":2072,"end":2085},{"text":"Cystic duct cut margins","label":"BIOLOGICAL_STRUCTURE","start":2087,"end":2110},{"text":"tumour","label":"SIGN_SYMPTOM","start":2124,"end":2130},{"text":"postoperative period","label":"DURATION","start":2156,"end":2176},{"text":"uneventful","label":"SIGN_SYMPTOM","start":2181,"end":2191},{"text":"discharged","label":"CLINICAL_EVENT","start":2204,"end":2214},{"text":"tapering doses","label":"DOSAGE","start":2218,"end":2232},{"text":"prednisolone","label":"COREFERENCE","start":2236,"end":2248}],"tokens":["A ","45-year-old"," ","lady"," sought ","dermatology consultation"," for ","severely tender"," ","erythematous"," ","vesicles"," and ","bullae"," over ","back",", ","chest"," and ","arms",".\n","These"," were ","sudden in onset"," associated with ","fever",", ","nausea"," and ","malaise",".\nAlong with this she also complained of ","pain"," in ","upper abdomen",".\nThere was ","no history of receiving any drugs prior to the onset of lesions",".\nShe did not report any ","significant"," ","weight loss"," or ","loss of appetite",".\nOn ","physical examination",", her ","temperature"," was ","38\u00b0C",", ","pulse rate"," was ","100\/min"," and ","blood pressure"," was ","126\/72\u2005mm\u2005Hg",".\nThere were ","multiple"," ","coalescing"," ","vesicles"," and ","bullae"," over ","upper back",", ","chest"," and ","arms"," ","distributed symmetrically"," showing areas of ","pustulation"," and ","necrosis",".\n","Surrounding"," ","them"," were ","multiple"," ","pseudovesicular"," ","satellite"," ","papule"," (figure 1A,B).\nOn per ","abdominal examination"," ","mild"," ","tenderness"," was present in the ","right hypochondrium",".\nPatient's initial ","laboratory investigations"," showed a ","total leucocyte count"," of ","12\u2005000 cells\/mm3"," with ","75% neutrophils",".\nThe ","haemoglobin"," level was ","14.3\u2005gm%"," and ","erythrocyte sedimentation rate"," was ","30\u2005mm\/h",".\n","Liver function test",", ","kidney function test"," and ","C reactive protein"," levels were within ","normal"," limits.\n","Gram stain"," from ","purulent exudates"," showed only ","neutrophils"," without any ","organisms"," and ","culture"," did not show any ","growth"," after ","72\u2005h of incubation",".\nA ","lesional"," ","skin"," ","biopsy"," taken from the ","satellite"," ","papule"," showed ","neutrophilic infiltration"," in ","dermis"," with ","papillary dermal oedema"," and ","spongiosis"," (figure 2A,B).\n","Abdominal"," ","ultrasonography"," revealed ","intraluminal"," ","gall bladder"," ","mass"," suggestive of ","malignancy",".\nOn the basis of these findings a final diagnosis of ","SS"," associated with ","gall bladder"," ","malignancy"," was made.\nShe was started on ","oral"," ","prednisolone"," in dose of ","40\u2005mg"," ","daily"," along with ","symptomatic"," ","treatment",".\nHer ","cutaneous"," ","lesions"," responded dramatically and ","subsided completely"," after ","1\u2005week"," of ","treatment"," (figure 3A,B).\nDose of ","prednisolone"," was ","tapered"," and an ","open"," ","cholecystectomy"," was performed.\n","Histopathology"," of ","excised tissue"," confirmed it to be ","well-differentiated"," ","gall bladder"," ","adenocarcinoma"," forming ","glands"," and ","papillae"," ","infiltrating"," the ","muscularis propria"," ","superficially",".\n","Cystic duct cut margins"," were free of ","tumour"," (figure 2C,D).\nPatient's ","postoperative period"," was ","uneventful"," and she was ","discharged"," on ","tapering doses"," of ","prednisolone"," with advice to follow-up periodically.\n"],"ner_labels":[0,5,0,65,0,13,0,73,0,22,0,69,0,69,0,12,0,12,0,12,0,18,0,22,0,69,0,69,0,69,0,69,0,12,0,39,0,22,0,69,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,22,0,18,0,18,0,12,0,12,0,12,0,22,0,69,0,69,0,51,0,18,0,42,0,22,0,22,0,69,0,24,0,63,0,69,0,12,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,24,0,12,0,69,0,24,0,69,0,32,0,22,0,12,0,24,0,22,0,18,0,69,0,12,0,69,0,69,0,12,0,24,0,22,0,12,0,69,0,69,0,26,0,18,0,18,0,4,0,46,0,29,0,35,0,22,0,46,0,22,0,69,0,22,0,32,0,46,0,18,0,13,0,22,0,75,0,24,0,12,0,22,0,12,0,26,0,12,0,12,0,69,0,12,0,22,0,12,0,69,0,32,0,69,0,13,0,29,0,18,0]}
-{"full_text":"A 76-year old woman presented with a 24-month history of enlarging mass involving the back history of trauma.\nPhysical examination showed a mass of an 3x4 cm in diameter, localized in the right inter-scapular region.\nThe mass was ulcerative helophytic, grayish in colour, hard in consistency and easily bleeding on manipulation.\nThe remainder of the examination was unremarkable; no lymphadenopathy and no abdominal masses were felt.\nAfter resection, the histological examinations of the specimens have concluded for basal cell carcinoma.\nA local recurrence was observed 18 months later; the patient was admitted to our institution for Lumpectomy (Figure 1).\nHistopathological examination revealed a syringomatous pattern infiltrating the dermis (Figure 2, Figure 3), subcutis and skeletal muscle.\nThe neoplastic epithelial cells were arranged in interconnecting cords with microcystic areas.\nNests, cords, and tubules of the tumour extended into the dermis and into the adjacent muscle.\nMany lobules showed squamous differentiation.\nSclerosis of stroma around the cords was present.\nTumour cells were not connected to the epidermis.\nThe immunohistochemical analysis showed positivity for anti-CK7 (Figure 4), AE1\/AE3 and negativity for anti CEA and anti CK20.\nBased upon her histological and immunohistochemical presentation, the diagnosis of syringomatous eccrine carcinoma was established.\nRadiotherapy of the involved area was performed (70 Gy, 35 sessions)\n","ner_info":[{"text":"76-year old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"24-month history","label":"DURATION","start":37,"end":53},{"text":"enlarging","label":"LAB_VALUE","start":57,"end":66},{"text":"mass","label":"SIGN_SYMPTOM","start":67,"end":71},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":86,"end":90},{"text":"trauma","label":"DISEASE_DISORDER","start":102,"end":108},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":110,"end":130},{"text":"mass","label":"SIGN_SYMPTOM","start":140,"end":144},{"text":"3x4 cm","label":"AREA","start":151,"end":157},{"text":"right inter-scapular region","label":"BIOLOGICAL_STRUCTURE","start":188,"end":215},{"text":"mass","label":"COREFERENCE","start":221,"end":225},{"text":"ulcerative","label":"DETAILED_DESCRIPTION","start":230,"end":240},{"text":"helophytic","label":"DETAILED_DESCRIPTION","start":241,"end":251},{"text":"grayish","label":"COLOR","start":253,"end":260},{"text":"hard","label":"TEXTURE","start":272,"end":276},{"text":"bleeding on manipulation","label":"DETAILED_DESCRIPTION","start":303,"end":327},{"text":"lymphadenopathy","label":"SIGN_SYMPTOM","start":383,"end":398},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":406,"end":415},{"text":"masses","label":"SIGN_SYMPTOM","start":416,"end":422},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":440,"end":449},{"text":"histological examinations","label":"DIAGNOSTIC_PROCEDURE","start":455,"end":480},{"text":"basal cell carcinoma","label":"DISEASE_DISORDER","start":517,"end":537},{"text":"local","label":"DETAILED_DESCRIPTION","start":541,"end":546},{"text":"recurrence","label":"SIGN_SYMPTOM","start":547,"end":557},{"text":"18 months later","label":"DATE","start":571,"end":586},{"text":"admitted","label":"CLINICAL_EVENT","start":604,"end":612},{"text":"institution","label":"NONBIOLOGICAL_LOCATION","start":620,"end":631},{"text":"Lumpectomy","label":"THERAPEUTIC_PROCEDURE","start":636,"end":646},{"text":"Histopathological examinatio","label":"DIAGNOSTIC_PROCEDURE","start":659,"end":687},{"text":"syringomatous pattern","label":"SIGN_SYMPTOM","start":700,"end":721},{"text":"dermis","label":"BIOLOGICAL_STRUCTURE","start":739,"end":745},{"text":"subcutis","label":"BIOLOGICAL_STRUCTURE","start":768,"end":776},{"text":"skeletal muscle","label":"BIOLOGICAL_STRUCTURE","start":781,"end":796},{"text":"neoplastic epithelial cells","label":"COREFERENCE","start":802,"end":829},{"text":"arranged in interconnecting cords","label":"DETAILED_DESCRIPTION","start":835,"end":868},{"text":"microcystic areas","label":"DETAILED_DESCRIPTION","start":874,"end":891},{"text":"tumour","label":"SIGN_SYMPTOM","start":926,"end":932},{"text":"dermis","label":"BIOLOGICAL_STRUCTURE","start":951,"end":957},{"text":"adjacent muscle","label":"BIOLOGICAL_STRUCTURE","start":971,"end":986},{"text":"lobules","label":"SIGN_SYMPTOM","start":993,"end":1000},{"text":"squamous differentiation","label":"DETAILED_DESCRIPTION","start":1008,"end":1032},{"text":"Sclerosis","label":"SIGN_SYMPTOM","start":1034,"end":1043},{"text":"stroma around the cords","label":"BIOLOGICAL_STRUCTURE","start":1047,"end":1070},{"text":"Tumour cells","label":"SIGN_SYMPTOM","start":1084,"end":1096},{"text":"epidermis","label":"BIOLOGICAL_STRUCTURE","start":1123,"end":1132},{"text":"immunohistochemical analysis","label":"DIAGNOSTIC_PROCEDURE","start":1138,"end":1166},{"text":"positivity","label":"LAB_VALUE","start":1174,"end":1184},{"text":"anti-CK7","label":"DIAGNOSTIC_PROCEDURE","start":1189,"end":1197},{"text":"AE1\/AE3","label":"DIAGNOSTIC_PROCEDURE","start":1210,"end":1217},{"text":"negativity","label":"LAB_VALUE","start":1222,"end":1232},{"text":"anti CEA","label":"DIAGNOSTIC_PROCEDURE","start":1237,"end":1245},{"text":"anti CK20","label":"DIAGNOSTIC_PROCEDURE","start":1250,"end":1259},{"text":"syringomatous eccrine carcinoma","label":"DISEASE_DISORDER","start":1344,"end":1375},{"text":"Radiotherapy","label":"THERAPEUTIC_PROCEDURE","start":1393,"end":1405},{"text":"70 Gy, 35 sessions","label":"DOSAGE","start":1442,"end":1460}],"tokens":["A ","76-year old"," ","woman"," ","presented"," with a ","24-month history"," of ","enlarging"," ","mass"," involving the ","back"," history of ","trauma",".\n","Physical examination"," showed a ","mass"," of an ","3x4 cm"," in diameter, localized in the ","right inter-scapular region",".\nThe ","mass"," was ","ulcerative"," ","helophytic",", ","grayish"," in colour, ","hard"," in consistency and easily ","bleeding on manipulation",".\nThe remainder of the examination was unremarkable; no ","lymphadenopathy"," and no ","abdominal"," ","masses"," were felt.\nAfter ","resection",", the ","histological examinations"," of the specimens have concluded for ","basal cell carcinoma",".\nA ","local"," ","recurrence"," was observed ","18 months later","; the patient was ","admitted"," to our ","institution"," for ","Lumpectomy"," (Figure 1).\n","Histopathological examinatio","n revealed a ","syringomatous pattern"," infiltrating the ","dermis"," (Figure 2, Figure 3), ","subcutis"," and ","skeletal muscle",".\nThe ","neoplastic epithelial cells"," were ","arranged in interconnecting cords"," with ","microcystic areas",".\nNests, cords, and tubules of the ","tumour"," extended into the ","dermis"," and into the ","adjacent muscle",".\nMany ","lobules"," showed ","squamous differentiation",".\n","Sclerosis"," of ","stroma around the cords"," was present.\n","Tumour cells"," were not connected to the ","epidermis",".\nThe ","immunohistochemical analysis"," showed ","positivity"," for ","anti-CK7"," (Figure 4), ","AE1\/AE3"," and ","negativity"," for ","anti CEA"," and ","anti CK20",".\nBased upon her histological and immunohistochemical presentation, the diagnosis of ","syringomatous eccrine carcinoma"," was established.\n","Radiotherapy"," of the involved area was performed (","70 Gy, 35 sessions",")\n"],"ner_labels":[0,5,0,65,0,13,0,32,0,42,0,69,0,12,0,26,0,24,0,69,0,8,0,12,0,18,0,22,0,22,0,15,0,73,0,22,0,69,0,12,0,69,0,75,0,24,0,26,0,22,0,69,0,19,0,13,0,48,0,75,0,24,0,69,0,12,0,12,0,12,0,18,0,22,0,22,0,69,0,12,0,12,0,69,0,22,0,69,0,12,0,69,0,12,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,26,0,75,0,29,0]}
-{"full_text":"The patient, a 4-year-old boy, was diagnosed as having Blau syndrome based on the manifestation of typical clinical features (ankle and wrist arthritis\/tenosynovitis, diffuse eczematous rash, and uveitis), histologic evidence of noncaseating granulomas, and a heterozygous NOD2 mutation (p.R334W).\nOcular involvement was initially controlled by topical and oral corticosteroids, but over the years visual impairment progressed.\nOther manifestations of Blau syndrome (arthritis and rash) subsided over time.\nBilateral panuveitis progressed after age 5 years, and was initially treated with methotrexate.\nHowever, ocular inflammation persisted despite the addition of local steroid injections and repeated intravenous (IV) bolus methylprednisolone treatment; therefore, when the patient was age 10 years, infliximab (initially at 5 mg\/kg increased to 10 mg\/kg IV every 4 to 6 weeks) was initiated.\nAlthough there was an initial improvement, 1 year after this treatment was started uveitis worsened, and at age 12 years infliximab was discontinued.\nAdalimumab (24 mg\/m2 every 2 weeks) was then initiated and the dosage of methotrexate (15 mg\/m2\/weekly) was increased.\nHowever, ocular disease remained active.\nMycophenolate mofetil (750 mg\/m2) and then abatacept (10 mg\/kg\/month IV) were sequentially administered, without significant improvement.\nAt age 16 years the patient still had granulomatous retinal lesions and anterior chamber inflammation, and macular edema developed, which led to retinal detachment.\nIn addition to the other steroid therapy, corticosteroid pulse therapy was necessary to control disease flares, with an average of 3 boluses\/month for 6 consecutive months.\nBecause of the supposed autoinflammatory nature of Blau syndrome, we initiated a trial of IL-1 antibody administration (2 mg\/kg\/month of canakinumab).\nDuring the 6 months that followed, no ocular flare occurred and no steroid pulse therapy was necessary.\nConcomitant treatment with oral methotrexate and low-dose prednisone (0.2 mg\/kg\/day) remained unchanged.\nFigure 1 shows fluorangiograms before treatment and after the first 6 injections.\nThe drug was well tolerated with no side effects, and findings on laboratory tests (performed monthly) were normal.\n","ner_info":[{"text":"4-year-old","label":"AGE","start":15,"end":25},{"text":"boy","label":"SEX","start":26,"end":29},{"text":"Blau syndrome","label":"DISEASE_DISORDER","start":55,"end":68},{"text":"ankle","label":"BIOLOGICAL_STRUCTURE","start":126,"end":131},{"text":"wrist","label":"BIOLOGICAL_STRUCTURE","start":136,"end":141},{"text":"arthritis","label":"DISEASE_DISORDER","start":142,"end":151},{"text":"tenosynovitis","label":"DISEASE_DISORDER","start":152,"end":165},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":167,"end":174},{"text":"eczematous","label":"BIOLOGICAL_ATTRIBUTE","start":175,"end":185},{"text":"rash","label":"SIGN_SYMPTOM","start":186,"end":190},{"text":"uveitis","label":"DISEASE_DISORDER","start":196,"end":203},{"text":"histologic","label":"DIAGNOSTIC_PROCEDURE","start":206,"end":216},{"text":"noncaseating","label":"DETAILED_DESCRIPTION","start":229,"end":241},{"text":"granulomas","label":"DISEASE_DISORDER","start":242,"end":252},{"text":"heterozygous","label":"DETAILED_DESCRIPTION","start":260,"end":272},{"text":"NOD2 mutation","label":"DIAGNOSTIC_PROCEDURE","start":273,"end":286},{"text":"p.R334W","label":"DIAGNOSTIC_PROCEDURE","start":288,"end":295},{"text":"Ocular involvement","label":"DISEASE_DISORDER","start":298,"end":316},{"text":"controlled","label":"DETAILED_DESCRIPTION","start":331,"end":341},{"text":"topical","label":"ADMINISTRATION","start":345,"end":352},{"text":"oral","label":"ADMINISTRATION","start":357,"end":361},{"text":"corticosteroids","label":"MEDICATION","start":362,"end":377},{"text":"over the years","label":"DURATION","start":383,"end":397},{"text":"visual impairment","label":"DISEASE_DISORDER","start":398,"end":415},{"text":"progressed","label":"DETAILED_DESCRIPTION","start":416,"end":426},{"text":"Blau syndrome","label":"DISEASE_DISORDER","start":452,"end":465},{"text":"arthritis","label":"DISEASE_DISORDER","start":467,"end":476},{"text":"rash","label":"SIGN_SYMPTOM","start":481,"end":485},{"text":"subsided","label":"DETAILED_DESCRIPTION","start":487,"end":495},{"text":"over time","label":"DURATION","start":496,"end":505},{"text":"Bilateral","label":"DETAILED_DESCRIPTION","start":507,"end":516},{"text":"panuveitis","label":"DISEASE_DISORDER","start":517,"end":527},{"text":"progressed","label":"DETAILED_DESCRIPTION","start":528,"end":538},{"text":"age 5 years","label":"DATE","start":545,"end":556},{"text":"methotrexate","label":"MEDICATION","start":589,"end":601},{"text":"ocular","label":"BIOLOGICAL_STRUCTURE","start":612,"end":618},{"text":"inflammation","label":"DISEASE_DISORDER","start":619,"end":631},{"text":"persisted","label":"DETAILED_DESCRIPTION","start":632,"end":641},{"text":"local","label":"DETAILED_DESCRIPTION","start":666,"end":671},{"text":"steroid","label":"MEDICATION","start":672,"end":679},{"text":"injections","label":"ADMINISTRATION","start":680,"end":690},{"text":"repeated","label":"DETAILED_DESCRIPTION","start":695,"end":703},{"text":"intravenous","label":"ADMINISTRATION","start":704,"end":715},{"text":"IV","label":"ADMINISTRATION","start":717,"end":719},{"text":"methylprednisolone treatment","label":"MEDICATION","start":727,"end":755},{"text":"age 10 years","label":"DATE","start":789,"end":801},{"text":"infliximab","label":"MEDICATION","start":803,"end":813},{"text":"5 mg\/kg increased to 10 mg\/kg IV every 4 to 6 weeks","label":"DOSAGE","start":828,"end":879},{"text":"1 year after this treatment was started","label":"DATE","start":939,"end":978},{"text":"uveitis","label":"DISEASE_DISORDER","start":979,"end":986},{"text":"worsened","label":"SEVERITY","start":987,"end":995},{"text":"age 12","label":"DATE","start":1004,"end":1010},{"text":"infliximab","label":"MEDICATION","start":1017,"end":1027},{"text":"discontinued","label":"DETAILED_DESCRIPTION","start":1032,"end":1044},{"text":"Adalimumab","label":"MEDICATION","start":1046,"end":1056},{"text":"24 mg\/m2 every 2 weeks","label":"DOSAGE","start":1058,"end":1080},{"text":"methotrexate","label":"MEDICATION","start":1119,"end":1131},{"text":"15 mg\/m2\/weekly","label":"DOSAGE","start":1133,"end":1148},{"text":"increased","label":"LAB_VALUE","start":1154,"end":1163},{"text":"ocular disease","label":"DISEASE_DISORDER","start":1174,"end":1188},{"text":"active","label":"DETAILED_DESCRIPTION","start":1198,"end":1204},{"text":"Mycophenolate mofetil","label":"MEDICATION","start":1206,"end":1227},{"text":"750 mg\/m2","label":"DOSAGE","start":1229,"end":1238},{"text":"abatacept","label":"MEDICATION","start":1249,"end":1258},{"text":"10 mg\/kg\/month","label":"DOSAGE","start":1260,"end":1274},{"text":"IV","label":"ADMINISTRATION","start":1275,"end":1277},{"text":"without significant improvement","label":"DIAGNOSTIC_PROCEDURE","start":1311,"end":1342},{"text":"age 16 years","label":"DATE","start":1347,"end":1359},{"text":"granulomatous","label":"DISEASE_DISORDER","start":1382,"end":1395},{"text":"retinal","label":"BIOLOGICAL_STRUCTURE","start":1396,"end":1403},{"text":"lesions","label":"DISEASE_DISORDER","start":1404,"end":1411},{"text":"anterior chamber","label":"BIOLOGICAL_STRUCTURE","start":1416,"end":1432},{"text":"inflammation","label":"DISEASE_DISORDER","start":1433,"end":1445},{"text":"macular","label":"BIOLOGICAL_STRUCTURE","start":1451,"end":1458},{"text":"edema","label":"SIGN_SYMPTOM","start":1459,"end":1464},{"text":"retinal detachment","label":"DISEASE_DISORDER","start":1489,"end":1507},{"text":"corticosteroid pulse therapy","label":"MEDICATION","start":1551,"end":1579},{"text":"an average of","label":"LAB_VALUE","start":1626,"end":1639},{"text":"3 boluses\/month","label":"DOSAGE","start":1640,"end":1655},{"text":"6 consecutive months","label":"DURATION","start":1660,"end":1680},{"text":"IL-1 antibody administration","label":"MEDICATION","start":1772,"end":1800},{"text":"2 mg\/kg\/month","label":"DOSAGE","start":1802,"end":1815},{"text":"canakinumab","label":"MEDICATION","start":1819,"end":1830},{"text":"6 months that followed","label":"DURATION","start":1844,"end":1866},{"text":"ocular flare","label":"DISEASE_DISORDER","start":1871,"end":1883},{"text":"steroid pulse therapy","label":"MEDICATION","start":1900,"end":1921},{"text":"oral","label":"ADMINISTRATION","start":1964,"end":1968},{"text":"methotrexate","label":"MEDICATION","start":1969,"end":1981},{"text":"low-dose","label":"LAB_VALUE","start":1986,"end":1994},{"text":"prednisone","label":"MEDICATION","start":1995,"end":2005},{"text":"0.2 mg\/kg\/day","label":"DOSAGE","start":2007,"end":2020},{"text":"fluorangiograms","label":"DIAGNOSTIC_PROCEDURE","start":2057,"end":2072},{"text":"The drug","label":"MEDICATION","start":2124,"end":2132},{"text":"well tolerated with no side effects","label":"DETAILED_DESCRIPTION","start":2137,"end":2172},{"text":"laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":2190,"end":2206},{"text":"monthly","label":"FREQUENCY","start":2218,"end":2225},{"text":"normal","label":"DETAILED_DESCRIPTION","start":2232,"end":2238}],"tokens":["The patient, a ","4-year-old"," ","boy",", was diagnosed as having ","Blau syndrome"," based on the manifestation of typical clinical features (","ankle"," and ","wrist"," ","arthritis","\/","tenosynovitis",", ","diffuse"," ","eczematous"," ","rash",", and ","uveitis","), ","histologic"," evidence of ","noncaseating"," ","granulomas",", and a ","heterozygous"," ","NOD2 mutation"," (","p.R334W",").\n","Ocular involvement"," was initially ","controlled"," by ","topical"," and ","oral"," ","corticosteroids",", but ","over the years"," ","visual impairment"," ","progressed",".\nOther manifestations of ","Blau syndrome"," (","arthritis"," and ","rash",") ","subsided"," ","over time",".\n","Bilateral"," ","panuveitis"," ","progressed"," after ","age 5 years",", and was initially treated with ","methotrexate",".\nHowever, ","ocular"," ","inflammation"," ","persisted"," despite the addition of ","local"," ","steroid"," ","injections"," and ","repeated"," ","intravenous"," (","IV",") bolus ","methylprednisolone treatment","; therefore, when the patient was ","age 10 years",", ","infliximab"," (initially at ","5 mg\/kg increased to 10 mg\/kg IV every 4 to 6 weeks",") was initiated.\nAlthough there was an initial improvement, ","1 year after this treatment was started"," ","uveitis"," ","worsened",", and at ","age 12"," years ","infliximab"," was ","discontinued",".\n","Adalimumab"," (","24 mg\/m2 every 2 weeks",") was then initiated and the dosage of ","methotrexate"," (","15 mg\/m2\/weekly",") was ","increased",".\nHowever, ","ocular disease"," remained ","active",".\n","Mycophenolate mofetil"," (","750 mg\/m2",") and then ","abatacept"," (","10 mg\/kg\/month"," ","IV",") were sequentially administered, ","without significant improvement",".\nAt ","age 16 years"," the patient still had ","granulomatous"," ","retinal"," ","lesions"," and ","anterior chamber"," ","inflammation",", and ","macular"," ","edema"," developed, which led to ","retinal detachment",".\nIn addition to the other steroid therapy, ","corticosteroid pulse therapy"," was necessary to control disease flares, with ","an average of"," ","3 boluses\/month"," for ","6 consecutive months",".\nBecause of the supposed autoinflammatory nature of Blau syndrome, we initiated a trial of ","IL-1 antibody administration"," (","2 mg\/kg\/month"," of ","canakinumab",").\nDuring the ","6 months that followed",", no ","ocular flare"," occurred and no ","steroid pulse therapy"," was necessary.\nConcomitant treatment with ","oral"," ","methotrexate"," and ","low-dose"," ","prednisone"," (","0.2 mg\/kg\/day",") remained unchanged.\nFigure 1 shows ","fluorangiograms"," before treatment and after the first 6 injections.\n","The drug"," was ","well tolerated with no side effects",", and findings on ","laboratory tests"," (performed ","monthly",") were ","normal",".\n"],"ner_labels":[0,5,0,65,0,26,0,12,0,12,0,26,0,26,0,22,0,9,0,69,0,26,0,24,0,22,0,26,0,22,0,24,0,24,0,26,0,22,0,4,0,4,0,46,0,32,0,26,0,22,0,26,0,26,0,69,0,22,0,32,0,22,0,26,0,22,0,19,0,46,0,12,0,26,0,22,0,22,0,46,0,4,0,22,0,4,0,4,0,46,0,19,0,46,0,29,0,19,0,26,0,63,0,19,0,46,0,22,0,46,0,29,0,46,0,29,0,42,0,26,0,22,0,46,0,29,0,46,0,29,0,4,0,24,0,19,0,26,0,12,0,26,0,12,0,26,0,12,0,69,0,26,0,46,0,42,0,29,0,32,0,46,0,29,0,46,0,32,0,26,0,46,0,4,0,46,0,42,0,46,0,29,0,24,0,46,0,22,0,24,0,35,0,22,0]}
-{"full_text":"A 57-year-old Jewish man with Crohn's disease (CD) of the ileum diagnosed at the age of thirteen, presented with multiple nonmelanoma skin cancers (NMSCs); these had developed over the past 16 years coinciding with the initiation of a prolonged course of the thiopurine 6-mercaptopurine (mercaptopurine, 6-MP).\nHe was diagnosed with a total of 84 NMSC: 72 NMSC at our clinic, 12 from other clinics.\nHe was also awaiting biopsy and removal for additional lesions.\nHis CD was initially treated with sulfasalazine and intermittent steroids at diagnosis, but for the past 20 years he had been taking 6-MP daily.\nIn the first ten years after beginning 6-MP he developed 30 NMSC; 14 were squamous cell carcinoma (SCC) and 16 were basal cell carcinoma (BCC).\nThe patient was then treated elsewhere for the subsequent ten years.\nThis past year, however, he returned to the clinic with over 100 new lesions suggestive of malignancy on his torso and extremities.\nSubsequent to this exam, he had 42 biopsy-proven lesions of NMCS; 20 were SCC and 22 were BCC.\nIn addition, three of the SCCs were moderately differentiated and two were poorly differentiated and some of his larger skin cancers have necessitated Mohs surgery and xenografting.\nThe largest of his lesions was pretibial and measured 64x53 mm (Figure 1).\nHe was awaiting biopsy for many other suspicious lesions.\nThe patient had Fitzpatrick II skin type and admitted to excessive sun exposure for 25 years in Hawai\u2018i.\nEarly on he did not use sunscreen, and would sail a catamaran during peak sun hours.\nHe also revealed that his mother had one skin cancer lesion removed and denied ever having been a smoker.\nWithin the past year he discontinued 6-MP and began using mesalamine (Pentasa) and later adalimumab (Humira) hoping to attenuate the progression of NMSC, and continued to have monthly skin exams.\nOverall, he was hospitalized 16 times for his CD, but never required any intestinal resection.\nUnfortunately, in his most recent hospitalization he was diagnosed with metastatic adenocarcinoma of the small bowel, and passed away shortly after.\n","ner_info":[{"text":"57-year-old","label":"AGE","start":2,"end":13},{"text":"Jewish","label":"PERSONAL_BACKGROUND","start":14,"end":20},{"text":"man","label":"SEX","start":21,"end":24},{"text":"Crohn's disease","label":"DISEASE_DISORDER","start":30,"end":45},{"text":"CD","label":"DISEASE_DISORDER","start":47,"end":49},{"text":"ileum","label":"BIOLOGICAL_STRUCTURE","start":58,"end":63},{"text":"age of thirteen","label":"DATE","start":81,"end":96},{"text":"presented","label":"CLINICAL_EVENT","start":98,"end":107},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":113,"end":121},{"text":"nonmelanoma skin cancers","label":"DISEASE_DISORDER","start":122,"end":146},{"text":"NMSCs","label":"DISEASE_DISORDER","start":148,"end":153},{"text":"over the past 16 years","label":"DURATION","start":176,"end":198},{"text":"prolonged 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differentiated","label":"DETAILED_DESCRIPTION","start":1084,"end":1109},{"text":"two","label":"QUANTITATIVE_CONCEPT","start":1114,"end":1117},{"text":"poorly differentiated","label":"DETAILED_DESCRIPTION","start":1123,"end":1144},{"text":"skin cancers","label":"DISEASE_DISORDER","start":1168,"end":1180},{"text":"Mohs surgery","label":"THERAPEUTIC_PROCEDURE","start":1199,"end":1211},{"text":"xenografting","label":"THERAPEUTIC_PROCEDURE","start":1216,"end":1228},{"text":"largest","label":"QUANTITATIVE_CONCEPT","start":1234,"end":1241},{"text":"lesions","label":"SIGN_SYMPTOM","start":1249,"end":1256},{"text":"pretibial","label":"BIOLOGICAL_STRUCTURE","start":1261,"end":1270},{"text":"64x53 mm","label":"AREA","start":1284,"end":1292},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1321,"end":1327},{"text":"esions","label":"SIGN_SYMPTOM","start":1355,"end":1361},{"text":"Fitzpatrick II","label":"LAB_VALUE","start":1379,"end":1393},{"text":"skin type","label":"DIAGNOSTIC_PROCEDURE","start":1394,"end":1403},{"text":"excessive","label":"DETAILED_DESCRIPTION","start":1420,"end":1429},{"text":"sun exposure","label":"ACTIVITY","start":1430,"end":1442},{"text":"25 years","label":"DURATION","start":1447,"end":1455},{"text":"Hawai\u2018i","label":"NONBIOLOGICAL_LOCATION","start":1459,"end":1466},{"text":"Early on","label":"DATE","start":1468,"end":1476},{"text":"did not use sunscreen","label":"HISTORY","start":1480,"end":1501},{"text":"sail","label":"ACTIVITY","start":1513,"end":1517},{"text":"catamaran","label":"DETAILED_DESCRIPTION","start":1520,"end":1529},{"text":"during peak sun hours","label":"DETAILED_DESCRIPTION","start":1530,"end":1551},{"text":"mother","label":"SUBJECT","start":1579,"end":1585},{"text":"one skin cancer lesion removed","label":"DETAILED_DESCRIPTION","start":1590,"end":1620},{"text":"denied ever having been a smoker","label":"HISTORY","start":1625,"end":1657},{"text":"past 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years"," coinciding with the initiation of a ","prolonged course"," of the ","thiopurine"," ","6-mercaptopurine"," (","mercaptopurine",", ","6-MP",").\nHe was diagnosed with a total of ","84"," ","NMSC",": ","72"," ","NMSC"," at ","our clinic",", ","12"," from ","other clinics",".\nHe was also awaiting ","biopsy"," and ","removal"," for additional ","lesions",".\nHis ","CD"," was initially treated with ","sulfasalazine"," and ","intermittent"," ","steroids"," at diagnosis, but for the ","past 20 years"," he had been taking ","6-MP"," ","daily",".\nIn the ","first ten years"," after beginning ","6-MP"," he developed ","30"," ","NMSC","; ","14"," were ","squamous cell carcinoma"," (","SCC",") and ","16"," were ","basal cell carcinoma"," (","BCC",").\nThe patient was then ","treated"," ","elsewhere"," for the ","subsequent ten years",".\nThis ","past year",", however, he ","returned"," to the ","clinic"," with over ","100"," ","new"," ","lesions"," suggestive of ","malignancy"," on his ","torso"," and ","extremities",".\nSubsequent to this exam, he had ","42"," ","biopsy","-proven ","lesions"," of ","NMCS","; ","20"," were ","SCC"," and ","22"," were ","BCC",".\nIn addition, ","three"," of the ","SCCs"," were ","moderately differentiated"," and ","two"," were ","poorly differentiated"," and some of his larger ","skin cancers"," have necessitated ","Mohs surgery"," and ","xenografting",".\nThe ","largest"," of his ","lesions"," was ","pretibial"," and measured ","64x53 mm"," (Figure 1).\nHe was awaiting ","biopsy"," for many other suspicious l","esions",".\nThe patient had ","Fitzpatrick II"," ","skin type"," and admitted to ","excessive"," ","sun exposure"," for ","25 years"," in ","Hawai\u2018i",".\n","Early on"," he ","did not use sunscreen",", and would ","sail"," a ","catamaran"," ","during peak sun hours",".\nHe also revealed that his ","mother"," had ","one skin cancer lesion removed"," and ","denied ever having been a smoker",".\nWithin the ","past year"," he discontinued ","6-MP"," and began using ","mesalamine"," (","Pentasa",") and later ","adalimumab"," (","Humira",") hoping to attenuate the progression of NMSC, and continued to have ","monthly"," ","skin exams",".\nOverall, he was ","hospitalized"," ","16 times"," for his ","CD",", but never required any ","intestinal"," ","resection",".\nUnfortunately, in his most recent ","hospitalization"," he was diagnosed with ","metastatic"," ","adenocarcinoma"," of the ","small bowel",", and ","passed away"," ","shortly 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-{"full_text":"An 18-year-old lady presented with history of progressive swaying while walking, worse in night since 5\u2005years.\nSpeech was normal and there was not any tremulousness of upper limbs.\nAlso, there was no history of weakness or numbness.\nThe family history was significant as her elder sister had similar difficulty in walking of 7-year duration and died because of poorly controlled diabetes mellitus at an age of 20\u2005years.\nNo other members of the kin were affected and there was no history of consanguinity in the parents.\nThe cognitive function was normal and her Mini Mental Status Score was 30\/30.\nVisual acuity and fundus examination were normal.\nThe extraocular movements including saccades, pursuits were normal, and no saccadic intrusions or nystagmus were noticed.\nThe tone and power were normal in all four limbs; however, there was generalised exaggeration of myotatic reflexes along with bilateral extensor plantar response.\nVibration and joint position sense were intact but Romberg's was positive.\nPatient swayed to either side while performing tandem walk.\nFasting and postprandial blood glucose levels were normal.\nHaemogram, renal, liver and thyroid function tests were normal.\nSerum vitamin B12 and folic acid levels were within normal limits.\nNerve conduction study showed absent sensory nerve action potential with normal distal latency, conduction velocity and amplitude of compound muscle action potential (CMAP) in all nerves trunks.\nMRI showed marked atrophy of the cervical cord as compared to cerebellum which was normal (figure 1).\nThe genetic testing using PCR disclosed expansion of GAA repeat in both alleles (254 and 298) of FXN gene.\nA variety of causes of autosomal recessive ataxias need to be considered in the differential diagnosis of FRDA.\nThese were systemically excluded here.\nAtaxia with vitamin E deficiency (AVED) has a phenotype quite similar to FRDA, though titubation and hyperkinesia are more common in AVED.4 A strong family history of ataxia and diabetes mellitus in elder sister favoured FRDA.\nAtaxia with oculomotor apraxia (AOA) types 1 and 2 were not considered owing to lack of apraxia of ocular movements, distal amyotrophy (severe axonal sensorimotor polyneuropathy), atrophy of cerebellum and involuntary movements.5 Ataxia telengiectesia has presentation very similar to AOA types 1 and 2.\nMuco-cutaneous markers, sino-pulmonary infections, hypogammaglobulinaemia and radiosensitivity along with predisposition to development of a variety of neoplasms are features of ataxia telengiectasia not seen in AOAs and FRDA.\nThe other important causes of autosomal recessive spastic ataxia apart from FRDA would be autosomal recessive spastic ataxia of Charlevoix-Saguenay and Marinesco-Sj\u00f6gren syndrome.\nCharcot-Marie-Tooth disease, an inherited polyneuropathy has gait ataxia in common with FRDA; however, in this case, CMT was improbable due to following features in this case: lack of motor weakness, retained reflexes, bilaterally extensor plantar and pure sensory neuropathy on nerve conduction study.\nIdebenone was started at a dose of 450\u2005mg twice a day for its antioxidant properties.\nFor gait ataxia, physiotherapy\u2014Frenkel's exercise\u2014was initiated.\nBlood glucose is monitored regularly.\nAt 4\u2005months, there was no significant change in the gait difficulty.\n","ner_info":[{"text":"18-year-old","label":"AGE","start":3,"end":14},{"text":"lady","label":"SEX","start":15,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"history of progressive swaying while walking, worse in night since 5\u2005years","label":"HISTORY","start":35,"end":109},{"text":"Speech","label":"DIAGNOSTIC_PROCEDURE","start":111,"end":117},{"text":"normal","label":"LAB_VALUE","start":122,"end":128},{"text":"tremulousness","label":"SIGN_SYMPTOM","start":151,"end":164},{"text":"upper limbs","label":"BIOLOGICAL_STRUCTURE","start":168,"end":179},{"text":"no history of weakness or numbness","label":"HISTORY","start":197,"end":231},{"text":"her elder sister had similar difficulty in walking of 7-year duration and died because of poorly controlled diabetes mellitus at an age of 20\u2005years","label":"FAMILY_HISTORY","start":271,"end":418},{"text":"No other members of the kin were affected","label":"FAMILY_HISTORY","start":420,"end":461},{"text":"no history of consanguinity in the parents","label":"FAMILY_HISTORY","start":476,"end":518},{"text":"cognitive function","label":"DIAGNOSTIC_PROCEDURE","start":524,"end":542},{"text":"normal","label":"LAB_VALUE","start":547,"end":553},{"text":"Mini Mental Status Score","label":"DIAGNOSTIC_PROCEDURE","start":562,"end":586},{"text":"30\/30","label":"LAB_VALUE","start":591,"end":596},{"text":"Visual acuity","label":"DIAGNOSTIC_PROCEDURE","start":598,"end":611},{"text":"fundus 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1 and 2","label":"COREFERENCE","start":2325,"end":2342},{"text":"Muco-cutaneous markers","label":"SIGN_SYMPTOM","start":2344,"end":2366},{"text":"sino-pulmonary","label":"BIOLOGICAL_STRUCTURE","start":2368,"end":2382},{"text":"infections","label":"SIGN_SYMPTOM","start":2383,"end":2393},{"text":"hypogammaglobulinaemia","label":"SIGN_SYMPTOM","start":2395,"end":2417},{"text":"radiosensitivity","label":"SIGN_SYMPTOM","start":2422,"end":2438},{"text":"neoplasms","label":"SIGN_SYMPTOM","start":2496,"end":2505},{"text":"ataxia telengiectasia","label":"COREFERENCE","start":2522,"end":2543},{"text":"AOAs","label":"COREFERENCE","start":2556,"end":2560},{"text":"FRDA","label":"COREFERENCE","start":2565,"end":2569},{"text":"autosomal recessive spastic ataxia","label":"DISEASE_DISORDER","start":2601,"end":2635},{"text":"FRDA","label":"COREFERENCE","start":2647,"end":2651},{"text":"autosomal recessive spastic ataxia of Charlevoix-Saguenay","label":"DISEASE_DISORDER","start":2661,"end":2718},{"text":"Marinesco-Sj\u00f6gren syndrome","label":"DISEASE_DISORDER","start":2723,"end":2749},{"text":"Charcot-Marie-Tooth disease","label":"DISEASE_DISORDER","start":2751,"end":2778},{"text":"inherited","label":"DETAILED_DESCRIPTION","start":2783,"end":2792},{"text":"polyneuropathy","label":"DISEASE_DISORDER","start":2793,"end":2807},{"text":"gait ataxia","label":"SIGN_SYMPTOM","start":2812,"end":2823},{"text":"FRDA","label":"COREFERENCE","start":2839,"end":2843},{"text":"CMT","label":"DISEASE_DISORDER","start":2868,"end":2871},{"text":"motor weakness","label":"SIGN_SYMPTOM","start":2935,"end":2949},{"text":"retained reflexes","label":"SIGN_SYMPTOM","start":2951,"end":2968},{"text":"bilaterally extensor plantar","label":"SIGN_SYMPTOM","start":2970,"end":2998},{"text":"pure sensory neuropathy","label":"SIGN_SYMPTOM","start":3003,"end":3026},{"text":"nerve conduction study","label":"DIAGNOSTIC_PROCEDURE","start":3030,"end":3052},{"text":"Idebenone","label":"MEDICATION","start":3054,"end":3063},{"text":"450\u2005mg twice a day","label":"DOSAGE","start":3089,"end":3107},{"text":"antioxidant properties","label":"DETAILED_DESCRIPTION","start":3116,"end":3138},{"text":"physiotherapy","label":"THERAPEUTIC_PROCEDURE","start":3157,"end":3170},{"text":"Frenkel's exercise","label":"THERAPEUTIC_PROCEDURE","start":3171,"end":3189},{"text":"Blood glucose","label":"DIAGNOSTIC_PROCEDURE","start":3205,"end":3218},{"text":"regularly","label":"FREQUENCY","start":3232,"end":3241},{"text":"4\u2005months","label":"DATE","start":3246,"end":3254},{"text":"no significant change","label":"SEVERITY","start":3266,"end":3287},{"text":"gait difficulty","label":"DIAGNOSTIC_PROCEDURE","start":3295,"end":3310}],"tokens":["An ","18-year-old"," ","lady"," ","presented"," with ","history of progressive swaying while walking, worse in night since 5\u2005years",".\n","Speech"," was ","normal"," and there was not any ","tremulousness"," of ","upper limbs",".\nAlso, there was ","no history of weakness or numbness",".\nThe family history was significant as ","her elder sister had similar difficulty in walking of 7-year duration and died because of poorly controlled diabetes mellitus at an age of 20\u2005years",".\n","No other members of the kin were affected"," and there was ","no history of consanguinity in the parents",".\nThe ","cognitive function"," was ","normal"," and her ","Mini Mental Status Score"," was ","30\/30",".\n","Visual acuity"," and ","fundus examination"," were ","normal",".\nThe ","extraocular movements"," including ","saccades",", ","pursuits"," were ","normal",", and no ","saccadic intrusions"," or ","nystagmus"," were noticed.\nThe ","tone"," and ","power"," were ","normal"," in ","all four limbs","; however, there was generalised ","exaggeration"," of ","myotatic reflexes"," along with ","bilateral extensor plantar response",".\n","Vibration"," and ","joint position sense"," were ","intact"," but ","Romberg's"," was ","positive",".\nPatient ","swayed"," ","to either side"," while ","performing tandem walk",".\n","Fasting"," and ","postprandial"," ","blood glucose"," levels were ","normal",".\n","Haemogram",", ","renal",", ","liver"," and ","thyroid function tests"," were ","normal",".\n","Serum vitamin B12"," and ","folic acid"," levels were within ","normal"," limits.\n","Nerve conduction study"," showed ","absent"," ","sensory nerve action potential"," with ","normal"," ","distal latency",", ","conduction velocity"," and ","amplitude of compound muscle action potential"," (","CMAP",") in all ","nerves trunks",".\n","MRI"," showed ","marked"," ","atrophy"," of the ","cervical cord"," as compared to ","cerebellum"," which was ","normal"," (figure 1).\nThe ","genetic testing"," using ","PCR"," disclosed ","expansion of GAA repeat"," in ","both alleles (254 and 298) of FXN gene",".\nA variety of causes of ","autosomal recessive ataxias"," need to be considered in the differential diagnosis of ","FRDA",".\nThese were systemically excluded here.\n","Ataxia with vitamin E deficiency"," (","AVED",") has a phenotype quite similar to ","FRDA",", though ","titubation"," and ","hyperkinesia"," are more common in ","AVED",".4 A ","strong family history of ataxia and diabetes mellitus in elder sister"," favoured ","FRDA",".\n","Ataxia with oculomotor apraxia"," (","AOA",") ","types 1 and 2"," were not considered owing to lack of ","apraxia of ocular movements",", ","distal amyotrophy"," (","severe"," ","axonal sensorimotor polyneuropathy","), ","atrophy"," of ","cerebellum"," and ","involuntary movements",".5 ","Ataxia telengiectesia"," has presentation very similar to ","AOA types 1 and 2",".\n","Muco-cutaneous markers",", ","sino-pulmonary"," ","infections",", ","hypogammaglobulinaemia"," and ","radiosensitivity"," along with predisposition to development of a variety of ","neoplasms"," are features of ","ataxia telengiectasia"," not seen in ","AOAs"," and ","FRDA",".\nThe other important causes of ","autosomal recessive spastic ataxia"," apart from ","FRDA"," would be ","autosomal recessive spastic ataxia of Charlevoix-Saguenay"," and ","Marinesco-Sj\u00f6gren syndrome",".\n","Charcot-Marie-Tooth disease",", an ","inherited"," ","polyneuropathy"," has ","gait ataxia"," in common with ","FRDA","; however, in this case, ","CMT"," was improbable due to following features in this case: lack of ","motor weakness",", ","retained reflexes",", ","bilaterally extensor plantar"," and ","pure sensory neuropathy"," on ","nerve conduction study",".\n","Idebenone"," was started at a dose of ","450\u2005mg twice a day"," for its ","antioxidant properties",".\nFor gait ataxia, ","physiotherapy","\u2014","Frenkel's exercise","\u2014was initiated.\n","Blood glucose"," is monitored ","regularly",".\nAt ","4\u2005months",", there was ","no significant change"," in the ","gait difficulty",".\n"],"ner_labels":[0,5,0,65,0,13,0,39,0,24,0,42,0,69,0,12,0,39,0,34,0,34,0,34,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,24,0,42,0,26,0,26,0,24,0,24,0,42,0,12,0,42,0,24,0,69,0,24,0,24,0,42,0,24,0,42,0,69,0,22,0,1,0,22,0,22,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,12,0,24,0,63,0,69,0,12,0,12,0,42,0,24,0,24,0,69,0,22,0,26,0,26,0,26,0,26,0,18,0,69,0,69,0,18,0,34,0,18,0,26,0,26,0,22,0,69,0,69,0,63,0,69,0,69,0,12,0,69,0,26,0,18,0,69,0,12,0,69,0,69,0,69,0,69,0,18,0,18,0,18,0,26,0,18,0,26,0,26,0,26,0,22,0,26,0,69,0,18,0,26,0,69,0,69,0,69,0,69,0,24,0,46,0,29,0,22,0,75,0,75,0,24,0,35,0,19,0,63,0,24,0]}
-{"full_text":"A 54 year-old diabetic woman complained of blurred vision in the left eye for 5 days without scalp tenderness or headache.\nVisual acuity (VA) was 20\/20 right eye and 20\/30 left eye.\nIntraocular pressures were normal.\nFunduscopic examination revealed left optic nerve edema and a small disc margin hemorrhage.\nWBC count was 12,700, ESR was 7 (normal 0\u201320 mm\/hr) and CRP was 2.4 (normal 0\u20131.0 mg\/dL).\nThree days later, she noted new left eye pain and her vision declined to counting fingers.\nThere was no pain on eye movement.\nThe right pupil was 4 mm and reacted to light; the left pupil was 4 mm, and there was a relative left afferent pupillary defect.\nThe left optic nerve was swollen with a few peripapillary nerve fiber layer hemorrhages along with a cherry red spot and mild macular edema consistent with central retinal artery occlusion; there were no posterior pole or peripheral retinal hemorrhages.\nTrace cells were seen in the anterior chamber, but not in the vitreous fluid.\nRepeat WBC, ESR and CRP were normal.\nTreponemal and Bartonella antibodies, the QuantiFERON-TB test, blood cultures, EKG and carotid Doppler ultrasound were unremarkable.\nBrain contrast MRI demonstrated no optic nerve enhancement.\nTwelve days later, left eye pain and vision worsened, and the patient complained of jaw claudication and scalp pain.\nVA declined to no light perception in the left eye with 1+ cells and flare in anterior chamber and 2+ vitreous cells and haze.\nFunduscopic examination revealed extensive retinal necrosis and diffuse hemorrhages with multiple areas of focal venous beading (Fig.1), consistent with acute retinal necrosis.\nVitreous fluid was examined by PCR for amplifiable HSV, VZV, CMV and toxoplasma sequences and returned positive for VZV DNA.\nShe was treated with a one-time intravitreal injection of ganciclovir 2000 mcg\/0.5 ml in the left eye, oral acyclovir 800 mg 5 times daily for 14 days and oral prednisone 60 mg daily for 7 days followed by 20 mg for 7 days.\nEleven days after starting treatment, because she had recently developed jaw claudication and intermittent scalp pain, a temporal artery biopsy was performed.\nHistological examination was normal (Fig.2) while immunohistochemical analysis demonstrated VZV antigen in the arterial adventitia; evaluation of adjacent sections for HSV-1 antigen and infiltrating leukocytes (CD45, not shown) was negative (Fig.3).\nAntiviral therapy was altered to intravenous acyclovir, 10 mg\/kg every 8 h for 14 days, and steroids were discontinued.\n","ner_info":[{"text":"54 year-old","label":"AGE","start":2,"end":13},{"text":"diabetic","label":"HISTORY","start":14,"end":22},{"text":"woman","label":"SEX","start":23,"end":28},{"text":"blurred vision","label":"SIGN_SYMPTOM","start":43,"end":57},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":65,"end":73},{"text":"5 days","label":"DURATION","start":78,"end":84},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":93,"end":98},{"text":"tenderness","label":"SIGN_SYMPTOM","start":99,"end":109},{"text":"headache","label":"SIGN_SYMPTOM","start":113,"end":121},{"text":"Visual acuity","label":"DIAGNOSTIC_PROCEDURE","start":123,"end":136},{"text":"VA","label":"DIAGNOSTIC_PROCEDURE","start":138,"end":140},{"text":"20\/20","label":"LAB_VALUE","start":146,"end":151},{"text":"right eye","label":"BIOLOGICAL_STRUCTURE","start":152,"end":161},{"text":"20\/30","label":"LAB_VALUE","start":166,"end":171},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":172,"end":180},{"text":"Intraocular pressures","label":"DIAGNOSTIC_PROCEDURE","start":182,"end":203},{"text":"normal","label":"LAB_VALUE","start":209,"end":215},{"text":"Funduscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":217,"end":240},{"text":"left optic nerve","label":"BIOLOGICAL_STRUCTURE","start":250,"end":266},{"text":"edema","label":"SIGN_SYMPTOM","start":267,"end":272},{"text":"small","label":"SEVERITY","start":279,"end":284},{"text":"disc margin","label":"BIOLOGICAL_STRUCTURE","start":285,"end":296},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":297,"end":307},{"text":"WBC count","label":"DIAGNOSTIC_PROCEDURE","start":309,"end":318},{"text":"12,700","label":"LAB_VALUE","start":323,"end":329},{"text":"ESR","label":"DIAGNOSTIC_PROCEDURE","start":331,"end":334},{"text":"7","label":"LAB_VALUE","start":339,"end":340},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":365,"end":368},{"text":"2.4","label":"LAB_VALUE","start":373,"end":376},{"text":"Three days later","label":"DATE","start":399,"end":415},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":431,"end":439},{"text":"pain","label":"SIGN_SYMPTOM","start":440,"end":444},{"text":"vision","label":"DIAGNOSTIC_PROCEDURE","start":453,"end":459},{"text":"counting fingers","label":"LAB_VALUE","start":472,"end":488},{"text":"pain","label":"SIGN_SYMPTOM","start":503,"end":507},{"text":"on eye movement","label":"DETAILED_DESCRIPTION","start":508,"end":523},{"text":"right pupil","label":"DIAGNOSTIC_PROCEDURE","start":529,"end":540},{"text":"4 mm","label":"DISTANCE","start":545,"end":549},{"text":"reacted to light","label":"LAB_VALUE","start":554,"end":570},{"text":"left pupil","label":"DIAGNOSTIC_PROCEDURE","start":576,"end":586},{"text":"4 mm","label":"DISTANCE","start":591,"end":595},{"text":"relative","label":"DETAILED_DESCRIPTION","start":613,"end":621},{"text":"left afferent pupillary","label":"BIOLOGICAL_STRUCTURE","start":622,"end":645},{"text":"defect","label":"SIGN_SYMPTOM","start":646,"end":652},{"text":"left optic nerve","label":"BIOLOGICAL_STRUCTURE","start":658,"end":674},{"text":"swollen","label":"SIGN_SYMPTOM","start":679,"end":686},{"text":"few","label":"DETAILED_DESCRIPTION","start":694,"end":697},{"text":"peripapillary nerve fiber layer","label":"BIOLOGICAL_STRUCTURE","start":698,"end":729},{"text":"hemorrhages","label":"SIGN_SYMPTOM","start":730,"end":741},{"text":"cherry red","label":"COLOR","start":755,"end":765},{"text":"spot","label":"SIGN_SYMPTOM","start":766,"end":770},{"text":"mild","label":"SEVERITY","start":775,"end":779},{"text":"macular","label":"BIOLOGICAL_STRUCTURE","start":780,"end":787},{"text":"edema","label":"SIGN_SYMPTOM","start":788,"end":793},{"text":"central retinal artery occlusion","label":"DISEASE_DISORDER","start":810,"end":842},{"text":"posterior pole","label":"BIOLOGICAL_STRUCTURE","start":858,"end":872},{"text":"peripheral retinal","label":"BIOLOGICAL_STRUCTURE","start":876,"end":894},{"text":"hemorrhages","label":"SIGN_SYMPTOM","start":895,"end":906},{"text":"Trace cells","label":"DIAGNOSTIC_PROCEDURE","start":908,"end":919},{"text":"seen","label":"LAB_VALUE","start":925,"end":929},{"text":"anterior 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cultures","label":"DIAGNOSTIC_PROCEDURE","start":1086,"end":1100},{"text":"EKG","label":"DIAGNOSTIC_PROCEDURE","start":1102,"end":1105},{"text":"carotid","label":"BIOLOGICAL_STRUCTURE","start":1110,"end":1117},{"text":"Doppler","label":"DETAILED_DESCRIPTION","start":1118,"end":1125},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1126,"end":1136},{"text":"unremarkable","label":"LAB_VALUE","start":1142,"end":1154},{"text":"Brain","label":"BIOLOGICAL_STRUCTURE","start":1156,"end":1161},{"text":"contrast","label":"DETAILED_DESCRIPTION","start":1162,"end":1170},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1171,"end":1174},{"text":"no","label":"LAB_VALUE","start":1188,"end":1190},{"text":"optic nerve","label":"BIOLOGICAL_STRUCTURE","start":1191,"end":1202},{"text":"Twelve days later","label":"DATE","start":1216,"end":1233},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":1235,"end":1243},{"text":"pain","label":"SIGN_SYMPTOM","start":1244,"end":1248},{"text":"vision","label":"DIAGNOSTIC_PROCEDURE","start":1253,"end":1259},{"text":"worsened","label":"LAB_VALUE","start":1260,"end":1268},{"text":"jaw","label":"BIOLOGICAL_STRUCTURE","start":1300,"end":1303},{"text":"claudication","label":"SIGN_SYMPTOM","start":1304,"end":1316},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":1321,"end":1326},{"text":"pain","label":"SIGN_SYMPTOM","start":1327,"end":1331},{"text":"VA","label":"DIAGNOSTIC_PROCEDURE","start":1333,"end":1335},{"text":"no light perception","label":"LAB_VALUE","start":1348,"end":1367},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":1375,"end":1383},{"text":"1+","label":"LAB_VALUE","start":1389,"end":1391},{"text":"cells and flare","label":"DIAGNOSTIC_PROCEDURE","start":1392,"end":1407},{"text":"anterior chamber","label":"BIOLOGICAL_STRUCTURE","start":1411,"end":1427},{"text":"2+","label":"LAB_VALUE","start":1432,"end":1434},{"text":"vitreous cells and haze","label":"DIAGNOSTIC_PROCEDURE","start":1435,"end":1458},{"text":"Funduscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1460,"end":1483},{"text":"extensive","label":"SEVERITY","start":1493,"end":1502},{"text":"retinal","label":"BIOLOGICAL_STRUCTURE","start":1503,"end":1510},{"text":"necrosis","label":"SIGN_SYMPTOM","start":1511,"end":1519},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1524,"end":1531},{"text":"hemorrhages","label":"SIGN_SYMPTOM","start":1532,"end":1543},{"text":"multiple areas","label":"DETAILED_DESCRIPTION","start":1549,"end":1563},{"text":"focal","label":"DETAILED_DESCRIPTION","start":1567,"end":1572},{"text":"venous beading","label":"SIGN_SYMPTOM","start":1573,"end":1587},{"text":"acute retinal necrosis","label":"DISEASE_DISORDER","start":1613,"end":1635},{"text":"Vitreous 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eye","label":"BIOLOGICAL_STRUCTURE","start":1855,"end":1863},{"text":"oral","label":"ADMINISTRATION","start":1865,"end":1869},{"text":"acyclovir","label":"MEDICATION","start":1870,"end":1879},{"text":"800 mg 5 times daily","label":"DOSAGE","start":1880,"end":1900},{"text":"14 days","label":"DURATION","start":1905,"end":1912},{"text":"oral","label":"ADMINISTRATION","start":1917,"end":1921},{"text":"prednisone","label":"MEDICATION","start":1922,"end":1932},{"text":"60 mg daily","label":"DOSAGE","start":1933,"end":1944},{"text":"7 days","label":"DURATION","start":1949,"end":1955},{"text":"20 mg","label":"DOSAGE","start":1968,"end":1973},{"text":"7 days","label":"DURATION","start":1978,"end":1984},{"text":"Eleven days 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adventitia","label":"BIOLOGICAL_STRUCTURE","start":2256,"end":2275},{"text":"HSV-1 antigen","label":"DIAGNOSTIC_PROCEDURE","start":2313,"end":2326},{"text":"infiltrating leukocytes","label":"DIAGNOSTIC_PROCEDURE","start":2331,"end":2354},{"text":"negative","label":"LAB_VALUE","start":2377,"end":2385},{"text":"intravenous","label":"ADMINISTRATION","start":2428,"end":2439},{"text":"acyclovir","label":"MEDICATION","start":2440,"end":2449},{"text":"10 mg\/kg every 8 h","label":"DOSAGE","start":2451,"end":2469},{"text":"14 days","label":"DURATION","start":2474,"end":2481},{"text":"steroids","label":"MEDICATION","start":2487,"end":2495}],"tokens":["A ","54 year-old"," ","diabetic"," ","woman"," complained of ","blurred vision"," in the ","left eye"," for ","5 days"," without ","scalp"," ","tenderness"," or ","headache",".\n","Visual acuity"," (","VA",") was ","20\/20"," ","right eye"," and ","20\/30"," ","left eye",".\n","Intraocular pressures"," were ","normal",".\n","Funduscopic examination"," revealed ","left optic nerve"," ","edema"," and a ","small"," ","disc margin"," ","hemorrhage",".\n","WBC count"," was ","12,700",", ","ESR"," was ","7"," (normal 0\u201320 mm\/hr) and ","CRP"," was ","2.4"," (normal 0\u20131.0 mg\/dL).\n","Three days later",", she noted new ","left eye"," ","pain"," and her ","vision"," declined to ","counting fingers",".\nThere was no ","pain"," ","on eye movement",".\nThe ","right pupil"," was ","4 mm"," and ","reacted to light","; the ","left pupil"," was ","4 mm",", and there was a ","relative"," ","left afferent pupillary"," ","defect",".\nThe ","left optic nerve"," was ","swollen"," with a ","few"," ","peripapillary nerve fiber layer"," ","hemorrhages"," along with a ","cherry red"," ","spot"," and ","mild"," ","macular"," ","edema"," consistent with ","central retinal artery occlusion","; there were no ","posterior pole"," or ","peripheral retinal"," ","hemorrhages",".\n","Trace cells"," were ","seen"," in the ","anterior chamber",", but ","not"," in the ","vitreous fluid",".\nRepeat ","WBC",", ","ESR"," and ","CRP"," were ","normal",".\n","Treponemal"," and ","Bartonella"," ","antibodies",", the ","QuantiFERON-TB test",", ","blood cultures",", ","EKG"," and ","carotid"," ","Doppler"," ","ultrasound"," were ","unremarkable",".\n","Brain"," ","contrast"," ","MRI"," demonstrated ","no"," ","optic nerve"," enhancement.\n","Twelve days later",", ","left eye"," ","pain"," and ","vision"," ","worsened",", and the patient complained of ","jaw"," ","claudication"," and ","scalp"," ","pain",".\n","VA"," declined to ","no light perception"," in the ","left eye"," with ","1+"," ","cells and flare"," in ","anterior chamber"," and ","2+"," ","vitreous cells and haze",".\n","Funduscopic examination"," revealed ","extensive"," ","retinal"," ","necrosis"," and ","diffuse"," ","hemorrhages"," with ","multiple areas"," of ","focal"," ","venous beading"," (Fig.1), consistent with ","acute retinal necrosis",".\n","Vitreous fluid"," was examined by ","PCR"," for amplifiable ","HSV",", ","VZV",", ","CMV"," and ","toxoplasma"," sequences and returned ","positive"," for ","VZV"," ","DNA",".\nShe was treated with a ","one-time"," ","intravitreal injection"," of ","ganciclovir"," ","2000 mcg\/0.5 ml"," in the ","left eye",", ","oral"," ","acyclovir"," ","800 mg 5 times daily"," for ","14 days"," and ","oral"," ","prednisone"," ","60 mg daily"," for ","7 days"," followed by ","20 mg"," for ","7 days",".\n","Eleven days after"," starting treatment, because she had recently developed ","jaw"," ","claudication"," and ","intermittent"," ","scalp"," ","pain",", a ","temporal artery"," ","biopsy"," was performed.\n","Histological examination"," was ","normal"," (Fig.2) while ","immunohistochemical analysis"," ","demonstrated"," ","VZV antigen"," in the ","arterial adventitia","; evaluation of adjacent sections for ","HSV-1 antigen"," and ","infiltrating leukocytes"," (CD45, not shown) was ","negative"," (Fig.3).\nAntiviral therapy was altered to ","intravenous"," ","acyclovir",", ","10 mg\/kg every 8 h"," for ","14 days",", and ","steroids"," were discontinued.\n"],"ner_labels":[0,5,0,39,0,65,0,69,0,12,0,32,0,12,0,69,0,69,0,24,0,24,0,42,0,12,0,42,0,12,0,24,0,42,0,24,0,12,0,69,0,63,0,12,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,19,0,12,0,69,0,24,0,42,0,69,0,22,0,24,0,27,0,42,0,24,0,27,0,22,0,12,0,69,0,12,0,69,0,22,0,12,0,69,0,15,0,69,0,63,0,12,0,69,0,26,0,12,0,12,0,69,0,24,0,42,0,12,0,42,0,12,0,24,0,24,0,24,0,42,0,22,0,22,0,24,0,24,0,24,0,24,0,12,0,22,0,24,0,42,0,12,0,22,0,24,0,42,0,12,0,19,0,12,0,69,0,24,0,42,0,12,0,69,0,12,0,69,0,24,0,42,0,12,0,42,0,24,0,12,0,42,0,24,0,24,0,63,0,12,0,69,0,22,0,69,0,22,0,22,0,69,0,26,0,12,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,22,0,35,0,4,0,46,0,29,0,12,0,4,0,46,0,29,0,32,0,4,0,46,0,29,0,32,0,29,0,32,0,19,0,12,0,69,0,35,0,12,0,69,0,12,0,24,0,24,0,42,0,24,0,42,0,24,0,12,0,24,0,24,0,42,0,4,0,46,0,29,0,32,0,46,0]}
-{"full_text":"A 23-year-old woman with a history of carnitine deficiency presented with exertional dyspnea and fatigue.\nShe was first diagnosed with nonischemic cardiomyopathy at age 10 years, when she presented with symptoms of congestive heart failure and transthoracic echocardiography (TTE) revealed severe left ventricular (LV) dysfunction.\nAt that time, her total carnitine level was <3 \u03bcmol\/L (normal range, 25\u201369 \u03bcmol\/L), and her free carnitine level was <3 \u03bcmol\/L (normal range, 16\u201360 \u03bcmol\/L).\nThe cardiomyopathy was attributed to carnitine deficiency.\nAfter 5 months of therapy with carnitine supplements, her total carnitine and free carnitine levels had increased to 86 \u03bcmol\/L and 48 \u03bcmol\/L, respectively, and her left ventricular systolic function had normalized, with fractional shortening of 34.7%.\nAt the current admission, the patient reported that, over the past 10 years, she had only been intermittently compliant with her carnitine supplement regimen, and that, approximately 6 months before presentation, her total carnitine and free carnitine levels had dropped to 18 \u03bcmol\/L and 17 \u03bcmol\/L, respectively.\nShe underwent TTE followed by cardiac magnetic resonance (CMR) with gadolinium enhancement.\nThe TTE showed normal LV function and mild, concentric LV hypertrophy (Fig.1).\nResults of CMR confirmed normal LV size and function but showed focal increased wall thickness at the basal and mid lateral wall (end-diastolic thickness, 1.6 cm) (Fig.2) with patchy delayed gadolinium enhancement (Fig.3).\nOn the basis of the patient's family history of sudden cardiac death, abnormal myocardial structure, and underlying disease process, a dual-chamber implantable cardioverter-defibrillator was placed for primary prevention of sudden cardiac death from both bradyarrhythmias and tachyarrhythmias.\n","ner_info":[{"text":"23-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"carnitine deficiency","label":"DISEASE_DISORDER","start":38,"end":58},{"text":"exertional","label":"DETAILED_DESCRIPTION","start":74,"end":84},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":85,"end":92},{"text":"fatigue","label":"SIGN_SYMPTOM","start":97,"end":104},{"text":"nonischemic","label":"DETAILED_DESCRIPTION","start":135,"end":146},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":147,"end":161},{"text":"age 10 years","label":"AGE","start":165,"end":177},{"text":"symptoms","label":"SIGN_SYMPTOM","start":203,"end":211},{"text":"congestive","label":"DETAILED_DESCRIPTION","start":215,"end":225},{"text":"heart failure","label":"DISEASE_DISORDER","start":226,"end":239},{"text":"transthoracic echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":244,"end":274},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":276,"end":279},{"text":"severe","label":"SEVERITY","start":290,"end":296},{"text":"total carnitine level","label":"DIAGNOSTIC_PROCEDURE","start":350,"end":371},{"text":"<3 \u03bcmol\/L","label":"LAB_VALUE","start":376,"end":385},{"text":"free carnitine level","label":"DIAGNOSTIC_PROCEDURE","start":424,"end":444},{"text":"<3 \u03bcmol\/L","label":"LAB_VALUE","start":449,"end":458},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":493,"end":507},{"text":"carnitine deficiency","label":"DISEASE_DISORDER","start":526,"end":546},{"text":"5 months","label":"DURATION","start":554,"end":562},{"text":"carnitine supplements","label":"MEDICATION","start":579,"end":600},{"text":"free carnitine levels","label":"DIAGNOSTIC_PROCEDURE","start":626,"end":647},{"text":"86 \u03bcmol\/L","label":"LAB_VALUE","start":665,"end":674},{"text":"48 \u03bcmol\/L","label":"LAB_VALUE","start":679,"end":688},{"text":"left ventricular","label":"BIOLOGICAL_STRUCTURE","start":712,"end":728},{"text":"systolic function","label":"DIAGNOSTIC_PROCEDURE","start":729,"end":746},{"text":"normalized","label":"LAB_VALUE","start":751,"end":761},{"text":"fractional shortening","label":"DIAGNOSTIC_PROCEDURE","start":768,"end":789},{"text":"34.7%","label":"LAB_VALUE","start":793,"end":798},{"text":"admission","label":"CLINICAL_EVENT","start":815,"end":824},{"text":"over the past 10 years","label":"DURATION","start":853,"end":875},{"text":"intermittently compliant","label":"DETAILED_DESCRIPTION","start":895,"end":919},{"text":"carnitine supplement regimen","label":"MEDICATION","start":929,"end":957},{"text":"6 months before presentation","label":"DATE","start":983,"end":1011},{"text":"total carnitine","label":"DIAGNOSTIC_PROCEDURE","start":1017,"end":1032},{"text":"free carnitine","label":"DIAGNOSTIC_PROCEDURE","start":1037,"end":1051},{"text":"18 \u03bcmol\/L","label":"LAB_VALUE","start":1074,"end":1083},{"text":"17 \u03bcmol\/L","label":"LAB_VALUE","start":1088,"end":1097},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":1127,"end":1130},{"text":"cardiac magnetic resonance","label":"DIAGNOSTIC_PROCEDURE","start":1143,"end":1169},{"text":"CMR","label":"DIAGNOSTIC_PROCEDURE","start":1171,"end":1174},{"text":"gadolinium enhancement","label":"DIAGNOSTIC_PROCEDURE","start":1181,"end":1203},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":1209,"end":1212},{"text":"normal","label":"LAB_VALUE","start":1220,"end":1226},{"text":"LV function","label":"DIAGNOSTIC_PROCEDURE","start":1227,"end":1238},{"text":"mild","label":"SEVERITY","start":1243,"end":1247},{"text":"concentric","label":"DETAILED_DESCRIPTION","start":1249,"end":1259},{"text":"LV hypertrophy","label":"DISEASE_DISORDER","start":1260,"end":1274},{"text":"CMR","label":"DIAGNOSTIC_PROCEDURE","start":1295,"end":1298},{"text":"normal","label":"LAB_VALUE","start":1309,"end":1315},{"text":"LV size","label":"DIAGNOSTIC_PROCEDURE","start":1316,"end":1323},{"text":"focal","label":"DETAILED_DESCRIPTION","start":1348,"end":1353},{"text":"increased","label":"LAB_VALUE","start":1354,"end":1363},{"text":"wall thickness","label":"DIAGNOSTIC_PROCEDURE","start":1364,"end":1378},{"text":"basal and mid lateral wall","label":"BIOLOGICAL_STRUCTURE","start":1386,"end":1412},{"text":"end-diastolic thickness","label":"DIAGNOSTIC_PROCEDURE","start":1414,"end":1437},{"text":"1.6 cm","label":"DISTANCE","start":1439,"end":1445},{"text":"patchy","label":"DETAILED_DESCRIPTION","start":1460,"end":1466},{"text":"delayed gadolinium enhancement","label":"DIAGNOSTIC_PROCEDURE","start":1467,"end":1497},{"text":"sudden cardiac death","label":"FAMILY_HISTORY","start":1555,"end":1575},{"text":"abnormal myocardial structure","label":"FAMILY_HISTORY","start":1577,"end":1606},{"text":"underlying disease process","label":"FAMILY_HISTORY","start":1612,"end":1638},{"text":"dual-chamber","label":"DETAILED_DESCRIPTION","start":1642,"end":1654},{"text":"implantable cardioverter-defibrillator","label":"THERAPEUTIC_PROCEDURE","start":1655,"end":1693},{"text":"sudden cardiac death","label":"DISEASE_DISORDER","start":1731,"end":1751},{"text":"bradyarrhythmias","label":"SIGN_SYMPTOM","start":1762,"end":1778},{"text":"tachyarrhythmias","label":"SIGN_SYMPTOM","start":1783,"end":1799}],"tokens":["A ","23-year-old"," ","woman"," with a history of ","carnitine deficiency"," presented with ","exertional"," ","dyspnea"," and ","fatigue",".\nShe was first diagnosed with ","nonischemic"," ","cardiomyopathy"," at ","age 10 years",", when she presented with ","symptoms"," of ","congestive"," ","heart failure"," and ","transthoracic echocardiography"," (","TTE",") revealed ","severe"," left ventricular (LV) dysfunction.\nAt that time, her ","total carnitine level"," was ","<3 \u03bcmol\/L"," (normal range, 25\u201369 \u03bcmol\/L), and her ","free carnitine level"," was ","<3 \u03bcmol\/L"," (normal range, 16\u201360 \u03bcmol\/L).\nThe ","cardiomyopathy"," was attributed to ","carnitine deficiency",".\nAfter ","5 months"," of therapy with ","carnitine supplements",", her total carnitine and ","free carnitine levels"," had increased to ","86 \u03bcmol\/L"," and ","48 \u03bcmol\/L",", respectively, and her ","left ventricular"," ","systolic function"," had ","normalized",", with ","fractional shortening"," of ","34.7%",".\nAt the current ","admission",", the patient reported that, ","over the past 10 years",", she had only been ","intermittently compliant"," with her ","carnitine supplement regimen",", and that, approximately ","6 months before presentation",", her ","total carnitine"," and ","free carnitine"," levels had dropped to ","18 \u03bcmol\/L"," and ","17 \u03bcmol\/L",", respectively.\nShe underwent ","TTE"," followed by ","cardiac magnetic resonance"," (","CMR",") with ","gadolinium enhancement",".\nThe ","TTE"," showed ","normal"," ","LV function"," and ","mild",", ","concentric"," ","LV hypertrophy"," (Fig.1).\nResults of ","CMR"," confirmed ","normal"," ","LV size"," and function but showed ","focal"," ","increased"," ","wall thickness"," at the ","basal and mid lateral wall"," (","end-diastolic thickness",", ","1.6 cm",") (Fig.2) with ","patchy"," ","delayed gadolinium enhancement"," (Fig.3).\nOn the basis of the patient's family history of ","sudden cardiac death",", ","abnormal myocardial structure",", and ","underlying disease process",", a ","dual-chamber"," ","implantable cardioverter-defibrillator"," was placed for primary prevention of ","sudden cardiac death"," from both ","bradyarrhythmias"," and ","tachyarrhythmias",".\n"],"ner_labels":[0,5,0,65,0,26,0,22,0,69,0,69,0,22,0,26,0,5,0,69,0,22,0,26,0,24,0,24,0,63,0,24,0,42,0,24,0,42,0,26,0,26,0,32,0,46,0,24,0,42,0,42,0,12,0,24,0,42,0,24,0,42,0,13,0,32,0,22,0,46,0,19,0,24,0,24,0,42,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,63,0,22,0,26,0,24,0,42,0,24,0,22,0,42,0,24,0,12,0,24,0,27,0,22,0,24,0,34,0,34,0,34,0,22,0,75,0,26,0,69,0,69,0]}
-{"full_text":"A 14-month-old boy was referred to our hospital from another hospital because of dilated and hypertrophied left ventricle (LV), neutropenia, and developmental delay on 27 October 2011.\nHe was born at full term, with a body weight of 3.2 kg.\nSixteen days after birth, he was hospitalized owing to persistent irritability.\nA chest radiograph showed cardiomegaly, and an echocardiogram revealed decreased LV contractility (ejection fraction: 24%).\nUnder the impression of myocarditis, he had been managed for 1 yr before presentation in our hospital.\nMoreover, the patient showed feeding difficulty and developmental delay from birth.\nBefore referral, he had been admitted to other hospitals 7 times because of infection episodes.\nHe was taking furosemide, spironolactone, enalapril, and carvedilol before referral.\nWhen he was referred to our hospital at 14 months old, his body weight was 6 kg (less than 3rd percentile) and his height was 71 cm (less than 3rd percentile).\nHis overall motor development was delayed, and he could not sit alone.\nHe could say \"mama\" and \"papa.\" The recorded blood pressure and heart rate were 94\/30 mmHg and 132 beats per minute, respectively.\nOn physical examination, no definite heart murmur was audible and the liver was not palpable.\nHe also showed persistent neutropenia, which started during his stay in the previous hospital.\nHis WBC and neutrophil counts were 8,800\/\u00b5L and only 2% (176\/\u00b5L), respectively.\nThe B-natriuretic peptide level was 1,045 pg\/mL.\nA chest radiograph showed mild cardiomegaly (cardiothoracic ratio: 62.8%; Fig.1A), and an electrocardiogram showed a low QRS voltage at the limb leads.\nAn echocardiogram revealed a dilated and hypertrophied globular LV with a hypertrophied papillary muscle and hyper-trabeculation, which did not meet the criteria of LV non-compaction.\nThe other echocardiographic parameters were as follows: LV internal diameter at diastole, 37.7 mm (Z = 10.2); ejection fraction, 36.6%; and LV mass index, 75.6 g (Z = 6.3; Fig.1B).\nTo rule out the systemic cause of the dilated and hypertrophied LV, we performed a thoraco-abdominal computed tomographic (CT) angiography with contrast dye.\nThe CT findings showed no abnormality in the kidney and other organs and vessels.\nHowever, after undergoing CT angiography, the patient showed abrupt high-grade spiking fever (Fig.2) and developed secretory diarrhea (800 cc per day) associated with metabolic acidosis.\nAt this time, his WBC and neutrophil counts decreased to 3,290\/\u00b5L and 1% (33\/\u00b5L), respectively.\nThe B-natriuretic peptide level was greater than 4,901 pg\/mL.\nHe did not show associated respiratory symptoms.\nThe results of the respiratory and gastrointestinal viral studies were negative, and the blood and stool cultures were negative for pathogens.\nThe C-reactive protein level was 7.08 mg\/dL.\nDespite supportive care including intravenous fluid resuscitation and empirical antibiotics, the patient's condition worsened, with aggravated metabolic acidosis and respiratory difficulty, requiring transfer to the intensive care unit (ICU).\nJust before the ICU transfer, the serum pH was 6.881; bicarbonate level, 7.8 mmol\/L; and total CO2 was 41.4 mm Hg.\nAlthough the patient had been treated with intensive ventilator care, several inotropic agents, and other supportive care measures, he eventually died from the aggravated metabolic acidosis and acutely decompensated heart failure 7 days after the ICU care.\nDuring the stay in ICU, we performed genetic analysis for Barth syndrome from the evidence of displayed cardiomyopathy, neutropenia, and developmental delay.\nThe gene sequence analysis revealed that his TAZ gene harbored a novel hemizygous frameshift mutation, c.227delC (p.Pro76LeufsX7), which he inherited from his mother (Fig.3).\n","ner_info":[{"text":"14-month-old","label":"AGE","start":2,"end":14},{"text":"boy","label":"SEX","start":15,"end":18},{"text":"referred","label":"CLINICAL_EVENT","start":23,"end":31},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":39,"end":47},{"text":"from another hospital","label":"NONBIOLOGICAL_LOCATION","start":48,"end":69},{"text":"dilated","label":"SIGN_SYMPTOM","start":81,"end":88},{"text":"hypertrophied","label":"SIGN_SYMPTOM","start":93,"end":106},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":107,"end":121},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":123,"end":125},{"text":"neutropenia","label":"SIGN_SYMPTOM","start":128,"end":139},{"text":"developmental delay","label":"DISEASE_DISORDER","start":145,"end":164},{"text":"27 October 2011","label":"DATE","start":168,"end":183},{"text":"born","label":"CLINICAL_EVENT","start":192,"end":196},{"text":"full term","label":"DETAILED_DESCRIPTION","start":200,"end":209},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":218,"end":229},{"text":"3.2 kg","label":"LAB_VALUE","start":233,"end":239},{"text":"Sixteen days after","label":"DATE","start":241,"end":259},{"text":"hospitalized","label":"CLINICAL_EVENT","start":274,"end":286},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":296,"end":306},{"text":"irritability","label":"SIGN_SYMPTOM","start":307,"end":319},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":323,"end":328},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":329,"end":339},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":347,"end":359},{"text":"echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":368,"end":382},{"text":"decreased","label":"QUALITATIVE_CONCEPT","start":392,"end":401},{"text":"LV contractility","label":"DIAGNOSTIC_PROCEDURE","start":402,"end":418},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":420,"end":437},{"text":"24%","label":"LAB_VALUE","start":439,"end":442},{"text":"myocarditis","label":"DISEASE_DISORDER","start":469,"end":480},{"text":"managed","label":"THERAPEUTIC_PROCEDURE","start":494,"end":501},{"text":"1 yr","label":"DURATION","start":506,"end":510},{"text":"presentation","label":"CLINICAL_EVENT","start":518,"end":530},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":538,"end":546},{"text":"feeding difficulty","label":"SIGN_SYMPTOM","start":577,"end":595},{"text":"developmental delay","label":"SIGN_SYMPTOM","start":600,"end":619},{"text":"birth","label":"CLINICAL_EVENT","start":625,"end":630},{"text":"referral","label":"CLINICAL_EVENT","start":639,"end":647},{"text":"admitted","label":"CLINICAL_EVENT","start":661,"end":669},{"text":"other hospitals","label":"NONBIOLOGICAL_LOCATION","start":673,"end":688},{"text":"7 times","label":"FREQUENCY","start":689,"end":696},{"text":"infection","label":"DISEASE_DISORDER","start":708,"end":717},{"text":"furosemide","label":"MEDICATION","start":742,"end":752},{"text":"spironolactone","label":"MEDICATION","start":754,"end":768},{"text":"enalapril","label":"MEDICATION","start":770,"end":779},{"text":"carvedilol","label":"MEDICATION","start":785,"end":795},{"text":"referral","label":"CLINICAL_EVENT","start":803,"end":811},{"text":"referred","label":"CLINICAL_EVENT","start":825,"end":833},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":841,"end":849},{"text":"14 months old","label":"DATE","start":853,"end":866},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":872,"end":883},{"text":"6 kg","label":"LAB_VALUE","start":888,"end":892},{"text":"less than 3rd percentile","label":"LAB_VALUE","start":894,"end":918},{"text":"height","label":"DIAGNOSTIC_PROCEDURE","start":928,"end":934},{"text":"71 cm","label":"LAB_VALUE","start":939,"end":944},{"text":"less than 3rd percentile","label":"LAB_VALUE","start":946,"end":970},{"text":"motor development","label":"DIAGNOSTIC_PROCEDURE","start":985,"end":1002},{"text":"delayed","label":"LAB_VALUE","start":1007,"end":1014},{"text":"sit alone","label":"ACTIVITY","start":1033,"end":1042},{"text":"could say \"mama\" and \"papa.\"","label":"ACTIVITY","start":1047,"end":1075},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1089,"end":1103},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":1108,"end":1118},{"text":"94\/30 mmHg","label":"LAB_VALUE","start":1124,"end":1134},{"text":"132 beats per minute","label":"LAB_VALUE","start":1139,"end":1159},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1178,"end":1198},{"text":"heart murmur","label":"SIGN_SYMPTOM","start":1212,"end":1224},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":1245,"end":1250},{"text":"palpable","label":"SIGN_SYMPTOM","start":1259,"end":1267},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":1284,"end":1294},{"text":"neutropenia","label":"SIGN_SYMPTOM","start":1295,"end":1306},{"text":"stay","label":"CLINICAL_EVENT","start":1333,"end":1337},{"text":"previous hospital","label":"NONBIOLOGICAL_LOCATION","start":1345,"end":1362},{"text":"WBC","label":"DIAGNOSTIC_PROCEDURE","start":1368,"end":1371},{"text":"neutrophil","label":"DIAGNOSTIC_PROCEDURE","start":1376,"end":1386},{"text":"8,800\/\u00b5L","label":"LAB_VALUE","start":1399,"end":1407},{"text":"2%","label":"LAB_VALUE","start":1417,"end":1419},{"text":"176\/\u00b5L","label":"LAB_VALUE","start":1421,"end":1427},{"text":"B-natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":1448,"end":1469},{"text":"1,045 pg\/mL","label":"LAB_VALUE","start":1480,"end":1491},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1495,"end":1500},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":1501,"end":1511},{"text":"mild","label":"SEVERITY","start":1519,"end":1523},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":1524,"end":1536},{"text":"cardiothoracic ratio","label":"DIAGNOSTIC_PROCEDURE","start":1538,"end":1558},{"text":"62.8%","label":"LAB_VALUE","start":1560,"end":1565},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1583,"end":1600},{"text":"low","label":"LAB_VALUE","start":1610,"end":1613},{"text":"QRS voltage","label":"DIAGNOSTIC_PROCEDURE","start":1614,"end":1625},{"text":"limb 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syndrome","label":"DETAILED_DESCRIPTION","start":3501,"end":3519},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":3551,"end":3565},{"text":"neutropenia","label":"SIGN_SYMPTOM","start":3567,"end":3578},{"text":"developmental delay","label":"DISEASE_DISORDER","start":3584,"end":3603},{"text":"gene sequence analysis","label":"DIAGNOSTIC_PROCEDURE","start":3609,"end":3631},{"text":"TAZ gene","label":"DETAILED_DESCRIPTION","start":3650,"end":3658},{"text":"hemizygous","label":"DETAILED_DESCRIPTION","start":3676,"end":3686},{"text":"frameshift","label":"DETAILED_DESCRIPTION","start":3687,"end":3697},{"text":"mutation","label":"LAB_VALUE","start":3698,"end":3706},{"text":"c.227delC","label":"LAB_VALUE","start":3708,"end":3717},{"text":"p.Pro76LeufsX7","label":"LAB_VALUE","start":3719,"end":3733},{"text":"inherited","label":"DETAILED_DESCRIPTION","start":3745,"end":3754},{"text":"mother","label":"SUBJECT","start":3764,"end":3770}],"tokens":["A ","14-month-old"," ","boy"," was ","referred"," to our ","hospital"," ","from another hospital"," because of ","dilated"," and ","hypertrophied"," ","left ventricle"," (","LV","), ","neutropenia",", and ","developmental delay"," on ","27 October 2011",".\nHe was ","born"," at ","full term",", with a ","body weight"," of ","3.2 kg",".\n","Sixteen days after"," birth, he was ","hospitalized"," owing to ","persistent"," ","irritability",".\nA ","chest"," ","radiograph"," showed ","cardiomegaly",", and an ","echocardiogram"," revealed ","decreased"," ","LV contractility"," (","ejection fraction",": ","24%",").\nUnder the impression of ","myocarditis",", he had been ","managed"," for ","1 yr"," before ","presentation"," in our ","hospital",".\nMoreover, the patient showed ","feeding difficulty"," and ","developmental delay"," from ","birth",".\nBefore ","referral",", he had been ","admitted"," to ","other hospitals"," ","7 times"," because of ","infection"," episodes.\nHe was taking ","furosemide",", ","spironolactone",", ","enalapril",", and ","carvedilol"," before ","referral",".\nWhen he was ","referred"," to our ","hospital"," at ","14 months old",", his ","body weight"," was ","6 kg"," (","less than 3rd percentile",") and his ","height"," was ","71 cm"," (","less than 3rd percentile",").\nHis overall ","motor development"," was ","delayed",", and he could not ","sit alone",".\nHe ","could say \"mama\" and \"papa.\""," The recorded ","blood pressure"," and ","heart rate"," were ","94\/30 mmHg"," and ","132 beats per minute",", respectively.\nOn ","physical examination",", no definite ","heart murmur"," was audible and the ","liver"," was not ","palpable",".\nHe also showed ","persistent"," ","neutropenia",", which started during his ","stay"," in the ","previous hospital",".\nHis ","WBC"," and ","neutrophil"," counts were ","8,800\/\u00b5L"," and only ","2%"," (","176\/\u00b5L","), respectively.\nThe ","B-natriuretic peptide"," level was ","1,045 pg\/mL",".\nA ","chest"," ","radiograph"," showed ","mild"," ","cardiomegaly"," (","cardiothoracic ratio",": ","62.8%","; Fig.1A), and an ","electrocardiogram"," showed a ","low"," ","QRS voltage"," at the ","limb leads",".\nAn ","echocardiogram"," revealed a ","dilated"," and ","hypertrophied"," ","globular"," ","LV"," with a ","hypertrophied"," ","papillary muscle"," and ","hyper-trabeculation",", which did not meet the criteria of ","LV"," ","non-compaction",".\nThe other ","echocardiographic parameters"," were as follows: ","LV"," ","internal diameter at diastole",", ","37.7 mm"," (Z = 10.2); ","ejection fraction",", ","36.6%","; and ","LV"," ","mass index",", ","75.6 g"," (Z = 6.3; Fig.1B).\nTo rule out the systemic cause of the ","dilated"," and ","hypertrophied"," ","LV",", we performed a ","thoraco-abdominal"," ","computed tomographic"," (","CT",") ","angiography"," with ","contrast dye",".\nThe ","CT"," findings showed no ","abnormality"," in the ","kidney"," and other ","organs"," and ","vessels",".\nHowever, after undergoing ","CT"," ","angiography",", the patient showed ","abrupt"," ","high-grade"," ","spiking"," ","fever"," (Fig.2) and developed ","secretory"," ","diarrhea"," (","800 cc per day",") associated with ","metabolic acidosis",".\nAt this time, his ","WBC"," and ","neutrophil"," counts ","decreased"," to ","3,290\/\u00b5L"," and ","1%"," (","33\/\u00b5L","), respectively.\nThe ","B-natriuretic peptide"," level was ","greater than 4,901 pg\/mL",".\nHe did not show associated ","respiratory symptoms",".\nThe results of the ","respiratory"," and ","gastrointestinal"," ","viral studies"," were ","negative",", and the ","blood"," and ","stool"," ","cultures"," were ","negative"," for pathogens.\nThe ","C-reactive protein"," level was ","7.08 mg\/dL",".\nDespite ","supportive care"," including ","intravenous"," ","fluid resuscitation"," and ","empirical"," ","antibiotics",", the patient's ","condition"," ","worsened",", with aggravated ","metabolic acidosis"," and ","respiratory difficulty",", requiring ","transfer"," to the ","intensive care unit"," (","ICU",").\nJust before the ","ICU"," ","transfer",", the ","serum"," ","pH"," was ","6.881","; ","bicarbonate"," level, ","7.8 mmol\/L","; and total ","CO2"," was ","41.4 mm Hg",".\nAlthough the patient had been treated with intensive ","ventilator"," care, ","several"," ","inotropic agents",", and other ","supportive care"," measures, he eventually ","died"," from the ","aggravated"," ","metabolic acidosis"," and ","acutely decompensated"," ","heart failure"," ","7 days after"," the ","ICU"," ","care",".\nDuring the ","stay"," in ","ICU",", we performed ","genetic analysis"," ","for Barth syndrome"," from the evidence of displayed ","cardiomyopathy",", ","neutropenia",", and ","developmental delay",".\nThe ","gene sequence analysis"," revealed that his ","TAZ gene"," harbored a novel ","hemizygous"," ","frameshift"," ","mutation",", ","c.227delC"," (","p.Pro76LeufsX7","), which he ","inherited"," from his ","mother"," 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-{"full_text":"An 84-year-old male patient with a history of coronary artery disease and right coronary artery (RCA) stenting was admitted to our university hospital in February 2012 because of progressive dyspnoea and recurring syncopes.\nCardiological work-up revealed a grade III severe symptomatic aortic stenosis.\nDue to relevant comorbidities (logistic EuroSCORE of 19 points) and severe femoral arteriopathy, he was scheduled for trans-subclavian TAVI.\nAfter successful implantation of a CoreValve prosthesis (Medtronic) [Medtronic World Headquarters Medtronic Parkway Minneapolis, Minnesota, USA] (diameter 31 mm) and initial discharge, he was referred back to the hospital because of dyspnoea due to bilateral pleural effusions.\nTransoesophageal echocardiography (TEE) showed a severe mitral regurgitation (MR), which was subsequently treated by interventional mitral valve repair using the MitraClip (Abbott Vascular, Abbott Laboratories, Abbott Park, Illinois, U.S.A.) and procedurally dependent atrial septal defect (ASD) closure AMPLATZER\u2122 PFO Occluder (St.\nJude Medical GmbH, Helfmann-Park 7, Eschborn, Germany).\nTwo weeks after secondary discharge, the patient developed progressive heart failure in combination with acute renal failure.\nImmediate echocardiography revealed a moderate-to-severe aortic regurgitation and recurrent severe MR.\nValvular defects resulted from a slight but significant aortic valve prosthesis migration towards the left ventricular outflow tract, which had caused aortic paravalvular leakage and partial posterior mitral leaflet detachment (Fig.1).\nAs a consequence of these findings, the patient was transferred to our cardiac surgery department.\nPreoperative coronary angiography revealed a progression of the coronary artery disease.\nConsequently the patient was scheduled for conventional aortic and mitral valve replacement, as well as coronary artery bypass surgery.\nThe operation was performed via median sternotomy.\nOn initialization of cardiopulmonary bypass, the ascending aorta was opened for exploration of the aortic valve (Fig.2A).\nAfter careful removal of the CoreValve prosthesis, an Edwards Perimount aortic valve prosthesis (diameter 25 mm) was implanted.\nAfter vein-grafting of the circumflex coronary artery, the mitral valve was explored via the left atrium and excised with the attached clip.\nThereafter, an Edwards Perimount mitral valve prosthesis (diameter 31 mm) was implanted.\nMore recently, the atrial septal occluder was removed prior to direct closure of the resulting septal defect with a single-suture line (Fig.2B).\nIntraoperative echocardiography revealed adequate function of both prostheses and the operation was completed in the usual manner.\nDuring the postoperative phase, the patient recovered well from surgery although hospitalization was prolonged by transient renal failure and recurring pleural effusions.\nAfter a month of postoperative care, the patient was discharged from hospital to rehabilitation in a good condition, without signs for heart failure.\nAt follow-up three months after surgery, the patient was still in a cardiopulmonary stable condition, undergoing additional physiotherapy.\n","ner_info":[{"text":"84-year-old","label":"AGE","start":3,"end":14},{"text":"male","label":"SEX","start":15,"end":19},{"text":"coronary artery disease and right coronary artery (RCA) stenting","label":"HISTORY","start":46,"end":110},{"text":"admitted","label":"CLINICAL_EVENT","start":115,"end":123},{"text":"university hospital","label":"NONBIOLOGICAL_LOCATION","start":131,"end":150},{"text":"February 2012","label":"DATE","start":154,"end":167},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":179,"end":190},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":191,"end":199},{"text":"recurring","label":"DETAILED_DESCRIPTION","start":204,"end":213},{"text":"syncopes","label":"SIGN_SYMPTOM","start":214,"end":222},{"text":"Cardiological 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prosthesis","label":"DETAILED_DESCRIPTION","start":479,"end":499},{"text":"Medtronic","label":"DETAILED_DESCRIPTION","start":501,"end":510},{"text":"Medtronic World Headquarters Medtronic Parkway Minneapolis, Minnesota, USA","label":"DETAILED_DESCRIPTION","start":513,"end":587},{"text":"diameter 31 mm","label":"DETAILED_DESCRIPTION","start":590,"end":604},{"text":"discharge","label":"CLINICAL_EVENT","start":618,"end":627},{"text":"referred","label":"CLINICAL_EVENT","start":636,"end":644},{"text":"hospital","label":"BIOLOGICAL_STRUCTURE","start":657,"end":665},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":677,"end":685},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":693,"end":702},{"text":"pleural effusions","label":"DISEASE_DISORDER","start":703,"end":720},{"text":"Transoesophageal echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":722,"end":755},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":757,"end":760},{"text":"severe","label":"SEVERITY","start":771,"end":777},{"text":"mitral regurgitation","label":"SIGN_SYMPTOM","start":778,"end":798},{"text":"MR","label":"SIGN_SYMPTOM","start":800,"end":802},{"text":"interventional","label":"DETAILED_DESCRIPTION","start":839,"end":853},{"text":"mitral valve repair","label":"THERAPEUTIC_PROCEDURE","start":854,"end":873},{"text":"MitraClip","label":"BIOLOGICAL_STRUCTURE","start":884,"end":893},{"text":"Abbott Vascular, Abbott Laboratories, Abbott Park, Illinois, U.S.A.","label":"DETAILED_DESCRIPTION","start":895,"end":962},{"text":"atrial septal defect (ASD) closure","label":"THERAPEUTIC_PROCEDURE","start":991,"end":1025},{"text":"AMPLATZER\u2122 PFO Occluder","label":"DETAILED_DESCRIPTION","start":1026,"end":1049},{"text":"Two weeks 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artery (RCA) stenting"," was ","admitted"," to our ","university hospital"," in ","February 2012"," because of ","progressive"," ","dyspnoea"," and ","recurring"," ","syncopes",".\n","Cardiological work-up"," revealed a ","grade III"," ","severe"," ","symptomatic"," ","aortic stenosis",".\nDue to relevant comorbidities (","logistic EuroSCORE"," of ","19 points",") and ","severe"," ","femoral"," ","arteriopathy",", he was scheduled for ","trans-subclavian"," ","TAVI",".\nAfter successful ","implantation"," of a ","CoreValve prosthesis"," (","Medtronic",") [","Medtronic World Headquarters Medtronic Parkway Minneapolis, Minnesota, USA","] (","diameter 31 mm",") and initial ","discharge",", he was ","referred"," back to the ","hospital"," because of ","dyspnoea"," due to ","bilateral"," ","pleural effusions",".\n","Transoesophageal echocardiography"," (","TEE",") showed a ","severe"," ","mitral regurgitation"," (","MR","), which was subsequently treated by ","interventional"," ","mitral valve repair"," using the ","MitraClip"," (","Abbott Vascular, Abbott Laboratories, Abbott Park, Illinois, U.S.A.",") and procedurally dependent ","atrial septal defect (ASD) closure"," ","AMPLATZER\u2122 PFO Occluder"," (St.\nJude Medical GmbH, Helfmann-Park 7, Eschborn, Germany).\n","Two weeks after"," ","secondary"," ","discharge",", the patient developed ","progressive"," ","heart failure"," in combination with ","acute"," ","renal failure",".\n","Immediate"," ","echocardiography"," revealed a ","moderate-to-severe"," ","aortic regurgitation"," and ","recurrent"," ","severe"," ","MR",".\n","Valvular defects"," resulted from a ","slight but significant"," ","aortic valve prosthesis migration"," towards the ","left ventricular outflow tract",", which had caused ","aortic paravalvular leakage"," and ","partial"," ","posterior"," ","mitral leaflet detachment"," (Fig.1).\nAs a consequence of these findings, the patient was ","transferred"," to our ","cardiac surgery department",".\nPreoperative ","coronary"," ","angiography"," revealed a progression of the ","coronary artery disease",".\nConsequently the patient was scheduled for ","conventional"," ","aortic"," and ","mitral"," ","valve replacement",", as well as ","coronary artery bypass surgery",".\nThe operation was performed via ","median sternotomy",".\nOn initialization of ","cardiopulmonary bypass",", the ","ascending aorta"," was ","opened"," for ","exploration"," of the ","aortic valve"," (Fig.2A).\nAfter careful ","removal"," of the ","CoreValve prosthesis",", an ","Edwards Perimount"," ","aortic valve prosthesis"," (","diameter 25 mm",") was ","implanted",".\nAfter ","vein-grafting"," of the ","circumflex coronary artery",", the ","mitral valve"," was ","explored via the left atrium"," and ","excised"," with the ","attached clip",".\nThereafter, an ","Edwards Perimount"," ","mitral valve prosthesis"," (","diameter 31 mm",") was ","implanted",".\nMore recently, the ","atrial septal occluder was removed"," prior to direct ","closure"," of the resulting ","septal defect"," with a ","single-suture line"," (Fig.2B).\n","Intraoperative"," ","echocardiography"," revealed ","adequate function of both prostheses"," and the operation was completed in the usual manner.\nDuring the postoperative phase, the patient ","recovered"," ","well"," from surgery although ","hospitalization was prolonged"," by ","transient"," ","renal failure"," and ","recurring"," ","pleural effusions",".\n","After a month"," of ","postoperative care",", the patient was ","discharged"," from ","hospital"," to ","rehabilitation"," in a ","good"," ","condition",", without ","signs for heart failure",".\nAt ","follow-up"," ","three months after"," surgery, the patient was still in a ","cardiopulmonary stable"," ","condition",", undergoing additional 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-{"full_text":"A 60-year-old Caucasian woman with no significant medical history developed exercise intolerance, fatigue and shortness of breath on exertion over the several months prior to her presentation to our outpatient clinic.\nAt the time of presentation, she also reported of dry cough, orthopnea, paroxysmal nocturnal dyspnoea, generalised weakness and intermittent numbness of her hands and feet.\nSocial history was negative for smoking, alcohol or illicit drugs.\nPhysical examination was unremarkable, except for jugular venous distension, audible S1 and S2 sounds, bilateral crackles on lung auscultation and bilateral pitting oedema.\nChest X-ray showed cardiomegaly, pulmonary oedema and small-sized bilateral pleural effusions.\nA 12-lead ECG demonstrated normal sinus rhythm, low-voltage complexes and extreme right-axis deviation (figure 1).\nTransthoracic echocardiogram (TTE) demonstrated asymmetric biventricular hypertrophy with preserved ejection fraction of 60%, elevated right-ventricular systolic pressure of 36\u2005mm\u2005Hg and abnormal myocardial texture, described as \u2018granular sparkling\u2019 (figure 2).\nCoronary CT angiogram demonstrated normal coronary arteries.\nSubsequently, cardiac MRI demonstrated early and diffuse subendocardial delayed enhancement, concerning for infiltrative myocardial disease and for diffuse biventricular hypertrophy, with normal ejection fraction (figure 3).\nThe patient underwent right heart catheterisation with endomyocardial biopsy, revealing diffuse amyloidosis with amorphous proteinaceous material around cardiac myocytes and within blood vessels, which was positive for Congo red stain (figure 4).\nSubsequent laboratory evaluation registered elevated, free \u03bb light chains (86.3\u2005mg\/L (normal: 5.7\u201326.3\u2005mg\/L)) and positive Bence-Jones protein (0.37\u2005g\/24\u2005h) in the urine.\nBone marrow biopsy revealed greater than 10% infiltration of CD19\u2212 CD56+ CD138+ plasma cells with reversal of marrow \u03ba\/\u03bb ratio (<1:2, normal: 2:1), consistent with MM.\nThe patient was eventually diagnosed with systemic AL amyloidosis with advanced, stage III, cardiac amyloidosis due to underlying MM.\nGiven her advanced cardiac amyloidosis, the patient was deemed a poor candidate for autologous stem-cell transplantation.\nThe patient was started on systemic chemotherapy with melphalan and dexamethasone.\nDespite receiving standard therapy for heart failure\u2014including diuretics, \u03b2-blockers and ACE inhibitors\u2014the patient's condition continued to worsen and she succumbed to sudden cardiac death.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":14,"end":23},{"text":"woman","label":"SEX","start":24,"end":29},{"text":"no significant medical history","label":"HISTORY","start":35,"end":65},{"text":"exercise intolerance","label":"SIGN_SYMPTOM","start":76,"end":96},{"text":"fatigue","label":"SIGN_SYMPTOM","start":98,"end":105},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":110,"end":129},{"text":"exertion","label":"DETAILED_DESCRIPTION","start":133,"end":141},{"text":"several months prior","label":"DURATION","start":151,"end":171},{"text":"presentation","label":"CLINICAL_EVENT","start":179,"end":191},{"text":"outpatient clinic","label":"NONBIOLOGICAL_LOCATION","start":199,"end":216},{"text":"dry","label":"DETAILED_DESCRIPTION","start":268,"end":271},{"text":"cough","label":"SIGN_SYMPTOM","start":272,"end":277},{"text":"orthopnea","label":"SIGN_SYMPTOM","start":279,"end":288},{"text":"paroxysmal","label":"DETAILED_DESCRIPTION","start":290,"end":300},{"text":"nocturnal","label":"DETAILED_DESCRIPTION","start":301,"end":310},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":311,"end":319},{"text":"generalised","label":"DETAILED_DESCRIPTION","start":321,"end":332},{"text":"weakness","label":"SIGN_SYMPTOM","start":333,"end":341},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":346,"end":358},{"text":"numbness","label":"SIGN_SYMPTOM","start":359,"end":367},{"text":"hands","label":"BIOLOGICAL_STRUCTURE","start":375,"end":380},{"text":"feet","label":"BIOLOGICAL_STRUCTURE","start":385,"end":389},{"text":"Social history was negative for smoking, alcohol or illicit drugs","label":"HISTORY","start":391,"end":456},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":458,"end":478},{"text":"unremarkable","label":"LAB_VALUE","start":483,"end":495},{"text":"jugular venous","label":"BIOLOGICAL_STRUCTURE","start":508,"end":522},{"text":"distension","label":"SIGN_SYMPTOM","start":523,"end":533},{"text":"S1 and S2 sounds","label":"SIGN_SYMPTOM","start":543,"end":559},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":561,"end":570},{"text":"crackles","label":"SIGN_SYMPTOM","start":571,"end":579},{"text":"lung auscultation","label":"DIAGNOSTIC_PROCEDURE","start":583,"end":600},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":605,"end":614},{"text":"pitting","label":"DETAILED_DESCRIPTION","start":615,"end":622},{"text":"oedema","label":"SIGN_SYMPTOM","start":623,"end":629},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":631,"end":636},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":637,"end":642},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":650,"end":662},{"text":"pulmonary oedema","label":"SIGN_SYMPTOM","start":664,"end":680},{"text":"small-sized","label":"SEVERITY","start":685,"end":696},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":697,"end":706},{"text":"pleural effusions","label":"SIGN_SYMPTOM","start":707,"end":724},{"text":"12-lead","label":"DETAILED_DESCRIPTION","start":728,"end":735},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":736,"end":739},{"text":"normal","label":"LAB_VALUE","start":753,"end":759},{"text":"sinus rhythm","label":"DIAGNOSTIC_PROCEDURE","start":760,"end":772},{"text":"low-voltage complexes","label":"SIGN_SYMPTOM","start":774,"end":795},{"text":"extreme","label":"SEVERITY","start":800,"end":807},{"text":"right-axis deviation","label":"SIGN_SYMPTOM","start":808,"end":828},{"text":"Transthoracic echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":841,"end":869},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":871,"end":874},{"text":"asymmetric","label":"DETAILED_DESCRIPTION","start":889,"end":899},{"text":"biventricular","label":"BIOLOGICAL_STRUCTURE","start":900,"end":913},{"text":"hypertrophy","label":"SIGN_SYMPTOM","start":914,"end":925},{"text":"preserved","label":"LAB_VALUE","start":931,"end":940},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":941,"end":958},{"text":"60%","label":"LAB_VALUE","start":962,"end":965},{"text":"elevated","label":"LAB_VALUE","start":967,"end":975},{"text":"right-ventricular","label":"BIOLOGICAL_STRUCTURE","start":976,"end":993},{"text":"systolic pressure","label":"DIAGNOSTIC_PROCEDURE","start":994,"end":1011},{"text":"36\u2005mm\u2005Hg","label":"LAB_VALUE","start":1015,"end":1023},{"text":"abnormal","label":"LAB_VALUE","start":1028,"end":1036},{"text":"myocardial texture","label":"DIAGNOSTIC_PROCEDURE","start":1037,"end":1055},{"text":"granular sparkling","label":"TEXTURE","start":1071,"end":1089},{"text":"Coronary","label":"BIOLOGICAL_STRUCTURE","start":1103,"end":1111},{"text":"CT angiogram","label":"DIAGNOSTIC_PROCEDURE","start":1112,"end":1124},{"text":"normal","label":"LAB_VALUE","start":1138,"end":1144},{"text":"coronary arteries","label":"BIOLOGICAL_STRUCTURE","start":1145,"end":1162},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":1178,"end":1185},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1186,"end":1189},{"text":"early","label":"DETAILED_DESCRIPTION","start":1203,"end":1208},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1213,"end":1220},{"text":"subendocardial","label":"BIOLOGICAL_STRUCTURE","start":1221,"end":1235},{"text":"delayed enhancement","label":"SIGN_SYMPTOM","start":1236,"end":1255},{"text":"infiltrative myocardial disease","label":"DISEASE_DISORDER","start":1272,"end":1303},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1312,"end":1319},{"text":"biventricular","label":"BIOLOGICAL_STRUCTURE","start":1320,"end":1333},{"text":"hypertrophy","label":"SIGN_SYMPTOM","start":1334,"end":1345},{"text":"normal","label":"LAB_VALUE","start":1352,"end":1358},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1359,"end":1376},{"text":"right","label":"DETAILED_DESCRIPTION","start":1411,"end":1416},{"text":"heart catheterisation","label":"THERAPEUTIC_PROCEDURE","start":1417,"end":1438},{"text":"endomyocardial","label":"BIOLOGICAL_STRUCTURE","start":1444,"end":1458},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1459,"end":1465},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1477,"end":1484},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":1485,"end":1496},{"text":"amorphous","label":"DETAILED_DESCRIPTION","start":1502,"end":1511},{"text":"proteinaceous material","label":"SIGN_SYMPTOM","start":1512,"end":1534},{"text":"cardiac myocytes","label":"BIOLOGICAL_STRUCTURE","start":1542,"end":1558},{"text":"blood vessels","label":"BIOLOGICAL_STRUCTURE","start":1570,"end":1583},{"text":"positive","label":"LAB_VALUE","start":1595,"end":1603},{"text":"Congo red stain","label":"DIAGNOSTIC_PROCEDURE","start":1608,"end":1623},{"text":"laboratory evaluation","label":"DIAGNOSTIC_PROCEDURE","start":1647,"end":1668},{"text":"elevated","label":"LAB_VALUE","start":1680,"end":1688},{"text":"free \u03bb light chains","label":"DIAGNOSTIC_PROCEDURE","start":1690,"end":1709},{"text":"86.3\u2005mg\/L","label":"LAB_VALUE","start":1711,"end":1720},{"text":"positive","label":"LAB_VALUE","start":1750,"end":1758},{"text":"Bence-Jones protein","label":"DIAGNOSTIC_PROCEDURE","start":1759,"end":1778},{"text":"0.37\u2005g\/24\u2005h","label":"LAB_VALUE","start":1780,"end":1791},{"text":"urine","label":"DETAILED_DESCRIPTION","start":1800,"end":1805},{"text":"Bone marrow","label":"BIOLOGICAL_STRUCTURE","start":1807,"end":1818},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1819,"end":1825},{"text":"greater than 10%","label":"LAB_VALUE","start":1835,"end":1851},{"text":"infiltration","label":"DIAGNOSTIC_PROCEDURE","start":1852,"end":1864},{"text":"CD19\u2212 CD56+ CD138+ plasma cells","label":"DETAILED_DESCRIPTION","start":1868,"end":1899},{"text":"reversal","label":"LAB_VALUE","start":1905,"end":1913},{"text":"marrow \u03ba\/\u03bb ratio","label":"DIAGNOSTIC_PROCEDURE","start":1917,"end":1933},{"text":"<1:2","label":"LAB_VALUE","start":1935,"end":1939},{"text":"MM","label":"DISEASE_DISORDER","start":1971,"end":1973},{"text":"systemic","label":"DETAILED_DESCRIPTION","start":2017,"end":2025},{"text":"AL","label":"DETAILED_DESCRIPTION","start":2026,"end":2028},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":2029,"end":2040},{"text":"advanced","label":"SEVERITY","start":2046,"end":2054},{"text":"stage III","label":"DETAILED_DESCRIPTION","start":2056,"end":2065},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2067,"end":2074},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":2075,"end":2086},{"text":"MM","label":"DISEASE_DISORDER","start":2105,"end":2107},{"text":"advanced","label":"SEVERITY","start":2119,"end":2127},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2128,"end":2135},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":2136,"end":2147},{"text":"autologous stem-cell transplantation","label":"THERAPEUTIC_PROCEDURE","start":2193,"end":2229},{"text":"systemic","label":"DETAILED_DESCRIPTION","start":2258,"end":2266},{"text":"chemotherapy","label":"MEDICATION","start":2267,"end":2279},{"text":"melphalan","label":"MEDICATION","start":2285,"end":2294},{"text":"dexamethasone","label":"MEDICATION","start":2299,"end":2312},{"text":"diuretics","label":"MEDICATION","start":2377,"end":2386},{"text":"\u03b2-blockers","label":"MEDICATION","start":2388,"end":2398},{"text":"ACE inhibitors","label":"MEDICATION","start":2403,"end":2417},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":2432,"end":2441},{"text":"worsen","label":"LAB_VALUE","start":2455,"end":2461},{"text":"succumbed","label":"OUTCOME","start":2470,"end":2479},{"text":"sudden cardiac death","label":"DISEASE_DISORDER","start":2483,"end":2503}],"tokens":["A ","60-year-old"," ","Caucasian"," ","woman"," with ","no significant medical history"," developed ","exercise intolerance",", ","fatigue"," and ","shortness of breath"," on ","exertion"," over the ","several months prior"," to her ","presentation"," to our ","outpatient clinic",".\nAt the time of presentation, she also reported of ","dry"," ","cough",", ","orthopnea",", ","paroxysmal"," ","nocturnal"," ","dyspnoea",", ","generalised"," ","weakness"," and ","intermittent"," ","numbness"," of her ","hands"," and ","feet",".\n","Social history was negative for smoking, alcohol or illicit drugs",".\n","Physical examination"," was ","unremarkable",", except for ","jugular venous"," ","distension",", audible ","S1 and S2 sounds",", ","bilateral"," ","crackles"," on ","lung auscultation"," and ","bilateral"," ","pitting"," ","oedema",".\n","Chest"," ","X-ray"," showed ","cardiomegaly",", ","pulmonary oedema"," and ","small-sized"," ","bilateral"," ","pleural effusions",".\nA ","12-lead"," ","ECG"," demonstrated ","normal"," ","sinus rhythm",", ","low-voltage complexes"," and ","extreme"," ","right-axis deviation"," (figure 1).\n","Transthoracic echocardiogram"," (","TTE",") demonstrated ","asymmetric"," ","biventricular"," ","hypertrophy"," with ","preserved"," ","ejection fraction"," of ","60%",", ","elevated"," ","right-ventricular"," ","systolic pressure"," of ","36\u2005mm\u2005Hg"," and ","abnormal"," ","myocardial texture",", described as \u2018","granular sparkling","\u2019 (figure 2).\n","Coronary"," ","CT angiogram"," demonstrated ","normal"," ","coronary arteries",".\nSubsequently, ","cardiac"," ","MRI"," demonstrated ","early"," and ","diffuse"," ","subendocardial"," ","delayed enhancement",", concerning for ","infiltrative myocardial disease"," and for ","diffuse"," ","biventricular"," ","hypertrophy",", with ","normal"," ","ejection fraction"," (figure 3).\nThe patient underwent ","right"," ","heart catheterisation"," with ","endomyocardial"," ","biopsy",", revealing ","diffuse"," ","amyloidosis"," with ","amorphous"," ","proteinaceous material"," around ","cardiac myocytes"," and within ","blood vessels",", which was ","positive"," for ","Congo red stain"," (figure 4).\nSubsequent ","laboratory evaluation"," registered ","elevated",", ","free \u03bb light chains"," (","86.3\u2005mg\/L"," (normal: 5.7\u201326.3\u2005mg\/L)) and ","positive"," ","Bence-Jones protein"," (","0.37\u2005g\/24\u2005h",") in the ","urine",".\n","Bone marrow"," ","biopsy"," revealed ","greater than 10%"," ","infiltration"," of ","CD19\u2212 CD56+ CD138+ plasma cells"," with ","reversal"," of ","marrow \u03ba\/\u03bb ratio"," (","<1:2",", normal: 2:1), consistent with ","MM",".\nThe patient was eventually diagnosed with ","systemic"," ","AL"," ","amyloidosis"," with ","advanced",", ","stage III",", ","cardiac"," ","amyloidosis"," due to underlying ","MM",".\nGiven her ","advanced"," ","cardiac"," ","amyloidosis",", the patient was deemed a poor candidate for ","autologous stem-cell transplantation",".\nThe patient was started on ","systemic"," ","chemotherapy"," with ","melphalan"," and ","dexamethasone",".\nDespite receiving standard therapy for heart failure\u2014including ","diuretics",", ","\u03b2-blockers"," and ","ACE inhibitors","\u2014the patient's ","condition"," continued to ","worsen"," and she ","succumbed"," to ","sudden cardiac death",".\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,69,0,69,0,69,0,22,0,32,0,13,0,48,0,22,0,69,0,69,0,22,0,22,0,69,0,22,0,69,0,22,0,69,0,12,0,12,0,39,0,24,0,42,0,12,0,69,0,69,0,22,0,69,0,24,0,22,0,22,0,69,0,12,0,24,0,69,0,69,0,63,0,22,0,69,0,22,0,24,0,42,0,24,0,69,0,63,0,69,0,24,0,24,0,22,0,12,0,69,0,42,0,24,0,42,0,42,0,12,0,24,0,42,0,42,0,24,0,73,0,12,0,24,0,42,0,12,0,12,0,24,0,22,0,22,0,12,0,69,0,26,0,22,0,12,0,69,0,42,0,24,0,22,0,75,0,12,0,24,0,22,0,26,0,22,0,69,0,12,0,12,0,42,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,22,0,12,0,24,0,42,0,24,0,22,0,42,0,24,0,42,0,26,0,22,0,22,0,26,0,63,0,22,0,12,0,26,0,26,0,63,0,12,0,26,0,75,0,22,0,46,0,46,0,46,0,46,0,46,0,46,0,24,0,42,0,56,0,26,0]}
-{"full_text":"A 24-year-old Malay male patient was referred to the respiratory clinic because of an abnormal pre-employment chest radiograph.\nHe had been smoking about 10 cigarettes a day since he was 21 years of age.\nHe stopped smoking 10 months ago after he noticed he had being having reduced effort tolerance for the past three years.\nHe was an office worker and did not have a history of exposure to organic or inorganic dusts.\nHis two siblings were asymptomatic.\nOn examination, the patient was not tachypnoeic.\nThere were no signs of finger clubbing or pulmonary hypertension.\nHis oxygen saturation on room air at rest was 94% and dropped to 92% after climbing up four flights of stairs.\nSpirometry testing revealed a restrictive pattern of lung disease with a forced expiratory volume in 1 second (FEV1) and a forced vital capacity (FVC) of 2.7 L (69% of predicted) and 3.2 L (68% of predicted), respectively.\nThe FEV1\/FVC ratio was 85%.\nHis haemoglobin (168 g\/L), serum parathyroid hormone (2.9 pmol\/L [normal, 1.1-7.3]) and calcium (2.34 mmol\/L) levels were normal.\n24-hour urine calcium was also normal 6.9 mmol with a 24-hour urine volume of 2.8 L.\nHis chest radiograph (Fig.1A) revealed dense micronodular opacities distributed symmetrically and predominantly in the middle to lower zones of both lungs giving the classical \"sandstorm\" appearance.\nThe cardiac borders were obscured by the sand-like opacities.\nA high-resolution computed tomography (HRCT) scan of the lungs (Fig.1B) showed widespread tiny microcalcifications throughout the lungs with a preponderance of microliths in the lower lobes.\nThere were associated areas of interlobular septal thickening and ground-glass changes.\nSubpleural cystic changes were also seen in both lower lobes giving rise to the 'black pleura sign' (Fig.1C) (2).\nNo pneumothorax or pleural effusion was present.\nBoth the bronchial system (including the small bronchioles) and the size of the pulmonary vessels were normal.\nAs this was diffuse parenchymal lung disease, videoassisted thoracic surgical (VATS) lung biopsy was planned but the procedure was converted into a mini-thoracotomy because there was difficulty in manoeuvering the endostapler.\nThere was a moderate pneumothorax postmini-thoracotomy from which the patient fully recovered after 5 days in the ward.\nThe lung biopsy specimen revealed features consistent with PAM, with numerous calcospherites within the alveolar spaces (Fig.1D).\nThe intervening alveolar septae were congested and showed mild fibrosis with infiltrates of mainly lymphoplasmacytic cells.\n","ner_info":[{"text":"24-year-old","label":"AGE","start":2,"end":13},{"text":"Malay","label":"PERSONAL_BACKGROUND","start":14,"end":19},{"text":"male","label":"SEX","start":20,"end":24},{"text":"referred","label":"CLINICAL_EVENT","start":37,"end":45},{"text":"respiratory clinic","label":"NONBIOLOGICAL_LOCATION","start":53,"end":71},{"text":"abnormal","label":"LAB_VALUE","start":86,"end":94},{"text":"pre-employment","label":"DETAILED_DESCRIPTION","start":95,"end":109},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":110,"end":115},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":116,"end":126},{"text":"smoking","label":"ACTIVITY","start":140,"end":147},{"text":"10 cigarettes a day","label":"DETAILED_DESCRIPTION","start":154,"end":173},{"text":"since he was 21 years of age","label":"DURATION","start":174,"end":202},{"text":"stopped smoking 10 months ago after he noticed he had being having reduced effort tolerance for the past three years","label":"HISTORY","start":207,"end":323},{"text":"office worker","label":"OCCUPATION","start":335,"end":348},{"text":"did not have a history of exposure to organic or inorganic dusts","label":"HISTORY","start":353,"end":417},{"text":"two siblings were asymptomatic","label":"FAMILY_HISTORY","start":423,"end":453},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":458,"end":469},{"text":"tachypnoeic","label":"SIGN_SYMPTOM","start":491,"end":502},{"text":"finger clubbing","label":"SIGN_SYMPTOM","start":527,"end":542},{"text":"pulmonary","label":"DETAILED_DESCRIPTION","start":546,"end":555},{"text":"hypertension","label":"DISEASE_DISORDER","start":556,"end":568},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":574,"end":591},{"text":"room air","label":"DETAILED_DESCRIPTION","start":595,"end":603},{"text":"at rest","label":"DETAILED_DESCRIPTION","start":604,"end":611},{"text":"94%","label":"LAB_VALUE","start":616,"end":619},{"text":"dropped","label":"LAB_VALUE","start":624,"end":631},{"text":"92%","label":"LAB_VALUE","start":635,"end":638},{"text":"climbing","label":"ACTIVITY","start":645,"end":653},{"text":"four flights of stairs","label":"DETAILED_DESCRIPTION","start":657,"end":679},{"text":"Spirometry testing","label":"DIAGNOSTIC_PROCEDURE","start":681,"end":699},{"text":"restrictive pattern","label":"DETAILED_DESCRIPTION","start":711,"end":730},{"text":"lung disease","label":"DISEASE_DISORDER","start":734,"end":746},{"text":"forced expiratory volume in 1 second","label":"DIAGNOSTIC_PROCEDURE","start":754,"end":790},{"text":"FEV1","label":"DIAGNOSTIC_PROCEDURE","start":792,"end":796},{"text":"forced vital capacity","label":"DIAGNOSTIC_PROCEDURE","start":804,"end":825},{"text":"FVC","label":"DIAGNOSTIC_PROCEDURE","start":827,"end":830},{"text":"2.7 L","label":"LAB_VALUE","start":835,"end":840},{"text":"3.2 L","label":"LAB_VALUE","start":864,"end":869},{"text":"FEV1\/FVC ratio","label":"DIAGNOSTIC_PROCEDURE","start":908,"end":922},{"text":"85%","label":"LAB_VALUE","start":927,"end":930},{"text":"haemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":936,"end":947},{"text":"168 g\/L","label":"LAB_VALUE","start":949,"end":956},{"text":"serum","label":"DETAILED_DESCRIPTION","start":959,"end":964},{"text":"parathyroid hormone","label":"DIAGNOSTIC_PROCEDURE","start":965,"end":984},{"text":"2.9 pmol\/L","label":"LAB_VALUE","start":986,"end":996},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":1020,"end":1027},{"text":"2.34 mmol\/L","label":"LAB_VALUE","start":1029,"end":1040},{"text":"normal","label":"LAB_VALUE","start":1054,"end":1060},{"text":"24-hour","label":"DETAILED_DESCRIPTION","start":1062,"end":1069},{"text":"urine","label":"DETAILED_DESCRIPTION","start":1070,"end":1075},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":1076,"end":1083},{"text":"normal","label":"LAB_VALUE","start":1093,"end":1099},{"text":"6.9 mmol","label":"LAB_VALUE","start":1100,"end":1108},{"text":"24-hour","label":"DETAILED_DESCRIPTION","start":1116,"end":1123},{"text":"urine volume","label":"DIAGNOSTIC_PROCEDURE","start":1124,"end":1136},{"text":"2.8 L","label":"LAB_VALUE","start":1140,"end":1145},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1151,"end":1156},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":1157,"end":1167},{"text":"dense","label":"DETAILED_DESCRIPTION","start":1186,"end":1191},{"text":"micronodular","label":"DETAILED_DESCRIPTION","start":1192,"end":1204},{"text":"opacities","label":"SIGN_SYMPTOM","start":1205,"end":1214},{"text":"distributed symmetrically","label":"DETAILED_DESCRIPTION","start":1215,"end":1240},{"text":"middle to lower zones of both lungs","label":"BIOLOGICAL_STRUCTURE","start":1266,"end":1301},{"text":"classical \"sandstorm\" appearance","label":"TEXTURE","start":1313,"end":1345},{"text":"cardiac borders","label":"BIOLOGICAL_STRUCTURE","start":1351,"end":1366},{"text":"obscured","label":"SIGN_SYMPTOM","start":1372,"end":1380},{"text":"sand-like","label":"TEXTURE","start":1388,"end":1397},{"text":"opacities","label":"SIGN_SYMPTOM","start":1398,"end":1407},{"text":"high-resolution computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1411,"end":1446},{"text":"HRCT","label":"DIAGNOSTIC_PROCEDURE","start":1448,"end":1452},{"text":"lungs","label":"BIOLOGICAL_STRUCTURE","start":1466,"end":1471},{"text":"widespread","label":"DETAILED_DESCRIPTION","start":1488,"end":1498},{"text":"tiny","label":"DETAILED_DESCRIPTION","start":1499,"end":1503},{"text":"microcalcifications","label":"SIGN_SYMPTOM","start":1504,"end":1523},{"text":"lungs","label":"BIOLOGICAL_STRUCTURE","start":1539,"end":1544},{"text":"microliths","label":"SIGN_SYMPTOM","start":1569,"end":1579},{"text":"lower lobes","label":"BIOLOGICAL_STRUCTURE","start":1587,"end":1598},{"text":"interlobular","label":"BIOLOGICAL_STRUCTURE","start":1631,"end":1643},{"text":"septal thickening","label":"SIGN_SYMPTOM","start":1644,"end":1661},{"text":"ground-glass changes","label":"SIGN_SYMPTOM","start":1666,"end":1686},{"text":"Subpleural","label":"BIOLOGICAL_STRUCTURE","start":1688,"end":1698},{"text":"cystic changes","label":"SIGN_SYMPTOM","start":1699,"end":1713},{"text":"both lower lobes","label":"BIOLOGICAL_STRUCTURE","start":1732,"end":1748},{"text":"black pleura sign","label":"SIGN_SYMPTOM","start":1769,"end":1786},{"text":"pneumothorax","label":"DISEASE_DISORDER","start":1805,"end":1817},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":1821,"end":1837},{"text":"bronchial system","label":"DIAGNOSTIC_PROCEDURE","start":1860,"end":1876},{"text":"small bronchioles","label":"BIOLOGICAL_STRUCTURE","start":1892,"end":1909},{"text":"size","label":"DIAGNOSTIC_PROCEDURE","start":1919,"end":1923},{"text":"pulmonary vessels","label":"BIOLOGICAL_STRUCTURE","start":1931,"end":1948},{"text":"normal","label":"LAB_VALUE","start":1954,"end":1960},{"text":"diffuse parenchymal lung disease","label":"DISEASE_DISORDER","start":1974,"end":2006},{"text":"videoassisted thoracic surgical","label":"THERAPEUTIC_PROCEDURE","start":2008,"end":2039},{"text":"VATS","label":"THERAPEUTIC_PROCEDURE","start":2041,"end":2045},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":2047,"end":2051},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2052,"end":2058},{"text":"mini-thoracotomy","label":"THERAPEUTIC_PROCEDURE","start":2110,"end":2126},{"text":"difficulty in manoeuvering the endostapler","label":"OTHER_EVENT","start":2145,"end":2187},{"text":"moderate","label":"SEVERITY","start":2201,"end":2209},{"text":"pneumothorax","label":"DISEASE_DISORDER","start":2210,"end":2222},{"text":"mini-thoracotomy","label":"THERAPEUTIC_PROCEDURE","start":2227,"end":2243},{"text":"recovered","label":"OUTCOME","start":2273,"end":2282},{"text":"5 days","label":"DURATION","start":2289,"end":2295},{"text":"ward","label":"NONBIOLOGICAL_LOCATION","start":2303,"end":2307},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":2313,"end":2317},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2318,"end":2324},{"text":"PAM","label":"DISEASE_DISORDER","start":2368,"end":2371},{"text":"calcospherites","label":"SIGN_SYMPTOM","start":2387,"end":2401},{"text":"alveolar spaces","label":"BIOLOGICAL_STRUCTURE","start":2413,"end":2428},{"text":"alveolar septae","label":"BIOLOGICAL_STRUCTURE","start":2455,"end":2470},{"text":"congested","label":"SIGN_SYMPTOM","start":2476,"end":2485},{"text":"mild","label":"SEVERITY","start":2497,"end":2501},{"text":"fibrosis","label":"SIGN_SYMPTOM","start":2502,"end":2510},{"text":"infiltrates","label":"SIGN_SYMPTOM","start":2516,"end":2527},{"text":"lymphoplasmacytic cells","label":"DETAILED_DESCRIPTION","start":2538,"end":2561}],"tokens":["A ","24-year-old"," ","Malay"," ","male"," patient was ","referred"," to the ","respiratory clinic"," because of an ","abnormal"," ","pre-employment"," ","chest"," ","radiograph",".\nHe had been ","smoking"," about ","10 cigarettes a day"," ","since he was 21 years of age",".\nHe ","stopped smoking 10 months ago after he noticed he had being having reduced effort tolerance for the past three years",".\nHe was an ","office worker"," and ","did not have a history of exposure to organic or inorganic dusts",".\nHis ","two siblings were asymptomatic",".\nOn ","examination",", the patient was not ","tachypnoeic",".\nThere were no signs of ","finger clubbing"," or ","pulmonary"," ","hypertension",".\nHis ","oxygen saturation"," on ","room air"," ","at rest"," was ","94%"," and ","dropped"," to ","92%"," after ","climbing"," up ","four flights of stairs",".\n","Spirometry testing"," revealed a ","restrictive pattern"," of ","lung disease"," with a ","forced expiratory volume in 1 second"," (","FEV1",") and a ","forced vital capacity"," (","FVC",") of ","2.7 L"," (69% of predicted) and ","3.2 L"," (68% of predicted), respectively.\nThe ","FEV1\/FVC ratio"," was ","85%",".\nHis ","haemoglobin"," (","168 g\/L","), ","serum"," ","parathyroid hormone"," (","2.9 pmol\/L"," [normal, 1.1-7.3]) and ","calcium"," (","2.34 mmol\/L",") levels were ","normal",".\n","24-hour"," ","urine"," ","calcium"," was also ","normal"," ","6.9 mmol"," with a ","24-hour"," ","urine volume"," of ","2.8 L",".\nHis ","chest"," ","radiograph"," (Fig.1A) revealed ","dense"," ","micronodular"," ","opacities"," ","distributed symmetrically"," and predominantly in the ","middle to lower zones of both lungs"," giving the ","classical \"sandstorm\" appearance",".\nThe ","cardiac borders"," were ","obscured"," by the ","sand-like"," ","opacities",".\nA ","high-resolution computed tomography"," (","HRCT",") scan of the ","lungs"," (Fig.1B) showed ","widespread"," ","tiny"," ","microcalcifications"," throughout the ","lungs"," with a preponderance of ","microliths"," in the ","lower lobes",".\nThere were associated areas of ","interlobular"," ","septal thickening"," and ","ground-glass changes",".\n","Subpleural"," ","cystic changes"," were also seen in ","both lower lobes"," giving rise to the '","black pleura sign","' (Fig.1C) (2).\nNo ","pneumothorax"," or ","pleural effusion"," was present.\nBoth the ","bronchial system"," (including the ","small bronchioles",") and the ","size"," of the ","pulmonary vessels"," were ","normal",".\nAs this was ","diffuse parenchymal lung disease",", ","videoassisted thoracic surgical"," (","VATS",") ","lung"," ","biopsy"," was planned but the procedure was converted into a ","mini-thoracotomy"," because there was ","difficulty in manoeuvering the endostapler",".\nThere was a ","moderate"," ","pneumothorax"," post","mini-thoracotomy"," from which the patient fully ","recovered"," after ","5 days"," in the ","ward",".\nThe ","lung"," ","biopsy"," specimen revealed features consistent with ","PAM",", with numerous ","calcospherites"," within the ","alveolar spaces"," (Fig.1D).\nThe intervening ","alveolar septae"," were ","congested"," and showed ","mild"," ","fibrosis"," with ","infiltrates"," of mainly ","lymphoplasmacytic cells",".\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,48,0,42,0,22,0,12,0,24,0,1,0,22,0,32,0,39,0,50,0,39,0,34,0,24,0,69,0,69,0,22,0,26,0,24,0,22,0,22,0,42,0,42,0,42,0,1,0,22,0,24,0,22,0,26,0,24,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,24,0,42,0,42,0,22,0,22,0,24,0,42,0,42,0,22,0,24,0,42,0,12,0,24,0,22,0,22,0,69,0,22,0,12,0,73,0,12,0,69,0,73,0,69,0,24,0,24,0,12,0,22,0,22,0,69,0,12,0,69,0,12,0,12,0,69,0,69,0,12,0,69,0,12,0,69,0,26,0,26,0,24,0,12,0,24,0,12,0,42,0,26,0,75,0,75,0,12,0,24,0,75,0,53,0,63,0,26,0,75,0,56,0,32,0,48,0,12,0,24,0,26,0,69,0,12,0,12,0,69,0,63,0,69,0,69,0,22,0]}
-{"full_text":"This young boy is the first child of healthy non-consanguineous, white British parents.\nHe was born at term following an uneventful pregnancy weighing 3132 g (9th\u201325th centile).\nEarly development was thought to be normal.\nAt approximately 6 months of age he developed tonic upward eye deviation associated with flexion of his arms and neck consistent with infantile spasms.\nAn electroencephalograph (EEG) at this time was grossly abnormal (hypsarrhythmia) and strongly supported a diagnosis of West Syndrome.\nCranial MRI was reported as normal.\nPrednisolone was prescribed and treated the seizures effectively.\nSteroids were weaned over 6 weeks and he remained seizure free for a further 6 months.\nBy the age of 1 year, it was apparent that his early developmental progress was not being maintained and that he was functioning at the 6\u20138 month developmental stage.\nSeizures returned shortly after his first birthday and were prolonged, frequent and on occasion focal, involving his right arm, leg and right side of face.\nClonazepam briefly improved seizure frequency, but subsequently his epilepsy has proved refractory to various combinations of anticonvulsant therapy.\nProlonged seizures of more than 60 min have been associated with a stepwise regression in his neurodevelopment.\nSeizure semiology is now predominantly one of epilepsia partialis continua involving the right side of his face, right arm and right leg.\nThe development of focal seizures and the progressive nature of the condition prompted a second cranial MRI at the age of 2 years 6 months.\nBy contrast with the previous scan, this MRI revealed symmetrical subcortical white matter lesions (Fig.1A) with thinning of the anterior and genu of the corpus callosum (Fig.1B).\nOn examination, the patient had small, round, anteriorly rotated ears and a broad nasal root.\nHe demonstrated no visual awareness but startled to loud noise.\nTone was increased in all 4 limbs with internal rotation of both legs at the hips.\nReflexes were pathologically brisk.\nBrief myoclonic jerks were evident throughout the examination.\n","ner_info":[{"text":"young","label":"AGE","start":5,"end":10},{"text":"boy","label":"SEX","start":11,"end":14},{"text":"healthy","label":"DETAILED_DESCRIPTION","start":37,"end":44},{"text":"non-consanguineous","label":"DETAILED_DESCRIPTION","start":45,"end":63},{"text":"white","label":"PERSONAL_BACKGROUND","start":65,"end":70},{"text":"British","label":"PERSONAL_BACKGROUND","start":71,"end":78},{"text":"parents","label":"SUBJECT","start":79,"end":86},{"text":"born","label":"CLINICAL_EVENT","start":95,"end":99},{"text":"at term","label":"DETAILED_DESCRIPTION","start":100,"end":107},{"text":"uneventful pregnancy","label":"DETAILED_DESCRIPTION","start":121,"end":141},{"text":"3132 g","label":"WEIGHT","start":151,"end":157},{"text":"Early development","label":"DIAGNOSTIC_PROCEDURE","start":178,"end":195},{"text":"normal","label":"LAB_VALUE","start":214,"end":220},{"text":"approximately 6 months of age","label":"DATE","start":225,"end":254},{"text":"tonic upward","label":"DETAILED_DESCRIPTION","start":268,"end":280},{"text":"eye deviation","label":"SIGN_SYMPTOM","start":281,"end":294},{"text":"flexion","label":"SIGN_SYMPTOM","start":311,"end":318},{"text":"arms","label":"BIOLOGICAL_STRUCTURE","start":326,"end":330},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":335,"end":339},{"text":"infantile spasms","label":"DISEASE_DISORDER","start":356,"end":372},{"text":"electroencephalograph","label":"DIAGNOSTIC_PROCEDURE","start":377,"end":398},{"text":"EEG","label":"DIAGNOSTIC_PROCEDURE","start":400,"end":403},{"text":"grossly abnormal","label":"LAB_VALUE","start":422,"end":438},{"text":"hypsarrhythmia","label":"SIGN_SYMPTOM","start":440,"end":454},{"text":"West Syndrome","label":"DISEASE_DISORDER","start":494,"end":507},{"text":"Cranial","label":"BIOLOGICAL_STRUCTURE","start":509,"end":516},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":517,"end":520},{"text":"normal","label":"LAB_VALUE","start":537,"end":543},{"text":"Prednisolone","label":"MEDICATION","start":545,"end":557},{"text":"seizures","label":"SIGN_SYMPTOM","start":589,"end":597},{"text":"Steroids","label":"MEDICATION","start":611,"end":619},{"text":"over 6 weeks","label":"DURATION","start":632,"end":644},{"text":"seizure","label":"SIGN_SYMPTOM","start":661,"end":668},{"text":"further 6 months","label":"DURATION","start":680,"end":696},{"text":"age of 1 year","label":"DATE","start":705,"end":718},{"text":"developmental progress","label":"DIAGNOSTIC_PROCEDURE","start":751,"end":773},{"text":"not being maintained","label":"LAB_VALUE","start":778,"end":798},{"text":"6\u20138 month","label":"LAB_VALUE","start":834,"end":843},{"text":"developmental stage","label":"DIAGNOSTIC_PROCEDURE","start":844,"end":863},{"text":"Seizures","label":"SIGN_SYMPTOM","start":865,"end":873},{"text":"after his first birthday","label":"DATE","start":891,"end":915},{"text":"prolonged","label":"DETAILED_DESCRIPTION","start":925,"end":934},{"text":"frequent","label":"DETAILED_DESCRIPTION","start":936,"end":944},{"text":"on occasion focal","label":"DETAILED_DESCRIPTION","start":949,"end":966},{"text":"right arm","label":"BIOLOGICAL_STRUCTURE","start":982,"end":991},{"text":"leg","label":"BIOLOGICAL_STRUCTURE","start":993,"end":996},{"text":"right side of face","label":"BIOLOGICAL_STRUCTURE","start":1001,"end":1019},{"text":"Clonazepam","label":"MEDICATION","start":1021,"end":1031},{"text":"seizure","label":"SIGN_SYMPTOM","start":1049,"end":1056},{"text":"epilepsy","label":"DISEASE_DISORDER","start":1089,"end":1097},{"text":"refractory to various combinations of anticonvulsant therapy","label":"DETAILED_DESCRIPTION","start":1109,"end":1169},{"text":"Prolonged","label":"DETAILED_DESCRIPTION","start":1171,"end":1180},{"text":"seizures","label":"SIGN_SYMPTOM","start":1181,"end":1189},{"text":"more than 60 min","label":"DETAILED_DESCRIPTION","start":1193,"end":1209},{"text":"stepwise regression","label":"LAB_VALUE","start":1238,"end":1257},{"text":"neurodevelopment","label":"DIAGNOSTIC_PROCEDURE","start":1265,"end":1281},{"text":"Seizure","label":"SIGN_SYMPTOM","start":1283,"end":1290},{"text":"epilepsia partialis continua","label":"DISEASE_DISORDER","start":1329,"end":1357},{"text":"right side of his face","label":"BIOLOGICAL_STRUCTURE","start":1372,"end":1394},{"text":"right arm","label":"BIOLOGICAL_STRUCTURE","start":1396,"end":1405},{"text":"right leg","label":"BIOLOGICAL_STRUCTURE","start":1410,"end":1419},{"text":"focal","label":"DETAILED_DESCRIPTION","start":1440,"end":1445},{"text":"seizures","label":"SIGN_SYMPTOM","start":1446,"end":1454},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":1463,"end":1474},{"text":"condition","label":"COREFERENCE","start":1489,"end":1498},{"text":"cranial","label":"BIOLOGICAL_STRUCTURE","start":1517,"end":1524},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1525,"end":1528},{"text":"age of 2 years 6 months","label":"DATE","start":1536,"end":1559},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1602,"end":1605},{"text":"symmetrical","label":"DETAILED_DESCRIPTION","start":1615,"end":1626},{"text":"subcortical white matter","label":"BIOLOGICAL_STRUCTURE","start":1627,"end":1651},{"text":"lesions","label":"SIGN_SYMPTOM","start":1652,"end":1659},{"text":"thinning","label":"SIGN_SYMPTOM","start":1674,"end":1682},{"text":"anterior and genu of the corpus callosum","label":"BIOLOGICAL_STRUCTURE","start":1690,"end":1730},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":1744,"end":1755},{"text":"small","label":"DETAILED_DESCRIPTION","start":1773,"end":1778},{"text":"round","label":"SHAPE","start":1780,"end":1785},{"text":"anteriorly rotated","label":"DETAILED_DESCRIPTION","start":1787,"end":1805},{"text":"ears","label":"BIOLOGICAL_STRUCTURE","start":1806,"end":1810},{"text":"broad","label":"DETAILED_DESCRIPTION","start":1817,"end":1822},{"text":"nasal root","label":"BIOLOGICAL_STRUCTURE","start":1823,"end":1833},{"text":"no","label":"LAB_VALUE","start":1851,"end":1853},{"text":"visual awareness","label":"DIAGNOSTIC_PROCEDURE","start":1854,"end":1870},{"text":"startled to loud noise","label":"SIGN_SYMPTOM","start":1875,"end":1897},{"text":"Tone","label":"DIAGNOSTIC_PROCEDURE","start":1899,"end":1903},{"text":"increased","label":"LAB_VALUE","start":1908,"end":1917},{"text":"all 4 limbs","label":"BIOLOGICAL_STRUCTURE","start":1921,"end":1932},{"text":"internal rotation","label":"SIGN_SYMPTOM","start":1938,"end":1955},{"text":"both legs at the hips","label":"BIOLOGICAL_STRUCTURE","start":1959,"end":1980},{"text":"Reflexes","label":"DIAGNOSTIC_PROCEDURE","start":1982,"end":1990},{"text":"pathologically brisk","label":"LAB_VALUE","start":1996,"end":2016},{"text":"Brief","label":"DETAILED_DESCRIPTION","start":2018,"end":2023},{"text":"myoclonic jerks","label":"SIGN_SYMPTOM","start":2024,"end":2039}],"tokens":["This ","young"," ","boy"," is the first child of ","healthy"," ","non-consanguineous",", ","white"," ","British"," ","parents",".\nHe was ","born"," ","at term"," following an ","uneventful pregnancy"," weighing ","3132 g"," (9th\u201325th centile).\n","Early development"," was thought to be ","normal",".\nAt ","approximately 6 months of age"," he developed ","tonic upward"," ","eye deviation"," associated with ","flexion"," of his ","arms"," and ","neck"," consistent with ","infantile spasms",".\nAn ","electroencephalograph"," (","EEG",") at this time was ","grossly abnormal"," (","hypsarrhythmia",") and strongly supported a diagnosis of ","West Syndrome",".\n","Cranial"," ","MRI"," was reported as ","normal",".\n","Prednisolone"," was prescribed and treated the ","seizures"," effectively.\n","Steroids"," were weaned ","over 6 weeks"," and he remained ","seizure"," free for a ","further 6 months",".\nBy the ","age of 1 year",", it was apparent that his early ","developmental progress"," was ","not being maintained"," and that he was functioning at the ","6\u20138 month"," ","developmental stage",".\n","Seizures"," returned shortly ","after his first birthday"," and were ","prolonged",", ","frequent"," and ","on occasion focal",", involving his ","right arm",", ","leg"," and ","right side of face",".\n","Clonazepam"," briefly improved ","seizure"," frequency, but subsequently his ","epilepsy"," has proved ","refractory to various combinations of anticonvulsant therapy",".\n","Prolonged"," ","seizures"," of ","more than 60 min"," have been associated with a ","stepwise regression"," in his ","neurodevelopment",".\n","Seizure"," semiology is now predominantly one of ","epilepsia partialis continua"," involving the ","right side of his face",", ","right arm"," and ","right leg",".\nThe development of ","focal"," ","seizures"," and the ","progressive"," nature of the ","condition"," prompted a second ","cranial"," ","MRI"," at the ","age of 2 years 6 months",".\nBy contrast with the previous scan, this ","MRI"," revealed ","symmetrical"," ","subcortical white matter"," ","lesions"," (Fig.1A) with ","thinning"," of the ","anterior and genu of the corpus callosum"," (Fig.1B).\nOn ","examination",", the patient had ","small",", ","round",", ","anteriorly rotated"," ","ears"," and a ","broad"," ","nasal root",".\nHe demonstrated ","no"," ","visual awareness"," but ","startled to loud noise",".\n","Tone"," was ","increased"," in ","all 4 limbs"," with ","internal rotation"," of ","both legs at the hips",".\n","Reflexes"," were ","pathologically brisk",".\n","Brief"," ","myoclonic jerks"," were evident throughout the examination.\n"],"ner_labels":[0,5,0,65,0,22,0,22,0,58,0,58,0,71,0,13,0,22,0,22,0,82,0,24,0,42,0,19,0,22,0,69,0,69,0,12,0,12,0,26,0,24,0,24,0,42,0,69,0,26,0,12,0,24,0,42,0,46,0,69,0,46,0,32,0,69,0,32,0,19,0,24,0,42,0,42,0,24,0,69,0,19,0,22,0,22,0,22,0,12,0,12,0,12,0,46,0,69,0,26,0,22,0,22,0,69,0,22,0,42,0,24,0,69,0,26,0,12,0,12,0,12,0,22,0,69,0,22,0,18,0,12,0,24,0,19,0,24,0,22,0,12,0,69,0,69,0,12,0,24,0,22,0,67,0,22,0,12,0,22,0,12,0,42,0,24,0,69,0,24,0,42,0,12,0,69,0,12,0,24,0,42,0,22,0,69,0]}
-{"full_text":"A 67-year-old Japanese female presented with a left buttock tumor, which had been first detected approximately 1 year earlier, and had recently gradually enlarged.\nPhysical examination revealed a relatively well-circumscribed skin-colored tumor with hyperkeratosis, measuring 43 x 38 mm in diameter, in her left buttock.\nThe biopsy specimen revealed Bowen\u2019s disease (squamous cell carcinoma in situ), and subsequently, total resection of the tumor was performed.\nHistopathological study of the resected specimen revealed proliferation of atypical squamous cells in the entire layer of the acanthotic epidermis accompanied by hyperparakeratosis (Figure 1A).\nThese atypical squamous cells had enlarged and hyperchromatic nuclei (Figure 1B), and multinucleated atypical squamous cells were also present.\nMitotic figures were scattered and present in the upper portion of the epidermis.\nAtypical mitotic figures were also observed (Figure 1B).\nNo invasive neoplastic growth was noted (Figure 1A).\nApproximately 95% of the lesion was composed of the above-mentioned Bowen\u2019s disease (squamous cell carcinoma in situ), and superficial sebaceous carcinoma was present in the central area of the lesion.\nThis latter component was composed of proliferation of nests of atypical cells with vacuolated clear cytoplasm and large nuclei containing conspicuous nucleoli (Figure 1C, \u200b,1D).1D).\nSebaceous carcinoma had invaded into the superficial reticular dermis (Figure 1C).\nMoreover, atypical cells containing vacuolated cytoplasm were present within the lesion of Bowen\u2019s disease adjacent to the sebaceous carcinoma (Figure 1E).\nImmunohistochemical studies were performed using an autostainer (Ventana) by the same method as previously reported [9-12].\nEpithelial membrane antigen (EMA), cytokeratin 7, and adipophilin were expressed in the sebaceous carcinoma component, but not in Bowen\u2019s disease (Figure 2A).\nAndrogen receptor was also expressed in some of the tumor cells of the sebaceous carcinoma, but not in Bowen\u2019s disease.\nMoreover, atypical vacuolated cells within the lesion of Bowen\u2019s disease were also positive for adipophilin (Figure 2B).\nOverexpression of p53 protein was observed in both the sebaceous carcinoma and Bowen\u2019s disease.\nAccordingly, an ultimate diagnosis of sebaceous carcinoma associated with Bowen\u2019s disease was made.\n","ner_info":[{"text":"67-year-old","label":"AGE","start":2,"end":13},{"text":"Japanese","label":"PERSONAL_BACKGROUND","start":14,"end":22},{"text":"female","label":"SEX","start":23,"end":29},{"text":"presented","label":"CLINICAL_EVENT","start":30,"end":39},{"text":"left buttock","label":"BIOLOGICAL_STRUCTURE","start":47,"end":59},{"text":"tumor","label":"SIGN_SYMPTOM","start":60,"end":65},{"text":"1 year earlier","label":"DATE","start":111,"end":125},{"text":"gradually enlarged","label":"DETAILED_DESCRIPTION","start":144,"end":162},{"text":"Physical 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study","label":"DIAGNOSTIC_PROCEDURE","start":463,"end":486},{"text":"proliferation","label":"SIGN_SYMPTOM","start":521,"end":534},{"text":"atypical squamous cells","label":"DETAILED_DESCRIPTION","start":538,"end":561},{"text":"acanthotic","label":"SIGN_SYMPTOM","start":589,"end":599},{"text":"epidermis","label":"BIOLOGICAL_STRUCTURE","start":600,"end":609},{"text":"hyperparakeratosis","label":"SIGN_SYMPTOM","start":625,"end":643},{"text":"squamous cells","label":"BIOLOGICAL_STRUCTURE","start":672,"end":686},{"text":"enlarged","label":"LAB_VALUE","start":691,"end":699},{"text":"hyperchromatic","label":"LAB_VALUE","start":704,"end":718},{"text":"nuclei","label":"DIAGNOSTIC_PROCEDURE","start":719,"end":725},{"text":"multinucleated","label":"SIGN_SYMPTOM","start":743,"end":757},{"text":"squamous cells","label":"BIOLOGICAL_STRUCTURE","start":767,"end":781},{"text":"Mitotic figures","label":"SIGN_SYMPTOM","start":801,"end":816},{"text":"upper portion of the epidermis","label":"BIOLOGICAL_STRUCTURE","start":851,"end":881},{"text":"mitotic figures","label":"SIGN_SYMPTOM","start":892,"end":907},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":943,"end":951},{"text":"neoplastic growth","label":"SIGN_SYMPTOM","start":952,"end":969},{"text":"95%","label":"QUANTITATIVE_CONCEPT","start":1007,"end":1010},{"text":"lesion","label":"SIGN_SYMPTOM","start":1018,"end":1024},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":1061,"end":1076},{"text":"squamous cell carcinoma in situ","label":"DISEASE_DISORDER","start":1078,"end":1109},{"text":"superficial","label":"DETAILED_DESCRIPTION","start":1116,"end":1127},{"text":"sebaceous carcinoma","label":"DISEASE_DISORDER","start":1128,"end":1147},{"text":"central area","label":"DETAILED_DESCRIPTION","start":1167,"end":1179},{"text":"lesion","label":"SIGN_SYMPTOM","start":1187,"end":1193},{"text":"cells with vacuolated clear cytoplasm","label":"SIGN_SYMPTOM","start":1268,"end":1305},{"text":"nuclei containing conspicuous nucleoli","label":"SIGN_SYMPTOM","start":1316,"end":1354},{"text":"Sebaceous carcinoma","label":"DISEASE_DISORDER","start":1378,"end":1397},{"text":"invaded","label":"SIGN_SYMPTOM","start":1402,"end":1409},{"text":"superficial reticular dermis","label":"BIOLOGICAL_STRUCTURE","start":1419,"end":1447},{"text":"cells containing vacuolated cytoplasm","label":"SIGN_SYMPTOM","start":1480,"end":1517},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":1552,"end":1567},{"text":"sebaceous carcinoma","label":"DISEASE_DISORDER","start":1584,"end":1603},{"text":"Immunohistochemical studies","label":"DIAGNOSTIC_PROCEDURE","start":1617,"end":1644},{"text":"autostainer","label":"DETAILED_DESCRIPTION","start":1669,"end":1680},{"text":"Ventana","label":"DETAILED_DESCRIPTION","start":1682,"end":1689},{"text":"Epithelial membrane antigen","label":"DIAGNOSTIC_PROCEDURE","start":1741,"end":1768},{"text":"EMA","label":"DIAGNOSTIC_PROCEDURE","start":1770,"end":1773},{"text":"cytokeratin 7","label":"DIAGNOSTIC_PROCEDURE","start":1776,"end":1789},{"text":"adipophilin","label":"DIAGNOSTIC_PROCEDURE","start":1795,"end":1806},{"text":"expressed","label":"LAB_VALUE","start":1812,"end":1821},{"text":"sebaceous carcinoma","label":"DISEASE_DISORDER","start":1829,"end":1848},{"text":"not","label":"LAB_VALUE","start":1864,"end":1867},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":1871,"end":1886},{"text":"Androgen receptor","label":"DIAGNOSTIC_PROCEDURE","start":1900,"end":1917},{"text":"expressed","label":"LAB_VALUE","start":1927,"end":1936},{"text":"sebaceous carcinoma","label":"DISEASE_DISORDER","start":1971,"end":1990},{"text":"not","label":"LAB_VALUE","start":1996,"end":1999},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":2003,"end":2018},{"text":"vacuolated cells","label":"SIGN_SYMPTOM","start":2039,"end":2055},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":2077,"end":2092},{"text":"positive","label":"LAB_VALUE","start":2103,"end":2111},{"text":"adipophilin","label":"DIAGNOSTIC_PROCEDURE","start":2116,"end":2127},{"text":"Overexpression","label":"LAB_VALUE","start":2141,"end":2155},{"text":"p53 protein","label":"DIAGNOSTIC_PROCEDURE","start":2159,"end":2170},{"text":"sebaceous carcinoma","label":"DISEASE_DISORDER","start":2196,"end":2215},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":2220,"end":2235},{"text":"sebaceous carcinoma","label":"DISEASE_DISORDER","start":2275,"end":2294},{"text":"Bowen\u2019s disease","label":"DISEASE_DISORDER","start":2311,"end":2326}],"tokens":["A ","67-year-old"," ","Japanese"," ","female"," ","presented"," with a ","left buttock"," ","tumor",", which had been first detected approximately ","1 year earlier",", and had recently ","gradually enlarged",".\n","Physical examination"," revealed a relatively ","well-circumscribed"," ","skin-colored"," ","tumor"," with ","hyperkeratosis",", measuring ","43 x 38 mm in diameter",", in her ","left buttock",".\nThe ","biopsy"," specimen revealed ","Bowen\u2019s disease"," (","squamous cell carcinoma in situ","), and subsequently, ","total"," ","resection"," of the ","tumor"," was performed.\n","Histopathological study"," of the resected specimen revealed ","proliferation"," of ","atypical squamous cells"," in the entire layer of the ","acanthotic"," ","epidermis"," accompanied by ","hyperparakeratosis"," (Figure 1A).\nThese atypical ","squamous cells"," had ","enlarged"," and ","hyperchromatic"," ","nuclei"," (Figure 1B), and ","multinucleated"," atypical ","squamous cells"," were also present.\n","Mitotic figures"," were scattered and present in the ","upper portion of the epidermis",".\nAtypical ","mitotic figures"," were also observed (Figure 1B).\nNo ","invasive"," ","neoplastic growth"," was noted (Figure 1A).\nApproximately ","95%"," of the ","lesion"," was composed of the above-mentioned ","Bowen\u2019s disease"," (","squamous cell carcinoma in situ","), and ","superficial"," ","sebaceous carcinoma"," was present in the ","central area"," of the ","lesion",".\nThis latter component was composed of proliferation of nests of atypical ","cells with vacuolated clear cytoplasm"," and large ","nuclei containing conspicuous nucleoli"," (Figure 1C, \u200b,1D).1D).\n","Sebaceous carcinoma"," had ","invaded"," into the ","superficial reticular dermis"," (Figure 1C).\nMoreover, atypical ","cells containing vacuolated cytoplasm"," were present within the lesion of ","Bowen\u2019s disease"," adjacent to the ","sebaceous carcinoma"," (Figure 1E).\n","Immunohistochemical studies"," were performed using an ","autostainer"," (","Ventana",") by the same method as previously reported [9-12].\n","Epithelial membrane antigen"," (","EMA","), ","cytokeratin 7",", and ","adipophilin"," were ","expressed"," in the ","sebaceous carcinoma"," component, but ","not"," in ","Bowen\u2019s disease"," (Figure 2A).\n","Androgen receptor"," was also ","expressed"," in some of the tumor cells of the ","sebaceous carcinoma",", but ","not"," in ","Bowen\u2019s disease",".\nMoreover, atypical ","vacuolated cells"," within the lesion of ","Bowen\u2019s disease"," were also ","positive"," for ","adipophilin"," (Figure 2B).\n","Overexpression"," of ","p53 protein"," was observed in both the ","sebaceous carcinoma"," and ","Bowen\u2019s disease",".\nAccordingly, an ultimate diagnosis of ","sebaceous carcinoma"," associated with ","Bowen\u2019s disease"," was made.\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,12,0,69,0,19,0,22,0,24,0,22,0,15,0,69,0,22,0,8,0,12,0,24,0,26,0,26,0,22,0,75,0,69,0,24,0,69,0,22,0,69,0,12,0,69,0,12,0,42,0,42,0,24,0,69,0,12,0,69,0,12,0,69,0,22,0,69,0,62,0,69,0,26,0,26,0,22,0,26,0,22,0,69,0,69,0,69,0,26,0,69,0,12,0,69,0,26,0,26,0,24,0,22,0,22,0,24,0,24,0,24,0,24,0,42,0,26,0,42,0,26,0,24,0,42,0,26,0,42,0,26,0,69,0,26,0,42,0,24,0,42,0,24,0,26,0,26,0,26,0,26,0]}
-{"full_text":"A 44-year-old Chinese man with a 7 pack-year smoking history was referred to Shanghai Pulmonary Hospital in February 2013 for a left upper lobe lung mass with multiple bilateral intrapulmonary metastases, left pleural effusion, and 2R\/4R\/10L\/11L lymphadenopathy.\nPleural fluid cytology revealed adenocarcinoma and Scorpion Amplification Refractory Mutation system (AmoyDx Co., Xiamen, China).\nshowed no detectable epidermal growth factor receptor mutation.\nHe commenced chemotherapy with gemcitabine and cisplatin.\nHowever, after a single cycle, his symptoms worsened and imaging confirmed progressive disease.\nA second opinion was requested from the University of Colorado and a computed tomography\u2013guided biopsy of the left upper lobe lesion was performed to permit additional molecular testing.\nIn the interim, the patient commenced pemetrexed and nedaplatin.\nUnfortunately, after two cycles his shortness of breath worsened, with evidence of further progression on his scans (Fig.1A).\nMolecular testing on his repeat biopsy specimen revealed no mutations by SNaPshot multiplex PCR testing (Life Technologies, Carlsbad, CA).\nHowever, although technically negative, the ALK break-apart FISH test showed an atypical negative pattern.\nSpecifically, 68% of cells demonstrated single copies of the 5\u2032 ALK signal and numerous cells with doublets of the 5\u2032 ALK signal combined with one 3\u2032 ALK signal (Fig.2A).\nSubsequently, confirmatory diagnostic assays demonstrated ALK protein expression by IHC using the D5F3 antibody (Cell Signaling Technology Inc., Danvers, MA; H score = 150; Fig.2B) and the presence of an echinoderm microtubule-associated protein-like 4 (EML4)-ALK transcript (E13; A20) by RT-PCR (Fig.2C).\nThe patient then received crizotinib (250 mg twice daily) as third-line therapy in May 2013 with an impressive symptomatic improvement and CT response after 1 month of therapy (Fig.1B).\nHe remains on treatment with crizotinib with no evidence of progression as of September 2013.\n","ner_info":[{"text":"44-year-old","label":"AGE","start":2,"end":13},{"text":"Chinese","label":"PERSONAL_BACKGROUND","start":14,"end":21},{"text":"man","label":"SEX","start":22,"end":25},{"text":"7 pack-year smoking history","label":"HISTORY","start":33,"end":60},{"text":"referred","label":"CLINICAL_EVENT","start":65,"end":73},{"text":"Shanghai Pulmonary Hospital","label":"NONBIOLOGICAL_LOCATION","start":77,"end":104},{"text":"February 2013","label":"DATE","start":108,"end":121},{"text":"left upper lobe","label":"BIOLOGICAL_STRUCTURE","start":128,"end":143},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":144,"end":148},{"text":"mass","label":"SIGN_SYMPTOM","start":149,"end":153},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":159,"end":167},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":168,"end":177},{"text":"intrapulmonary","label":"BIOLOGICAL_STRUCTURE","start":178,"end":192},{"text":"metastases","label":"SIGN_SYMPTOM","start":193,"end":203},{"text":"left","label":"DETAILED_DESCRIPTION","start":205,"end":209},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":210,"end":226},{"text":"2R\/4R\/10L\/11L","label":"LAB_VALUE","start":232,"end":245},{"text":"lymphadenopathy","label":"DISEASE_DISORDER","start":246,"end":261},{"text":"Pleural fluid","label":"BIOLOGICAL_STRUCTURE","start":263,"end":276},{"text":"cytology","label":"DIAGNOSTIC_PROCEDURE","start":277,"end":285},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":295,"end":309},{"text":"Scorpion Amplification Refractory Mutation system","label":"DIAGNOSTIC_PROCEDURE","start":314,"end":363},{"text":"AmoyDx Co., Xiamen, China","label":"DETAILED_DESCRIPTION","start":365,"end":390},{"text":"epidermal growth factor receptor mutation","label":"SIGN_SYMPTOM","start":414,"end":455},{"text":"chemotherapy","label":"MEDICATION","start":470,"end":482},{"text":"gemcitabine","label":"MEDICATION","start":488,"end":499},{"text":"cisplatin","label":"MEDICATION","start":504,"end":513},{"text":"symptoms","label":"SIGN_SYMPTOM","start":550,"end":558},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":590,"end":601},{"text":"disease","label":"DISEASE_DISORDER","start":602,"end":609},{"text":"second opinion was requested","label":"CLINICAL_EVENT","start":613,"end":641},{"text":"University of Colorado","label":"NONBIOLOGICAL_LOCATION","start":651,"end":673},{"text":"computed tomography\u2013guided","label":"DETAILED_DESCRIPTION","start":680,"end":706},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":707,"end":713},{"text":"left upper lobe","label":"BIOLOGICAL_STRUCTURE","start":721,"end":736},{"text":"lesion","label":"SIGN_SYMPTOM","start":737,"end":743},{"text":"pemetrexed","label":"MEDICATION","start":836,"end":846},{"text":"nedaplatin","label":"MEDICATION","start":851,"end":861},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":899,"end":918},{"text":"further progression","label":"SIGN_SYMPTOM","start":946,"end":965},{"text":"scans","label":"DIAGNOSTIC_PROCEDURE","start":973,"end":978},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1021,"end":1027},{"text":"mutations","label":"SIGN_SYMPTOM","start":1049,"end":1058},{"text":"SNaPshot multiplex","label":"DETAILED_DESCRIPTION","start":1062,"end":1080},{"text":"PCR testing","label":"DIAGNOSTIC_PROCEDURE","start":1081,"end":1092},{"text":"ALK break-apart","label":"DETAILED_DESCRIPTION","start":1172,"end":1187},{"text":"FISH test","label":"DIAGNOSTIC_PROCEDURE","start":1188,"end":1197},{"text":"atypical negative pattern","label":"LAB_VALUE","start":1208,"end":1233},{"text":"68% of cells demonstrated single copies of the 5\u2032 ALK signal","label":"LAB_VALUE","start":1249,"end":1309},{"text":"numerous cells with doublets of the 5\u2032 ALK signal combined with one 3\u2032 ALK signal","label":"LAB_VALUE","start":1314,"end":1395},{"text":"diagnostic assays","label":"DIAGNOSTIC_PROCEDURE","start":1433,"end":1450},{"text":"ALK protein expression","label":"LAB_VALUE","start":1464,"end":1486},{"text":"IHC","label":"DIAGNOSTIC_PROCEDURE","start":1490,"end":1493},{"text":"D5F3 antibody","label":"DETAILED_DESCRIPTION","start":1504,"end":1517},{"text":"Cell Signaling Technology Inc., Danvers, MA","label":"DETAILED_DESCRIPTION","start":1519,"end":1562},{"text":"presence of an echinoderm microtubule-associated protein-like 4 (EML4)-ALK transcript","label":"LAB_VALUE","start":1595,"end":1680},{"text":"RT-PCR","label":"DIAGNOSTIC_PROCEDURE","start":1695,"end":1701},{"text":"crizotinib","label":"MEDICATION","start":1738,"end":1748},{"text":"250 mg twice daily","label":"DOSAGE","start":1750,"end":1768},{"text":"May 2013","label":"DATE","start":1795,"end":1803},{"text":"symptomatic improvement","label":"SIGN_SYMPTOM","start":1823,"end":1846},{"text":"after 1 month","label":"DATE","start":1863,"end":1876},{"text":"crizotinib","label":"MEDICATION","start":1927,"end":1937},{"text":"progression","label":"SIGN_SYMPTOM","start":1958,"end":1969},{"text":"September 2013","label":"DATE","start":1976,"end":1990}],"tokens":["A ","44-year-old"," ","Chinese"," ","man"," with a ","7 pack-year smoking history"," was ","referred"," to ","Shanghai Pulmonary Hospital"," in ","February 2013"," for a ","left upper lobe"," ","lung"," ","mass"," with ","multiple"," ","bilateral"," ","intrapulmonary"," ","metastases",", ","left"," ","pleural effusion",", and ","2R\/4R\/10L\/11L"," ","lymphadenopathy",".\n","Pleural fluid"," ","cytology"," revealed ","adenocarcinoma"," and ","Scorpion Amplification Refractory Mutation system"," (","AmoyDx Co., Xiamen, China",").\nshowed no detectable ","epidermal growth factor receptor mutation",".\nHe commenced ","chemotherapy"," with ","gemcitabine"," and ","cisplatin",".\nHowever, after a single cycle, his ","symptoms"," worsened and imaging confirmed ","progressive"," ","disease",".\nA ","second opinion was requested"," from the ","University of Colorado"," and a ","computed tomography\u2013guided"," ","biopsy"," of the ","left upper lobe"," ","lesion"," was performed to permit additional molecular testing.\nIn the interim, the patient commenced ","pemetrexed"," and ","nedaplatin",".\nUnfortunately, after two cycles his ","shortness of breath"," worsened, with evidence of ","further progression"," on his ","scans"," (Fig.1A).\nMolecular testing on his repeat ","biopsy"," specimen revealed no ","mutations"," by ","SNaPshot multiplex"," ","PCR testing"," (Life Technologies, Carlsbad, CA).\nHowever, although technically negative, the ","ALK break-apart"," ","FISH test"," showed an ","atypical negative pattern",".\nSpecifically, ","68% of cells demonstrated single copies of the 5\u2032 ALK signal"," and ","numerous cells with doublets of the 5\u2032 ALK signal combined with one 3\u2032 ALK signal"," (Fig.2A).\nSubsequently, confirmatory ","diagnostic assays"," demonstrated ","ALK protein expression"," by ","IHC"," using the ","D5F3 antibody"," (","Cell Signaling Technology Inc., Danvers, MA","; H score = 150; Fig.2B) and the ","presence of an echinoderm microtubule-associated protein-like 4 (EML4)-ALK transcript"," (E13; A20) by ","RT-PCR"," (Fig.2C).\nThe patient then received ","crizotinib"," (","250 mg twice daily",") as third-line therapy in ","May 2013"," with an impressive ","symptomatic improvement"," and CT response ","after 1 month"," of therapy (Fig.1B).\nHe remains on treatment with ","crizotinib"," with no evidence of ","progression"," as of ","September 2013",".\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,13,0,48,0,19,0,12,0,12,0,69,0,22,0,22,0,12,0,69,0,22,0,26,0,42,0,26,0,12,0,24,0,26,0,24,0,22,0,69,0,46,0,46,0,46,0,69,0,22,0,26,0,13,0,48,0,22,0,24,0,12,0,69,0,46,0,46,0,69,0,69,0,24,0,24,0,69,0,22,0,24,0,22,0,24,0,42,0,42,0,42,0,24,0,42,0,24,0,22,0,22,0,42,0,24,0,46,0,29,0,19,0,69,0,19,0,46,0,69,0,19,0]}
-{"full_text":"A 35-year-old woman presented to the medical emergency department with low-grade fever for 3\u2005weeks, vomiting for 1\u2005week and anuria for 3\u2005days.\nShe also reported dysuria and breathlessness for 1\u2005week.\nThere was no history of decreased urine output, dialysis, effort intolerance, chest pain or palpitation, dyspnoea and weight loss.\nMenstrual history was within normal limit but she reported gradually progressive loss of appetite.\nFamily history included smoky urine in her younger brother in his childhood, who died in an accident.\nOn general survey, the patient was conscious and alert.\nShe was dyspnoeic and febrile.\nSevere pallor was present with mild pedal oedema.\nBlood pressure was 180\/100\u2005mm\u2005Hg and pulse rate of 116\/min regular.\nNo evidence of jaundice, clubbing cyanosis or lymphadenopathy was found.\nPhysical examination revealed bibasilar end-inspiratory crepitations in lungs and suprapubic tenderness.\nThere was no hepatosplenomegaly or ascites.\nCardiac examination was normal.\nShe was found to have severe bilateral hearing loss, which was gradually progressive for 5\u2005years.\nThe fundi were bilaterally pale.\nThe patient was referred to the department of ophthalmology for a comprehensive eye examination.\nHer visual acuity was documented as 6\/18 in both eyes with no obvious lenticular opacity.\nSlit-lamp examination showed bilateral anterior lentiglobus (figure 1) with posterior lenticonus (figure 2).\nDistant direct ophthalmoscopy revealed oil droplet sign (a suggestive confirmation of the presence of lenticonus); and peripheral retina revealed multiple yellowish white lesion-like flecks in the mid-periphery, and few blot haemorrhages indicative of hypertensive changes (figures 3 and \u200b4).\n","ner_info":[{"text":"35-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"medical emergency department","label":"NONBIOLOGICAL_LOCATION","start":37,"end":65},{"text":"low-grade","label":"SEVERITY","start":71,"end":80},{"text":"fever","label":"SIGN_SYMPTOM","start":81,"end":86},{"text":"3\u2005weeks","label":"DURATION","start":91,"end":98},{"text":"vomiting","label":"SIGN_SYMPTOM","start":100,"end":108},{"text":"1\u2005week","label":"DURATION","start":113,"end":119},{"text":"anuria","label":"SIGN_SYMPTOM","start":124,"end":130},{"text":"3\u2005days","label":"DURATION","start":135,"end":141},{"text":"dysuria","label":"SIGN_SYMPTOM","start":161,"end":168},{"text":"breathlessness","label":"SIGN_SYMPTOM","start":173,"end":187},{"text":"1\u2005week","label":"DURATION","start":192,"end":198},{"text":"no history of decreased urine output, dialysis, effort intolerance, chest pain or palpitation, dyspnoea and weight loss","label":"HISTORY","start":210,"end":329},{"text":"Menstrual history","label":"DIAGNOSTIC_PROCEDURE","start":331,"end":348},{"text":"within normal limit","label":"LAB_VALUE","start":353,"end":372},{"text":"gradually progressive","label":"LAB_VALUE","start":390,"end":411},{"text":"loss of appetite","label":"SIGN_SYMPTOM","start":412,"end":428},{"text":"smoky urine in her younger brother in his childhood, who died in an accident","label":"FAMILY_HISTORY","start":454,"end":530},{"text":"general survey","label":"DIAGNOSTIC_PROCEDURE","start":535,"end":549},{"text":"conscious","label":"SIGN_SYMPTOM","start":567,"end":576},{"text":"alert","label":"SIGN_SYMPTOM","start":581,"end":586},{"text":"dyspnoeic","label":"SIGN_SYMPTOM","start":596,"end":605},{"text":"febrile","label":"SIGN_SYMPTOM","start":610,"end":617},{"text":"Severe","label":"SEVERITY","start":619,"end":625},{"text":"pallor","label":"SIGN_SYMPTOM","start":626,"end":632},{"text":"mild","label":"SEVERITY","start":650,"end":654},{"text":"pedal","label":"BIOLOGICAL_STRUCTURE","start":655,"end":660},{"text":"oedema","label":"SIGN_SYMPTOM","start":661,"end":667},{"text":"Blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":669,"end":683},{"text":"180\/100\u2005mm\u2005Hg","label":"LAB_VALUE","start":688,"end":701},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":706,"end":716},{"text":"116\/min","label":"LAB_VALUE","start":720,"end":727},{"text":"regular","label":"LAB_VALUE","start":728,"end":735},{"text":"jaundice","label":"SIGN_SYMPTOM","start":752,"end":760},{"text":"clubbing","label":"DETAILED_DESCRIPTION","start":762,"end":770},{"text":"cyanosis","label":"SIGN_SYMPTOM","start":771,"end":779},{"text":"lymphadenopathy","label":"DISEASE_DISORDER","start":783,"end":798},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":810,"end":830},{"text":"bibasilar","label":"BIOLOGICAL_STRUCTURE","start":840,"end":849},{"text":"end-inspiratory","label":"DETAILED_DESCRIPTION","start":850,"end":865},{"text":"crepitations","label":"SIGN_SYMPTOM","start":866,"end":878},{"text":"lungs","label":"BIOLOGICAL_STRUCTURE","start":882,"end":887},{"text":"suprapubic","label":"BIOLOGICAL_STRUCTURE","start":892,"end":902},{"text":"tenderness","label":"SIGN_SYMPTOM","start":903,"end":913},{"text":"hepatosplenomegaly","label":"SIGN_SYMPTOM","start":928,"end":946},{"text":"ascites","label":"SIGN_SYMPTOM","start":950,"end":957},{"text":"Cardiac examination","label":"DIAGNOSTIC_PROCEDURE","start":959,"end":978},{"text":"normal","label":"LAB_VALUE","start":983,"end":989},{"text":"severe","label":"SEVERITY","start":1013,"end":1019},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1020,"end":1029},{"text":"hearing loss","label":"SIGN_SYMPTOM","start":1030,"end":1042},{"text":"gradually progressive","label":"LAB_VALUE","start":1054,"end":1075},{"text":"5\u2005years","label":"DURATION","start":1080,"end":1087},{"text":"fundi","label":"BIOLOGICAL_STRUCTURE","start":1093,"end":1098},{"text":"bilaterally","label":"DETAILED_DESCRIPTION","start":1104,"end":1115},{"text":"pale","label":"SIGN_SYMPTOM","start":1116,"end":1120},{"text":"referred","label":"CLINICAL_EVENT","start":1138,"end":1146},{"text":"department of ophthalmology","label":"NONBIOLOGICAL_LOCATION","start":1154,"end":1181},{"text":"eye examination","label":"DIAGNOSTIC_PROCEDURE","start":1202,"end":1217},{"text":"visual acuity","label":"DIAGNOSTIC_PROCEDURE","start":1223,"end":1236},{"text":"6\/18","label":"LAB_VALUE","start":1255,"end":1259},{"text":"both eyes","label":"BIOLOGICAL_STRUCTURE","start":1263,"end":1272},{"text":"lenticular opacity","label":"SIGN_SYMPTOM","start":1289,"end":1307},{"text":"Slit-lamp examination","label":"DIAGNOSTIC_PROCEDURE","start":1309,"end":1330},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1338,"end":1347},{"text":"anterior lentiglobus","label":"SIGN_SYMPTOM","start":1348,"end":1368},{"text":"posterior lenticonus","label":"SIGN_SYMPTOM","start":1385,"end":1405},{"text":"Distant direct","label":"DETAILED_DESCRIPTION","start":1418,"end":1432},{"text":"ophthalmoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1433,"end":1447},{"text":"oil droplet sign","label":"SIGN_SYMPTOM","start":1457,"end":1473},{"text":"lenticonus","label":"SIGN_SYMPTOM","start":1520,"end":1530},{"text":"peripheral retina","label":"BIOLOGICAL_STRUCTURE","start":1537,"end":1554},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1564,"end":1572},{"text":"yellowish white","label":"COLOR","start":1573,"end":1588},{"text":"lesion-like flecks","label":"SIGN_SYMPTOM","start":1589,"end":1607},{"text":"mid-periphery","label":"BIOLOGICAL_STRUCTURE","start":1615,"end":1628},{"text":"few","label":"DETAILED_DESCRIPTION","start":1634,"end":1637},{"text":"blot haemorrhages","label":"SIGN_SYMPTOM","start":1638,"end":1655},{"text":"hypertensive changes","label":"SIGN_SYMPTOM","start":1670,"end":1690}],"tokens":["A ","35-year-old"," ","woman"," ","presented"," to the ","medical emergency department"," with ","low-grade"," ","fever"," for ","3\u2005weeks",", ","vomiting"," for ","1\u2005week"," and ","anuria"," for ","3\u2005days",".\nShe also reported ","dysuria"," and ","breathlessness"," for ","1\u2005week",".\nThere was ","no history of decreased urine output, dialysis, effort intolerance, chest pain or palpitation, dyspnoea and weight loss",".\n","Menstrual history"," was ","within normal limit"," but she reported ","gradually progressive"," ","loss of appetite",".\nFamily history included ","smoky urine in her younger brother in his childhood, who died in an accident",".\nOn ","general survey",", the patient was ","conscious"," and ","alert",".\nShe was ","dyspnoeic"," and ","febrile",".\n","Severe"," ","pallor"," was present with ","mild"," ","pedal"," ","oedema",".\n","Blood pressure"," was ","180\/100\u2005mm\u2005Hg"," and ","pulse rate"," of ","116\/min"," ","regular",".\nNo evidence of ","jaundice",", ","clubbing"," ","cyanosis"," or ","lymphadenopathy"," was found.\n","Physical examination"," revealed ","bibasilar"," ","end-inspiratory"," ","crepitations"," in ","lungs"," and ","suprapubic"," ","tenderness",".\nThere was no ","hepatosplenomegaly"," or ","ascites",".\n","Cardiac examination"," was ","normal",".\nShe was found to have ","severe"," ","bilateral"," ","hearing loss",", which was ","gradually progressive"," for ","5\u2005years",".\nThe ","fundi"," were ","bilaterally"," ","pale",".\nThe patient was ","referred"," to the ","department of ophthalmology"," for a comprehensive ","eye examination",".\nHer ","visual acuity"," was documented as ","6\/18"," in ","both eyes"," with no obvious ","lenticular opacity",".\n","Slit-lamp examination"," showed ","bilateral"," ","anterior lentiglobus"," (figure 1) with ","posterior lenticonus"," (figure 2).\n","Distant direct"," ","ophthalmoscopy"," revealed ","oil droplet sign"," (a suggestive confirmation of the presence of ","lenticonus","); and ","peripheral retina"," revealed ","multiple"," ","yellowish white"," ","lesion-like flecks"," in the ","mid-periphery",", and ","few"," ","blot haemorrhages"," indicative of ","hypertensive changes"," (figures 3 and \u200b4).\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,63,0,69,0,32,0,69,0,32,0,69,0,32,0,69,0,69,0,32,0,39,0,24,0,42,0,42,0,69,0,34,0,24,0,69,0,69,0,69,0,69,0,63,0,69,0,63,0,12,0,69,0,24,0,42,0,24,0,42,0,42,0,69,0,22,0,69,0,26,0,24,0,12,0,22,0,69,0,12,0,12,0,69,0,69,0,69,0,24,0,42,0,63,0,22,0,69,0,42,0,32,0,12,0,22,0,69,0,13,0,48,0,24,0,24,0,42,0,12,0,69,0,24,0,22,0,69,0,69,0,22,0,24,0,69,0,69,0,12,0,22,0,15,0,69,0,12,0,22,0,69,0,69,0]}
-{"full_text":"A 30-year-old woman with a history of HIV and HCV presented to the emergency department with a 4-month history of gradual but progressive swelling of her lower limbs and abdomen.\nShe denied any chest pain, dyspnoea, paroxysmal nocturnal dyspnoea or orthopnoea.\nVitals were stable.\nCardiovascular examination was remarkable for an elevated jugular venous pressure (JVP) of about 12\u2005cm with a pronounced \u2018y\u2019 descent.\nThere was a prominent pericardial knock sound heard over the praecordium.\nThere was no pericardial rub or murmur.\nThe lungs were clear to auscultation.\nThe patient was markedly oedematous from the abdomen to the lower limbs.\nShe was admitted for further diagnostic work-up and management.\nShe was diagnosed with HIV around May 2010 and had been on antiretroviral therapy.\nShe had not used illicit drugs for approximately 5\u20136\u2005years.\nRenal and hepatic diseases were ruled out through blood tests and imaging.\nPeritoneal fluid was negative for malignancy.\nEchocardiogram showed a thickened bright pericardium adjacent to the right heart border (figure 1) with parallel separation between epicardial and pericardial echoes (railroad track sign), septal bounce and lack of pericardial slide.\nAnnulus paradoxus was demonstrated on tissue Doppler (figure 2).\nLeft ventricular ejection fraction was 64%.\nThe right ventricle was normal in size and function.\nThere was moderate tricuspid regurgitation.\nThere was no pericardial effusion, but the pericardial space was remarkable for debris.\nConstrictive physiology was demonstrated by Doppler study of tricuspid and mitral inflows (figure 3) during inspiration and expiration; diastolic flow reversal was also demonstrated in the hepatic veins during expiration.\nThere was marked dilatation of the inferior vena cava with no change during inspiration or expiration.\nCT of the chest revealed thickening of the pericardium with no evidence of calcification.\nThere were no lung nodules.\nBilateral pleural effusions and interstitial thickening were present in the lung bases.\nCardiac MRI confirmed the presence of a diffusely thickened pericardium at 5\u2005mm.\nThe inferior vena cava and hepatic veins appeared plethoric.\nThere was a rapid early diastolic filling and associated diastolic septal bounce secondary to hindered late diastolic filling (figure 4).\nThe patient showed a good response to diuresis.\nShe underwent right and left heart catheterisation to confirm constrictive physiology.\n","ner_info":[{"text":"30-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"HIV","label":"HISTORY","start":38,"end":41},{"text":"HCV","label":"HISTORY","start":46,"end":49},{"text":"presented","label":"CLINICAL_EVENT","start":50,"end":59},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":67,"end":87},{"text":"4-month","label":"DURATION","start":95,"end":102},{"text":"gradual","label":"DETAILED_DESCRIPTION","start":114,"end":121},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":126,"end":137},{"text":"swelling","label":"SIGN_SYMPTOM","start":138,"end":146},{"text":"lower limbs","label":"BIOLOGICAL_STRUCTURE","start":154,"end":165},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":170,"end":177},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":194,"end":199},{"text":"pain","label":"SIGN_SYMPTOM","start":200,"end":204},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":206,"end":214},{"text":"paroxysmal","label":"DETAILED_DESCRIPTION","start":216,"end":226},{"text":"nocturnal","label":"DETAILED_DESCRIPTION","start":227,"end":236},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":237,"end":245},{"text":"orthopnoea","label":"SIGN_SYMPTOM","start":249,"end":259},{"text":"Vitals","label":"DIAGNOSTIC_PROCEDURE","start":261,"end":267},{"text":"stable","label":"LAB_VALUE","start":273,"end":279},{"text":"Cardiovascular examination","label":"DIAGNOSTIC_PROCEDURE","start":281,"end":307},{"text":"elevated","label":"LAB_VALUE","start":330,"end":338},{"text":"jugular venous pressure","label":"DIAGNOSTIC_PROCEDURE","start":339,"end":362},{"text":"JVP","label":"DIAGNOSTIC_PROCEDURE","start":364,"end":367},{"text":"12\u2005cm","label":"LAB_VALUE","start":378,"end":383},{"text":"pronounced \u2018y\u2019 descent","label":"LAB_VALUE","start":391,"end":413},{"text":"prominent","label":"SEVERITY","start":427,"end":436},{"text":"pericardial knock sound","label":"SIGN_SYMPTOM","start":437,"end":460},{"text":"praecordium","label":"BIOLOGICAL_STRUCTURE","start":476,"end":487},{"text":"pericardial rub","label":"SIGN_SYMPTOM","start":502,"end":517},{"text":"murmur","label":"SIGN_SYMPTOM","start":521,"end":527},{"text":"lungs","label":"BIOLOGICAL_STRUCTURE","start":533,"end":538},{"text":"clear","label":"LAB_VALUE","start":544,"end":549},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":553,"end":565},{"text":"oedematous","label":"SIGN_SYMPTOM","start":592,"end":602},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":612,"end":619},{"text":"lower limbs","label":"BIOLOGICAL_STRUCTURE","start":627,"end":638},{"text":"admitted","label":"CLINICAL_EVENT","start":648,"end":656},{"text":"diagnostic work-up","label":"DIAGNOSTIC_PROCEDURE","start":669,"end":687},{"text":"management","label":"THERAPEUTIC_PROCEDURE","start":692,"end":702},{"text":"HIV","label":"DISEASE_DISORDER","start":727,"end":730},{"text":"May 2010","label":"DATE","start":738,"end":746},{"text":"antiretroviral therapy","label":"MEDICATION","start":763,"end":785},{"text":"illicit drugs","label":"ACTIVITY","start":804,"end":817},{"text":"approximately 5\u20136\u2005years","label":"DURATION","start":822,"end":845},{"text":"Renal and hepatic diseases","label":"DISEASE_DISORDER","start":847,"end":873},{"text":"blood tests","label":"DIAGNOSTIC_PROCEDURE","start":897,"end":908},{"text":"imaging","label":"DIAGNOSTIC_PROCEDURE","start":913,"end":920},{"text":"Peritoneal fluid","label":"BIOLOGICAL_STRUCTURE","start":922,"end":938},{"text":"malignancy","label":"DISEASE_DISORDER","start":956,"end":966},{"text":"Echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":968,"end":982},{"text":"thickened","label":"LAB_VALUE","start":992,"end":1001},{"text":"bright","label":"LAB_VALUE","start":1002,"end":1008},{"text":"pericardium","label":"BIOLOGICAL_STRUCTURE","start":1009,"end":1020},{"text":"right heart border","label":"BIOLOGICAL_STRUCTURE","start":1037,"end":1055},{"text":"parallel separation between epicardial and pericardial echoes","label":"LAB_VALUE","start":1072,"end":1133},{"text":"septal bounce","label":"LAB_VALUE","start":1157,"end":1170},{"text":"pericardial slide","label":"LAB_VALUE","start":1183,"end":1200},{"text":"Annulus paradoxus","label":"SIGN_SYMPTOM","start":1202,"end":1219},{"text":"tissue","label":"BIOLOGICAL_STRUCTURE","start":1240,"end":1246},{"text":"Doppler","label":"DIAGNOSTIC_PROCEDURE","start":1247,"end":1254},{"text":"Left ventricular ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1267,"end":1301},{"text":"64%","label":"LAB_VALUE","start":1306,"end":1309},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":1315,"end":1330},{"text":"normal","label":"LAB_VALUE","start":1335,"end":1341},{"text":"size","label":"DIAGNOSTIC_PROCEDURE","start":1345,"end":1349},{"text":"function","label":"DIAGNOSTIC_PROCEDURE","start":1354,"end":1362},{"text":"moderate","label":"SEVERITY","start":1374,"end":1382},{"text":"tricuspid regurgitation","label":"SIGN_SYMPTOM","start":1383,"end":1406},{"text":"pericardial effusion","label":"SIGN_SYMPTOM","start":1421,"end":1441},{"text":"pericardial space","label":"BIOLOGICAL_STRUCTURE","start":1451,"end":1468},{"text":"debris","label":"SIGN_SYMPTOM","start":1488,"end":1494},{"text":"Constrictive physiology","label":"DISEASE_DISORDER","start":1496,"end":1519},{"text":"Doppler","label":"DIAGNOSTIC_PROCEDURE","start":1540,"end":1547},{"text":"tricuspid and mitral inflows","label":"OTHER_EVENT","start":1557,"end":1585},{"text":"inspiration","label":"ACTIVITY","start":1604,"end":1615},{"text":"expiration","label":"ACTIVITY","start":1620,"end":1630},{"text":"diastolic flow reversal","label":"SIGN_SYMPTOM","start":1632,"end":1655},{"text":"hepatic veins","label":"BIOLOGICAL_STRUCTURE","start":1685,"end":1698},{"text":"expiration","label":"ACTIVITY","start":1706,"end":1716},{"text":"dilatation","label":"SIGN_SYMPTOM","start":1735,"end":1745},{"text":"inferior vena cava","label":"BIOLOGICAL_STRUCTURE","start":1753,"end":1771},{"text":"inspiration","label":"ACTIVITY","start":1794,"end":1805},{"text":"expiration","label":"ACTIVITY","start":1809,"end":1819},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1821,"end":1823},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1831,"end":1836},{"text":"thickening","label":"SIGN_SYMPTOM","start":1846,"end":1856},{"text":"pericardium","label":"BIOLOGICAL_STRUCTURE","start":1864,"end":1875},{"text":"calcification","label":"SIGN_SYMPTOM","start":1896,"end":1909},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":1925,"end":1929},{"text":"nodules","label":"SIGN_SYMPTOM","start":1930,"end":1937},{"text":"Bilateral","label":"DETAILED_DESCRIPTION","start":1939,"end":1948},{"text":"pleural effusions","label":"DISEASE_DISORDER","start":1949,"end":1966},{"text":"interstitial","label":"DETAILED_DESCRIPTION","start":1971,"end":1983},{"text":"thickening","label":"SIGN_SYMPTOM","start":1984,"end":1994},{"text":"lung bases","label":"BIOLOGICAL_STRUCTURE","start":2015,"end":2025},{"text":"Cardiac","label":"BIOLOGICAL_STRUCTURE","start":2027,"end":2034},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":2035,"end":2038},{"text":"diffusely","label":"DETAILED_DESCRIPTION","start":2067,"end":2076},{"text":"thickened","label":"SIGN_SYMPTOM","start":2077,"end":2086},{"text":"pericardium","label":"BIOLOGICAL_STRUCTURE","start":2087,"end":2098},{"text":"5\u2005mm","label":"LAB_VALUE","start":2102,"end":2106},{"text":"inferior vena cava","label":"BIOLOGICAL_STRUCTURE","start":2112,"end":2130},{"text":"hepatic veins","label":"BIOLOGICAL_STRUCTURE","start":2135,"end":2148},{"text":"plethoric","label":"SIGN_SYMPTOM","start":2158,"end":2167},{"text":"rapid","label":"LAB_VALUE","start":2181,"end":2186},{"text":"early diastolic filling","label":"DIAGNOSTIC_PROCEDURE","start":2187,"end":2210},{"text":"diastolic septal bounce","label":"SIGN_SYMPTOM","start":2226,"end":2249},{"text":"hindered","label":"LAB_VALUE","start":2263,"end":2271},{"text":"late diastolic filling","label":"DIAGNOSTIC_PROCEDURE","start":2272,"end":2294},{"text":"good","label":"LAB_VALUE","start":2328,"end":2332},{"text":"response","label":"DIAGNOSTIC_PROCEDURE","start":2333,"end":2341},{"text":"diuresis","label":"THERAPEUTIC_PROCEDURE","start":2345,"end":2353},{"text":"right","label":"DETAILED_DESCRIPTION","start":2369,"end":2374},{"text":"left","label":"DETAILED_DESCRIPTION","start":2379,"end":2383},{"text":"heart","label":"BIOLOGICAL_STRUCTURE","start":2384,"end":2389},{"text":"catheterisation","label":"THERAPEUTIC_PROCEDURE","start":2390,"end":2405},{"text":"constrictive physiology","label":"DISEASE_DISORDER","start":2417,"end":2440}],"tokens":["A ","30-year-old"," ","woman"," with a history of ","HIV"," and ","HCV"," ","presented"," to the ","emergency department"," with a ","4-month"," history of ","gradual"," but ","progressive"," ","swelling"," of her ","lower limbs"," and ","abdomen",".\nShe denied any ","chest"," ","pain",", ","dyspnoea",", ","paroxysmal"," ","nocturnal"," ","dyspnoea"," or ","orthopnoea",".\n","Vitals"," were ","stable",".\n","Cardiovascular examination"," was remarkable for an ","elevated"," ","jugular venous pressure"," (","JVP",") of about ","12\u2005cm"," with a ","pronounced \u2018y\u2019 descent",".\nThere was a ","prominent"," ","pericardial knock sound"," heard over the ","praecordium",".\nThere was no ","pericardial rub"," or ","murmur",".\nThe ","lungs"," were ","clear"," to ","auscultation",".\nThe patient was markedly ","oedematous"," from the ","abdomen"," to the ","lower limbs",".\nShe was ","admitted"," for further ","diagnostic work-up"," and ","management",".\nShe was diagnosed with ","HIV"," around ","May 2010"," and had been on ","antiretroviral therapy",".\nShe had not used ","illicit drugs"," for ","approximately 5\u20136\u2005years",".\n","Renal and hepatic diseases"," were ruled out through ","blood tests"," and ","imaging",".\n","Peritoneal fluid"," was negative for ","malignancy",".\n","Echocardiogram"," showed a ","thickened"," ","bright"," ","pericardium"," adjacent to the ","right heart border"," (figure 1) with ","parallel separation between epicardial and pericardial echoes"," (railroad track sign), ","septal bounce"," and lack of ","pericardial slide",".\n","Annulus paradoxus"," was demonstrated on ","tissue"," ","Doppler"," (figure 2).\n","Left ventricular ejection fraction"," was ","64%",".\nThe ","right ventricle"," was ","normal"," in ","size"," and ","function",".\nThere was ","moderate"," ","tricuspid regurgitation",".\nThere was no ","pericardial effusion",", but the ","pericardial space"," was remarkable for ","debris",".\n","Constrictive physiology"," was demonstrated by ","Doppler"," study of ","tricuspid and mitral inflows"," (figure 3) during ","inspiration"," and ","expiration","; ","diastolic flow reversal"," was also demonstrated in the ","hepatic veins"," during ","expiration",".\nThere was marked ","dilatation"," of the ","inferior vena cava"," with no change during ","inspiration"," or ","expiration",".\n","CT"," of the ","chest"," revealed ","thickening"," of the ","pericardium"," with no evidence of ","calcification",".\nThere were no ","lung"," ","nodules",".\n","Bilateral"," ","pleural effusions"," and ","interstitial"," ","thickening"," were present in the ","lung bases",".\n","Cardiac"," ","MRI"," confirmed the presence of a ","diffusely"," ","thickened"," ","pericardium"," at ","5\u2005mm",".\nThe ","inferior vena cava"," and ","hepatic veins"," appeared ","plethoric",".\nThere was a ","rapid"," ","early diastolic filling"," and associated ","diastolic septal bounce"," secondary to ","hindered"," ","late diastolic filling"," (figure 4).\nThe patient showed a ","good"," ","response"," to ","diuresis",".\nShe underwent ","right"," and ","left"," ","heart"," ","catheterisation"," to confirm ","constrictive physiology",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,13,0,48,0,32,0,22,0,22,0,69,0,12,0,12,0,12,0,69,0,69,0,22,0,22,0,69,0,69,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,42,0,63,0,69,0,12,0,69,0,69,0,12,0,42,0,24,0,69,0,12,0,12,0,13,0,24,0,75,0,26,0,19,0,46,0,1,0,32,0,26,0,24,0,24,0,12,0,26,0,24,0,42,0,42,0,12,0,12,0,42,0,42,0,42,0,69,0,12,0,24,0,24,0,42,0,12,0,42,0,24,0,24,0,63,0,69,0,69,0,12,0,69,0,26,0,24,0,53,0,1,0,1,0,69,0,12,0,1,0,69,0,12,0,1,0,1,0,24,0,12,0,69,0,12,0,69,0,12,0,69,0,22,0,26,0,22,0,69,0,12,0,12,0,24,0,22,0,69,0,12,0,42,0,12,0,12,0,69,0,42,0,24,0,69,0,42,0,24,0,42,0,24,0,75,0,22,0,22,0,12,0,75,0,26,0]}
-{"full_text":"The affected individual, a male, was the fourth child born to an Arab Muslim family of Palestinian origin.\nParents are first cousins.\nOne sibling, a girl died at the age of 1 month due to SIDS according to parents, without any investigation.\nInformed consent for muscle, skin biopsy and exome sequencing was obtained from the parents, and the study was approved by the local institutional review board.\nDuring pregnancy, the patient was suspected to have IUGR and was delivered by Cesarian section at 36+2 gestational weeks with Apgar scores 9 and 10.\nBirth weight was 2.3\u2009kg (10th percentile) and head circumference 32\u2009cm (10th percentile).\nPhysical exam after birth, detected a systolic murmur 3\/6.\nOn the first day of life, the patient developed metabolic acidosis with lactate level of 27\u2009mm (normal range 0.5\u20132.4\u2009mm) and elevated ammonia levels 277\u2009\u03bcm (normal range 10\u201360\u2009\u03bcm).\nMetabolic work up showed normal acylcarnitines, elevated alanine level 1400\u2009\u03bcm (normal <700\u2009\u03bcm), and urine organic acids showed increased lactic acidosis and ketones.\nChest X-ray revealed cardiomegaly, and cardiac Echo revealed symmetrical left ventricular hypertrophy tricuspid regurge and pulmonary hypertension.\nThe patient was transported to the NICU and treated with bicarbonate, acetate and diuretics.\nAt the age of 4 days, quadriceps muscle biopsy was performed.\nPathology showed decreased cytochrome c oxidase stain.\nBrain ultrasound performed at age 5 days was normal.\nSubsequently, head circumference grew rapidly adding 13 centimeters by age 35 days, repeated brain US revealed dilated ventricles confirmed by head CT, which also showed subcortical and white matter cortical hemorrhage in the occipital region.\nAt 15 weeks, a ventriculoperitoneal (VP) shunt was inserted.\nHead CT performed at age 2 years showed prominent dilatation of the ventricles (Figure 1).\nDue to hypotonia with feeding difficulties and recurrent aspirations, a percutaneous endoscopic gastrostomy (PEG) feeding tube was inserted at age 10 weeks.\nEye examination at the age of 15 weeks revealed cortical blindness.\nHearing test ABR was normal.\nRepeated cardiac Echo continued to show mild tricuspid regurge, mild left ventricular hypertrophy (LVH) and pulmonary hypertension (PHTN) in the first months of life.\nAt the age of 4 months, he started developing hypertrophic obstructive cardiomyopathy, he was started on diuretics and beta blockers and later calcium channel blockers were added; follow-up Echo at the age of 2 years revealed improvement in the LVH and no PHTN.\nCoenzyme Q10 supplementation (60\u2009mg twice daily) was initiated at 4 months but discontinued by the parents.\nIn the following months, the patient was admitted several times to the hospital mainly due to chest infections, shunt malfunctioning and fevers.\nHe died at the age of 30 months due to severe hypoxemia after a febrile illness with chest infection and pulmonary edema; parents refused mechanical ventilation and refused reanimation.\n","ner_info":[{"text":"male","label":"SEX","start":27,"end":31},{"text":"fourth child","label":"FAMILY_HISTORY","start":41,"end":53},{"text":"Arab Muslim family of Palestinian origin","label":"FAMILY_HISTORY","start":65,"end":105},{"text":"Parents","label":"SUBJECT","start":107,"end":114},{"text":"first cousins","label":"DETAILED_DESCRIPTION","start":119,"end":132},{"text":"One sibling, a girl died at the age of 1 month due to SIDS according to parents","label":"FAMILY_HISTORY","start":134,"end":213},{"text":"muscle","label":"BIOLOGICAL_STRUCTURE","start":263,"end":269},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":271,"end":275},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":276,"end":282},{"text":"exome","label":"DETAILED_DESCRIPTION","start":287,"end":292},{"text":"sequencing","label":"DIAGNOSTIC_PROCEDURE","start":293,"end":303},{"text":"IUGR","label":"DISEASE_DISORDER","start":455,"end":459},{"text":"delivered","label":"CLINICAL_EVENT","start":468,"end":477},{"text":"Cesarian section","label":"THERAPEUTIC_PROCEDURE","start":481,"end":497},{"text":"36+2 gestational weeks","label":"DATE","start":501,"end":523},{"text":"Apgar","label":"DIAGNOSTIC_PROCEDURE","start":529,"end":534},{"text":"9","label":"LAB_VALUE","start":542,"end":543},{"text":"10","label":"LAB_VALUE","start":548,"end":550},{"text":"Birth weight","label":"DIAGNOSTIC_PROCEDURE","start":552,"end":564},{"text":"2.3\u2009kg","label":"LAB_VALUE","start":569,"end":575},{"text":"10th percentile","label":"LAB_VALUE","start":577,"end":592},{"text":"head circumference","label":"DIAGNOSTIC_PROCEDURE","start":598,"end":616},{"text":"32\u2009cm","label":"LAB_VALUE","start":617,"end":622},{"text":"10th percentile","label":"LAB_VALUE","start":624,"end":639},{"text":"Physical exam","label":"DIAGNOSTIC_PROCEDURE","start":642,"end":655},{"text":"birth","label":"CLINICAL_EVENT","start":662,"end":667},{"text":"systolic murmur","label":"SIGN_SYMPTOM","start":680,"end":695},{"text":"3\/6","label":"LAB_VALUE","start":696,"end":699},{"text":"first day of life","label":"DATE","start":708,"end":725},{"text":"metabolic acidosis","label":"DISEASE_DISORDER","start":749,"end":767},{"text":"lactate","label":"DIAGNOSTIC_PROCEDURE","start":773,"end":780},{"text":"27\u2009mm","label":"LAB_VALUE","start":790,"end":795},{"text":"elevated","label":"LAB_VALUE","start":826,"end":834},{"text":"ammonia","label":"DIAGNOSTIC_PROCEDURE","start":835,"end":842},{"text":"277\u2009\u03bcm","label":"LAB_VALUE","start":850,"end":856},{"text":"Metabolic work up","label":"DIAGNOSTIC_PROCEDURE","start":882,"end":899},{"text":"normal","label":"LAB_VALUE","start":907,"end":913},{"text":"acylcarnitines","label":"DIAGNOSTIC_PROCEDURE","start":914,"end":928},{"text":"elevated","label":"LAB_VALUE","start":930,"end":938},{"text":"alanine","label":"DIAGNOSTIC_PROCEDURE","start":939,"end":946},{"text":"1400\u2009\u03bcm","label":"LAB_VALUE","start":953,"end":960},{"text":"urine","label":"DETAILED_DESCRIPTION","start":983,"end":988},{"text":"organic acids","label":"DIAGNOSTIC_PROCEDURE","start":989,"end":1002},{"text":"lactic acidosis","label":"SIGN_SYMPTOM","start":1020,"end":1035},{"text":"ketones","label":"SIGN_SYMPTOM","start":1040,"end":1047},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1049,"end":1054},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":1055,"end":1060},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":1070,"end":1082},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":1088,"end":1095},{"text":"Echo","label":"DIAGNOSTIC_PROCEDURE","start":1096,"end":1100},{"text":"symmetrical","label":"DETAILED_DESCRIPTION","start":1110,"end":1121},{"text":"left ventricular hypertrophy","label":"SIGN_SYMPTOM","start":1122,"end":1150},{"text":"tricuspid regurge","label":"SIGN_SYMPTOM","start":1151,"end":1168},{"text":"pulmonary hypertension","label":"SIGN_SYMPTOM","start":1173,"end":1195},{"text":"transported","label":"CLINICAL_EVENT","start":1213,"end":1224},{"text":"NICU","label":"NONBIOLOGICAL_LOCATION","start":1232,"end":1236},{"text":"bicarbonate","label":"MEDICATION","start":1254,"end":1265},{"text":"acetate","label":"MEDICATION","start":1267,"end":1274},{"text":"diuretics","label":"MEDICATION","start":1279,"end":1288},{"text":"4 days","label":"DATE","start":1304,"end":1310},{"text":"quadriceps muscle","label":"BIOLOGICAL_STRUCTURE","start":1312,"end":1329},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1330,"end":1336},{"text":"Pathology","label":"DIAGNOSTIC_PROCEDURE","start":1352,"end":1361},{"text":"decreased","label":"LAB_VALUE","start":1369,"end":1378},{"text":"cytochrome c oxidase stain","label":"DIAGNOSTIC_PROCEDURE","start":1379,"end":1405},{"text":"Brain","label":"BIOLOGICAL_STRUCTURE","start":1407,"end":1412},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1413,"end":1423},{"text":"5 days","label":"DATE","start":1441,"end":1447},{"text":"normal","label":"LAB_VALUE","start":1452,"end":1458},{"text":"head circumference","label":"DIAGNOSTIC_PROCEDURE","start":1474,"end":1492},{"text":"grew rapidly","label":"LAB_VALUE","start":1493,"end":1505},{"text":"adding 13 centimeters","label":"LAB_VALUE","start":1506,"end":1527},{"text":"35 days","label":"DATE","start":1535,"end":1542},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":1553,"end":1558},{"text":"US","label":"DIAGNOSTIC_PROCEDURE","start":1559,"end":1561},{"text":"dilated","label":"SIGN_SYMPTOM","start":1571,"end":1578},{"text":"ventricles","label":"BIOLOGICAL_STRUCTURE","start":1579,"end":1589},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":1603,"end":1607},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1608,"end":1610},{"text":"subcortical","label":"BIOLOGICAL_STRUCTURE","start":1630,"end":1641},{"text":"white matter cortical","label":"BIOLOGICAL_STRUCTURE","start":1646,"end":1667},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":1668,"end":1678},{"text":"occipital region","label":"BIOLOGICAL_STRUCTURE","start":1686,"end":1702},{"text":"15 weeks","label":"DATE","start":1707,"end":1715},{"text":"ventriculoperitoneal","label":"DETAILED_DESCRIPTION","start":1719,"end":1739},{"text":"VP","label":"DETAILED_DESCRIPTION","start":1741,"end":1743},{"text":"shunt","label":"THERAPEUTIC_PROCEDURE","start":1745,"end":1750},{"text":"Head","label":"BIOLOGICAL_STRUCTURE","start":1765,"end":1769},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1770,"end":1772},{"text":"2 years","label":"DATE","start":1790,"end":1797},{"text":"dilatation","label":"SIGN_SYMPTOM","start":1815,"end":1825},{"text":"ventricles","label":"BIOLOGICAL_STRUCTURE","start":1833,"end":1843},{"text":"hypotonia","label":"DISEASE_DISORDER","start":1863,"end":1872},{"text":"feeding difficulties","label":"DISEASE_DISORDER","start":1878,"end":1898},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":1903,"end":1912},{"text":"aspirations","label":"DISEASE_DISORDER","start":1913,"end":1924},{"text":"percutaneous endoscopic gastrostomy","label":"DETAILED_DESCRIPTION","start":1928,"end":1963},{"text":"PEG","label":"DETAILED_DESCRIPTION","start":1965,"end":1968},{"text":"feeding tube","label":"THERAPEUTIC_PROCEDURE","start":1970,"end":1982},{"text":"10 weeks","label":"DATE","start":2003,"end":2011},{"text":"Eye","label":"BIOLOGICAL_STRUCTURE","start":2013,"end":2016},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":2017,"end":2028},{"text":"15 weeks","label":"DATE","start":2043,"end":2051},{"text":"cortical","label":"BIOLOGICAL_STRUCTURE","start":2061,"end":2069},{"text":"blindness","label":"DISEASE_DISORDER","start":2070,"end":2079},{"text":"Hearing test","label":"DIAGNOSTIC_PROCEDURE","start":2081,"end":2093},{"text":"ABR","label":"DIAGNOSTIC_PROCEDURE","start":2094,"end":2097},{"text":"normal","label":"LAB_VALUE","start":2102,"end":2108},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2119,"end":2126},{"text":"Echo","label":"DIAGNOSTIC_PROCEDURE","start":2127,"end":2131},{"text":"mild","label":"SEVERITY","start":2150,"end":2154},{"text":"tricuspid regurge","label":"SIGN_SYMPTOM","start":2155,"end":2172},{"text":"mild","label":"SEVERITY","start":2174,"end":2178},{"text":"left ventricular hypertrophy","label":"SIGN_SYMPTOM","start":2179,"end":2207},{"text":"LVH","label":"SIGN_SYMPTOM","start":2209,"end":2212},{"text":"pulmonary hypertension","label":"SIGN_SYMPTOM","start":2218,"end":2240},{"text":"PHTN","label":"SIGN_SYMPTOM","start":2242,"end":2246},{"text":"first months of life","label":"DATE","start":2255,"end":2275},{"text":"4 months","label":"DATE","start":2291,"end":2299},{"text":"hypertrophic","label":"DETAILED_DESCRIPTION","start":2323,"end":2335},{"text":"obstructive","label":"DETAILED_DESCRIPTION","start":2336,"end":2347},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":2348,"end":2362},{"text":"diuretics","label":"MEDICATION","start":2382,"end":2391},{"text":"beta blockers","label":"MEDICATION","start":2396,"end":2409},{"text":"calcium channel blockers","label":"MEDICATION","start":2420,"end":2444},{"text":"Echo","label":"DIAGNOSTIC_PROCEDURE","start":2467,"end":2471},{"text":"2 years","label":"DATE","start":2486,"end":2493},{"text":"LVH","label":"SIGN_SYMPTOM","start":2522,"end":2525},{"text":"PHTN","label":"SIGN_SYMPTOM","start":2533,"end":2537},{"text":"Coenzyme Q10","label":"MEDICATION","start":2539,"end":2551},{"text":"60\u2009mg twice daily","label":"DOSAGE","start":2569,"end":2586},{"text":"4 months","label":"DATE","start":2605,"end":2613},{"text":"discontinued","label":"DETAILED_DESCRIPTION","start":2618,"end":2630},{"text":"parents","label":"SUBJECT","start":2638,"end":2645},{"text":"following months","label":"DURATION","start":2654,"end":2670},{"text":"admitted","label":"CLINICAL_EVENT","start":2688,"end":2696},{"text":"several times","label":"FREQUENCY","start":2697,"end":2710},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":2718,"end":2726},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2741,"end":2746},{"text":"infections","label":"DISEASE_DISORDER","start":2747,"end":2757},{"text":"shunt malfunctioning","label":"DISEASE_DISORDER","start":2759,"end":2779},{"text":"fevers","label":"SIGN_SYMPTOM","start":2784,"end":2790},{"text":"died","label":"OUTCOME","start":2795,"end":2799},{"text":"age of 30 months","label":"DATE","start":2807,"end":2823},{"text":"severe","label":"SEVERITY","start":2831,"end":2837},{"text":"hypoxemia","label":"SIGN_SYMPTOM","start":2838,"end":2847},{"text":"febrile illness","label":"DISEASE_DISORDER","start":2856,"end":2871},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2877,"end":2882},{"text":"infection","label":"DISEASE_DISORDER","start":2883,"end":2892},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":2897,"end":2906},{"text":"edema","label":"SIGN_SYMPTOM","start":2907,"end":2912},{"text":"parents","label":"SUBJECT","start":2914,"end":2921},{"text":"refused","label":"DETAILED_DESCRIPTION","start":2922,"end":2929},{"text":"mechanical ventilation","label":"THERAPEUTIC_PROCEDURE","start":2930,"end":2952},{"text":"refused","label":"DETAILED_DESCRIPTION","start":2957,"end":2964},{"text":"reanimation","label":"THERAPEUTIC_PROCEDURE","start":2965,"end":2976}],"tokens":["The affected individual, a ","male",", was the ","fourth child"," born to an ","Arab Muslim family of Palestinian origin",".\n","Parents"," are ","first cousins",".\n","One sibling, a girl died at the age of 1 month due to SIDS according to parents",", without any investigation.\nInformed consent for ","muscle",", ","skin"," ","biopsy"," and ","exome"," ","sequencing"," was obtained from the parents, and the study was approved by the local institutional review board.\nDuring pregnancy, the patient was suspected to have ","IUGR"," and was ","delivered"," by ","Cesarian section"," at ","36+2 gestational weeks"," with ","Apgar"," scores ","9"," and ","10",".\n","Birth weight"," was ","2.3\u2009kg"," (","10th percentile",") and ","head circumference"," ","32\u2009cm"," (","10th percentile",").\n","Physical exam"," after ","birth",", detected a ","systolic murmur"," ","3\/6",".\nOn the ","first day of life",", the patient developed ","metabolic acidosis"," with ","lactate"," level of ","27\u2009mm"," (normal range 0.5\u20132.4\u2009mm) and ","elevated"," ","ammonia"," levels ","277\u2009\u03bcm"," (normal range 10\u201360\u2009\u03bcm).\n","Metabolic work up"," showed ","normal"," ","acylcarnitines",", ","elevated"," ","alanine"," level ","1400\u2009\u03bcm"," (normal <700\u2009\u03bcm), and ","urine"," ","organic acids"," showed increased ","lactic acidosis"," and ","ketones",".\n","Chest"," ","X-ray"," revealed ","cardiomegaly",", and ","cardiac"," ","Echo"," revealed ","symmetrical"," ","left ventricular hypertrophy"," ","tricuspid regurge"," and ","pulmonary hypertension",".\nThe patient was ","transported"," to the ","NICU"," and treated with ","bicarbonate",", ","acetate"," and ","diuretics",".\nAt the age of ","4 days",", ","quadriceps muscle"," ","biopsy"," was performed.\n","Pathology"," showed ","decreased"," ","cytochrome c oxidase stain",".\n","Brain"," ","ultrasound"," performed at age ","5 days"," was ","normal",".\nSubsequently, ","head circumference"," ","grew rapidly"," ","adding 13 centimeters"," by age ","35 days",", repeated ","brain"," ","US"," revealed ","dilated"," ","ventricles"," confirmed by ","head"," ","CT",", which also showed ","subcortical"," and ","white matter cortical"," ","hemorrhage"," in the ","occipital region",".\nAt ","15 weeks",", a ","ventriculoperitoneal"," (","VP",") ","shunt"," was inserted.\n","Head"," ","CT"," performed at age ","2 years"," showed prominent ","dilatation"," of the ","ventricles"," (Figure 1).\nDue to ","hypotonia"," with ","feeding difficulties"," and ","recurrent"," ","aspirations",", a ","percutaneous endoscopic gastrostomy"," (","PEG",") ","feeding tube"," was inserted at age ","10 weeks",".\n","Eye"," ","examination"," at the age of ","15 weeks"," revealed ","cortical"," ","blindness",".\n","Hearing test"," ","ABR"," was ","normal",".\nRepeated ","cardiac"," ","Echo"," continued to show ","mild"," ","tricuspid regurge",", ","mild"," ","left ventricular hypertrophy"," (","LVH",") and ","pulmonary hypertension"," (","PHTN",") in the ","first months of life",".\nAt the age of ","4 months",", he started developing ","hypertrophic"," ","obstructive"," ","cardiomyopathy",", he was started on ","diuretics"," and ","beta blockers"," and later ","calcium channel blockers"," were added; follow-up ","Echo"," at the age of ","2 years"," revealed improvement in the ","LVH"," and no ","PHTN",".\n","Coenzyme Q10"," supplementation (","60\u2009mg twice daily",") was initiated at ","4 months"," but ","discontinued"," by the ","parents",".\nIn the ","following months",", the patient was ","admitted"," ","several times"," to the ","hospital"," mainly due to ","chest"," ","infections",", ","shunt malfunctioning"," and ","fevers",".\nHe ","died"," at the ","age of 30 months"," due to ","severe"," ","hypoxemia"," after a ","febrile illness"," with ","chest"," ","infection"," and ","pulmonary"," ","edema","; ","parents"," ","refused"," ","mechanical ventilation"," and ","refused"," ","reanimation",".\n"],"ner_labels":[0,65,0,34,0,34,0,71,0,22,0,34,0,12,0,12,0,24,0,22,0,24,0,26,0,13,0,75,0,19,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,13,0,69,0,42,0,19,0,26,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,69,0,69,0,12,0,24,0,69,0,12,0,24,0,22,0,69,0,69,0,69,0,13,0,48,0,46,0,46,0,46,0,19,0,12,0,24,0,24,0,42,0,24,0,12,0,24,0,19,0,42,0,24,0,42,0,42,0,19,0,12,0,24,0,69,0,12,0,12,0,24,0,12,0,12,0,69,0,12,0,19,0,22,0,22,0,75,0,12,0,24,0,19,0,69,0,12,0,26,0,26,0,22,0,26,0,22,0,22,0,75,0,19,0,12,0,24,0,19,0,12,0,26,0,24,0,24,0,42,0,12,0,24,0,63,0,69,0,63,0,69,0,69,0,69,0,69,0,19,0,19,0,22,0,22,0,26,0,46,0,46,0,46,0,24,0,19,0,69,0,69,0,46,0,29,0,19,0,22,0,71,0,32,0,13,0,35,0,48,0,12,0,26,0,26,0,69,0,56,0,19,0,63,0,69,0,26,0,12,0,26,0,12,0,69,0,71,0,22,0,75,0,22,0,75,0]}
-{"full_text":"A woman in her 60s was found to have screen detected invasive lobular breast carcinoma of the right breast and invasive ductal carcinoma, no special type, of the left breast.\nStaging CT imaging prior to mastectomy showed a 12\u2005cm pelvic mass which on initial impression was thought to be a fibroid uterus.\nAssociated postmenopausal bleeding led to pelvic ultrasound, hysteroscopy and biopsy.\nThe biopsy showed undifferentiated sarcoma, unclassifiable with immunohistochemistry.\nFollowing discussion at a multidisciplinary team meeting it was felt that the uterine tumour was a separate primary malignancy rather than metastasis from the breast.\nHysterectomy and bilateral salpingo-oophorectomy was performed for both treatment purposes and to fully categorise the malignancy to guide further adjuvant therapy.\nHistological examination of the resection specimen showed a partially necrotic tumour with a discrete outline located within and extending throughout the myometrium.\nThe tumour was composed of malignant spindle cells (figure 1A), with an intermittent component of pleomorphic cells with abundant eosinophilic cytoplasm.\nPlentiful osteoclast-like giant cells were present (figure 1B).\nMitoses were numerous and structurally abnormal forms were common.\nNeoplastic cells were surrounded by hyaline osteoid matrix and foci of coarse neoplastic woven bone (figure 1C).\nGenerous sampling of the tumour showed no admixed neoplastic epithelial elements, thus ruling out the more common carcinosarcoma (malignant mixed M\u00fcllerian tumour).\nTumour cells showed immunohistochemical expression for vimentin, smooth muscle actin (SMA), desmin (focally) and CD99.\nEpithelial markers were not expressed.\nThe morphological and immunohistochemical appearances were in keeping with primary uterine osteoblastic variant of osteosarcoma.\nUnfortunately, despite treatment, further CT imaging showed the development of multiple peritoneal and pulmonary deposits, confirmed on biopsy to be metastatic osteosarcoma.\nThe patient received palliative chemotherapy and died several months later.\n","ner_info":[{"text":"woman","label":"SEX","start":2,"end":7},{"text":"60s","label":"AGE","start":15,"end":18},{"text":"screen","label":"DIAGNOSTIC_PROCEDURE","start":37,"end":43},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":53,"end":61},{"text":"lobular","label":"DETAILED_DESCRIPTION","start":62,"end":69},{"text":"breast carcinoma","label":"DISEASE_DISORDER","start":70,"end":86},{"text":"right breast","label":"BIOLOGICAL_STRUCTURE","start":94,"end":106},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":111,"end":119},{"text":"ductal carcinoma","label":"DISEASE_DISORDER","start":120,"end":136},{"text":"no special type","label":"DETAILED_DESCRIPTION","start":138,"end":153},{"text":"left breast","label":"BIOLOGICAL_STRUCTURE","start":162,"end":173},{"text":"CT imaging","label":"DIAGNOSTIC_PROCEDURE","start":183,"end":193},{"text":"mastectomy","label":"THERAPEUTIC_PROCEDURE","start":203,"end":213},{"text":"12\u2005cm","label":"DISTANCE","start":223,"end":228},{"text":"pelvic","label":"BIOLOGICAL_STRUCTURE","start":229,"end":235},{"text":"mass","label":"SIGN_SYMPTOM","start":236,"end":240},{"text":"fibroid","label":"SIGN_SYMPTOM","start":289,"end":296},{"text":"uterus","label":"BIOLOGICAL_STRUCTURE","start":297,"end":303},{"text":"postmenopausal","label":"DETAILED_DESCRIPTION","start":316,"end":330},{"text":"bleeding","label":"SIGN_SYMPTOM","start":331,"end":339},{"text":"pelvic","label":"BIOLOGICAL_STRUCTURE","start":347,"end":353},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":354,"end":364},{"text":"hysteroscopy","label":"DIAGNOSTIC_PROCEDURE","start":366,"end":378},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":383,"end":389},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":395,"end":401},{"text":"undifferentiated","label":"DETAILED_DESCRIPTION","start":409,"end":425},{"text":"sarcoma","label":"DISEASE_DISORDER","start":426,"end":433},{"text":"unclassifiable","label":"LAB_VALUE","start":435,"end":449},{"text":"immunohistochemistry","label":"DIAGNOSTIC_PROCEDURE","start":455,"end":475},{"text":"uterine","label":"BIOLOGICAL_STRUCTURE","start":555,"end":562},{"text":"tumour","label":"SIGN_SYMPTOM","start":563,"end":569},{"text":"primary malignancy","label":"DETAILED_DESCRIPTION","start":585,"end":603},{"text":"metastasis","label":"DISEASE_DISORDER","start":616,"end":626},{"text":"breast","label":"BIOLOGICAL_STRUCTURE","start":636,"end":642},{"text":"Hysterectomy","label":"THERAPEUTIC_PROCEDURE","start":644,"end":656},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":661,"end":670},{"text":"salpingo-oophorectomy","label":"THERAPEUTIC_PROCEDURE","start":671,"end":692},{"text":"adjuvant therapy","label":"THERAPEUTIC_PROCEDURE","start":791,"end":807},{"text":"Histological examination","label":"DIAGNOSTIC_PROCEDURE","start":809,"end":833},{"text":"partially necrotic","label":"DETAILED_DESCRIPTION","start":869,"end":887},{"text":"tumour","label":"SIGN_SYMPTOM","start":888,"end":894},{"text":"discrete outline","label":"DETAILED_DESCRIPTION","start":902,"end":918},{"text":"myometrium","label":"BIOLOGICAL_STRUCTURE","start":963,"end":973},{"text":"tumour","label":"COREFERENCE","start":979,"end":985},{"text":"malignant spindle cells","label":"DETAILED_DESCRIPTION","start":1002,"end":1025},{"text":"pleomorphic cells","label":"DETAILED_DESCRIPTION","start":1073,"end":1090},{"text":"eosinophilic cytoplasm","label":"DETAILED_DESCRIPTION","start":1105,"end":1127},{"text":"Plentiful","label":"DETAILED_DESCRIPTION","start":1129,"end":1138},{"text":"osteoclast-like","label":"DETAILED_DESCRIPTION","start":1139,"end":1154},{"text":"giant cells","label":"SIGN_SYMPTOM","start":1155,"end":1166},{"text":"Mitoses","label":"DIAGNOSTIC_PROCEDURE","start":1193,"end":1200},{"text":"numerous","label":"LAB_VALUE","start":1206,"end":1214},{"text":"structurally abnormal forms","label":"SIGN_SYMPTOM","start":1219,"end":1246},{"text":"Neoplastic cells","label":"COREFERENCE","start":1260,"end":1276},{"text":"neoplastic epithelial elements","label":"SIGN_SYMPTOM","start":1423,"end":1453},{"text":"malignant mixed M\u00fcllerian tumour","label":"DISEASE_DISORDER","start":1503,"end":1535},{"text":"Tumour cells","label":"COREFERENCE","start":1538,"end":1550},{"text":"immunohistochemical","label":"DIAGNOSTIC_PROCEDURE","start":1558,"end":1577},{"text":"expression","label":"LAB_VALUE","start":1578,"end":1588},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":1593,"end":1601},{"text":"smooth muscle actin","label":"DIAGNOSTIC_PROCEDURE","start":1603,"end":1622},{"text":"SMA","label":"DIAGNOSTIC_PROCEDURE","start":1624,"end":1627},{"text":"desmin","label":"DIAGNOSTIC_PROCEDURE","start":1630,"end":1636},{"text":"focally","label":"LAB_VALUE","start":1638,"end":1645},{"text":"CD99","label":"DIAGNOSTIC_PROCEDURE","start":1651,"end":1655},{"text":"Epithelial markers","label":"DIAGNOSTIC_PROCEDURE","start":1657,"end":1675},{"text":"not expressed","label":"LAB_VALUE","start":1681,"end":1694},{"text":"primary uterine osteoblastic variant","label":"DETAILED_DESCRIPTION","start":1771,"end":1807},{"text":"osteosarcoma","label":"DISEASE_DISORDER","start":1811,"end":1823},{"text":"CT imaging","label":"DIAGNOSTIC_PROCEDURE","start":1867,"end":1877},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1904,"end":1912},{"text":"peritoneal","label":"BIOLOGICAL_STRUCTURE","start":1913,"end":1923},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1928,"end":1937},{"text":"deposits","label":"SIGN_SYMPTOM","start":1938,"end":1946},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1961,"end":1967},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":1974,"end":1984},{"text":"osteosarcoma","label":"DISEASE_DISORDER","start":1985,"end":1997},{"text":"palliative","label":"DETAILED_DESCRIPTION","start":2020,"end":2030},{"text":"chemotherapy","label":"THERAPEUTIC_PROCEDURE","start":2031,"end":2043},{"text":"died","label":"OUTCOME","start":2048,"end":2052},{"text":"several months later","label":"DATE","start":2053,"end":2073}],"tokens":["A ","woman"," in her ","60s"," was found to have ","screen"," detected ","invasive"," ","lobular"," ","breast carcinoma"," of the ","right breast"," and ","invasive"," ","ductal carcinoma",", ","no special type",", of the ","left breast",".\nStaging ","CT imaging"," prior to ","mastectomy"," showed a ","12\u2005cm"," ","pelvic"," ","mass"," which on initial impression was thought to be a ","fibroid"," ","uterus",".\nAssociated ","postmenopausal"," ","bleeding"," led to ","pelvic"," ","ultrasound",", ","hysteroscopy"," and ","biopsy",".\nThe ","biopsy"," showed ","undifferentiated"," ","sarcoma",", ","unclassifiable"," with ","immunohistochemistry",".\nFollowing discussion at a multidisciplinary team meeting it was felt that the ","uterine"," ","tumour"," was a separate ","primary malignancy"," rather than ","metastasis"," from the ","breast",".\n","Hysterectomy"," and ","bilateral"," ","salpingo-oophorectomy"," was performed for both treatment purposes and to fully categorise the malignancy to guide further ","adjuvant therapy",".\n","Histological examination"," of the resection specimen showed a ","partially necrotic"," ","tumour"," with a ","discrete outline"," located within and extending throughout the ","myometrium",".\nThe ","tumour"," was composed of ","malignant spindle cells"," (figure 1A), with an intermittent component of ","pleomorphic cells"," with abundant ","eosinophilic cytoplasm",".\n","Plentiful"," ","osteoclast-like"," ","giant cells"," were present (figure 1B).\n","Mitoses"," were ","numerous"," and ","structurally abnormal forms"," were common.\n","Neoplastic cells"," were surrounded by hyaline osteoid matrix and foci of coarse neoplastic woven bone (figure 1C).\nGenerous sampling of the tumour showed no admixed ","neoplastic epithelial elements",", thus ruling out the more common carcinosarcoma (","malignant mixed M\u00fcllerian tumour",").\n","Tumour cells"," showed ","immunohistochemical"," ","expression"," for ","vimentin",", ","smooth muscle actin"," (","SMA","), ","desmin"," (","focally",") and ","CD99",".\n","Epithelial markers"," were ","not expressed",".\nThe morphological and immunohistochemical appearances were in keeping with ","primary uterine osteoblastic variant"," of ","osteosarcoma",".\nUnfortunately, despite treatment, further ","CT imaging"," showed the development of ","multiple"," ","peritoneal"," and ","pulmonary"," ","deposits",", confirmed on ","biopsy"," to be ","metastatic"," ","osteosarcoma",".\nThe patient received ","palliative"," ","chemotherapy"," and ","died"," ","several months later",".\n"],"ner_labels":[0,65,0,5,0,24,0,22,0,22,0,26,0,12,0,22,0,26,0,22,0,12,0,24,0,75,0,27,0,12,0,69,0,69,0,12,0,22,0,69,0,12,0,24,0,24,0,24,0,24,0,22,0,26,0,42,0,24,0,12,0,69,0,22,0,26,0,12,0,75,0,22,0,75,0,75,0,24,0,22,0,69,0,22,0,12,0,18,0,22,0,22,0,22,0,22,0,22,0,69,0,24,0,42,0,69,0,18,0,69,0,26,0,18,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,42,0,22,0,26,0,24,0,22,0,12,0,12,0,69,0,24,0,22,0,26,0,22,0,75,0,56,0,19,0]}
-{"full_text":"A 56-year-old African American man who initially presented with diarrhea, weight loss and painless jaundice, was subsequently found to have adenocarcinoma of the head of pancreas.\nAn initial workup revealed localized cancer with no evidence of distant metastases.\nHe then underwent pancreaticoduodenectomy with complete surgical resection of a 5cm moderately differentiated pancreatic adenocarcinoma.\nAlthough our patient underwent complete surgical resection, a pathological examination revealed a neoplastic invasion of the resected adjacent organs, and one out of the seven resected lymph nodes contained cancer (T3N1M0).\nAt that point, the oncology department recommended to proceed with adjuvant chemotherapy with gemcitabine (1000mg\/m2 IV on days 1, 8, 15 on a 28-day cycle for six cycles) to try to reduce the likelihood of recurrence.\nHowever, after completing two cycles (a total of six doses) of chemotherapy, he presented to the emergency department with worsening exertional dyspnea, three-pillow orthopnea, paroxysmal nocturnal dyspnea and fatigue.\nHis physical examination revealed an elevated jugular venous pressure (JVP) (10cm above the sternal angle), bibasilar rales and +2 pitting edema of both lower extremities.\nCardiac auscultation revealed a gallop rhythm with an S3 and a grade 3 holosystolic murmur over precordium.\nA chest X-ray showed cardiomegaly with mild to moderate-sized right-sided pleural effusion.\nIt was thought that his presentation was consistent with fluid overload secondary to congestive heart failure (CHF) and he was started on intravenous (IV) furosemide with partial improvement in his symptoms.\nThe next day, a two-dimensional echocardiography (2D Echo) was performed, which showed left ventricular ejection fraction (LVEF) of 15 to 20 percent with global hypokinesia along with moderate mitral regurgitation.\nGiven the findings of 2D Echo and the absence of significant risk factors for coronary artery disease (CAD) and ischemic cardiomyopathy (CMP), it was concluded that our patient\u2019s CMP was related to the recent use of gemcitabine.\nOur patient was then started on carvedilol and an angiotensin-converting enzyme inhibitor in addition to diuretics and he was discharged from the hospital two days later in a euvolemic state.\nAt that point, the cardiology department recommended stopping further chemotherapy with gemcitabine.\nThe oncology department advised further testing to rule out ischemia as a cause of CMP as, in their opinion, chemotherapy with gemcitabine was the only option to reduce the risk of recurrence in this patient.\nTwo weeks later, our patient underwent myocardial perfusion imaging (MPI), which showed a fixed small- to moderate-sized inferior wall defect without any evidence of active ischemia.\nThe ejection fraction (EF) on MPI was calculated to be around 17 to 20 percent with severe global hypokinesia.\nOur patient was continued on standard heart failure therapy with one more admission to the hospital for CHF exacerbation about two months later.\nHe responded well to IV furosemide and adjustment of heart failure therapy.\nA 2D Echo was repeated a few months later and it showed improvement in systolic function with an LVEF of 40 percent.\nDue to his poor functional status and underlying CMP, further gemcitabine chemotherapy was stopped.\nLater, our patient developed a recurrence of his pancreatic cancer; he refused further chemotherapy and decided to proceed with palliative care.\nAlthough the exact etiology of our patient\u2019s dilated cardiomyopathy remains unclear, gemcitabine remains the most likely culprit.\nThe temporal relationship of his symptoms to the initiation of gemcitabine chemotherapy; the lack of risk factors for ischemic CMP and prior history of CAD, finding of global hypokinesia on 2D Echo, absence of ischemia on MPI; and improvement in his systolic function after discontinuation of gemcitabine were all consistent with gemcitabine-induced cardiomyopathy.\n","ner_info":[{"text":"56-year-old","label":"AGE","start":2,"end":13},{"text":"African American","label":"PERSONAL_BACKGROUND","start":14,"end":30},{"text":"man","label":"SEX","start":31,"end":34},{"text":"presented","label":"CLINICAL_EVENT","start":49,"end":58},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":64,"end":72},{"text":"weight loss","label":"SIGN_SYMPTOM","start":74,"end":85},{"text":"painless","label":"DETAILED_DESCRIPTION","start":90,"end":98},{"text":"jaundice","label":"SIGN_SYMPTOM","start":99,"end":107},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":140,"end":154},{"text":"head of pancreas","label":"BIOLOGICAL_STRUCTURE","start":162,"end":178},{"text":"initial workup","label":"DIAGNOSTIC_PROCEDURE","start":183,"end":197},{"text":"localized","label":"DETAILED_DESCRIPTION","start":207,"end":216},{"text":"cancer","label":"DISEASE_DISORDER","start":217,"end":223},{"text":"distant","label":"DETAILED_DESCRIPTION","start":244,"end":251},{"text":"metastases","label":"DISEASE_DISORDER","start":252,"end":262},{"text":"pancreaticoduodenectomy","label":"THERAPEUTIC_PROCEDURE","start":282,"end":305},{"text":"complete","label":"DETAILED_DESCRIPTION","start":311,"end":319},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":320,"end":338},{"text":"5cm","label":"DISTANCE","start":344,"end":347},{"text":"moderately differentiated","label":"DETAILED_DESCRIPTION","start":348,"end":373},{"text":"pancreatic","label":"BIOLOGICAL_STRUCTURE","start":374,"end":384},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":385,"end":399},{"text":"complete","label":"DETAILED_DESCRIPTION","start":432,"end":440},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":441,"end":459},{"text":"pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":463,"end":487},{"text":"neoplastic invasion","label":"SIGN_SYMPTOM","start":499,"end":518},{"text":"adjacent organs","label":"BIOLOGICAL_STRUCTURE","start":535,"end":550},{"text":"one out of the seven","label":"QUANTITATIVE_CONCEPT","start":556,"end":576},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":586,"end":597},{"text":"cancer","label":"SIGN_SYMPTOM","start":608,"end":614},{"text":"T3N1M0","label":"LAB_VALUE","start":616,"end":622},{"text":"oncology department","label":"NONBIOLOGICAL_LOCATION","start":644,"end":663},{"text":"recommended","label":"CLINICAL_EVENT","start":664,"end":675},{"text":"adjuvant","label":"DETAILED_DESCRIPTION","start":692,"end":700},{"text":"chemotherapy","label":"MEDICATION","start":701,"end":713},{"text":"gemcitabine","label":"MEDICATION","start":719,"end":730},{"text":"1000mg\/m2","label":"DOSAGE","start":732,"end":741},{"text":"IV","label":"ADMINISTRATION","start":742,"end":744},{"text":"days 1, 8, 15 on a 28-day cycle for six cycles","label":"FREQUENCY","start":748,"end":794},{"text":"recurrence","label":"SIGN_SYMPTOM","start":831,"end":841},{"text":"two cycles","label":"QUANTITATIVE_CONCEPT","start":869,"end":879},{"text":"six doses","label":"QUANTITATIVE_CONCEPT","start":892,"end":901},{"text":"chemotherapy","label":"MEDICATION","start":906,"end":918},{"text":"presented","label":"CLINICAL_EVENT","start":923,"end":932},{"text":"emergency 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","surgical resection"," of a ","5cm"," ","moderately differentiated"," ","pancreatic"," ","adenocarcinoma",".\nAlthough our patient underwent ","complete"," ","surgical resection",", a ","pathological examination"," revealed a ","neoplastic invasion"," of the resected ","adjacent organs",", and ","one out of the seven"," resected ","lymph nodes"," contained ","cancer"," (","T3N1M0",").\nAt that point, the ","oncology department"," ","recommended"," to proceed with ","adjuvant"," ","chemotherapy"," with ","gemcitabine"," (","1000mg\/m2"," ","IV"," on ","days 1, 8, 15 on a 28-day cycle for six cycles",") to try to reduce the likelihood of ","recurrence",".\nHowever, after completing ","two cycles"," (a total of ","six doses",") of ","chemotherapy",", he ","presented"," to the ","emergency department"," with worsening ","exertional"," ","dyspnea",", ","three-pillow"," ","orthopnea",", ","paroxysmal"," ","nocturnal"," ","dyspnea"," and ","fatigue",".\nHis ","physical examination"," revealed an ","elevated"," ","jugular venous pressure"," (","JVP",") (","10cm above the sternal angle","), ","bibasilar"," ","rales"," and ","+2"," ","pitting"," ","edema"," of ","both lower extremities",".\n","Cardiac"," ","auscultation"," revealed a ","gallop rhythm"," with an ","S3"," and a ","grade 3"," ","holosystolic"," ","murmur"," over ","precordium",".\nA ","chest"," ","X-ray"," showed ","cardiomegaly"," with ","mild"," to ","moderate-sized"," ","right-sided"," ","pleural effusion",".\nIt was thought that his presentation was consistent with ","fluid overload"," secondary to ","congestive heart failure"," (","CHF",") and he was started on ","intravenous"," (","IV",") ","furosemide"," with partial improvement in his ","symptoms",".\nThe ","next day",", a ","two-dimensional echocardiography"," (","2D Echo",") was performed, which showed ","left ventricular ejection fraction"," (","LVEF",") of ","15 to 20 percent"," with ","global"," ","hypokinesia"," along with ","moderate"," ","mitral regurgitation",".\nGiven the findings of ","2D Echo"," and the absence of significant ","risk factors for coronary artery disease"," (","CAD",") and ","ischemic"," ","cardiomyopathy"," (","CMP","), it was concluded that our patient\u2019s ","CMP"," was related to the recent use of ","gemcitabine",".\nOur patient was then started on ","carvedilol"," and an ","angiotensin-converting enzyme inhibitor"," in addition to ","diuretics"," and he was ","discharged"," from the ","hospital"," ","two days later"," in a ","euvolemic"," state.\nAt that point, the ","cardiology department"," ","recommended"," stopping further ","chemotherapy"," with ","gemcitabine",".\nThe ","oncology department"," ","advised"," further ","testing"," to rule out ","ischemia"," as a cause of ","CMP"," as, in their opinion, ","chemotherapy"," with ","gemcitabine"," was the only option to reduce the risk of ","recurrence"," in this patient.\n","Two weeks later",", our patient underwent ","myocardial perfusion 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","chemotherapy"," and decided to proceed with ","palliative care",".\nAlthough the exact etiology of our patient\u2019s ","dilated"," ","cardiomyopathy"," remains unclear, ","gemcitabine"," remains the most likely culprit.\nThe temporal relationship of his symptoms to the initiation of ","gemcitabine"," ","chemotherapy","; the lack of ","risk factors for ischemic CMP"," and prior ","history of CAD",", finding of ","global"," ","hypokinesia"," on ","2D Echo",", absence of ","ischemia"," on ","MPI","; and ","improvement"," in his ","systolic function"," after discontinuation of ","gemcitabine"," were all consistent with ","gemcitabine","-induced 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-{"full_text":"A 66-year-old Caucasian woman with a history of hypertension was admitted to our hospital with a recent diagnosis of Burkitt lymphoma.\nHer lactate dehydrogenase level was high and the diameter of her mediastinal mass was more than 10cm.\nHer physical examination was normal, and basal electrocardiography (ECG) showed sinus rhythm with a heart rate of 72 beats\/minute.\nTwo-dimensional transthoracic echocardiography (TTE; Siemens, Acuson Sequoia, C512) revealed normal biventricular functions with an LV ejection fraction (LVEF) of 60%, mild mitral and tricuspid regurgitation, and moderate pericardial effusion.\nA risk assessment of the patient put her into a high-risk category and she underwent rituximab-hyperfractionated-cyclophosphamide-vincristine-doxorubicin-dexamethasone (R-Hyper-CVAD) chemotherapy protocol.\nHer laboratory values are summarized in Table 1.\nShe received high-dose cyclophosphamide 300mg\/m2 twice daily for 3 days, doxorubicin 25mg\/m2\/day for 2 days, rituximab 375mg\/m2\/day for 1 day, dexamethasone 40mg\/day for 4 days, and vincristine 2mg\/day for 2 days.\nThe total treatment dose of cyclophosphamide and doxorubicin received was 1800mg\/m2 and 50mg\/m2, respectively.\nShe was given allopurinol 300mg\/day perorally, sodium bicarbonate (8.4%, 10 flacon\/day) infusion for 24 hours before chemotherapy, and mesna 600mg\/m2\/day for 2 days as prophylaxis against tumor lysis syndrome and hemorrhagic cystitis, respectively.\nShe also received granisetron 2mg\/day and lansoprazole 30mg\/day as antiemetogenic and gastric prophylaxis, respectively.\nThe patient developed dyspnea on the seventh day of therapy.\nA physical examination revealed blood pressure of 100\/60mmHg and a heart rate of 110 beats\/minute.\nOn chest auscultation, no inspiratory sounds were heard at lower zones and inspiratory crackles were heard at middle zones.\nNeither cardiac murmurs nor S3 were heard.\nAn ECG showed low voltage in the limb and precordial leads.\nTTE showed diffusely increased myocardial echogenicity, mild pericardial effusion, and generally impaired biventricular systolic functions with an LVEF 31% and right ventricular mid-apical akinesis.\nManifest pleural effusion was also detected.\nDrug-induced cardiotoxicity (myocarditis) was suspected.\nFurosemide and ramipril were started.\nThe beta-blocker therapy the patient was already taking for hypertension was continued.\nAfter 12 days, TTE showed an LVEF of 37% and normal right ventricular functions.\nHer dyspnea decreased and she was discharged on day 20.\nAfter 1 month, TTE showed normal biventricular functions with an LVEF of 60%.\nAfter the first course of the R-Hyper-CVAD chemotherapy protocol, she underwent a high-dose methotrexate and cytarabine cycle.\nShe had severe neutropenia and pneumonia.\nShe had no cardiac failure symptoms during this chemotherapy course, but she declined another course of chemotherapy.\nShe is still in remission despite the abbreviated course of chemotherapy.\n","ner_info":[{"text":"66-year-old","label":"AGE","start":2,"end":13},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":14,"end":23},{"text":"woman","label":"SEX","start":24,"end":29},{"text":"hypertension","label":"HISTORY","start":48,"end":60},{"text":"admitted","label":"CLINICAL_EVENT","start":65,"end":73},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":81,"end":89},{"text":"Burkitt lymphoma","label":"DISEASE_DISORDER","start":117,"end":133},{"text":"lactate dehydrogenase","label":"DIAGNOSTIC_PROCEDURE","start":139,"end":160},{"text":"high","label":"QUALITATIVE_CONCEPT","start":171,"end":175},{"text":"mediastinal","label":"BIOLOGICAL_STRUCTURE","start":200,"end":211},{"text":"mass","label":"SIGN_SYMPTOM","start":212,"end":216},{"text":"more than 10cm","label":"DISTANCE","start":221,"end":235},{"text":"physical 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Sequoia","label":"DETAILED_DESCRIPTION","start":430,"end":444},{"text":"C512","label":"DETAILED_DESCRIPTION","start":446,"end":450},{"text":"normal","label":"LAB_VALUE","start":461,"end":467},{"text":"biventricular functions","label":"DIAGNOSTIC_PROCEDURE","start":468,"end":491},{"text":"LV ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":500,"end":520},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":522,"end":526},{"text":"60%","label":"LAB_VALUE","start":531,"end":534},{"text":"mild","label":"SEVERITY","start":536,"end":540},{"text":"mitral","label":"BIOLOGICAL_STRUCTURE","start":541,"end":547},{"text":"tricuspid","label":"BIOLOGICAL_STRUCTURE","start":552,"end":561},{"text":"regurgitation","label":"SIGN_SYMPTOM","start":562,"end":575},{"text":"moderate","label":"SEVERITY","start":581,"end":589},{"text":"pericardial effusion","label":"SIGN_SYMPTOM","start":590,"end":610},{"text":"risk assessment","label":"DIAGNOSTIC_PROCEDURE","start":614,"end":629},{"text":"high-risk","label":"QUALITATIVE_CONCEPT","start":660,"end":669},{"text":"rituximab-hyperfractionated-cyclophosphamide-vincristine-doxorubicin-dexamethasone","label":"MEDICATION","start":697,"end":779},{"text":"R-Hyper-CVAD","label":"MEDICATION","start":781,"end":793},{"text":"chemotherapy","label":"MEDICATION","start":795,"end":807},{"text":"laboratory values","label":"DIAGNOSTIC_PROCEDURE","start":822,"end":839},{"text":"high-dose","label":"DOSAGE","start":880,"end":889},{"text":"cyclophosphamide","label":"MEDICATION","start":890,"end":906},{"text":"300mg\/m2 twice daily","label":"DOSAGE","start":907,"end":927},{"text":"3 days","label":"DURATION","start":932,"end":938},{"text":"doxorubicin","label":"MEDICATION","start":940,"end":951},{"text":"25mg\/m2\/day","label":"DOSAGE","start":952,"end":963},{"text":"2 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cystitis","label":"DISEASE_DISORDER","start":1405,"end":1425},{"text":"granisetron","label":"MEDICATION","start":1459,"end":1470},{"text":"2mg\/day","label":"DOSAGE","start":1471,"end":1478},{"text":"lansoprazole","label":"MEDICATION","start":1483,"end":1495},{"text":"30mg\/day","label":"DOSAGE","start":1496,"end":1504},{"text":"antiemetogenic","label":"DETAILED_DESCRIPTION","start":1508,"end":1522},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":1527,"end":1534},{"text":"prophylaxis","label":"THERAPEUTIC_PROCEDURE","start":1535,"end":1546},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1584,"end":1591},{"text":"seventh day","label":"DATE","start":1599,"end":1610},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1625,"end":1645},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1655,"end":1669},{"text":"100\/60mmHg","label":"LAB_VALUE","start":1673,"end":1683},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":1690,"end":1700},{"text":"110 beats\/minute","label":"LAB_VALUE","start":1704,"end":1720},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1725,"end":1730},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":1731,"end":1743},{"text":"inspiratory sounds","label":"SIGN_SYMPTOM","start":1748,"end":1766},{"text":"lower zones","label":"BIOLOGICAL_STRUCTURE","start":1781,"end":1792},{"text":"inspiratory crackles","label":"SIGN_SYMPTOM","start":1797,"end":1817},{"text":"middle zones","label":"BIOLOGICAL_STRUCTURE","start":1832,"end":1844},{"text":"cardiac murmurs","label":"SIGN_SYMPTOM","start":1854,"end":1869},{"text":"S3","label":"SIGN_SYMPTOM","start":1874,"end":1876},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":1892,"end":1895},{"text":"low voltage","label":"LAB_VALUE","start":1903,"end":1914},{"text":"limb and precordial leads","label":"DIAGNOSTIC_PROCEDURE","start":1922,"end":1947},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":1949,"end":1952},{"text":"diffusely increased","label":"LAB_VALUE","start":1960,"end":1979},{"text":"myocardial","label":"BIOLOGICAL_STRUCTURE","start":1980,"end":1990},{"text":"echogenicity","label":"DIAGNOSTIC_PROCEDURE","start":1991,"end":2003},{"text":"mild","label":"SEVERITY","start":2005,"end":2009},{"text":"pericardial effusion","label":"SIGN_SYMPTOM","start":2010,"end":2030},{"text":"generally impaired","label":"LAB_VALUE","start":2036,"end":2054},{"text":"biventricular","label":"DETAILED_DESCRIPTION","start":2055,"end":2068},{"text":"systolic functions","label":"DIAGNOSTIC_PROCEDURE","start":2069,"end":2087},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":2096,"end":2100},{"text":"31%","label":"LAB_VALUE","start":2101,"end":2104},{"text":"right ventricular","label":"BIOLOGICAL_STRUCTURE","start":2109,"end":2126},{"text":"mid-apical","label":"DETAILED_DESCRIPTION","start":2127,"end":2137},{"text":"akinesis","label":"SIGN_SYMPTOM","start":2138,"end":2146},{"text":"Manifest","label":"DETAILED_DESCRIPTION","start":2148,"end":2156},{"text":"pleural effusion","label":"SIGN_SYMPTOM","start":2157,"end":2173},{"text":"Drug-induced cardiotoxicity","label":"DISEASE_DISORDER","start":2193,"end":2220},{"text":"myocarditis","label":"DISEASE_DISORDER","start":2222,"end":2233},{"text":"Furosemide","label":"MEDICATION","start":2250,"end":2260},{"text":"ramipril","label":"MEDICATION","start":2265,"end":2273},{"text":"beta-blocker","label":"MEDICATION","start":2292,"end":2304},{"text":"hypertension","label":"SIGN_SYMPTOM","start":2348,"end":2360},{"text":"After 12 days","label":"DATE","start":2376,"end":2389},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":2391,"end":2394},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":2405,"end":2409},{"text":"37%","label":"LAB_VALUE","start":2413,"end":2416},{"text":"normal","label":"LAB_VALUE","start":2421,"end":2427},{"text":"right ventricular functions","label":"DIAGNOSTIC_PROCEDURE","start":2428,"end":2455},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2461,"end":2468},{"text":"discharged","label":"ACTIVITY","start":2491,"end":2501},{"text":"day 20","label":"DATE","start":2505,"end":2511},{"text":"After 1 month","label":"DATE","start":2513,"end":2526},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":2528,"end":2531},{"text":"normal","label":"LAB_VALUE","start":2539,"end":2545},{"text":"biventricular functions","label":"DIAGNOSTIC_PROCEDURE","start":2546,"end":2569},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":2578,"end":2582},{"text":"60%","label":"LAB_VALUE","start":2586,"end":2589},{"text":"R-Hyper-CVAD","label":"MEDICATION","start":2621,"end":2633},{"text":"chemotherapy","label":"MEDICATION","start":2634,"end":2646},{"text":"high-dose","label":"DOSAGE","start":2673,"end":2682},{"text":"methotrexate","label":"MEDICATION","start":2683,"end":2695},{"text":"cytarabine","label":"MEDICATION","start":2700,"end":2710},{"text":"neutropenia","label":"SIGN_SYMPTOM","start":2733,"end":2744},{"text":"pneumonia","label":"DISEASE_DISORDER","start":2749,"end":2758},{"text":"cardiac failure symptoms","label":"SIGN_SYMPTOM","start":2771,"end":2795},{"text":"chemotherapy","label":"MEDICATION","start":2808,"end":2820},{"text":"another course","label":"DETAILED_DESCRIPTION","start":2846,"end":2860},{"text":"chemotherapy","label":"MEDICATION","start":2864,"end":2876},{"text":"remission","label":"SIGN_SYMPTOM","start":2894,"end":2903},{"text":"chemotherapy","label":"MEDICATION","start":2938,"end":2950}],"tokens":["A ","66-year-old"," ","Caucasian"," ","woman"," with a history of ","hypertension"," was ","admitted"," to our ","hospital"," with a recent diagnosis of ","Burkitt lymphoma",".\nHer ","lactate dehydrogenase"," level was ","high"," and the diameter of her ","mediastinal"," ","mass"," was ","more than 10cm",".\nHer ","physical examination"," was ","normal",", and ","basal"," ","electrocardiography"," (","ECG",") showed ","sinus rhythm"," with a ","heart rate"," of ","72 beats\/minute",".\n","Two-dimensional transthoracic echocardiography"," (","TTE","; ","Siemens",", ","Acuson Sequoia",", ","C512",") revealed ","normal"," ","biventricular functions"," with an ","LV ejection fraction"," (","LVEF",") of ","60%",", ","mild"," ","mitral"," and ","tricuspid"," ","regurgitation",", and ","moderate"," ","pericardial effusion",".\nA ","risk assessment"," of the patient put her into a ","high-risk"," category and she underwent ","rituximab-hyperfractionated-cyclophosphamide-vincristine-doxorubicin-dexamethasone"," (","R-Hyper-CVAD",") ","chemotherapy"," protocol.\nHer ","laboratory values"," are summarized in Table 1.\nShe received ","high-dose"," ","cyclophosphamide"," ","300mg\/m2 twice daily"," for ","3 days",", ","doxorubicin"," ","25mg\/m2\/day"," for ","2 days",", ","rituximab"," ","375mg\/m2\/day"," for ","1 day",", ","dexamethasone"," ","40mg\/day"," for ","4 days",", and ","vincristine"," ","2mg\/day"," for ","2 days",".\nThe total treatment dose of ","cyclophosphamide"," and ","doxorubicin"," received was ","1800mg\/m2"," and ","50mg\/m2",", respectively.\nShe was given ","allopurinol"," ","300mg\/day"," ","perorally",", ","sodium bicarbonate"," (","8.4%",", ","10 flacon\/day",") ","infusion"," for ","24 hours before"," ","chemotherapy",", and ","mesna"," ","600mg\/m2\/day"," for ","2 days"," as ","prophylaxis"," against ","tumor lysis syndrome"," and ","hemorrhagic cystitis",", respectively.\nShe also received ","granisetron"," ","2mg\/day"," and ","lansoprazole"," ","30mg\/day"," as ","antiemetogenic"," and ","gastric"," ","prophylaxis",", respectively.\nThe patient developed ","dyspnea"," on the ","seventh day"," of therapy.\nA ","physical examination"," revealed ","blood pressure"," of ","100\/60mmHg"," and a ","heart rate"," of ","110 beats\/minute",".\nOn ","chest"," ","auscultation",", no ","inspiratory sounds"," were heard at ","lower zones"," and ","inspiratory crackles"," were heard at ","middle zones",".\nNeither ","cardiac murmurs"," nor ","S3"," were heard.\nAn ","ECG"," showed ","low voltage"," in the ","limb and precordial leads",".\n","TTE"," showed ","diffusely increased"," ","myocardial"," ","echogenicity",", ","mild"," ","pericardial effusion",", and ","generally impaired"," ","biventricular"," ","systolic functions"," with an ","LVEF"," ","31%"," and ","right ventricular"," ","mid-apical"," ","akinesis",".\n","Manifest"," ","pleural effusion"," was also detected.\n","Drug-induced cardiotoxicity"," (","myocarditis",") was suspected.\n","Furosemide"," and ","ramipril"," were started.\nThe ","beta-blocker"," therapy the patient was already taking for ","hypertension"," was continued.\n","After 12 days",", ","TTE"," showed an ","LVEF"," of ","37%"," and ","normal"," ","right ventricular functions",".\nHer ","dyspnea"," decreased and she was ","discharged"," on ","day 20",".\n","After 1 month",", ","TTE"," showed ","normal"," ","biventricular functions"," with an ","LVEF"," of ","60%",".\nAfter the first course of the ","R-Hyper-CVAD"," ","chemotherapy"," protocol, she underwent a ","high-dose"," ","methotrexate"," and ","cytarabine"," cycle.\nShe had severe ","neutropenia"," and ","pneumonia",".\nShe had no ","cardiac failure symptoms"," during this ","chemotherapy"," course, but she declined ","another course"," of ","chemotherapy",".\nShe is still in ","remission"," despite the abbreviated course of ","chemotherapy",".\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,13,0,48,0,26,0,24,0,59,0,12,0,69,0,27,0,24,0,42,0,22,0,24,0,24,0,69,0,24,0,42,0,24,0,24,0,22,0,22,0,22,0,42,0,24,0,24,0,24,0,42,0,63,0,12,0,12,0,69,0,63,0,69,0,24,0,59,0,46,0,46,0,46,0,24,0,29,0,46,0,29,0,32,0,46,0,29,0,32,0,46,0,29,0,32,0,46,0,29,0,32,0,46,0,29,0,32,0,46,0,46,0,29,0,29,0,46,0,29,0,4,0,46,0,29,0,29,0,4,0,32,0,46,0,46,0,29,0,32,0,75,0,26,0,26,0,46,0,29,0,46,0,29,0,22,0,12,0,75,0,69,0,19,0,24,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,12,0,69,0,12,0,69,0,69,0,24,0,42,0,24,0,24,0,42,0,12,0,24,0,63,0,69,0,42,0,22,0,24,0,24,0,42,0,12,0,22,0,69,0,22,0,69,0,26,0,26,0,46,0,46,0,46,0,69,0,19,0,24,0,24,0,42,0,42,0,24,0,69,0,1,0,19,0,19,0,24,0,42,0,24,0,24,0,42,0,46,0,46,0,29,0,46,0,46,0,69,0,26,0,69,0,46,0,22,0,46,0,69,0,46,0]}
-{"full_text":"A 29-year-old primipara presented with complaints of persistent, severe right -sided upper abdominal pain during deep inspiration, physical exercise and on local pressure.\nThese complaints had developed gradually after giving birth one year earlier.\nThis pregnancy had been complicated by HELLP syndrome with a subcapsular liver hematoma sized 20 cm \u00d7 5 cm, which had resolved spontaneously.\nAt current presentation, liver function tests were normal.\nShe assured having never experienced signs suggestive of sexually transmitted diseases or pelvic inflammatory disease (PID).\nShe had never undergone intra-abdominal interventions.\nAn upper-abdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma, suspect of perihepatic adhesions (Figure \u200b1).\nShe was referred to the hepatobiliary surgeon, who performed a laparoscopy and confirmed the presence of a thick adhesion between liver segment V\/VIII and the diaphragm (Figure \u200b2).\nAdhesiolysis was performed in the same session by monopolar diathermia and sharp dissection, followed by the instillation of 1.5 L Adept (4% icodextrin solution) into the peritoneal cavity to prevent the formation of new adhesions.\nOn follow-up until three years post-surgery, she was free of symptoms.\n","ner_info":[{"text":"29-year-old","label":"AGE","start":2,"end":13},{"text":"primipara","label":"HISTORY","start":14,"end":23},{"text":"presented","label":"CLINICAL_EVENT","start":24,"end":33},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":53,"end":63},{"text":"severe","label":"SEVERITY","start":65,"end":71},{"text":"right -sided","label":"DETAILED_DESCRIPTION","start":72,"end":84},{"text":"upper abdominal","label":"BIOLOGICAL_STRUCTURE","start":85,"end":100},{"text":"pain","label":"SIGN_SYMPTOM","start":101,"end":105},{"text":"during deep inspiration","label":"DETAILED_DESCRIPTION","start":106,"end":129},{"text":"physical exercise","label":"ACTIVITY","start":131,"end":148},{"text":"on local pressure","label":"DETAILED_DESCRIPTION","start":153,"end":170},{"text":"complaints","label":"COREFERENCE","start":178,"end":188},{"text":"developed gradually","label":"DETAILED_DESCRIPTION","start":193,"end":212},{"text":"giving birth","label":"CLINICAL_EVENT","start":219,"end":231},{"text":"one year earlier","label":"DATE","start":232,"end":248},{"text":"pregnancy","label":"CLINICAL_EVENT","start":255,"end":264},{"text":"HELLP syndrome","label":"DISEASE_DISORDER","start":289,"end":303},{"text":"subcapsular","label":"DETAILED_DESCRIPTION","start":311,"end":322},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":323,"end":328},{"text":"hematoma","label":"SIGN_SYMPTOM","start":329,"end":337},{"text":"20 cm \u00d7 5 cm","label":"AREA","start":344,"end":356},{"text":"resolved spontaneously","label":"DETAILED_DESCRIPTION","start":368,"end":390},{"text":"liver function tests","label":"DIAGNOSTIC_PROCEDURE","start":417,"end":437},{"text":"normal","label":"LAB_VALUE","start":443,"end":449},{"text":"sexually transmitted diseases","label":"DISEASE_DISORDER","start":508,"end":537},{"text":"pelvic inflammatory disease","label":"DISEASE_DISORDER","start":541,"end":568},{"text":"(PID)","label":"DISEASE_DISORDER","start":569,"end":574},{"text":"intra-abdominal","label":"BIOLOGICAL_STRUCTURE","start":600,"end":615},{"text":"interventions","label":"THERAPEUTIC_PROCEDURE","start":616,"end":629},{"text":"upper-abdominal","label":"BIOLOGICAL_STRUCTURE","start":634,"end":649},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":650,"end":676},{"text":"density","label":"SIGN_SYMPTOM","start":688,"end":695},{"text":"between liver and diaphragm","label":"BIOLOGICAL_STRUCTURE","start":696,"end":723},{"text":"site of the former subcapsular hematoma","label":"BIOLOGICAL_STRUCTURE","start":731,"end":770},{"text":"perihepatic adhesions","label":"SIGN_SYMPTOM","start":783,"end":804},{"text":"referred","label":"CLINICAL_EVENT","start":826,"end":834},{"text":"hepatobiliary surgeon","label":"NONBIOLOGICAL_LOCATION","start":842,"end":863},{"text":"laparoscopy","label":"DIAGNOSTIC_PROCEDURE","start":881,"end":892},{"text":"thick","label":"DETAILED_DESCRIPTION","start":925,"end":930},{"text":"adhesion","label":"SIGN_SYMPTOM","start":931,"end":939},{"text":"between liver segment V\/VIII and the diaphragm","label":"BIOLOGICAL_STRUCTURE","start":940,"end":986},{"text":"Adhesiolysis","label":"THERAPEUTIC_PROCEDURE","start":1000,"end":1012},{"text":"monopolar diathermia","label":"THERAPEUTIC_PROCEDURE","start":1050,"end":1070},{"text":"sharp dissection","label":"THERAPEUTIC_PROCEDURE","start":1075,"end":1091},{"text":"1.5 L","label":"DOSAGE","start":1125,"end":1130},{"text":"Adept","label":"MEDICATION","start":1131,"end":1136},{"text":"4% icodextrin solution","label":"MEDICATION","start":1138,"end":1160},{"text":"into the peritoneal cavity","label":"ADMINISTRATION","start":1162,"end":1188},{"text":"follow-up","label":"CLINICAL_EVENT","start":1235,"end":1244},{"text":"until three years post-surgery","label":"DURATION","start":1245,"end":1275},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1293,"end":1301}],"tokens":["A ","29-year-old"," ","primipara"," ","presented"," with complaints of ","persistent",", ","severe"," ","right -sided"," ","upper abdominal"," ","pain"," ","during deep inspiration",", ","physical exercise"," and ","on local pressure",".\nThese ","complaints"," had ","developed gradually"," after ","giving birth"," ","one year earlier",".\nThis ","pregnancy"," had been complicated by ","HELLP syndrome"," with a ","subcapsular"," ","liver"," ","hematoma"," sized ","20 cm \u00d7 5 cm",", which had ","resolved spontaneously",".\nAt current presentation, ","liver function tests"," were ","normal",".\nShe assured having never experienced signs suggestive of ","sexually transmitted diseases"," or ","pelvic inflammatory disease"," ","(PID)",".\nShe had never undergone ","intra-abdominal"," ","interventions",".\nAn ","upper-abdominal"," ","magnetic resonance imaging"," revealed a ","density"," ","between liver and diaphragm"," at the ","site of the former subcapsular hematoma",", suspect of ","perihepatic adhesions"," (Figure \u200b1).\nShe was ","referred"," to the ","hepatobiliary surgeon",", who performed a ","laparoscopy"," and confirmed the presence of a ","thick"," ","adhesion"," ","between liver segment V\/VIII and the diaphragm"," (Figure \u200b2).\n","Adhesiolysis"," was performed in the same session by ","monopolar diathermia"," and ","sharp dissection",", followed by the instillation of ","1.5 L"," ","Adept"," (","4% icodextrin solution",") ","into the peritoneal cavity"," to prevent the formation of new adhesions.\nOn ","follow-up"," ","until three years post-surgery",", she was free of ","symptoms",".\n"],"ner_labels":[0,5,0,39,0,13,0,22,0,63,0,22,0,12,0,69,0,22,0,1,0,22,0,18,0,22,0,13,0,19,0,13,0,26,0,22,0,12,0,69,0,8,0,22,0,24,0,42,0,26,0,26,0,26,0,12,0,75,0,12,0,24,0,69,0,12,0,12,0,69,0,13,0,48,0,24,0,22,0,69,0,12,0,75,0,75,0,75,0,29,0,46,0,46,0,4,0,13,0,32,0,69,0]}
-{"full_text":"A 45-year-old woman presents to her general practitioner because of left-sided neck and shoulder pain.\nThe pain was mild and non-specific and the patient's history was unremarkable.\nShe denied a history of smoking, excessive alcohol use and radiation exposure.\nPhysical examination demonstrated mild left sided cervical lymphadenopathy.\nRoutine blood tests revealed borderline elevated calcium of 10.5\u2005mg\/dL and subsequent work up exhibited a markedly elevated parathyroid hormone level of 286\u2005pg\/mL, so the patient was referred to otolaryngology for further evaluation.\nThyroid ultrasound showed a hypoechoic nodule in the left lower lobe of the thyroid.\nCT scan of the neck revealed a 2\u2005cm hypodense nodule on the posterior inferior aspect of the left lower thyroid and sestamibi scan showed increased uptake along the lower pole of the left thyroid lobe.\nElevated PTH along with an aberrant parathyroid gland on imaging suggests primary hyperparathyroidism.\nHistorically, hyperparathyroidism is associated with bone disease, renal stones and neuromuscular dysfunction, however, with the current screening modalities, most patients are caught early and often asymptomatic.3 Primary hyperparathyroidism is most commonly caused by a parathyroid adenoma.\nInfrequent causes include parathyroid hyperplasia, which would affect all four glands and rarely caused by parathyroid carcinoma.\nMarkedly elevated serum PTH and calcium levels leading to severe renal and bone manifestations are helpful in the diagnosis of cancer, however, it is usually discovered operatively based on local invasion and metastases.3\nThe primary indication for parathyroidectomy, historically, is for symptomatic patients.\nCurrently, since most patients are caught earlier, there are newer indications for surgery.\nThese include an asymptomatic patient with any of the following: glomerular filtration rate <60\u2005mL\/min, bone density T-score <\u22122.5 at any site and\/or previous fractures, age <50, and serum calcium 1.0\u2005ng\/dL above the upper limit of normal.3 This patient presented with pain, markedly elevated PTH, and was younger than 50\u2005years old, so it was decided that surgery was the best choice in management.\nThe patient was brought to the operating room and underwent a parathyroidectomy.\nThe surgeon found the parathyroid gland to be firm and densely adherent to the thyroid capsule and overlying strap muscle, making it difficult to dissect.\nThere was no visible invasion into the capsule, surrounding muscle or regional lymph nodes.\nThe resected specimen was noted to be brownish grey in colour with scattered necrotic foci, and irregular texture.\nOn postoperative pathology, the specimen was confirmed positive for parathyroid carcinoma with capsular invasion, focal tumour necrosis, reactive fibrosis and local skeletal muscle invasion (figures 1 and \u200b2).\nMargins were resected.\nImmunohistochemical stains showed increased Ki-67 reactivity as well as strong Bcl-1 (cyclin D1) reactivity, which support the diagnosis of parathyroid carcinoma (figure 3).\nAdditionally, P57 staining was negative.\nAlthough most reports of parathyroid carcinomas are associated with marked hypercalcaemia, non-functioning cancers in patients tend to behave more aggressively.1 Owing to the severity and uncertainty of the lesion, the patient was followed up postoperatively for repeat imaging to determine if residual tumour remained.\nRepeat sestamibi and positron emission tomography (PET) scan revealed residual activity along the surgical area so the patient subsequently underwent a second operation for a radical left neck dissection and left hemithyroidectomy.\nThe patient recovered very well postoperatively and it has now been 3\u2005years since the second surgery.\nThe patient continues to do very well and is followed up every 3\u2005months to monitor serum PTH and calcium levels.\nShe no longer reports of neck and shoulder pain.\nSometimes the patient's blood tests show marginally elevated PTH levels, however, she remains eucalcaemic and follow-up nuclear scans and PET scans continue to be negative.\nThe patient will continue to be monitored every 3\u2005months indefinitely.\n","ner_info":[{"text":"45-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presents","label":"CLINICAL_EVENT","start":20,"end":28},{"text":"general practitioner","label":"NONBIOLOGICAL_LOCATION","start":36,"end":56},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":68,"end":78},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":79,"end":83},{"text":"shoulder","label":"BIOLOGICAL_STRUCTURE","start":88,"end":96},{"text":"pain","label":"SIGN_SYMPTOM","start":97,"end":101},{"text":"pain","label":"SIGN_SYMPTOM","start":107,"end":111},{"text":"mild","label":"SEVERITY","start":116,"end":120},{"text":"non-specific","label":"DETAILED_DESCRIPTION","start":125,"end":137},{"text":"history was unremarkable","label":"HISTORY","start":156,"end":180},{"text":"denied a history of smoking, excessive alcohol use and radiation exposure","label":"HISTORY","start":186,"end":259},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":261,"end":281},{"text":"mild","label":"SEVERITY","start":295,"end":299},{"text":"left sided","label":"DETAILED_DESCRIPTION","start":300,"end":310},{"text":"cervical","label":"BIOLOGICAL_STRUCTURE","start":311,"end":319},{"text":"lymphadenopathy","label":"SIGN_SYMPTOM","start":320,"end":335},{"text":"blood tests","label":"DIAGNOSTIC_PROCEDURE","start":345,"end":356},{"text":"borderline elevated","label":"LAB_VALUE","start":366,"end":385},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":386,"end":393},{"text":"10.5\u2005mg\/dL","label":"LAB_VALUE","start":397,"end":407},{"text":"work up","label":"DIAGNOSTIC_PROCEDURE","start":423,"end":430},{"text":"elevated","label":"LAB_VALUE","start":452,"end":460},{"text":"parathyroid hormone","label":"DIAGNOSTIC_PROCEDURE","start":461,"end":480},{"text":"286\u2005pg\/mL","label":"LAB_VALUE","start":490,"end":499},{"text":"referred","label":"CLINICAL_EVENT","start":520,"end":528},{"text":"otolaryngology","label":"NONBIOLOGICAL_LOCATION","start":532,"end":546},{"text":"Thyroid","label":"BIOLOGICAL_STRUCTURE","start":571,"end":578},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":579,"end":589},{"text":"hypoechoic","label":"DETAILED_DESCRIPTION","start":599,"end":609},{"text":"nodule","label":"SIGN_SYMPTOM","start":610,"end":616},{"text":"left lower lobe of the thyroid","label":"BIOLOGICAL_STRUCTURE","start":624,"end":654},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":656,"end":658},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":671,"end":675},{"text":"2\u2005cm","label":"DISTANCE","start":687,"end":691},{"text":"hypodense","label":"DETAILED_DESCRIPTION","start":692,"end":701},{"text":"nodule","label":"SIGN_SYMPTOM","start":702,"end":708},{"text":"posterior inferior aspect of the left lower thyroid","label":"BIOLOGICAL_STRUCTURE","start":716,"end":767},{"text":"sestamibi","label":"DIAGNOSTIC_PROCEDURE","start":772,"end":781},{"text":"increased uptake","label":"SIGN_SYMPTOM","start":794,"end":810},{"text":"lower pole of the left thyroid lobe","label":"BIOLOGICAL_STRUCTURE","start":821,"end":856},{"text":"Elevated","label":"LAB_VALUE","start":858,"end":866},{"text":"PTH","label":"DIAGNOSTIC_PROCEDURE","start":867,"end":870},{"text":"aberrant","label":"SIGN_SYMPTOM","start":885,"end":893},{"text":"parathyroid 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filtration rate","label":"DIAGNOSTIC_PROCEDURE","start":1852,"end":1878},{"text":"bone density T-score","label":"DIAGNOSTIC_PROCEDURE","start":1891,"end":1911},{"text":"fractures","label":"DISEASE_DISORDER","start":1946,"end":1955},{"text":"serum","label":"DETAILED_DESCRIPTION","start":1970,"end":1975},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":1976,"end":1983},{"text":"pain","label":"SIGN_SYMPTOM","start":2056,"end":2060},{"text":"elevated","label":"LAB_VALUE","start":2071,"end":2079},{"text":"PTH","label":"DIAGNOSTIC_PROCEDURE","start":2080,"end":2083},{"text":"younger than 50\u2005years old","label":"AGE","start":2093,"end":2118},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":2143,"end":2150},{"text":"brought","label":"CLINICAL_EVENT","start":2202,"end":2209},{"text":"operating room","label":"NONBIOLOGICAL_LOCATION","start":2217,"end":2231},{"text":"parathyroidectomy","label":"THERAPEUTIC_PROCEDURE","start":2248,"end":2265},{"text":"parathyroid 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carcinomas","label":"DISEASE_DISORDER","start":3102,"end":3124},{"text":"hypercalcaemia","label":"SIGN_SYMPTOM","start":3152,"end":3166},{"text":"followed up","label":"CLINICAL_EVENT","start":3308,"end":3319},{"text":"imaging","label":"DIAGNOSTIC_PROCEDURE","start":3347,"end":3354},{"text":"residual","label":"DETAILED_DESCRIPTION","start":3371,"end":3379},{"text":"tumour","label":"SIGN_SYMPTOM","start":3380,"end":3386},{"text":"sestamibi","label":"DIAGNOSTIC_PROCEDURE","start":3404,"end":3413},{"text":"positron emission tomography","label":"DIAGNOSTIC_PROCEDURE","start":3418,"end":3446},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":3448,"end":3451},{"text":"operation","label":"THERAPEUTIC_PROCEDURE","start":3556,"end":3565},{"text":"radical","label":"DETAILED_DESCRIPTION","start":3572,"end":3579},{"text":"left","label":"DETAILED_DESCRIPTION","start":3580,"end":3584},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":3585,"end":3589},{"text":"dissection","label":"THERAPEUTIC_PROCEDURE","start":3590,"end":3600},{"text":"left","label":"DETAILED_DESCRIPTION","start":3605,"end":3609},{"text":"hemithyroidectomy","label":"THERAPEUTIC_PROCEDURE","start":3610,"end":3627},{"text":"recovered","label":"SIGN_SYMPTOM","start":3641,"end":3650},{"text":"3\u2005years","label":"DATE","start":3697,"end":3704},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":3722,"end":3729},{"text":"continues to do very well","label":"OUTCOME","start":3743,"end":3768},{"text":"followed up","label":"CLINICAL_EVENT","start":3776,"end":3787},{"text":"every 3\u2005months","label":"FREQUENCY","start":3788,"end":3802},{"text":"serum","label":"DETAILED_DESCRIPTION","start":3814,"end":3819},{"text":"PTH","label":"DIAGNOSTIC_PROCEDURE","start":3820,"end":3823},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":3828,"end":3835},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":3869,"end":3873},{"text":"shoulder","label":"BIOLOGICAL_STRUCTURE","start":3878,"end":3886},{"text":"pain","label":"SIGN_SYMPTOM","start":3887,"end":3891},{"text":"Sometimes","label":"FREQUENCY","start":3893,"end":3902},{"text":"blood tests","label":"DIAGNOSTIC_PROCEDURE","start":3917,"end":3928},{"text":"marginally elevated","label":"LAB_VALUE","start":3934,"end":3953},{"text":"PTH","label":"DIAGNOSTIC_PROCEDURE","start":3954,"end":3957},{"text":"eucalcaemic","label":"SIGN_SYMPTOM","start":3987,"end":3998},{"text":"nuclear scans","label":"DIAGNOSTIC_PROCEDURE","start":4013,"end":4026},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":4031,"end":4034},{"text":"negative","label":"LAB_VALUE","start":4056,"end":4064},{"text":"monitored","label":"CLINICAL_EVENT","start":4098,"end":4107},{"text":"every 3\u2005months","label":"FREQUENCY","start":4108,"end":4122}],"tokens":["A ","45-year-old"," ","woman"," ","presents"," to her ","general practitioner"," because of ","left-sided"," ","neck"," and ","shoulder"," ","pain",".\nThe ","pain"," was ","mild"," and ","non-specific"," and the patient's ","history was unremarkable",".\nShe ","denied a history of smoking, excessive alcohol use and radiation exposure",".\n","Physical examination"," demonstrated ","mild"," ","left sided"," ","cervical"," ","lymphadenopathy",".\nRoutine ","blood tests"," revealed ","borderline elevated"," ","calcium"," of ","10.5\u2005mg\/dL"," and subsequent ","work up"," exhibited a markedly ","elevated"," ","parathyroid hormone"," level of ","286\u2005pg\/mL",", so the patient was ","referred"," to ","otolaryngology"," for further evaluation.\n","Thyroid"," ","ultrasound"," showed a ","hypoechoic"," ","nodule"," in the ","left lower lobe of the thyroid",".\n","CT"," scan of the ","neck"," revealed a ","2\u2005cm"," ","hypodense"," ","nodule"," on the ","posterior inferior aspect of the left lower thyroid"," and ","sestamibi"," scan showed ","increased uptake"," along the ","lower pole of the left thyroid lobe",".\n","Elevated"," ","PTH"," along with an ","aberrant"," ","parathyroid gland"," on ","imaging"," suggests ","primary"," ","hyperparathyroidism",".\nHistorically, ","hyperparathyroidism"," is associated with ","bone disease",", ","renal stones"," and ","neuromuscular dysfunction",", however, with the current ","screening modalities",", most patients are caught early and often ","asymptomatic",".3 ","Primary"," ","hyperparathyroidism"," is most commonly caused by a ","parathyroid"," ","adenoma",".\nInfrequent causes include ","parathyroid"," ","hyperplasia",", which would affect all four glands and rarely caused by ","parathyroid"," ","carcinoma",".\nMarkedly ","elevated"," ","serum"," ","PTH"," and ","calcium"," levels leading to ","severe"," ","renal"," and ","bone"," ","manifestations"," are helpful in the diagnosis of ","cancer",", however, it is usually discovered ","operatively"," based on local ","invasion"," and ","metastases",".3\nThe primary indication for ","parathyroidectomy",", historically, is for symptomatic patients.\nCurrently, since most patients are caught earlier, there are newer indications for ","surgery",".\nThese include an asymptomatic patient with any of the following: ","glomerular filtration rate"," <60\u2005mL\/min, ","bone density T-score"," <\u22122.5 at any site and\/or previous ","fractures",", age <50, and ","serum"," ","calcium"," 1.0\u2005ng\/dL above the upper limit of normal.3 This patient presented with ","pain",", markedly ","elevated"," ","PTH",", and was ","younger than 50\u2005years old",", so it was decided that ","surgery"," was the best choice in management.\nThe patient was ","brought"," to the ","operating room"," and underwent a ","parathyroidectomy",".\nThe surgeon found the ","parathyroid gland"," to be ","firm"," and ","densely"," ","adherent"," to the ","thyroid capsule"," and overlying ","strap muscle",", making it difficult to ","dissect",".\nThere was no visible ","invasion"," into the ","capsule",", surrounding ","muscle"," or regional ","lymph nodes",".\nThe ","resected specimen"," was noted to be ","brownish grey"," in colour with ","scattered"," ","necrotic foci",", and ","irregular texture",".\nOn postoperative ","pathology",", the specimen was confirmed positive for ","parathyroid carcinoma"," with ","capsular"," ","invasion",", ","focal"," ","tumour necrosis",", ","reactive"," ","fibrosis"," and local ","skeletal muscle"," ","invasion"," (figures 1 and \u200b2).\n","Margins were resected",".\n","Immunohistochemical stains"," showed ","increased"," ","Ki-67"," reactivity as well as ","strong"," ","Bcl-1"," (","cyclin D1",") reactivity, which support the diagnosis of ","parathyroid carcinoma"," (figure 3).\nAdditionally, ","P57 staining"," was ","negative",".\nAlthough most reports of ","parathyroid carcinomas"," are associated with marked ","hypercalcaemia",", non-functioning cancers in patients tend to behave more aggressively.1 Owing to the severity and uncertainty of the lesion, the patient was ","followed up"," postoperatively for repeat ","imaging"," to determine if ","residual"," ","tumour"," remained.\nRepeat ","sestamibi"," and ","positron emission tomography"," (","PET",") scan revealed residual activity along the surgical area so the patient subsequently underwent a second ","operation"," for a ","radical"," ","left"," ","neck"," ","dissection"," and ","left"," ","hemithyroidectomy",".\nThe patient ","recovered"," very well postoperatively and it has now been ","3\u2005years"," since the second ","surgery",".\nThe patient ","continues to do very well"," and is ","followed up"," ","every 3\u2005months"," to monitor ","serum"," ","PTH"," and ","calcium"," levels.\nShe no longer reports of ","neck"," and ","shoulder"," ","pain",".\n","Sometimes"," the patient's ","blood tests"," show ","marginally elevated"," ","PTH"," levels, however, she remains ","eucalcaemic"," and follow-up ","nuclear scans"," and ","PET"," scans continue to be ","negative",".\nThe patient will continue to be ","monitored"," ","every 3\u2005months"," indefinitely.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,12,0,12,0,69,0,69,0,63,0,22,0,39,0,39,0,24,0,63,0,22,0,12,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,13,0,48,0,12,0,24,0,22,0,69,0,12,0,24,0,12,0,27,0,22,0,69,0,12,0,24,0,69,0,12,0,42,0,24,0,69,0,12,0,24,0,22,0,26,0,26,0,26,0,26,0,26,0,24,0,69,0,22,0,26,0,12,0,26,0,12,0,26,0,12,0,26,0,42,0,22,0,24,0,24,0,63,0,12,0,12,0,69,0,26,0,75,0,69,0,26,0,75,0,75,0,24,0,24,0,26,0,22,0,24,0,69,0,42,0,24,0,5,0,75,0,13,0,48,0,75,0,12,0,69,0,22,0,69,0,12,0,12,0,75,0,69,0,12,0,12,0,12,0,24,0,15,0,22,0,69,0,73,0,24,0,26,0,12,0,69,0,22,0,69,0,22,0,69,0,12,0,69,0,75,0,24,0,42,0,24,0,42,0,24,0,24,0,26,0,24,0,42,0,26,0,69,0,13,0,24,0,22,0,69,0,24,0,24,0,24,0,75,0,22,0,22,0,12,0,75,0,22,0,75,0,69,0,19,0,75,0,56,0,13,0,35,0,22,0,24,0,24,0,12,0,12,0,69,0,35,0,24,0,42,0,24,0,69,0,24,0,24,0,42,0,13,0,35,0]}
-{"full_text":"A 20-year-old male with cystic fibrosis was transferred to Houston Methodist Hospital in January 2013 to be evaluated for lung and kidney transplant.\nPatients with cystic fibrosis are known to develop chronic lung infections that adapt over time to this unique anatomic niche (14, 15).\nHis complicated medical history included pancreatic insufficiency, liver transplantation in 2004, steroid-induced diabetes, end-stage renal disease, and testicular cancer.\nHe had a long history of respiratory infections with several multidrug-resistant bacteria, including MRSA.\nHe was treated with ceftaroline at an outside hospital immediately prior to transfer to Houston Methodist Hospital.\nThe patient was periodically hospitalized from January to July 2013 and was treated for recurrent respiratory and catheter-related infections caused by MRSA and multidrug-resistant Pseudomonas aeruginosa.\nHis antibiotic exposure included long treatment courses with various agents, including meropenem, ceftazidime, doxycycline, vancomycin, linezolid, cefepime, ciprofloxacin, and inhaled and systemic colistin and tobramycin.\nShortly after being readmitted to our hospital in June 2013, MRSA was grown from cultures of blood and respiratory specimens.\nThese two isolates were resistant to clindamycin, linezolid, oxacillin, and trimethoprim-sulfamethoxazole and susceptible to minocycline, rifampin, and vancomycin.\nHis blood isolate grew confluently around the ceftaroline Etest strip, yielding an MIC of >32 mg\/liter.\nFive additional S. aureus respiratory tract isolates were available for further study.\nAll MRSA isolates from this patient had a small-colony-variant (SCV) phenotype.\n","ner_info":[{"text":"20-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"cystic fibrosis","label":"HISTORY","start":24,"end":39},{"text":"transferred","label":"CLINICAL_EVENT","start":44,"end":55},{"text":"Houston Methodist 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2013","label":"DATE","start":1158,"end":1167},{"text":"MRSA","label":"DISEASE_DISORDER","start":1169,"end":1173},{"text":"cultures","label":"DIAGNOSTIC_PROCEDURE","start":1189,"end":1197},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":1201,"end":1206},{"text":"respiratory specimens","label":"BIOLOGICAL_STRUCTURE","start":1211,"end":1232},{"text":"isolates","label":"COREFERENCE","start":1244,"end":1252},{"text":"resistant","label":"LAB_VALUE","start":1258,"end":1267},{"text":"clindamycin","label":"DIAGNOSTIC_PROCEDURE","start":1271,"end":1282},{"text":"linezolid","label":"DIAGNOSTIC_PROCEDURE","start":1284,"end":1293},{"text":"oxacillin","label":"DIAGNOSTIC_PROCEDURE","start":1295,"end":1304},{"text":"trimethoprim-sulfamethoxazole","label":"DIAGNOSTIC_PROCEDURE","start":1310,"end":1339},{"text":"susceptible","label":"LAB_VALUE","start":1344,"end":1355},{"text":"minocycline","label":"DIAGNOSTIC_PROCEDURE","start":1359,"end":1370},{"text":"rifampin","label":"DIAGNOSTIC_PROCEDURE","start":1372,"end":1380},{"text":"vancomycin","label":"DIAGNOSTIC_PROCEDURE","start":1386,"end":1396},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":1402,"end":1407},{"text":"isolate","label":"DIAGNOSTIC_PROCEDURE","start":1408,"end":1415},{"text":"grew confluently","label":"LAB_VALUE","start":1416,"end":1432},{"text":"ceftaroline Etest strip","label":"DIAGNOSTIC_PROCEDURE","start":1444,"end":1467},{"text":"MIC of >32 mg\/liter","label":"LAB_VALUE","start":1481,"end":1500},{"text":"Five","label":"LAB_VALUE","start":1502,"end":1506},{"text":"S. aureus","label":"DISEASE_DISORDER","start":1518,"end":1527},{"text":"respiratory tract","label":"BIOLOGICAL_STRUCTURE","start":1528,"end":1545},{"text":"isolates","label":"DIAGNOSTIC_PROCEDURE","start":1546,"end":1554}],"tokens":["A ","20-year-old"," ","male"," with ","cystic fibrosis"," was ","transferred"," to ","Houston Methodist Hospital"," in ","January 2013"," to be ","evaluated"," for ","lung"," and ","kidney"," ","transplant",".\nPatients with cystic fibrosis are known to develop chronic lung infections that adapt over time to this unique anatomic niche (14, 15).\nHis complicated medical history included ","pancreatic insufficiency",", ","liver"," ","transplantation"," in ","2004",", ","steroid","-induced ","diabetes",", ","end-stage renal disease",", and ","testicular cancer",".\nHe had a long history of ","respiratory infections"," with several ","multidrug-resistant bacteria",", including ","MRSA",".\nHe was treated with ","ceftaroline"," at an ","outside hospital"," immediately prior to ","transfer"," to ","Houston Methodist Hospital",".\nThe patient was ","periodically"," ","hospitalized"," from ","January to July 2013"," and was treated for recurrent ","respiratory"," and ","catheter-related"," ","infections"," caused by ","MRSA"," and ","multidrug-resistant Pseudomonas aeruginosa",".\nHis ","antibiotic"," exposure included long treatment courses with various agents, including ","meropenem",", ","ceftazidime",", ","doxycycline",", ","vancomycin",", ","linezolid",", ","cefepime",", ","ciprofloxacin",", and ","inhaled"," and ","systemic"," ","colistin"," and ","tobramycin",".\nShortly after being ","readmitted"," to our ","hospital"," in ","June 2013",", ","MRSA"," was grown from ","cultures"," of ","blood"," and ","respiratory specimens",".\nThese two ","isolates"," were ","resistant"," to ","clindamycin",", ","linezolid",", ","oxacillin",", and ","trimethoprim-sulfamethoxazole"," and ","susceptible"," to ","minocycline",", ","rifampin",", and ","vancomycin",".\nHis ","blood"," ","isolate"," ","grew confluently"," around the ","ceftaroline Etest strip",", yielding an ","MIC of >32 mg\/liter",".\n","Five"," additional ","S. aureus"," ","respiratory tract"," ","isolates"," were available for further study.\nAll MRSA isolates from this patient had a small-colony-variant (SCV) phenotype.\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,48,0,19,0,13,0,12,0,12,0,75,0,26,0,12,0,75,0,19,0,46,0,26,0,26,0,26,0,26,0,26,0,26,0,46,0,48,0,13,0,48,0,35,0,13,0,32,0,12,0,22,0,26,0,26,0,26,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,4,0,4,0,46,0,46,0,13,0,48,0,19,0,26,0,24,0,12,0,12,0,18,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,12,0,24,0,42,0,24,0,42,0,42,0,26,0,12,0,24,0]}
-{"full_text":"A 7-year-old boy with Goldenhar syndrome with post-natal genetic diagnosis was referred to our Department of Radiology for imaging study of the temporal bone.\nThe patient underwent a 3D-CT scan.\nBrilliance CT-64-channel (Philips Medical Systems, Amsterdam, The Netherlands) was employed.\nThe protocol generated 120 kV and a current of 150 mA.\nSlice thickness of the images was 1-mm with a 0.5-mm increment.\nImages in DICOM format were processed on a PC using commercial software, obtaining a three-dimensional reconstruction of skeletal structures.\nThe 3-dimensional reconstruction of the skin plans showed hypoplasia of the auricle that on the right side consisted of a simple dysmorphic rough.\nThe left auricle had regular dimensions and morphology.\nAtresia of the right auditory conduit and a normal left auditory conduit were observed.\nThe upper images showed partial ossification of the cranium typical in paediatric age.\nDescription of the profile: typical II class very convex profile with interposition of the inferior lip and a reduced neck-chin angle.(Fig.1).\nSkeletal studies show that the mandibular condyle, ramus and corpus were shorter on the affected side.\nTilting of oral rhyme, occlusal plane and mandibular plane were evident.\nNumber or form abnormalities were not found during mixed dentition.\nMandibular condyles and temporo-mandibular joints seemed to be asymmetric, and in particular the right condyle was deformed, shorter and wider than the other side (mandibular condyle dimensions were 11 \u00d7 7 mm right and 14 \u00d7 7 mm left).\nThe 3-dimensional reconstruction of the skeleton planes showed the different morphology of the right and left hemimandibula.\nMandibular 3-dimensional reconstruction showed in detail the shift of the medial axis to the hypoplastic right side and the asymmetry of the right mandibular condyles that appears dysmorphic short and wide in axial and coronal scansions (Figs.2, 3).\nThe study of the temporal bone showed on the right side an external auditory canal atresia, hypoplasia of tympanic cavity that was not pneumatized and occupied by dense materials from soft parts.\nNo pneumatization was present in right mastoid cells.\nLeft external auditory canal dimensions and morphology were normal.\nThe left tympanic cavity was normally formed and totally occupied by dense materials from soft tissues.\nBoth right and left ears presented minor hypoplasia of auricle bones in the right side.\nIn agreement with the resolution of our instrument, normal representation of the malleus head that seemed articulated with a dysmorphic rough of a deformed incus was observed; it was impossible to see the staples.\nThe left malleus and incus were visible and appeared to be articulated in an abnormal manner (reduce contact surface); the staples was difficult to observe but seemed to have regular morphology.\nDimensions and morphology of cochlea semicircular canals, vestibulum and utriculum were unaltered (Figs.4-\u200b7).\nIn conclusion, through 3D-CT valuation of this young patient we observed asymmetry of the condyles; in particular, the right condyle was dysmorphic, short and wide; the auricle of the right external ear was hypoplastic, only a dysmorphic rough was present; the right middle ear had a hypoplastic tympanic cavity; the right internal ear has an atresic auditory conduit.\n","ner_info":[{"text":"7-year-old","label":"AGE","start":2,"end":12},{"text":"boy","label":"SEX","start":13,"end":16},{"text":"Goldenhar syndrome","label":"DISEASE_DISORDER","start":22,"end":40},{"text":"post-natal genetic diagnosis","label":"DIAGNOSTIC_PROCEDURE","start":46,"end":74},{"text":"referred","label":"CLINICAL_EVENT","start":79,"end":87},{"text":"Department of Radiology","label":"NONBIOLOGICAL_LOCATION","start":95,"end":118},{"text":"imaging study","label":"DIAGNOSTIC_PROCEDURE","start":123,"end":136},{"text":"temporal bone","label":"BIOLOGICAL_STRUCTURE","start":144,"end":157},{"text":"3D-CT 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software","label":"DETAILED_DESCRIPTION","start":435,"end":478},{"text":"three-dimensional reconstruction","label":"DIAGNOSTIC_PROCEDURE","start":492,"end":524},{"text":"skeletal structures","label":"BIOLOGICAL_STRUCTURE","start":528,"end":547},{"text":"3-dimensional reconstruction","label":"DIAGNOSTIC_PROCEDURE","start":553,"end":581},{"text":"skin plans","label":"BIOLOGICAL_STRUCTURE","start":589,"end":599},{"text":"hypoplasia","label":"DISEASE_DISORDER","start":607,"end":617},{"text":"auricle","label":"BIOLOGICAL_STRUCTURE","start":625,"end":632},{"text":"right side","label":"DETAILED_DESCRIPTION","start":645,"end":655},{"text":"simple","label":"DETAILED_DESCRIPTION","start":671,"end":677},{"text":"dysmorphic rough","label":"SIGN_SYMPTOM","start":678,"end":694},{"text":"left auricle","label":"BIOLOGICAL_STRUCTURE","start":700,"end":712},{"text":"regular","label":"LAB_VALUE","start":717,"end":724},{"text":"dimensions","label":"DIAGNOSTIC_PROCEDURE","start":725,"end":735},{"text":"morphology","label":"DIAGNOSTIC_PROCEDURE","start":740,"end":750},{"text":"Atresia","label":"DISEASE_DISORDER","start":752,"end":759},{"text":"right auditory conduit","label":"BIOLOGICAL_STRUCTURE","start":767,"end":789},{"text":"normal","label":"LAB_VALUE","start":796,"end":802},{"text":"left auditory conduit","label":"BIOLOGICAL_STRUCTURE","start":803,"end":824},{"text":"observed","label":"DIAGNOSTIC_PROCEDURE","start":830,"end":838},{"text":"upper","label":"DETAILED_DESCRIPTION","start":844,"end":849},{"text":"images","label":"DIAGNOSTIC_PROCEDURE","start":850,"end":856},{"text":"partial","label":"SEVERITY","start":864,"end":871},{"text":"ossification","label":"OTHER_EVENT","start":872,"end":884},{"text":"cranium","label":"BIOLOGICAL_STRUCTURE","start":892,"end":899},{"text":"typical in paediatric age","label":"DETAILED_DESCRIPTION","start":900,"end":925},{"text":"typical II class","label":"DETAILED_DESCRIPTION","start":955,"end":971},{"text":"very","label":"SEVERITY","start":972,"end":976},{"text":"convex profile","label":"DIAGNOSTIC_PROCEDURE","start":977,"end":991},{"text":"interposition","label":"DETAILED_DESCRIPTION","start":997,"end":1010},{"text":"inferior lip","label":"BIOLOGICAL_STRUCTURE","start":1018,"end":1030},{"text":"reduced","label":"LAB_VALUE","start":1037,"end":1044},{"text":"neck-chin angle","label":"BIOLOGICAL_STRUCTURE","start":1045,"end":1060},{"text":"Skeletal studies","label":"DIAGNOSTIC_PROCEDURE","start":1070,"end":1086},{"text":"mandibular condyle","label":"BIOLOGICAL_STRUCTURE","start":1101,"end":1119},{"text":"shorter on the affected side","label":"DETAILED_DESCRIPTION","start":1143,"end":1171},{"text":"Tilting","label":"DETAILED_DESCRIPTION","start":1173,"end":1180},{"text":"oral rhyme","label":"BIOLOGICAL_STRUCTURE","start":1184,"end":1194},{"text":"occlusal plane","label":"BIOLOGICAL_STRUCTURE","start":1196,"end":1210},{"text":"mandibular plane","label":"BIOLOGICAL_STRUCTURE","start":1215,"end":1231},{"text":"form abnormalities","label":"DISEASE_DISORDER","start":1256,"end":1274},{"text":"mixed dentition","label":"DIAGNOSTIC_PROCEDURE","start":1297,"end":1312},{"text":"Mandibular condyles","label":"BIOLOGICAL_STRUCTURE","start":1314,"end":1333},{"text":"temporo-mandibular joints","label":"BIOLOGICAL_STRUCTURE","start":1338,"end":1363},{"text":"asymmetric","label":"DETAILED_DESCRIPTION","start":1377,"end":1387},{"text":"right condyle","label":"BIOLOGICAL_STRUCTURE","start":1411,"end":1424},{"text":"deformed","label":"BIOLOGICAL_ATTRIBUTE","start":1429,"end":1437},{"text":"wider than the other side","label":"LAB_VALUE","start":1451,"end":1476},{"text":"mandibular condyle","label":"BIOLOGICAL_STRUCTURE","start":1478,"end":1496},{"text":"dimensions","label":"DIAGNOSTIC_PROCEDURE","start":1497,"end":1507},{"text":"11 \u00d7 7 mm","label":"AREA","start":1513,"end":1522},{"text":"right","label":"DETAILED_DESCRIPTION","start":1523,"end":1528},{"text":"14 \u00d7 7 mm","label":"AREA","start":1533,"end":1542},{"text":"left","label":"DETAILED_DESCRIPTION","start":1543,"end":1547},{"text":"3-dimensional reconstruction","label":"DIAGNOSTIC_PROCEDURE","start":1554,"end":1582},{"text":"skeleton planes","label":"BIOLOGICAL_STRUCTURE","start":1590,"end":1605},{"text":"morphology","label":"DIAGNOSTIC_PROCEDURE","start":1627,"end":1637},{"text":"left hemimandibula","label":"BIOLOGICAL_STRUCTURE","start":1655,"end":1673},{"text":"Mandibular","label":"BIOLOGICAL_STRUCTURE","start":1675,"end":1685},{"text":"3-dimensional reconstruction","label":"DIAGNOSTIC_PROCEDURE","start":1686,"end":1714},{"text":"shift","label":"DETAILED_DESCRIPTION","start":1736,"end":1741},{"text":"medial axis","label":"BIOLOGICAL_STRUCTURE","start":1749,"end":1760},{"text":"hypoplastic","label":"DISEASE_DISORDER","start":1768,"end":1779},{"text":"right side","label":"DETAILED_DESCRIPTION","start":1780,"end":1790},{"text":"asymmetry","label":"DETAILED_DESCRIPTION","start":1799,"end":1808},{"text":"right mandibular condyles","label":"BIOLOGICAL_STRUCTURE","start":1816,"end":1841},{"text":"dysmorphic","label":"DETAILED_DESCRIPTION","start":1855,"end":1865},{"text":"short","label":"LAB_VALUE","start":1866,"end":1871},{"text":"wide","label":"LAB_VALUE","start":1876,"end":1880},{"text":"axial","label":"DETAILED_DESCRIPTION","start":1884,"end":1889},{"text":"coronal","label":"DETAILED_DESCRIPTION","start":1894,"end":1901},{"text":"scansions","label":"DIAGNOSTIC_PROCEDURE","start":1902,"end":1911},{"text":"study","label":"COREFERENCE","start":1929,"end":1934},{"text":"temporal bone","label":"BIOLOGICAL_STRUCTURE","start":1942,"end":1955},{"text":"right side","label":"DETAILED_DESCRIPTION","start":1970,"end":1980},{"text":"external auditory canal","label":"BIOLOGICAL_STRUCTURE","start":1984,"end":2007},{"text":"atresia","label":"DISEASE_DISORDER","start":2008,"end":2015},{"text":"hypoplasia","label":"DISEASE_DISORDER","start":2017,"end":2027},{"text":"tympanic cavity","label":"BIOLOGICAL_STRUCTURE","start":2031,"end":2046},{"text":"pneumatized","label":"DISEASE_DISORDER","start":2060,"end":2071},{"text":"occupied by dense materials from soft parts","label":"DETAILED_DESCRIPTION","start":2076,"end":2119},{"text":"pneumatization","label":"DISEASE_DISORDER","start":2124,"end":2138},{"text":"right mastoid cells","label":"BIOLOGICAL_STRUCTURE","start":2154,"end":2173},{"text":"Left external auditory canal","label":"BIOLOGICAL_STRUCTURE","start":2175,"end":2203},{"text":"dimensions","label":"DIAGNOSTIC_PROCEDURE","start":2204,"end":2214},{"text":"morphology","label":"DIAGNOSTIC_PROCEDURE","start":2219,"end":2229},{"text":"normal","label":"LAB_VALUE","start":2235,"end":2241},{"text":"left tympanic cavity","label":"BIOLOGICAL_STRUCTURE","start":2247,"end":2267},{"text":"normally formed","label":"DETAILED_DESCRIPTION","start":2272,"end":2287},{"text":"totally occupied by dense materials from soft tissues","label":"DETAILED_DESCRIPTION","start":2292,"end":2345},{"text":"left ears","label":"BIOLOGICAL_STRUCTURE","start":2362,"end":2371},{"text":"minor","label":"SEVERITY","start":2382,"end":2387},{"text":"hypoplasia","label":"DISEASE_DISORDER","start":2388,"end":2398},{"text":"auricle bones","label":"BIOLOGICAL_STRUCTURE","start":2402,"end":2415},{"text":"right side","label":"DETAILED_DESCRIPTION","start":2423,"end":2433},{"text":"our instrument","label":"COREFERENCE","start":2471,"end":2485},{"text":"normal representation","label":"DETAILED_DESCRIPTION","start":2487,"end":2508},{"text":"malleus head","label":"BIOLOGICAL_STRUCTURE","start":2516,"end":2528},{"text":"dysmorphic rough","label":"SIGN_SYMPTOM","start":2560,"end":2576},{"text":"deformed","label":"DETAILED_DESCRIPTION","start":2582,"end":2590},{"text":"incus","label":"BIOLOGICAL_STRUCTURE","start":2591,"end":2596},{"text":"impossible to see","label":"DETAILED_DESCRIPTION","start":2618,"end":2635},{"text":"staples","label":"BIOLOGICAL_STRUCTURE","start":2640,"end":2647},{"text":"left malleus","label":"BIOLOGICAL_STRUCTURE","start":2653,"end":2665},{"text":"incus","label":"BIOLOGICAL_STRUCTURE","start":2670,"end":2675},{"text":"visible","label":"DETAILED_DESCRIPTION","start":2681,"end":2688},{"text":"articulated in an abnormal manner","label":"DETAILED_DESCRIPTION","start":2708,"end":2741},{"text":"reduce contact surface","label":"DETAILED_DESCRIPTION","start":2743,"end":2765},{"text":"staples","label":"BIOLOGICAL_STRUCTURE","start":2772,"end":2779},{"text":"difficult to observe","label":"DETAILED_DESCRIPTION","start":2784,"end":2804},{"text":"regular","label":"DETAILED_DESCRIPTION","start":2824,"end":2831},{"text":"morphology","label":"DIAGNOSTIC_PROCEDURE","start":2832,"end":2842},{"text":"Dimensions","label":"DIAGNOSTIC_PROCEDURE","start":2844,"end":2854},{"text":"morphology","label":"DIAGNOSTIC_PROCEDURE","start":2859,"end":2869},{"text":"cochlea semicircular canals","label":"BIOLOGICAL_STRUCTURE","start":2873,"end":2900},{"text":"unaltered","label":"DETAILED_DESCRIPTION","start":2932,"end":2941},{"text":"3D-CT valuation","label":"DIAGNOSTIC_PROCEDURE","start":2978,"end":2993},{"text":"asymmetry","label":"DETAILED_DESCRIPTION","start":3028,"end":3037},{"text":"condyles","label":"BIOLOGICAL_STRUCTURE","start":3045,"end":3053},{"text":"right condyle","label":"BIOLOGICAL_STRUCTURE","start":3074,"end":3087},{"text":"dysmorphic","label":"DETAILED_DESCRIPTION","start":3092,"end":3102},{"text":"short","label":"LAB_VALUE","start":3104,"end":3109},{"text":"wide","label":"LAB_VALUE","start":3114,"end":3118},{"text":"auricle","label":"BIOLOGICAL_STRUCTURE","start":3124,"end":3131},{"text":"right external ear","label":"BIOLOGICAL_STRUCTURE","start":3139,"end":3157},{"text":"hypoplastic","label":"DISEASE_DISORDER","start":3162,"end":3173},{"text":"dysmorphic rough","label":"SIGN_SYMPTOM","start":3182,"end":3198},{"text":"right middle ear","label":"BIOLOGICAL_STRUCTURE","start":3216,"end":3232},{"text":"hypoplastic","label":"DISEASE_DISORDER","start":3239,"end":3250},{"text":"tympanic cavity","label":"BIOLOGICAL_STRUCTURE","start":3251,"end":3266},{"text":"right internal ear","label":"BIOLOGICAL_STRUCTURE","start":3272,"end":3290},{"text":"atresic","label":"DISEASE_DISORDER","start":3298,"end":3305},{"text":"auditory conduit","label":"BIOLOGICAL_STRUCTURE","start":3306,"end":3322}],"tokens":["A ","7-year-old"," ","boy"," with ","Goldenhar syndrome"," with ","post-natal genetic diagnosis"," was ","referred"," to our ","Department of Radiology"," for ","imaging study"," of the ","temporal bone",".\nThe patient underwent a ","3D-CT scan",".\n","Brilliance CT-64-channel"," (","Philips Medical Systems, Amsterdam, The Netherlands",") was employed.\nThe ","protocol"," generated ","120 kV"," and a current of ","150 mA",".\n","Slice thickness"," of ","the images"," was ","1-mm"," with a ","0.5-mm"," ","increment",".\n","Images"," in ","DICOM format"," were ","processed on a PC using commercial software",", obtaining a ","three-dimensional reconstruction"," of ","skeletal structures",".\nThe ","3-dimensional reconstruction"," of the ","skin plans"," showed ","hypoplasia"," of the ","auricle"," that on the ","right side"," consisted of a ","simple"," ","dysmorphic rough",".\nThe ","left auricle"," had ","regular"," ","dimensions"," and ","morphology",".\n","Atresia"," of the ","right auditory conduit"," and a ","normal"," ","left auditory conduit"," were ","observed",".\nThe ","upper"," ","images"," showed ","partial"," ","ossification"," of the ","cranium"," ","typical in paediatric age",".\nDescription of the profile: ","typical II class"," ","very"," ","convex profile"," with ","interposition"," of the ","inferior lip"," and a ","reduced"," ","neck-chin angle",".(Fig.1).\n","Skeletal studies"," show that the ","mandibular condyle",", ramus and corpus were ","shorter on the affected side",".\n","Tilting"," of ","oral rhyme",", ","occlusal plane"," and ","mandibular plane"," were evident.\nNumber or ","form abnormalities"," were not found during ","mixed dentition",".\n","Mandibular condyles"," and ","temporo-mandibular joints"," seemed to be ","asymmetric",", and in particular the ","right condyle"," was ","deformed",", shorter and ","wider than the other side"," (","mandibular condyle"," ","dimensions"," were ","11 \u00d7 7 mm"," ","right"," and ","14 \u00d7 7 mm"," ","left",").\nThe ","3-dimensional reconstruction"," of the ","skeleton planes"," showed the different ","morphology"," of the right and ","left hemimandibula",".\n","Mandibular"," ","3-dimensional reconstruction"," showed in detail the ","shift"," of the ","medial axis"," to the ","hypoplastic"," ","right side"," and the ","asymmetry"," of the ","right mandibular condyles"," that appears ","dysmorphic"," ","short"," and ","wide"," in ","axial"," and ","coronal"," ","scansions"," (Figs.2, 3).\nThe ","study"," of the ","temporal bone"," showed on the ","right side"," an ","external auditory canal"," ","atresia",", ","hypoplasia"," of ","tympanic cavity"," that was not ","pneumatized"," and ","occupied by dense materials from soft parts",".\nNo ","pneumatization"," was present in ","right mastoid cells",".\n","Left external auditory canal"," ","dimensions"," and ","morphology"," were ","normal",".\nThe ","left tympanic cavity"," was ","normally formed"," and ","totally occupied by dense materials from soft tissues",".\nBoth right and ","left ears"," presented ","minor"," ","hypoplasia"," of ","auricle bones"," in the ","right side",".\nIn agreement with the resolution of ","our instrument",", ","normal representation"," of the ","malleus head"," that seemed articulated with a ","dysmorphic rough"," of a ","deformed"," ","incus"," was observed; it was ","impossible to see"," the ","staples",".\nThe ","left malleus"," and ","incus"," were ","visible"," and appeared to be ","articulated in an abnormal manner"," (","reduce contact surface","); the ","staples"," was ","difficult to observe"," but seemed to have ","regular"," ","morphology",".\n","Dimensions"," and ","morphology"," of ","cochlea semicircular canals",", vestibulum and utriculum were ","unaltered"," (Figs.4-\u200b7).\nIn conclusion, through ","3D-CT valuation"," of this young patient we observed ","asymmetry"," of the ","condyles","; in particular, the ","right condyle"," was ","dysmorphic",", ","short"," and ","wide","; the ","auricle"," of the ","right external ear"," was ","hypoplastic",", only a ","dysmorphic rough"," was present; the ","right middle ear"," had a ","hypoplastic"," ","tympanic cavity","; the ","right internal ear"," has an ","atresic"," ","auditory 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-{"full_text":"A 19-year-old woman presented with a lump in her right breast.\nShe had macrocephaly and milimetric papules on the tongue giving a cobble stone appearance.\nThe breast ultrasonography (US) showed more than twenty circumscribed, oval masses in each breast.\nAn US-guided core biopsy was performed for the palpable masses which were confirmed as juvenile fibroadenomas.\nAfter the biopsy, a breast US was done as follow-up every 6 or 12 months for 3 years.\nDuring the surveillance period, core biopsies were performed six times, followed by US-guided vacuum-assisted core needle excisions or surgical excisions of lesions with increased sizes.\nPathologic results were fibroadenoma, tubular adenoma or atypical ductal hyperplasia (ADH) involving fibroadenoma.\nAt the age of 19 years, the patient underwent a neck US for a palpable mass in the left neck.\nSeveral indeterminate nodules were revealed in both thyroid glands.\nA follow-up US revealed that some of those nodules increased in size.\nThe patient underwent a total thyroidectomy and the pathologic result revealed an invasive follicular carcinoma in the left thyroid and follicular adenoma in the right thyroid (Fig.1A).\nAt the age of 21 years, she visited the hospital due to a swelling of her left cheek.\nHead and neck CT scan revealed a vascular mass in the left parotid gland extended into the left forehead.\nAn external carotid angiography confirmed the diagnosis of an AVM with feeder vessel arising from the left internal maxillary artery (Fig.1B).\nA partial embolization decreased the blood flow through the AVM, alleviating the patient's symptom.\nShe was referred to genetic counseling under the suggestion of a Cowden syndrome and the PTEN DNA sequencing test of her blood sample revealed a frameshift mutation, c.301dupA (p.I101NfsX6).\nAt the age of 22 years, the patient presented with a mass with increased size and increased vascularity in the left breast.\nAn US-guided vacuum-assisted core needle excision revealed a ductal carcinoma in situ (DCIS) of non-comedo type and a low grade involving fibroadenoma (Fig.1C).\nThe contrast-enhanced breast MRI for the preoperative evaluation demonstrated multiple, well-circumscribed, enhancing masses in both breasts (Fig.1D).\nAll masses showed high or intermediate signal intensity on T2-weighted images (Fig.1E).\nSeveral masses showed an early rapid enhancement with washout kinetic pattern on time-signal intensity curve evaluation, which tends to be associated with malignancy (Fig.1F).\nA bilateral prophylactic mastectomy with immediate breast reconstruction was performed in view of multiple bilateral breast masses with suspicious kinetic features on breast MRI and a high risk for breast cancer of Cowden syndrome.\nThe surgical histopathology revealed ADH involving tubular adenoma without residual carcinoma in the left breast and multiple tubular adenomas, fibroadenomas and intraductal papillomas in both breasts.\nThe patient had no family history of breast cancer or Cowden syndrome.\n","ner_info":[{"text":"19-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"lump","label":"SIGN_SYMPTOM","start":37,"end":41},{"text":"right breast","label":"BIOLOGICAL_STRUCTURE","start":49,"end":61},{"text":"macrocephaly","label":"DISEASE_DISORDER","start":71,"end":83},{"text":"milimetric","label":"BIOLOGICAL_ATTRIBUTE","start":88,"end":98},{"text":"papules","label":"SIGN_SYMPTOM","start":99,"end":106},{"text":"tongue","label":"BIOLOGICAL_STRUCTURE","start":114,"end":120},{"text":"cobble stone","label":"TEXTURE","start":130,"end":142},{"text":"breast","label":"BIOLOGICAL_STRUCTURE","start":159,"end":165},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":166,"end":181},{"text":"US","label":"DIAGNOSTIC_PROCEDURE","start":183,"end":185},{"text":"more than twenty","label":"LAB_VALUE","start":194,"end":210},{"text":"circumscribed","label":"DETAILED_DESCRIPTION","start":211,"end":224},{"text":"oval","label":"SHAPE","start":226,"end":230},{"text":"masses","label":"DISEASE_DISORDER","start":231,"end":237},{"text":"breast","label":"BIOLOGICAL_STRUCTURE","start":246,"end":252},{"text":"US-guided core","label":"DETAILED_DESCRIPTION","start":257,"end":271},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":272,"end":278},{"text":"palpable","label":"DETAILED_DESCRIPTION","start":301,"end":309},{"text":"masses","label":"DISEASE_DISORDER","start":310,"end":316},{"text":"juvenile","label":"DETAILED_DESCRIPTION","start":341,"end":349},{"text":"fibroadenomas","label":"DISEASE_DISORDER","start":350,"end":363},{"text":"breast","label":"BIOLOGICAL_STRUCTURE","start":385,"end":391},{"text":"US","label":"DIAGNOSTIC_PROCEDURE","start":392,"end":394},{"text":"every 6 or 12 months","label":"FREQUENCY","start":417,"end":437},{"text":"3 years","label":"DURATION","start":442,"end":449},{"text":"core","label":"DETAILED_DESCRIPTION","start":483,"end":487},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":488,"end":496},{"text":"six times","label":"QUANTITATIVE_CONCEPT","start":512,"end":521},{"text":"US-guided","label":"DETAILED_DESCRIPTION","start":535,"end":544},{"text":"vacuum-assisted","label":"DETAILED_DESCRIPTION","start":545,"end":560},{"text":"core","label":"DETAILED_DESCRIPTION","start":561,"end":565},{"text":"needle excisions","label":"DIAGNOSTIC_PROCEDURE","start":566,"end":582},{"text":"surgical excisions","label":"DIAGNOSTIC_PROCEDURE","start":586,"end":604},{"text":"lesions","label":"DISEASE_DISORDER","start":608,"end":615},{"text":"increased sizes","label":"LAB_VALUE","start":621,"end":636},{"text":"Pathologic results","label":"COREFERENCE","start":638,"end":656},{"text":"fibroadenoma","label":"DISEASE_DISORDER","start":662,"end":674},{"text":"tubular adenoma","label":"DISEASE_DISORDER","start":676,"end":691},{"text":"atypical ductal hyperplasia","label":"DISEASE_DISORDER","start":695,"end":722},{"text":"ADH","label":"DISEASE_DISORDER","start":724,"end":727},{"text":"fibroadenoma","label":"DISEASE_DISORDER","start":739,"end":751},{"text":"At the age of 19 years","label":"DATE","start":753,"end":775},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":801,"end":805},{"text":"US","label":"DIAGNOSTIC_PROCEDURE","start":806,"end":808},{"text":"palpable","label":"DETAILED_DESCRIPTION","start":815,"end":823},{"text":"mass","label":"DISEASE_DISORDER","start":824,"end":828},{"text":"left neck","label":"BIOLOGICAL_STRUCTURE","start":836,"end":845},{"text":"indeterminate","label":"DETAILED_DESCRIPTION","start":855,"end":868},{"text":"nodules","label":"SIGN_SYMPTOM","start":869,"end":876},{"text":"both","label":"LAB_VALUE","start":894,"end":898},{"text":"thyroid glands","label":"BIOLOGICAL_STRUCTURE","start":899,"end":913},{"text":"follow-up","label":"DETAILED_DESCRIPTION","start":917,"end":926},{"text":"US","label":"DIAGNOSTIC_PROCEDURE","start":927,"end":929},{"text":"some","label":"LAB_VALUE","start":944,"end":948},{"text":"nodules","label":"SIGN_SYMPTOM","start":958,"end":965},{"text":"increased in size","label":"LAB_VALUE","start":966,"end":983},{"text":"total","label":"DETAILED_DESCRIPTION","start":1009,"end":1014},{"text":"thyroidectomy","label":"THERAPEUTIC_PROCEDURE","start":1015,"end":1028},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":1067,"end":1075},{"text":"follicular carcinoma","label":"DISEASE_DISORDER","start":1076,"end":1096},{"text":"left thyroid","label":"BIOLOGICAL_STRUCTURE","start":1104,"end":1116},{"text":"follicular adenoma","label":"DISEASE_DISORDER","start":1121,"end":1139},{"text":"right thyroid","label":"BIOLOGICAL_STRUCTURE","start":1147,"end":1160},{"text":"At the age of 21 years","label":"DATE","start":1171,"end":1193},{"text":"visited","label":"CLINICAL_EVENT","start":1199,"end":1206},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1211,"end":1219},{"text":"swelling","label":"SIGN_SYMPTOM","start":1229,"end":1237},{"text":"left cheek","label":"BIOLOGICAL_STRUCTURE","start":1245,"end":1255},{"text":"Head","label":"BIOLOGICAL_STRUCTURE","start":1257,"end":1261},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":1266,"end":1270},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":1271,"end":1278},{"text":"vascular","label":"BIOLOGICAL_STRUCTURE","start":1290,"end":1298},{"text":"mass","label":"DISEASE_DISORDER","start":1299,"end":1303},{"text":"left parotid gland","label":"BIOLOGICAL_STRUCTURE","start":1311,"end":1329},{"text":"left forehead","label":"BIOLOGICAL_STRUCTURE","start":1348,"end":1361},{"text":"external carotid","label":"BIOLOGICAL_STRUCTURE","start":1366,"end":1382},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":1383,"end":1394},{"text":"AVM","label":"DISEASE_DISORDER","start":1425,"end":1428},{"text":"feeder vessel","label":"BIOLOGICAL_STRUCTURE","start":1434,"end":1447},{"text":"left internal maxillary artery","label":"BIOLOGICAL_STRUCTURE","start":1465,"end":1495},{"text":"partial","label":"DETAILED_DESCRIPTION","start":1508,"end":1515},{"text":"embolization","label":"THERAPEUTIC_PROCEDURE","start":1516,"end":1528},{"text":"decreased","label":"LAB_VALUE","start":1529,"end":1538},{"text":"blood flow","label":"DIAGNOSTIC_PROCEDURE","start":1543,"end":1553},{"text":"AVM","label":"DISEASE_DISORDER","start":1566,"end":1569},{"text":"the patient's symptom","label":"COREFERENCE","start":1583,"end":1604},{"text":"genetic counseling","label":"THERAPEUTIC_PROCEDURE","start":1626,"end":1644},{"text":"Cowden syndrome","label":"DISEASE_DISORDER","start":1671,"end":1686},{"text":"PTEN","label":"DIAGNOSTIC_PROCEDURE","start":1695,"end":1699},{"text":"DNA sequencing test","label":"DIAGNOSTIC_PROCEDURE","start":1700,"end":1719},{"text":"blood sample","label":"DIAGNOSTIC_PROCEDURE","start":1727,"end":1739},{"text":"frameshift mutation","label":"DIAGNOSTIC_PROCEDURE","start":1751,"end":1770},{"text":"c.301dupA","label":"DIAGNOSTIC_PROCEDURE","start":1772,"end":1781},{"text":"p.I101NfsX6","label":"DIAGNOSTIC_PROCEDURE","start":1783,"end":1794},{"text":"At the age of 22 years","label":"DATE","start":1797,"end":1819},{"text":"mass","label":"DISEASE_DISORDER","start":1850,"end":1854},{"text":"increased size","label":"LAB_VALUE","start":1860,"end":1874},{"text":"increased vascularity","label":"LAB_VALUE","start":1879,"end":1900},{"text":"left breast","label":"BIOLOGICAL_STRUCTURE","start":1908,"end":1919},{"text":"US-guided","label":"DETAILED_DESCRIPTION","start":1924,"end":1933},{"text":"vacuum-assisted","label":"DETAILED_DESCRIPTION","start":1934,"end":1949},{"text":"core","label":"DETAILED_DESCRIPTION","start":1950,"end":1954},{"text":"needle excision","label":"DIAGNOSTIC_PROCEDURE","start":1955,"end":1970},{"text":"ductal carcinoma in situ","label":"DISEASE_DISORDER","start":1982,"end":2006},{"text":"DCIS","label":"DISEASE_DISORDER","start":2008,"end":2012},{"text":"non-comedo type","label":"DETAILED_DESCRIPTION","start":2017,"end":2032},{"text":"low 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intensity","label":"DIAGNOSTIC_PROCEDURE","start":2272,"end":2288},{"text":"T2-weighted images","label":"DIAGNOSTIC_PROCEDURE","start":2292,"end":2310},{"text":"Several","label":"LAB_VALUE","start":2321,"end":2328},{"text":"masses","label":"DISEASE_DISORDER","start":2329,"end":2335},{"text":"early rapid enhancement","label":"DETAILED_DESCRIPTION","start":2346,"end":2369},{"text":"washout kinetic pattern","label":"DIAGNOSTIC_PROCEDURE","start":2375,"end":2398},{"text":"time-signal intensity curve evaluation","label":"DIAGNOSTIC_PROCEDURE","start":2402,"end":2440},{"text":"malignancy","label":"DISEASE_DISORDER","start":2476,"end":2486},{"text":"bilateral prophylactic","label":"DETAILED_DESCRIPTION","start":2499,"end":2521},{"text":"mastectomy","label":"THERAPEUTIC_PROCEDURE","start":2522,"end":2532},{"text":"immediate","label":"DETAILED_DESCRIPTION","start":2538,"end":2547},{"text":"breast 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","macrocephaly"," and ","milimetric"," ","papules"," on the ","tongue"," giving a ","cobble stone"," appearance.\nThe ","breast"," ","ultrasonography"," (","US",") showed ","more than twenty"," ","circumscribed",", ","oval"," ","masses"," in each ","breast",".\nAn ","US-guided core"," ","biopsy"," was performed for the ","palpable"," ","masses"," which were confirmed as ","juvenile"," ","fibroadenomas",".\nAfter the biopsy, a ","breast"," ","US"," was done as follow-up ","every 6 or 12 months"," for ","3 years",".\nDuring the surveillance period, ","core"," ","biopsies"," were performed ","six times",", followed by ","US-guided"," ","vacuum-assisted"," ","core"," ","needle excisions"," or ","surgical excisions"," of ","lesions"," with ","increased sizes",".\n","Pathologic results"," were ","fibroadenoma",", ","tubular adenoma"," or ","atypical ductal hyperplasia"," (","ADH",") involving ","fibroadenoma",".\n","At the age of 19 years",", the patient underwent a ","neck"," ","US"," for a ","palpable"," ","mass"," in the ","left neck",".\nSeveral ","indeterminate"," ","nodules"," were revealed in ","both"," ","thyroid glands",".\nA ","follow-up"," ","US"," revealed that ","some"," of those ","nodules"," ","increased in size",".\nThe patient underwent a ","total"," ","thyroidectomy"," and the pathologic result revealed an ","invasive"," ","follicular carcinoma"," in the ","left thyroid"," and ","follicular adenoma"," in the ","right thyroid"," (Fig.1A).\n","At the age of 21 years",", she ","visited"," the ","hospital"," due to a ","swelling"," of her ","left cheek",".\n","Head"," and ","neck"," ","CT scan"," revealed a ","vascular"," ","mass"," in the ","left parotid gland"," extended into the ","left forehead",".\nAn ","external carotid"," ","angiography"," confirmed the diagnosis of an ","AVM"," with ","feeder vessel"," arising from the ","left internal maxillary artery"," (Fig.1B).\nA ","partial"," ","embolization"," ","decreased"," the ","blood flow"," through the ","AVM",", alleviating ","the patient's symptom",".\nShe was referred to ","genetic counseling"," under the suggestion of a ","Cowden syndrome"," and the ","PTEN"," ","DNA sequencing test"," of her ","blood sample"," revealed a ","frameshift mutation",", ","c.301dupA"," (","p.I101NfsX6",").\n","At the age of 22 years",", the patient presented with a ","mass"," with ","increased size"," and ","increased vascularity"," in the ","left breast",".\nAn ","US-guided"," ","vacuum-assisted"," ","core"," ","needle excision"," revealed a ","ductal carcinoma in situ"," (","DCIS",") of ","non-comedo type"," and a ","low grade"," involving ","fibroadenoma"," (Fig.1C).\nThe ","contrast-enhanced"," ","breast"," ","MRI"," for the preoperative evaluation demonstrated ","multiple",", ","well-circumscribed",", ","enhancing"," ","masses"," in ","both"," ","breasts"," (Fig.1D).\n","All"," ","masses"," showed ","high"," or ","intermediate"," ","signal intensity"," on ","T2-weighted images"," (Fig.1E).\n","Several"," ","masses"," showed an ","early rapid enhancement"," with ","washout kinetic pattern"," on ","time-signal intensity curve evaluation",", which tends to be associated with ","malignancy"," (Fig.1F).\nA ","bilateral prophylactic"," ","mastectomy"," with ","immediate"," ","breast reconstruction"," was performed in view of ","multiple"," ","bilateral"," ","breast"," ","masses"," with ","suspicious"," ","kinetic features"," on ","breast"," ","MRI"," and a high risk for ","breast cancer"," of ","Cowden syndrome",".\nThe ","surgical histopathology"," revealed ","ADH"," involving ","tubular adenoma"," without ","residual"," ","carcinoma"," in the ","left breast"," and ","multiple"," ","tubular adenomas",", ","fibroadenomas"," and ","intraductal papillomas"," in ","both"," ","breasts",".\nThe patient had no family history of ","breast cancer"," or ","Cowden 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-{"full_text":"Our patient (ID 73387) is a female child, born by an emergency caesarean section at 34 weeks of gestation to consanguineous, first-cousin British Pakistani parents.\nAntenatal scans showed that she was small for her gestation, weighing 1.19\u2009kg at birth with a head circumference of 26.7\u2009cm, considerably below the 0.4th centile.\nInduction of labour had been attempted because of the growth retardation but had failed, leading to the emergency caesarean section.\nThe Apgar scores were 4 at 1\u2009min, 7 at 5\u2009min and 9 at 10\u2009min.\nShe was admitted to the neonatal intensive care unit for continuous positive airway pressure ventilation.\nAt a few hours of age, she developed a severe lactic acidosis.\nThe initial lactic acid concentration was 22\u2009mmol\/l and subsequently increased to 63\u2009mmol\/l (normal range, 0.7\u20132.1\u2009mmol\/l).\nShe was treated with intravenous infusions of sodium bicarbonate and Tris-hydroxymethyl aminomethane (THAM), but it was never possible to correct the metabolic acidosis.\nShe also developed hypoglycaemia within hours of birth that was corrected with an intravenous infusion of 15% glucose (7.8\u2009mg\/kg\/min).\nThe ammonia concentration was normal.\nUrine organic acid profile showed massive excretion of lactic acid and increased phenolic acids, especially hydroxyphenyllactate.\nPlasma amino acids showed raised concentrations of alanine and glutamine (1567 and 1369\u2009\u03bcmol\/l, respectively), consistent with the lactic acidosis; several other amino acids were also mildly increased.\nThere was gross generalised aminoaciduria.\nBlood acylcarnitine analysis was normal.\nEchocardiography showed a structurally normal heart and good ventricular function.\nCranial ultrasound showed bilateral intraventricular cysts within the frontal horns and anterior portions of the lateral ventricles.\nThe left-sided cysts were larger, up to 15\u2009mm in diameter, whereas the largest cyst on the right was 8\u2009mm in diameter.\nThe choroid plexuses were hyperechoic and irregular, suggesting previous intraventricular haemorrhage.\nAbdominal ultrasound showed a distended urinary bladder but was otherwise unremarkable.\nThere was severe coagulopathy with an extended prothrombin time of 47.7\u2009s (normal 12.3\u201316.6\u2009s), a very low plasma albumin of 7\u2009g\/l (normal 35\u201350\u2009g\/l), otherwise normal liver function tests but a raised creatine kinase of 2700\u2009U\/l (normal <300\u2009U\/l).\nShe was transferred to a tertiary centre because of her worsening metabolic acidosis.\nShe started having seizures at \u223c48\u2009h of age.\nDespite infusions of bicarbonate and THAM, her acidosis continued to worsen.\nMuscle and skin biopsies were performed and the family agreed to the withdrawal of intensive care treatment.\nShe died aged 55\u2009h.\nAll documented studies were approved and performed under the ethical guidelines issued by each of our Institutions for clinical studies, with written informed consent obtained from the family.\n","ner_info":[{"text":"female","label":"SEX","start":28,"end":34},{"text":"child","label":"AGE","start":35,"end":40},{"text":"born","label":"CLINICAL_EVENT","start":42,"end":46},{"text":"emergency","label":"DETAILED_DESCRIPTION","start":53,"end":62},{"text":"caesarean section","label":"THERAPEUTIC_PROCEDURE","start":63,"end":80},{"text":"34 weeks of gestation","label":"QUANTITATIVE_CONCEPT","start":84,"end":105},{"text":"consanguineous, first-cousin British Pakistani parents","label":"FAMILY_HISTORY","start":109,"end":163},{"text":"Antenatal scans","label":"DIAGNOSTIC_PROCEDURE","start":165,"end":180},{"text":"small","label":"LAB_VALUE","start":201,"end":206},{"text":"weighing","label":"DIAGNOSTIC_PROCEDURE","start":226,"end":234},{"text":"1.19\u2009kg","label":"LAB_VALUE","start":235,"end":242},{"text":"birth","label":"CLINICAL_EVENT","start":246,"end":251},{"text":"head circumference","label":"DIAGNOSTIC_PROCEDURE","start":259,"end":277},{"text":"26.7\u2009cm","label":"LAB_VALUE","start":281,"end":288},{"text":"considerably below the 0.4th centile","label":"LAB_VALUE","start":290,"end":326},{"text":"Induction of labour","label":"THERAPEUTIC_PROCEDURE","start":328,"end":347},{"text":"growth retardation","label":"SIGN_SYMPTOM","start":382,"end":400},{"text":"failed","label":"QUALITATIVE_CONCEPT","start":409,"end":415},{"text":"emergency","label":"DETAILED_DESCRIPTION","start":432,"end":441},{"text":"caesarean section","label":"THERAPEUTIC_PROCEDURE","start":442,"end":459},{"text":"Apgar 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concentration","label":"DIAGNOSTIC_PROCEDURE","start":704,"end":729},{"text":"22\u2009mmol\/l","label":"LAB_VALUE","start":734,"end":743},{"text":"subsequently","label":"DETAILED_DESCRIPTION","start":748,"end":760},{"text":"increased","label":"LAB_VALUE","start":761,"end":770},{"text":"63\u2009mmol\/l","label":"LAB_VALUE","start":774,"end":783},{"text":"intravenous infusions","label":"ADMINISTRATION","start":837,"end":858},{"text":"sodium bicarbonate","label":"MEDICATION","start":862,"end":880},{"text":"Tris-hydroxymethyl aminomethane","label":"MEDICATION","start":885,"end":916},{"text":"THAM","label":"MEDICATION","start":918,"end":922},{"text":"metabolic acidosis","label":"SIGN_SYMPTOM","start":966,"end":984},{"text":"hypoglycaemia","label":"SIGN_SYMPTOM","start":1005,"end":1018},{"text":"within hours","label":"TIME","start":1019,"end":1031},{"text":"birth","label":"CLINICAL_EVENT","start":1035,"end":1040},{"text":"intravenous infusion","label":"ADMINISTRATION","start":1068,"end":1088},{"text":"15%","label":"DOSAGE","start":1092,"end":1095},{"text":"glucose","label":"MEDICATION","start":1096,"end":1103},{"text":"7.8\u2009mg\/kg\/min","label":"DOSAGE","start":1105,"end":1118},{"text":"ammonia concentration","label":"DIAGNOSTIC_PROCEDURE","start":1125,"end":1146},{"text":"normal","label":"LAB_VALUE","start":1151,"end":1157},{"text":"Urine","label":"DETAILED_DESCRIPTION","start":1159,"end":1164},{"text":"organic acid profile","label":"DIAGNOSTIC_PROCEDURE","start":1165,"end":1185},{"text":"massive","label":"SEVERITY","start":1193,"end":1200},{"text":"excretion","label":"LAB_VALUE","start":1201,"end":1210},{"text":"lactic acid","label":"DIAGNOSTIC_PROCEDURE","start":1214,"end":1225},{"text":"increased","label":"LAB_VALUE","start":1230,"end":1239},{"text":"phenolic acids","label":"DIAGNOSTIC_PROCEDURE","start":1240,"end":1254},{"text":"especially hydroxyphenyllactate","label":"LAB_VALUE","start":1256,"end":1287},{"text":"Plasma","label":"DETAILED_DESCRIPTION","start":1289,"end":1295},{"text":"amino acids","label":"DIAGNOSTIC_PROCEDURE","start":1296,"end":1307},{"text":"raised","label":"LAB_VALUE","start":1315,"end":1321},{"text":"alanine","label":"DIAGNOSTIC_PROCEDURE","start":1340,"end":1347},{"text":"glutamine","label":"DIAGNOSTIC_PROCEDURE","start":1352,"end":1361},{"text":"1567","label":"LAB_VALUE","start":1363,"end":1367},{"text":"1369\u2009\u03bcmol\/l","label":"LAB_VALUE","start":1372,"end":1383},{"text":"lactic acidosis","label":"SIGN_SYMPTOM","start":1420,"end":1435},{"text":"other amino acids","label":"DIAGNOSTIC_PROCEDURE","start":1445,"end":1462},{"text":"increased","label":"LAB_VALUE","start":1480,"end":1489},{"text":"gross","label":"SEVERITY","start":1501,"end":1506},{"text":"generalised","label":"DETAILED_DESCRIPTION","start":1507,"end":1518},{"text":"aminoaciduria","label":"SIGN_SYMPTOM","start":1519,"end":1532},{"text":"Blood","label":"DETAILED_DESCRIPTION","start":1534,"end":1539},{"text":"acylcarnitine analysis","label":"DIAGNOSTIC_PROCEDURE","start":1540,"end":1562},{"text":"normal","label":"LAB_VALUE","start":1567,"end":1573},{"text":"Echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1575,"end":1591},{"text":"structurally normal","label":"LAB_VALUE","start":1601,"end":1620},{"text":"heart","label":"BIOLOGICAL_STRUCTURE","start":1621,"end":1626},{"text":"good","label":"LAB_VALUE","start":1631,"end":1635},{"text":"ventricular function","label":"DIAGNOSTIC_PROCEDURE","start":1636,"end":1656},{"text":"Cranial","label":"BIOLOGICAL_STRUCTURE","start":1658,"end":1665},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1666,"end":1676},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1684,"end":1693},{"text":"intraventricular","label":"BIOLOGICAL_STRUCTURE","start":1694,"end":1710},{"text":"cysts","label":"SIGN_SYMPTOM","start":1711,"end":1716},{"text":"frontal horns and anterior portions of the lateral ventricles","label":"BIOLOGICAL_STRUCTURE","start":1728,"end":1789},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":1795,"end":1805},{"text":"cysts","label":"SIGN_SYMPTOM","start":1806,"end":1811},{"text":"up to 15\u2009mm in diameter","label":"DISTANCE","start":1825,"end":1848},{"text":"cyst","label":"SIGN_SYMPTOM","start":1870,"end":1874},{"text":"8\u2009mm in diameter","label":"DISTANCE","start":1892,"end":1908},{"text":"choroid plexuses","label":"BIOLOGICAL_STRUCTURE","start":1914,"end":1930},{"text":"hyperechoic","label":"SIGN_SYMPTOM","start":1936,"end":1947},{"text":"irregular","label":"SIGN_SYMPTOM","start":1952,"end":1961},{"text":"intraventricular haemorrhage","label":"DISEASE_DISORDER","start":1983,"end":2011},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":2013,"end":2022},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2023,"end":2033},{"text":"distended","label":"SIGN_SYMPTOM","start":2043,"end":2052},{"text":"urinary bladder","label":"BIOLOGICAL_STRUCTURE","start":2053,"end":2068},{"text":"severe","label":"SEVERITY","start":2111,"end":2117},{"text":"coagulopathy","label":"DISEASE_DISORDER","start":2118,"end":2130},{"text":"extended","label":"LAB_VALUE","start":2139,"end":2147},{"text":"prothrombin time","label":"DIAGNOSTIC_PROCEDURE","start":2148,"end":2164},{"text":"47.7\u2009s","label":"LAB_VALUE","start":2168,"end":2174},{"text":"very low","label":"LAB_VALUE","start":2199,"end":2207},{"text":"plasma albumin","label":"DIAGNOSTIC_PROCEDURE","start":2208,"end":2222},{"text":"7\u2009g\/l","label":"LAB_VALUE","start":2226,"end":2231},{"text":"normal","label":"LAB_VALUE","start":2262,"end":2268},{"text":"liver function tests","label":"DIAGNOSTIC_PROCEDURE","start":2269,"end":2289},{"text":"raised","label":"LAB_VALUE","start":2296,"end":2302},{"text":"creatine kinase","label":"DIAGNOSTIC_PROCEDURE","start":2303,"end":2318},{"text":"2700\u2009U\/l","label":"LAB_VALUE","start":2322,"end":2330},{"text":"transferred","label":"CLINICAL_EVENT","start":2358,"end":2369},{"text":"tertiary centre","label":"NONBIOLOGICAL_LOCATION","start":2375,"end":2390},{"text":"metabolic acidosis","label":"SIGN_SYMPTOM","start":2416,"end":2434},{"text":"seizures","label":"SIGN_SYMPTOM","start":2455,"end":2463},{"text":"\u223c48\u2009h of age","label":"DATE","start":2467,"end":2479},{"text":"infusions","label":"ADMINISTRATION","start":2489,"end":2498},{"text":"bicarbonate","label":"MEDICATION","start":2502,"end":2513},{"text":"THAM","label":"MEDICATION","start":2518,"end":2522},{"text":"acidosis","label":"SIGN_SYMPTOM","start":2528,"end":2536},{"text":"Muscle","label":"BIOLOGICAL_STRUCTURE","start":2558,"end":2564},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":2569,"end":2573},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":2574,"end":2582},{"text":"intensive care treatment","label":"THERAPEUTIC_PROCEDURE","start":2641,"end":2665},{"text":"died","label":"CLINICAL_EVENT","start":2671,"end":2675},{"text":"55\u2009h","label":"DATE","start":2681,"end":2685}],"tokens":["Our patient (ID 73387) is a ","female"," ","child",", ","born"," by an ","emergency"," ","caesarean section"," at ","34 weeks of gestation"," to ","consanguineous, first-cousin British Pakistani parents",".\n","Antenatal scans"," showed that she was ","small"," for her gestation, ","weighing"," ","1.19\u2009kg"," at ","birth"," with a ","head circumference"," of ","26.7\u2009cm",", ","considerably below the 0.4th centile",".\n","Induction of labour"," had been attempted because of the ","growth retardation"," but had ","failed",", leading to the ","emergency"," ","caesarean section",".\nThe ","Apgar scores"," were ","4"," at ","1\u2009min",", ","7"," at ","5\u2009min"," and ","9"," at ","10\u2009min",".\nShe was ","admitted"," to the ","neonatal intensive care unit"," for ","continuous positive airway pressure ventilation",".\nAt a ","few hours of age",", she developed a ","severe"," ","lactic acidosis",".\nThe initial ","lactic acid concentration"," was ","22\u2009mmol\/l"," and ","subsequently"," ","increased"," to ","63\u2009mmol\/l"," (normal range, 0.7\u20132.1\u2009mmol\/l).\nShe was treated with ","intravenous infusions"," of ","sodium bicarbonate"," and ","Tris-hydroxymethyl aminomethane"," (","THAM","), but it was never possible to correct the ","metabolic acidosis",".\nShe also developed ","hypoglycaemia"," ","within hours"," of ","birth"," that was corrected with an ","intravenous infusion"," of ","15%"," ","glucose"," (","7.8\u2009mg\/kg\/min",").\nThe ","ammonia concentration"," was ","normal",".\n","Urine"," ","organic acid profile"," showed ","massive"," ","excretion"," of ","lactic acid"," and ","increased"," ","phenolic acids",", ","especially hydroxyphenyllactate",".\n","Plasma"," ","amino acids"," showed ","raised"," concentrations of ","alanine"," and ","glutamine"," (","1567"," and ","1369\u2009\u03bcmol\/l",", respectively), consistent with the ","lactic acidosis","; several ","other amino acids"," were also mildly ","increased",".\nThere was ","gross"," ","generalised"," ","aminoaciduria",".\n","Blood"," ","acylcarnitine analysis"," was ","normal",".\n","Echocardiography"," showed a ","structurally normal"," ","heart"," and ","good"," ","ventricular function",".\n","Cranial"," ","ultrasound"," showed ","bilateral"," ","intraventricular"," ","cysts"," within the ","frontal horns and anterior portions of the lateral ventricles",".\nThe ","left-sided"," ","cysts"," were larger, ","up to 15\u2009mm in diameter",", whereas the largest ","cyst"," on the right was ","8\u2009mm in diameter",".\nThe ","choroid plexuses"," were ","hyperechoic"," and ","irregular",", suggesting previous ","intraventricular haemorrhage",".\n","Abdominal"," ","ultrasound"," showed a ","distended"," ","urinary bladder"," but was otherwise unremarkable.\nThere was ","severe"," ","coagulopathy"," with an ","extended"," ","prothrombin time"," of ","47.7\u2009s"," (normal 12.3\u201316.6\u2009s), a ","very low"," ","plasma albumin"," of ","7\u2009g\/l"," (normal 35\u201350\u2009g\/l), otherwise ","normal"," ","liver function tests"," but a ","raised"," ","creatine kinase"," of ","2700\u2009U\/l"," (normal <300\u2009U\/l).\nShe was ","transferred"," to a ","tertiary centre"," because of her worsening ","metabolic acidosis",".\nShe started having ","seizures"," at ","\u223c48\u2009h of age",".\nDespite ","infusions"," of ","bicarbonate"," and ","THAM",", her ","acidosis"," continued to worsen.\n","Muscle"," and ","skin"," ","biopsies"," were performed and the family agreed to the withdrawal of ","intensive care treatment",".\nShe ","died"," aged ","55\u2009h",".\nAll documented studies were approved and performed under the ethical guidelines issued by each of our Institutions for clinical studies, with written informed consent obtained from the family.\n"],"ner_labels":[0,65,0,5,0,13,0,22,0,75,0,62,0,34,0,24,0,42,0,24,0,42,0,13,0,24,0,42,0,42,0,75,0,69,0,59,0,22,0,75,0,24,0,42,0,22,0,42,0,22,0,42,0,22,0,13,0,48,0,75,0,78,0,63,0,69,0,24,0,42,0,22,0,42,0,42,0,4,0,46,0,46,0,46,0,69,0,69,0,78,0,13,0,4,0,29,0,46,0,29,0,24,0,42,0,22,0,24,0,63,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,24,0,24,0,42,0,42,0,69,0,24,0,42,0,63,0,22,0,69,0,22,0,24,0,42,0,24,0,42,0,12,0,42,0,24,0,12,0,24,0,22,0,12,0,69,0,12,0,22,0,69,0,27,0,69,0,27,0,12,0,69,0,69,0,26,0,12,0,24,0,69,0,12,0,63,0,26,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,13,0,48,0,69,0,69,0,19,0,4,0,46,0,46,0,69,0,12,0,12,0,24,0,75,0,13,0,19,0]}
-{"full_text":"The patient is a 57-year-old woman who had noted a rapidly enlarging mass on the left side of her neck in 2010.\nShe underwent a total thyroidectomy and central neck dissection, which revealed a 3.8-cm anaplastic thyroid cancer arising in a background of an oncocytic variant of poorly differentiated thyroid cancer (Fig.1A, and Fig.S1 in Supplementary Appendix 1, available with the full text of this article at NEJM.org).\nResection margins were positive, and 3 of 12 lymph nodes were involved.\nAt 3 weeks after surgery, the serum thyroglobulin level was 17.2 ng per milliliter, with undetectable thyroglobulin antibodies.\nThe patient received concurrent radiation therapy and weekly carboplatin and paclitaxel chemotherapy.\nThe serum thyroglobulin level at 4 weeks after the completion of chemotherapy and radiation therapy was 12.0 ng per milliliter.\nRestaging scans obtained 3 months later revealed a new, right-sided hilar mass (Fig.1C), and the patient enrolled in a phase 2 clinical trial of everolimus, which was administered at a dose of 10 mg daily.\nWithin 6 months, follow-up scans showed that the lesion had greatly diminished in size (from 3.0 by 2.6 cm to 1.1 by 0.8 cm) (Fig.1D).\nAfter 18 months of a sustained response to everolimus, scans revealed progressive disease (Fig.1E).\nThe patient underwent a mediastinoscopy with removal of an enlarged lymph node, which contained metastatic anaplastic thyroid cancer (Fig.1B, and Fig.S1 in Supplementary Appendix 1).\nWhole-exome sequencing was performed on biopsy samples of the pretreatment and resistant tumors as well as on a blood sample.\n","ner_info":[{"text":"57-year-old","label":"AGE","start":17,"end":28},{"text":"woman","label":"SEX","start":29,"end":34},{"text":"rapidly enlarging","label":"LAB_VALUE","start":51,"end":68},{"text":"mass","label":"SIGN_SYMPTOM","start":69,"end":73},{"text":"left side of her 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margins","label":"DIAGNOSTIC_PROCEDURE","start":423,"end":440},{"text":"positive","label":"LAB_VALUE","start":446,"end":454},{"text":"3 of 12","label":"LAB_VALUE","start":460,"end":467},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":468,"end":479},{"text":"involved","label":"SIGN_SYMPTOM","start":485,"end":493},{"text":"3 weeks after","label":"DATE","start":498,"end":511},{"text":"serum","label":"DETAILED_DESCRIPTION","start":525,"end":530},{"text":"thyroglobulin","label":"DIAGNOSTIC_PROCEDURE","start":531,"end":544},{"text":"17.2 ng per milliliter","label":"LAB_VALUE","start":555,"end":577},{"text":"undetectable","label":"LAB_VALUE","start":584,"end":596},{"text":"thyroglobulin antibodies","label":"DIAGNOSTIC_PROCEDURE","start":597,"end":621},{"text":"radiation therapy","label":"THERAPEUTIC_PROCEDURE","start":655,"end":672},{"text":"carboplatin","label":"MEDICATION","start":684,"end":695},{"text":"paclitaxel","label":"MEDICATION","start":700,"end":710},{"text":"chemotherapy","label":"MEDICATION","start":711,"end":723},{"text":"serum","label":"DETAILED_DESCRIPTION","start":729,"end":734},{"text":"thyroglobulin","label":"DIAGNOSTIC_PROCEDURE","start":735,"end":748},{"text":"4 weeks after","label":"DATE","start":758,"end":771},{"text":"12.0 ng per milliliter","label":"LAB_VALUE","start":829,"end":851},{"text":"scans","label":"DIAGNOSTIC_PROCEDURE","start":863,"end":868},{"text":"3 months later","label":"DATE","start":878,"end":892},{"text":"right-sided hilar","label":"BIOLOGICAL_STRUCTURE","start":909,"end":926},{"text":"mass","label":"SIGN_SYMPTOM","start":927,"end":931},{"text":"phase 2","label":"DETAILED_DESCRIPTION","start":972,"end":979},{"text":"clinical trial","label":"CLINICAL_EVENT","start":980,"end":994},{"text":"everolimus","label":"MEDICATION","start":998,"end":1008},{"text":"10 mg daily","label":"DOSAGE","start":1046,"end":1057},{"text":"Within 6 months","label":"DATE","start":1059,"end":1074},{"text":"follow-up","label":"CLINICAL_EVENT","start":1076,"end":1085},{"text":"scans","label":"DIAGNOSTIC_PROCEDURE","start":1086,"end":1091},{"text":"lesion","label":"COREFERENCE","start":1108,"end":1114},{"text":"diminished in size","label":"SIGN_SYMPTOM","start":1127,"end":1145},{"text":"3.0 by 2.6 cm","label":"AREA","start":1152,"end":1165},{"text":"1.1 by 0.8 cm","label":"AREA","start":1169,"end":1182},{"text":"18 months","label":"DURATION","start":1200,"end":1209},{"text":"response","label":"SIGN_SYMPTOM","start":1225,"end":1233},{"text":"everolimus","label":"MEDICATION","start":1237,"end":1247},{"text":"scans","label":"DIAGNOSTIC_PROCEDURE","start":1249,"end":1254},{"text":"progressive disease","label":"DISEASE_DISORDER","start":1264,"end":1283},{"text":"mediastinoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1318,"end":1333},{"text":"removal","label":"THERAPEUTIC_PROCEDURE","start":1339,"end":1346},{"text":"enlarged","label":"SIGN_SYMPTOM","start":1353,"end":1361},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":1362,"end":1372},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":1390,"end":1400},{"text":"anaplastic","label":"DETAILED_DESCRIPTION","start":1401,"end":1411},{"text":"thyroid cancer","label":"DISEASE_DISORDER","start":1412,"end":1426},{"text":"Whole-exome","label":"DETAILED_DESCRIPTION","start":1477,"end":1488},{"text":"sequencing","label":"DIAGNOSTIC_PROCEDURE","start":1489,"end":1499},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1517,"end":1523},{"text":"pretreatment and resistant tumors","label":"DETAILED_DESCRIPTION","start":1539,"end":1572},{"text":"blood sample","label":"DETAILED_DESCRIPTION","start":1589,"end":1601}],"tokens":["The patient is a ","57-year-old"," ","woman"," who had noted a ","rapidly enlarging"," ","mass"," on the ","left side of her neck"," in ","2010",".\nShe underwent a ","total"," ","thyroidectomy"," and ","central neck"," ","dissection",", which revealed a ","3.8-cm"," ","anaplastic"," ","thyroid cancer"," arising in a background of an ","oncocytic variant"," of ","poorly differentiated"," ","thyroid cancer"," (Fig.1A, and Fig.S1 in Supplementary Appendix 1, available with the full text of this article at NEJM.org).\n","Resection margins"," were ","positive",", and ","3 of 12"," ","lymph nodes"," were ","involved",".\nAt ","3 weeks after"," surgery, the ","serum"," ","thyroglobulin"," level was ","17.2 ng per milliliter",", with ","undetectable"," ","thyroglobulin antibodies",".\nThe patient received concurrent ","radiation therapy"," and weekly ","carboplatin"," and ","paclitaxel"," ","chemotherapy",".\nThe ","serum"," ","thyroglobulin"," level at ","4 weeks after"," the completion of chemotherapy and radiation therapy was ","12.0 ng per milliliter",".\nRestaging ","scans"," obtained ","3 months later"," revealed a new, ","right-sided hilar"," ","mass"," (Fig.1C), and the patient enrolled in a ","phase 2"," ","clinical trial"," of ","everolimus",", which was administered at a dose of ","10 mg daily",".\n","Within 6 months",", ","follow-up"," ","scans"," showed that the ","lesion"," had greatly ","diminished in size"," (from ","3.0 by 2.6 cm"," to ","1.1 by 0.8 cm",") (Fig.1D).\nAfter ","18 months"," of a sustained ","response"," to ","everolimus",", ","scans"," revealed ","progressive disease"," (Fig.1E).\nThe patient underwent a ","mediastinoscopy"," with ","removal"," of an ","enlarged"," ","lymph node",", which contained ","metastatic"," ","anaplastic"," ","thyroid cancer"," (Fig.1B, and Fig.S1 in Supplementary Appendix 1).\n","Whole-exome"," ","sequencing"," was performed on 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-{"full_text":"A 46-year-old Caucasian woman of Ashkenazi Jewish descent presented with the chief complaint of severe and constant throbbing pain in her left posterior mandible.\nShe reported that her pain was aggravated by chewing, and started months before the initial consultation visit.\nVisual analog scale of pain was reported 7\/10 at the day of the visit.\nPast medical history was remarkable for Gaucher disease, left hip replacement, gall bladder removal, herniorrhaphy, spleen abscess drainage, hepatitis C infection, and asthma.\nSocial history was significant for 20 pack-years of cigarette smoking.\nHer family history was unremarkable for any hereditary or systemic diseases.\nHer medications included the oral antiresorptive drug alendronate for early osteoporosis associated with Gaucher disease (70mg weekly for 2 years), calcium supplements, loratadine, hydromorphone, esomeprazole, promethazine, levalbuterol, carisoprodol, fluticasone and ibuprofen.\nShe reported that she had been on enzyme replacement therapy (ERT) intermittently for several years to treat her Gaucher disease which was diagnosed 20 years prior.\nShe received intravenous injections twice a month for ERT and recounted fatigue after each infusion.\nShe also reported receiving antibiotic and analgesic medications for her pain months ago but they were not helpful.Head and neck examination, cranial nerve examination and vital signs were within normal limits.\nIntraoral examination was completed using percussion testing, vitality testing and probing for evaluation of her mandibular posterior teeth in the region of the chief complaint.\nHer left mandibular first molar was endodontically treated 3 years prior and tested non-vital, while her remaining mandibular teeth were normal on vitality testing with evaluation of several opposing non-restored and non-carious teeth as internal controls.\nGingival tissues in both jaws were non-inflamed and there was no gross evidence of plaque or calculus.\nPeriodontal pockets in her mandible ranged from 4 to 6mm with no significant bony defects.\nFull mouth dental X-rays and a panoramic radiograph were taken and showed relatively well-defined radiolucent lesions in multiple regions of the mandible bilaterally, with a pseudocystic (multilocular) appearance; cone-beam computed tomography confirmed these findings and revealed a large lytic lesion of her left posterior mandible in the region of her chief complaint (Figure 1).Our clinical and radiographic differential diagnosis for her chief complaint included chronic apical periodontitis, radicular cyst, central giant cell granuloma, keratocystic odontogenic tumor, ameloblastoma, odontogenic fibroma, neuralgia\/neuropathy or mandibular involvement of Gaucher disease given her medical history.\nOur findings were discussed with the patient and written consent was obtained for surgical biopsy of her left mandible with local anesthesia for more definitive diagnosis.\nA four-corner gingival flap buccally was reflected in her posterior left mandible extending from the canine to the second molar, and cortical bone was removed with a surgical bur to create a window for access to the lesion.\nPathologic soft tissue was evident through the access window.\nThe entire pathologic soft tissue along with the bone from the access window was submitted to the pathology laboratory for histological evaluation.\nHistopathological findings revealed infiltration of jawbone marrow with fibrous connective tissue containing abundant Gaucher cells (Figure 2).\nThere was no evidence of abscess or neutrophils, granuloma or malignancy.\nPostoperative healing was uneventful, and the patient reported resolution of her chief complaint and symptomatology at 1-month follow-up.\nShe was referred to her physician for consultation and further evaluation as related to her Gaucher disease status following our findings.\nShe was again treated with ERT and at 1-year re-evaluation was still symptom free in her oral cavity.\n","ner_info":[{"text":"46-year-old","label":"AGE","start":2,"end":13},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":14,"end":23},{"text":"woman","label":"SEX","start":24,"end":29},{"text":"Ashkenazi Jewish","label":"PERSONAL_BACKGROUND","start":33,"end":49},{"text":"presented","label":"ACTIVITY","start":58,"end":67},{"text":"severe","label":"SEVERITY","start":96,"end":102},{"text":"constant","label":"DETAILED_DESCRIPTION","start":107,"end":115},{"text":"throbbing","label":"DETAILED_DESCRIPTION","start":116,"end":125},{"text":"pain","label":"SIGN_SYMPTOM","start":126,"end":130},{"text":"left posterior mandible","label":"BIOLOGICAL_STRUCTURE","start":138,"end":161},{"text":"pain","label":"SIGN_SYMPTOM","start":185,"end":189},{"text":"chewing","label":"ACTIVITY","start":208,"end":215},{"text":"months before","label":"DATE","start":229,"end":242},{"text":"consultation","label":"CLINICAL_EVENT","start":255,"end":267},{"text":"Visual analog scale of pain","label":"DIAGNOSTIC_PROCEDURE","start":275,"end":302},{"text":"7\/10","label":"QUANTITATIVE_CONCEPT","start":316,"end":320},{"text":"day of the visit","label":"DATE","start":328,"end":344},{"text":"Gaucher disease","label":"DISEASE_DISORDER","start":386,"end":401},{"text":"left hip replacement","label":"HISTORY","start":403,"end":423},{"text":"gall bladder","label":"BIOLOGICAL_STRUCTURE","start":425,"end":437},{"text":"removal","label":"THERAPEUTIC_PROCEDURE","start":438,"end":445},{"text":"herniorrhaphy","label":"THERAPEUTIC_PROCEDURE","start":447,"end":460},{"text":"spleen","label":"BIOLOGICAL_STRUCTURE","start":462,"end":468},{"text":"abscess drainage","label":"THERAPEUTIC_PROCEDURE","start":469,"end":485},{"text":"hepatitis C infection","label":"DISEASE_DISORDER","start":487,"end":508},{"text":"asthma","label":"DISEASE_DISORDER","start":514,"end":520},{"text":"20 pack-years","label":"QUANTITATIVE_CONCEPT","start":557,"end":570},{"text":"cigarette smoking","label":"ACTIVITY","start":574,"end":591},{"text":"unremarkable for any hereditary or systemic diseases","label":"FAMILY_HISTORY","start":616,"end":668},{"text":"oral","label":"ADMINISTRATION","start":699,"end":703},{"text":"antiresorptive","label":"DETAILED_DESCRIPTION","start":704,"end":718},{"text":"alendronate","label":"MEDICATION","start":724,"end":735},{"text":"osteoporosis","label":"DISEASE_DISORDER","start":746,"end":758},{"text":"Gaucher disease","label":"DISEASE_DISORDER","start":775,"end":790},{"text":"70mg weekly","label":"DOSAGE","start":792,"end":803},{"text":"2 years","label":"DURATION","start":808,"end":815},{"text":"calcium supplements","label":"MEDICATION","start":818,"end":837},{"text":"loratadine","label":"MEDICATION","start":839,"end":849},{"text":"hydromorphone","label":"MEDICATION","start":851,"end":864},{"text":"esomeprazole","label":"MEDICATION","start":866,"end":878},{"text":"promethazine","label":"MEDICATION","start":880,"end":892},{"text":"levalbuterol","label":"MEDICATION","start":894,"end":906},{"text":"carisoprodol","label":"MEDICATION","start":908,"end":920},{"text":"fluticasone","label":"MEDICATION","start":922,"end":933},{"text":"ibuprofen","label":"MEDICATION","start":938,"end":947},{"text":"enzyme replacement therapy","label":"MEDICATION","start":983,"end":1009},{"text":"ERT","label":"MEDICATION","start":1011,"end":1014},{"text":"intermittently","label":"FREQUENCY","start":1016,"end":1030},{"text":"several years","label":"DURATION","start":1035,"end":1048},{"text":"Gaucher disease","label":"DISEASE_DISORDER","start":1062,"end":1077},{"text":"20 years prior","label":"DATE","start":1098,"end":1112},{"text":"intravenous injections","label":"ADMINISTRATION","start":1127,"end":1149},{"text":"twice a month","label":"FREQUENCY","start":1150,"end":1163},{"text":"ERT","label":"COREFERENCE","start":1168,"end":1171},{"text":"fatigue","label":"SIGN_SYMPTOM","start":1186,"end":1193},{"text":"antibiotic","label":"MEDICATION","start":1243,"end":1253},{"text":"analgesic","label":"MEDICATION","start":1258,"end":1267},{"text":"months ago","label":"DATE","start":1293,"end":1303},{"text":"Head and neck examination","label":"DIAGNOSTIC_PROCEDURE","start":1330,"end":1355},{"text":"cranial nerve examination","label":"DIAGNOSTIC_PROCEDURE","start":1357,"end":1382},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":1387,"end":1398},{"text":"within normal limits","label":"QUALITATIVE_CONCEPT","start":1404,"end":1424},{"text":"Intraoral examination","label":"DIAGNOSTIC_PROCEDURE","start":1426,"end":1447},{"text":"percussion testing","label":"DIAGNOSTIC_PROCEDURE","start":1468,"end":1486},{"text":"vitality testing","label":"DIAGNOSTIC_PROCEDURE","start":1488,"end":1504},{"text":"probing","label":"DIAGNOSTIC_PROCEDURE","start":1509,"end":1516},{"text":"mandibular posterior teeth","label":"BIOLOGICAL_STRUCTURE","start":1539,"end":1565},{"text":"left mandibular first molar","label":"BIOLOGICAL_STRUCTURE","start":1608,"end":1635},{"text":"endodontically treated","label":"THERAPEUTIC_PROCEDURE","start":1640,"end":1662},{"text":"3 years prior","label":"DATE","start":1663,"end":1676},{"text":"tested","label":"DIAGNOSTIC_PROCEDURE","start":1681,"end":1687},{"text":"non-vital","label":"LAB_VALUE","start":1688,"end":1697},{"text":"mandibular teeth","label":"BIOLOGICAL_STRUCTURE","start":1719,"end":1735},{"text":"normal","label":"LAB_VALUE","start":1741,"end":1747},{"text":"vitality testing","label":"DIAGNOSTIC_PROCEDURE","start":1751,"end":1767},{"text":"evaluation","label":"DIAGNOSTIC_PROCEDURE","start":1773,"end":1783},{"text":"several","label":"DETAILED_DESCRIPTION","start":1787,"end":1794},{"text":"opposing","label":"DETAILED_DESCRIPTION","start":1795,"end":1803},{"text":"non-restored","label":"DETAILED_DESCRIPTION","start":1804,"end":1816},{"text":"non-carious","label":"SIGN_SYMPTOM","start":1821,"end":1832},{"text":"teeth","label":"BIOLOGICAL_STRUCTURE","start":1833,"end":1838},{"text":"Gingival tissues","label":"BIOLOGICAL_STRUCTURE","start":1861,"end":1877},{"text":"jaws","label":"BIOLOGICAL_STRUCTURE","start":1886,"end":1890},{"text":"non-inflamed","label":"SIGN_SYMPTOM","start":1896,"end":1908},{"text":"plaque","label":"SIGN_SYMPTOM","start":1944,"end":1950},{"text":"calculus","label":"SIGN_SYMPTOM","start":1954,"end":1962},{"text":"Periodontal pockets","label":"SIGN_SYMPTOM","start":1964,"end":1983},{"text":"mandible","label":"BIOLOGICAL_STRUCTURE","start":1991,"end":1999},{"text":"4 to 6mm","label":"QUANTITATIVE_CONCEPT","start":2012,"end":2020},{"text":"bony defects","label":"SIGN_SYMPTOM","start":2041,"end":2053},{"text":"Full mouth","label":"BIOLOGICAL_STRUCTURE","start":2055,"end":2065},{"text":"dental X-rays","label":"DIAGNOSTIC_PROCEDURE","start":2066,"end":2079},{"text":"panoramic","label":"DETAILED_DESCRIPTION","start":2086,"end":2095},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":2096,"end":2106},{"text":"relatively well-defined","label":"DETAILED_DESCRIPTION","start":2129,"end":2152},{"text":"radiolucent","label":"DETAILED_DESCRIPTION","start":2153,"end":2164},{"text":"lesions","label":"SIGN_SYMPTOM","start":2165,"end":2172},{"text":"multiple 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cyst","label":"DISEASE_DISORDER","start":2553,"end":2567},{"text":"central giant cell granuloma","label":"DISEASE_DISORDER","start":2569,"end":2597},{"text":"keratocystic","label":"DETAILED_DESCRIPTION","start":2599,"end":2611},{"text":"odontogenic tumor","label":"DISEASE_DISORDER","start":2612,"end":2629},{"text":"ameloblastoma","label":"DISEASE_DISORDER","start":2631,"end":2644},{"text":"odontogenic fibroma","label":"DISEASE_DISORDER","start":2646,"end":2665},{"text":"neuralgia","label":"SIGN_SYMPTOM","start":2667,"end":2676},{"text":"neuropathy","label":"DISEASE_DISORDER","start":2677,"end":2687},{"text":"mandibular","label":"BIOLOGICAL_STRUCTURE","start":2691,"end":2701},{"text":"Gaucher disease","label":"DISEASE_DISORDER","start":2717,"end":2732},{"text":"discussed","label":"CLINICAL_EVENT","start":2778,"end":2787},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2851,"end":2857},{"text":"left mandible","label":"BIOLOGICAL_STRUCTURE","start":2865,"end":2878},{"text":"local anesthesia","label":"MEDICATION","start":2884,"end":2900},{"text":"four-corner","label":"DETAILED_DESCRIPTION","start":2934,"end":2945},{"text":"gingival flap","label":"THERAPEUTIC_PROCEDURE","start":2946,"end":2959},{"text":"buccally","label":"BIOLOGICAL_STRUCTURE","start":2960,"end":2968},{"text":"posterior left mandible","label":"BIOLOGICAL_STRUCTURE","start":2990,"end":3013},{"text":"canine","label":"BIOLOGICAL_STRUCTURE","start":3033,"end":3039},{"text":"second molar","label":"BIOLOGICAL_STRUCTURE","start":3047,"end":3059},{"text":"cortical bone","label":"BIOLOGICAL_STRUCTURE","start":3065,"end":3078},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":3083,"end":3090},{"text":"surgical bur","label":"THERAPEUTIC_PROCEDURE","start":3098,"end":3110},{"text":"create a window","label":"THERAPEUTIC_PROCEDURE","start":3114,"end":3129},{"text":"lesion","label":"SIGN_SYMPTOM","start":3148,"end":3154},{"text":"Pathologic","label":"SIGN_SYMPTOM","start":3156,"end":3166},{"text":"soft 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","herniorrhaphy",", ","spleen"," ","abscess drainage",", ","hepatitis C infection",", and ","asthma",".\nSocial history was significant for ","20 pack-years"," of ","cigarette smoking",".\nHer family history was ","unremarkable for any hereditary or systemic diseases",".\nHer medications included the ","oral"," ","antiresorptive"," drug ","alendronate"," for early ","osteoporosis"," associated with ","Gaucher disease"," (","70mg weekly"," for ","2 years","), ","calcium supplements",", ","loratadine",", ","hydromorphone",", ","esomeprazole",", ","promethazine",", ","levalbuterol",", ","carisoprodol",", ","fluticasone"," and ","ibuprofen",".\nShe reported that she had been on ","enzyme replacement therapy"," (","ERT",") ","intermittently"," for ","several years"," to treat her ","Gaucher disease"," which was diagnosed ","20 years prior",".\nShe received ","intravenous injections"," ","twice a month"," for ","ERT"," and recounted ","fatigue"," after each infusion.\nShe also reported receiving ","antibiotic"," and ","analgesic"," medications for her pain ","months ago"," but they were not helpful.","Head and neck examination",", ","cranial nerve examination"," and ","vital signs"," were ","within normal limits",".\n","Intraoral examination"," was completed using ","percussion testing",", ","vitality testing"," and ","probing"," for evaluation of her ","mandibular posterior teeth"," in the region of the chief complaint.\nHer ","left mandibular first molar"," was ","endodontically treated"," ","3 years prior"," and ","tested"," ","non-vital",", while her remaining ","mandibular teeth"," were ","normal"," on ","vitality testing"," with ","evaluation"," of ","several"," ","opposing"," ","non-restored"," and ","non-carious"," ","teeth"," as internal controls.\n","Gingival tissues"," in both ","jaws"," were ","non-inflamed"," and there was no gross evidence of ","plaque"," or ","calculus",".\n","Periodontal pockets"," in her ","mandible"," ranged from ","4 to 6mm"," with no significant ","bony defects",".\n","Full mouth"," ","dental X-rays"," and a ","panoramic"," ","radiograph"," were taken and showed ","relatively well-defined"," ","radiolucent"," ","lesions"," in ","multiple regions"," of the ","mandible"," ","bilaterally",", with a ","pseudocystic"," (","multilocular",") appearance; ","cone-beam"," ","computed tomography"," confirmed these findings and revealed a ","large"," ","lytic"," ","lesion"," of her ","left posterior mandible"," in the region of her chief complaint (Figure 1).Our clinical and radiographic differential diagnosis for her chief complaint included ","chronic"," ","apical periodontitis",", ","radicular cyst",", ","central giant cell granuloma",", ","keratocystic"," ","odontogenic tumor",", ","ameloblastoma",", ","odontogenic fibroma",", ","neuralgia","\/","neuropathy"," or ","mandibular"," involvement of ","Gaucher disease"," given her medical history.\nOur findings were ","discussed"," with the patient and written consent was obtained for surgical ","biopsy"," of her ","left mandible"," with ","local anesthesia"," for more definitive diagnosis.\nA ","four-corner"," ","gingival flap"," ","buccally"," was reflected in her ","posterior left mandible"," extending from the ","canine"," to the ","second molar",", and ","cortical bone"," was ","removed"," with a ","surgical bur"," to ","create a window"," for access to the ","lesion",".\n","Pathologic"," ","soft tissue"," was evident through the access window.\nThe entire ","pathologic"," ","soft tissue"," along with the bone from the access window was submitted to the ","pathology laboratory"," for ","histological evaluation",".\n","Histopathological findings"," revealed ","infiltration"," of ","jawbone marrow"," with ","fibrous connective tissue"," containing abundant ","Gaucher cells"," (Figure 2).\nThere was no evidence of ","abscess"," or ","neutrophils",", ","granuloma"," or ","malignancy",".\n","Postoperative healing"," was ","uneventful",", and the patient reported ","resolution"," of her chief complaint and symptomatology at ","1-month"," ","follow-up",".\nShe was ","referred"," to her ","physician"," for ","consultation"," and further ","evaluation"," as related to her ","Gaucher disease"," status following our findings.\nShe was again treated with ","ERT"," and at ","1-year"," ","re-evaluation"," was still ","symptom"," free in her ","oral cavity",".\n"],"ner_labels":[0,5,0,58,0,65,0,58,0,1,0,63,0,22,0,22,0,69,0,12,0,69,0,1,0,19,0,13,0,24,0,62,0,19,0,26,0,39,0,12,0,75,0,75,0,12,0,75,0,26,0,26,0,62,0,1,0,34,0,4,0,22,0,46,0,26,0,26,0,29,0,32,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,35,0,32,0,26,0,19,0,4,0,35,0,18,0,69,0,46,0,46,0,19,0,24,0,24,0,24,0,59,0,24,0,24,0,24,0,24,0,12,0,12,0,75,0,19,0,24,0,42,0,12,0,42,0,24,0,24,0,22,0,22,0,22,0,69,0,12,0,12,0,12,0,69,0,69,0,69,0,69,0,12,0,62,0,69,0,12,0,24,0,22,0,24,0,22,0,22,0,69,0,22,0,12,0,22,0,22,0,22,0,22,0,24,0,63,0,22,0,69,0,12,0,22,0,26,0,26,0,26,0,22,0,26,0,26,0,26,0,69,0,26,0,12,0,26,0,13,0,24,0,12,0,46,0,22,0,75,0,12,0,12,0,12,0,12,0,12,0,75,0,75,0,75,0,69,0,69,0,12,0,69,0,12,0,48,0,24,0,24,0,69,0,12,0,22,0,69,0,69,0,69,0,26,0,69,0,24,0,42,0,56,0,19,0,13,0,13,0,48,0,13,0,24,0,26,0,46,0,19,0,13,0,69,0,12,0]}
-{"full_text":"A 21-year-old man presented to the emergency department with a rash on his arms and neck (figure 1).\nIt had developed over the course of 36\u2005h from discrete \u2018pin prick\u2019 areas of erythema into a maculopapular rash with vesicles (figure 2).\nIt covered his forearms from the dorsal aspect of the hands to the flexor surface of the elbows.\nIt was also beginning to develop around his neck (figure 3).\nHe described the rash as itchy and painful, and was feeling \u2018under the weather\u2019.\nThe patient had no previous dermatological or other medical history of note.\nHe took no medication.\nHe worked in a supermarket handling food items but there was no history of occupational chemical exposure.\nHe had not recently had any change in washing powder or personal hygiene products.\nPhysiological observations were entirely normal and systemic examination unremarkable.\nCloser examination of the rash revealed that it was present only on skin exposed to the sun when wearing a short-sleeved shirt; the most striking feature was the \u2018V\u2019 shape on the patient's chest in keeping with the neck line of a polo shirt.\nOn further questioning the patient described a period of time 48\u2005h prior to presentation (and 12\u2005h prior to the development of the rash) spent strimming the grass under the hedges in his garden.\nBlood tests including full blood count, urea and electrolytes, liver function test and C-reactive protein were all within normal reference ranges.\nThe list of potential differential diagnoses for a maculopapular rash is long, but given the distribution of the rash and the history of plant material exposure a diagnosis of phytophotodermatitis was made.\nThe patient was discharged with chlorphenamine, simple analgesia and the advice to wear a long-sleeved t-shirt and sunscreen when gardening in the future.\nThe rash resolved over a period of 3\u2005weeks.\nIt remained pruritic throughout healing but the associated pain settled over a few days.\nResidual scarring is beginning to fade 2\u2005months after presentation.\n","ner_info":[{"text":"21-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":35,"end":55},{"text":"rash","label":"SIGN_SYMPTOM","start":63,"end":67},{"text":"arms","label":"BIOLOGICAL_STRUCTURE","start":75,"end":79},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":84,"end":88},{"text":"It","label":"COREFERENCE","start":101,"end":103},{"text":"over the course of 36\u2005h","label":"DURATION","start":118,"end":141},{"text":"discrete \u2018pin prick\u2019 areas","label":"DETAILED_DESCRIPTION","start":147,"end":173},{"text":"erythema","label":"SIGN_SYMPTOM","start":177,"end":185},{"text":"maculopapular","label":"DETAILED_DESCRIPTION","start":193,"end":206},{"text":"rash","label":"SIGN_SYMPTOM","start":207,"end":211},{"text":"vesicles","label":"DETAILED_DESCRIPTION","start":217,"end":225},{"text":"It","label":"COREFERENCE","start":238,"end":240},{"text":"forearms","label":"BIOLOGICAL_STRUCTURE","start":253,"end":261},{"text":"dorsal aspect of the hands","label":"BIOLOGICAL_STRUCTURE","start":271,"end":297},{"text":"flexor surface of the elbows","label":"BIOLOGICAL_STRUCTURE","start":305,"end":333},{"text":"It","label":"COREFERENCE","start":335,"end":337},{"text":"neck","label":"BIOLOGICAL_STRUCTURE","start":379,"end":383},{"text":"rash","label":"SIGN_SYMPTOM","start":413,"end":417},{"text":"itchy","label":"DETAILED_DESCRIPTION","start":421,"end":426},{"text":"painful","label":"DETAILED_DESCRIPTION","start":431,"end":438},{"text":"feeling","label":"DIAGNOSTIC_PROCEDURE","start":448,"end":455},{"text":"under the weather","label":"LAB_VALUE","start":457,"end":474},{"text":"no previous dermatological or other medical history of note","label":"HISTORY","start":493,"end":552},{"text":"medication","label":"MEDICATION","start":565,"end":575},{"text":"worked in a supermarket handling food items","label":"OCCUPATION","start":580,"end":623},{"text":"no history of occupational chemical exposure","label":"HISTORY","start":638,"end":682},{"text":"had not recently had any change in washing powder or personal hygiene products","label":"HISTORY","start":687,"end":765},{"text":"Physiological observations","label":"DIAGNOSTIC_PROCEDURE","start":767,"end":793},{"text":"normal","label":"LAB_VALUE","start":808,"end":814},{"text":"systemic examination","label":"DIAGNOSTIC_PROCEDURE","start":819,"end":839},{"text":"unremarkable","label":"LAB_VALUE","start":840,"end":852},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":861,"end":872},{"text":"rash","label":"SIGN_SYMPTOM","start":880,"end":884},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":922,"end":926},{"text":"exposed to the sun","label":"ACTIVITY","start":927,"end":945},{"text":"wearing a short-sleeved shirt","label":"ACTIVITY","start":951,"end":980},{"text":"\u2018V\u2019 shape on the patient's chest","label":"OTHER_ENTITY","start":1016,"end":1048},{"text":"48\u2005h prior","label":"DATE","start":1158,"end":1168},{"text":"12\u2005h prior","label":"DATE","start":1190,"end":1200},{"text":"rash","label":"SIGN_SYMPTOM","start":1227,"end":1231},{"text":"strimming the grass","label":"ACTIVITY","start":1239,"end":1258},{"text":"Blood tests","label":"DIAGNOSTIC_PROCEDURE","start":1291,"end":1302},{"text":"full blood count","label":"DIAGNOSTIC_PROCEDURE","start":1313,"end":1329},{"text":"urea","label":"DIAGNOSTIC_PROCEDURE","start":1331,"end":1335},{"text":"electrolytes","label":"DIAGNOSTIC_PROCEDURE","start":1340,"end":1352},{"text":"liver function test","label":"DIAGNOSTIC_PROCEDURE","start":1354,"end":1373},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1378,"end":1396},{"text":"within normal reference ranges","label":"LAB_VALUE","start":1406,"end":1436},{"text":"phytophotodermatitis","label":"DISEASE_DISORDER","start":1614,"end":1634},{"text":"discharged","label":"CLINICAL_EVENT","start":1661,"end":1671},{"text":"chlorphenamine","label":"MEDICATION","start":1677,"end":1691},{"text":"simple analgesia","label":"MEDICATION","start":1693,"end":1709},{"text":"advice to wear a long-sleeved t-shirt and sunscreen","label":"OTHER_EVENT","start":1718,"end":1769},{"text":"rash","label":"SIGN_SYMPTOM","start":1804,"end":1808},{"text":"period of 3\u2005weeks","label":"DURATION","start":1825,"end":1842},{"text":"It","label":"COREFERENCE","start":1844,"end":1846},{"text":"pruritic","label":"DETAILED_DESCRIPTION","start":1856,"end":1864},{"text":"pain","label":"SIGN_SYMPTOM","start":1903,"end":1907},{"text":"over a few days","label":"DURATION","start":1916,"end":1931},{"text":"scarring","label":"SIGN_SYMPTOM","start":1942,"end":1950},{"text":"2\u2005months after","label":"DATE","start":1972,"end":1986}],"tokens":["A ","21-year-old"," ","man"," ","presented"," to the ","emergency department"," with a ","rash"," on his ","arms"," and ","neck"," (figure 1).\n","It"," had developed ","over the course of 36\u2005h"," from ","discrete \u2018pin prick\u2019 areas"," of ","erythema"," into a ","maculopapular"," ","rash"," with ","vesicles"," (figure 2).\n","It"," covered his ","forearms"," from the ","dorsal aspect of the hands"," to the ","flexor surface of the elbows",".\n","It"," was also beginning to develop around his ","neck"," (figure 3).\nHe described the ","rash"," as ","itchy"," and ","painful",", and was ","feeling"," \u2018","under the weather","\u2019.\nThe patient had ","no previous dermatological or other medical history of note",".\nHe took no ","medication",".\nHe ","worked in a supermarket handling food items"," but there was ","no history of occupational chemical exposure",".\nHe ","had not recently had any change in washing powder or personal hygiene products",".\n","Physiological observations"," were entirely ","normal"," and ","systemic examination"," ","unremarkable",".\nCloser ","examination"," of the ","rash"," revealed that it was present only on ","skin"," ","exposed to the sun"," when ","wearing a short-sleeved shirt","; the most striking feature was the ","\u2018V\u2019 shape on the patient's chest"," in keeping with the neck line of a polo shirt.\nOn further questioning the patient described a period of time ","48\u2005h prior"," to presentation (and ","12\u2005h prior"," to the development of the ","rash",") spent ","strimming the grass"," under the hedges in his garden.\n","Blood tests"," including ","full blood count",", ","urea"," and ","electrolytes",", ","liver function test"," and ","C-reactive protein"," were all ","within normal reference ranges",".\nThe list of potential differential diagnoses for a maculopapular rash is long, but given the distribution of the rash and the history of plant material exposure a diagnosis of ","phytophotodermatitis"," was made.\nThe patient was ","discharged"," with ","chlorphenamine",", ","simple analgesia"," and the ","advice to wear a long-sleeved t-shirt and sunscreen"," when gardening in the future.\nThe ","rash"," resolved over a ","period of 3\u2005weeks",".\n","It"," remained ","pruritic"," throughout healing but the associated ","pain"," settled ","over a few days",".\nResidual ","scarring"," is beginning to fade ","2\u2005months after"," presentation.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,12,0,12,0,18,0,32,0,22,0,69,0,22,0,69,0,22,0,18,0,12,0,12,0,12,0,18,0,12,0,69,0,22,0,22,0,24,0,42,0,39,0,46,0,50,0,39,0,39,0,24,0,42,0,24,0,42,0,24,0,69,0,12,0,1,0,1,0,51,0,19,0,19,0,69,0,1,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,26,0,13,0,46,0,46,0,53,0,69,0,32,0,18,0,22,0,69,0,32,0,69,0,19,0]}
-{"full_text":"A 77-year-old woman with dysphagia presented with a two-week history of rash characterized by brown plaques with erythematous borders and overlying thick scales involving the face and a prior percutaneous endoscopic gastrostomy (PEG) tube site (Fig.1a, c).\nNo oral or conjunctival involvement was present.\nShe had been receiving parenteral nutrition for two months following removal of the PEG tube due to infection.\nAlthough the differential diagnosis included drug hypersensitivity, autoimmune disorders and nutritional deficiency, the rash appearance was most consistent with acrodermatitis enteropathica-like eruption secondary to zinc deficiency.\nHer serum zinc level was 12 mcg\/dL (normal, 55\u2013150 mcg\/dL), and the rash resolved within one week of parenteral zinc supplementation (Fig.1b, d).\nZinc is essential for protein synthesis and wound healing.\nAcrodermatitis enteropathica presents in infancy as a periorificial desquamative dermatitis, resulting from an autosomal recessive mutation that impairs zinc absorption. A similar syndrome may occur due to nutritional zinc deficiency, and has been reported in the setting of parenteral nutrition that fails to include zinc supplementation; a prompt response to supplementation helps to confirm the diagnosis.\nA recent national shortage of parenteral zinc in the United States likely contributed to this patient\u2019s presentation.\n","ner_info":[{"text":"77-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":25,"end":34},{"text":"presented","label":"CLINICAL_EVENT","start":35,"end":44},{"text":"two-week history","label":"DURATION","start":52,"end":68},{"text":"rash","label":"SIGN_SYMPTOM","start":72,"end":76},{"text":"brown","label":"COLOR","start":94,"end":99},{"text":"plaques","label":"SIGN_SYMPTOM","start":100,"end":107},{"text":"erythematous borders","label":"DETAILED_DESCRIPTION","start":113,"end":133},{"text":"overlying thick scales","label":"DETAILED_DESCRIPTION","start":138,"end":160},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":175,"end":179},{"text":"percutaneous endoscopic gastrostomy","label":"DIAGNOSTIC_PROCEDURE","start":192,"end":227},{"text":"PEG","label":"DIAGNOSTIC_PROCEDURE","start":229,"end":232},{"text":"site","label":"BIOLOGICAL_STRUCTURE","start":239,"end":243},{"text":"oral","label":"BIOLOGICAL_STRUCTURE","start":260,"end":264},{"text":"conjunctival","label":"BIOLOGICAL_STRUCTURE","start":268,"end":280},{"text":"involvement","label":"SIGN_SYMPTOM","start":281,"end":292},{"text":"parenteral nutrition","label":"MEDICATION","start":329,"end":349},{"text":"two months","label":"DURATION","start":354,"end":364},{"text":"PEG tube","label":"DIAGNOSTIC_PROCEDURE","start":390,"end":398},{"text":"infection","label":"DISEASE_DISORDER","start":406,"end":415},{"text":"drug hypersensitivity","label":"DISEASE_DISORDER","start":462,"end":483},{"text":"autoimmune disorders","label":"DISEASE_DISORDER","start":485,"end":505},{"text":"nutritional deficiency","label":"DISEASE_DISORDER","start":510,"end":532},{"text":"rash","label":"SIGN_SYMPTOM","start":538,"end":542},{"text":"acrodermatitis enteropathica","label":"DISEASE_DISORDER","start":579,"end":607},{"text":"eruption","label":"SIGN_SYMPTOM","start":613,"end":621},{"text":"zinc deficiency","label":"DISEASE_DISORDER","start":635,"end":650},{"text":"serum","label":"DETAILED_DESCRIPTION","start":656,"end":661},{"text":"zinc","label":"DIAGNOSTIC_PROCEDURE","start":662,"end":666},{"text":"12 mcg\/dL","label":"LAB_VALUE","start":677,"end":686},{"text":"rash","label":"SIGN_SYMPTOM","start":720,"end":724},{"text":"within one week","label":"DATE","start":734,"end":749},{"text":"parenteral","label":"ADMINISTRATION","start":753,"end":763},{"text":"zinc supplementation","label":"MEDICATION","start":764,"end":784},{"text":"national shortage of parenteral zinc","label":"OTHER_EVENT","start":1275,"end":1311},{"text":"United States","label":"NONBIOLOGICAL_LOCATION","start":1319,"end":1332}],"tokens":["A ","77-year-old"," ","woman"," with ","dysphagia"," ","presented"," with a ","two-week history"," of ","rash"," characterized by ","brown"," ","plaques"," with ","erythematous borders"," and ","overlying thick scales"," involving the ","face"," and a prior ","percutaneous endoscopic gastrostomy"," (","PEG",") tube ","site"," (Fig.1a, c).\nNo ","oral"," or ","conjunctival"," ","involvement"," was present.\nShe had been receiving ","parenteral nutrition"," for ","two months"," following removal of the ","PEG tube"," due to ","infection",".\nAlthough the differential diagnosis included ","drug hypersensitivity",", ","autoimmune disorders"," and ","nutritional deficiency",", the ","rash"," appearance was most consistent with ","acrodermatitis enteropathica","-like ","eruption"," secondary to ","zinc deficiency",".\nHer ","serum"," ","zinc"," level was ","12 mcg\/dL"," (normal, 55\u2013150 mcg\/dL), and the ","rash"," resolved ","within one week"," of ","parenteral"," ","zinc supplementation"," (Fig.1b, d).\nZinc is essential for protein synthesis and wound healing.\nAcrodermatitis enteropathica presents in infancy as a periorificial desquamative dermatitis, resulting from an autosomal recessive mutation that impairs zinc absorption. A similar syndrome may occur due to nutritional zinc deficiency, and has been reported in the setting of parenteral nutrition that fails to include zinc supplementation; a prompt response to supplementation helps to confirm the diagnosis.\nA recent ","national shortage of parenteral zinc"," in the ","United States"," likely contributed to this patient\u2019s presentation.\n"],"ner_labels":[0,5,0,65,0,69,0,13,0,32,0,69,0,15,0,69,0,22,0,22,0,12,0,24,0,24,0,12,0,12,0,12,0,69,0,46,0,32,0,24,0,26,0,26,0,26,0,26,0,69,0,26,0,69,0,26,0,22,0,24,0,42,0,69,0,19,0,4,0,46,0,53,0,48,0]}
-{"full_text":"A 42 year-old man with chronic lymphocytic leukemia underwent allogeneic bone marrow transplant in September 2013.\nThe graft was mismatched at a single human leukocyte antigen allele (DQB1), and was T-cell depleted using in vivo alemtuzumab.\nHe engrafted on day 12 after transplant.\nAside from persistent lymphopenia and diarrhea from norovirus infection, his posttransplant course was unremarkable until mid-October when he developed tinnitus and rapidly progressive sensorineural deafness, resulting in subtotal hearing loss bilaterally (>95 dB) over 2\u20133 weeks.\nBrain magnetic resonance imaging (MRI) was unremarkable, as was cerebrospinal fluid (CSF) analysis (4 leukocytes\/\u00b5L with 50% neutrophils and 50% lymphocytes, 6 red blood cells\/\u00b5L, glucose 2.4 mmol\/L [normal range, 2.2\u20134.7 mmol\/L], protein 61 mg\/dL [normal range, 15\u201345 mg\/L], absence of oligoclonal bands).\nViral polymerase chain reaction (PCR) testing of CSF was negative for enterovirus and herpesvirus infection.\nThe patient was treated empirically with high-dose valacyclovir, broad-spectrum antibiotics, and 2 g\/kg intravenous immunoglobulin (IVIG).\nDespite these interventions, he developed new symptoms of central dyspnea, postural hypotension, nausea, and gradually worsening balance.\nRepeat neurological assessment confirmed persistent vestibulocochlear dysfunction 6 weeks after symptom onset.\nBy mid-December, the patient had become increasingly withdrawn, irritable, and intermittently agitated.\nHe remained lymphopenic (lymphocytes 0.54 \u00d7 106\/\u03bcL [normal range, 1.2\u20133.6 \u00d7 106\/\u03bcL]).\nMRI scans of the brain were unremarkable, as was serum testing for antineuronal antibodies; an electroencephalogram revealed only diffuse encephalopathy.\nGiven continued suspicion for a viral etiology, the patient was treated with high-dose glucocorticoids and again with IVIG.\nHe began refusing fluids, food, and medication, and was detained under the UK Mental Health Act.\nRepeat MRI scanning showed interval development of new, nonenhancing signal abnormalities in both thalami and midbrain with cranial nerve involvement but no meningeal enhancement (Figure \u200b1A).\nNear the end of December, a frontal lobe biopsy was performed.\nHistology revealed reactive gliosis and diffuse infiltration with CD3+\/8+ lymphocytes (Figure 1B).\nExtensive microbiological testing of the biopsy tissue for an infectious etiology was negative (Supplementary Table 1).\nGiven the absence of a diagnosis and the patient's progressive neurological deterioration, CSF and brain biopsy tissue were analyzed in January 2014 by metagenomic next-generation sequencing (NGS) [2].\nNGS analysis of the brain biopsy, genome assembly, and in situ hybridization revealed findings of neuroinvasive astrovirus (AstV) infection.\nDespite lack of approved therapies, the patient was treated with ribavirin and IVIG.\nHowever, he did not respond to these interventions, and remained in a minimally conscious state following withdrawal of sedation in March 2014.\nHe eventually died at the end of May, 4 months after the NGS diagnosis and approximately 7.5 months after onset of symptoms.\n","ner_info":[{"text":"42 year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":23,"end":30},{"text":"lymphocytic leukemia","label":"DISEASE_DISORDER","start":31,"end":51},{"text":"allogeneic","label":"DETAILED_DESCRIPTION","start":62,"end":72},{"text":"bone marrow transplant","label":"THERAPEUTIC_PROCEDURE","start":73,"end":95},{"text":"September 2013","label":"DATE","start":99,"end":113},{"text":"graft","label":"COREFERENCE","start":119,"end":124},{"text":"mismatched at a single human leukocyte antigen allele","label":"DETAILED_DESCRIPTION","start":129,"end":182},{"text":"DQB1","label":"DETAILED_DESCRIPTION","start":184,"end":188},{"text":"T-cell 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leukocytes\/\u00b5L","label":"LAB_VALUE","start":664,"end":679},{"text":"50%","label":"LAB_VALUE","start":685,"end":688},{"text":"neutrophils","label":"DIAGNOSTIC_PROCEDURE","start":689,"end":700},{"text":"50%","label":"LAB_VALUE","start":705,"end":708},{"text":"lymphocytes","label":"DIAGNOSTIC_PROCEDURE","start":709,"end":720},{"text":"6 red blood cells\/\u00b5L","label":"LAB_VALUE","start":722,"end":742},{"text":"glucose","label":"DIAGNOSTIC_PROCEDURE","start":744,"end":751},{"text":"2.4 mmol\/L","label":"LAB_VALUE","start":752,"end":762},{"text":"protein","label":"DIAGNOSTIC_PROCEDURE","start":795,"end":802},{"text":"61 mg\/dL","label":"LAB_VALUE","start":803,"end":811},{"text":"absence","label":"LAB_VALUE","start":840,"end":847},{"text":"oligoclonal bands","label":"DIAGNOSTIC_PROCEDURE","start":851,"end":868},{"text":"Viral","label":"DETAILED_DESCRIPTION","start":871,"end":876},{"text":"polymerase chain 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deterioration","label":"DISEASE_DISORDER","start":2471,"end":2497},{"text":"CSF and brain biopsy tissue","label":"DETAILED_DESCRIPTION","start":2499,"end":2526},{"text":"January 2014","label":"DATE","start":2544,"end":2556},{"text":"metagenomic","label":"DETAILED_DESCRIPTION","start":2560,"end":2571},{"text":"next-generation sequencing","label":"DIAGNOSTIC_PROCEDURE","start":2572,"end":2598},{"text":"NGS","label":"DIAGNOSTIC_PROCEDURE","start":2600,"end":2603},{"text":"NGS","label":"DIAGNOSTIC_PROCEDURE","start":2610,"end":2613},{"text":"brain biopsy","label":"DETAILED_DESCRIPTION","start":2630,"end":2642},{"text":"genome assembly","label":"DIAGNOSTIC_PROCEDURE","start":2644,"end":2659},{"text":"in situ hybridization","label":"DIAGNOSTIC_PROCEDURE","start":2665,"end":2686},{"text":"neuroinvasive","label":"DETAILED_DESCRIPTION","start":2708,"end":2721},{"text":"astrovirus","label":"DISEASE_DISORDER","start":2722,"end":2732},{"text":"AstV","label":"DISEASE_DISORDER","start":2734,"end":2738},{"text":"ribavirin","label":"MEDICATION","start":2816,"end":2825},{"text":"IVIG","label":"MEDICATION","start":2830,"end":2834},{"text":"minimally conscious state","label":"SIGN_SYMPTOM","start":2906,"end":2931},{"text":"sedation","label":"MEDICATION","start":2956,"end":2964},{"text":"March 2014","label":"DATE","start":2968,"end":2978},{"text":"died","label":"OUTCOME","start":2994,"end":2998},{"text":"end of May","label":"DATE","start":3006,"end":3016},{"text":"4 months after","label":"DATE","start":3018,"end":3032},{"text":"NGS","label":"DIAGNOSTIC_PROCEDURE","start":3037,"end":3040},{"text":"7.5 months after","label":"DATE","start":3069,"end":3085},{"text":"symptoms","label":"SIGN_SYMPTOM","start":3095,"end":3103}],"tokens":["A ","42 year-old"," ","man"," with ","chronic"," ","lymphocytic leukemia"," underwent ","allogeneic"," ","bone marrow transplant"," in ","September 2013",".\nThe ","graft"," was ","mismatched at a single human leukocyte antigen allele"," (","DQB1","), and was ","T-cell depleted"," using ","in vivo"," ","alemtuzumab",".\nHe ","engrafted"," on ","day 12"," after ","transplant",".\nAside from ","persistent"," ","lymphopenia"," and ","diarrhea"," from ","norovirus"," infection, his ","posttransplant course"," was ","unremarkable"," until ","mid-October"," when he developed ","tinnitus"," and ","rapidly progressive"," ","sensorineural deafness",", resulting in ","subtotal"," ","hearing loss"," ","bilaterally"," (",">95 dB",") ","over 2\u20133 weeks",".\n","Brain"," ","magnetic resonance imaging"," (","MRI",") was unremarkable, as was ","cerebrospinal fluid"," (","CSF",") analysis (","4 leukocytes\/\u00b5L"," with ","50%"," ","neutrophils"," and ","50%"," ","lymphocytes",", ","6 red blood cells\/\u00b5L",", ","glucose"," ","2.4 mmol\/L"," [normal range, 2.2\u20134.7 mmol\/L], ","protein"," ","61 mg\/dL"," [normal range, 15\u201345 mg\/L], ","absence"," of ","oligoclonal bands",").\n","Viral"," ","polymerase chain reaction"," (PCR) testing of ","CSF"," was negative for ","enterovirus"," and ","herpesvirus"," infection.\nThe patient was treated empirically with high-dose ","valacyclovir",", broad-spectrum ","antibiotics",", and ","2 g\/kg"," ","intravenous"," ","immunoglobulin"," (","IVIG",").\nDespite these interventions, he developed new symptoms of central ","dyspnea",", ","postural"," ","hypotension",", ","nausea",", and ","gradually worsening"," ","balance",".\nRepeat ","neurological assessment"," confirmed ","persistent"," ","vestibulocochlear dysfunction"," ","6 weeks after"," ","symptom"," onset.\nBy ","mid-December",", the patient had become increasingly ","withdrawn",", ","irritable",", and ","intermittently"," ","agitated",".\nHe remained ","lymphopenic"," (","lymphocytes"," ","0.54 \u00d7 106\/\u03bcL"," [normal range, 1.2\u20133.6 \u00d7 106\/\u03bcL]).\n","MRI"," scans of the ","brain"," were ","unremarkable",", as was ","serum testing"," for ","antineuronal antibodies","; an ","electroencephalogram"," revealed only diffuse ","encephalopathy",".\nGiven continued suspicion for a ","viral"," etiology, the patient was treated with ","high-dose"," ","glucocorticoids"," and again with ","IVIG",".\nHe began refusing ","fluids",", ","food",", and ","medication",", and was ","detained"," under the ","UK Mental Health Act",".\nRepeat ","MRI"," scanning showed interval development of ","new",", ","nonenhancing"," ","signal abnormalities"," in ","both thalami"," and ","midbrain"," with ","cranial nerve"," involvement but no ","meningeal"," ","enhancement"," (Figure \u200b1A).\n","Near the end of December",", a ","frontal lobe"," ","biopsy"," was performed.\n","Histology"," revealed ","reactive"," ","gliosis"," and ","diffuse"," ","infiltration"," with ","CD3+\/8+ lymphocytes"," (Figure 1B).\nExtensive ","microbiological testing"," of the ","biopsy tissue"," for an ","infectious etiology"," was ","negative"," (Supplementary Table 1).\nGiven the absence of a diagnosis and the patient's progressive ","neurological deterioration",", ","CSF and brain biopsy tissue"," were analyzed in ","January 2014"," by ","metagenomic"," ","next-generation sequencing"," (","NGS",") [2].\n","NGS"," analysis of the ","brain biopsy",", ","genome assembly",", and ","in situ hybridization"," revealed findings of ","neuroinvasive"," ","astrovirus"," (","AstV",") infection.\nDespite lack of approved therapies, the patient was treated with ","ribavirin"," and ","IVIG",".\nHowever, he did not respond to these interventions, and remained in a ","minimally conscious state"," following withdrawal of ","sedation"," in ","March 2014",".\nHe eventually ","died"," at the ","end of May",", ","4 months after"," the ","NGS"," diagnosis and approximately ","7.5 months after"," onset of ","symptoms",".\n"],"ner_labels":[0,5,0,65,0,22,0,26,0,22,0,75,0,19,0,18,0,22,0,22,0,22,0,22,0,46,0,75,0,19,0,75,0,22,0,69,0,69,0,26,0,24,0,42,0,19,0,69,0,22,0,26,0,22,0,69,0,22,0,42,0,32,0,12,0,24,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,22,0,24,0,22,0,26,0,26,0,46,0,46,0,29,0,4,0,46,0,46,0,69,0,22,0,69,0,69,0,42,0,24,0,24,0,22,0,26,0,19,0,69,0,19,0,69,0,69,0,22,0,69,0,69,0,24,0,42,0,24,0,12,0,42,0,22,0,24,0,24,0,26,0,26,0,29,0,46,0,46,0,1,0,1,0,46,0,13,0,22,0,24,0,22,0,22,0,69,0,12,0,12,0,12,0,12,0,69,0,19,0,12,0,24,0,24,0,22,0,69,0,22,0,69,0,22,0,24,0,22,0,22,0,42,0,26,0,22,0,19,0,22,0,24,0,24,0,24,0,22,0,24,0,24,0,22,0,26,0,26,0,46,0,46,0,69,0,46,0,19,0,56,0,19,0,19,0,24,0,19,0,69,0]}
-{"full_text":"A 68-year-old man was referred by his optometrist to HES with suspected LTG due to repeatedly irregular visual field test results, advanced optic disc cupping, normal intraocular pressures (IOPs) and a family history of glaucoma.\nThe patient subjectively felt that vision in his \u2018good\u2019 left eye (LE), which normally had a visual acuity of 6\/6 N5, started to deteriorate 6\u2005months earlier; at the point of referral it was best corrected to 6\/7.5 N6.\nHis right eye (RE) was known to be amblyopic with a visual acuity of 6\/18 N12.\nHis medical history included considerable risk factors for systemic vasculopathy, such as hypertension, hypercholesterolaemia, 50 pack-years of smoking and type 2 diabetes with no diabetic retinopathy.\nDespite detailed questioning, he denied any new systemic symptoms apart from experiencing increased lethargy.\nClinical examination at HES revealed advanced bilateral cupped optic discs with a cup-to-disc ratio right 0.9 (90%) and left 0.8 (80%; figure 1).\nFurthermore, the findings from the referring optometrist of equal and reactive pupils, normal eye movements and IOPs in mid-teens were confirmed.\nComputerised perimetry showed constricted visual fields in both eyes, albeit with considerably raised false-negative error rates in excess of 30% (figure 2A).\nSince this can be a result of poor concentration and attention span with testing compounded, especially with an amblyopic RE, the field test was repeated 4\u2005weeks later with similar results (figure 2B).\nAt this visit, the patient experienced further deterioration of his \u2018good\u2019 LE.\nVisual acuities measured 6\/24 (loss of one Snellen line) N36 in his amblyopic RE, and 6\/18 (loss of two Snellen lines) N36 in his LE, which now also showed depressed colour vision.\nAn urgent scan of the patient's head and orbit was requested to rule out a compressive lesion and blood analysis was carried out to screen for other causes of optic neuropathy including vitamin B12, folate levels and inflammatory markers.\nMRI revealed a large mass centred at the pituitary fossa measuring approximately 4.5\u2005cm\u00d75.1\u2005cm\u00d7 4.8\u2005cm (figure 3A\u2013C) extending into the suprasellar cistern and infrasellar sphenoid sinuses.\nThe optic chiasm and both optic nerves were displaced superiorly and compressed on both sides.\nThe mass showed heterogeneous T1 and T2 signals with multiple fluid levels most likely due to previous haemorrhage and low-signal components suggesting calcifications.\nThe appearance was probably due to a craniopharyngioma or haemorrhagic pituitary adenoma.\nThe patient was referred urgently to the neurosurgery unit and was found to have markedly raised prolactin levels of greater than 200\u2005000\u2005mIU\/L, confirming the diagnosis of a giant prolactinoma.\nIn cooperation with the local endocrinology service, he was started on cabergoline 500\u2005\u00b5g and dexamethasone 8\u2005mg.\nWithin a week this led to a dramatic improvement of the patient's visual fields and acuities to 6\/18 RE and to 6\/9 LE.\nHis prolactin levels showed a similar dramatic response with levels coming down to 336\u2005mIU\/L.\nThree months later his visual acuity in his RE and LE were 6\/18 and 6\/5, respectively, and visual field examination showed striking recovery with almost normal results (figure 2C).\n","ner_info":[{"text":"68-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"his optometrist","label":"SUBJECT","start":34,"end":49},{"text":"HES","label":"NONBIOLOGICAL_LOCATION","start":53,"end":56},{"text":"LTG","label":"DISEASE_DISORDER","start":72,"end":75},{"text":"repeatedly irregular","label":"DETAILED_DESCRIPTION","start":83,"end":103},{"text":"visual field test 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N5","label":"LAB_VALUE","start":339,"end":345},{"text":"deteriorate","label":"DETAILED_DESCRIPTION","start":358,"end":369},{"text":"6\u2005months earlier","label":"DATE","start":370,"end":386},{"text":"it","label":"COREFERENCE","start":413,"end":415},{"text":"6\/7.5 N6","label":"LAB_VALUE","start":438,"end":446},{"text":"right eye","label":"BIOLOGICAL_STRUCTURE","start":452,"end":461},{"text":"RE","label":"BIOLOGICAL_STRUCTURE","start":463,"end":465},{"text":"amblyopic","label":"DISEASE_DISORDER","start":483,"end":492},{"text":"visual acuity","label":"DIAGNOSTIC_PROCEDURE","start":500,"end":513},{"text":"6\/18 N12","label":"LAB_VALUE","start":517,"end":525},{"text":"risk 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examination","label":"DIAGNOSTIC_PROCEDURE","start":839,"end":859},{"text":"HES","label":"NONBIOLOGICAL_LOCATION","start":863,"end":866},{"text":"advanced bilateral","label":"DETAILED_DESCRIPTION","start":876,"end":894},{"text":"cupped optic discs","label":"DIAGNOSTIC_PROCEDURE","start":895,"end":913},{"text":"cup-to-disc ratio","label":"DIAGNOSTIC_PROCEDURE","start":921,"end":938},{"text":"right","label":"DETAILED_DESCRIPTION","start":939,"end":944},{"text":"0.9","label":"LAB_VALUE","start":945,"end":948},{"text":"90%","label":"LAB_VALUE","start":950,"end":953},{"text":"left","label":"DETAILED_DESCRIPTION","start":959,"end":963},{"text":"0.8","label":"LAB_VALUE","start":964,"end":967},{"text":"80%","label":"LAB_VALUE","start":969,"end":972},{"text":"findings","label":"DIAGNOSTIC_PROCEDURE","start":1002,"end":1010},{"text":"referring","label":"DETAILED_DESCRIPTION","start":1020,"end":1029},{"text":"optometrist","label":"SUBJECT","start":1030,"end":1041},{"text":"equal and reactive 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30%","label":"LAB_VALUE","start":1260,"end":1276},{"text":"this","label":"COREFERENCE","start":1296,"end":1300},{"text":"poor","label":"SEVERITY","start":1320,"end":1324},{"text":"concentration","label":"SIGN_SYMPTOM","start":1325,"end":1338},{"text":"attention span","label":"SIGN_SYMPTOM","start":1343,"end":1357},{"text":"with testing compounded","label":"DETAILED_DESCRIPTION","start":1358,"end":1381},{"text":"amblyopic","label":"DISEASE_DISORDER","start":1402,"end":1411},{"text":"RE","label":"BIOLOGICAL_STRUCTURE","start":1412,"end":1414},{"text":"field test","label":"DIAGNOSTIC_PROCEDURE","start":1420,"end":1430},{"text":"4\u2005weeks later","label":"DATE","start":1444,"end":1457},{"text":"with similar results","label":"DETAILED_DESCRIPTION","start":1458,"end":1478},{"text":"visit","label":"CLINICAL_EVENT","start":1500,"end":1505},{"text":"further deterioration","label":"LAB_VALUE","start":1531,"end":1552},{"text":"good","label":"DETAILED_DESCRIPTION","start":1561,"end":1565},{"text":"LE","label":"BIOLOGICAL_STRUCTURE","start":1567,"end":1569},{"text":"Visual acuities","label":"DIAGNOSTIC_PROCEDURE","start":1571,"end":1586},{"text":"loss of one Snellen line","label":"DETAILED_DESCRIPTION","start":1602,"end":1626},{"text":"amblyopic","label":"DISEASE_DISORDER","start":1639,"end":1648},{"text":"RE","label":"BIOLOGICAL_STRUCTURE","start":1649,"end":1651},{"text":"loss of two Snellen lines","label":"DETAILED_DESCRIPTION","start":1663,"end":1688},{"text":"LE","label":"BIOLOGICAL_STRUCTURE","start":1701,"end":1703},{"text":"depressed","label":"LAB_VALUE","start":1727,"end":1736},{"text":"colour 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sides","label":"DETAILED_DESCRIPTION","start":2250,"end":2274},{"text":"mass","label":"DISEASE_DISORDER","start":2280,"end":2284},{"text":"heterogeneous","label":"DETAILED_DESCRIPTION","start":2292,"end":2305},{"text":"T2 signals","label":"DIAGNOSTIC_PROCEDURE","start":2313,"end":2323},{"text":"multiple","label":"LAB_VALUE","start":2329,"end":2337},{"text":"fluid levels","label":"DIAGNOSTIC_PROCEDURE","start":2338,"end":2350},{"text":"haemorrhage","label":"DISEASE_DISORDER","start":2379,"end":2390},{"text":"low-signal components","label":"DIAGNOSTIC_PROCEDURE","start":2395,"end":2416},{"text":"calcifications","label":"DISEASE_DISORDER","start":2428,"end":2442},{"text":"The appearance","label":"COREFERENCE","start":2444,"end":2458},{"text":"craniopharyngioma","label":"DISEASE_DISORDER","start":2481,"end":2498},{"text":"haemorrhagic","label":"DETAILED_DESCRIPTION","start":2502,"end":2514},{"text":"pituitary adenoma","label":"DISEASE_DISORDER","start":2515,"end":2532},{"text":"referred","label":"CLINICAL_EVENT","start":2550,"end":2558},{"text":"neurosurgery unit","label":"NONBIOLOGICAL_LOCATION","start":2575,"end":2592},{"text":"markedly raised","label":"LAB_VALUE","start":2615,"end":2630},{"text":"prolactin levels","label":"DIAGNOSTIC_PROCEDURE","start":2631,"end":2647},{"text":"greater than 200\u2005000\u2005mIU\/L","label":"LAB_VALUE","start":2651,"end":2677},{"text":"giant","label":"SEVERITY","start":2709,"end":2714},{"text":"prolactinoma","label":"DISEASE_DISORDER","start":2715,"end":2727},{"text":"local endocrinology service","label":"NONBIOLOGICAL_LOCATION","start":2753,"end":2780},{"text":"cabergoline","label":"MEDICATION","start":2800,"end":2811},{"text":"500\u2005\u00b5g","label":"DOSAGE","start":2812,"end":2818},{"text":"dexamethasone","label":"MEDICATION","start":2823,"end":2836},{"text":"8\u2005mg","label":"DOSAGE","start":2837,"end":2841},{"text":"Within a 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eye"," (","LE","), which normally had a ","visual acuity"," of ","6\/6 N5",", started to ","deteriorate"," ","6\u2005months earlier","; at the point of referral ","it"," was best corrected to ","6\/7.5 N6",".\nHis ","right eye"," (","RE",") was known to be ","amblyopic"," with a ","visual acuity"," of ","6\/18 N12",".\nHis medical history included considerable ","risk factors"," for ","systemic"," ","vasculopathy",", such as ","hypertension",", ","hypercholesterolaemia",", ","50 pack-years"," of ","smoking"," and ","type 2 diabetes"," with no ","diabetic retinopathy",".\nDespite detailed questioning, he denied any ","new systemic symptoms"," apart from experiencing ","increased"," ","lethargy",".\n","Clinical examination"," at ","HES"," revealed ","advanced bilateral"," ","cupped optic discs"," with a ","cup-to-disc ratio"," ","right"," ","0.9"," (","90%",") and ","left"," ","0.8"," (","80%","; figure 1).\nFurthermore, the ","findings"," from the ","referring"," ","optometrist"," of ","equal and reactive pupils",", ","normal"," ","eye movements"," and ","IOPs"," in ","mid-teens"," were confirmed.\n","Computerised perimetry"," showed ","constricted"," ","visual fields"," in ","both"," ","eyes",", albeit with ","considerably raised"," ","false-negative error rates"," ","in excess of 30%"," (figure 2A).\nSince ","this"," can be a result of ","poor"," ","concentration"," and ","attention span"," ","with testing compounded",", especially with an ","amblyopic"," ","RE",", the ","field test"," was repeated ","4\u2005weeks later"," ","with similar results"," (figure 2B).\nAt this ","visit",", the patient experienced ","further deterioration"," of his \u2018","good","\u2019 ","LE",".\n","Visual acuities"," measured 6\/24 (","loss of one Snellen line",") N36 in his ","amblyopic"," ","RE",", and 6\/18 (","loss of two Snellen lines",") N36 in his ","LE",", which now also showed ","depressed"," ","colour vision",".\nAn ","urgent"," ","scan"," of the patient's ","head"," and ","orbit"," was requested to rule out a ","compressive"," ","lesion"," and ","blood analysis"," was carried out to screen for ","other causes of optic neuropathy"," including ","vitamin B12",", ","folate levels"," and ","inflammatory markers",".\n","MRI"," revealed a ","large"," ","mass"," centred at the ","pituitary fossa"," measuring approximately ","4.5\u2005cm\u00d75.1\u2005cm\u00d7 4.8\u2005cm"," (figure 3A\u2013C) extending into the ","suprasellar cistern"," and ","infrasellar sphenoid sinuses",".\nThe ","optic chiasm"," and ","both"," ","optic nerves"," were ","displaced superiorly"," and ","compressed on both sides",".\nThe ","mass"," showed ","heterogeneous"," T1 and ","T2 signals"," with ","multiple"," ","fluid levels"," most likely due to previous ","haemorrhage"," and ","low-signal components"," suggesting ","calcifications",".\n","The appearance"," was probably due to a ","craniopharyngioma"," or ","haemorrhagic"," ","pituitary adenoma",".\nThe patient was ","referred"," urgently to the ","neurosurgery unit"," and was found to have ","markedly raised"," ","prolactin levels"," of ","greater than 200\u2005000\u2005mIU\/L",", confirming the diagnosis of a ","giant"," ","prolactinoma",".\nIn cooperation with the ","local endocrinology service",", he was started on ","cabergoline"," ","500\u2005\u00b5g"," and ","dexamethasone"," ","8\u2005mg",".\n","Within a week"," this led to a ","dramatic improvement"," of the patient's ","visual fields and acuities"," to ","6\/18"," ","RE"," and to ","6\/9"," ","LE",".\nHis ","prolactin levels"," showed a similar ","dramatic response with levels coming down"," to ","336\u2005mIU\/L",".\n","Three months later"," his ","visual acuity"," in his ","RE"," and ","LE"," were ","6\/18"," and ","6\/5",", respectively, and ","visual field examination"," showed ","striking recovery"," with ","almost normal results"," (figure 2C).\n"],"ner_labels":[0,5,0,65,0,13,0,71,0,48,0,26,0,22,0,24,0,22,0,24,0,42,0,24,0,24,0,26,0,69,0,22,0,12,0,12,0,24,0,42,0,22,0,19,0,18,0,42,0,12,0,12,0,26,0,24,0,42,0,69,0,22,0,26,0,26,0,26,0,42,0,39,0,26,0,26,0,69,0,42,0,69,0,24,0,48,0,22,0,24,0,24,0,22,0,42,0,42,0,22,0,42,0,42,0,24,0,22,0,71,0,24,0,42,0,24,0,24,0,5,0,24,0,22,0,24,0,42,0,12,0,42,0,24,0,42,0,18,0,63,0,69,0,69,0,22,0,26,0,12,0,24,0,19,0,22,0,13,0,42,0,22,0,12,0,24,0,22,0,26,0,12,0,22,0,12,0,42,0,24,0,22,0,24,0,12,0,12,0,22,0,26,0,24,0,24,0,24,0,24,0,24,0,24,0,9,0,26,0,12,0,79,0,12,0,12,0,12,0,42,0,12,0,22,0,22,0,26,0,22,0,24,0,42,0,24,0,26,0,24,0,26,0,18,0,26,0,22,0,26,0,13,0,48,0,42,0,24,0,42,0,63,0,26,0,48,0,46,0,29,0,46,0,29,0,19,0,42,0,24,0,42,0,12,0,42,0,12,0,24,0,42,0,42,0,19,0,24,0,12,0,12,0,42,0,42,0,24,0,22,0,22,0]}
-{"full_text":"An 8-year-old boy was referred for evaluation of fatigue.\nHe was born at term weighing 4\u2005kg to non-consanguineous parents and attained normal early developmental milestones.\nHeight and weight were on the 10th and 50th centiles, respectively.\nPreliminary examination was remarkable only for hepatomegaly extending 3.5\u2005cm below the right costal margin.\nInitial laboratory evaluation revealed normochromic normocytic anaemia (haemoglobin 7.8\u2005g\/dL (11.5\u201316), mean corpuscular volume (MCV) 85.8\u2005fL (75\u201387) and mean corpuscular haemoglobin (MCH) 25.4\u2005pg (25\u201335)) with marked anisocytosis (red-cell distribution width (RDW) 29% (11\u201314.5)).\nHypochromia and teardrops were evident on a blood film.\nLeucopoenia was also a feature (white cell count 2.9\u00d7109\/L (4.5\u201313.5), neutrophils 1.7\u00d7109\/L (2\u20137.5) and lymphocytes 0.8\u00d7109\/L (1.5\u20134)).\nA bone marrow aspirate and biopsy revealed a hypercellular marrow with erythroid hyperplasia.\nAn iron stain revealed that approximately 50% of erythroblasts were ringed sideroblasts.\nMarrow cytogenetics were normal including fluorescence in situ hybridisation studies of chromosomes 5q, 7 and 8 and flow cytometry did not detect a blast population.\nSerum copper and lead were normal, as were blood smears on the proband\u2019s parents and sister.\nAnalysis of several genes responsible for hereditary SA (ALAS2, ABC7, FECH and PUS1) revealed no reported pathogenic variants.\nFasting lactate was elevated at 3.8\u2005mmol\/L.\nNeurological examination identified upper motor neuron signs in the lower limbs bilaterally; however, cerebellar signs were negative.\nMRI of the brain demonstrated volume loss with slight prominence of the cerebellar folia.\nUrine organic acids revealed elevated 3-methylglutaconate and 3-methylglutarate.\nThe lactate:pyruvate ratio was elevated (30:1).\nMuscle biopsy revealed a structurally normal muscle and biochemical assay of respiratory chain components resulted in a diagnosis of partial complex IV deficiency.\nHe subsequently commenced a high-fat diet and coenzyme Q with a resultant improvement in energy.\nAnalysis of mtDNA in leucocytes and muscle utilising PCR did not reveal a deletion.\nCarnitine, vitamin A, thiamine, pyridoxine, folate and uridine were supplemented without improvement in his anaemia.\nHaemoglobin levels fell to 4.4\u2005g\/dL, leading to occasional and then regular three-weekly red cell transfusions.\nWith repeated transfusions, ferritin rose to 1700\u2005\u00b5g\/L, necessitating iron chelation.\nPeak growth hormone and cortisol to insulin-induced hypoglycaemia were 30.9\u2005mU\/L (normal >20) and 447\u2005nmol\/L (normal >500), respectively, at age 13 years.\nThyroid function was normal.\nRepeat peak cortisol was 384\u2005nmol\/L following adrenocorticotropic hormone (ACTH) stimulation.\nPlasma renin activity was elevated to 15\u2005ng\/mL\/h, and adrenal androgens were below the lower limit of assay detection.\nA urinary steroid profile was qualitatively normal, as was an abdominal ultrasound.\nHydrocortisone 5\u2005mg twice daily and fludrocortisone 100\u2005\u00b5g daily were initiated.\nAdrenal autoantibodies to 21-hydroxylase were negative and very-long-chain fatty acids were normal.\nThe patient has recently developed a renal tubular Fanconi syndrome including glycosuria, hypokalaemia, hypophosphataemia with low maximal tubular reabsorption of phosphate and a generalised aminoaciduria.\nIn addition, he was incidentally noted to have hyperglycaemia during an admission for percutaneous endoscopic gastrostomy insertion.\nGlycated haemoglobin was elevated to 62\u2005mmol\/mol (7.8%) despite rapid red cell turnover.\nPancreatic autoantibodies were negative (glutamic acid decarboxylase, anti-insulin, anti-islet antigen 2 and pancreatic islet cell antibodies).\nHe is maintained on twice daily insulin detemir with satisfactory glycaemic control with fructosamine 161\u2005\u00b5mol\/L (205\u2013285).\n","ner_info":[{"text":"8-year-old","label":"AGE","start":3,"end":13},{"text":"boy","label":"SEX","start":14,"end":17},{"text":"referred","label":"ACTIVITY","start":22,"end":30},{"text":"fatigue","label":"SIGN_SYMPTOM","start":49,"end":56},{"text":"born","label":"CLINICAL_EVENT","start":65,"end":69},{"text":"weighing","label":"DIAGNOSTIC_PROCEDURE","start":78,"end":86},{"text":"4\u2005kg","label":"LAB_VALUE","start":87,"end":91},{"text":"non-consanguineous parents","label":"FAMILY_HISTORY","start":95,"end":121},{"text":"normal","label":"LAB_VALUE","start":135,"end":141},{"text":"early developmental 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8","label":"DETAILED_DESCRIPTION","start":1097,"end":1120},{"text":"flow cytometry","label":"DIAGNOSTIC_PROCEDURE","start":1125,"end":1139},{"text":"did not detect","label":"LAB_VALUE","start":1140,"end":1154},{"text":"blast population","label":"DIAGNOSTIC_PROCEDURE","start":1157,"end":1173},{"text":"Serum","label":"DETAILED_DESCRIPTION","start":1175,"end":1180},{"text":"copper","label":"DIAGNOSTIC_PROCEDURE","start":1181,"end":1187},{"text":"lead","label":"DIAGNOSTIC_PROCEDURE","start":1192,"end":1196},{"text":"normal","label":"LAB_VALUE","start":1202,"end":1208},{"text":"blood smears","label":"DIAGNOSTIC_PROCEDURE","start":1218,"end":1230},{"text":"parents","label":"SUBJECT","start":1248,"end":1255},{"text":"sister","label":"SUBJECT","start":1260,"end":1266},{"text":"Analysis of several genes responsible for hereditary 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phosphate","label":"DIAGNOSTIC_PROCEDURE","start":3245,"end":3286},{"text":"generalised","label":"DETAILED_DESCRIPTION","start":3293,"end":3304},{"text":"aminoaciduria","label":"SIGN_SYMPTOM","start":3305,"end":3318},{"text":"hyperglycaemia","label":"SIGN_SYMPTOM","start":3367,"end":3381},{"text":"admission","label":"CLINICAL_EVENT","start":3392,"end":3401},{"text":"percutaneous","label":"DETAILED_DESCRIPTION","start":3406,"end":3418},{"text":"endoscopic","label":"DETAILED_DESCRIPTION","start":3419,"end":3429},{"text":"gastrostomy","label":"THERAPEUTIC_PROCEDURE","start":3430,"end":3441},{"text":"Glycated","label":"DETAILED_DESCRIPTION","start":3453,"end":3461},{"text":"haemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":3462,"end":3473},{"text":"elevated","label":"LAB_VALUE","start":3478,"end":3486},{"text":"62\u2005mmol\/mol","label":"LAB_VALUE","start":3490,"end":3501},{"text":"7.8%","label":"LAB_VALUE","start":3503,"end":3507},{"text":"rapid","label":"LAB_VALUE","start":3517,"end":3522},{"text":"red cell turnover","label":"DIAGNOSTIC_PROCEDURE","start":3523,"end":3540},{"text":"Pancreatic autoantibodies","label":"DIAGNOSTIC_PROCEDURE","start":3542,"end":3567},{"text":"negative","label":"LAB_VALUE","start":3573,"end":3581},{"text":"glutamic acid decarboxylase","label":"DIAGNOSTIC_PROCEDURE","start":3583,"end":3610},{"text":"anti-insulin","label":"DIAGNOSTIC_PROCEDURE","start":3612,"end":3624},{"text":"anti-islet antigen 2","label":"DIAGNOSTIC_PROCEDURE","start":3626,"end":3646},{"text":"pancreatic islet cell antibodies","label":"DIAGNOSTIC_PROCEDURE","start":3651,"end":3683},{"text":"twice daily","label":"DOSAGE","start":3706,"end":3717},{"text":"insulin detemir","label":"MEDICATION","start":3718,"end":3733},{"text":"satisfactory","label":"LAB_VALUE","start":3739,"end":3751},{"text":"glycaemic control","label":"DIAGNOSTIC_PROCEDURE","start":3752,"end":3769},{"text":"fructosamine","label":"DIAGNOSTIC_PROCEDURE","start":3775,"end":3787},{"text":"161\u2005\u00b5mol\/L","label":"LAB_VALUE","start":3788,"end":3798}],"tokens":["An ","8-year-old"," ","boy"," was ","referred"," for evaluation of ","fatigue",".\nHe was ","born"," at term ","weighing"," ","4\u2005kg"," to ","non-consanguineous parents"," and attained ","normal"," ","early developmental milestones",".\n","Height"," and ","weight"," were on the ","10th"," and ","50th"," ","centiles",", respectively.\nPreliminary ","examination"," was remarkable only for ","hepatomegaly"," extending ","3.5\u2005cm below"," the ","right costal margin",".\nInitial ","laboratory evaluation"," revealed ","normochromic"," ","normocytic"," ","anaemia"," (","haemoglobin"," ","7.8\u2005g\/dL"," (11.5\u201316), ","mean corpuscular volume"," (","MCV",") ","85.8\u2005fL"," (75\u201387) and ","mean corpuscular haemoglobin"," (","MCH",") ","25.4\u2005pg"," (25\u201335)) with marked ","anisocytosis"," (","red-cell distribution width"," (","RDW",") ","29%"," (11\u201314.5)).\n","Hypochromia"," and ","teardrops"," were evident on a ","blood film",".\n","Leucopoenia"," was also a feature (","white cell count"," ","2.9\u00d7109\/L"," (4.5\u201313.5), ","neutrophils"," ","1.7\u00d7109\/L"," (2\u20137.5) and ","lymphocytes"," ","0.8\u00d7109\/L"," (1.5\u20134)).\nA ","bone marrow"," ","aspirate"," and ","biopsy"," revealed a ","hypercellular"," ","marrow"," with ","erythroid hyperplasia",".\nAn ","iron stain"," revealed that approximately ","50% of erythroblasts were ringed sideroblasts",".\n","Marrow"," ","cytogenetics"," were ","normal"," including ","fluorescence in situ hybridisation"," studies of ","chromosomes 5q, 7 and 8"," and ","flow cytometry"," ","did not detect"," a ","blast population",".\n","Serum"," ","copper"," and ","lead"," were ","normal",", as were ","blood smears"," on the proband\u2019s ","parents"," and ","sister",".\n","Analysis of several genes responsible for hereditary SA"," (","ALAS2",", ","ABC7",", ","FECH"," and ","PUS1",") revealed no reported ","pathogenic variants",".\n","Fasting"," ","lactate"," was ","elevated"," at ","3.8\u2005mmol\/L",".\n","Neurological examination"," identified ","upper motor neuron signs"," in the ","lower limbs"," ","bilaterally","; however, ","cerebellar signs"," were ","negative",".\n","MRI"," of the ","brain"," demonstrated ","volume loss"," with ","slight"," ","prominence"," of the ","cerebellar folia",".\n","Urine"," ","organic acids"," revealed ","elevated"," ","3-methylglutaconate"," and ","3-methylglutarate",".\nThe ","lactate:pyruvate ratio"," was ","elevated"," (","30:1",").\n","Muscle"," ","biopsy"," revealed a ","structurally normal"," ","muscle"," and ","biochemical assay"," of ","respiratory chain components"," resulted in a diagnosis of ","partial"," ","complex IV deficiency",".\nHe subsequently commenced a ","high-fat diet"," and ","coenzyme Q"," with a resultant ","improvement"," in ","energy",".\nAnalysis of ","mtDNA"," in ","leucocytes"," and ","muscle"," utilising ","PCR"," did not reveal a ","deletion",".\n","Carnitine",", ","vitamin A",", ","thiamine",", ","pyridoxine",", ","folate"," and ","uridine"," were supplemented without improvement in his ","anaemia",".\n","Haemoglobin"," levels ","fell"," to ","4.4\u2005g\/dL",", leading to ","occasional"," and then regular ","three-weekly"," ","red cell"," ","transfusions",".\nWith repeated ","transfusions",", ","ferritin"," ","rose"," to ","1700\u2005\u00b5g\/L",", necessitating ","iron chelation",".\n","Peak"," ","growth hormone"," and ","cortisol"," to ","insulin","-induced ","hypoglycaemia"," were ","30.9\u2005mU\/L"," (normal >20) and ","447\u2005nmol\/L"," (normal >500), respectively, at ","age 13 years",".\n","Thyroid function"," was ","normal",".\nRepeat ","peak"," ","cortisol"," was ","384\u2005nmol\/L"," following ","adrenocorticotropic hormone"," (","ACTH",") stimulation.\n","Plasma"," ","renin activity"," was ","elevated"," to ","15\u2005ng\/mL\/h",", and ","adrenal androgens"," were ","below the lower limit of assay detection",".\nA ","urinary"," ","steroid profile"," was ","qualitatively normal",", as was an ","abdominal"," ","ultrasound",".\n","Hydrocortisone"," ","5\u2005mg twice daily"," and ","fludrocortisone"," ","100\u2005\u00b5g daily"," were initiated.\n","Adrenal autoantibodies to 21-hydroxylase"," were ","negative"," and ","very-long-chain fatty acids"," were ","normal",".\nThe patient has recently developed a ","renal tubular"," ","Fanconi syndrome"," including ","glycosuria",", ","hypokalaemia",", ","hypophosphataemia"," with ","low"," ","maximal tubular reabsorption of phosphate"," and a ","generalised"," ","aminoaciduria",".\nIn addition, he was incidentally noted to have ","hyperglycaemia"," during an ","admission"," for ","percutaneous"," ","endoscopic"," ","gastrostomy"," insertion.\n","Glycated"," ","haemoglobin"," was ","elevated"," to ","62\u2005mmol\/mol"," (","7.8%",") despite ","rapid"," ","red cell turnover",".\n","Pancreatic autoantibodies"," were ","negative"," (","glutamic acid decarboxylase",", ","anti-insulin",", ","anti-islet antigen 2"," and ","pancreatic islet cell antibodies",").\nHe is maintained on ","twice daily"," ","insulin detemir"," with ","satisfactory"," ","glycaemic control"," with ","fructosamine"," ","161\u2005\u00b5mol\/L"," (205\u2013285).\n"],"ner_labels":[0,5,0,65,0,1,0,69,0,13,0,24,0,42,0,34,0,42,0,24,0,24,0,24,0,42,0,42,0,22,0,24,0,69,0,27,0,12,0,24,0,22,0,22,0,69,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,69,0,24,0,24,0,42,0,69,0,69,0,24,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,24,0,69,0,12,0,69,0,24,0,42,0,12,0,24,0,42,0,24,0,22,0,24,0,42,0,24,0,22,0,24,0,24,0,42,0,24,0,71,0,71,0,24,0,24,0,24,0,24,0,24,0,69,0,22,0,24,0,42,0,42,0,24,0,42,0,12,0,22,0,24,0,42,0,24,0,12,0,69,0,63,0,69,0,12,0,22,0,24,0,42,0,24,0,24,0,24,0,42,0,42,0,12,0,24,0,42,0,12,0,24,0,24,0,22,0,26,0,75,0,46,0,42,0,24,0,24,0,12,0,12,0,24,0,69,0,46,0,46,0,46,0,46,0,46,0,46,0,69,0,24,0,42,0,42,0,22,0,35,0,22,0,75,0,75,0,24,0,42,0,42,0,46,0,22,0,24,0,24,0,46,0,69,0,42,0,42,0,19,0,24,0,42,0,22,0,24,0,42,0,46,0,46,0,22,0,24,0,42,0,42,0,24,0,42,0,22,0,24,0,42,0,12,0,24,0,46,0,29,0,46,0,29,0,24,0,42,0,24,0,42,0,12,0,26,0,69,0,69,0,69,0,42,0,24,0,22,0,69,0,69,0,13,0,22,0,22,0,75,0,22,0,24,0,42,0,42,0,42,0,42,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,29,0,46,0,42,0,24,0,24,0,42,0]}
-{"full_text":"A 71-year-old African-American woman presented to the hospital with worsening exertional dyspnoea associated with orthopnoea and lower extremity oedema for 3\u2005weeks.\nShe had a long-standing history of hypertension and documented G6PD deficiency with prior episodes of haemolysis.\nShe was a former cigarette smoker and had family members with G6PD deficiency, hypertension and diabetes mellitus.\nVital signs measurement revealed a blood pressure of 150\/73\u2005mm\u2005Hg, pulse rate of 70\u2005bpm, respiratory rate of 24\u2005breaths\/min, temperature of 36.6\u00b0C and 97% saturation on room air.\nShe was comfortable at rest.\nHer physical examination showed distended jugular veins, inspiratory crackles in bilateral lung bases, a laterally displaced apical impulse and bipedal oedema.\nThe ECG showed left ventricular hypertrophy and inferolateral T-wave inversions.\nChest radiography revealed cardiomegaly and mild pulmonary oedema.\nThe metabolic panel and troponin levels were normal but the B-type natriuretic peptide was increased at 826.5\u2005pg\/mL.\nEchocardiography showed a dilated left ventricle with an ejection fraction (EF) of 30% and mild right ventricular systolic dysfunction.\nCoronary artery catheterisation revealed normal coronary circulation.\nEthacrynic acid at 50\u2005mg daily was chosen for diuresis.\nShe improved after a day but still had dyspnoea, so we added spironolactone.\nSubsequently, metoprolol succinate and losartan were included in the regimen.\nRepeat chest radiography showed resolution of pulmonary oedema.\nThe patient's laboratory results during her hospital stay did not show signs of haemolysis nor worsening kidney function.\nShe did not develop ototoxicity and was discharged home asymptomatic.\n","ner_info":[{"text":"71-year-old","label":"AGE","start":2,"end":13},{"text":"African-American","label":"PERSONAL_BACKGROUND","start":14,"end":30},{"text":"woman","label":"SEX","start":31,"end":36},{"text":"presented","label":"CLINICAL_EVENT","start":37,"end":46},{"text":"worsening","label":"LAB_VALUE","start":68,"end":77},{"text":"exertional","label":"DETAILED_DESCRIPTION","start":78,"end":88},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":89,"end":97},{"text":"orthopnoea","label":"SIGN_SYMPTOM","start":114,"end":124},{"text":"lower extremity","label":"BIOLOGICAL_STRUCTURE","start":129,"end":144},{"text":"oedema","label":"SIGN_SYMPTOM","start":145,"end":151},{"text":"3\u2005weeks","label":"DURATION","start":156,"end":163},{"text":"hypertension","label":"HISTORY","start":200,"end":212},{"text":"G6PD deficiency","label":"DISEASE_DISORDER","start":228,"end":243},{"text":"haemolysis","label":"SIGN_SYMPTOM","start":267,"end":277},{"text":"former cigarette smoker","label":"HISTORY","start":289,"end":312},{"text":"family members","label":"SUBJECT","start":321,"end":335},{"text":"G6PD deficiency","label":"FAMILY_HISTORY","start":341,"end":356},{"text":"hypertension","label":"FAMILY_HISTORY","start":358,"end":370},{"text":"diabetes mellitus","label":"FAMILY_HISTORY","start":375,"end":392},{"text":"Vital signs measurement","label":"DIAGNOSTIC_PROCEDURE","start":394,"end":417},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":429,"end":443},{"text":"150\/73\u2005mm\u2005Hg","label":"LAB_VALUE","start":447,"end":459},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":461,"end":471},{"text":"70\u2005bpm","label":"LAB_VALUE","start":475,"end":481},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":483,"end":499},{"text":"24\u2005breaths\/min","label":"LAB_VALUE","start":503,"end":517},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":519,"end":530},{"text":"36.6\u00b0C","label":"LAB_VALUE","start":534,"end":540},{"text":"97%","label":"LAB_VALUE","start":545,"end":548},{"text":"saturation","label":"DIAGNOSTIC_PROCEDURE","start":549,"end":559},{"text":"room air.","label":"DETAILED_DESCRIPTION","start":563,"end":572},{"text":"comfortable","label":"SIGN_SYMPTOM","start":581,"end":592},{"text":"rest","label":"DETAILED_DESCRIPTION","start":596,"end":600},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":606,"end":626},{"text":"distended","label":"SIGN_SYMPTOM","start":634,"end":643},{"text":"jugular veins","label":"BIOLOGICAL_STRUCTURE","start":644,"end":657},{"text":"inspiratory","label":"DETAILED_DESCRIPTION","start":659,"end":670},{"text":"crackles","label":"SIGN_SYMPTOM","start":671,"end":679},{"text":"bilateral lung bases","label":"BIOLOGICAL_STRUCTURE","start":683,"end":703},{"text":"laterally displaced","label":"LAB_VALUE","start":707,"end":726},{"text":"apical impulse","label":"DIAGNOSTIC_PROCEDURE","start":727,"end":741},{"text":"bipedal","label":"BIOLOGICAL_STRUCTURE","start":746,"end":753},{"text":"oedema","label":"SIGN_SYMPTOM","start":754,"end":760},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":766,"end":769},{"text":"left ventricular","label":"BIOLOGICAL_STRUCTURE","start":777,"end":793},{"text":"hypertrophy","label":"SIGN_SYMPTOM","start":794,"end":805},{"text":"inferolateral","label":"DETAILED_DESCRIPTION","start":810,"end":823},{"text":"T-wave inversions","label":"SIGN_SYMPTOM","start":824,"end":841},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":843,"end":848},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":849,"end":860},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":870,"end":882},{"text":"mild","label":"SEVERITY","start":887,"end":891},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":892,"end":901},{"text":"oedema","label":"SIGN_SYMPTOM","start":902,"end":908},{"text":"metabolic panel","label":"DIAGNOSTIC_PROCEDURE","start":914,"end":929},{"text":"troponin","label":"DIAGNOSTIC_PROCEDURE","start":934,"end":942},{"text":"normal","label":"LAB_VALUE","start":955,"end":961},{"text":"B-type natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":970,"end":996},{"text":"increased","label":"LAB_VALUE","start":1001,"end":1010},{"text":"826.5\u2005pg\/mL","label":"LAB_VALUE","start":1014,"end":1025},{"text":"Echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1027,"end":1043},{"text":"dilated","label":"SIGN_SYMPTOM","start":1053,"end":1060},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":1061,"end":1075},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1084,"end":1101},{"text":"EF","label":"DIAGNOSTIC_PROCEDURE","start":1103,"end":1105},{"text":"30%","label":"LAB_VALUE","start":1110,"end":1113},{"text":"mild","label":"SEVERITY","start":1118,"end":1122},{"text":"right ventricular","label":"BIOLOGICAL_STRUCTURE","start":1123,"end":1140},{"text":"systolic dysfunction","label":"DISEASE_DISORDER","start":1141,"end":1161},{"text":"Coronary artery","label":"BIOLOGICAL_STRUCTURE","start":1163,"end":1178},{"text":"catheterisation","label":"THERAPEUTIC_PROCEDURE","start":1179,"end":1194},{"text":"normal","label":"LAB_VALUE","start":1204,"end":1210},{"text":"coronary circulation","label":"DIAGNOSTIC_PROCEDURE","start":1211,"end":1231},{"text":"Ethacrynic acid","label":"MEDICATION","start":1233,"end":1248},{"text":"50\u2005mg daily","label":"DOSAGE","start":1252,"end":1263},{"text":"improved","label":"SIGN_SYMPTOM","start":1293,"end":1301},{"text":"after a day","label":"DATE","start":1302,"end":1313},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":1328,"end":1336},{"text":"spironolactone","label":"MEDICATION","start":1350,"end":1364},{"text":"metoprolol succinate","label":"MEDICATION","start":1380,"end":1400},{"text":"losartan","label":"MEDICATION","start":1405,"end":1413},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1451,"end":1456},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":1457,"end":1468},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1490,"end":1499},{"text":"oedema","label":"SIGN_SYMPTOM","start":1500,"end":1506},{"text":"laboratory results","label":"DIAGNOSTIC_PROCEDURE","start":1522,"end":1540},{"text":"haemolysis","label":"SIGN_SYMPTOM","start":1588,"end":1598},{"text":"worsening kidney function","label":"SIGN_SYMPTOM","start":1603,"end":1628},{"text":"ototoxicity","label":"SIGN_SYMPTOM","start":1650,"end":1661},{"text":"discharged","label":"CLINICAL_EVENT","start":1670,"end":1680},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":1681,"end":1685},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":1686,"end":1698}],"tokens":["A ","71-year-old"," ","African-American"," ","woman"," ","presented"," to the hospital with ","worsening"," ","exertional"," ","dyspnoea"," associated with ","orthopnoea"," and ","lower extremity"," ","oedema"," for ","3\u2005weeks",".\nShe had a long-standing history of ","hypertension"," and documented ","G6PD deficiency"," with prior episodes of ","haemolysis",".\nShe was a ","former cigarette smoker"," and had ","family members"," with ","G6PD deficiency",", ","hypertension"," and ","diabetes mellitus",".\n","Vital signs measurement"," revealed a ","blood pressure"," of ","150\/73\u2005mm\u2005Hg",", ","pulse rate"," of ","70\u2005bpm",", ","respiratory rate"," of ","24\u2005breaths\/min",", ","temperature"," of ","36.6\u00b0C"," and ","97%"," ","saturation"," on ","room air.","\nShe was ","comfortable"," at ","rest",".\nHer ","physical examination"," showed ","distended"," ","jugular veins",", ","inspiratory"," ","crackles"," in ","bilateral lung bases",", a ","laterally displaced"," ","apical impulse"," and ","bipedal"," ","oedema",".\nThe ","ECG"," showed ","left ventricular"," ","hypertrophy"," and ","inferolateral"," ","T-wave inversions",".\n","Chest"," ","radiography"," revealed ","cardiomegaly"," and ","mild"," ","pulmonary"," ","oedema",".\nThe ","metabolic panel"," and ","troponin"," levels were ","normal"," but the ","B-type natriuretic peptide"," was ","increased"," at ","826.5\u2005pg\/mL",".\n","Echocardiography"," showed a ","dilated"," ","left ventricle"," with an ","ejection fraction"," (","EF",") of ","30%"," and ","mild"," ","right ventricular"," ","systolic dysfunction",".\n","Coronary artery"," ","catheterisation"," revealed ","normal"," ","coronary circulation",".\n","Ethacrynic acid"," at ","50\u2005mg daily"," was chosen for diuresis.\nShe ","improved"," ","after a day"," but still had ","dyspnoea",", so we added ","spironolactone",".\nSubsequently, ","metoprolol succinate"," and ","losartan"," were included in the regimen.\nRepeat ","chest"," ","radiography"," showed resolution of ","pulmonary"," ","oedema",".\nThe patient's ","laboratory results"," during her hospital stay did not show signs of ","haemolysis"," nor ","worsening kidney function",".\nShe did not develop ","ototoxicity"," and was ","discharged"," ","home"," ","asymptomatic",".\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,42,0,22,0,69,0,69,0,12,0,69,0,32,0,39,0,26,0,69,0,39,0,71,0,34,0,34,0,34,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,22,0,69,0,22,0,24,0,69,0,12,0,22,0,69,0,12,0,42,0,24,0,12,0,69,0,24,0,12,0,69,0,22,0,69,0,12,0,24,0,69,0,63,0,12,0,69,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,69,0,12,0,24,0,24,0,42,0,63,0,12,0,26,0,12,0,75,0,42,0,24,0,46,0,29,0,69,0,19,0,69,0,46,0,46,0,46,0,12,0,24,0,12,0,69,0,24,0,69,0,69,0,69,0,13,0,48,0,69,0]}
-{"full_text":"A 65-year-old woman presented with a complaint of right upper quadrant pain.\nThree years prior, the patient was incidentally diagnosed with idiopathic BCS during health checkup; Doppler ultrasound (US) examination showed obstruction of the middle and left hepatic veins, and investigations for underlying thrombophilia were unremarkable.\nShe was treated with warfarin to maintain an international normalized ratio between 2 and 3, but discontinued after at least 1 year due to non-compliance; the patient did not consult with any doctors for 2 years.\nShe has remained asymptomatic for the past 3 years until recently she started experiencing steadily worsening, intermittent pain in the right upper quadrant of her abdomen, with no associated or alleviating factors.\nPhysical examination was only notable for mild right upper quadrant tenderness.\nLaboratory tests revealed mildly elevated bilirubin (2.2 mg\/dL) and albumin deficit (2.38 g\/dL).\nHer Child-Pugh (CP) score was 8, Model for End-Stage Liver Disease (MELD) score was 11, Rotterdam score was 0.15, and BCS-TIPS prognostic index (BCS-TIPS PI) score was 6.3.\nA contrast-enhanced computed tomography (CT) scan showed non-visualized middle and left hepatic veins, hepatomegaly with hypertrophy of the caudate lobe, splenomegaly, hepatic venous collaterals, and a saccular aneurysm located at the extrahepatic portal vein main branch measuring 3.2 cm in height and 2.5 cm \u00d7 2.4 cm in diameter (Figure \u200b1A).\nThe aneurysm was thought to be associated with BCS as there was no preceding history of trauma and it had not been present on Doppler US examination performed 3 years previously.\nAlthough the patient had no ascites or variceal bleeding, the decision was made to create a TIPS to relieve hepatic venous outflow obstruction because of increasing pain and concern for complications due to aneurysm size; direct approach to the aneurysm was not considered due to risk of associated complications in the setting of portal hypertension, and stent-grafting was not considered due to concerns about patency in the settings of hepatic venous outflow obstruction and underlying thrombophilia.\nAfter informed consent was obtained, the patient was brought to the interventional radiology suite.\nThe procedure was performed with the patient under conscious sedation.\nPortal vein access was obtained via the right hepatic vein under fluoroscopy, and portography showed a saccular aneurysm located at the main portal vein, extensive intrahepatic portal vein thrombosis, and small splenorenal varices (Figure \u200b2A).\nA 10-mm diameter expanded polytetrafluoroethylene (ePTFE) covered stent-graft (Fluency Plus; Bard Peripheral Vascular, Tempe, Arizona, United States) was deployed across the liver parenchymal tract; deploying the stent-graft into the main portal vein trunk to cover the aneurysm neck was not considered because it would obstruct blood flow to the portal vein branches.\nCompletion portography showed a widely patent shunt and markedly decreased aneurysm filling (Figure 2B).\nThe portosystemic pressure gradient (PPG) was decreased from 19 mmHg to 8 mmHg.\nThe patient recovered uneventfully and had complete resolution of her abdominal pain in 2 d.\nShe was discharged on long-term warfarin and remained asymptomatic after 1 year of follow-up.\nMost recent laboratory tests revealed normal liver function, and Doppler US examination performed at 1, 3, 6, and 12 mo postprocedure confirmed a patent shunt.\nHer CP score was 5, MELD score was 8, Rotterdam score was 0.12, and TIPS-BCS PI score was 6.1.\nCT scans showed that the aneurysm had decreased in size to 2.4 cm in height and 2.0 cm \u00d7 1.9 cm in diameter at 3 mo after TIPS (Figure 1B), and had further decreased to 1.9 cm in height and 1.6 cm \u00d7 1.5 cm in diameter at 1 year (Figure \u200b1C).\n","ner_info":[{"text":"65-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":50,"end":70},{"text":"pain","label":"SIGN_SYMPTOM","start":71,"end":75},{"text":"Three years prior","label":"DATE","start":77,"end":94},{"text":"idiopathic","label":"DETAILED_DESCRIPTION","start":140,"end":150},{"text":"BCS","label":"DISEASE_DISORDER","start":151,"end":154},{"text":"checkup","label":"CLINICAL_EVENT","start":169,"end":176},{"text":"Doppler","label":"DETAILED_DESCRIPTION","start":178,"end":185},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":186,"end":196},{"text":"US","label":"DIAGNOSTIC_PROCEDURE","start":198,"end":200},{"text":"obstruction","label":"SIGN_SYMPTOM","start":221,"end":232},{"text":"middle and left hepatic 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mg\/dL","label":"LAB_VALUE","start":900,"end":909},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":915,"end":922},{"text":"deficit","label":"LAB_VALUE","start":923,"end":930},{"text":"2.38 g\/dL","label":"LAB_VALUE","start":932,"end":941},{"text":"Child-Pugh","label":"DIAGNOSTIC_PROCEDURE","start":948,"end":958},{"text":"CP","label":"DIAGNOSTIC_PROCEDURE","start":960,"end":962},{"text":"8","label":"LAB_VALUE","start":974,"end":975},{"text":"Model for End-Stage Liver Disease","label":"DIAGNOSTIC_PROCEDURE","start":977,"end":1010},{"text":"MELD","label":"DIAGNOSTIC_PROCEDURE","start":1012,"end":1016},{"text":"11","label":"LAB_VALUE","start":1028,"end":1030},{"text":"Rotterdam","label":"DIAGNOSTIC_PROCEDURE","start":1032,"end":1041},{"text":"0.15","label":"LAB_VALUE","start":1052,"end":1056},{"text":"BCS-TIPS prognostic index","label":"DIAGNOSTIC_PROCEDURE","start":1062,"end":1087},{"text":"BCS-TIPS 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","Doppler"," ","ultrasound"," (","US",") examination showed ","obstruction"," of the ","middle and left hepatic veins",", and investigations for underlying ","thrombophilia"," were unremarkable.\nShe was treated with ","warfarin"," to maintain an ","international normalized ratio"," ","between 2 and 3",", but ","discontinued"," ","after at least 1 year"," due to ","non-compliance","; the patient did not ","consult"," with any doctors for ","2 years",".\nShe has remained ","asymptomatic"," for the ","past 3 years"," until recently she started experiencing steadily ","worsening",", ","intermittent"," ","pain"," in the ","right upper quadrant"," of her abdomen, with no ","associated or alleviating factors",".\n","Physical examination"," was only notable for mild ","right upper quadrant"," ","tenderness",".\n","Laboratory tests"," revealed ","mildly elevated"," ","bilirubin"," (","2.2 mg\/dL",") and ","albumin"," ","deficit"," (","2.38 g\/dL",").\nHer ","Child-Pugh"," (","CP",") score was ","8",", ","Model for End-Stage Liver Disease"," (","MELD",") score was ","11",", ","Rotterdam"," score was ","0.15",", and ","BCS-TIPS prognostic index"," (","BCS-TIPS PI",") score was ","6.3",".\nA ","contrast-enhanced"," ","computed tomography"," (","CT",") scan showed ","non-visualized"," ","middle and left hepatic veins",", ","hepatomegaly"," with ","hypertrophy"," of the ","caudate lobe",", ","splenomegaly",", ","hepatic"," ","venous collaterals",", and a ","saccular"," ","aneurysm"," located at the ","extrahepatic portal vein main branch"," measuring ","3.2 cm in height"," and ","2.5 cm \u00d7 2.4 cm in diameter"," (Figure \u200b1A).\nThe ","aneurysm"," was thought to be associated with ","BCS"," as there was ","no preceding history of trauma"," and it had not been present on ","Doppler"," ","US"," examination performed ","3 years previously",".\nAlthough the patient had no ","ascites"," or ","variceal"," ","bleeding",", the decision was made to create a ","TIPS"," to relieve ","hepatic venous"," ","outflow"," ","obstruction"," because of increasing ","pain"," and concern for ","complications"," due to ","aneurysm"," size; ","direct approach"," to the ","aneurysm"," was not considered due to risk of associated complications in the setting of ","portal"," ","hypertension",", and ","stent-grafting"," was not considered due to concerns about patency in the settings of ","hepatic venous"," ","outflow"," ","obstruction"," and underlying ","thrombophilia",".\nAfter informed consent was obtained, the patient was ","brought"," to the ","interventional radiology suite",".\nThe procedure was performed with the patient under ","conscious sedation",".\n","Portal vein access"," was obtained via the ","right hepatic vein"," under ","fluoroscopy",", and ","portography"," showed a ","saccular"," ","aneurysm"," located at the ","main portal vein",", ","extensive"," ","intrahepatic portal vein"," ","thrombosis",", and ","small"," ","splenorenal"," ","varices"," (Figure \u200b2A).\nA ","10-mm diameter"," ","expanded"," ","polytetrafluoroethylene"," (","ePTFE",") ","covered"," ","stent-graft"," (","Fluency Plus","; ","Bard Peripheral Vascular, Tempe, Arizona, United States",") was deployed across the ","liver parenchymal tract","; deploying the ","stent-graft"," into the ","main portal vein trunk"," to cover the ","aneurysm"," neck was not considered because it would ","obstruct"," blood flow to the ","portal vein branches",".\nCompletion ","portography"," showed a widely ","patent shunt"," and markedly decreased ","aneurysm"," filling (Figure 2B).\nThe ","portosystemic pressure gradient"," (","PPG",") was ","decreased"," from ","19 mmHg"," to ","8 mmHg",".\nThe patient ","recovered"," ","uneventfully"," and had complete resolution of her ","abdominal"," ","pain"," in ","2 d",".\nShe was ","discharged"," on long-term ","warfarin"," and remained ","asymptomatic"," after ","1 year"," of ","follow-up",".\nMost recent ","laboratory tests"," revealed ","normal"," ","liver function",", and ","Doppler"," ","US"," examination performed at ","1, 3, 6, and 12 mo postprocedure"," confirmed a ","patent shunt",".\nHer ","CP"," score was ","5",", ","MELD"," score was ","8",", ","Rotterdam"," score was ","0.12",", and ","TIPS-BCS PI"," score was ","6.1",".\n","CT"," scans showed that the ","aneurysm"," had decreased in size to ","2.4 cm in height"," and ","2.0 cm \u00d7 1.9 cm in diameter"," at ","3 mo after"," ","TIPS"," (Figure 1B), and had further decreased to ","1.9 cm in height"," and ","1.6 cm \u00d7 1.5 cm in diameter"," at ","1 year"," (Figure 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-{"full_text":"We present the case of a 66-year-old female patient with no significant past medical history presenting with chest pain that was treated with antacids by her primary care physician.\nThe next day she presented to the emergency room, where an electrocardiogram revealed posterolateral ST elevation myocardial infarction.\nThe patient was immediately taken to the catheterization lab.\nA successful percutaneous intervention was performed on an acutely occluded large ramus intermedius vessel that was supplying a large portion of the lateral wall (Figure 1).\nThe patient did well initially, but several hours later she suddenly went into cardiogenic shock.\nAn intra-aortic balloon pump was placed, and an echocardiogram demonstrated that she had severe mitral regurgitation from a ruptured papillary muscle (Figure 2).\nThe patient, on maximal support, deteriorated rapidly with progressive acidosis, oliguria, and florid pulmonary edema.\nIn spite of the very high risk, we decided to intervene surgically.\nOnce in the operating room, transesophageal echocardiography confirmed severe mitral regurgitation with a ruptured anterolateral papillary muscle and a small left atrium.\nShortly after the patient was put on cardiopulmonary bypass, the acidosis resolved and she began to make urine.\nExcellent visualization of the mitral valve was obtained using a vertical transseptal approach through the right atrium.\nThe valve was carefully inspected and the necrotic ruptured anterolateral papillary muscle was seen (Figure 3).\nThere was a large chunk of muscle attached to the A1 chordal apparatus.\nThe anterior leaflet of the mitral valve was excised while keeping the posterior leaflet intact.\nA 27-mm St Jude Epic bioprosthesis was inserted (Figure 4).\nShe was placed on extracorporeal membrane oxygenation that was successfully weaned 3 days later.\nFollowing this, she made a remarkable early recovery.\nOne month later, just prior to discharge, she expired after developing pneumonia that progressed to sepsis with multiorgan failure.\n","ner_info":[{"text":"66-year-old","label":"AGE","start":25,"end":36},{"text":"female","label":"SEX","start":37,"end":43},{"text":"no significant past medical history","label":"HISTORY","start":57,"end":92},{"text":"presenting","label":"CLINICAL_EVENT","start":93,"end":103},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":109,"end":114},{"text":"pain","label":"SIGN_SYMPTOM","start":115,"end":119},{"text":"antacids","label":"MEDICATION","start":142,"end":150},{"text":"primary care physician","label":"NONBIOLOGICAL_LOCATION","start":158,"end":180},{"text":"next day","label":"DATE","start":186,"end":194},{"text":"presented","label":"CLINICAL_EVENT","start":199,"end":208},{"text":"emergency 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well","label":"SIGN_SYMPTOM","start":567,"end":575},{"text":"initially","label":"DETAILED_DESCRIPTION","start":576,"end":585},{"text":"several hours later","label":"TIME","start":591,"end":610},{"text":"suddenly","label":"LAB_VALUE","start":615,"end":623},{"text":"cardiogenic shock","label":"DISEASE_DISORDER","start":634,"end":651},{"text":"intra-aortic balloon pump","label":"THERAPEUTIC_PROCEDURE","start":656,"end":681},{"text":"echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":701,"end":715},{"text":"severe","label":"SEVERITY","start":742,"end":748},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":749,"end":769},{"text":"ruptured","label":"DISEASE_DISORDER","start":777,"end":785},{"text":"papillary muscle","label":"BIOLOGICAL_STRUCTURE","start":786,"end":802},{"text":"maximal","label":"LAB_VALUE","start":831,"end":838},{"text":"support","label":"THERAPEUTIC_PROCEDURE","start":839,"end":846},{"text":"deteriorated","label":"SIGN_SYMPTOM","start":848,"end":860},{"text":"rapidly","label":"SEVERITY","start":861,"end":868},{"text":"progressive","label":"LAB_VALUE","start":874,"end":885},{"text":"acidosis","label":"SIGN_SYMPTOM","start":886,"end":894},{"text":"oliguria","label":"SIGN_SYMPTOM","start":896,"end":904},{"text":"florid","label":"DETAILED_DESCRIPTION","start":910,"end":916},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":917,"end":926},{"text":"edema","label":"SIGN_SYMPTOM","start":927,"end":932},{"text":"operating room","label":"NONBIOLOGICAL_LOCATION","start":1014,"end":1028},{"text":"transesophageal","label":"BIOLOGICAL_STRUCTURE","start":1030,"end":1045},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1046,"end":1062},{"text":"severe","label":"SEVERITY","start":1073,"end":1079},{"text":"mitral regurgitation","label":"DISEASE_DISORDER","start":1080,"end":1100},{"text":"ruptured","label":"DISEASE_DISORDER","start":1108,"end":1116},{"text":"anterolateral papillary muscle","label":"BIOLOGICAL_STRUCTURE","start":1117,"end":1147},{"text":"small","label":"SIGN_SYMPTOM","start":1154,"end":1159},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":1160,"end":1171},{"text":"cardiopulmonary bypass","label":"THERAPEUTIC_PROCEDURE","start":1210,"end":1232},{"text":"acidosis","label":"SIGN_SYMPTOM","start":1238,"end":1246},{"text":"make urine","label":"CLINICAL_EVENT","start":1273,"end":1283},{"text":"visualization","label":"DIAGNOSTIC_PROCEDURE","start":1295,"end":1308},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":1316,"end":1328},{"text":"vertical transseptal approach","label":"DETAILED_DESCRIPTION","start":1350,"end":1379},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":1392,"end":1404},{"text":"valve","label":"COREFERENCE","start":1410,"end":1415},{"text":"inspected","label":"DIAGNOSTIC_PROCEDURE","start":1430,"end":1439},{"text":"necrotic","label":"SIGN_SYMPTOM","start":1448,"end":1456},{"text":"ruptured","label":"DISEASE_DISORDER","start":1457,"end":1465},{"text":"anterolateral papillary muscle","label":"BIOLOGICAL_STRUCTURE","start":1466,"end":1496},{"text":"large","label":"SEVERITY","start":1530,"end":1535},{"text":"chunk of muscle","label":"BIOLOGICAL_STRUCTURE","start":1536,"end":1551},{"text":"attached","label":"SIGN_SYMPTOM","start":1552,"end":1560},{"text":"A1 chordal apparatus","label":"BIOLOGICAL_STRUCTURE","start":1568,"end":1588},{"text":"anterior leaflet of the mitral valve","label":"BIOLOGICAL_STRUCTURE","start":1594,"end":1630},{"text":"excised","label":"THERAPEUTIC_PROCEDURE","start":1635,"end":1642},{"text":"posterior leaflet","label":"BIOLOGICAL_STRUCTURE","start":1661,"end":1678},{"text":"intact","label":"SIGN_SYMPTOM","start":1679,"end":1685},{"text":"27-mm","label":"DISTANCE","start":1689,"end":1694},{"text":"St Jude Epic","label":"DETAILED_DESCRIPTION","start":1695,"end":1707},{"text":"bioprosthesis","label":"THERAPEUTIC_PROCEDURE","start":1708,"end":1721},{"text":"extracorporeal membrane oxygenation","label":"THERAPEUTIC_PROCEDURE","start":1765,"end":1800},{"text":"weaned","label":"THERAPEUTIC_PROCEDURE","start":1823,"end":1829},{"text":"3 days later","label":"DATE","start":1830,"end":1842},{"text":"early","label":"LAB_VALUE","start":1882,"end":1887},{"text":"recovery","label":"SIGN_SYMPTOM","start":1888,"end":1896},{"text":"One month later","label":"DATE","start":1898,"end":1913},{"text":"discharge","label":"CLINICAL_EVENT","start":1929,"end":1938},{"text":"expired","label":"OUTCOME","start":1944,"end":1951},{"text":"pneumonia","label":"DISEASE_DISORDER","start":1969,"end":1978},{"text":"sepsis","label":"DISEASE_DISORDER","start":1998,"end":2004},{"text":"multiorgan failure","label":"DISEASE_DISORDER","start":2010,"end":2028}],"tokens":["We present the case of a ","66-year-old"," ","female"," patient with ","no significant past medical history"," ","presenting"," with ","chest"," ","pain"," that was treated with ","antacids"," by her ","primary care physician",".\nThe ","next day"," she ","presented"," to the ","emergency room",", where an ","electrocardiogram"," revealed ","posterolateral"," ","ST elevation"," ","myocardial infarction",".\nThe patient was immediately ","taken"," to the ","catheterization lab",".\nA successful ","percutaneous intervention"," was performed on an ","acutely"," ","occluded"," ","large ramus intermedius vessel"," that was ","supplying"," a large portion of the ","lateral wall"," (Figure 1).\nThe patient ","did well"," ","initially",", but ","several hours later"," she ","suddenly"," went into ","cardiogenic shock",".\nAn ","intra-aortic balloon pump"," was placed, and an ","echocardiogram"," demonstrated that she had ","severe"," ","mitral regurgitation"," from a ","ruptured"," ","papillary muscle"," (Figure 2).\nThe patient, on ","maximal"," ","support",", ","deteriorated"," ","rapidly"," with ","progressive"," ","acidosis",", ","oliguria",", and ","florid"," ","pulmonary"," ","edema",".\nIn spite of the very high risk, we decided to intervene surgically.\nOnce in the ","operating room",", ","transesophageal"," ","echocardiography"," confirmed ","severe"," ","mitral regurgitation"," with a ","ruptured"," ","anterolateral papillary muscle"," and a ","small"," ","left atrium",".\nShortly after the patient was put on ","cardiopulmonary bypass",", the ","acidosis"," resolved and she began to ","make urine",".\nExcellent ","visualization"," of the ","mitral valve"," was obtained using a ","vertical transseptal approach"," through the ","right atrium",".\nThe ","valve"," was carefully ","inspected"," and the ","necrotic"," ","ruptured"," ","anterolateral papillary muscle"," was seen (Figure 3).\nThere was a ","large"," ","chunk of muscle"," ","attached"," to the ","A1 chordal apparatus",".\nThe ","anterior leaflet of the mitral valve"," was ","excised"," while keeping the ","posterior leaflet"," ","intact",".\nA ","27-mm"," ","St Jude Epic"," ","bioprosthesis"," was inserted (Figure 4).\nShe was placed on ","extracorporeal membrane oxygenation"," that was successfully ","weaned"," ","3 days later",".\nFollowing this, she made a remarkable ","early"," ","recovery",".\n","One month later",", just prior to ","discharge",", she ","expired"," after developing ","pneumonia"," that progressed to ","sepsis"," with ","multiorgan failure",".\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,12,0,69,0,46,0,48,0,19,0,13,0,48,0,24,0,22,0,22,0,26,0,13,0,48,0,75,0,63,0,69,0,12,0,69,0,12,0,69,0,22,0,78,0,42,0,26,0,75,0,24,0,63,0,26,0,26,0,12,0,42,0,75,0,69,0,63,0,42,0,69,0,69,0,22,0,12,0,69,0,48,0,12,0,24,0,63,0,26,0,26,0,12,0,69,0,12,0,75,0,69,0,13,0,24,0,12,0,22,0,12,0,18,0,24,0,69,0,26,0,12,0,63,0,12,0,69,0,12,0,12,0,75,0,12,0,69,0,27,0,22,0,75,0,75,0,75,0,19,0,42,0,69,0,19,0,13,0,56,0,26,0,26,0,26,0]}
-{"full_text":"Our patient was a 68-year-old woman with chronic obstructive pulmonary disease.\nShe had no history of gastroesophageal reflux disease or esophageal disorders but was found to have a progressive solitary pulmonary nodule (1\u00d71.3cm).\nA right lower wedge resection was performed in December 2011 and the University of Iowa pathology department identified the tumor as a LCNEC.\nApproximately six months after her operation, our patient started having slowly progressing dysphagia for both solids and liquids.\nA positron emission tomography (PET) scan performed in 2012, one year post surgery, was unremarkable for recurrence or metastasis.\nRepeat computed tomography (CT) in June 2013 (18 months post surgery) did not show any recurrence (Figure 1).\nOur patient had an esophagogastroduodenoscopy (EGD) and barium swallow that revealed no stricture of her esophagus but failure of primary and secondary peristaltic waves and reflux.\nIn July 2013, esophageal manometry found failure of the lower esophageal sphincter to relax, with a residual pressure of 32mmHg.\nOur patient was treated with calcium channel blockers with partial relief.\nThus far, up to 18 months post resection, our patient had been able to maintain her weight and her basic laboratory parameters, including hemoglobin, albumin and cholesterol levels.\nHowever, in January 2014, she reported worsening dysphagia and weight loss of 10lbs over a period of one month.\nShe was referred to our center for further treatment of her achalasia.\nA repeat esophageal manometry showed an elevated lower esophageal sphincter pressure of 50mmHg as well non-propagative, non-peristaltic contractions throughout her esophageal musculature (Figure 2).\nA repeat EGD with an intention to perform therapeutic pneumatic dilation showed a nearly circumferential ulcerated, fungating mass from approximately 36cm that extended to her gastroesophageal junction at 39cm.\nBiopsies revealed a LCNEC with similar features to the primary tumor resected in 2011, and was concluded to be a metastasis.\nSubsequently, a repeat CT scan revealed progressive diffuse metastatic disease.\nOur patient underwent two courses of chemotherapy but died from the disease after six months.\n","ner_info":[{"text":"68-year-old","label":"AGE","start":18,"end":29},{"text":"woman","label":"SEX","start":30,"end":35},{"text":"chronic obstructive pulmonary disease","label":"HISTORY","start":41,"end":78},{"text":"no history of gastroesophageal reflux disease or esophageal disorders","label":"HISTORY","start":88,"end":157},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":182,"end":193},{"text":"solitary","label":"DETAILED_DESCRIPTION","start":194,"end":202},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":203,"end":212},{"text":"nodule","label":"SIGN_SYMPTOM","start":213,"end":219},{"text":"1\u00d71.3cm","label":"AREA","start":221,"end":228},{"text":"right lower wedge","label":"DETAILED_DESCRIPTION","start":233,"end":250},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":251,"end":260},{"text":"December 2011","label":"DATE","start":278,"end":291},{"text":"University of Iowa pathology department","label":"NONBIOLOGICAL_LOCATION","start":300,"end":339},{"text":"tumor","label":"COREFERENCE","start":355,"end":360},{"text":"LCNEC","label":"DISEASE_DISORDER","start":366,"end":371},{"text":"six months after","label":"DATE","start":387,"end":403},{"text":"slowly progressing","label":"DETAILED_DESCRIPTION","start":446,"end":464},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":465,"end":474},{"text":"for both solids and liquids","label":"DETAILED_DESCRIPTION","start":475,"end":502},{"text":"positron emission tomography","label":"DIAGNOSTIC_PROCEDURE","start":506,"end":534},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":536,"end":539},{"text":"2012","label":"DATE","start":559,"end":563},{"text":"one year post surgery","label":"DATE","start":565,"end":586},{"text":"unremarkable","label":"LAB_VALUE","start":592,"end":604},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":642,"end":661},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":663,"end":665},{"text":"June 2013","label":"DATE","start":670,"end":679},{"text":"18 months post surgery","label":"DATE","start":681,"end":703},{"text":"recurrence","label":"SIGN_SYMPTOM","start":722,"end":732},{"text":"esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":764,"end":790},{"text":"EGD","label":"DIAGNOSTIC_PROCEDURE","start":792,"end":795},{"text":"barium swallow","label":"DIAGNOSTIC_PROCEDURE","start":801,"end":815},{"text":"stricture","label":"SIGN_SYMPTOM","start":833,"end":842},{"text":"esophagus","label":"BIOLOGICAL_STRUCTURE","start":850,"end":859},{"text":"failure","label":"SIGN_SYMPTOM","start":864,"end":871},{"text":"primary and secondary peristaltic waves","label":"BIOLOGICAL_STRUCTURE","start":875,"end":914},{"text":"reflux","label":"BIOLOGICAL_STRUCTURE","start":919,"end":925},{"text":"July 2013","label":"DATE","start":930,"end":939},{"text":"esophageal manometry","label":"DIAGNOSTIC_PROCEDURE","start":941,"end":961},{"text":"failure","label":"SIGN_SYMPTOM","start":968,"end":975},{"text":"lower esophageal sphincter to relax","label":"DETAILED_DESCRIPTION","start":983,"end":1018},{"text":"residual pressure","label":"DIAGNOSTIC_PROCEDURE","start":1027,"end":1044},{"text":"32mmHg","label":"LAB_VALUE","start":1048,"end":1054},{"text":"calcium channel blockers","label":"MEDICATION","start":1085,"end":1109},{"text":"relief","label":"SIGN_SYMPTOM","start":1123,"end":1129},{"text":"up to 18 months post","label":"DURATION","start":1141,"end":1161},{"text":"maintain","label":"LAB_VALUE","start":1202,"end":1210},{"text":"weight","label":"DIAGNOSTIC_PROCEDURE","start":1215,"end":1221},{"text":"basic laboratory parameters","label":"DIAGNOSTIC_PROCEDURE","start":1230,"end":1257},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1269,"end":1279},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":1281,"end":1288},{"text":"cholesterol","label":"DIAGNOSTIC_PROCEDURE","start":1293,"end":1304},{"text":"January 2014","label":"DATE","start":1325,"end":1337},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":1362,"end":1371},{"text":"weight loss","label":"SIGN_SYMPTOM","start":1376,"end":1387},{"text":"10lbs","label":"LAB_VALUE","start":1391,"end":1396},{"text":"over a period of one month","label":"DURATION","start":1397,"end":1423},{"text":"referred","label":"CLINICAL_EVENT","start":1433,"end":1441},{"text":"center","label":"NONBIOLOGICAL_LOCATION","start":1449,"end":1455},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":1468,"end":1477},{"text":"achalasia","label":"DISEASE_DISORDER","start":1485,"end":1494},{"text":"esophageal manometry","label":"DIAGNOSTIC_PROCEDURE","start":1505,"end":1525},{"text":"elevated","label":"LAB_VALUE","start":1536,"end":1544},{"text":"lower esophageal sphincter pressure","label":"DIAGNOSTIC_PROCEDURE","start":1545,"end":1580},{"text":"50mmHg","label":"LAB_VALUE","start":1584,"end":1590},{"text":"non-propagative","label":"DETAILED_DESCRIPTION","start":1599,"end":1614},{"text":"non-peristaltic","label":"DETAILED_DESCRIPTION","start":1616,"end":1631},{"text":"contractions","label":"SIGN_SYMPTOM","start":1632,"end":1644},{"text":"esophageal musculature","label":"BIOLOGICAL_STRUCTURE","start":1660,"end":1682},{"text":"EGD","label":"DIAGNOSTIC_PROCEDURE","start":1704,"end":1707},{"text":"pneumatic dilation","label":"THERAPEUTIC_PROCEDURE","start":1749,"end":1767},{"text":"nearly circumferential","label":"DETAILED_DESCRIPTION","start":1777,"end":1799},{"text":"ulcerated","label":"DETAILED_DESCRIPTION","start":1800,"end":1809},{"text":"fungating","label":"DETAILED_DESCRIPTION","start":1811,"end":1820},{"text":"mass","label":"SIGN_SYMPTOM","start":1821,"end":1825},{"text":"approximately 36cm","label":"DISTANCE","start":1831,"end":1849},{"text":"gastroesophageal junction","label":"BIOLOGICAL_STRUCTURE","start":1871,"end":1896},{"text":"at 39cm","label":"DISTANCE","start":1897,"end":1904},{"text":"Biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1906,"end":1914},{"text":"LCNEC","label":"DISEASE_DISORDER","start":1926,"end":1931},{"text":"similar features to the primary tumor resected in 2011","label":"DETAILED_DESCRIPTION","start":1937,"end":1991},{"text":"metastasis","label":"SIGN_SYMPTOM","start":2019,"end":2029},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":2054,"end":2061},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":2071,"end":2082},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2083,"end":2090},{"text":"metastatic disease","label":"DISEASE_DISORDER","start":2091,"end":2109},{"text":"two courses","label":"DETAILED_DESCRIPTION","start":2133,"end":2144},{"text":"chemotherapy","label":"MEDICATION","start":2148,"end":2160},{"text":"died","label":"OUTCOME","start":2165,"end":2169},{"text":"after six months","label":"DATE","start":2187,"end":2203}],"tokens":["Our patient was a ","68-year-old"," ","woman"," with ","chronic obstructive pulmonary disease",".\nShe had ","no history of gastroesophageal reflux disease or esophageal disorders"," but was found to have a ","progressive"," ","solitary"," ","pulmonary"," ","nodule"," (","1\u00d71.3cm",").\nA ","right lower wedge"," ","resection"," was performed in ","December 2011"," and the ","University of Iowa pathology department"," identified the ","tumor"," as a ","LCNEC",".\nApproximately ","six months after"," her operation, our patient started having ","slowly progressing"," ","dysphagia"," ","for both solids and liquids",".\nA ","positron emission tomography"," (","PET",") scan performed in ","2012",", ","one year post surgery",", was ","unremarkable"," for recurrence or metastasis.\nRepeat ","computed tomography"," (","CT",") in ","June 2013"," (","18 months post surgery",") did not show any ","recurrence"," (Figure 1).\nOur patient had an ","esophagogastroduodenoscopy"," (","EGD",") and ","barium swallow"," that revealed no ","stricture"," of her ","esophagus"," but ","failure"," of ","primary and secondary peristaltic waves"," and ","reflux",".\nIn ","July 2013",", ","esophageal manometry"," found ","failure"," of the ","lower esophageal sphincter to relax",", with a ","residual pressure"," of ","32mmHg",".\nOur patient was treated with ","calcium channel blockers"," with partial ","relief",".\nThus far, ","up to 18 months post"," resection, our patient had been able to ","maintain"," her ","weight"," and her ","basic laboratory parameters",", including ","hemoglobin",", ","albumin"," and ","cholesterol"," levels.\nHowever, in ","January 2014",", she reported worsening ","dysphagia"," and ","weight loss"," of ","10lbs"," ","over a period of one month",".\nShe was ","referred"," to our ","center"," for further ","treatment"," of her ","achalasia",".\nA repeat ","esophageal manometry"," showed an ","elevated"," ","lower esophageal sphincter pressure"," of ","50mmHg"," as well ","non-propagative",", ","non-peristaltic"," ","contractions"," throughout her ","esophageal musculature"," (Figure 2).\nA repeat ","EGD"," with an intention to perform therapeutic ","pneumatic dilation"," showed a ","nearly circumferential"," ","ulcerated",", ","fungating"," ","mass"," from ","approximately 36cm"," that extended to her ","gastroesophageal junction"," ","at 39cm",".\n","Biopsies"," revealed a ","LCNEC"," with ","similar features to the primary tumor resected in 2011",", and was concluded to be a ","metastasis",".\nSubsequently, a repeat ","CT scan"," revealed ","progressive"," ","diffuse"," ","metastatic disease",".\nOur patient underwent ","two courses"," of ","chemotherapy"," but ","died"," from the disease ","after six months",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,22,0,22,0,12,0,69,0,8,0,22,0,75,0,19,0,48,0,18,0,26,0,19,0,22,0,69,0,22,0,24,0,24,0,19,0,19,0,42,0,24,0,24,0,19,0,19,0,69,0,24,0,24,0,24,0,69,0,12,0,69,0,12,0,12,0,19,0,24,0,69,0,22,0,24,0,42,0,46,0,69,0,32,0,42,0,24,0,24,0,24,0,24,0,24,0,19,0,69,0,69,0,42,0,32,0,13,0,48,0,75,0,26,0,24,0,42,0,24,0,42,0,22,0,22,0,69,0,12,0,24,0,75,0,22,0,22,0,22,0,69,0,27,0,12,0,27,0,24,0,26,0,22,0,69,0,24,0,22,0,22,0,26,0,22,0,46,0,56,0,19,0]}
-{"full_text":"A woman in her early 70s presented to our emergency room 30\u2005min after her husband expired with 8\/10, substernal chest pain with concurrent diaphoresis and dyspnoea.\nThe patient's husband had an out-of-hospital cardiac arrest earlier that day and was brought to our emergency room and subsequently admitted to the coronary care unit.\nHe had recurrent ventricular fibrillation and could not be successfully resuscitated.\nThe patient's medical history included hypertension and hypothyroidism.\nShe denied having had a similar episode of pain.\nShe had regular appointments with her primary care physician.\nHer medication included oral furosemide 20\u2005mg and levothyroxine 100\u2005\u00b5g, both once daily.\nShe denied allergies.\nOn presentation, the patient was afebrile, with a blood pressure of 105\/55, heart rate of 93\u2005bpm, respiratory rate of 20\/min and an oxygen saturation of 98% on room air.\nOn physical examination, she was in significant distress due to pain.\nHer skin was warm and moist, with minimal crackles in bilateral bases, regular rate and rhythm, 2\/6 systolic murmur of the apex without radiation, no rubs, elevated jugular vein distention of 8\u2005cm, strong peripheral pulses and no peripheral oedema.\nThe abdomen was soft, non-tender, non-distended, with bowel sounds, and the patient was alert and oriented without focal neurological deficits.\nThe complete blood count, basic metabolic panel and coagulation tests were within normal limits.\nThe cardiac enzymes were increased with a troponin I of 2.59\u2005ng\/mL (normal range 0.015\u20130.045\u2005ng\/mL), creatine phosphokinase of 84\u2005U\/L (normal range 26\u2013192\u2005U\/L).\nECG on admission revealed normal sinus rhythm with 2\u20133\u2005mm ST segment elevations in leads V2\u2013V3 and Q waves in leads V1\u2013V3, suggestive of anterior wall infarct (figure 2).\nAn echocardiogram revealed left ventricular ejection fraction of 30\u201335% with mild concentric left ventricular hypertrophy, akinesis of the apex and 2\/3 of the inferoseptum and apical inferior-anterior wall segments, suggesting ischaemic damage at the left anterior descending artery distribution versus takotsubo cardiomyopathy (figures 3 and \u200b4).\nThe patient received aspirin 162\u2005mg and prasugrel 60\u2005mg, and was taken to the cardiac catheterisation laboratory.\nThe angiogram showed non-obstructive coronary artery disease with luminal irregularities (figures 5 and \u200b6).\nThe left ventriculography showed an ejection fraction of 35% with akinesis of apical wall and hyperkinesis of basal segments (figures 7 and 8).\nThe patient remained haemodynamically stable and was started on oral heart failure medications, including lisinopril 2.5\u2005mg daily and metoprolol tartrate 12.5\u2005mg two times a day.\nHer pain and shortness of breath resolved and she was discharged home after 48\u2005h of hospitalisation in stable condition.\nA repeat echocardiogram 2\u2005months later showed resolution of her cardiomyopathy and an ejection fraction of 65\u201370%, with normal left ventricular motion.\n","ner_info":[{"text":"woman","label":"SEX","start":2,"end":7},{"text":"early 70s","label":"AGE","start":15,"end":24},{"text":"presented","label":"CLINICAL_EVENT","start":25,"end":34},{"text":"emergency room","label":"NONBIOLOGICAL_LOCATION","start":42,"end":56},{"text":"30\u2005min after","label":"TIME","start":57,"end":69},{"text":"husband","label":"SUBJECT","start":74,"end":81},{"text":"expired","label":"OUTCOME","start":82,"end":89},{"text":"8\/10","label":"LAB_VALUE","start":95,"end":99},{"text":"substernal","label":"BIOLOGICAL_STRUCTURE","start":101,"end":111},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":112,"end":117},{"text":"pain","label":"SIGN_SYMPTOM","start":118,"end":122},{"text":"diaphoresis","label":"SIGN_SYMPTOM","start":139,"end":150},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":155,"end":163},{"text":"husband","label":"SUBJECT","start":179,"end":186},{"text":"out-of-hospital cardiac arrest","label":"DETAILED_DESCRIPTION","start":194,"end":224},{"text":"earlier that day","label":"TIME","start":225,"end":241},{"text":"brought to our emergency room","label":"DETAILED_DESCRIPTION","start":250,"end":279},{"text":"admitted to the coronary care unit","label":"DETAILED_DESCRIPTION","start":297,"end":331},{"text":"He","label":"COREFERENCE","start":333,"end":335},{"text":"recurrent ventricular fibrillation","label":"DETAILED_DESCRIPTION","start":340,"end":374},{"text":"could not be successfully resuscitated","label":"DETAILED_DESCRIPTION","start":379,"end":417},{"text":"hypertension","label":"HISTORY","start":458,"end":470},{"text":"hypothyroidism","label":"HISTORY","start":475,"end":489},{"text":"denied having had a similar episode of pain","label":"HISTORY","start":495,"end":538},{"text":"had regular appointments with her primary care physician","label":"HISTORY","start":544,"end":600},{"text":"medication","label":"MEDICATION","start":606,"end":616},{"text":"oral","label":"ADMINISTRATION","start":626,"end":630},{"text":"furosemide","label":"MEDICATION","start":631,"end":641},{"text":"20\u2005mg","label":"DOSAGE","start":642,"end":647},{"text":"levothyroxine","label":"MEDICATION","start":652,"end":665},{"text":"100\u2005\u00b5g","label":"DOSAGE","start":666,"end":672},{"text":"once daily","label":"DOSAGE","start":679,"end":689},{"text":"denied allergies","label":"HISTORY","start":695,"end":711},{"text":"presentation","label":"CLINICAL_EVENT","start":716,"end":728},{"text":"afebrile","label":"SIGN_SYMPTOM","start":746,"end":754},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":763,"end":777},{"text":"105\/55","label":"LAB_VALUE","start":781,"end":787},{"text":"heart 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ventricular motion","label":"DIAGNOSTIC_PROCEDURE","start":2917,"end":2940}],"tokens":["A ","woman"," in her ","early 70s"," ","presented"," to our ","emergency room"," ","30\u2005min after"," her ","husband"," ","expired"," with ","8\/10",", ","substernal"," ","chest"," ","pain"," with concurrent ","diaphoresis"," and ","dyspnoea",".\nThe patient's ","husband"," had an ","out-of-hospital cardiac arrest"," ","earlier that day"," and was ","brought to our emergency room"," and subsequently ","admitted to the coronary care unit",".\n","He"," had ","recurrent ventricular fibrillation"," and ","could not be successfully resuscitated",".\nThe patient's medical history included ","hypertension"," and ","hypothyroidism",".\nShe ","denied having had a similar episode of pain",".\nShe ","had regular appointments with her primary care physician",".\nHer ","medication"," included ","oral"," ","furosemide"," ","20\u2005mg"," and ","levothyroxine"," ","100\u2005\u00b5g",", both ","once daily",".\nShe ","denied allergies",".\nOn ","presentation",", the patient was ","afebrile",", with a ","blood pressure"," of ","105\/55",", ","heart rate"," of ","93\u2005bpm",", ","respiratory rate"," of ","20\/min"," and an ","oxygen saturation"," of ","98%"," on ","room air",".\nOn ","physical examination",", she was in ","significant"," ","distress"," due to ","pain",".\nHer ","skin"," was ","warm"," and ","moist",", with ","minimal crackles"," in ","bilateral bases",", ","regular"," ","rate and rhythm",", ","2\/6 systolic"," ","murmur"," ","of the apex without radiation",", no ","rubs",", ","elevated"," ","jugular vein"," ","distention"," of ","8\u2005cm",", ","strong"," ","peripheral"," ","pulses"," and no ","peripheral"," ","oedema",".\nThe ","abdomen"," was ","soft",", ","non-tender",", ","non-distended",", ","with bowel sounds",", and the patient was ","alert"," and ","oriented"," without ","focal"," ","neurological deficits",".\nThe ","complete blood count",", ","basic metabolic panel"," and ","coagulation tests"," were ","within normal limits",".\nThe ","cardiac enzymes"," were ","increased"," with a ","troponin I"," of ","2.59\u2005ng\/mL"," (normal range 0.015\u20130.045\u2005ng\/mL), ","creatine phosphokinase"," of ","84\u2005U\/L"," (normal range 26\u2013192\u2005U\/L).\n","ECG"," on ","admission"," revealed ","normal"," ","sinus rhythm"," with ","2\u20133\u2005mm ST segment elevations in leads V2\u2013V3"," and ","Q waves in leads V1\u2013V3",", suggestive of ","anterior wall"," ","infarct"," (figure 2).\nAn ","echocardiogram"," revealed ","left ventricular ejection fraction"," of ","30\u201335%"," with ","mild"," ","concentric"," ","left ventricular"," ","hypertrophy",", ","akinesis"," of the ","apex"," and ","2\/3 of the inferoseptum"," and ","apical inferior-anterior wall segments",", suggesting ","ischaemic damage"," at the ","left anterior descending artery"," distribution versus ","takotsubo cardiomyopathy"," (figures 3 and \u200b4).\nThe patient received ","aspirin"," ","162\u2005mg"," and ","prasugrel"," ","60\u2005mg",", and was ","taken"," to the ","cardiac catheterisation laboratory",".\nThe ","angiogram"," showed ","non-obstructive"," ","coronary artery disease"," with ","luminal"," ","irregularities"," (figures 5 and \u200b6).\nThe ","left ventriculography"," showed an ","ejection fraction"," of ","35%"," with ","akinesis"," of ","apical wall"," and ","hyperkinesis"," of ","basal segments"," (figures 7 and 8).\nThe patient remained ","haemodynamically"," ","stable"," and was started on ","oral"," ","heart failure medications",", including ","lisinopril"," ","2.5\u2005mg daily"," and ","metoprolol tartrate"," ","12.5\u2005mg two times a day",".\nHer ","pain"," and ","shortness of breath"," resolved and she was ","discharged"," ","home"," ","after 48\u2005h"," of hospitalisation in ","stable"," ","condition",".\nA repeat ","echocardiogram"," ","2\u2005months later"," showed resolution of her ","cardiomyopathy"," 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-{"full_text":"A 36-yr-old previously healthy Sri Lankan male who takes care of a horse presented to the medical casualty ward with fever, arthralgia and myalgia for one day.\nHe complained of mild dysuria but had normal urine output.\nHe did not have chest pain or shortness of breath.\nFurther inquiry revealed that he was treated for leptospirosis during a febrile illness in the past.\nOn examination, patient was afebrile, anicteric.\nHis blood pressure was 90\/60 mmHg and pulse rate 76 bpm.\nRest of the examination was unremarkable.\nInitial investigations performed on the day of admission revealed neutrophil leukocytosis, mild thrombocytopaenia and microscopic haematuria (Table 1).\nRenal function and liver enzymes were within normal limits.\nUrine analysis revealed pus cells 05 \u2013 06 \/hpf, red cells 30 \u2013 35 \/hpf.\nCRP (C-reactive protein) was 75 mg\/dl.\nA clinical diagnosis of leptospirosis was made and he was started on intravenous penicillin in addition to adequate hydration.\nOn the second day of illness, he developed hypotension with tachycardia and dyspnoea.\nECG revealed sinus tachycardia with ST depression in leads V4 \u2013 V6 [Figure 1].\nHis CXR (chest x ray) showed gross cardiomegaly and bilateral pulmonary shadows [Figure 2].\nCVP (central venous pressure) was 16 cmH2O and 2D echocardiogram revealed dilatation of all four chambers, severe global hypokinesia and ejection fraction of 20%.\nTroponin I was 12.77 ng\/ml (normal range\u2009<\u20090.40).\nHe was diagnosed to have early and severe myocarditis.\nPatient was transferred to ICU (intensive care unit) as he needed inotropic support.\nIntravenous antibiotics including penicillin, meropenem and levofloxacin were continued.\nPatient was electively ventilated on the 3rd day of illness due to severe respiratory distress.\nOn the same day, he developed rapid atrial fibrillation [Figure 3] unresponsive to digoxin and intravenous amiodarone.\nPlatelet count dropped to 10 \u00d7 103 \u03bc\/L and he was given platelet transfusions to prevent bleeding [Table 1].\nWe started intravenous methylprednisolone based on previous studies showing a mortality benefit in severe leptospirosis complicated with myocarditis [11].\nHis serum creatinine increased to 362 \u03bc mol\/L by the 5th day of illness and ALT (alanine transaminase) and AST (aspartate transaminase) were markedly elevated up to 2726 U\/l and 7438 U\/l respectively.\nDengue and Mycoplasma infections were excluded.\nBlood cultures were negative.\nLeptospira IgM antibody performed on the 5th day of illness was positive (IgG negative).\nPatient developed refractory shock and died of persistent ventricular tachycardia despite optimal treatment in the ICU.\n","ner_info":[{"text":"36-yr-old","label":"AGE","start":2,"end":11},{"text":"previously healthy","label":"HISTORY","start":12,"end":30},{"text":"Sri 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chambers","label":"BIOLOGICAL_STRUCTURE","start":1314,"end":1331},{"text":"severe","label":"SEVERITY","start":1333,"end":1339},{"text":"global","label":"DETAILED_DESCRIPTION","start":1340,"end":1346},{"text":"hypokinesia","label":"DISEASE_DISORDER","start":1347,"end":1358},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1363,"end":1380},{"text":"20%","label":"LAB_VALUE","start":1384,"end":1387},{"text":"Troponin I","label":"DIAGNOSTIC_PROCEDURE","start":1389,"end":1399},{"text":"12.77 ng\/ml","label":"LAB_VALUE","start":1404,"end":1415},{"text":"early","label":"DETAILED_DESCRIPTION","start":1464,"end":1469},{"text":"severe","label":"SEVERITY","start":1474,"end":1480},{"text":"myocarditis","label":"DISEASE_DISORDER","start":1481,"end":1492},{"text":"transferred","label":"CLINICAL_EVENT","start":1506,"end":1517},{"text":"ICU","label":"NONBIOLOGICAL_LOCATION","start":1521,"end":1524},{"text":"intensive care 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fibrillation","label":"DISEASE_DISORDER","start":1800,"end":1819},{"text":"digoxin","label":"MEDICATION","start":1847,"end":1854},{"text":"intravenous","label":"ADMINISTRATION","start":1859,"end":1870},{"text":"amiodarone","label":"MEDICATION","start":1871,"end":1881},{"text":"Platelet count","label":"DIAGNOSTIC_PROCEDURE","start":1883,"end":1897},{"text":"dropped","label":"LAB_VALUE","start":1898,"end":1905},{"text":"10 \u00d7 103 \u03bc\/L","label":"LAB_VALUE","start":1909,"end":1921},{"text":"platelet transfusions","label":"THERAPEUTIC_PROCEDURE","start":1939,"end":1960},{"text":"intravenous","label":"ADMINISTRATION","start":2003,"end":2014},{"text":"methylprednisolone","label":"MEDICATION","start":2015,"end":2033},{"text":"serum","label":"BIOLOGICAL_STRUCTURE","start":2151,"end":2156},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":2157,"end":2167},{"text":"increased","label":"LAB_VALUE","start":2168,"end":2177},{"text":"362 \u03bc mol\/L","label":"LAB_VALUE","start":2181,"end":2192},{"text":"5th day","label":"DATE","start":2200,"end":2207},{"text":"ALT","label":"DIAGNOSTIC_PROCEDURE","start":2223,"end":2226},{"text":"alanine transaminase","label":"DIAGNOSTIC_PROCEDURE","start":2228,"end":2248},{"text":"AST","label":"DIAGNOSTIC_PROCEDURE","start":2254,"end":2257},{"text":"aspartate transaminase","label":"DIAGNOSTIC_PROCEDURE","start":2259,"end":2281},{"text":"elevated","label":"LAB_VALUE","start":2297,"end":2305},{"text":"2726 U\/l","label":"LAB_VALUE","start":2312,"end":2320},{"text":"7438 U\/l","label":"LAB_VALUE","start":2325,"end":2333},{"text":"Dengue","label":"DETAILED_DESCRIPTION","start":2348,"end":2354},{"text":"Mycoplasma","label":"DETAILED_DESCRIPTION","start":2359,"end":2369},{"text":"infections","label":"DISEASE_DISORDER","start":2370,"end":2380},{"text":"Blood cultures","label":"DIAGNOSTIC_PROCEDURE","start":2396,"end":2410},{"text":"negative","label":"LAB_VALUE","start":2416,"end":2424},{"text":"Leptospira IgM","label":"DETAILED_DESCRIPTION","start":2426,"end":2440},{"text":"antibody","label":"DIAGNOSTIC_PROCEDURE","start":2441,"end":2449},{"text":"5th day","label":"DATE","start":2467,"end":2474},{"text":"positive","label":"LAB_VALUE","start":2490,"end":2498},{"text":"IgG","label":"DIAGNOSTIC_PROCEDURE","start":2500,"end":2503},{"text":"negative","label":"LAB_VALUE","start":2504,"end":2512},{"text":"refractory shock","label":"DISEASE_DISORDER","start":2533,"end":2549},{"text":"died","label":"CLINICAL_EVENT","start":2554,"end":2558},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":2562,"end":2572},{"text":"ventricular","label":"BIOLOGICAL_STRUCTURE","start":2573,"end":2584},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":2585,"end":2596},{"text":"optimal","label":"DETAILED_DESCRIPTION","start":2605,"end":2612},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":2613,"end":2622},{"text":"ICU","label":"NONBIOLOGICAL_LOCATION","start":2630,"end":2633}],"tokens":["A ","36-yr-old"," ","previously healthy"," ","Sri Lankan"," ","male"," who ","takes care of a horse"," ","presented"," to the ","medical casualty ward"," with ","fever",", ","arthralgia"," and ","myalgia"," for ","one day",".\nHe complained of ","mild"," ","dysuria"," but had ","normal"," ","urine output",".\nHe did not have ","chest"," ","pain"," or ","shortness of breath",".\nFurther inquiry revealed that he was ","treated for leptospirosis during a febrile illness in the past",".\nOn ","examination",", patient was ","afebrile",", ","anicteric",".\nHis ","blood pressure"," was ","90\/60 mmHg"," and ","pulse rate"," ","76 bpm",".\nRest of the ","examination"," was ","unremarkable",".\nInitial ","investigations"," performed on the day of admission revealed ","neutrophil"," ","leukocytosis",", ","mild"," ","thrombocytopaenia"," and ","microscopic"," ","haematuria"," (Table 1).\n","Renal function"," and ","liver enzymes"," were ","within normal limits",".\n","Urine analysis"," revealed ","pus cells 05 \u2013 06 \/hpf",", ","red cells 30 \u2013 35 \/hpf",".\n","CRP"," (","C-reactive protein",") was ","75 mg\/dl",".\nA clinical diagnosis of ","leptospirosis"," was made and he was started on ","intravenous"," ","penicillin"," in addition to adequate ","hydration",".\nOn the ","second day"," of illness, he developed ","hypotension"," with ","tachycardia"," and ","dyspnoea",".\n","ECG"," revealed ","sinus"," ","tachycardia"," with ","ST depression in leads V4 \u2013 V6"," [Figure 1].\nHis ","CXR"," (","chest x ray",") showed ","gross"," ","cardiomegaly"," and ","bilateral"," ","pulmonary"," ","shadows"," [Figure 2].\n","CVP"," (","central venous pressure",") was ","16 cmH2O"," and ","2D"," ","echocardiogram"," revealed ","dilatation"," of ","all four chambers",", ","severe"," ","global"," ","hypokinesia"," and ","ejection fraction"," of ","20%",".\n","Troponin I"," was ","12.77 ng\/ml"," (normal range\u2009<\u20090.40).\nHe was diagnosed to have ","early"," and ","severe"," ","myocarditis",".\nPatient was ","transferred"," to ","ICU"," (","intensive care unit",") as he needed ","inotropic support",".\n","Intravenous"," ","antibiotics"," including ","penicillin",", ","meropenem"," and ","levofloxacin"," were continued.\nPatient was electively ","ventilated"," on the ","3rd day"," of illness due to ","severe"," ","respiratory distress",".\nOn the ","same day",", he developed ","rapid"," ","atrial fibrillation"," [Figure 3] unresponsive to ","digoxin"," and ","intravenous"," ","amiodarone",".\n","Platelet count"," ","dropped"," to ","10 \u00d7 103 \u03bc\/L"," and he was given ","platelet transfusions"," to prevent bleeding [Table 1].\nWe started ","intravenous"," ","methylprednisolone"," based on previous studies showing a mortality benefit in severe leptospirosis complicated with myocarditis [11].\nHis ","serum"," ","creatinine"," ","increased"," to ","362 \u03bc mol\/L"," by the ","5th day"," of illness and ","ALT"," (","alanine transaminase",") and ","AST"," (","aspartate transaminase",") were markedly ","elevated"," up to ","2726 U\/l"," and ","7438 U\/l"," respectively.\n","Dengue"," and ","Mycoplasma"," ","infections"," were excluded.\n","Blood cultures"," were ","negative",".\n","Leptospira IgM"," ","antibody"," performed on the ","5th day"," of illness was ","positive"," (","IgG"," ","negative",").\nPatient developed ","refractory shock"," and ","died"," of ","persistent"," ","ventricular"," ","tachycardia"," despite ","optimal"," ","treatment"," in the ","ICU",".\n"],"ner_labels":[0,5,0,39,0,58,0,65,0,50,0,13,0,48,0,69,0,69,0,69,0,32,0,63,0,69,0,42,0,24,0,12,0,69,0,69,0,39,0,24,0,69,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,12,0,69,0,63,0,69,0,22,0,69,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,24,0,42,0,26,0,4,0,46,0,75,0,19,0,69,0,69,0,69,0,24,0,22,0,69,0,22,0,24,0,24,0,22,0,26,0,22,0,12,0,69,0,24,0,24,0,42,0,22,0,24,0,69,0,12,0,63,0,22,0,26,0,24,0,42,0,24,0,42,0,22,0,63,0,26,0,13,0,48,0,48,0,75,0,4,0,46,0,46,0,46,0,46,0,75,0,19,0,63,0,26,0,78,0,22,0,26,0,46,0,4,0,46,0,24,0,42,0,42,0,75,0,4,0,46,0,12,0,24,0,42,0,42,0,19,0,24,0,24,0,24,0,24,0,42,0,42,0,42,0,22,0,22,0,26,0,24,0,42,0,22,0,24,0,19,0,42,0,24,0,42,0,26,0,13,0,22,0,12,0,69,0,22,0,75,0,48,0]}
-{"full_text":"A 35-year-old woman presented to the ear, nose and throat outpatient department with headache and a blocked left-sided nasal canal with epistaxis for 2\u2005years.\nMedical history revealed secondary amenorrhoea for the past 19\u2005years with regression of secondary sexual characteristics with no galactorrhoea.\nPhysical and ophthalmological examinations were within normal limits.\nNasal examination revealed a left-sided choanal mass.\nAs the mass was bleeding on palpation, imaging was advised prior to performing a biopsy.\nMRI of the head showed a sellar and infra-sellar mass extending into the nasopharynx (figure 1).\nThe patient was then referred to the endocrinologist for further hormonal investigation.\nHer serum prolactin was very high\u20147443\u2005\u00b5g\/L (N<20).\nOther pituitary hormones were within normal limits.\nA final diagnosis of giant prolactinoma was made and the patient was prescribed cabergoline 0.25\u2005mg twice per week with the associated risks explained in advance.\n","ner_info":[{"text":"35-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"ear, nose and throat outpatient department","label":"NONBIOLOGICAL_LOCATION","start":37,"end":79},{"text":"headache","label":"SIGN_SYMPTOM","start":85,"end":93},{"text":"blocked left-sided nasal canal","label":"SIGN_SYMPTOM","start":100,"end":130},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":136,"end":145},{"text":"2\u2005years","label":"DURATION","start":150,"end":157},{"text":"secondary amenorrhoea for the past 19\u2005years","label":"HISTORY","start":184,"end":227},{"text":"regression of secondary sexual characteristics","label":"SIGN_SYMPTOM","start":233,"end":279},{"text":"galactorrhoea","label":"SIGN_SYMPTOM","start":288,"end":301},{"text":"Physical","label":"DIAGNOSTIC_PROCEDURE","start":303,"end":311},{"text":"ophthalmological examinations","label":"DIAGNOSTIC_PROCEDURE","start":316,"end":345},{"text":"within normal limits","label":"LAB_VALUE","start":351,"end":371},{"text":"Nasal examination","label":"DIAGNOSTIC_PROCEDURE","start":373,"end":390},{"text":"left-sided","label":"BIOLOGICAL_STRUCTURE","start":402,"end":412},{"text":"choanal","label":"BIOLOGICAL_STRUCTURE","start":413,"end":420},{"text":"mass","label":"SIGN_SYMPTOM","start":421,"end":425},{"text":"mass","label":"COREFERENCE","start":434,"end":438},{"text":"bleeding on palpation","label":"DETAILED_DESCRIPTION","start":443,"end":464},{"text":"imaging","label":"DIAGNOSTIC_PROCEDURE","start":466,"end":473},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":516,"end":519},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":527,"end":531},{"text":"sellar","label":"BIOLOGICAL_STRUCTURE","start":541,"end":547},{"text":"infra-sellar","label":"BIOLOGICAL_STRUCTURE","start":552,"end":564},{"text":"mass","label":"SIGN_SYMPTOM","start":565,"end":569},{"text":"extending into the nasopharynx","label":"BIOLOGICAL_STRUCTURE","start":570,"end":600},{"text":"referred","label":"CLINICAL_EVENT","start":634,"end":642},{"text":"endocrinologist","label":"NONBIOLOGICAL_LOCATION","start":650,"end":665},{"text":"hormonal investigation","label":"DIAGNOSTIC_PROCEDURE","start":678,"end":700},{"text":"serum prolactin","label":"DIAGNOSTIC_PROCEDURE","start":706,"end":721},{"text":"very high","label":"LAB_VALUE","start":726,"end":735},{"text":"7443\u2005\u00b5g\/L","label":"LAB_VALUE","start":736,"end":745},{"text":"Other pituitary hormones","label":"DIAGNOSTIC_PROCEDURE","start":754,"end":778},{"text":"within normal limits","label":"LAB_VALUE","start":784,"end":804},{"text":"giant prolactinoma","label":"DISEASE_DISORDER","start":827,"end":845},{"text":"cabergoline","label":"MEDICATION","start":886,"end":897},{"text":"0.25\u2005mg twice per week","label":"DOSAGE","start":898,"end":920}],"tokens":["A ","35-year-old"," ","woman"," ","presented"," to the ","ear, nose and throat outpatient department"," with ","headache"," and a ","blocked left-sided nasal canal"," with ","epistaxis"," for ","2\u2005years",".\nMedical history revealed ","secondary amenorrhoea for the past 19\u2005years"," with ","regression of secondary sexual characteristics"," with no ","galactorrhoea",".\n","Physical"," and ","ophthalmological examinations"," were ","within normal limits",".\n","Nasal examination"," revealed a ","left-sided"," ","choanal"," ","mass",".\nAs the ","mass"," was ","bleeding on palpation",", ","imaging"," was advised prior to performing a biopsy.\n","MRI"," of the ","head"," showed a ","sellar"," and ","infra-sellar"," ","mass"," ","extending into the nasopharynx"," (figure 1).\nThe patient was then ","referred"," to the ","endocrinologist"," for further ","hormonal investigation",".\nHer ","serum prolactin"," was ","very high","\u2014","7443\u2005\u00b5g\/L"," (N<20).\n","Other pituitary hormones"," were ","within normal limits",".\nA final diagnosis of ","giant prolactinoma"," was made and the patient was prescribed ","cabergoline"," ","0.25\u2005mg twice per week"," with the associated risks explained in advance.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,69,0,69,0,32,0,39,0,69,0,69,0,24,0,24,0,42,0,24,0,12,0,12,0,69,0,18,0,22,0,24,0,24,0,12,0,12,0,12,0,69,0,12,0,13,0,48,0,24,0,24,0,42,0,42,0,24,0,42,0,26,0,46,0,29,0]}
-{"full_text":"A 38-year-old woman presented to our Emergency Department with severe abdominal pain.\nShe had no history of drug use or constipation.\nShe said that she had intermittent bloody diarrhea.\nPhysical examination revealed rebound tenderness and guarding over the abdomen.\nStool microscopy was negative for amoeba trophozoites or any parasites.\nFecal occult blood was found.\nSedimentation was 27 mm\/s, CRP (nephelometry) was 65.6 mg\/L (normal range 0\u20135), anti-nuclear antibody was 0.4 (0\u20130.8 negative), anti-ds DNA <10 (<20 negative), white blood cell count was 14.98 (normal range 4\u201310), hemoglobin level was 10.9, neutro-phil count was 13.14, platelet count was 473 (100\u2013300), urea level was 17 mg\/dl, BUN level was 7.94 mg\/dl, creatinine level was 0.56 mg\/dl, AST was 20 U\/L, and ALT was 24 U\/L.\nHIV was negative.\nAbdominal ultrasound scanning showed free fluid at the right paracolic, perihepatic, left paracolic gutters and pelvis.\nUpon detection of air-fluid level and free air under the diaphragm on erect abdominal x-ray, emergency laparotomy was performed.\nIn the operation, multiple perforation areas were found in the sigmoid colon, descending colon, and transverse colon.\nWide resection of the transverse colon with descending and sigmoid colon resection was undertaken (Figure 1).\nPathergy test was positive.\nThe patient had recurrent oral and genital aphthous ulcers 4\u20135 times within the past year.\nEye examination results were normal.\nComputed tomography revealed extensive thrombus within the inferior vena cava extending through the right and middle hepatic vein (Figure 2).\nThe patient received corticosteroid, anticoagulant, and immunosuppressive therapy.\nOur patient is still alive and healthy 53 weeks later (Figure 3).\nIn macroscopy, the transverse colon was 50 cm and sigmoid and descending colon specimens were 27 cm in length.\nSpecimens of both colon segments were 4 cm in diameter.\nPerforation areas were evident in the serosal surface.\nColonic wall and bowel mucosa was edematous and hyperemic.\nPlicae were regular in their course.\nThere were 3 roundish, punched-out perforations in the transverse colon and 4 in the descending and sigmoid colon, which were somewhat separate from the colonic wall, with the largest being 2 cm in diameter (Figure 4).\nThere were multiple ulcers (the largest was 1 cm in diameter) in different locations, which were not merging together, and were somewhat separate from the surrounding mucosa via a certain limit, covered with exudate and surrounded by a hyperemic region.\nThere were no macroscopic lymph nodes in the serosa.\nNumerous samples were taken from ulcerated and perforated regions and normal mucosa.\nThe samples were submitted for routine microscopic tissue follow-up.\nHematoxylin-eosin, tissue Giemsa and PAS-stained slides were prepared for examination.\nIn microscopic examination, there were neutrophil leukocyte and lymphocyte reaction around and within the walls and lumens of arterioles, and venules around the perforated and ulcerated lesions (Figures 5 and \u200band6).6).\nThere were well-organized thrombi and intimal proliferation within some vessels (Figures 7 and \u200band8).8).\nThere was marked acute peritonitis.\nSurface epithelium and colonic crypts were regular within the colonic mucosa apart from the ulcerated or perforated lesions.\nSamples were free of parasites or their eggs.\n","ner_info":[{"text":"38-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"Emergency Department","label":"NONBIOLOGICAL_LOCATION","start":37,"end":57},{"text":"severe","label":"SEVERITY","start":63,"end":69},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":70,"end":79},{"text":"pain","label":"SIGN_SYMPTOM","start":80,"end":84},{"text":"no history of drug use or constipation","label":"HISTORY","start":94,"end":132},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":156,"end":168},{"text":"bloody","label":"DETAILED_DESCRIPTION","start":169,"end":175},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":176,"end":184},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":186,"end":206},{"text":"rebound","label":"DETAILED_DESCRIPTION","start":216,"end":223},{"text":"tenderness","label":"SIGN_SYMPTOM","start":224,"end":234},{"text":"guarding","label":"SIGN_SYMPTOM","start":239,"end":247},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":257,"end":264},{"text":"Stool microscopy","label":"DIAGNOSTIC_PROCEDURE","start":266,"end":282},{"text":"negative","label":"LAB_VALUE","start":287,"end":295},{"text":"amoeba trophozoites","label":"DIAGNOSTIC_PROCEDURE","start":300,"end":319},{"text":"parasites","label":"DIAGNOSTIC_PROCEDURE","start":327,"end":336},{"text":"Fecal occult blood","label":"DIAGNOSTIC_PROCEDURE","start":338,"end":356},{"text":"found","label":"LAB_VALUE","start":361,"end":366},{"text":"Sedimentation","label":"DIAGNOSTIC_PROCEDURE","start":368,"end":381},{"text":"27 mm\/s","label":"LAB_VALUE","start":386,"end":393},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":395,"end":398},{"text":"nephelometry","label":"DIAGNOSTIC_PROCEDURE","start":400,"end":412},{"text":"65.6 mg\/L","label":"LAB_VALUE","start":418,"end":427},{"text":"anti-nuclear antibody","label":"DIAGNOSTIC_PROCEDURE","start":448,"end":469},{"text":"0.4","label":"LAB_VALUE","start":474,"end":477},{"text":"anti-ds DNA","label":"DIAGNOSTIC_PROCEDURE","start":496,"end":507},{"text":"<10","label":"LAB_VALUE","start":508,"end":511},{"text":"white blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":528,"end":550},{"text":"14.98","label":"LAB_VALUE","start":555,"end":560},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":582,"end":592},{"text":"10.9","label":"LAB_VALUE","start":603,"end":607},{"text":"neutro-phil count","label":"DIAGNOSTIC_PROCEDURE","start":609,"end":626},{"text":"13.14","label":"LAB_VALUE","start":631,"end":636},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":638,"end":652},{"text":"473","label":"LAB_VALUE","start":657,"end":660},{"text":"urea","label":"DIAGNOSTIC_PROCEDURE","start":672,"end":676},{"text":"17 mg\/dl","label":"LAB_VALUE","start":687,"end":695},{"text":"BUN","label":"DIAGNOSTIC_PROCEDURE","start":697,"end":700},{"text":"7.94 mg\/dl","label":"LAB_VALUE","start":711,"end":721},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":723,"end":733},{"text":"0.56 mg\/dl","label":"LAB_VALUE","start":744,"end":754},{"text":"AST","label":"DIAGNOSTIC_PROCEDURE","start":756,"end":759},{"text":"20 U\/L","label":"LAB_VALUE","start":764,"end":770},{"text":"ALT","label":"DIAGNOSTIC_PROCEDURE","start":776,"end":779},{"text":"24 U\/L","label":"LAB_VALUE","start":784,"end":790},{"text":"HIV","label":"DIAGNOSTIC_PROCEDURE","start":792,"end":795},{"text":"negative","label":"LAB_VALUE","start":800,"end":808},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":810,"end":819},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":820,"end":830},{"text":"free fluid","label":"SIGN_SYMPTOM","start":847,"end":857},{"text":"right paracolic","label":"BIOLOGICAL_STRUCTURE","start":865,"end":880},{"text":"perihepatic","label":"BIOLOGICAL_STRUCTURE","start":882,"end":893},{"text":"left paracolic","label":"BIOLOGICAL_STRUCTURE","start":895,"end":909},{"text":"gutters","label":"BIOLOGICAL_STRUCTURE","start":910,"end":917},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":922,"end":928},{"text":"air-fluid level","label":"SIGN_SYMPTOM","start":948,"end":963},{"text":"free air","label":"SIGN_SYMPTOM","start":968,"end":976},{"text":"under the diaphragm","label":"BIOLOGICAL_STRUCTURE","start":977,"end":996},{"text":"erect","label":"DETAILED_DESCRIPTION","start":1000,"end":1005},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1006,"end":1015},{"text":"x-ray","label":"DIAGNOSTIC_PROCEDURE","start":1016,"end":1021},{"text":"emergency","label":"DETAILED_DESCRIPTION","start":1023,"end":1032},{"text":"laparotomy","label":"THERAPEUTIC_PROCEDURE","start":1033,"end":1043},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1077,"end":1085},{"text":"perforation","label":"SIGN_SYMPTOM","start":1086,"end":1097},{"text":"sigmoid colon","label":"BIOLOGICAL_STRUCTURE","start":1122,"end":1135},{"text":"descending colon","label":"BIOLOGICAL_STRUCTURE","start":1137,"end":1153},{"text":"transverse colon","label":"BIOLOGICAL_STRUCTURE","start":1159,"end":1175},{"text":"Wide","label":"DETAILED_DESCRIPTION","start":1177,"end":1181},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1182,"end":1191},{"text":"transverse colon","label":"BIOLOGICAL_STRUCTURE","start":1199,"end":1215},{"text":"descending and sigmoid colon","label":"BIOLOGICAL_STRUCTURE","start":1221,"end":1249},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1250,"end":1259},{"text":"Pathergy test","label":"DIAGNOSTIC_PROCEDURE","start":1287,"end":1300},{"text":"positive","label":"LAB_VALUE","start":1305,"end":1313},{"text":"oral","label":"BIOLOGICAL_STRUCTURE","start":1341,"end":1345},{"text":"genital","label":"BIOLOGICAL_STRUCTURE","start":1350,"end":1357},{"text":"aphthous","label":"DETAILED_DESCRIPTION","start":1358,"end":1366},{"text":"ulcers","label":"DISEASE_DISORDER","start":1367,"end":1373},{"text":"4\u20135 times","label":"LAB_VALUE","start":1374,"end":1383},{"text":"within the past year","label":"DATE","start":1384,"end":1404},{"text":"Eye examination","label":"DIAGNOSTIC_PROCEDURE","start":1406,"end":1421},{"text":"normal","label":"LAB_VALUE","start":1435,"end":1441},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1443,"end":1462},{"text":"extensive","label":"DETAILED_DESCRIPTION","start":1472,"end":1481},{"text":"thrombus","label":"DISEASE_DISORDER","start":1482,"end":1490},{"text":"inferior vena cava","label":"BIOLOGICAL_STRUCTURE","start":1502,"end":1520},{"text":"right and middle hepatic vein","label":"BIOLOGICAL_STRUCTURE","start":1543,"end":1572},{"text":"corticosteroid","label":"MEDICATION","start":1606,"end":1620},{"text":"anticoagulant","label":"MEDICATION","start":1622,"end":1635},{"text":"immunosuppressive therapy","label":"THERAPEUTIC_PROCEDURE","start":1641,"end":1666},{"text":"alive","label":"SIGN_SYMPTOM","start":1689,"end":1694},{"text":"healthy","label":"SIGN_SYMPTOM","start":1699,"end":1706},{"text":"53 weeks later","label":"DATE","start":1707,"end":1721},{"text":"macroscopy","label":"DIAGNOSTIC_PROCEDURE","start":1737,"end":1747},{"text":"transverse colon","label":"DIAGNOSTIC_PROCEDURE","start":1753,"end":1769},{"text":"50 cm","label":"DISTANCE","start":1774,"end":1779},{"text":"sigmoid","label":"LAB_VALUE","start":1784,"end":1791},{"text":"descending colon specimens","label":"DIAGNOSTIC_PROCEDURE","start":1796,"end":1822},{"text":"27 cm","label":"DISTANCE","start":1828,"end":1833},{"text":"Specimens of both colon segments","label":"DIAGNOSTIC_PROCEDURE","start":1845,"end":1877},{"text":"4 cm","label":"DISTANCE","start":1883,"end":1887},{"text":"Perforation","label":"DISEASE_DISORDER","start":1901,"end":1912},{"text":"serosal surface","label":"BIOLOGICAL_STRUCTURE","start":1939,"end":1954},{"text":"Colonic wall","label":"BIOLOGICAL_STRUCTURE","start":1956,"end":1968},{"text":"bowel mucosa","label":"BIOLOGICAL_STRUCTURE","start":1973,"end":1985},{"text":"edematous","label":"SIGN_SYMPTOM","start":1990,"end":1999},{"text":"hyperemic","label":"SIGN_SYMPTOM","start":2004,"end":2013},{"text":"Plicae","label":"DIAGNOSTIC_PROCEDURE","start":2015,"end":2021},{"text":"regular","label":"LAB_VALUE","start":2027,"end":2034},{"text":"3","label":"LAB_VALUE","start":2063,"end":2064},{"text":"roundish","label":"SHAPE","start":2065,"end":2073},{"text":"punched-out","label":"DETAILED_DESCRIPTION","start":2075,"end":2086},{"text":"perforations","label":"DISEASE_DISORDER","start":2087,"end":2099},{"text":"transverse colon","label":"BIOLOGICAL_STRUCTURE","start":2107,"end":2123},{"text":"4","label":"LAB_VALUE","start":2128,"end":2129},{"text":"descending and sigmoid colon","label":"BIOLOGICAL_STRUCTURE","start":2137,"end":2165},{"text":"separate from the colonic wall","label":"DETAILED_DESCRIPTION","start":2187,"end":2217},{"text":"largest being 2 cm","label":"DISTANCE","start":2228,"end":2246},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":2282,"end":2290},{"text":"ulcers","label":"DISEASE_DISORDER","start":2291,"end":2297},{"text":"largest was 1 cm","label":"DISTANCE","start":2303,"end":2319},{"text":"not merging together","label":"DETAILED_DESCRIPTION","start":2368,"end":2388},{"text":"somewhat separate from the surrounding mucosa via a certain limit","label":"DETAILED_DESCRIPTION","start":2399,"end":2464},{"text":"covered with exudate","label":"DETAILED_DESCRIPTION","start":2466,"end":2486},{"text":"surrounded","label":"DETAILED_DESCRIPTION","start":2491,"end":2501},{"text":"hyperemic region","label":"SIGN_SYMPTOM","start":2507,"end":2523},{"text":"macroscopic lymph nodes","label":"SIGN_SYMPTOM","start":2539,"end":2562},{"text":"serosa","label":"BIOLOGICAL_STRUCTURE","start":2570,"end":2576},{"text":"microscopic tissue follow-up","label":"DIAGNOSTIC_PROCEDURE","start":2702,"end":2730},{"text":"Hematoxylin-eosin","label":"DIAGNOSTIC_PROCEDURE","start":2732,"end":2749},{"text":"tissue Giemsa","label":"DIAGNOSTIC_PROCEDURE","start":2751,"end":2764},{"text":"PAS-stained slides","label":"DIAGNOSTIC_PROCEDURE","start":2769,"end":2787},{"text":"microscopic examination","label":"COREFERENCE","start":2822,"end":2845},{"text":"neutrophil leukocyte","label":"BIOLOGICAL_STRUCTURE","start":2858,"end":2878},{"text":"lymphocyte","label":"BIOLOGICAL_STRUCTURE","start":2883,"end":2893},{"text":"reaction","label":"SIGN_SYMPTOM","start":2894,"end":2902},{"text":"walls and lumens of arterioles","label":"BIOLOGICAL_STRUCTURE","start":2925,"end":2955},{"text":"venules","label":"SIGN_SYMPTOM","start":2961,"end":2968},{"text":"perforated","label":"DETAILED_DESCRIPTION","start":2980,"end":2990},{"text":"ulcerated","label":"DETAILED_DESCRIPTION","start":2995,"end":3004},{"text":"lesions","label":"SIGN_SYMPTOM","start":3005,"end":3012},{"text":"well-organized","label":"DETAILED_DESCRIPTION","start":3050,"end":3064},{"text":"thrombi","label":"SIGN_SYMPTOM","start":3065,"end":3072},{"text":"intimal proliferation","label":"SIGN_SYMPTOM","start":3077,"end":3098},{"text":"some vessels","label":"BIOLOGICAL_STRUCTURE","start":3106,"end":3118},{"text":"acute","label":"DETAILED_DESCRIPTION","start":3162,"end":3167},{"text":"peritonitis","label":"DISEASE_DISORDER","start":3168,"end":3179},{"text":"Surface epithelium","label":"DIAGNOSTIC_PROCEDURE","start":3181,"end":3199},{"text":"colonic crypts","label":"DIAGNOSTIC_PROCEDURE","start":3204,"end":3218},{"text":"regular","label":"LAB_VALUE","start":3224,"end":3231},{"text":"colonic mucosa","label":"BIOLOGICAL_STRUCTURE","start":3243,"end":3257},{"text":"parasites","label":"DISEASE_DISORDER","start":3327,"end":3336}],"tokens":["A ","38-year-old"," ","woman"," ","presented"," to our ","Emergency Department"," with ","severe"," ","abdominal"," ","pain",".\nShe had ","no history of drug use or constipation",".\nShe said that she had ","intermittent"," ","bloody"," ","diarrhea",".\n","Physical examination"," revealed ","rebound"," ","tenderness"," and ","guarding"," over the ","abdomen",".\n","Stool microscopy"," was ","negative"," for ","amoeba trophozoites"," or any ","parasites",".\n","Fecal occult blood"," was ","found",".\n","Sedimentation"," was ","27 mm\/s",", ","CRP"," (","nephelometry",") was ","65.6 mg\/L"," (normal range 0\u20135), ","anti-nuclear antibody"," was ","0.4"," (0\u20130.8 negative), ","anti-ds DNA"," ","<10"," (<20 negative), ","white blood cell count"," was ","14.98"," (normal range 4\u201310), ","hemoglobin"," level was ","10.9",", ","neutro-phil count"," was ","13.14",", ","platelet count"," was ","473"," (100\u2013300), ","urea"," level was ","17 mg\/dl",", ","BUN"," level was ","7.94 mg\/dl",", ","creatinine"," level was ","0.56 mg\/dl",", ","AST"," was ","20 U\/L",", and ","ALT"," was ","24 U\/L",".\n","HIV"," was ","negative",".\n","Abdominal"," ","ultrasound"," scanning showed ","free fluid"," at the ","right paracolic",", ","perihepatic",", ","left paracolic"," ","gutters"," and ","pelvis",".\nUpon detection of ","air-fluid level"," and ","free air"," ","under the diaphragm"," on ","erect"," ","abdominal"," ","x-ray",", ","emergency"," ","laparotomy"," was performed.\nIn the operation, ","multiple"," ","perforation"," areas were found in the ","sigmoid colon",", ","descending colon",", and ","transverse colon",".\n","Wide"," ","resection"," of the ","transverse colon"," with ","descending and sigmoid colon"," ","resection"," was undertaken (Figure 1).\n","Pathergy test"," was ","positive",".\nThe patient had recurrent ","oral"," and ","genital"," ","aphthous"," ","ulcers"," ","4\u20135 times"," ","within the past year",".\n","Eye examination"," results were ","normal",".\n","Computed tomography"," revealed ","extensive"," ","thrombus"," within the ","inferior vena cava"," extending through the ","right and middle hepatic vein"," (Figure 2).\nThe patient received ","corticosteroid",", ","anticoagulant",", and ","immunosuppressive therapy",".\nOur patient is still ","alive"," and ","healthy"," ","53 weeks later"," (Figure 3).\nIn ","macroscopy",", the ","transverse colon"," was ","50 cm"," and ","sigmoid"," and ","descending colon specimens"," were ","27 cm"," in length.\n","Specimens of both colon segments"," were ","4 cm"," in diameter.\n","Perforation"," areas were evident in the ","serosal surface",".\n","Colonic wall"," and ","bowel mucosa"," was ","edematous"," and ","hyperemic",".\n","Plicae"," were ","regular"," in their course.\nThere were ","3"," ","roundish",", ","punched-out"," ","perforations"," in the ","transverse colon"," and ","4"," in the ","descending and sigmoid colon",", which were somewhat ","separate from the colonic wall",", with the ","largest being 2 cm"," in diameter (Figure 4).\nThere were ","multiple"," ","ulcers"," (the ","largest was 1 cm"," in diameter) in different locations, which were ","not merging together",", and were ","somewhat separate from the surrounding mucosa via a certain limit",", ","covered with exudate"," and ","surrounded"," by a ","hyperemic region",".\nThere were no ","macroscopic lymph nodes"," in the ","serosa",".\nNumerous samples were taken from ulcerated and perforated regions and normal mucosa.\nThe samples were submitted for routine ","microscopic tissue follow-up",".\n","Hematoxylin-eosin",", ","tissue Giemsa"," and ","PAS-stained slides"," were prepared for examination.\nIn ","microscopic examination",", there were ","neutrophil leukocyte"," and ","lymphocyte"," ","reaction"," around and within the ","walls and lumens of arterioles",", and ","venules"," around the ","perforated"," and ","ulcerated"," ","lesions"," (Figures 5 and \u200band6).6).\nThere were ","well-organized"," ","thrombi"," and ","intimal proliferation"," within ","some vessels"," (Figures 7 and \u200band8).8).\nThere was marked ","acute"," ","peritonitis",".\n","Surface epithelium"," and ","colonic crypts"," were ","regular"," within the ","colonic mucosa"," apart from the ulcerated or perforated lesions.\nSamples were free of ","parasites"," or their eggs.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,63,0,12,0,69,0,39,0,22,0,22,0,69,0,24,0,22,0,69,0,69,0,12,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,12,0,12,0,12,0,12,0,12,0,69,0,69,0,12,0,22,0,12,0,24,0,22,0,75,0,22,0,69,0,12,0,12,0,12,0,22,0,75,0,12,0,12,0,75,0,24,0,42,0,12,0,12,0,22,0,26,0,42,0,19,0,24,0,42,0,24,0,22,0,26,0,12,0,12,0,46,0,46,0,75,0,69,0,69,0,19,0,24,0,24,0,27,0,42,0,24,0,27,0,24,0,27,0,26,0,12,0,12,0,12,0,69,0,69,0,24,0,42,0,42,0,67,0,22,0,26,0,12,0,42,0,12,0,22,0,27,0,22,0,26,0,27,0,22,0,22,0,22,0,22,0,69,0,69,0,12,0,24,0,24,0,24,0,24,0,18,0,12,0,12,0,69,0,12,0,69,0,22,0,22,0,69,0,22,0,69,0,69,0,12,0,22,0,26,0,24,0,24,0,42,0,12,0,26,0]}
-{"full_text":"The patient was a 38-year-old Caucasian man of Spanish origin.\nHis height was 165 cm and his parents were cousins.\nBoth parents were of normal height and neither showed any minor anomalies of the EvC syndrome spectrum.\nThe patient had two healthy sisters.\nHis morphological features were: (a) normal mouth opening with missing lower incisors (Fig.1); (b) small chest, as determined by a cardiothoracic examination; and (c) disproportionately short extremities with one additional postaxial digit on each hand (Fig.2).\nAlthough no sensory-motor deficit was noted, the patient presented with mild mental retardation.\nGenetic analysis in his early infancy showed a previously reported homozygous nonsense mutation c.1195 C1T, p.Arg399X of EvC2, resulting in loss of function of the protein.(5) His parents were heterozygous carriers of the mutation.\nIn 1998, the patient underwent successful ostium primum atrial septal defect closure through a midsternotomy.\nHe re-presented with embolic cerebral ictus in 2007, and cavotricuspid isthmus ablation for common atrial flutter was performed successfully.\nThere were no serious aftereffects.\nDuring a routine examination in 2012, a high-pitched systolic murmur was discovered.\nElectrocardiography showed sinus rhythm with hemiblock and right bundle branch block, while echocardiography revealed a dilated and hypertrophic left ventricle.\nThese abnormalities produced a flow that was directed to the left atrial appendage, leading to severe mitral valve regurgitation.\nThe patient\u2019s systolic pulmonary artery pressure was 50 mmHg and his aortic valve was normal.\nHis medical treatment included ramipril, duloxetine, alprazolam and acenocumarol.\nThe patient was scheduled for mitral valve surgery.\nIn the operating theatre, the patient\u2019s right femoral artery was cannulated.\nA right thoracotomy was performed on the fourth intercostal space and bicaval cannulation was established.\nBoth veins were excluded.\nThe operation used a normothermic cardiopulmonary bypass without cross-clamping of the aorta in the beating heart.\nTo avoid air embolisms, continuous carbon dioxide (CO2) field flooding was applied using a CarbonAid CO2 diffuser (Cardia Innovation AB, Stockholm, Sweden).\nThe attempt to perform a mitral valve repair was unsuccessful and a bileaflet mechanical valve (no.29) was implanted.\nNo complications associated with anaesthesia occurred.\nThe patient\u2019s postoperative recovery was uneventful and he was discharged on postoperative day 10.\nAfter two years of follow-up, echocardiography revealed optimal function of the mitral valve and a decrease in systolic pulmonary artery pressure (30 mmHg).\n","ner_info":[{"text":"38-year-old","label":"AGE","start":18,"end":29},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":30,"end":39},{"text":"man","label":"SEX","start":40,"end":43},{"text":"Spanish origin","label":"PERSONAL_BACKGROUND","start":47,"end":61},{"text":"165 cm","label":"HEIGHT","start":78,"end":84},{"text":"parents were cousins","label":"FAMILY_HISTORY","start":93,"end":113},{"text":"Both parents were of normal height and neither showed any minor anomalies of the EvC syndrome spectrum","label":"FAMILY_HISTORY","start":115,"end":217},{"text":"The patient had two healthy sisters","label":"FAMILY_HISTORY","start":219,"end":254},{"text":"morphological features","label":"DIAGNOSTIC_PROCEDURE","start":260,"end":282},{"text":"normal mouth opening","label":"SIGN_SYMPTOM","start":293,"end":313},{"text":"missing lower incisors","label":"SIGN_SYMPTOM","start":319,"end":341},{"text":"small chest","label":"SIGN_SYMPTOM","start":355,"end":366},{"text":"cardiothoracic examination","label":"DIAGNOSTIC_PROCEDURE","start":387,"end":413},{"text":"short extremities","label":"SIGN_SYMPTOM","start":442,"end":459},{"text":"one","label":"DETAILED_DESCRIPTION","start":465,"end":468},{"text":"additional postaxial digit","label":"SIGN_SYMPTOM","start":469,"end":495},{"text":"each hand","label":"BIOLOGICAL_STRUCTURE","start":499,"end":508},{"text":"sensory-motor deficit","label":"SIGN_SYMPTOM","start":530,"end":551},{"text":"mild","label":"DETAILED_DESCRIPTION","start":590,"end":594},{"text":"mental retardation","label":"DISEASE_DISORDER","start":595,"end":613},{"text":"Genetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":615,"end":631},{"text":"homozygous","label":"DETAILED_DESCRIPTION","start":682,"end":692},{"text":"nonsense","label":"DETAILED_DESCRIPTION","start":693,"end":701},{"text":"mutation","label":"SIGN_SYMPTOM","start":702,"end":710},{"text":"c.1195 C1T, p.Arg399X of EvC2","label":"DETAILED_DESCRIPTION","start":711,"end":740},{"text":"loss of function of the protein","label":"DETAILED_DESCRIPTION","start":755,"end":786},{"text":"parents","label":"SUBJECT","start":795,"end":802},{"text":"heterozygous carriers","label":"DETAILED_DESCRIPTION","start":808,"end":829},{"text":"mutation","label":"COREFERENCE","start":837,"end":845},{"text":"1998","label":"DATE","start":850,"end":854},{"text":"ostium primum","label":"BIOLOGICAL_STRUCTURE","start":889,"end":902},{"text":"atrial septal defect closure","label":"THERAPEUTIC_PROCEDURE","start":903,"end":931},{"text":"midsternotomy","label":"THERAPEUTIC_PROCEDURE","start":942,"end":955},{"text":"re-presented","label":"CLINICAL_EVENT","start":960,"end":972},{"text":"embolic","label":"DETAILED_DESCRIPTION","start":978,"end":985},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":986,"end":994},{"text":"ictus","label":"SIGN_SYMPTOM","start":995,"end":1000},{"text":"2007","label":"DATE","start":1004,"end":1008},{"text":"cavotricuspid isthmus","label":"BIOLOGICAL_STRUCTURE","start":1014,"end":1035},{"text":"ablation","label":"THERAPEUTIC_PROCEDURE","start":1036,"end":1044},{"text":"common","label":"DETAILED_DESCRIPTION","start":1049,"end":1055},{"text":"atrial flutter","label":"DISEASE_DISORDER","start":1056,"end":1070},{"text":"serious","label":"SEVERITY","start":1113,"end":1120},{"text":"aftereffects","label":"SIGN_SYMPTOM","start":1121,"end":1133},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":1152,"end":1163},{"text":"2012","label":"DATE","start":1167,"end":1171},{"text":"high-pitched","label":"DETAILED_DESCRIPTION","start":1175,"end":1187},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":1188,"end":1196},{"text":"murmur","label":"SIGN_SYMPTOM","start":1197,"end":1203},{"text":"Electrocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1220,"end":1239},{"text":"sinus rhythm","label":"LAB_VALUE","start":1247,"end":1259},{"text":"hemiblock","label":"DISEASE_DISORDER","start":1265,"end":1274},{"text":"right bundle branch block","label":"DISEASE_DISORDER","start":1279,"end":1304},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1312,"end":1328},{"text":"dilated","label":"SIGN_SYMPTOM","start":1340,"end":1347},{"text":"hypertrophic","label":"SIGN_SYMPTOM","start":1352,"end":1364},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":1365,"end":1379},{"text":"flow","label":"SIGN_SYMPTOM","start":1412,"end":1416},{"text":"directed to the left atrial appendage","label":"BIOLOGICAL_STRUCTURE","start":1426,"end":1463},{"text":"mitral valve regurgitation","label":"SIGN_SYMPTOM","start":1483,"end":1509},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":1525,"end":1533},{"text":"pulmonary artery pressure","label":"DIAGNOSTIC_PROCEDURE","start":1534,"end":1559},{"text":"50 mmHg","label":"LAB_VALUE","start":1564,"end":1571},{"text":"aortic valve was normal","label":"SIGN_SYMPTOM","start":1580,"end":1603},{"text":"ramipril","label":"MEDICATION","start":1636,"end":1644},{"text":"duloxetine","label":"MEDICATION","start":1646,"end":1656},{"text":"alprazolam","label":"MEDICATION","start":1658,"end":1668},{"text":"acenocumarol","label":"MEDICATION","start":1673,"end":1685},{"text":"mitral valve surgery","label":"THERAPEUTIC_PROCEDURE","start":1717,"end":1737},{"text":"right femoral artery","label":"BIOLOGICAL_STRUCTURE","start":1779,"end":1799},{"text":"cannulated","label":"THERAPEUTIC_PROCEDURE","start":1804,"end":1814},{"text":"right","label":"DETAILED_DESCRIPTION","start":1818,"end":1823},{"text":"thoracotomy","label":"THERAPEUTIC_PROCEDURE","start":1824,"end":1835},{"text":"fourth intercostal space","label":"BIOLOGICAL_STRUCTURE","start":1857,"end":1881},{"text":"bicaval","label":"DETAILED_DESCRIPTION","start":1886,"end":1893},{"text":"cannulation","label":"THERAPEUTIC_PROCEDURE","start":1894,"end":1905},{"text":"Both veins were excluded","label":"DETAILED_DESCRIPTION","start":1923,"end":1947},{"text":"normothermic","label":"DETAILED_DESCRIPTION","start":1970,"end":1982},{"text":"cardiopulmonary bypass","label":"THERAPEUTIC_PROCEDURE","start":1983,"end":2005},{"text":"without cross-clamping of the aorta in the beating heart","label":"DETAILED_DESCRIPTION","start":2006,"end":2062},{"text":"continuous carbon dioxide (CO2) field flooding","label":"THERAPEUTIC_PROCEDURE","start":2088,"end":2134},{"text":"CarbonAid CO2 diffuser","label":"DETAILED_DESCRIPTION","start":2155,"end":2177},{"text":"Cardia Innovation AB, Stockholm, Sweden","label":"DETAILED_DESCRIPTION","start":2179,"end":2218},{"text":"mitral valve repair","label":"THERAPEUTIC_PROCEDURE","start":2246,"end":2265},{"text":"bileaflet mechanical valve","label":"DETAILED_DESCRIPTION","start":2289,"end":2315},{"text":"no.29","label":"DETAILED_DESCRIPTION","start":2317,"end":2322},{"text":"implanted","label":"THERAPEUTIC_PROCEDURE","start":2328,"end":2337},{"text":"complications","label":"SIGN_SYMPTOM","start":2342,"end":2355},{"text":"associated with anaesthesia","label":"DETAILED_DESCRIPTION","start":2356,"end":2383},{"text":"postoperative recovery","label":"THERAPEUTIC_PROCEDURE","start":2408,"end":2430},{"text":"uneventful","label":"LAB_VALUE","start":2435,"end":2445},{"text":"discharged","label":"CLINICAL_EVENT","start":2457,"end":2467},{"text":"postoperative day 10","label":"DATE","start":2471,"end":2491},{"text":"two years","label":"DURATION","start":2499,"end":2508},{"text":"follow-up","label":"CLINICAL_EVENT","start":2512,"end":2521},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":2523,"end":2539},{"text":"optimal function","label":"LAB_VALUE","start":2549,"end":2565},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":2573,"end":2585},{"text":"decrease","label":"LAB_VALUE","start":2592,"end":2600},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":2604,"end":2612},{"text":"pulmonary artery pressure","label":"DIAGNOSTIC_PROCEDURE","start":2613,"end":2638},{"text":"30 mmHg","label":"LAB_VALUE","start":2640,"end":2647}],"tokens":["The patient was a ","38-year-old"," ","Caucasian"," ","man"," of ","Spanish origin",".\nHis height was ","165 cm"," and his ","parents were cousins",".\n","Both parents were of normal height and neither showed any minor anomalies of the EvC syndrome spectrum",".\n","The patient had two healthy sisters",".\nHis ","morphological features"," were: (a) ","normal mouth opening"," with ","missing lower incisors"," (Fig.1); (b) ","small chest",", as determined by a ","cardiothoracic examination","; and (c) disproportionately ","short extremities"," with ","one"," ","additional postaxial digit"," on ","each hand"," (Fig.2).\nAlthough no ","sensory-motor deficit"," was noted, the patient presented with ","mild"," ","mental retardation",".\n","Genetic analysis"," in his early infancy showed a previously reported ","homozygous"," ","nonsense"," ","mutation"," ","c.1195 C1T, p.Arg399X of EvC2",", resulting in ","loss of function of the protein",".(5) His ","parents"," were ","heterozygous carriers"," of the ","mutation",".\nIn ","1998",", the patient underwent successful ","ostium primum"," ","atrial septal defect closure"," through a ","midsternotomy",".\nHe ","re-presented"," with ","embolic"," ","cerebral"," ","ictus"," in ","2007",", and ","cavotricuspid isthmus"," ","ablation"," for ","common"," ","atrial flutter"," was performed successfully.\nThere were no ","serious"," ","aftereffects",".\nDuring a routine ","examination"," in ","2012",", a ","high-pitched"," ","systolic"," ","murmur"," was discovered.\n","Electrocardiography"," showed ","sinus rhythm"," with ","hemiblock"," and ","right bundle branch block",", while ","echocardiography"," revealed a ","dilated"," and ","hypertrophic"," ","left ventricle",".\nThese abnormalities produced a ","flow"," that was ","directed to the left atrial appendage",", leading to severe ","mitral valve regurgitation",".\nThe patient\u2019s ","systolic"," ","pulmonary artery pressure"," was ","50 mmHg"," and his ","aortic valve was normal",".\nHis medical treatment included ","ramipril",", ","duloxetine",", ","alprazolam"," and ","acenocumarol",".\nThe patient was scheduled for ","mitral valve surgery",".\nIn the operating theatre, the patient\u2019s ","right femoral artery"," was ","cannulated",".\nA ","right"," ","thoracotomy"," was performed on the ","fourth intercostal space"," and ","bicaval"," ","cannulation"," was established.\n","Both veins were excluded",".\nThe operation used a ","normothermic"," ","cardiopulmonary bypass"," ","without cross-clamping of the aorta in the beating heart",".\nTo avoid air embolisms, ","continuous carbon dioxide (CO2) field flooding"," was applied using a ","CarbonAid CO2 diffuser"," (","Cardia Innovation AB, Stockholm, Sweden",").\nThe attempt to perform a ","mitral valve repair"," was unsuccessful and a ","bileaflet mechanical valve"," (","no.29",") was ","implanted",".\nNo ","complications"," ","associated with anaesthesia"," occurred.\nThe patient\u2019s ","postoperative recovery"," was ","uneventful"," and he was ","discharged"," on ","postoperative day 10",".\nAfter ","two years"," of ","follow-up",", ","echocardiography"," revealed ","optimal function"," of the ","mitral valve"," and a ","decrease"," in ","systolic"," ","pulmonary artery pressure"," (","30 mmHg",").\n"],"ner_labels":[0,5,0,58,0,65,0,58,0,38,0,34,0,34,0,34,0,24,0,69,0,69,0,69,0,24,0,69,0,22,0,69,0,12,0,69,0,22,0,26,0,24,0,22,0,22,0,69,0,22,0,22,0,71,0,22,0,18,0,19,0,12,0,75,0,75,0,13,0,22,0,12,0,69,0,19,0,12,0,75,0,22,0,26,0,63,0,69,0,24,0,19,0,22,0,22,0,69,0,24,0,42,0,26,0,26,0,24,0,69,0,69,0,12,0,69,0,12,0,69,0,22,0,24,0,42,0,69,0,46,0,46,0,46,0,46,0,75,0,12,0,75,0,22,0,75,0,12,0,22,0,75,0,22,0,22,0,75,0,22,0,75,0,22,0,22,0,75,0,22,0,22,0,75,0,69,0,22,0,75,0,42,0,13,0,19,0,32,0,13,0,24,0,42,0,12,0,42,0,22,0,24,0,42,0]}
-{"full_text":"In March 2009, a 21-year-old man was admitted to another institution with symptoms of intermittent fever, headache, polyarthralgias, skin rash over the trunk, and petechiae in the fingers and palms.\nThe patient was previously healthy, had no history of drug abuse, and took no regular medication.\nHe also had no pets and had not traveled recently.\nHe had been in his usual state of health until one month before admission, when intermittent high fever developed (maximum axillary temperature, >39 \u00b0C).\nIn addition, he reported headaches, bilateral and symmetric arthralgia on the wrists and hands (with an inflammatory pattern), petechiae over the palms and fingers, salmon-colored rash on the trunk, nausea, and vomiting.\nAn evanescent, salmon-colored rash was observed on his chest and abdomen, and 2-mm petechiae covered the palms and the fingers.\nNo signs suggested arthritis, and there was no lymphadenopathy or hepatosplenomegaly.\nBlood testing showed elevated inflammatory markers (Table II).\nThe electrocardiographic (ECG) and chest radiographic results were normal.\nIbuprofen (1,200 mg\/d) and acetaminophen (as needed) were begun and provided symptomatic relief.\nAn extensive evaluation was performed, including blood cultures, viral and bacterial serologic studies, immunologic screening (rheumatoid factor and antinuclear antibodies), and computed tomographic (CT) studies of the chest, abdomen, pelvis, and cranium.\nNo significant changes were found.\nHowever, a transthoracic echocardiogram (TTE) showed circumferential, mild pericardial effusion (maximal diameter, 8 mm), with no signs of tamponade or other relevant findings.\nA few days later, dyspnea and diffuse chest pain developed.\nThe pain was relieved by chest anteflexion and aggravated by deep inspiration and by lying supine.\nThe patient was hypotensive, tachycardic, and hyperpneic, and he manifested jugular venous distention.\nThe ECG showed sinus tachycardia and diffuse ST-segment elevation (Fig.1), the chest radiograph revealed an enlarged cardiac silhouette (Fig.2), and the inflammatory markers were again elevated (Table II).\nA repeat TTE showed an increase in the pericardial effusion (maximal diameter, 12 mm) (Fig.3) and collapse of the right heart chambers.\nEmergency pericardiocentesis drained 60 mL of serosanguineous fluid.\nWhen repeated, CT of the chest and abdomen revealed mild right and severe left pleural effusion, as well as mild ascites.\nThoracocentesis was then performed, during which 350 mL of serosanguineous pleural fluid was drained.\nBoth heart and lung fluids were exudates that yielded negative microbiologic examination and were unremarkable upon histologic analysis.\nThe diagnosis of AOSD was established, and the patient was medicated with prednisone (0.5 mg\/kg\/d), with major clinical and laboratory improvement (Table II).\nThere was also ST-segment normalization, and the follow-up echocardiogram showed only mild pericardial effusion (2\u20133 mm), without hemodynamic compromise.\nScreening for autoimmune and infectious disorders was repeated, and no significant changes were found.\nThe patient was discharged from the hospital on a regimen of prednisone.\nThere was a recurrence of pericardial and pleural effusion 2 months after discharge (after corticosteroid weaning and withdrawal), which was resolved by resuming the prednisone therapy.\nTen months after discharge, the patient presented at our institution for a follow-up visit.\nHe was asymptomatic and was maintained on corticosteroid therapy.\nFollow-up ECG and TTE showed no significant changes (Figs.4 and \u200b5).\n","ner_info":[{"text":"March 2009","label":"DATE","start":3,"end":13},{"text":"21-year-old","label":"AGE","start":17,"end":28},{"text":"man","label":"SEX","start":29,"end":32},{"text":"admitted","label":"ACTIVITY","start":37,"end":45},{"text":"another institution","label":"NONBIOLOGICAL_LOCATION","start":49,"end":68},{"text":"intermittent","label":"FREQUENCY","start":86,"end":98},{"text":"fever","label":"SIGN_SYMPTOM","start":99,"end":104},{"text":"headache","label":"SIGN_SYMPTOM","start":106,"end":114},{"text":"polyarthralgias","label":"SIGN_SYMPTOM","start":116,"end":131},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":133,"end":137},{"text":"rash","label":"SIGN_SYMPTOM","start":138,"end":142},{"text":"trunk","label":"BIOLOGICAL_STRUCTURE","start":152,"end":157},{"text":"petechiae","label":"SIGN_SYMPTOM","start":163,"end":172},{"text":"fingers","label":"BIOLOGICAL_STRUCTURE","start":180,"end":187},{"text":"palms","label":"BIOLOGICAL_STRUCTURE","start":192,"end":197},{"text":"previously healthy","label":"HISTORY","start":215,"end":233},{"text":"no history of drug abuse","label":"HISTORY","start":239,"end":263},{"text":"no regular medication","label":"HISTORY","start":274,"end":295},{"text":"no pets","label":"HISTORY","start":309,"end":316},{"text":"had not traveled recently","label":"HISTORY","start":321,"end":346},{"text":"one month before","label":"DATE","start":395,"end":411},{"text":"admission","label":"ACTIVITY","start":412,"end":421},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":428,"end":440},{"text":"high","label":"SEVERITY","start":441,"end":445},{"text":"fever","label":"SIGN_SYMPTOM","start":446,"end":451},{"text":"maximum axillary temperature","label":"DIAGNOSTIC_PROCEDURE","start":463,"end":491},{"text":">39 \u00b0C","label":"QUANTITATIVE_CONCEPT","start":493,"end":499},{"text":"headaches","label":"SIGN_SYMPTOM","start":527,"end":536},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":538,"end":547},{"text":"symmetric","label":"DETAILED_DESCRIPTION","start":552,"end":561},{"text":"arthralgia","label":"SIGN_SYMPTOM","start":562,"end":572},{"text":"wrists","label":"BIOLOGICAL_STRUCTURE","start":580,"end":586},{"text":"hands","label":"BIOLOGICAL_STRUCTURE","start":591,"end":596},{"text":"inflammatory pattern","label":"DETAILED_DESCRIPTION","start":606,"end":626},{"text":"petechiae","label":"SIGN_SYMPTOM","start":629,"end":638},{"text":"palms","label":"BIOLOGICAL_STRUCTURE","start":648,"end":653},{"text":"fingers","label":"BIOLOGICAL_STRUCTURE","start":658,"end":665},{"text":"salmon-colored","label":"COLOR","start":667,"end":681},{"text":"rash","label":"SIGN_SYMPTOM","start":682,"end":686},{"text":"trunk","label":"BIOLOGICAL_STRUCTURE","start":694,"end":699},{"text":"nausea","label":"SIGN_SYMPTOM","start":701,"end":707},{"text":"vomiting","label":"SIGN_SYMPTOM","start":713,"end":721},{"text":"evanescent","label":"DETAILED_DESCRIPTION","start":726,"end":736},{"text":"salmon-colored","label":"COLOR","start":738,"end":752},{"text":"rash","label":"SIGN_SYMPTOM","start":753,"end":757},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":778,"end":783},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":788,"end":795},{"text":"2-mm","label":"DISTANCE","start":801,"end":805},{"text":"petechiae","label":"SIGN_SYMPTOM","start":806,"end":815},{"text":"palms","label":"BIOLOGICAL_STRUCTURE","start":828,"end":833},{"text":"fingers","label":"BIOLOGICAL_STRUCTURE","start":842,"end":849},{"text":"arthritis","label":"DISEASE_DISORDER","start":870,"end":879},{"text":"lymphadenopathy","label":"SIGN_SYMPTOM","start":898,"end":913},{"text":"hepatosplenomegaly","label":"SIGN_SYMPTOM","start":917,"end":935},{"text":"Blood 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needed","label":"DOSAGE","start":1117,"end":1126},{"text":"symptomatic","label":"SIGN_SYMPTOM","start":1152,"end":1163},{"text":"evaluation","label":"DIAGNOSTIC_PROCEDURE","start":1185,"end":1195},{"text":"blood cultures","label":"DIAGNOSTIC_PROCEDURE","start":1221,"end":1235},{"text":"viral and bacterial","label":"DETAILED_DESCRIPTION","start":1237,"end":1256},{"text":"serologic studies","label":"DIAGNOSTIC_PROCEDURE","start":1257,"end":1274},{"text":"immunologic screening","label":"DIAGNOSTIC_PROCEDURE","start":1276,"end":1297},{"text":"rheumatoid factor","label":"DIAGNOSTIC_PROCEDURE","start":1299,"end":1316},{"text":"antinuclear antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1321,"end":1343},{"text":"computed tomographic","label":"DIAGNOSTIC_PROCEDURE","start":1350,"end":1370},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1372,"end":1374},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1391,"end":1396},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1398,"end":1405},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":1407,"end":1413},{"text":"cranium","label":"BIOLOGICAL_STRUCTURE","start":1419,"end":1426},{"text":"No significant changes","label":"LAB_VALUE","start":1428,"end":1450},{"text":"transthoracic echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1474,"end":1502},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":1504,"end":1507},{"text":"circumferential","label":"DETAILED_DESCRIPTION","start":1516,"end":1531},{"text":"mild","label":"SEVERITY","start":1533,"end":1537},{"text":"pericardial effusion","label":"SIGN_SYMPTOM","start":1538,"end":1558},{"text":"maximal diameter","label":"DIAGNOSTIC_PROCEDURE","start":1560,"end":1576},{"text":"8 mm","label":"LAB_VALUE","start":1578,"end":1582},{"text":"tamponade","label":"SIGN_SYMPTOM","start":1602,"end":1611},{"text":"A few days later","label":"DATE","start":1640,"end":1656},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1658,"end":1665},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1670,"end":1677},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1678,"end":1683},{"text":"pain","label":"SIGN_SYMPTOM","start":1684,"end":1688},{"text":"pain","label":"SIGN_SYMPTOM","start":1704,"end":1708},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1725,"end":1730},{"text":"anteflexion","label":"ACTIVITY","start":1731,"end":1742},{"text":"deep","label":"DETAILED_DESCRIPTION","start":1761,"end":1765},{"text":"inspiration","label":"ACTIVITY","start":1766,"end":1777},{"text":"lying 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elevation","label":"SIGN_SYMPTOM","start":1947,"end":1967},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1981,"end":1986},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":1987,"end":1997},{"text":"enlarged","label":"SIGN_SYMPTOM","start":2010,"end":2018},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2019,"end":2026},{"text":"inflammatory markers","label":"DIAGNOSTIC_PROCEDURE","start":2055,"end":2075},{"text":"elevated","label":"LAB_VALUE","start":2087,"end":2095},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":2117,"end":2120},{"text":"pericardial effusion","label":"SIGN_SYMPTOM","start":2147,"end":2167},{"text":"12 mm","label":"DISTANCE","start":2187,"end":2192},{"text":"collapse","label":"SIGN_SYMPTOM","start":2206,"end":2214},{"text":"right heart chambers","label":"BIOLOGICAL_STRUCTURE","start":2222,"end":2242},{"text":"Emergency","label":"DETAILED_DESCRIPTION","start":2244,"end":2253},{"text":"pericardiocentesis","label":"THERAPEUTIC_PROCEDURE","start":2254,"end":2272},{"text":"60 mL","label":"VOLUME","start":2281,"end":2286},{"text":"serosanguineous fluid","label":"SIGN_SYMPTOM","start":2290,"end":2311},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2328,"end":2330},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2338,"end":2343},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":2348,"end":2355},{"text":"mild","label":"SEVERITY","start":2365,"end":2369},{"text":"right","label":"DETAILED_DESCRIPTION","start":2370,"end":2375},{"text":"severe","label":"SEVERITY","start":2380,"end":2386},{"text":"left","label":"DETAILED_DESCRIPTION","start":2387,"end":2391},{"text":"pleural 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after","label":"DATE","start":3222,"end":3236},{"text":"discharge","label":"CLINICAL_EVENT","start":3237,"end":3246},{"text":"corticosteroid","label":"MEDICATION","start":3254,"end":3268},{"text":"prednisone","label":"MEDICATION","start":3329,"end":3339},{"text":"Ten months after","label":"DATE","start":3349,"end":3365},{"text":"presented","label":"ACTIVITY","start":3389,"end":3398},{"text":"institution","label":"NONBIOLOGICAL_LOCATION","start":3406,"end":3417},{"text":"follow-up visit","label":"ACTIVITY","start":3424,"end":3439},{"text":"asymptomatic","label":"OUTCOME","start":3448,"end":3460},{"text":"corticosteroid","label":"MEDICATION","start":3483,"end":3497},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":3517,"end":3520},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":3525,"end":3528},{"text":"no significant changes","label":"LAB_VALUE","start":3536,"end":3558}],"tokens":["In ","March 2009",", a ","21-year-old"," ","man"," was ","admitted"," to ","another institution"," with symptoms of ","intermittent"," ","fever",", ","headache",", ","polyarthralgias",", ","skin"," ","rash"," over the ","trunk",", and ","petechiae"," in the ","fingers"," and ","palms",".\nThe patient was ","previously healthy",", had ","no history of drug abuse",", and took ","no regular medication",".\nHe also had ","no pets"," and ","had not traveled recently",".\nHe had been in his usual state of health until ","one month before"," ","admission",", when ","intermittent"," ","high"," ","fever"," developed (","maximum axillary temperature",", ",">39 \u00b0C",").\nIn addition, he reported ","headaches",", ","bilateral"," and ","symmetric"," ","arthralgia"," on the ","wrists"," and ","hands"," (with an ","inflammatory pattern","), ","petechiae"," over the ","palms"," and ","fingers",", ","salmon-colored"," ","rash"," on the ","trunk",", ","nausea",", and ","vomiting",".\nAn ","evanescent",", ","salmon-colored"," ","rash"," was observed on his ","chest"," and ","abdomen",", and ","2-mm"," ","petechiae"," covered the ","palms"," and the ","fingers",".\nNo signs suggested ","arthritis",", and there was no ","lymphadenopathy"," or ","hepatosplenomegaly",".\n","Blood testing"," showed ","elevated"," ","inflammatory markers"," (Table II).\nThe ","electrocardiographic"," (","ECG",") and ","chest"," ","radiographic"," results were ","normal",".\n","Ibuprofen"," (","1,200 mg\/d",") and ","acetaminophen"," (","as needed",") were begun and provided ","symptomatic"," relief.\nAn extensive ","evaluation"," was performed, including ","blood cultures",", ","viral and bacterial"," ","serologic studies",", ","immunologic screening"," (","rheumatoid factor"," and ","antinuclear antibodies","), and ","computed tomographic"," (","CT",") studies of the ","chest",", ","abdomen",", ","pelvis",", and ","cranium",".\n","No significant changes"," were found.\nHowever, a ","transthoracic echocardiogram"," (","TTE",") showed ","circumferential",", ","mild"," ","pericardial effusion"," (","maximal diameter",", ","8 mm","), with no signs of ","tamponade"," or other relevant findings.\n","A few days later",", ","dyspnea"," and ","diffuse"," ","chest"," ","pain"," developed.\nThe ","pain"," was relieved by ","chest"," ","anteflexion"," and aggravated by ","deep"," ","inspiration"," and by ","lying supine",".\nThe patient was ","hypotensive",", ","tachycardic",", and ","hyperpneic",", and he manifested ","jugular venous"," ","distention",".\nThe ","ECG"," showed ","sinus"," ","tachycardia"," and ","diffuse"," ","ST-segment elevation"," (Fig.1), the ","chest"," ","radiograph"," revealed an ","enlarged"," ","cardiac"," silhouette (Fig.2), and the ","inflammatory markers"," were again ","elevated"," (Table II).\nA repeat ","TTE"," showed an increase in the ","pericardial effusion"," (maximal diameter, ","12 mm",") (Fig.3) and ","collapse"," of the ","right heart chambers",".\n","Emergency"," ","pericardiocentesis"," drained ","60 mL"," of ","serosanguineous fluid",".\nWhen repeated, ","CT"," of the ","chest"," and ","abdomen"," revealed ","mild"," ","right"," and ","severe"," ","left"," ","pleural effusion",", as well as ","mild"," ","ascites",".\n","Thoracocentesis"," was then performed, during which ","350 mL"," of ","serosanguineous pleural fluid"," was drained.\nBoth ","heart"," and ","lung"," ","fluids"," were exudates that yielded ","negative"," ","microbiologic examination"," and were ","unremarkable"," upon ","histologic analysis",".\nThe diagnosis of ","AOSD"," was established, and the patient was ","medicated"," with ","prednisone"," (","0.5 mg\/kg\/d","), with major ","clinical"," and ","laboratory"," ","improvement"," (Table II).\nThere was also ","ST-segment normalization",", and the follow-up ","echocardiogram"," showed only ","mild"," ","pericardial effusion"," (","2\u20133 mm","), without ","hemodynamic compromise",".\n","Screening"," for ","autoimmune"," and ","infectious"," ","disorders"," was repeated, and ","no significant changes"," were found.\nThe patient was ","discharged"," from the ","hospital"," on a regimen of ","prednisone",".\nThere was a recurrence of ","pericardial"," and ","pleural"," ","effusion"," ","2 months after"," ","discharge"," (after ","corticosteroid"," weaning and withdrawal), which was resolved by resuming the ","prednisone"," therapy.\n","Ten months after"," discharge, the patient ","presented"," at our ","institution"," for a ","follow-up visit",".\nHe was ","asymptomatic"," and was maintained on ","corticosteroid"," therapy.\nFollow-up ","ECG"," and ","TTE"," showed ","no significant changes"," (Figs.4 and \u200b5).\n"],"ner_labels":[0,19,0,5,0,65,0,1,0,48,0,35,0,69,0,69,0,69,0,12,0,69,0,12,0,69,0,12,0,12,0,39,0,39,0,39,0,39,0,39,0,19,0,1,0,22,0,63,0,69,0,24,0,62,0,69,0,22,0,22,0,69,0,12,0,12,0,22,0,69,0,12,0,12,0,15,0,69,0,12,0,69,0,69,0,22,0,15,0,69,0,12,0,12,0,27,0,69,0,12,0,12,0,26,0,69,0,69,0,24,0,59,0,24,0,24,0,24,0,12,0,24,0,42,0,46,0,29,0,46,0,29,0,69,0,24,0,24,0,22,0,24,0,24,0,24,0,24,0,24,0,24,0,12,0,12,0,12,0,12,0,42,0,24,0,24,0,22,0,63,0,69,0,24,0,42,0,69,0,19,0,69,0,22,0,12,0,69,0,69,0,12,0,1,0,22,0,1,0,1,0,69,0,69,0,69,0,12,0,69,0,24,0,22,0,69,0,22,0,69,0,12,0,24,0,69,0,12,0,24,0,42,0,24,0,69,0,27,0,69,0,12,0,22,0,75,0,79,0,69,0,24,0,12,0,12,0,63,0,22,0,63,0,22,0,69,0,63,0,69,0,75,0,79,0,69,0,12,0,12,0,22,0,42,0,24,0,42,0,24,0,26,0,46,0,46,0,29,0,22,0,22,0,69,0,69,0,24,0,63,0,69,0,27,0,26,0,24,0,22,0,22,0,26,0,42,0,1,0,48,0,46,0,22,0,22,0,69,0,19,0,13,0,46,0,46,0,19,0,1,0,48,0,1,0,56,0,46,0,24,0,24,0,42,0]}
-{"full_text":"An 11-year-old boy presented with a history of headaches and vomiting that had been present for several months.\nPhysical examination showed papilledema without the presence of any other neurological deficits.\nMagnetic resonance imaging (MRI) revealed a large prepontine mass with dorsal displacement of the brainstem and a secondary obstructive hydrocephalus due to compression of the aqueduct.\nThe lesion had an inhomogeneous hypointense aspect on the T1-weighted image (T1WI) and an inhomogeneous hyperintense aspect on the T2-weighted image (T2WI).\nAfter administration of IV gadolinium, there was some inhomogeneous enhancement (Fig.1).\nComputed tomography (CT) imaging showed no bone involvement.\nDuring the first operation, a ventriculoperitoneal shunt was inserted into the right lateral ventricle to treat the hydrocephalus.\nA careful study of the MRI suggested that this infra- and supratentorially located tumour might be resected through a single approach.\nA left frontotemporal transsylvian approach was performed to gain access to the tumour.\nThe tumour had well-defined margins and was entirely located in the intradural plane.\nThere were no attachments to the cranial nerves or brainstem.\nA macroscopic complete resection was performed.\nPostoperatively, the patient had developed a left oculomotor nerve palsy, which completely recovered within the next 4 weeks.\nThe postoperative MRI showed a complete removal of the tumour (Fig.2).\nAfter careful consideration by a multidisciplinary team, we decided that there was no indication for postoperative radiation therapy.\nAt follow-up one and a half years later, the patient was found to have remained asymptomatic.\nThere were no signs of tumour recurrence on the MRI scan.\nAt a follow-up of more than 6 years after treatment, there were still no signs of tumour recurrence on the MRI scan.\nHistological examination showed a slightly lobulated tumour consisting of a chondromyxoid matrix.\nThe tumour cells showed a vacuolated and pale cytoplasm.\nModerate nuclear polymorphism was observed but no obvious mitotic activity (Fig.3).\nSome calcifications were seen.\nThe tumour cells stained positive for pan-keratin, S-100 and epithelial membrane antigen (EMA).\nThese findings suggest a histopathological diagnosis of chordoma.\n","ner_info":[{"text":"11-year-old","label":"AGE","start":3,"end":14},{"text":"boy","label":"SEX","start":15,"end":18},{"text":"presented","label":"CLINICAL_EVENT","start":19,"end":28},{"text":"headaches","label":"SIGN_SYMPTOM","start":47,"end":56},{"text":"vomiting","label":"SIGN_SYMPTOM","start":61,"end":69},{"text":"several months","label":"DURATION","start":96,"end":110},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":112,"end":132},{"text":"papilledema","label":"DISEASE_DISORDER","start":140,"end":151},{"text":"neurological deficits","label":"DISEASE_DISORDER","start":186,"end":207},{"text":"Magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":209,"end":235},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":237,"end":240},{"text":"large","label":"DETAILED_DESCRIPTION","start":253,"end":258},{"text":"prepontine","label":"BIOLOGICAL_STRUCTURE","start":259,"end":269},{"text":"mass","label":"SIGN_SYMPTOM","start":270,"end":274},{"text":"dorsal","label":"DETAILED_DESCRIPTION","start":280,"end":286},{"text":"displacement","label":"SIGN_SYMPTOM","start":287,"end":299},{"text":"brainstem","label":"BIOLOGICAL_STRUCTURE","start":307,"end":316},{"text":"secondary","label":"DETAILED_DESCRIPTION","start":323,"end":332},{"text":"obstructive","label":"DETAILED_DESCRIPTION","start":333,"end":344},{"text":"hydrocephalus","label":"DISEASE_DISORDER","start":345,"end":358},{"text":"compression","label":"SIGN_SYMPTOM","start":366,"end":377},{"text":"aqueduct","label":"BIOLOGICAL_STRUCTURE","start":385,"end":393},{"text":"lesion","label":"COREFERENCE","start":399,"end":405},{"text":"inhomogeneous","label":"DETAILED_DESCRIPTION","start":413,"end":426},{"text":"hypointense aspect","label":"SIGN_SYMPTOM","start":427,"end":445},{"text":"T1-weighted image","label":"DIAGNOSTIC_PROCEDURE","start":453,"end":470},{"text":"T1WI","label":"DIAGNOSTIC_PROCEDURE","start":472,"end":476},{"text":"inhomogeneous","label":"DETAILED_DESCRIPTION","start":485,"end":498},{"text":"hyperintense aspect","label":"SIGN_SYMPTOM","start":499,"end":518},{"text":"T2-weighted image","label":"DIAGNOSTIC_PROCEDURE","start":526,"end":543},{"text":"T2WI","label":"DIAGNOSTIC_PROCEDURE","start":545,"end":549},{"text":"IV","label":"ADMINISTRATION","start":576,"end":578},{"text":"gadolinium","label":"MEDICATION","start":579,"end":589},{"text":"inhomogeneous","label":"DETAILED_DESCRIPTION","start":606,"end":619},{"text":"enhancement","label":"SIGN_SYMPTOM","start":620,"end":631},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":641,"end":660},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":662,"end":664},{"text":"bone involvement","label":"SIGN_SYMPTOM","start":684,"end":700},{"text":"ventriculoperitoneal","label":"DETAILED_DESCRIPTION","start":732,"end":752},{"text":"shunt","label":"THERAPEUTIC_PROCEDURE","start":753,"end":758},{"text":"right lateral ventricle","label":"BIOLOGICAL_STRUCTURE","start":781,"end":804},{"text":"hydrocephalus","label":"COREFERENCE","start":818,"end":831},{"text":"left","label":"DETAILED_DESCRIPTION","start":970,"end":974},{"text":"frontotemporal","label":"DETAILED_DESCRIPTION","start":975,"end":989},{"text":"transsylvian approach","label":"THERAPEUTIC_PROCEDURE","start":990,"end":1011},{"text":"tumour","label":"SIGN_SYMPTOM","start":1060,"end":1066},{"text":"well-defined margins","label":"DETAILED_DESCRIPTION","start":1071,"end":1091},{"text":"intradural plane","label":"BIOLOGICAL_STRUCTURE","start":1124,"end":1140},{"text":"attachments","label":"SIGN_SYMPTOM","start":1156,"end":1167},{"text":"cranial nerves","label":"BIOLOGICAL_STRUCTURE","start":1175,"end":1189},{"text":"brainstem","label":"BIOLOGICAL_STRUCTURE","start":1193,"end":1202},{"text":"macroscopic","label":"DETAILED_DESCRIPTION","start":1206,"end":1217},{"text":"complete","label":"DETAILED_DESCRIPTION","start":1218,"end":1226},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1227,"end":1236},{"text":"left oculomotor","label":"BIOLOGICAL_STRUCTURE","start":1297,"end":1312},{"text":"nerve palsy","label":"DISEASE_DISORDER","start":1313,"end":1324},{"text":"recovered","label":"SIGN_SYMPTOM","start":1343,"end":1352},{"text":"within the next 4 weeks","label":"DATE","start":1353,"end":1376},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1396,"end":1399},{"text":"complete removal","label":"DETAILED_DESCRIPTION","start":1409,"end":1425},{"text":"tumour","label":"SIGN_SYMPTOM","start":1433,"end":1439},{"text":"radiation therapy","label":"THERAPEUTIC_PROCEDURE","start":1564,"end":1581},{"text":"follow-up","label":"CLINICAL_EVENT","start":1586,"end":1595},{"text":"one and a half years later","label":"DATE","start":1596,"end":1622},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":1663,"end":1675},{"text":"tumour recurrence","label":"SIGN_SYMPTOM","start":1700,"end":1717},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1725,"end":1728},{"text":"follow-up","label":"CLINICAL_EVENT","start":1740,"end":1749},{"text":"more than 6 years","label":"DATE","start":1753,"end":1770},{"text":"tumour recurrence","label":"SIGN_SYMPTOM","start":1817,"end":1834},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1842,"end":1845},{"text":"Histological examination","label":"DIAGNOSTIC_PROCEDURE","start":1852,"end":1876},{"text":"slightly lobulated","label":"SHAPE","start":1886,"end":1904},{"text":"tumour","label":"SIGN_SYMPTOM","start":1905,"end":1911},{"text":"chondromyxoid matrix","label":"DETAILED_DESCRIPTION","start":1928,"end":1948},{"text":"tumour cells","label":"COREFERENCE","start":1954,"end":1966},{"text":"vacuolated","label":"LAB_VALUE","start":1976,"end":1986},{"text":"pale","label":"LAB_VALUE","start":1991,"end":1995},{"text":"cytoplasm","label":"DIAGNOSTIC_PROCEDURE","start":1996,"end":2005},{"text":"Moderate","label":"SEVERITY","start":2007,"end":2015},{"text":"nuclear polymorphism","label":"SIGN_SYMPTOM","start":2016,"end":2036},{"text":"mitotic activity","label":"SIGN_SYMPTOM","start":2065,"end":2081},{"text":"calcifications","label":"SIGN_SYMPTOM","start":2096,"end":2110},{"text":"tumour cells","label":"COREFERENCE","start":2126,"end":2138},{"text":"positive","label":"LAB_VALUE","start":2147,"end":2155},{"text":"pan-keratin","label":"DIAGNOSTIC_PROCEDURE","start":2160,"end":2171},{"text":"S-100","label":"DIAGNOSTIC_PROCEDURE","start":2173,"end":2178},{"text":"epithelial membrane antigen","label":"DIAGNOSTIC_PROCEDURE","start":2183,"end":2210},{"text":"EMA","label":"DIAGNOSTIC_PROCEDURE","start":2212,"end":2215},{"text":"chordoma","label":"DISEASE_DISORDER","start":2274,"end":2282}],"tokens":["An ","11-year-old"," ","boy"," ","presented"," with a history of ","headaches"," and ","vomiting"," that had been present for ","several months",".\n","Physical examination"," showed ","papilledema"," without the presence of any other ","neurological deficits",".\n","Magnetic resonance imaging"," (","MRI",") revealed a ","large"," ","prepontine"," ","mass"," with ","dorsal"," ","displacement"," of the ","brainstem"," and a ","secondary"," ","obstructive"," ","hydrocephalus"," due to ","compression"," of the ","aqueduct",".\nThe ","lesion"," had an ","inhomogeneous"," ","hypointense aspect"," on the ","T1-weighted image"," (","T1WI",") and an ","inhomogeneous"," ","hyperintense aspect"," on the ","T2-weighted image"," (","T2WI",").\nAfter administration of ","IV"," ","gadolinium",", there was some ","inhomogeneous"," ","enhancement"," (Fig.1).\n","Computed tomography"," (","CT",") imaging showed no ","bone involvement",".\nDuring the first operation, a ","ventriculoperitoneal"," ","shunt"," was inserted into the ","right lateral ventricle"," to treat the ","hydrocephalus",".\nA careful study of the MRI suggested that this infra- and supratentorially located tumour might be resected through a single approach.\nA ","left"," ","frontotemporal"," ","transsylvian approach"," was performed to gain access to the tumour.\nThe ","tumour"," had ","well-defined margins"," and was entirely located in the ","intradural plane",".\nThere were no ","attachments"," to the ","cranial nerves"," or ","brainstem",".\nA ","macroscopic"," ","complete"," ","resection"," was performed.\nPostoperatively, the patient had developed a ","left oculomotor"," ","nerve palsy",", which completely ","recovered"," ","within the next 4 weeks",".\nThe postoperative ","MRI"," showed a ","complete removal"," of the ","tumour"," (Fig.2).\nAfter careful consideration by a multidisciplinary team, we decided that there was no indication for postoperative ","radiation therapy",".\nAt ","follow-up"," ","one and a half years later",", the patient was found to have remained ","asymptomatic",".\nThere were no signs of ","tumour recurrence"," on the ","MRI"," scan.\nAt a ","follow-up"," of ","more than 6 years"," after treatment, there were still no signs of ","tumour recurrence"," on the ","MRI"," scan.\n","Histological examination"," showed a ","slightly lobulated"," ","tumour"," consisting of a ","chondromyxoid matrix",".\nThe ","tumour cells"," showed a ","vacuolated"," and ","pale"," ","cytoplasm",".\n","Moderate"," ","nuclear polymorphism"," was observed but no obvious ","mitotic activity"," (Fig.3).\nSome ","calcifications"," were seen.\nThe ","tumour cells"," stained ","positive"," for ","pan-keratin",", ","S-100"," and ","epithelial membrane antigen"," (","EMA",").\nThese findings suggest a histopathological diagnosis of ","chordoma",".\n"],"ner_labels":[0,5,0,65,0,13,0,69,0,69,0,32,0,24,0,26,0,26,0,24,0,24,0,22,0,12,0,69,0,22,0,69,0,12,0,22,0,22,0,26,0,69,0,12,0,18,0,22,0,69,0,24,0,24,0,22,0,69,0,24,0,24,0,4,0,46,0,22,0,69,0,24,0,24,0,69,0,22,0,75,0,12,0,18,0,22,0,22,0,75,0,69,0,22,0,12,0,69,0,12,0,12,0,22,0,22,0,75,0,12,0,26,0,69,0,19,0,24,0,22,0,69,0,75,0,13,0,19,0,69,0,69,0,24,0,13,0,19,0,69,0,24,0,24,0,67,0,69,0,22,0,18,0,42,0,42,0,24,0,63,0,69,0,69,0,69,0,18,0,42,0,24,0,24,0,24,0,24,0,26,0]}
-{"full_text":"A 25-year-old female patient had noticed left-sided visual loss and amenorrhea 2 years prior to being seen, with right hemiparesis developing 6 months beforehand.\nAggravated symptoms (drooping at corner of right lip and bilateral temporal hemianopia) finally prompted hospitalization.\nAt that time, a massive (>5 cm) tumor of intra- and suprasellar location, excluding mesencephalon backward, was seen on computerized tomography (CT) of the head (Fig.1a).\nFurther testing revealed an exceedingly high-serum level of prolactin (PRL) (4408 ng\/ml), whereas levels of all other pituitary hormones were within reference ranges (growth hormone (GH), 0.50 ng\/ml; luteinizing hormone (LH), 2.60 mIU\/ml; follicle-stimulating hormone (FSH), 4.57 mIU\/ml; adrenocorticotropic hormone (ACTH), 37.4 pg\/ml; thyroid-stimulating hormone (TSH), 2.68 \u03bcIU\/ml).\nT1-weighted magnetic resonance (MR) imaging with contrast (gadolinium) showed homogeneous tumor enhancement, but adjacent tissue was not edematous in T2-weighted views.\nThe mass did not regress, despite a 4-week course of the dopamine analog, cabergoline (1 mg\/week), and serum PRL level (2207 ng\/ml) remained elevated.\nRelative to status at admission, the right lateral ventricle also had enlarged somewhat, due to obstruction at foramen of Monro (Fig.1b).\nIn light of this intransigence, surgical debulking of tumor was elected first, through craniotomy and then via transsphenoidal approach.\nThe hardened elastic quality of the tumor and its strong attachments to neighboring structures prevented complete removal, but related mass effect was significantly reduced and serum PRL level declined (to 250 ng\/ml) in steps at each procedural stage.\nBut the normalization of PRL level had not been achieved with the administration of cabergoline increased up to 0.5 mg\/day.\nThe residual tumor showed no evidence of regrowth or distant metastasis 1 year after surgery.\nHistopathologically, hematoxylin and eosin (H&E)-stained sections of specimens from the first and second surgical procedures similarly were composed of polygonal and spindle cells with round, oval, or elongated nuclei and eosinophilic cytoplasm (Fig.2a\u2013c).\nThe cells formed irregular nests or short fascicles, accompanied by frequent hyaline changes in vessel walls and vacuolation (Fig.2d).\nSome nuclear pleomorphism was prominent; on the other hand, neither a high mitotic rate nor necrosis was evident (Fig.2b, c).\nConspicuous fibrous change of tumor stroma was noted focally as well (Fig.3a).\nThe chromophobic nature of tumor cells was confirmed by Pearse\u2019s Periodic Acid Schiff (PAS) stain (Fig.3b).\nImmunostains showed strong diffuse positivity for PRL (Fig.3c), chromogranin-A, and synaptophysin.\nNo other hormones (GH, TSH, ACTH, LH, FSH) were expressed by tumor cells, and the other markers, including S-100 protein (Fig.3d), glial fibrillary acidic protein (GFAP), epithelial membrane antigen (EMA), cytokeratin AE1\/AE3 (CK AE1\/AE3), vimentin, p53, and bcl-2, were also negative by immunostaining.\nKi-67 labeling index was approximately 2 %.\nA final diagnosis of PRL-producing pituitary adenoma was reached after considering the immunohistochemical profile, suprasellar location, and prolactin production of the tumor, as well as the absence of metastatic foci and invasion into surrounding tissue.\n","ner_info":[{"text":"25-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":41,"end":51},{"text":"visual loss","label":"DISEASE_DISORDER","start":52,"end":63},{"text":"amenorrhea","label":"DISEASE_DISORDER","start":68,"end":78},{"text":"2 years 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cm","label":"DISTANCE","start":310,"end":315},{"text":"tumor","label":"SIGN_SYMPTOM","start":317,"end":322},{"text":"intra- and suprasellar location","label":"BIOLOGICAL_STRUCTURE","start":326,"end":357},{"text":"excluding mesencephalon backward","label":"DETAILED_DESCRIPTION","start":359,"end":391},{"text":"computerized tomography","label":"DIAGNOSTIC_PROCEDURE","start":405,"end":428},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":430,"end":432},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":441,"end":445},{"text":"exceedingly high","label":"LAB_VALUE","start":484,"end":500},{"text":"serum","label":"BIOLOGICAL_STRUCTURE","start":501,"end":506},{"text":"prolactin","label":"DIAGNOSTIC_PROCEDURE","start":516,"end":525},{"text":"PRL","label":"DIAGNOSTIC_PROCEDURE","start":527,"end":530},{"text":"4408 ng\/ml","label":"LAB_VALUE","start":533,"end":543},{"text":"other pituitary hormones","label":"DIAGNOSTIC_PROCEDURE","start":568,"end":592},{"text":"within reference ranges","label":"LAB_VALUE","start":598,"end":621},{"text":"(growth hormone","label":"DIAGNOSTIC_PROCEDURE","start":622,"end":637},{"text":"GH","label":"DIAGNOSTIC_PROCEDURE","start":639,"end":641},{"text":"0.50 ng\/ml","label":"LAB_VALUE","start":644,"end":654},{"text":"luteinizing hormone","label":"DIAGNOSTIC_PROCEDURE","start":656,"end":675},{"text":"LH","label":"DIAGNOSTIC_PROCEDURE","start":677,"end":679},{"text":"2.60 mIU\/ml","label":"LAB_VALUE","start":682,"end":693},{"text":"follicle-stimulating hormone","label":"DIAGNOSTIC_PROCEDURE","start":695,"end":723},{"text":"FSH","label":"DIAGNOSTIC_PROCEDURE","start":725,"end":728},{"text":"4.57 mIU\/ml","label":"LAB_VALUE","start":731,"end":742},{"text":"adrenocorticotropic hormone","label":"DIAGNOSTIC_PROCEDURE","start":744,"end":771},{"text":"ACTH","label":"DIAGNOSTIC_PROCEDURE","start":773,"end":777},{"text":"37.4 pg\/ml","label":"LAB_VALUE","start":780,"end":790},{"text":"thyroid-stimulating hormone","label":"DIAGNOSTIC_PROCEDURE","start":792,"end":819},{"text":"TSH","label":"DIAGNOSTIC_PROCEDURE","start":821,"end":824},{"text":"2.68 \u03bcIU\/ml","label":"LAB_VALUE","start":827,"end":838},{"text":"T1-weighted","label":"DETAILED_DESCRIPTION","start":841,"end":852},{"text":"magnetic resonance","label":"DIAGNOSTIC_PROCEDURE","start":853,"end":871},{"text":"MR","label":"DIAGNOSTIC_PROCEDURE","start":873,"end":875},{"text":"contrast","label":"DETAILED_DESCRIPTION","start":890,"end":898},{"text":"gadolinium","label":"DETAILED_DESCRIPTION","start":900,"end":910},{"text":"homogeneous","label":"DETAILED_DESCRIPTION","start":919,"end":930},{"text":"tumor","label":"SIGN_SYMPTOM","start":931,"end":936},{"text":"enhancement","label":"DETAILED_DESCRIPTION","start":937,"end":948},{"text":"adjacent tissue","label":"BIOLOGICAL_STRUCTURE","start":954,"end":969},{"text":"edematous","label":"SIGN_SYMPTOM","start":978,"end":987},{"text":"T2-weighted 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(","drooping"," at ","corner of right lip"," and ","bilateral"," ","temporal"," ","hemianopia",") finally prompted ","hospitalization",".\nAt that time, a ","massive"," (",">5 cm",") ","tumor"," of ","intra- and suprasellar location",", ","excluding mesencephalon backward",", was seen on ","computerized tomography"," (","CT",") of the ","head"," (Fig.1a).\nFurther testing revealed an ","exceedingly high","-","serum"," level of ","prolactin"," (","PRL",") (","4408 ng\/ml","), whereas levels of all ","other pituitary hormones"," were ","within reference ranges"," ","(growth hormone"," (","GH","), ","0.50 ng\/ml","; ","luteinizing hormone"," (","LH","), ","2.60 mIU\/ml","; ","follicle-stimulating hormone"," (","FSH","), ","4.57 mIU\/ml","; ","adrenocorticotropic hormone"," (","ACTH","), ","37.4 pg\/ml","; ","thyroid-stimulating hormone"," (","TSH","), ","2.68 \u03bcIU\/ml",").\n","T1-weighted"," ","magnetic resonance"," (","MR",") imaging with ","contrast"," (","gadolinium",") showed ","homogeneous"," ","tumor"," ","enhancement",", but ","adjacent tissue"," was not ","edematous"," in ","T2-weighted views",".\nThe ","mass"," did not ","regress",", despite a ","4-week"," course of the ","dopamine analog",", ","cabergoline"," (","1 mg\/week","), and ","serum"," ","PRL"," level (","2207 ng\/ml",") remained ","elevated",".\nRelative to status at admission, the ","right lateral ventricle"," also had ","enlarged"," ","somewhat",", due to ","obstruction"," at ","foramen of Monro"," (Fig.1b).\nIn light of this intransigence, ","surgical"," ","debulking"," of tumor was elected first, through ","craniotomy"," and then via ","transsphenoidal approach",".\nThe ","hardened elastic"," quality of the ","tumor"," and its ","strong"," ","attachments"," to ","neighboring structures"," prevented ","complete removal",", but related ","mass effect"," was significantly reduced and ","serum"," ","PRL"," level ","declined"," (to ","250 ng\/ml",") in steps at each procedural stage.\nBut the ","normalization"," of ","PRL"," level had not been achieved with the administration of ","cabergoline"," increased up to ","0.5 mg\/day",".\nThe residual tumor showed no evidence of ","regrowth"," or ","distant"," ","metastasis"," ","1 year after"," surgery.\n","Histopathologically",", ","hematoxylin and eosin"," (","H&E",")-stained sections of ","specimens"," from the first and second surgical procedures similarly were composed of ","polygonal"," and ","spindle cells"," with ","round",", ","oval",", or ","elongated"," ","nuclei"," and ","eosinophilic"," ","cytoplasm"," (Fig.2a\u2013c).\nThe ","cells"," formed ","irregular nests"," or ","short fascicles",", accompanied by ","frequent hyaline changes in vessel walls and vacuolation"," (Fig.2d).\nSome ","nuclear pleomorphism"," was prominent; on the other hand, neither a ","high mitotic rate"," nor ","necrosis"," was evident (Fig.2b, c).\nConspicuous ","fibrous change"," of ","tumor stroma"," was noted focally as well (Fig.3a).\nThe ","chromophobic"," nature of ","tumor cells"," was confirmed by ","Pearse\u2019s Periodic Acid Schiff"," (","PAS",") stain (Fig.3b).\n","Immunostains"," showed strong diffuse ","positivity"," for ","PRL"," (Fig.3c), ","chromogranin-A",", and ","synaptophysin",".\n","No"," ","other hormones"," (","GH",", ","TSH",", ","ACTH",", ","LH",", ","FSH",") were expressed by tumor cells, and the ","other markers",", including ","S-100 protein"," (Fig.3d), ","glial fibrillary acidic protein"," (","GFAP","), ","epithelial membrane antigen"," (","EMA","), ","cytokeratin AE1\/AE3"," (","CK AE1\/AE3","), ","vimentin",", ","p53",", and ","bcl-2",", were also ","negative"," by immunostaining.\n","Ki-67 labeling index"," was approximately ","2 %",".\nA final diagnosis of ","PRL-producing"," ","pituitary adenoma"," was reached after considering the immunohistochemical profile, suprasellar location, and prolactin production of the tumor, as well as the absence of metastatic foci and invasion into 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-{"full_text":"A 62-year-old male presented with a 15-day history of dyspnea on exertion, associated with both lower extremity edema.\nBefore this admission, he also had suffered from abdominal bloating and tasteless for a year with noticeable body weight loss at the same time (up to 20 kg).\nOver the past 6 months, he developed a multiple system disorder, which included painless paresthesias in the lower limbs, erectile dysfunction, and chronic diarrhea.\nHe had an average stool frequency of up to ten times per day, with no obvious blood or mucus and no abdominal pain or tenesmus.\nUnfortunately, previous stomach and rectum biopsy did not examine for accumulations of amyloid fibril protein.\nHis family history was unremarkable.\nOn physical examination, his blood pressure was 82\/56 mmHg and heart rate was 52 bpm.\nSignificant jugular venous distention, moderate hepatomegaly, and lower extremity edema were noted.\nA neurological examination revealed weakness and muscular atrophy in the bilateral tibialis anterior and gastrocnemius.\nHyporeflexia was noted on both knees and ankles.\nSensory examination revealed diminished tactile and pain sensation in a stocking and glove pattern and vibratory sensation was distally reduced in the lower limbs.\nThe motor and sensory functions of upper extremities were relatively spared.\nInitial laboratory data that included full blood count, transaminase, creatinine, electrolytes, cardiac troponin, and thyroid function were normal or negative.\nN-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) was 3,996 pg\/mL.\nNerve conduction studies confirmed bilateral sensory-motor neuropathy (Table 1).\nAn electromyography study demonstrated active denervation and chronic reinnervation changes in the tibialis anterior and gastrocnemius.\nElectrocardiogram (ECG) revealed sinus rhythm, low voltages in limb leads, QS waves in precordial and inferior leads, first-degree atrioventricular block, and prolonged QTc (Figure 1).\nTwo-dimensional echocardiography revealed marked concentrically thickened and speckled appearance of ventricular walls, biatrial dilatation, and left ventricular ejection fraction of 70% (Figure 2).\nDoppler revealed a severe restrictive mitral filling pattern with E\/A ratio 2.1.\nCoronary angiography findings were normal.\nThe combined occurrence of low QRS voltage in the ECG, ventricular thickening, and signs of diastolic dysfunction is strongly suggestive of cardiac amyloidosis.\nThe following serum \u03bb light-chain concentration was 1,763 (normal range: 598\u20131,329 mg\/dL, and \u03ba light-chain concentration was normal.\nRectum biopsy confirmed amyloid infiltrate (Figure 3).\nSo, the diagnosis of AL amyloidosis was established.\nDespite chemotherapy administration of melphalan, dexamethasone, immunomodulator lenalidomide, and supportive therapy including montmorillonite to decrease diarrhea and low-dose furosemide to alleviate fluid retention, the patient continued to deteriorate and died at home after 3 months after the initial diagnosis.\n","ner_info":[{"text":"62-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"presented","label":"ACTIVITY","start":19,"end":28},{"text":"15-day history","label":"DURATION","start":36,"end":50},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":54,"end":61},{"text":"exertion","label":"DETAILED_DESCRIPTION","start":65,"end":73},{"text":"both lower extremity","label":"BIOLOGICAL_STRUCTURE","start":91,"end":111},{"text":"edema","label":"SIGN_SYMPTOM","start":112,"end":117},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":168,"end":177},{"text":"bloating","label":"SIGN_SYMPTOM","start":178,"end":186},{"text":"tasteless","label":"SIGN_SYMPTOM","start":191,"end":200},{"text":"for a year","label":"DURATION","start":201,"end":211},{"text":"weight loss","label":"SIGN_SYMPTOM","start":233,"end":244},{"text":"up to 20 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voltage","label":"DIAGNOSTIC_PROCEDURE","start":2313,"end":2324},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":2332,"end":2335},{"text":"ventricular","label":"BIOLOGICAL_STRUCTURE","start":2337,"end":2348},{"text":"thickening","label":"SIGN_SYMPTOM","start":2349,"end":2359},{"text":"diastolic dysfunction","label":"SIGN_SYMPTOM","start":2374,"end":2395},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2422,"end":2429},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":2430,"end":2441},{"text":"serum","label":"DETAILED_DESCRIPTION","start":2457,"end":2462},{"text":"\u03bb light-chain concentration","label":"DIAGNOSTIC_PROCEDURE","start":2463,"end":2490},{"text":"1,763","label":"LAB_VALUE","start":2495,"end":2500},{"text":"\u03ba light-chain concentration","label":"DIAGNOSTIC_PROCEDURE","start":2537,"end":2564},{"text":"normal","label":"LAB_VALUE","start":2569,"end":2575},{"text":"Rectum","label":"BIOLOGICAL_STRUCTURE","start":2577,"end":2583},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2584,"end":2590},{"text":"amyloid","label":"DETAILED_DESCRIPTION","start":2601,"end":2608},{"text":"infiltrate","label":"SIGN_SYMPTOM","start":2609,"end":2619},{"text":"AL amyloidosis","label":"DISEASE_DISORDER","start":2653,"end":2667},{"text":"chemotherapy","label":"MEDICATION","start":2693,"end":2705},{"text":"melphalan","label":"MEDICATION","start":2724,"end":2733},{"text":"dexamethasone","label":"MEDICATION","start":2735,"end":2748},{"text":"immunomodulator","label":"DETAILED_DESCRIPTION","start":2750,"end":2765},{"text":"lenalidomide","label":"MEDICATION","start":2766,"end":2778},{"text":"supportive therapy","label":"THERAPEUTIC_PROCEDURE","start":2784,"end":2802},{"text":"montmorillonite","label":"MEDICATION","start":2813,"end":2828},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":2841,"end":2849},{"text":"low-dose","label":"DOSAGE","start":2854,"end":2862},{"text":"furosemide","label":"MEDICATION","start":2863,"end":2873},{"text":"fluid retention","label":"SIGN_SYMPTOM","start":2887,"end":2902},{"text":"deteriorate","label":"SIGN_SYMPTOM","start":2929,"end":2940},{"text":"died","label":"OUTCOME","start":2945,"end":2949},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":2953,"end":2957},{"text":"after 3 months","label":"DATE","start":2958,"end":2972}],"tokens":["A ","62-year-old"," ","male"," ","presented"," with a ","15-day history"," of ","dyspnea"," on ","exertion",", associated with ","both lower extremity"," ","edema",".\nBefore this admission, he also had suffered from ","abdominal"," ","bloating"," and ","tasteless"," ","for a year"," with noticeable body ","weight loss"," at the same time (","up to 20 kg",").\n","Over the past 6 months",", he developed a ","multiple system disorder",", which included ","painless"," ","paresthesias"," in the ","lower limbs",", ","erectile dysfunction",", and ","chronic diarrhea",".\nHe had an average ","stool frequency"," of ","up to ten times per day",", with ","no obvious"," ","blood"," or ","mucus"," and no ","abdominal"," ","pain"," or ","tenesmus",".\nUnfortunately, previous ","stomach"," and ","rectum"," ","biopsy"," did not examine for accumulations of ","amyloid fibril protein",".\nHis ","family history was unremarkable",".\nOn ","physical examination",", his ","blood pressure"," was ","82\/56 mmHg"," and ","heart rate"," was ","52 bpm",".\n","Significant"," ","jugular venous"," ","distention",", ","moderate"," ","hepatomegaly",", and ","lower extremity"," ","edema"," were noted.\nA ","neurological examination"," revealed ","weakness"," and ","muscular"," ","atrophy"," in the ","bilateral tibialis anterior"," and ","gastrocnemius",".\n","Hyporeflexia"," was noted on ","both knees"," and ","ankles",".\n","Sensory examination"," revealed ","diminished"," ","tactile and pain sensation"," in a ","stocking and glove pattern"," and ","vibratory sensation"," was ","distally reduced"," in the ","lower limbs",".\nThe ","motor and sensory functions"," of ","upper extremities"," were ","relatively spared",".\nInitial ","laboratory data"," that included ","full blood count",", ","transaminase",", ","creatinine",", ","electrolytes",", ","cardiac troponin",", and ","thyroid function"," were ","normal"," or ","negative",".\n","N-terminal fragment of pro-brain natriuretic peptide"," (","NT-proBNP",") was ","3,996 pg\/mL",".\n","Nerve conduction studies"," confirmed ","bilateral"," ","sensory-motor neuropathy"," (Table 1).\nAn ","electromyography study"," demonstrated active ","denervation"," and chronic ","reinnervation changes"," in the ","tibialis anterior"," and ","gastrocnemius",".\n","Electrocardiogram"," (","ECG",") revealed ","sinus rhythm",", ","low voltages"," in ","limb leads",", ","QS waves"," in ","precordial and inferior leads",", ","first-degree"," ","atrioventricular block",", and ","prolonged"," ","QTc"," (Figure 1).\n","Two-dimensional"," ","echocardiography"," revealed marked ","concentrically"," ","thickened"," and ","speckled appearance"," of ","ventricular walls",", ","biatrial"," ","dilatation",", and ","left ventricular ejection fraction"," of ","70%"," (Figure 2).\n","Doppler"," revealed a ","severe"," ","restrictive mitral filling pattern"," with ","E\/A ratio"," ","2.1",".\n","Coronary angiography"," findings were ","normal",".\nThe combined occurrence of ","low"," ","QRS voltage"," in the ","ECG",", ","ventricular"," ","thickening",", and signs of ","diastolic dysfunction"," is strongly suggestive of ","cardiac"," ","amyloidosis",".\nThe following ","serum"," ","\u03bb light-chain concentration"," was ","1,763"," (normal range: 598\u20131,329 mg\/dL, and ","\u03ba light-chain concentration"," was ","normal",".\n","Rectum"," ","biopsy"," confirmed ","amyloid"," ","infiltrate"," (Figure 3).\nSo, the diagnosis of ","AL amyloidosis"," was established.\nDespite ","chemotherapy"," administration of ","melphalan",", ","dexamethasone",", ","immunomodulator"," ","lenalidomide",", and ","supportive therapy"," including ","montmorillonite"," to decrease ","diarrhea"," and ","low-dose"," ","furosemide"," to alleviate ","fluid retention",", the patient continued to ","deteriorate"," and ","died"," at ","home"," ","after 3 months"," after the initial diagnosis.\n"],"ner_labels":[0,5,0,65,0,1,0,32,0,69,0,22,0,12,0,69,0,12,0,69,0,69,0,32,0,69,0,62,0,32,0,26,0,22,0,69,0,12,0,26,0,26,0,24,0,62,0,42,0,24,0,24,0,12,0,69,0,69,0,12,0,12,0,24,0,24,0,34,0,24,0,24,0,42,0,24,0,42,0,63,0,12,0,69,0,63,0,69,0,12,0,69,0,24,0,69,0,12,0,69,0,12,0,12,0,69,0,12,0,12,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,12,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,42,0,24,0,24,0,42,0,24,0,22,0,26,0,24,0,69,0,69,0,12,0,12,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,22,0,69,0,42,0,24,0,22,0,24,0,22,0,69,0,69,0,12,0,12,0,69,0,24,0,42,0,24,0,63,0,69,0,24,0,42,0,24,0,42,0,42,0,24,0,24,0,12,0,69,0,69,0,12,0,26,0,22,0,24,0,42,0,24,0,42,0,12,0,24,0,22,0,69,0,26,0,46,0,46,0,46,0,22,0,46,0,75,0,46,0,69,0,29,0,46,0,69,0,69,0,56,0,48,0,19,0]}
-{"full_text":"A 56-year-old man presented with a 2-year history of dysphagia.\nHe was diagnosed with a middle thoracic oesophageal squamous cell carcinoma by both a gastroscopy and a biopsy.\nA chest computed tomography (CT) scan showed an enlarged azygos vein (a diameter of 2.5 cm) that was a continuation of the IVC (Fig.1a, b).\nA CT scan of the abdomen showed a defect in the suprarenal segment of the inferior vena cava and direct drainage of the hepatic vein into the right atrium.\nAfter consultation with the thoracic surgery department clinicians and the anaesthesiology department, we decided to perform a McKeown oesophagectomy.\nThe patient was anaesthetised with a double-lumen tube and underwent a standard posterolateral thoracotomy by traditional open surgery.\nWe first performed the jugular and femoral vein percutaneous puncture to create a veno-venous bypass and then connected the pressure sensor system to the monitor.\nThe monitor displayed the real-time pressure value of the jugular vein and the femoral vein.\nMacroscopically, the diameter of the azygos arch was approximately 2.5 cm (Fig.1c), and the superior edge of the tumour adhered tightly to the arch of the azygos vein.\nWhen the arch of the azygos vein was pulled with a rubber hose to dissociate it from the carcinoma, the monitor showed that the femoral vein pressure increased to 52 mmH2O; the pressure returned to a normal value when we opened the bypass between the femoral vein and the jugular vein (Fig.2).\nThe surgery was performed smoothly, without injury to the azygos vein, and the postoperative recovery was uneventful.\nThe pathology of the resected specimen showed a poorly differentiated squamous cell carcinoma and no evidence of malignancy in 15 of the lymph nodes.\nAfter 5 months of follow-up, the patient was asymptomatic, with no evidence of recurrent disease either clinically or on CT.\n","ner_info":[{"text":"56-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"2-year","label":"DURATION","start":35,"end":41},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":53,"end":62},{"text":"middle thoracic","label":"BIOLOGICAL_STRUCTURE","start":88,"end":103},{"text":"oesophageal","label":"BIOLOGICAL_STRUCTURE","start":104,"end":115},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":116,"end":139},{"text":"gastroscopy","label":"DIAGNOSTIC_PROCEDURE","start":150,"end":161},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":168,"end":174},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":178,"end":183},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":184,"end":203},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":205,"end":207},{"text":"enlarged","label":"SIGN_SYMPTOM","start":224,"end":232},{"text":"azygos vein","label":"BIOLOGICAL_STRUCTURE","start":233,"end":244},{"text":"2.5 cm","label":"DISTANCE","start":260,"end":266},{"text":"continuation","label":"SIGN_SYMPTOM","start":279,"end":291},{"text":"IVC","label":"BIOLOGICAL_STRUCTURE","start":299,"end":302},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":318,"end":320},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":333,"end":340},{"text":"defect","label":"SIGN_SYMPTOM","start":350,"end":356},{"text":"suprarenal segment of the inferior vena cava","label":"BIOLOGICAL_STRUCTURE","start":364,"end":408},{"text":"direct","label":"DETAILED_DESCRIPTION","start":413,"end":419},{"text":"drainage","label":"SIGN_SYMPTOM","start":420,"end":428},{"text":"hepatic vein","label":"BIOLOGICAL_STRUCTURE","start":436,"end":448},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":458,"end":470},{"text":"consultation","label":"CLINICAL_EVENT","start":478,"end":490},{"text":"thoracic surgery department clinicians","label":"NONBIOLOGICAL_LOCATION","start":500,"end":538},{"text":"anaesthesiology department","label":"NONBIOLOGICAL_LOCATION","start":547,"end":573},{"text":"McKeown","label":"DETAILED_DESCRIPTION","start":599,"end":606},{"text":"oesophagectomy","label":"THERAPEUTIC_PROCEDURE","start":607,"end":621},{"text":"anaesthetised","label":"THERAPEUTIC_PROCEDURE","start":639,"end":652},{"text":"double-lumen tube","label":"DETAILED_DESCRIPTION","start":660,"end":677},{"text":"standard","label":"DETAILED_DESCRIPTION","start":694,"end":702},{"text":"posterolateral","label":"DETAILED_DESCRIPTION","start":703,"end":717},{"text":"thoracotomy","label":"THERAPEUTIC_PROCEDURE","start":718,"end":729},{"text":"traditional open surgery","label":"DETAILED_DESCRIPTION","start":733,"end":757},{"text":"jugular and femoral vein","label":"BIOLOGICAL_STRUCTURE","start":782,"end":806},{"text":"percutaneous puncture","label":"DETAILED_DESCRIPTION","start":807,"end":828},{"text":"veno-venous bypass","label":"THERAPEUTIC_PROCEDURE","start":841,"end":859},{"text":"pressure sensor system","label":"THERAPEUTIC_PROCEDURE","start":883,"end":905},{"text":"Macroscopically","label":"DIAGNOSTIC_PROCEDURE","start":1015,"end":1030},{"text":"diameter","label":"DIAGNOSTIC_PROCEDURE","start":1036,"end":1044},{"text":"azygos arch","label":"BIOLOGICAL_STRUCTURE","start":1052,"end":1063},{"text":"2.5 cm","label":"DISTANCE","start":1082,"end":1088},{"text":"superior edge","label":"DETAILED_DESCRIPTION","start":1107,"end":1120},{"text":"tumour","label":"SIGN_SYMPTOM","start":1128,"end":1134},{"text":"arch of the azygos vein","label":"BIOLOGICAL_STRUCTURE","start":1158,"end":1181},{"text":"arch of the azygos vein","label":"BIOLOGICAL_STRUCTURE","start":1192,"end":1215},{"text":"pulled","label":"THERAPEUTIC_PROCEDURE","start":1220,"end":1226},{"text":"rubber hose","label":"DETAILED_DESCRIPTION","start":1234,"end":1245},{"text":"carcinoma","label":"COREFERENCE","start":1272,"end":1281},{"text":"femoral vein","label":"BIOLOGICAL_STRUCTURE","start":1311,"end":1323},{"text":"pressure","label":"DIAGNOSTIC_PROCEDURE","start":1324,"end":1332},{"text":"increased","label":"LAB_VALUE","start":1333,"end":1342},{"text":"52 mmH2O","label":"LAB_VALUE","start":1346,"end":1354},{"text":"normal value","label":"LAB_VALUE","start":1383,"end":1395},{"text":"bypass","label":"COREFERENCE","start":1415,"end":1421},{"text":"injury","label":"DISEASE_DISORDER","start":1521,"end":1527},{"text":"azygos vein","label":"BIOLOGICAL_STRUCTURE","start":1535,"end":1546},{"text":"postoperative recovery","label":"DIAGNOSTIC_PROCEDURE","start":1556,"end":1578},{"text":"uneventful","label":"LAB_VALUE","start":1583,"end":1593},{"text":"pathology","label":"DIAGNOSTIC_PROCEDURE","start":1599,"end":1608},{"text":"resected specimen","label":"DETAILED_DESCRIPTION","start":1616,"end":1633},{"text":"poorly differentiated","label":"LAB_VALUE","start":1643,"end":1664},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":1665,"end":1688},{"text":"malignancy","label":"SIGN_SYMPTOM","start":1708,"end":1718},{"text":"15","label":"LAB_VALUE","start":1722,"end":1724},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1732,"end":1743},{"text":"5 months","label":"DURATION","start":1751,"end":1759},{"text":"follow-up","label":"CLINICAL_EVENT","start":1763,"end":1772},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":1790,"end":1802},{"text":"recurrent disease","label":"DISEASE_DISORDER","start":1824,"end":1841},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1866,"end":1868}],"tokens":["A ","56-year-old"," ","man"," ","presented"," with a ","2-year"," history of ","dysphagia",".\nHe was diagnosed with a ","middle thoracic"," ","oesophageal"," ","squamous cell carcinoma"," by both a ","gastroscopy"," and a ","biopsy",".\nA ","chest"," ","computed tomography"," (","CT",") scan showed an ","enlarged"," ","azygos vein"," (a diameter of ","2.5 cm",") that was a ","continuation"," of the ","IVC"," (Fig.1a, b).\nA ","CT"," scan of the ","abdomen"," showed a ","defect"," in the ","suprarenal segment of the inferior vena cava"," and ","direct"," ","drainage"," of the ","hepatic vein"," into the ","right atrium",".\nAfter ","consultation"," with the ","thoracic surgery department clinicians"," and the ","anaesthesiology department",", we decided to perform a ","McKeown"," ","oesophagectomy",".\nThe patient was ","anaesthetised"," with a ","double-lumen tube"," and underwent a ","standard"," ","posterolateral"," ","thoracotomy"," by ","traditional open surgery",".\nWe first performed the ","jugular and femoral vein"," ","percutaneous puncture"," to create a ","veno-venous bypass"," and then connected the ","pressure sensor system"," to the monitor.\nThe monitor displayed the real-time pressure value of the jugular vein and the femoral vein.\n","Macroscopically",", the ","diameter"," of the ","azygos arch"," was approximately ","2.5 cm"," (Fig.1c), and the ","superior edge"," of the ","tumour"," adhered tightly to the ","arch of the azygos vein",".\nWhen the ","arch of the azygos vein"," was ","pulled"," with a ","rubber hose"," to dissociate it from the ","carcinoma",", the monitor showed that the ","femoral vein"," ","pressure"," ","increased"," to ","52 mmH2O","; the pressure returned to a ","normal value"," when we opened the ","bypass"," between the femoral vein and the jugular vein (Fig.2).\nThe surgery was performed smoothly, without ","injury"," to the ","azygos vein",", and the ","postoperative recovery"," was ","uneventful",".\nThe ","pathology"," of the ","resected specimen"," showed a ","poorly differentiated"," ","squamous cell carcinoma"," and no evidence of ","malignancy"," in ","15"," of the ","lymph nodes",".\nAfter ","5 months"," of ","follow-up",", the patient was ","asymptomatic",", with no evidence of ","recurrent disease"," either clinically or on ","CT",".\n"],"ner_labels":[0,5,0,65,0,13,0,32,0,69,0,12,0,12,0,26,0,24,0,24,0,12,0,24,0,24,0,69,0,12,0,27,0,69,0,12,0,24,0,12,0,69,0,12,0,22,0,69,0,12,0,12,0,13,0,48,0,48,0,22,0,75,0,75,0,22,0,22,0,22,0,75,0,22,0,12,0,22,0,75,0,75,0,24,0,24,0,12,0,27,0,22,0,69,0,12,0,12,0,75,0,22,0,18,0,12,0,24,0,42,0,42,0,42,0,18,0,26,0,12,0,24,0,42,0,24,0,22,0,42,0,26,0,69,0,42,0,12,0,32,0,13,0,69,0,26,0,24,0]}
-{"full_text":"A 55-year-old woman was referred to our hospital because of a suspicion of mediastinal tumor incidentally found through a medical-checkup plain X-ray photography (X-P) (Figure \u200b(Figure1A).1A).\nChest MRI revealed a 3\u200acm diameter tumor which seemed to connect to the right lobe of thyroid and projected into the mediastinum (Figure \u200b1B).\nBy 123I-RI, no unusual accumulation was detected (Figure \u200b1C).\nA fine needle aspiration biopsy, which is viewed as the \u201cgold standard\u201d for diagnosis in most cases, was tried but could not reach a conclusive diagnosis.\nThereby, 18F-FDG-PET was performed and a high accumulation was revealed with standardized uptake value (SUV) of 3.8 (Figure \u200b1D).\nThus, as a possibility of malignancy could not be excluded, the right lobe excision procedure for thyroid gland was enforced.\nThe obtained tumor was continuous to the right lobe as expected.\nThe surface was flat and smooth and the exfoliation from the circumference organization was easy (Figure \u200b2A).\nMicroscopically, the encapsulated tumor consisted of atypical large-sized follicles without malignant characteristics, the background thyroid tissue showing no remarkable change (Figure 2B).\nThus, histological diagnosis was follicular thyroid adenoma.\nEthical approval was not thought to be necessary because all the clinical course of the case was completely within usual medical cares.\nInformed consent was given from the case on each occasion of diagnostic examinations and therapeutic procedures.\n","ner_info":[{"text":"55-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"referred","label":"CLINICAL_EVENT","start":24,"end":32},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":40,"end":48},{"text":"mediastinal","label":"BIOLOGICAL_STRUCTURE","start":75,"end":86},{"text":"tumor","label":"SIGN_SYMPTOM","start":87,"end":92},{"text":"medical-checkup","label":"CLINICAL_EVENT","start":122,"end":137},{"text":"X-ray photography","label":"DIAGNOSTIC_PROCEDURE","start":144,"end":161},{"text":"X-P","label":"DIAGNOSTIC_PROCEDURE","start":163,"end":166},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":193,"end":198},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":199,"end":202},{"text":"3\u200acm","label":"DISTANCE","start":214,"end":218},{"text":"tumor","label":"SIGN_SYMPTOM","start":228,"end":233},{"text":"right lobe of thyroid","label":"BIOLOGICAL_STRUCTURE","start":265,"end":286},{"text":"mediastinum","label":"BIOLOGICAL_STRUCTURE","start":310,"end":321},{"text":"123I-RI","label":"DIAGNOSTIC_PROCEDURE","start":339,"end":346},{"text":"no unusual accumulation","label":"LAB_VALUE","start":348,"end":371},{"text":"fine needle aspiration","label":"DETAILED_DESCRIPTION","start":401,"end":423},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":424,"end":430},{"text":"could not reach a conclusive diagnosis","label":"LAB_VALUE","start":514,"end":552},{"text":"18F-FDG-PET","label":"DIAGNOSTIC_PROCEDURE","start":563,"end":574},{"text":"high accumulation","label":"LAB_VALUE","start":595,"end":612},{"text":"standardized uptake value","label":"DIAGNOSTIC_PROCEDURE","start":631,"end":656},{"text":"SUV","label":"DIAGNOSTIC_PROCEDURE","start":658,"end":661},{"text":"3.8","label":"LAB_VALUE","start":666,"end":669},{"text":"malignancy","label":"DISEASE_DISORDER","start":710,"end":720},{"text":"right lobe","label":"BIOLOGICAL_STRUCTURE","start":748,"end":758},{"text":"excision","label":"THERAPEUTIC_PROCEDURE","start":759,"end":767},{"text":"thyroid gland","label":"BIOLOGICAL_STRUCTURE","start":782,"end":795},{"text":"tumor","label":"SIGN_SYMPTOM","start":823,"end":828},{"text":"right lobe","label":"BIOLOGICAL_STRUCTURE","start":851,"end":861},{"text":"flat","label":"TEXTURE","start":891,"end":895},{"text":"smooth","label":"TEXTURE","start":900,"end":906},{"text":"Microscopically","label":"DIAGNOSTIC_PROCEDURE","start":986,"end":1001},{"text":"tumor","label":"COREFERENCE","start":1020,"end":1025},{"text":"atypical","label":"SIGN_SYMPTOM","start":1039,"end":1047},{"text":"large-sized","label":"DETAILED_DESCRIPTION","start":1048,"end":1059},{"text":"follicles","label":"BIOLOGICAL_STRUCTURE","start":1060,"end":1069},{"text":"malignant characteristics","label":"SIGN_SYMPTOM","start":1078,"end":1103},{"text":"thyroid tissue","label":"BIOLOGICAL_STRUCTURE","start":1120,"end":1134},{"text":"change","label":"SIGN_SYMPTOM","start":1157,"end":1163},{"text":"histological diagnosis","label":"DIAGNOSTIC_PROCEDURE","start":1183,"end":1205},{"text":"follicular thyroid adenoma","label":"DISEASE_DISORDER","start":1210,"end":1236}],"tokens":["A ","55-year-old"," ","woman"," was ","referred"," to our ","hospital"," because of a suspicion of ","mediastinal"," ","tumor"," incidentally found through a ","medical-checkup"," plain ","X-ray photography"," (","X-P",") (Figure \u200b(Figure1A).1A).\n","Chest"," ","MRI"," revealed a ","3\u200acm"," diameter ","tumor"," which seemed to connect to the ","right lobe of thyroid"," and projected into the ","mediastinum"," (Figure \u200b1B).\nBy ","123I-RI",", ","no unusual accumulation"," was detected (Figure \u200b1C).\nA ","fine needle aspiration"," ","biopsy",", which is viewed as the \u201cgold standard\u201d for diagnosis in most cases, was tried but ","could not reach a conclusive diagnosis",".\nThereby, ","18F-FDG-PET"," was performed and a ","high accumulation"," was revealed with ","standardized uptake value"," (","SUV",") of ","3.8"," (Figure \u200b1D).\nThus, as a possibility of ","malignancy"," could not be excluded, the ","right lobe"," ","excision"," procedure for ","thyroid gland"," was enforced.\nThe obtained ","tumor"," was continuous to the ","right lobe"," as expected.\nThe surface was ","flat"," and ","smooth"," and the exfoliation from the circumference organization was easy (Figure \u200b2A).\n","Microscopically",", the encapsulated ","tumor"," consisted of ","atypical"," ","large-sized"," ","follicles"," without ","malignant characteristics",", the background ","thyroid tissue"," showing no remarkable ","change"," (Figure 2B).\nThus, ","histological diagnosis"," was ","follicular thyroid adenoma",".\nEthical approval was not thought to be necessary because all the clinical course of the case was completely within usual medical cares.\nInformed consent was given from the case on each occasion of diagnostic examinations and therapeutic procedures.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,12,0,69,0,13,0,24,0,24,0,12,0,24,0,27,0,69,0,12,0,12,0,24,0,42,0,22,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,26,0,12,0,75,0,12,0,69,0,12,0,73,0,73,0,24,0,18,0,69,0,22,0,12,0,69,0,12,0,69,0,24,0,26,0]}
-{"full_text":"A 65-year old female was admitted with progressive dysphagia for 2 months and 5 kg weight loss.\nHer past medical history was significant for osteoporosis treated with calcium lactate tablets, daily, for 5 years.\nUpper gastrointestinal endoscopy described a 4 cm whitish firm mass in the middle esophagus (Fig.1) and a semi-circumferential deep ulcer with irregular borders on the opposite mucosa (Fig.2).\nDuring endoscopy a pedicle was not identify by handling a polipectomy snare around the esophageal mass.\nUpper gastrointestinal series with gastrografin (Fig.3) revealed an ovoid lacunar image at the distal part of the esophagus esophageal, inhomogeneous, with calcifications and smooth contours.\nDuring peristalsis the image was mobile and no pedicle was identified.\nThe esophageal lumen was enlarged with a diverticula development at the posterior wall.\nAlso computer tomography of the thorax excluded a pedunculated tumor, describing an intra-luminal calcified esophageal mass (Fig.4).\nThe biopsies obtained from the esophageal ulcerated mucosa revealed inflammatory cells, without malignancy.\nBased on these endoscopic and imagistic results a bezoar was supposed to have been developed in an esophageal diverticula, subsequently with ulcerated mucosa.\nThe esophageal mass was removed with an endoscopic snare in one piece, as the fragmentation was not physically possible.\nThe macroscopic appearance revealed a 4 cm, globular mass, heterogeneous, dense, whitish, in places with harsh yellow foci, most likely dystrophic calcification.\nThe macroscopic examination on cross section revealed a light gray aspect (fibrous appearance) that includes multiple harsh yellow-orange structures, difficult to section (Fig.5).\nThis mass was immersed into trichloracetic acid for decalcification.\nMicroscopic examination revealed hyaline fibrous tissue (Fig.6a), stained in green in Tricrom Mason (Fig.6b), with numerous crystalline basophils deposits of minerals, rare fibrocytes and very few vessels.\nThe presence of capillary structures, rare fibroblasts and collagen fibers brought in discussion a mesenchymal originating mass, most likely a fibrovascular polyp.\nA definitive histological diagnosis was not possible, as the pedicle was not identified, but the presence of the connective tissue suggested the previous presence of a pedicle into the lesion.\nThe long term calcium tablets intake might explain the calcification process developed into the vascular-connective tissue, revealed on histology by the numerous crystalline basophils deposits of minerals.\nOne month later the patient was asymptomatic.\nThe endoscopy did not revealed an enlarged esophagus, the appearance of the esophageal mucosa was normal (without ulcerations) and no diverticula was identified.\nNo motility disturbances were found on esophageal manometry.\nBased on the clinical course, the history of calcium lactate intake and histological appearance a diagnosis of an esophageal benign mesenchymal originating mass (most probably a fibrovascular polyp) auto-amputated and calcified was formulated.\n","ner_info":[{"text":"65-year old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"admitted","label":"CLINICAL_EVENT","start":25,"end":33},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":39,"end":50},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":51,"end":60},{"text":"2 months","label":"DURATION","start":65,"end":73},{"text":"5 kg","label":"MASS","start":78,"end":82},{"text":"weight loss","label":"SIGN_SYMPTOM","start":83,"end":94},{"text":"osteoporosis","label":"HISTORY","start":141,"end":153},{"text":"calcium lactate","label":"MEDICATION","start":167,"end":182},{"text":"tablets","label":"ADMINISTRATION","start":183,"end":190},{"text":"daily","label":"DOSAGE","start":192,"end":197},{"text":"5 years","label":"DURATION","start":203,"end":210},{"text":"Upper gastrointestinal","label":"BIOLOGICAL_STRUCTURE","start":212,"end":234},{"text":"endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":235,"end":244},{"text":"4 cm","label":"DISTANCE","start":257,"end":261},{"text":"whitish","label":"COLOR","start":262,"end":269},{"text":"firm","label":"TEXTURE","start":270,"end":274},{"text":"mass","label":"SIGN_SYMPTOM","start":275,"end":279},{"text":"middle esophagus","label":"BIOLOGICAL_STRUCTURE","start":287,"end":303},{"text":"semi-circumferential","label":"DETAILED_DESCRIPTION","start":318,"end":338},{"text":"deep","label":"SEVERITY","start":339,"end":343},{"text":"ulcer","label":"SIGN_SYMPTOM","start":344,"end":349},{"text":"irregular borders","label":"SHAPE","start":355,"end":372},{"text":"opposite mucosa","label":"BIOLOGICAL_STRUCTURE","start":380,"end":395},{"text":"endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":412,"end":421},{"text":"pedicle","label":"SIGN_SYMPTOM","start":424,"end":431},{"text":"polipectomy snare","label":"DIAGNOSTIC_PROCEDURE","start":463,"end":480},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":492,"end":502},{"text":"mass","label":"SIGN_SYMPTOM","start":503,"end":507},{"text":"Upper gastrointestinal","label":"BIOLOGICAL_STRUCTURE","start":509,"end":531},{"text":"gastrografin","label":"DIAGNOSTIC_PROCEDURE","start":544,"end":556},{"text":"ovoid","label":"SHAPE","start":577,"end":582},{"text":"lacunar","label":"DETAILED_DESCRIPTION","start":583,"end":590},{"text":"image","label":"SIGN_SYMPTOM","start":591,"end":596},{"text":"distal part of the esophagus esophageal","label":"BIOLOGICAL_STRUCTURE","start":604,"end":643},{"text":"inhomogeneous","label":"DETAILED_DESCRIPTION","start":645,"end":658},{"text":"calcifications","label":"SIGN_SYMPTOM","start":665,"end":679},{"text":"smooth","label":"TEXTURE","start":684,"end":690},{"text":"peristalsis","label":"ACTIVITY","start":708,"end":719},{"text":"image","label":"SIGN_SYMPTOM","start":724,"end":729},{"text":"mobile","label":"DETAILED_DESCRIPTION","start":734,"end":740},{"text":"pedicle","label":"SIGN_SYMPTOM","start":748,"end":755},{"text":"esophageal lumen","label":"BIOLOGICAL_STRUCTURE","start":776,"end":792},{"text":"enlarged","label":"SIGN_SYMPTOM","start":797,"end":805},{"text":"diverticula","label":"SIGN_SYMPTOM","start":813,"end":824},{"text":"posterior wall","label":"BIOLOGICAL_STRUCTURE","start":844,"end":858},{"text":"computer tomography","label":"DIAGNOSTIC_PROCEDURE","start":865,"end":884},{"text":"thorax","label":"BIOLOGICAL_STRUCTURE","start":892,"end":898},{"text":"pedunculated","label":"DETAILED_DESCRIPTION","start":910,"end":922},{"text":"tumor","label":"SIGN_SYMPTOM","start":923,"end":928},{"text":"intra-luminal","label":"DETAILED_DESCRIPTION","start":944,"end":957},{"text":"calcified","label":"DETAILED_DESCRIPTION","start":958,"end":967},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":968,"end":978},{"text":"mass","label":"SIGN_SYMPTOM","start":979,"end":983},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":997,"end":1005},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":1024,"end":1034},{"text":"ulcerated","label":"SIGN_SYMPTOM","start":1035,"end":1044},{"text":"mucosa","label":"BIOLOGICAL_STRUCTURE","start":1045,"end":1051},{"text":"inflammatory cells","label":"SIGN_SYMPTOM","start":1061,"end":1079},{"text":"malignancy","label":"SIGN_SYMPTOM","start":1089,"end":1099},{"text":"endoscopic","label":"DIAGNOSTIC_PROCEDURE","start":1116,"end":1126},{"text":"imagistic","label":"DIAGNOSTIC_PROCEDURE","start":1131,"end":1140},{"text":"bezoar","label":"SIGN_SYMPTOM","start":1151,"end":1157},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":1200,"end":1210},{"text":"diverticula","label":"SIGN_SYMPTOM","start":1211,"end":1222},{"text":"ulcerated","label":"SIGN_SYMPTOM","start":1242,"end":1251},{"text":"mucosa","label":"BIOLOGICAL_STRUCTURE","start":1252,"end":1258},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":1264,"end":1274},{"text":"mass","label":"SIGN_SYMPTOM","start":1275,"end":1279},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":1284,"end":1291},{"text":"endoscopic snare","label":"DIAGNOSTIC_PROCEDURE","start":1300,"end":1316},{"text":"fragmentation","label":"THERAPEUTIC_PROCEDURE","start":1338,"end":1351},{"text":"macroscopic appearance","label":"DIAGNOSTIC_PROCEDURE","start":1385,"end":1407},{"text":"4 cm","label":"DISTANCE","start":1419,"end":1423},{"text":"globular","label":"SHAPE","start":1425,"end":1433},{"text":"mass","label":"SIGN_SYMPTOM","start":1434,"end":1438},{"text":"heterogeneous","label":"DETAILED_DESCRIPTION","start":1440,"end":1453},{"text":"dense","label":"DETAILED_DESCRIPTION","start":1455,"end":1460},{"text":"whitish","label":"COLOR","start":1462,"end":1469},{"text":"harsh yellow","label":"COLOR","start":1486,"end":1498},{"text":"foci","label":"DETAILED_DESCRIPTION","start":1499,"end":1503},{"text":"dystrophic","label":"DETAILED_DESCRIPTION","start":1517,"end":1527},{"text":"calcification","label":"SIGN_SYMPTOM","start":1528,"end":1541},{"text":"macroscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1547,"end":1570},{"text":"light gray","label":"COLOR","start":1599,"end":1609},{"text":"aspect","label":"SIGN_SYMPTOM","start":1610,"end":1616},{"text":"fibrous appearance","label":"TEXTURE","start":1618,"end":1636},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1652,"end":1660},{"text":"harsh yellow-orange","label":"COLOR","start":1661,"end":1680},{"text":"structures","label":"DETAILED_DESCRIPTION","start":1681,"end":1691},{"text":"mass","label":"SIGN_SYMPTOM","start":1728,"end":1732},{"text":"trichloracetic acid","label":"DIAGNOSTIC_PROCEDURE","start":1751,"end":1770},{"text":"decalcification","label":"DIAGNOSTIC_PROCEDURE","start":1775,"end":1790},{"text":"Microscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1792,"end":1815},{"text":"hyaline fibrous tissue","label":"SIGN_SYMPTOM","start":1825,"end":1847},{"text":"stained in green","label":"LAB_VALUE","start":1858,"end":1874},{"text":"Tricrom Mason","label":"DIAGNOSTIC_PROCEDURE","start":1878,"end":1891},{"text":"crystalline","label":"SHAPE","start":1916,"end":1927},{"text":"basophils","label":"SIGN_SYMPTOM","start":1928,"end":1937},{"text":"deposits of minerals","label":"SIGN_SYMPTOM","start":1938,"end":1958},{"text":"rare","label":"LAB_VALUE","start":1960,"end":1964},{"text":"fibrocytes","label":"DIAGNOSTIC_PROCEDURE","start":1965,"end":1975},{"text":"very few","label":"LAB_VALUE","start":1980,"end":1988},{"text":"vessels","label":"DIAGNOSTIC_PROCEDURE","start":1989,"end":1996},{"text":"capillary structures","label":"SIGN_SYMPTOM","start":2014,"end":2034},{"text":"rare","label":"LAB_VALUE","start":2036,"end":2040},{"text":"fibroblasts","label":"DIAGNOSTIC_PROCEDURE","start":2041,"end":2052},{"text":"collagen fibers","label":"SIGN_SYMPTOM","start":2057,"end":2072},{"text":"mesenchymal originating","label":"BIOLOGICAL_STRUCTURE","start":2097,"end":2120},{"text":"mass","label":"SIGN_SYMPTOM","start":2121,"end":2125},{"text":"fibrovascular polyp","label":"DISEASE_DISORDER","start":2141,"end":2160},{"text":"pedicle","label":"SIGN_SYMPTOM","start":2223,"end":2230},{"text":"pedicle","label":"SIGN_SYMPTOM","start":2330,"end":2337},{"text":"calcium","label":"MEDICATION","start":2369,"end":2376},{"text":"tablets","label":"ADMINISTRATION","start":2377,"end":2384},{"text":"crystalline","label":"SHAPE","start":2517,"end":2528},{"text":"basophils","label":"SIGN_SYMPTOM","start":2529,"end":2538},{"text":"deposits of minerals","label":"SIGN_SYMPTOM","start":2539,"end":2559},{"text":"One month later","label":"DATE","start":2561,"end":2576},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":2593,"end":2605},{"text":"endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":2611,"end":2620},{"text":"enlarged","label":"SIGN_SYMPTOM","start":2641,"end":2649},{"text":"esophagus","label":"BIOLOGICAL_STRUCTURE","start":2650,"end":2659},{"text":"appearance","label":"DIAGNOSTIC_PROCEDURE","start":2665,"end":2675},{"text":"esophageal mucosa","label":"BIOLOGICAL_STRUCTURE","start":2683,"end":2700},{"text":"normal","label":"LAB_VALUE","start":2705,"end":2711},{"text":"ulcerations","label":"SIGN_SYMPTOM","start":2721,"end":2732},{"text":"diverticula","label":"SIGN_SYMPTOM","start":2741,"end":2752},{"text":"motility disturbances","label":"SIGN_SYMPTOM","start":2772,"end":2793},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":2808,"end":2818},{"text":"manometry","label":"DIAGNOSTIC_PROCEDURE","start":2819,"end":2828},{"text":"history of calcium lactate intake","label":"HISTORY","start":2864,"end":2897},{"text":"histological appearance","label":"DIAGNOSTIC_PROCEDURE","start":2902,"end":2925},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":2944,"end":2954},{"text":"benign","label":"SEVERITY","start":2955,"end":2961},{"text":"mesenchymal originating","label":"BIOLOGICAL_STRUCTURE","start":2962,"end":2985},{"text":"mass","label":"SIGN_SYMPTOM","start":2986,"end":2990},{"text":"fibrovascular polyp","label":"DISEASE_DISORDER","start":3008,"end":3027},{"text":"auto-amputated","label":"OTHER_EVENT","start":3029,"end":3043},{"text":"calcified","label":"SIGN_SYMPTOM","start":3048,"end":3057}],"tokens":["A ","65-year old"," ","female"," was ","admitted"," with ","progressive"," ","dysphagia"," for ","2 months"," and ","5 kg"," ","weight loss",".\nHer past medical history was significant for ","osteoporosis"," treated with ","calcium lactate"," ","tablets",", ","daily",", for ","5 years",".\n","Upper gastrointestinal"," ","endoscopy"," described a ","4 cm"," ","whitish"," ","firm"," ","mass"," in the ","middle esophagus"," (Fig.1) and a ","semi-circumferential"," ","deep"," ","ulcer"," with ","irregular borders"," on the ","opposite mucosa"," (Fig.2).\nDuring ","endoscopy"," a ","pedicle"," was not identify by handling a ","polipectomy snare"," around the ","esophageal"," ","mass",".\n","Upper gastrointestinal"," series with ","gastrografin"," (Fig.3) revealed an ","ovoid"," ","lacunar"," ","image"," at the ","distal part of the esophagus esophageal",", ","inhomogeneous",", with ","calcifications"," and ","smooth"," contours.\nDuring ","peristalsis"," the ","image"," was ","mobile"," and no ","pedicle"," was identified.\nThe ","esophageal lumen"," was ","enlarged"," with a ","diverticula"," development at the ","posterior wall",".\nAlso ","computer tomography"," of the ","thorax"," excluded a ","pedunculated"," ","tumor",", describing an ","intra-luminal"," ","calcified"," ","esophageal"," ","mass"," (Fig.4).\nThe ","biopsies"," obtained from the ","esophageal"," ","ulcerated"," ","mucosa"," revealed ","inflammatory cells",", without ","malignancy",".\nBased on these ","endoscopic"," and ","imagistic"," results a ","bezoar"," was supposed to have been developed in an ","esophageal"," ","diverticula",", subsequently with ","ulcerated"," ","mucosa",".\nThe ","esophageal"," ","mass"," was ","removed"," with an ","endoscopic snare"," in one piece, as the ","fragmentation"," was not physically possible.\nThe ","macroscopic appearance"," revealed a ","4 cm",", ","globular"," ","mass",", ","heterogeneous",", ","dense",", ","whitish",", in places with ","harsh yellow"," ","foci",", most likely ","dystrophic"," ","calcification",".\nThe ","macroscopic examination"," on cross section revealed a ","light gray"," ","aspect"," (","fibrous appearance",") that includes ","multiple"," ","harsh yellow-orange"," ","structures",", difficult to section (Fig.5).\nThis ","mass"," was immersed into ","trichloracetic acid"," for ","decalcification",".\n","Microscopic examination"," revealed ","hyaline fibrous tissue"," (Fig.6a), ","stained in green"," in ","Tricrom Mason"," (Fig.6b), with numerous ","crystalline"," ","basophils"," ","deposits of minerals",", ","rare"," ","fibrocytes"," and ","very few"," ","vessels",".\nThe presence of ","capillary structures",", ","rare"," ","fibroblasts"," and ","collagen fibers"," brought in discussion a ","mesenchymal originating"," ","mass",", most likely a ","fibrovascular polyp",".\nA definitive histological diagnosis was not possible, as the ","pedicle"," was not identified, but the presence of the connective tissue suggested the previous presence of a ","pedicle"," into the lesion.\nThe long term ","calcium"," ","tablets"," intake might explain the calcification process developed into the vascular-connective tissue, revealed on histology by the numerous ","crystalline"," ","basophils"," ","deposits of minerals",".\n","One month later"," the patient was ","asymptomatic",".\nThe ","endoscopy"," did not revealed an ","enlarged"," ","esophagus",", the ","appearance"," of the ","esophageal mucosa"," was ","normal"," (without ","ulcerations",") and no ","diverticula"," was identified.\nNo ","motility disturbances"," were found on ","esophageal"," ","manometry",".\nBased on the clinical course, the ","history of calcium lactate intake"," and ","histological appearance"," a diagnosis of an ","esophageal"," ","benign"," ","mesenchymal originating"," ","mass"," (most probably a ","fibrovascular polyp",") ","auto-amputated"," and ","calcified"," was formulated.\n"],"ner_labels":[0,5,0,65,0,13,0,22,0,69,0,32,0,44,0,69,0,39,0,46,0,4,0,29,0,32,0,12,0,24,0,27,0,15,0,73,0,69,0,12,0,22,0,63,0,69,0,67,0,12,0,24,0,69,0,24,0,12,0,69,0,12,0,24,0,67,0,22,0,69,0,12,0,22,0,69,0,73,0,1,0,69,0,22,0,69,0,12,0,69,0,69,0,12,0,24,0,12,0,22,0,69,0,22,0,22,0,12,0,69,0,24,0,12,0,69,0,12,0,69,0,69,0,24,0,24,0,69,0,12,0,69,0,69,0,12,0,12,0,69,0,75,0,24,0,75,0,24,0,27,0,67,0,69,0,22,0,22,0,15,0,15,0,22,0,22,0,69,0,24,0,15,0,69,0,73,0,22,0,15,0,22,0,69,0,24,0,24,0,24,0,69,0,42,0,24,0,67,0,69,0,69,0,42,0,24,0,42,0,24,0,69,0,42,0,24,0,69,0,12,0,69,0,26,0,69,0,69,0,46,0,4,0,67,0,69,0,69,0,19,0,69,0,24,0,69,0,12,0,24,0,12,0,42,0,69,0,69,0,69,0,12,0,24,0,39,0,24,0,12,0,63,0,12,0,69,0,26,0,53,0,69,0]}
-{"full_text":"A 58-year-old man with a past medical history of poorly controlled hypertension and type 2 diabetes, presented to the ICU for a cardiogenic shock complicating acute myocardial infarction.\nPhysical examination revealed reduced level of consciousness (Glasgow Coma Scale 10\/15) and weak vital signs; a blood pressure of 80\/50 mmHg, 80% of oxygen saturation, capillary blood glucose at 2.26 g\/L, a heart rate over 125 bpm, and crackling in pulmonary auscultation.\nCardiovascular examination showed neither cardiac murmur nor signs of right heart failure.\nECG on admission showed normal sinus rhythm, with heart rate of 125 bpm and extended ST-elevation in anterior territory.\nLaboratory results demonstrated Troponin I level of 6.41 ng\/ml, creatinine kinase (CKMB) was 67 UI\/L, Lactate deshydrogenase was 281 UI\/L, glucose level 2.70 g\/l, urea 0.40 g\/l and creatinine 18.6 mg \/ L.\nThe patient was intubated and sedated, inotropic agents were started (norepinephrine 0.4\u00b5g\/kg\/min and dobutamine 20\u00b5g\/kg\/min).\nChest X-rays showed diffuse alveolar syndrome.\nTransthoracic echocardiography revealed wall motion abnormalities namely extensive akinesis of anteroseptal, anterior, lateral and inferior walls, and severe left ventricular systolic dysfunction (ejection fraction of 29%).\nMedical management was initiated; anticoagulant therapy for acute coronary syndrome was started (500 mg of acetylsalicylic acid and subcutaneous low-molecular-weight heparin (0.6ml of enoxaparin)) and patient was prepared for myocardial revascularization by coronary angioplasty.\nBecause of non-improvement of neurological status and occurrence of seizures, a brain CT was indicated and revealed infratentorial diffuse hemorrhage (Fisher grade III) (Figure 1).\nCerebral angiography confirmed a dissecting aneurysm of an anastomotic branch between left PICA and the V4 segment of left vertebral artery Figure 2 that was successfully embolized.\nAfter 24 hours, the patient improved with withdrawal of vasoactive drugs in 24 hours.\nLeft hemicorporeal seizures persisted despite anticonvulsant treatment.\nControl brain CT did not report rebleeding and angiography showed complete exclusion of the aneurysm while the EEG revealed a diffuse brain damage.\n10 days after admission, the patient was discharged in stable condition but still suffers from amnesia.\n","ner_info":[{"text":"58-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"poorly controlled","label":"DETAILED_DESCRIPTION","start":49,"end":66},{"text":"hypertension","label":"DISEASE_DISORDER","start":67,"end":79},{"text":"type 2 diabetes","label":"DISEASE_DISORDER","start":84,"end":99},{"text":"presented","label":"CLINICAL_EVENT","start":101,"end":110},{"text":"ICU","label":"NONBIOLOGICAL_LOCATION","start":118,"end":121},{"text":"cardiogenic 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after","label":"DATE","start":2225,"end":2238},{"text":"discharged","label":"CLINICAL_EVENT","start":2266,"end":2276},{"text":"stable","label":"LAB_VALUE","start":2280,"end":2286},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":2287,"end":2296},{"text":"amnesia","label":"DISEASE_DISORDER","start":2320,"end":2327}],"tokens":["A ","58-year-old"," ","man"," with a past medical history of ","poorly controlled"," ","hypertension"," and ","type 2 diabetes",", ","presented"," to the ","ICU"," for a ","cardiogenic shock"," complicating ","acute"," ","myocardial infarction",".\n","Physical examination"," revealed ","reduced"," ","level of consciousness"," (","Glasgow Coma Scale"," ","10\/15",") and ","weak"," ","vital signs","; a ","blood pressure"," of ","80\/50 mmHg",", ","80%"," of ","oxygen saturation",", ","capillary"," ","blood glucose"," at ","2.26 g\/L",", a ","heart rate"," ","over 125 bpm",", and ","crackling"," in ","pulmonary auscultation",".\n","Cardiovascular 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","inferior"," ","walls",", and ","severe"," ","left ventricular systolic dysfunction"," (","ejection fraction"," of ","29%",").\n","Medical management"," was initiated; ","anticoagulant"," therapy for ","acute coronary syndrome"," was started (","500 mg"," of ","acetylsalicylic acid"," and ","subcutaneous"," ","low-molecular-weight heparin"," (","0.6ml"," of ","enoxaparin",")) and patient was prepared for ","myocardial revascularization"," by ","coronary"," ","angioplasty",".\nBecause of ","non-improvement"," of ","neurological status"," and occurrence of ","seizures",", a ","brain"," ","CT"," was indicated and revealed ","infratentorial"," ","diffuse"," ","hemorrhage"," (","Fisher grade"," ","III",") (Figure 1).\n","Cerebral"," ","angiography"," confirmed a ","dissecting aneurysm"," of an ","anastomotic branch"," between ","left PICA"," and the ","V4 segment of left vertebral artery"," Figure 2 that was successfully ","embolized",".\n","After 24 hours",", the patient ","improved"," with withdrawal of ","vasoactive drugs"," in ","24 hours",".\n","Left hemicorporeal"," ","seizures"," persisted despite ","anticonvulsant"," treatment.\nControl ","brain"," ","CT"," did not report ","rebleeding"," and ","angiography"," showed complete exclusion of the ","aneurysm"," while the ","EEG"," revealed a ","diffuse"," ","brain damage",".\n","10 days after"," admission, the patient was ","discharged"," in ","stable"," ","condition"," but still suffers from 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-{"full_text":"This is a 53-year-old male patient who went to our hospital with chief complaint of massive gum bleeding for 1 day.\nThe patient had a history of chronic hepatitis C.\nPEG-IFN-\u03b1-2a (180\u200a\u03bcg) plus ribavirin (1200\u200amg\/day) were prescribed to the patient since March 17, 2014.\nHe denied any autoimmune conditions before treatment.\nThe baseline virological data revealed high virus load (HCV RNA 2.1\u200a\u00d7\u200a106\u200aIU\/mL) with genotype 1b.\nRapid virological response was not achieved at the fourth week (HCV RNA: 2.12\u200a\u00d7\u200a106\u200aIU\/mL).\nPartial early virological response (HCV RNA: 103\u200aIU\/mL at week 12) and delayed virological response (HCV RNA: <15\u200aIU\/mL at Week 24) were noted.\nHowever, fatigue, anemia, and depression syndrome were progressed at 30th week.\nThe patient requested to stop treatment at Week 36.\nThe viral load at the end-of-treatment (EOT) was undetectable.\nThe platelet count at EOT was 92\u200a\u00d7\u200a103\u200acells\/\u03bcL and elevated to 159\u200a\u00d7\u200a103\u200acells\/\u03bcL 1 week later.\nTwo weeks following EOT, the patient developed massive gum bleeding.\nThe physical examination showed the multiple petechiae on the extremities.\nThere is no sign of intracerebral hemorrhage, gastrointestinal bleeding, or other internal bleeding.\nThe initial platelet count was 4\u200a\u00d7\u200a103cells\/\u03bcL.\nCoagulation profile showed normal prothrombin time, activated partial thromboplastin time, fibrinogen, d-dimer, and fibrin degradation product.\nPeripheral blood smear showed neither fragmented red blood cells, helmet cells nor abnormal platelet aggregation.\nConcomitant autoimmune connective tissue diseases such as systemic lupus erythematosus or cryoglobulinemia were excluded due to negative anti-nuclear antibody and cryoglobulin except for positive anti-cardiolipin IgG (116 GPL, normal range <20 GPL) and anti-phospholipid IgG (165\u200aU, normal range <15\u200aU).\nAnti-phospholipid syndrome was excluded due to no previous thromboembolic events, according to 2006 Sapporo criteria.12 Bone marrow biopsy was also performed, which revealed hypocellular marrow with even cellular distribution and without evidence of lymphoid neoplasia.\nThe potential drugs that may cause platelet lysis were ruled out.\nBlood transfusion of platelet was performed, but poor response with rapid decline of platelet count in the next day of transfusion.\nA diagnosis of immune thrombocytopenic purpura was made.\nWe started intravenous methylprednisolone therapy (40\u200amg, 3 times daily) on November 27 combined with platelet transfusion treatments.\nIt still showed no significant improvement.\nAzathioprine (100\u200amg, oral, once daily) was added since December 3.\nHydroxychloroquine (400\u200amg, oral, once daily) was also prescribed due to positive anti-phospholipid antibodies.\nPlatelet count gradually increased to 93\u200a\u00d7\u200a103\u200acells\/\u03bcL 17 days after admission, so methylprednisolone was changed to oral form and slowly tapered off.\nOn December 15, the patient was discharged due to stable condition with platelet counts elevating to 117\u200a\u00d7\u200a103\u200acells\/\u03bcL (Figure \u200b1).\nFollowed laboratory data after 5 months revealed sustained virologic response, platelet count above 150\u200a\u00d7\u200a103\u200acells\/\u03bcL, and decreased anti-cardiolipin IgG (30.5GPL) and anti-phospholipid IgG (73.21\u200aU) levels.\n","ner_info":[{"text":"53-year-old","label":"AGE","start":10,"end":21},{"text":"male","label":"SEX","start":22,"end":26},{"text":"went","label":"CLINICAL_EVENT","start":39,"end":43},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":51,"end":59},{"text":"massive","label":"SEVERITY","start":84,"end":91},{"text":"gum","label":"BIOLOGICAL_STRUCTURE","start":92,"end":95},{"text":"bleeding","label":"SIGN_SYMPTOM","start":96,"end":104},{"text":"1 day","label":"DURATION","start":109,"end":114},{"text":"chronic hepatitis C","label":"HISTORY","start":145,"end":164},{"text":"PEG-IFN-\u03b1-2a","label":"MEDICATION","start":166,"end":178},{"text":"180\u200a\u03bcg","label":"DOSAGE","start":180,"end":186},{"text":"ribavirin","label":"MEDICATION","start":193,"end":202},{"text":"1200\u200amg\/day","label":"DOSAGE","start":204,"end":215},{"text":"since March 17, 2014","label":"DURATION","start":248,"end":268},{"text":"denied any autoimmune conditions","label":"HISTORY","start":273,"end":305},{"text":"virological data","label":"DIAGNOSTIC_PROCEDURE","start":337,"end":353},{"text":"high","label":"LAB_VALUE","start":363,"end":367},{"text":"virus load","label":"DIAGNOSTIC_PROCEDURE","start":368,"end":378},{"text":"HCV 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transfusion","label":"THERAPEUTIC_PROCEDURE","start":2142,"end":2159},{"text":"poor","label":"LAB_VALUE","start":2191,"end":2195},{"text":"response","label":"DIAGNOSTIC_PROCEDURE","start":2196,"end":2204},{"text":"rapid decline","label":"LAB_VALUE","start":2210,"end":2223},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2227,"end":2241},{"text":"next day","label":"DATE","start":2249,"end":2257},{"text":"transfusion","label":"THERAPEUTIC_PROCEDURE","start":2261,"end":2272},{"text":"immune thrombocytopenic purpura","label":"DISEASE_DISORDER","start":2289,"end":2320},{"text":"intravenous","label":"ADMINISTRATION","start":2342,"end":2353},{"text":"methylprednisolone","label":"MEDICATION","start":2354,"end":2372},{"text":"40\u200amg, 3 times daily","label":"DOSAGE","start":2382,"end":2402},{"text":"November 27","label":"DATE","start":2407,"end":2418},{"text":"platelet transfusion treatments","label":"THERAPEUTIC_PROCEDURE","start":2433,"end":2464},{"text":"improvement","label":"SIGN_SYMPTOM","start":2497,"end":2508},{"text":"Azathioprine","label":"MEDICATION","start":2510,"end":2522},{"text":"100\u200amg","label":"DOSAGE","start":2524,"end":2530},{"text":"oral","label":"ADMINISTRATION","start":2532,"end":2536},{"text":"once daily","label":"DOSAGE","start":2538,"end":2548},{"text":"since December 3","label":"DATE","start":2560,"end":2576},{"text":"Hydroxychloroquine","label":"MEDICATION","start":2578,"end":2596},{"text":"400\u200amg","label":"DOSAGE","start":2598,"end":2604},{"text":"oral","label":"ADMINISTRATION","start":2606,"end":2610},{"text":"once daily","label":"DOSAGE","start":2612,"end":2622},{"text":"positive","label":"LAB_VALUE","start":2651,"end":2659},{"text":"anti-phospholipid antibodies","label":"DIAGNOSTIC_PROCEDURE","start":2660,"end":2688},{"text":"Platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2690,"end":2704},{"text":"increased","label":"LAB_VALUE","start":2715,"end":2724},{"text":"93\u200a\u00d7\u200a103\u200acells\/\u03bcL","label":"LAB_VALUE","start":2728,"end":2745},{"text":"17 days after admission","label":"DATE","start":2746,"end":2769},{"text":"methylprednisolone","label":"MEDICATION","start":2774,"end":2792},{"text":"oral","label":"ADMINISTRATION","start":2808,"end":2812},{"text":"tapered off","label":"DOSAGE","start":2829,"end":2840},{"text":"December 15","label":"DATE","start":2845,"end":2856},{"text":"discharged","label":"CLINICAL_EVENT","start":2874,"end":2884},{"text":"stable condition","label":"SIGN_SYMPTOM","start":2892,"end":2908},{"text":"platelet counts","label":"DIAGNOSTIC_PROCEDURE","start":2914,"end":2929},{"text":"elevating","label":"LAB_VALUE","start":2930,"end":2939},{"text":"117\u200a\u00d7\u200a103\u200acells\/\u03bcL","label":"LAB_VALUE","start":2943,"end":2961},{"text":"laboratory data","label":"DIAGNOSTIC_PROCEDURE","start":2984,"end":2999},{"text":"after 5 months","label":"DATE","start":3000,"end":3014},{"text":"sustained","label":"DETAILED_DESCRIPTION","start":3024,"end":3033},{"text":"virologic response","label":"SIGN_SYMPTOM","start":3034,"end":3052},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":3054,"end":3068},{"text":"above 150\u200a\u00d7\u200a103\u200acells\/\u03bcL","label":"LAB_VALUE","start":3069,"end":3093},{"text":"decreased","label":"LAB_VALUE","start":3099,"end":3108},{"text":"anti-cardiolipin IgG","label":"DIAGNOSTIC_PROCEDURE","start":3109,"end":3129},{"text":"30.5GPL","label":"LAB_VALUE","start":3131,"end":3138},{"text":"anti-phospholipid IgG","label":"DIAGNOSTIC_PROCEDURE","start":3144,"end":3165},{"text":"73.21\u200aU","label":"LAB_VALUE","start":3167,"end":3174}],"tokens":["This is a ","53-year-old"," ","male"," patient who ","went"," to our ","hospital"," with chief complaint of ","massive"," ","gum"," ","bleeding"," for ","1 day",".\nThe patient had a history of ","chronic hepatitis C",".\n","PEG-IFN-\u03b1-2a"," (","180\u200a\u03bcg",") plus ","ribavirin"," (","1200\u200amg\/day",") were prescribed to the patient ","since March 17, 2014",".\nHe ","denied any autoimmune conditions"," before treatment.\nThe baseline ","virological data"," revealed ","high"," ","virus load"," (","HCV RNA"," ","2.1\u200a\u00d7\u200a106\u200aIU\/mL",") with ","genotype"," ","1b",".\n","Rapid"," ","virological response"," was not achieved at the ","fourth week"," (","HCV RNA",": ","2.12\u200a\u00d7\u200a106\u200aIU\/mL",").\n","Partial"," ","early"," ","virological response"," (","HCV RNA",": ","103\u200aIU\/mL"," at ","week 12",") and delayed virological response (","HCV RNA",": ","<15\u200aIU\/mL"," at ","Week 24",") were noted.\nHowever, ","fatigue",", ","anemia",", and ","depression syndrome"," were progressed at ","30th week",".\nThe patient requested to stop ","treatment"," at ","Week 36",".\nThe ","viral load"," at the ","end-of-treatment"," (","EOT",") was ","undetectable",".\nThe ","platelet count"," at ","EOT"," was ","92\u200a\u00d7\u200a103\u200acells\/\u03bcL"," and ","elevated"," to ","159\u200a\u00d7\u200a103\u200acells\/\u03bcL"," ","1 week later",".\n","Two weeks following EOT",", the patient developed ","massive"," ","gum"," ","bleeding",".\nThe ","physical examination"," showed the ","multiple"," ","petechiae"," on the ","extremities",".\nThere is no sign of ","intracerebral"," ","hemorrhage",", ","gastrointestinal"," ","bleeding",", or other internal bleeding.\nThe ","initial"," ","platelet count"," was ","4\u200a\u00d7\u200a103cells\/\u03bcL",".\n","Coagulation profile"," showed ","normal"," ","prothrombin time",", ","activated partial thromboplastin time",", ","fibrinogen",", ","d-dimer",", and ","fibrin degradation product",".\n","Peripheral blood smear"," showed neither ","fragmented red blood cells",", ","helmet cells"," nor ","abnormal platelet aggregation",".\nConcomitant autoimmune ","connective tissue diseases"," such as ","systemic lupus erythematosus"," or ","cryoglobulinemia"," were excluded due to ","negative"," ","anti-nuclear antibody"," and ","cryoglobulin"," except for ","positive"," ","anti-cardiolipin IgG"," (","116 GPL",", normal range <20 GPL) and ","anti-phospholipid IgG"," (","165\u200aU",", normal range <15\u200aU).\n","Anti-phospholipid syndrome"," was excluded due to ","no previous thromboembolic events",", according to ","2006"," ","Sapporo criteria",".12 ","Bone marrow"," ","biopsy"," was also performed, which revealed ","hypocellular"," ","marrow"," with ","even"," ","cellular distribution"," and without evidence of ","lymphoid neoplasia",".\nThe potential ","drugs that may cause platelet lysis"," were ruled out.\n","Blood transfusion"," of platelet was performed, but ","poor"," ","response"," with ","rapid decline"," of ","platelet count"," in the ","next day"," of ","transfusion",".\nA diagnosis of ","immune thrombocytopenic purpura"," was made.\nWe started ","intravenous"," ","methylprednisolone"," therapy (","40\u200amg, 3 times daily",") on ","November 27"," combined with ","platelet transfusion treatments",".\nIt still showed no significant ","improvement",".\n","Azathioprine"," (","100\u200amg",", ","oral",", ","once daily",") was added ","since December 3",".\n","Hydroxychloroquine"," (","400\u200amg",", ","oral",", ","once daily",") was also prescribed due to ","positive"," ","anti-phospholipid antibodies",".\n","Platelet count"," gradually ","increased"," to ","93\u200a\u00d7\u200a103\u200acells\/\u03bcL"," ","17 days after admission",", so ","methylprednisolone"," was changed to ","oral"," form and slowly ","tapered off",".\nOn ","December 15",", the patient was ","discharged"," due to ","stable condition"," with ","platelet counts"," ","elevating"," to ","117\u200a\u00d7\u200a103\u200acells\/\u03bcL"," (Figure \u200b1).\nFollowed ","laboratory data"," ","after 5 months"," revealed ","sustained"," ","virologic response",", ","platelet count"," ","above 150\u200a\u00d7\u200a103\u200acells\/\u03bcL",", and ","decreased"," ","anti-cardiolipin IgG"," (","30.5GPL",") and ","anti-phospholipid IgG"," (","73.21\u200aU",") levels.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,63,0,12,0,69,0,32,0,39,0,46,0,29,0,46,0,29,0,32,0,39,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,22,0,69,0,19,0,24,0,42,0,22,0,22,0,69,0,24,0,42,0,19,0,24,0,42,0,19,0,69,0,69,0,69,0,19,0,46,0,19,0,24,0,19,0,19,0,42,0,24,0,19,0,42,0,42,0,42,0,19,0,19,0,63,0,12,0,69,0,24,0,62,0,69,0,12,0,12,0,69,0,12,0,69,0,22,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,69,0,69,0,69,0,26,0,26,0,26,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,26,0,39,0,22,0,24,0,12,0,24,0,69,0,12,0,42,0,24,0,26,0,46,0,75,0,42,0,24,0,42,0,24,0,19,0,75,0,26,0,4,0,46,0,29,0,19,0,75,0,69,0,46,0,29,0,4,0,29,0,19,0,46,0,29,0,4,0,29,0,42,0,24,0,24,0,42,0,42,0,19,0,46,0,4,0,29,0,19,0,13,0,69,0,24,0,42,0,42,0,24,0,19,0,22,0,69,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0]}
-{"full_text":"A 66 year old patient with a history of UC treated by mesalazine since 5 years consulted in July 2012 for a painful erythematous swelling of the back of the right hand.\nThe bacteriological samples were negative, the lesion was considered as an abscesses and the patient was treated with antibiotics and local antiseptics without improvement.\nThe evolution was characterized by the appearance of an erythematous vesiculobullous centrifugal expansion taking the whole back of the right hand treated several times by various antibiotics unsuccessfully.\nBiopsy of this lesion was initially not specific.\nIn October 2012, the patient was hospitalized for fever and polyarthralgia in the context of impaired general condition.\nHe had a quiescent UC disease.\nThe skin examination found an erythematous plaque of 10 cm of diameter, with a raised border and vesicules, taking the back of the right hand and wrist (Figure 1).\nThere was also an infiltrated erythematous plaque on the right leg (Figure 2) and another topped with a large pustule at the left ankle (Figure 3).\nIn biology, there was a biological inflammatory syndrome and high leukocytosis with neutrophils.\nHepatic and renal functions were normal.\nSkin biopsy showed at the edge of the back of the closet right hand ulcerated epidermis and the dermis infiltrate rich in neutrophils with leukocytoclastic vasculitis finding a PG (Figure 4).\nOther biopsies taken at infiltrated erythematous plaques of the ankle showed a normal appearance of skin, edema of the superficial dermis based on an infiltrate rich in neutrophils without vasculitis confirming the diagnosis of SS (Figure 5).\nCorticosteroid treatment was then started with prednisolone at a dose of 1mg\/Kg\/j.\nThe evolution was marked since day 7 of treatment by the desinfiltration of the plaques (Figure 6), the recovery of the general condition and disappearance of biological inflammatory syndrome.\n","ner_info":[{"text":"66 year old","label":"AGE","start":2,"end":13},{"text":"history of UC","label":"HISTORY","start":29,"end":42},{"text":"mesalazine","label":"MEDICATION","start":54,"end":64},{"text":"since 5 years","label":"DURATION","start":65,"end":78},{"text":"consulted","label":"CLINICAL_EVENT","start":79,"end":88},{"text":"July 2012","label":"DATE","start":92,"end":101},{"text":"painful","label":"DETAILED_DESCRIPTION","start":108,"end":115},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":116,"end":128},{"text":"swelling","label":"SIGN_SYMPTOM","start":129,"end":137},{"text":"back of the right hand","label":"BIOLOGICAL_STRUCTURE","start":145,"end":167},{"text":"bacteriological samples","label":"DIAGNOSTIC_PROCEDURE","start":173,"end":196},{"text":"negative","label":"LAB_VALUE","start":202,"end":210},{"text":"lesion","label":"COREFERENCE","start":216,"end":222},{"text":"abscesses","label":"SIGN_SYMPTOM","start":244,"end":253},{"text":"antibiotics","label":"MEDICATION","start":287,"end":298},{"text":"local antiseptics","label":"MEDICATION","start":303,"end":320},{"text":"improvement","label":"SIGN_SYMPTOM","start":329,"end":340},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":398,"end":410},{"text":"vesiculobullous","label":"DETAILED_DESCRIPTION","start":411,"end":426},{"text":"centrifugal expansion","label":"SIGN_SYMPTOM","start":427,"end":448},{"text":"whole back of the right hand","label":"BIOLOGICAL_STRUCTURE","start":460,"end":488},{"text":"several times","label":"FREQUENCY","start":497,"end":510},{"text":"various antibiotics","label":"MEDICATION","start":514,"end":533},{"text":"Biopsy","label":"DIAGNOSTIC_PROCEDURE","start":550,"end":556},{"text":"not specific","label":"LAB_VALUE","start":586,"end":598},{"text":"October 2012","label":"DATE","start":603,"end":615},{"text":"hospitalized","label":"CLINICAL_EVENT","start":633,"end":645},{"text":"fever","label":"SIGN_SYMPTOM","start":650,"end":655},{"text":"polyarthralgia","label":"SIGN_SYMPTOM","start":660,"end":674},{"text":"impaired general condition","label":"SIGN_SYMPTOM","start":693,"end":719},{"text":"quiescent","label":"DETAILED_DESCRIPTION","start":730,"end":739},{"text":"UC disease","label":"DISEASE_DISORDER","start":740,"end":750},{"text":"skin examination","label":"DIAGNOSTIC_PROCEDURE","start":756,"end":772},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":782,"end":794},{"text":"plaque","label":"SIGN_SYMPTOM","start":795,"end":801},{"text":"10 cm","label":"DISTANCE","start":805,"end":810},{"text":"raised border","label":"DETAILED_DESCRIPTION","start":831,"end":844},{"text":"vesicules","label":"DETAILED_DESCRIPTION","start":849,"end":858},{"text":"back of the right hand","label":"BIOLOGICAL_STRUCTURE","start":871,"end":893},{"text":"wrist","label":"BIOLOGICAL_STRUCTURE","start":898,"end":903},{"text":"infiltrated","label":"DETAILED_DESCRIPTION","start":934,"end":945},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":946,"end":958},{"text":"plaque","label":"SIGN_SYMPTOM","start":959,"end":965},{"text":"right leg","label":"BIOLOGICAL_STRUCTURE","start":973,"end":982},{"text":"topped with a large pustule","label":"DETAILED_DESCRIPTION","start":1006,"end":1033},{"text":"left ankle","label":"BIOLOGICAL_STRUCTURE","start":1041,"end":1051},{"text":"biological inflammatory syndrome","label":"DISEASE_DISORDER","start":1088,"end":1120},{"text":"high","label":"SEVERITY","start":1125,"end":1129},{"text":"leukocytosis","label":"SIGN_SYMPTOM","start":1130,"end":1142},{"text":"with neutrophils","label":"DETAILED_DESCRIPTION","start":1143,"end":1159},{"text":"Hepatic","label":"DIAGNOSTIC_PROCEDURE","start":1161,"end":1168},{"text":"renal functions","label":"DIAGNOSTIC_PROCEDURE","start":1173,"end":1188},{"text":"normal","label":"LAB_VALUE","start":1194,"end":1200},{"text":"Skin biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1202,"end":1213},{"text":"edge of the back of the closet right hand","label":"BIOLOGICAL_STRUCTURE","start":1228,"end":1269},{"text":"ulcerated epidermis","label":"SIGN_SYMPTOM","start":1270,"end":1289},{"text":"dermis infiltrate rich in neutrophils","label":"DETAILED_DESCRIPTION","start":1298,"end":1335},{"text":"leukocytoclastic","label":"DETAILED_DESCRIPTION","start":1341,"end":1357},{"text":"vasculitis","label":"SIGN_SYMPTOM","start":1358,"end":1368},{"text":"PG","label":"DISEASE_DISORDER","start":1379,"end":1381},{"text":"Other biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1394,"end":1408},{"text":"infiltrated","label":"DETAILED_DESCRIPTION","start":1418,"end":1429},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":1430,"end":1442},{"text":"plaques","label":"SIGN_SYMPTOM","start":1443,"end":1450},{"text":"ankle","label":"BIOLOGICAL_STRUCTURE","start":1458,"end":1463},{"text":"normal","label":"LAB_VALUE","start":1473,"end":1479},{"text":"appearance of skin","label":"DIAGNOSTIC_PROCEDURE","start":1480,"end":1498},{"text":"edema","label":"SIGN_SYMPTOM","start":1500,"end":1505},{"text":"superficial dermis","label":"BIOLOGICAL_STRUCTURE","start":1513,"end":1531},{"text":"infiltrate rich in neutrophils","label":"DETAILED_DESCRIPTION","start":1544,"end":1574},{"text":"vasculitis","label":"SIGN_SYMPTOM","start":1583,"end":1593},{"text":"SS","label":"DISEASE_DISORDER","start":1622,"end":1624},{"text":"Corticosteroid","label":"MEDICATION","start":1637,"end":1651},{"text":"prednisolone","label":"MEDICATION","start":1684,"end":1696},{"text":"1mg\/Kg\/j","label":"DOSAGE","start":1710,"end":1718},{"text":"since day 7 of treatment","label":"DATE","start":1745,"end":1769},{"text":"desinfiltration of the plaques","label":"SIGN_SYMPTOM","start":1777,"end":1807},{"text":"recovery of the general condition","label":"SIGN_SYMPTOM","start":1824,"end":1857},{"text":"biological inflammatory syndrome","label":"DISEASE_DISORDER","start":1879,"end":1911}],"tokens":["A ","66 year old"," patient with a ","history of UC"," treated by ","mesalazine"," ","since 5 years"," ","consulted"," in ","July 2012"," for a ","painful"," ","erythematous"," ","swelling"," of the ","back of the right hand",".\nThe ","bacteriological samples"," were ","negative",", the ","lesion"," was considered as an ","abscesses"," and the patient was treated with ","antibiotics"," and ","local antiseptics"," without ","improvement",".\nThe evolution was characterized by the appearance of an ","erythematous"," ","vesiculobullous"," ","centrifugal expansion"," taking the ","whole back of the right hand"," treated ","several times"," by ","various antibiotics"," unsuccessfully.\n","Biopsy"," of this lesion was initially ","not specific",".\nIn ","October 2012",", the patient was ","hospitalized"," for ","fever"," and ","polyarthralgia"," in the context of ","impaired general condition",".\nHe had a ","quiescent"," ","UC disease",".\nThe ","skin examination"," found an ","erythematous"," ","plaque"," of ","10 cm"," of diameter, with a ","raised border"," and ","vesicules",", taking the ","back of the right hand"," and ","wrist"," (Figure 1).\nThere was also an ","infiltrated"," ","erythematous"," ","plaque"," on the ","right leg"," (Figure 2) and another ","topped with a large pustule"," at the ","left ankle"," (Figure 3).\nIn biology, there was a ","biological inflammatory syndrome"," and ","high"," ","leukocytosis"," ","with neutrophils",".\n","Hepatic"," and ","renal functions"," were ","normal",".\n","Skin biopsy"," showed at the ","edge of the back of the closet right hand"," ","ulcerated epidermis"," and the ","dermis infiltrate rich in neutrophils"," with ","leukocytoclastic"," ","vasculitis"," finding a ","PG"," (Figure 4).\n","Other biopsies"," taken at ","infiltrated"," ","erythematous"," ","plaques"," of the ","ankle"," showed a ","normal"," ","appearance of skin",", ","edema"," of the ","superficial dermis"," based on an ","infiltrate rich in neutrophils"," without ","vasculitis"," confirming the diagnosis of ","SS"," (Figure 5).\n","Corticosteroid"," treatment was then started with ","prednisolone"," at a dose of ","1mg\/Kg\/j",".\nThe evolution was marked ","since day 7 of treatment"," by the ","desinfiltration of the plaques"," (Figure 6), the ","recovery of the general condition"," and disappearance of ","biological inflammatory syndrome",".\n"],"ner_labels":[0,5,0,39,0,46,0,32,0,13,0,19,0,22,0,22,0,69,0,12,0,24,0,42,0,18,0,69,0,46,0,46,0,69,0,22,0,22,0,69,0,12,0,35,0,46,0,24,0,42,0,19,0,13,0,69,0,69,0,69,0,22,0,26,0,24,0,22,0,69,0,27,0,22,0,22,0,12,0,12,0,22,0,22,0,69,0,12,0,22,0,12,0,26,0,63,0,69,0,22,0,24,0,24,0,42,0,24,0,12,0,69,0,22,0,22,0,69,0,26,0,24,0,22,0,22,0,69,0,12,0,42,0,24,0,69,0,12,0,22,0,69,0,26,0,46,0,46,0,29,0,19,0,69,0,69,0,26,0]}
-{"full_text":"A 35-year-old woman was admitted with a 5-day history of increasing drowsiness, fatigue, personality changes, generalised weakness and deteriorating mobility.\nHer medical history included a 10-year history of schizo-affective disorder, lithium-induced diabetes insipidus and hypothyroidism.\nHer medications included sodium valproate 1\u2005g twice daily, carbamazepine, quetiapine and lithium.\nOn admission, the patient was drowsy, difficult to rouse (sleeping all night and in the afternoon).\nHer Glasgow Coma Scale (GCS) was 14\/15, her abbreviated mini-mental test score was 6\/10 and she was noted to be slow in her responses.\nNeurological examination showed reduced power in her lower limbs (3\u20134\/5) in a pyramidal distribution, and brisk reflexes with intact sensation in all modalities.\nCardiovascular, respiratory and gastrointestinal examinations were unremarkable and there were no demonstrable features of hepatic disease.\nRoutine biochemistry was unremarkable.\nThe patient's alanine transaminase was 7\u2005u\/L (1\u201315), alkaline phosphatase 61\u2005u\/L (30\u2013130), \u03b3-glutamyl transferase 17\u2005u\/L (<45) and bilirubin was 6\u2005\u03bcmol\/L (<21).\nShe had normal serum B12 and folate levels, and normal thyroid function tests.\nSerum lithium levels were within the therapeutic range.\nHer serum ammonia was 47\u2005\u03bcmol\/L (11.2\u201335.4) and valproate concentrations were elevated 140\u2005mg\/L (50\u2013100).\nBrain imaging including CT and MRI did not show any haemorrhage or intracranial mass.\nLumbar puncture demonstrated clear cerebrospinal fluid (white cell count <1\u00d7106\/L, protein 0.25\u2005g\/L (0.2\u20130.4)).\nEEG demonstrated mild variable slowing and irregularity of background activity (likely due to medication).\nThe differential diagnosis included encephalitis, Guillain-Barr\u00e9 syndrome and acute disseminated encephalomyelitis (ADEM), which were excluded through our investigations.\nIn view of the raised valproate and ammonia levels, a diagnosis of valproate hyperammonaemic encephalopathy (VHE) was made at this point\nThe dose of sodium valproate was reduced by half rather than being completely withdrawn.\nThis was due to the complex and challenging nature of managing the patient's schizo-affective disorder.\nWithin 3\u2005days, there was evident clinical improvement in her mental status.\nThe patient was able to sit and communicate with the team, and her abbreviated mental test score improved to 10\/10.The serum ammonia normalised and valproate levels decreased to the therapeutic range.\nAfter 4\u2005days she was discharged home.\nResults of investigations of her urea cycle were awaited.\nThree weeks postdischarge, the patient was clinically stable in terms of mental functioning, having had no further episodes of confusion or drowsiness.\nHowever, she continued to have fatigue and walking difficulties (due to residual leg weakness).\nResults of her serum amino acids revealed that our patient had carnitine deficiency evident by low acyl-carnitine, low free serum carnitine (14.2\u2005\u03bcmol\/L, normal range: 23\u201352) and low total serum carnitine (19.9\u2005\u03bcmol\/L, normal range: 27\u201363).\nShe was started on oral carnitine 1\u2005g twice daily.\nWithin 2\u2005weeks, her symptoms resolved completely with normalisation of serum carnitine levels (free carnitine 25.2\u2005\u03bcmol\/L and total carnitine of 41.3\u2005\u03bcmol\/L).\nThe sodium valproate was initially stopped completely, but due to a serious relapse of the patient's schizo-affective disorder, it was restarted and she is now well on valproate 1\u2005g once daily and long-term carnitine supplements.\n","ner_info":[{"text":"35-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"admitted","label":"CLINICAL_EVENT","start":24,"end":32},{"text":"5-day","label":"DURATION","start":40,"end":45},{"text":"drowsiness","label":"SIGN_SYMPTOM","start":68,"end":78},{"text":"fatigue","label":"SIGN_SYMPTOM","start":80,"end":87},{"text":"personality changes","label":"SIGN_SYMPTOM","start":89,"end":108},{"text":"generalised","label":"DETAILED_DESCRIPTION","start":110,"end":121},{"text":"weakness","label":"SIGN_SYMPTOM","start":122,"end":130},{"text":"deteriorating","label":"QUALITATIVE_CONCEPT","start":135,"end":148},{"text":"mobility","label":"DIAGNOSTIC_PROCEDURE","start":149,"end":157},{"text":"10-year history of schizo-affective disorder","label":"HISTORY","start":190,"end":234},{"text":"lithium-induced diabetes 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valproate"," ","1\u2005g twice daily",", ","carbamazepine",", ","quetiapine"," and ","lithium",".\nOn ","admission",", the patient was ","drowsy",", ","difficult to rouse"," (","sleeping"," ","all night and in the afternoon",").\nHer ","Glasgow Coma Scale"," (","GCS",") was ","14\/15",", her abbreviated ","mini-mental test score"," was ","6\/10"," and she was noted to be ","slow"," in her responses.\n","Neurological examination"," showed ","reduced"," ","power"," in her ","lower limbs"," (","3\u20134\/5",") in a ","pyramidal distribution",", and ","brisk"," ","reflexes"," with ","intact"," ","sensation"," in ","all modalities",".\n","Cardiovascular",", ","respiratory"," and ","gastrointestinal"," ","examinations"," were ","unremarkable"," and there were no demonstrable features of ","hepatic disease",".\n","Routine"," ","biochemistry"," was ","unremarkable",".\nThe patient's ","alanine transaminase"," was ","7\u2005u\/L"," (1\u201315), ","alkaline phosphatase"," ","61\u2005u\/L"," (30\u2013130), ","\u03b3-glutamyl transferase"," ","17\u2005u\/L"," (<45) and ","bilirubin"," was ","6\u2005\u03bcmol\/L"," (<21).\nShe had ","normal"," ","serum"," ","B12"," and ","folate"," levels, and ","normal"," ","thyroid function tests",".\n","Serum"," ","lithium"," levels were ","within the therapeutic range",".\nHer ","serum"," ","ammonia"," was ","47\u2005\u03bcmol\/L"," (11.2\u201335.4) and ","valproate"," concentrations were ","elevated"," ","140\u2005mg\/L"," (50\u2013100).\n","Brain"," ","imaging"," including ","CT"," and ","MRI"," did not show any ","haemorrhage"," or ","intracranial"," ","mass",".\n","Lumbar puncture"," demonstrated ","clear"," ","cerebrospinal fluid"," (","white cell count"," ","<1\u00d7106\/L",", ","protein"," ","0.25\u2005g\/L"," (0.2\u20130.4)).\n","EEG"," demonstrated ","mild"," variable ","slowing"," and ","irregularity of background activity"," (likely due to ","medication",").\nThe differential diagnosis included ","encephalitis",", ","Guillain-Barr\u00e9 syndrome"," and ","acute disseminated encephalomyelitis"," (","ADEM","), which were excluded through our investigations.\nIn view of the ","raised"," ","valproate"," and ","ammonia"," levels, a diagnosis of ","valproate hyperammonaemic encephalopathy"," (","VHE",") was made at this point\nThe dose of ","sodium valproate"," was ","reduced by half"," rather than being completely withdrawn.\nThis was due to the complex and challenging nature of managing the patient's ","schizo-affective disorder",".\n","Within 3\u2005days",", there was evident clinical ","improvement"," in her ","mental status",".\nThe patient was able to ","sit"," and ","communicate"," with the team, and her ","abbreviated mental test score"," ","improved"," to ","10\/10",".The ","serum"," ","ammonia"," ","normalised"," and ","valproate"," levels ","decreased"," to the ","therapeutic range",".\n","After 4\u2005days"," she was ","discharged"," ","home",".\nResults of ","investigations"," of her ","urea cycle"," were awaited.\n","Three weeks"," post","discharge",", the patient was clinically ","stable"," in terms of ","mental functioning",", having had no further episodes of ","confusion"," or ","drowsiness",".\nHowever, she continued to have ","fatigue"," and ","walking difficulties"," (due to ","residual"," ","leg"," ","weakness",").\nResults of her ","serum"," ","amino acids"," revealed that our patient had ","carnitine deficiency"," evident by ","low"," ","acyl-carnitine",", ","low"," ","free"," ","serum"," ","carnitine"," (","14.2\u2005\u03bcmol\/L",", normal range: 23\u201352) and ","low"," ","total"," ","serum"," ","carnitine"," (","19.9\u2005\u03bcmol\/L",", normal range: 27\u201363).\nShe was started on ","oral"," ","carnitine"," ","1\u2005g twice daily",".\n","Within 2\u2005weeks",", her ","symptoms"," resolved completely with ","normalisation"," of ","serum"," ","carnitine"," levels (","free"," ","carnitine"," ","25.2\u2005\u03bcmol\/L"," and ","total"," ","carnitine"," of ","41.3\u2005\u03bcmol\/L",").\nThe ","sodium valproate"," was initially stopped completely, but due to a serious ","relapse"," of the patient's ","schizo-affective disorder",", it was restarted and she is now ","well"," on ","valproate"," ","1\u2005g once daily"," and ","long-term"," ","carnitine 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-{"full_text":"A 50-year-old male patient was admitted to our Department for a thyroid nodule on the right side of the neck, which was incidentally detected on carotid Doppler ultrasound scan.\nFine-needle aspiration cytology (FNAC) showed a follicular lesion.\nAt the time of our evaluation, the patient was in good health.\nThe medical history revealed hypertension, vitiligo, and celiac disease.\nOn physical examination, a small nodule (1 cm) was palpable in the right thyroid lobe.\nNo enlarged neck lymph nodes were palpable.\nNeck ultrasound showed a 1.3 cm hypoechoic nodule with irregular margins in the right thyroid lobe together with bilateral small thyroid nodules (4\u20135 mm) and the absence of enlarged cervical bilateral lymph nodes.\nThyroid function tests were normal with the absence of thyroid autoantibodies.\nSerum calcium was normal (9.7 mg\/dl; normal range, 8.4\u201310.4 mg\/dL) and PTH, routinely measured together with serum calcium in our Center in patients undergoing thyroid surgery, slightly elevated (68 pg\/mL (intact PTH, 2nd generation assay; normal range, 10\u201365 pg\/mL)).\nThe re-review of the original slides of FNAC confirmed a follicular lesion.\nIn particular, the cytology of the nodule showed epithelial cells with hyperchromatic nuclei organized in small cohesive clusters resembling microfollicles typically observed in thyroid follicular lesions were evident (Fig.1a).\nThe patients underwent right lobectomy.\nDuring neck exploration, there were no macroscopic signs of local invasion.\nThe intraoperative frozen-section pathological examination raised the suspicion of a PC.\nDefinitive histology showed a markedly irregular infiltrative growth of the tumor with invasion of the thyroid tissue and cervical soft tissues (Fig.1b, c).\nImmunostaining for thyroglobulin was negative, whereas staining for chromogranin A and PTH showed a strong reactivity (Fig.1d\u2013f).\nBased on the light microscopic findings and the immunohistochemical profile, the tumor was diagnosed as a PC.\nPostoperative serum calcium (8.7 mg\/dl) and phosphate (3 mg\/dl) levels were in the normal range.\nOne month after surgery, serum calcium and plasma PTH were 9.6 mg\/dL and 47 pg\/mL, respectively.\nNeck ultrasound and total body computed tomography scan were negative for local and metastatic disease.\nEight months later, serum calcium and plasma PTH levels were 9.1\u20139.2 mg\/dl and 38\u201344 pg\/ml (1\u201384 PTH 3rd generation assay, normal range, 8\u201340 pg\/mL), respectively.\nNeck ultrasound did not show any pathological lesions.\nIn order to exclude a familiar form of PHPT, in which PC may rarely occur as a nonfunctioning tumor [11], the screening of serum calcium and neck ultrasound in the first-degree relatives was normal.\n","ner_info":[{"text":"50-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"admitted","label":"CLINICAL_EVENT","start":31,"end":39},{"text":"Department","label":"NONBIOLOGICAL_LOCATION","start":47,"end":57},{"text":"thyroid","label":"BIOLOGICAL_STRUCTURE","start":64,"end":71},{"text":"nodule","label":"SIGN_SYMPTOM","start":72,"end":78},{"text":"right side of the neck","label":"BIOLOGICAL_STRUCTURE","start":86,"end":108},{"text":"carotid","label":"BIOLOGICAL_STRUCTURE","start":145,"end":152},{"text":"Doppler","label":"DETAILED_DESCRIPTION","start":153,"end":160},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":161,"end":171},{"text":"Fine-needle aspiration 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cm","label":"DISTANCE","start":422,"end":426},{"text":"palpable","label":"SIGN_SYMPTOM","start":432,"end":440},{"text":"right thyroid lobe","label":"BIOLOGICAL_STRUCTURE","start":448,"end":466},{"text":"enlarged","label":"SIGN_SYMPTOM","start":471,"end":479},{"text":"neck lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":480,"end":496},{"text":"palpable","label":"SIGN_SYMPTOM","start":502,"end":510},{"text":"Neck","label":"BIOLOGICAL_STRUCTURE","start":512,"end":516},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":517,"end":527},{"text":"1.3 cm","label":"DISTANCE","start":537,"end":543},{"text":"hypoechoic","label":"DETAILED_DESCRIPTION","start":544,"end":554},{"text":"nodule","label":"SIGN_SYMPTOM","start":555,"end":561},{"text":"irregular margins","label":"DETAILED_DESCRIPTION","start":567,"end":584},{"text":"right thyroid 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relatives","label":"SUBJECT","start":2661,"end":2683},{"text":"normal","label":"LAB_VALUE","start":2688,"end":2694}],"tokens":["A ","50-year-old"," ","male"," patient was ","admitted"," to our ","Department"," for a ","thyroid"," ","nodule"," on the ","right side of the neck",", which was incidentally detected on ","carotid"," ","Doppler"," ","ultrasound"," scan.\n","Fine-needle aspiration cytology"," (","FNAC",") showed a ","follicular"," ","lesion",".\nAt the time of our ","evaluation",", the patient was in ","good"," ","health",".\nThe medical history revealed ","hypertension",", ","vitiligo",", and ","celiac disease",".\nOn ","physical examination",", a ","small"," ","nodule"," (","1 cm",") was ","palpable"," in the ","right thyroid lobe",".\nNo ","enlarged"," ","neck lymph nodes"," were ","palpable",".\n","Neck"," ","ultrasound"," showed a ","1.3 cm"," ","hypoechoic"," ","nodule"," with ","irregular margins"," in the ","right thyroid lobe"," together with ","bilateral"," ","small"," ","thyroid"," ","nodules"," (","4\u20135 mm",") and the absence of ","enlarged"," ","cervical bilateral lymph nodes",".\n","Thyroid function tests"," were ","normal"," with the absence of ","thyroid autoantibodies",".\n","Serum"," ","calcium"," was ","normal"," (","9.7 mg\/dl","; normal range, 8.4\u201310.4 mg\/dL) and ","PTH",", routinely measured together with ","serum"," ","calcium"," in our ","Center"," in patients undergoing ","thyroid"," ","surgery",", ","slightly elevated"," (","68 pg\/mL"," (intact PTH, 2nd generation assay; normal range, 10\u201365 pg\/mL)).\nThe re-review of the original slides of ","FNAC"," confirmed a ","follicular"," ","lesion",".\nIn particular, the ","cytology"," of the ","nodule"," showed ","epithelial cells with hyperchromatic nuclei organized in small cohesive clusters resembling microfollicles"," typically observed in ","thyroid follicular"," ","lesions"," were evident (Fig.1a).\nThe patients underwent ","right"," ","lobectomy",".\nDuring ","neck"," ","exploration",", there were no ","macroscopic signs"," of ","local"," ","invasion",".\nThe ","intraoperative"," ","frozen-section"," ","pathological examination"," raised the suspicion of a ","PC",".\nDefinitive ","histology"," showed a markedly ","irregular"," ","infiltrative growth"," of the ","tumor"," with ","invasion"," of the ","thyroid tissue"," and ","cervical soft tissues"," (Fig.1b, c).\n","Immunostaining"," for ","thyroglobulin"," was ","negative",", whereas staining for ","chromogranin A"," and ","PTH"," showed a ","strong reactivity"," (Fig.1d\u2013f).\nBased on the ","light microscopic findings"," and the ","immunohistochemical profile",", the tumor was diagnosed as a ","PC",".\nPostoperative ","serum"," ","calcium"," (","8.7 mg\/dl",") and ","phosphate"," (","3 mg\/dl",") levels were in the ","normal range",".\n","One month after"," ","surgery",", ","serum"," ","calcium"," and ","plasma"," ","PTH"," were ","9.6 mg\/dL"," and ","47 pg\/mL",", respectively.\n","Neck"," ","ultrasound"," and ","total body"," ","computed tomography"," scan were negative for ","local"," and ","metastatic"," ","disease",".\n","Eight months later",", ","serum"," ","calcium"," and ","plasma"," ","PTH"," levels were ","9.1\u20139.2 mg\/dl"," and ","38\u201344 pg\/ml"," (1\u201384 PTH 3rd generation assay, normal range, 8\u201340 pg\/mL), respectively.\n","Neck"," ","ultrasound"," did not show any ","pathological"," ","lesions",".\nIn order to exclude a familiar form of ","PHPT",", in which ","PC"," may rarely occur as a ","nonfunctioning"," ","tumor"," [11], the screening of ","serum"," ","calcium"," and ","neck"," ","ultrasound"," in the ","first-degree relatives"," was 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-{"full_text":"A 60-year-old male visited our outpatient clinic with a mass on his left hip.\nHe had diabetes and alcoholic hepatitis.\nOn physical examination, a large mass measuring 10 cm in diameter was observed on his hip and an approximate 5 cm left inguinal lymph node was palpable (Figure \u200b1).\nSerum tumor markers, including CEA and CA 19-9, were within normal limits, whereas serum amylase (227 IU\/L, normal range 43-116 IU\/L), lipase (378 IU\/L, normal range 7-60), fasting blood sugar (144 mg\/dL, normal range, 70-100 mg\/dL), and liver function test levels [including aspartate aminotransferase (178 IU\/L, normal range, 7-38 IU\/L), alanine aminotransferase (225 IU\/L; normal range, 4-43 IU\/L), and serum alkaline phosphatase (370 IU\/L, normal range, 103-335 IU\/L)] were all above normal ranges.\nAn abdominal computerized tomography (CT) scan demonstrated not only a left hip mass and an enlarged left inguinal lymph node, but also a huge heterogeneous enhancing mass on the body of the pancreas (Figure \u200b2).\nOn a PET scan, additional metastases were not found.\nWe planned a staged surgery and performed a hip and inguinal mass excision on December 19, 2014.\nThe histopathological report revealed a metastatic small cell neuroendocrine carcinoma with a maximal diameter of 10.5 cm on the buttock mass and a 7 cm growth on an inguinal lymph node.\nThe mitotic index was over 50 mitoses per 50 HPF and the Ki-67 index measured at 50%.\nOn January 21, 2015, we performed a total pancreatectomy and a total gastrectomy, with the findings revealing a tumor of the body of the pancreas about 9 cm \u00d7 6 cm in diameter involving the left gastric artery, splenic artery, and splenic vein.\nThe histopathological report was the same as that of a metastatic lesion.\nAdditionally, the tumor had spread to 8 of the 32 lymph nodes (Figure \u200b3).\nOn the 7th post-operative day, the patient developed a high fever and leukocytosis.\nWe administered an abdominal CT scan, which revealed infected fluid collection in the lesser sac and a 4.7 cm-sized recurring mass which was detected at the operative bed of the left hip (Figure \u200b(Figure4).4).\nAfter infection of the abdominal cavity was treated by antibiotics, we removed the left hip recurring mass on February 3, 2015.\nThe histopathology was the same as in the previous report; with a maximum diameter of 7.5 cm.\nThe patient was discharged without other complications on February 9, 2015.\nHe is currently receiving chemotherapy based on etoposide and cisplatin treatment.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"visited","label":"ACTIVITY","start":19,"end":26},{"text":"outpatient clinic","label":"NONBIOLOGICAL_LOCATION","start":31,"end":48},{"text":"mass","label":"SIGN_SYMPTOM","start":56,"end":60},{"text":"left 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IU\/L","label":"LAB_VALUE","start":650,"end":658},{"text":"serum","label":"DETAILED_DESCRIPTION","start":690,"end":695},{"text":"alkaline phosphatase","label":"DIAGNOSTIC_PROCEDURE","start":696,"end":716},{"text":"370 IU\/L","label":"LAB_VALUE","start":718,"end":726},{"text":"above normal ranges","label":"QUALITATIVE_CONCEPT","start":766,"end":785},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":790,"end":799},{"text":"computerized tomography","label":"DIAGNOSTIC_PROCEDURE","start":800,"end":823},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":825,"end":827},{"text":"left hip","label":"BIOLOGICAL_STRUCTURE","start":858,"end":866},{"text":"mass","label":"SIGN_SYMPTOM","start":867,"end":871},{"text":"enlarged","label":"SIGN_SYMPTOM","start":879,"end":887},{"text":"left inguinal lymph node","label":"BIOLOGICAL_STRUCTURE","start":888,"end":912},{"text":"huge","label":"QUALITATIVE_CONCEPT","start":925,"end":929},{"text":"heterogeneous","label":"DETAILED_DESCRIPTION","start":930,"end":943},{"text":"enhancing","label":"DETAILED_DESCRIPTION","start":944,"end":953},{"text":"mass","label":"SIGN_SYMPTOM","start":954,"end":958},{"text":"pancreas","label":"BIOLOGICAL_STRUCTURE","start":978,"end":986},{"text":"PET scan","label":"DIAGNOSTIC_PROCEDURE","start":1005,"end":1013},{"text":"metastases","label":"DISEASE_DISORDER","start":1026,"end":1036},{"text":"staged surgery","label":"THERAPEUTIC_PROCEDURE","start":1066,"end":1080},{"text":"hip","label":"BIOLOGICAL_STRUCTURE","start":1097,"end":1100},{"text":"inguinal","label":"BIOLOGICAL_STRUCTURE","start":1105,"end":1113},{"text":"mass excision","label":"THERAPEUTIC_PROCEDURE","start":1114,"end":1127},{"text":"December 19, 2014","label":"DATE","start":1131,"end":1148},{"text":"histopathological 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report","label":"DIAGNOSTIC_PROCEDURE","start":1672,"end":1696},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":1723,"end":1733},{"text":"lesion","label":"SIGN_SYMPTOM","start":1734,"end":1740},{"text":"tumor","label":"SIGN_SYMPTOM","start":1760,"end":1765},{"text":"8 of the 32","label":"QUANTITATIVE_CONCEPT","start":1780,"end":1791},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1792,"end":1803},{"text":"7th post-operative day","label":"DATE","start":1824,"end":1846},{"text":"high","label":"SEVERITY","start":1872,"end":1876},{"text":"fever","label":"SIGN_SYMPTOM","start":1877,"end":1882},{"text":"leukocytosis","label":"SIGN_SYMPTOM","start":1887,"end":1899},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1920,"end":1929},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1930,"end":1932},{"text":"infected","label":"DETAILED_DESCRIPTION","start":1954,"end":1962},{"text":"fluid collection","label":"SIGN_SYMPTOM","start":1963,"end":1979},{"text":"lesser sac","label":"BIOLOGICAL_STRUCTURE","start":1987,"end":1997},{"text":"4.7 cm-sized","label":"DISTANCE","start":2004,"end":2016},{"text":"recurring","label":"DETAILED_DESCRIPTION","start":2017,"end":2026},{"text":"mass","label":"SIGN_SYMPTOM","start":2027,"end":2031},{"text":"left hip","label":"BIOLOGICAL_STRUCTURE","start":2079,"end":2087},{"text":"infection","label":"DISEASE_DISORDER","start":2117,"end":2126},{"text":"abdominal cavity","label":"BIOLOGICAL_STRUCTURE","start":2134,"end":2150},{"text":"antibiotics","label":"MEDICATION","start":2166,"end":2177},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":2182,"end":2189},{"text":"left hip","label":"BIOLOGICAL_STRUCTURE","start":2194,"end":2202},{"text":"recurring","label":"DETAILED_DESCRIPTION","start":2203,"end":2212},{"text":"mass","label":"SIGN_SYMPTOM","start":2213,"end":2217},{"text":"February 3, 2015","label":"DATE","start":2221,"end":2237},{"text":"histopathology","label":"DIAGNOSTIC_PROCEDURE","start":2243,"end":2257},{"text":"maximum diameter of 7.5 cm","label":"DISTANCE","start":2305,"end":2331},{"text":"discharged","label":"CLINICAL_EVENT","start":2349,"end":2359},{"text":"complications","label":"DISEASE_DISORDER","start":2374,"end":2387},{"text":"February 9, 2015","label":"DATE","start":2391,"end":2407},{"text":"chemotherapy","label":"MEDICATION","start":2435,"end":2447},{"text":"etoposide","label":"MEDICATION","start":2457,"end":2466},{"text":"cisplatin","label":"MEDICATION","start":2471,"end":2480}],"tokens":["A ","60-year-old"," ","male"," ","visited"," our ","outpatient clinic"," with a ","mass"," on his ","left hip",".\nHe had ","diabetes"," and ","alcoholic hepatitis",".\nOn ","physical examination",", a ","large"," ","mass"," measuring ","10 cm"," in diameter was observed on his ","hip"," and an approximate ","5 cm"," ","left inguinal lymph node"," was ","palpable"," (Figure \u200b1).\n","Serum"," ","tumor markers",", including ","CEA"," and ","CA 19-9",", were ","within normal limits",", whereas ","serum"," ","amylase"," (","227 IU\/L",", normal range 43-116 IU\/L), ","lipase"," (","378 IU\/L",", normal range 7-60), ","fasting blood sugar"," (","144 mg\/dL",", normal range, 70-100 mg\/dL), and ","liver function test"," levels [including ","aspartate aminotransferase"," (","178 IU\/L",", normal range, 7-38 IU\/L), ","alanine aminotransferase"," (","225 IU\/L","; normal range, 4-43 IU\/L), and ","serum"," ","alkaline phosphatase"," (","370 IU\/L",", normal range, 103-335 IU\/L)] were all ","above normal ranges",".\nAn ","abdominal"," ","computerized tomography"," (","CT",") scan demonstrated not only a ","left hip"," ","mass"," and an ","enlarged"," ","left inguinal lymph node",", but also a ","huge"," ","heterogeneous"," ","enhancing"," ","mass"," on the body of the ","pancreas"," (Figure \u200b2).\nOn a ","PET scan",", additional ","metastases"," were not found.\nWe planned a ","staged surgery"," and performed a ","hip"," and ","inguinal"," ","mass excision"," on ","December 19, 2014",".\nThe ","histopathological report"," revealed a ","metastatic"," ","small cell"," ","neuroendocrine carcinoma"," with a ","maximal diameter of 10.5 cm"," on the ","buttock"," ","mass"," and a ","7 cm"," ","growth"," on an ","inguinal lymph node",".\nThe ","mitotic index"," was ","over 50 mitoses per 50 HPF"," and the ","Ki-67 index"," measured at ","50%",".\nOn ","January 21, 2015",", we performed a ","total"," ","pancreatectomy"," and a ","total"," ","gastrectomy",", with the findings revealing a ","tumor"," of the body of the ","pancreas"," about ","9 cm \u00d7 6 cm in diameter"," involving the ","left gastric artery",", ","splenic artery",", and ","splenic vein",".\nThe ","histopathological report"," was the same as that of a ","metastatic"," ","lesion",".\nAdditionally, the ","tumor"," had spread to ","8 of the 32"," ","lymph nodes"," (Figure \u200b3).\nOn the ","7th post-operative day",", the patient developed a ","high"," ","fever"," and ","leukocytosis",".\nWe administered an ","abdominal"," ","CT"," scan, which revealed ","infected"," ","fluid collection"," in the ","lesser sac"," and a ","4.7 cm-sized"," ","recurring"," ","mass"," which was detected at the operative bed of the ","left hip"," (Figure \u200b(Figure4).4).\nAfter ","infection"," of the ","abdominal cavity"," was treated by ","antibiotics",", we ","removed"," the ","left hip"," ","recurring"," ","mass"," on ","February 3, 2015",".\nThe ","histopathology"," was the same as in the previous report; with a ","maximum diameter of 7.5 cm",".\nThe patient was ","discharged"," without other ","complications"," on ","February 9, 2015",".\nHe is currently receiving ","chemotherapy"," based on ","etoposide"," and ","cisplatin"," treatment.\n"],"ner_labels":[0,5,0,65,0,1,0,48,0,69,0,12,0,39,0,39,0,24,0,22,0,69,0,27,0,12,0,27,0,12,0,69,0,22,0,24,0,24,0,24,0,59,0,22,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,59,0,12,0,24,0,24,0,12,0,69,0,69,0,12,0,59,0,22,0,22,0,69,0,12,0,24,0,26,0,75,0,12,0,12,0,75,0,19,0,24,0,22,0,22,0,26,0,27,0,12,0,69,0,27,0,69,0,12,0,24,0,42,0,24,0,42,0,19,0,22,0,75,0,22,0,75,0,69,0,12,0,8,0,12,0,12,0,12,0,24,0,22,0,69,0,69,0,62,0,12,0,19,0,63,0,69,0,69,0,12,0,24,0,22,0,69,0,12,0,27,0,22,0,69,0,12,0,26,0,12,0,46,0,75,0,12,0,22,0,69,0,19,0,24,0,27,0,13,0,26,0,19,0,46,0,46,0,46,0]}
-{"full_text":"A 68-year-old female nonsmoker, nondrinker with a medical history of hypertension presented with new-onset painless jaundice and pruritus, a three-month history of 9.9 kg weight loss and chronic diarrhea with four to five loose bowel movements per day.\nMedications included vitamin D, amlodipine and eprosartan.\nPhysical examination was normal except for jaundice and muscle wasting.\nRecent colonoscopy had been normal.\nTotal and direct bilirubin levels were 6.84 mg\/dL (116.96 \u03bcmol\/L) and 9.18 mg\/dL (156.98 \u03bcmol\/L), respectively.\nOther results included an international normalized ratio of 1.0, alanine aminotransferase level 247 U\/L (normal <33 U\/L), aspartate aminotransferase level 139 U\/L (normal <32 U\/L) and alkaline phosphatase level 524 U\/L (normal 35 to 104 U\/L).\nViral hepatitis serologies, and antimitochondrial antibody and anti-smooth muscle antibody tests were negative.\nHer alpha-fetoprotein level was 2.4 ng\/mL (normal <5 ng\/mL), total immunoglobulin (Ig) G was 1880 mg\/dL (normal <640 mg\/dL), carbohydrate antigen 19-9 was 856 U\/mL (normal <33 U\/mL) and IgG4 was 890 g\/L (normal <3 g\/L).\nDoppler ultrasound, magnetic resonance cholangiopancreatography and magnetic resonance imaging of the liver were suspicious for a subtly enhancing mass (2.8 cm to 4.2 cm in diameter) in the region of the hilum and porta hepatis, obstructing both the right and left hepatic ducts.\nEndoscopic retrograde cholangiopancreatography identified strictures in the central portions of the right and left hepatic duct, which was concerning for cholangiocarcinoma (Figure 1).\nBiliary brushings were negative for malignancy.\nEsophagogastroduodenoscopy was normal.\nBiopsies of the ampulla of Vater revealed chronic active duodenitis (Figures 2 and \u200band3);3); an ancillary test confirmed the diagnosis (Figure 4).\nTreatment with corticosteroids normalized the patient\u2019s biochemical and radiological abnormalities within three months.\n","ner_info":[{"text":"68-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"nonsmoker","label":"HISTORY","start":21,"end":30},{"text":"nondrinker","label":"HISTORY","start":32,"end":42},{"text":"hypertension","label":"DISEASE_DISORDER","start":69,"end":81},{"text":"presented","label":"CLINICAL_EVENT","start":82,"end":91},{"text":"new-onset","label":"DETAILED_DESCRIPTION","start":97,"end":106},{"text":"painless","label":"DETAILED_DESCRIPTION","start":107,"end":115},{"text":"jaundice","label":"SIGN_SYMPTOM","start":116,"end":124},{"text":"pruritus","label":"SIGN_SYMPTOM","start":129,"end":137},{"text":"three-month","label":"DURATION","start":141,"end":152},{"text":"9.9 kg","label":"LAB_VALUE","start":164,"end":170},{"text":"weight loss","label":"SIGN_SYMPTOM","start":171,"end":182},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":187,"end":194},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":195,"end":203},{"text":"four to five","label":"LAB_VALUE","start":209,"end":221},{"text":"loose","label":"LAB_VALUE","start":222,"end":227},{"text":"bowel movements","label":"DIAGNOSTIC_PROCEDURE","start":228,"end":243},{"text":"per day","label":"DETAILED_DESCRIPTION","start":244,"end":251},{"text":"Medications","label":"MEDICATION","start":253,"end":264},{"text":"vitamin D","label":"MEDICATION","start":274,"end":283},{"text":"amlodipine","label":"MEDICATION","start":285,"end":295},{"text":"eprosartan","label":"MEDICATION","start":300,"end":310},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":312,"end":332},{"text":"normal","label":"LAB_VALUE","start":337,"end":343},{"text":"jaundice","label":"SIGN_SYMPTOM","start":355,"end":363},{"text":"muscle wasting","label":"DISEASE_DISORDER","start":368,"end":382},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":391,"end":402},{"text":"normal","label":"LAB_VALUE","start":412,"end":418},{"text":"Total","label":"DETAILED_DESCRIPTION","start":420,"end":425},{"text":"direct","label":"DETAILED_DESCRIPTION","start":430,"end":436},{"text":"bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":437,"end":446},{"text":"6.84 mg\/dL","label":"LAB_VALUE","start":459,"end":469},{"text":"116.96 \u03bcmol\/L","label":"LAB_VALUE","start":471,"end":484},{"text":"9.18 mg\/dL","label":"LAB_VALUE","start":490,"end":500},{"text":"156.98 \u03bcmol\/L","label":"LAB_VALUE","start":502,"end":515},{"text":"international normalized ratio","label":"DIAGNOSTIC_PROCEDURE","start":558,"end":588},{"text":"1.0","label":"LAB_VALUE","start":592,"end":595},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":597,"end":621},{"text":"247 U\/L","label":"LAB_VALUE","start":628,"end":635},{"text":"aspartate aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":654,"end":680},{"text":"139 U\/L","label":"LAB_VALUE","start":687,"end":694},{"text":"alkaline phosphatase","label":"DIAGNOSTIC_PROCEDURE","start":716,"end":736},{"text":"524 U\/L","label":"LAB_VALUE","start":743,"end":750},{"text":"Viral hepatitis serologies","label":"DIAGNOSTIC_PROCEDURE","start":775,"end":801},{"text":"antimitochondrial antibody","label":"DIAGNOSTIC_PROCEDURE","start":807,"end":833},{"text":"anti-smooth muscle antibody","label":"DIAGNOSTIC_PROCEDURE","start":838,"end":865},{"text":"negative","label":"LAB_VALUE","start":877,"end":885},{"text":"alpha-fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":891,"end":908},{"text":"2.4 ng\/mL","label":"LAB_VALUE","start":919,"end":928},{"text":"total immunoglobulin (Ig) G","label":"DIAGNOSTIC_PROCEDURE","start":948,"end":975},{"text":"1880 mg\/dL","label":"LAB_VALUE","start":980,"end":990},{"text":"carbohydrate antigen 19-9","label":"DIAGNOSTIC_PROCEDURE","start":1012,"end":1037},{"text":"856 U\/mL","label":"LAB_VALUE","start":1042,"end":1050},{"text":"IgG4","label":"DIAGNOSTIC_PROCEDURE","start":1073,"end":1077},{"text":"890 g\/L","label":"LAB_VALUE","start":1082,"end":1089},{"text":"Doppler","label":"DETAILED_DESCRIPTION","start":1107,"end":1114},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1115,"end":1125},{"text":"magnetic resonance cholangiopancreatography","label":"DIAGNOSTIC_PROCEDURE","start":1127,"end":1170},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":1175,"end":1201},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":1209,"end":1214},{"text":"subtly enhancing","label":"DETAILED_DESCRIPTION","start":1237,"end":1253},{"text":"mass","label":"SIGN_SYMPTOM","start":1254,"end":1258},{"text":"2.8 cm to 4.2 cm","label":"DISTANCE","start":1260,"end":1276},{"text":"hilum","label":"BIOLOGICAL_STRUCTURE","start":1311,"end":1316},{"text":"porta hepatis","label":"BIOLOGICAL_STRUCTURE","start":1321,"end":1334},{"text":"obstructing","label":"SIGN_SYMPTOM","start":1336,"end":1347},{"text":"right and left hepatic ducts","label":"BIOLOGICAL_STRUCTURE","start":1357,"end":1385},{"text":"Endoscopic","label":"DETAILED_DESCRIPTION","start":1387,"end":1397},{"text":"retrograde","label":"DETAILED_DESCRIPTION","start":1398,"end":1408},{"text":"cholangiopancreatography","label":"DIAGNOSTIC_PROCEDURE","start":1409,"end":1433},{"text":"strictures","label":"SIGN_SYMPTOM","start":1445,"end":1455},{"text":"central portions of the right and left hepatic duct","label":"BIOLOGICAL_STRUCTURE","start":1463,"end":1514},{"text":"cholangiocarcinoma","label":"DISEASE_DISORDER","start":1541,"end":1559},{"text":"Biliary brushings","label":"DIAGNOSTIC_PROCEDURE","start":1572,"end":1589},{"text":"negative for malignancy","label":"LAB_VALUE","start":1595,"end":1618},{"text":"Esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1620,"end":1646},{"text":"normal","label":"LAB_VALUE","start":1651,"end":1657},{"text":"Biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1659,"end":1667},{"text":"ampulla of Vater","label":"BIOLOGICAL_STRUCTURE","start":1675,"end":1691},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":1701,"end":1708},{"text":"active","label":"DETAILED_DESCRIPTION","start":1709,"end":1715},{"text":"duodenitis","label":"DISEASE_DISORDER","start":1716,"end":1726},{"text":"ancillary test","label":"DIAGNOSTIC_PROCEDURE","start":1756,"end":1770},{"text":"confirmed the diagnosis","label":"LAB_VALUE","start":1771,"end":1794},{"text":"corticosteroids","label":"MEDICATION","start":1822,"end":1837},{"text":"biochemical","label":"DETAILED_DESCRIPTION","start":1863,"end":1874},{"text":"radiological","label":"DETAILED_DESCRIPTION","start":1879,"end":1891},{"text":"abnormalities","label":"DISEASE_DISORDER","start":1892,"end":1905},{"text":"within three months","label":"DATE","start":1906,"end":1925}],"tokens":["A ","68-year-old"," ","female"," ","nonsmoker",", ","nondrinker"," with a medical history of ","hypertension"," ","presented"," with ","new-onset"," ","painless"," ","jaundice"," and ","pruritus",", a ","three-month"," history of ","9.9 kg"," ","weight loss"," and ","chronic"," ","diarrhea"," with ","four to five"," ","loose"," ","bowel movements"," ","per day",".\n","Medications"," included ","vitamin D",", ","amlodipine"," and ","eprosartan",".\n","Physical examination"," was ","normal"," except for ","jaundice"," and ","muscle wasting",".\nRecent ","colonoscopy"," had been ","normal",".\n","Total"," and ","direct"," ","bilirubin"," levels were ","6.84 mg\/dL"," (","116.96 \u03bcmol\/L",") and ","9.18 mg\/dL"," (","156.98 \u03bcmol\/L","), respectively.\nOther results included an ","international normalized ratio"," of ","1.0",", ","alanine aminotransferase"," level ","247 U\/L"," (normal <33 U\/L), ","aspartate aminotransferase"," level ","139 U\/L"," (normal <32 U\/L) and ","alkaline phosphatase"," level ","524 U\/L"," (normal 35 to 104 U\/L).\n","Viral hepatitis serologies",", and ","antimitochondrial antibody"," and ","anti-smooth muscle antibody"," tests were ","negative",".\nHer ","alpha-fetoprotein"," level was ","2.4 ng\/mL"," (normal <5 ng\/mL), ","total immunoglobulin (Ig) G"," was ","1880 mg\/dL"," (normal <640 mg\/dL), ","carbohydrate antigen 19-9"," was ","856 U\/mL"," (normal <33 U\/mL) and ","IgG4"," was ","890 g\/L"," (normal <3 g\/L).\n","Doppler"," ","ultrasound",", ","magnetic resonance cholangiopancreatography"," and ","magnetic resonance imaging"," of the ","liver"," were suspicious for a ","subtly enhancing"," ","mass"," (","2.8 cm to 4.2 cm"," in diameter) in the region of the ","hilum"," and ","porta hepatis",", ","obstructing"," both the ","right and left hepatic ducts",".\n","Endoscopic"," ","retrograde"," ","cholangiopancreatography"," identified ","strictures"," in the ","central portions of the right and left hepatic duct",", which was concerning for ","cholangiocarcinoma"," (Figure 1).\n","Biliary brushings"," were ","negative for malignancy",".\n","Esophagogastroduodenoscopy"," was ","normal",".\n","Biopsies"," of the ","ampulla of Vater"," revealed ","chronic"," ","active"," ","duodenitis"," (Figures 2 and \u200band3);3); an ","ancillary test"," ","confirmed the diagnosis"," (Figure 4).\nTreatment with ","corticosteroids"," normalized the patient\u2019s ","biochemical"," and ","radiological"," ","abnormalities"," ","within three months",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,26,0,13,0,22,0,22,0,69,0,69,0,32,0,42,0,69,0,22,0,69,0,42,0,42,0,24,0,22,0,46,0,46,0,46,0,46,0,24,0,42,0,69,0,26,0,24,0,42,0,22,0,22,0,24,0,42,0,42,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,24,0,24,0,12,0,22,0,69,0,27,0,12,0,12,0,69,0,12,0,22,0,22,0,24,0,69,0,12,0,26,0,24,0,42,0,24,0,42,0,24,0,12,0,22,0,22,0,26,0,24,0,42,0,46,0,22,0,22,0,26,0,19,0]}
-{"full_text":"We report the case of a previously healthy 28-year-old woman, Afro-Brazilian, in her first pregnancy.\nOur patient had no medical records until the 36th pregnancy week and reported allergy to diclofenac.\nShe presented to our emergency department with an acute onset of abdominal pain, jaundice, nausea and vomiting, with no signs of encephalopathy.\nHer arterial blood pressure was 110\/60mmHg, heart rate was 98bpm, axillary temperature was 35\u00b0C, she was severely dehydrated and with decreased peripheral perfusion.\nThe laboratory examinations revealed hemoglobin 12.3g\/dL, leukocytes 13\u2009\u00d7\u2009109\/mL, platelets 97\u2009\u00d7\u2009103\/mm3, international nationalized ratio (INR) 6.9, fibrinogen 98mg\/dL, total bilirubin 14.2mg\/dL, serum creatinine 3.4mg\/dL, serum aspartate aminotransferase (AST) 306U\/L, serum alanine aminotransferase (ALP) 302U\/L, arterial bicarbonate 11mEq\/L, arterial pH 7.21, blood glucose 65mg\/dL and ionic calcium 1.02mmol\/L.\nAn abdominal ultrasound depicted fatty infiltration of the liver and confirmed fetal viability.\nOur patient received an initial fluid load with crystalloids.\nThe calcium, glucose and hypothermia were reversed.\nThe diagnosis of AFLP was confirmed following the Swansea\u2019s criteria [9].\nTherefore, a cesarean section was indicated.\nA thromboelastometry (ROTEM\u00ae, Pentapharm Co., Munich, Germany) was performed at the beginning of the surgery.\nThe thromboelastometry analysis showed an intense kinetic and structural hypocoagulable state (Fig.1 and Table 1).\nThe FIBTEM revealed an impairment in fibrinogen function quality while the EXTEM depicted a coagulation factor deficiency (Fig.1a-c and Table 1).\nBased on, respectively, FIBTEM maximum clot firmness (MCF) (0mm; Table 1) and EXTEM clotting time (CT) (228s; Table 1), 4.0g of fibrinogen concentrate (Haemocomplettan\u00ae P, CSL Behring, Marburg, Germany) and 1000UI of prothrombin complex concentrate (Beriplex\u00ae P\/N 500UI, CSL Behring, Marburg, Germany) were administered at the beginning of the cesarean section.\nThe fluid input (crystalloids) and output during the caesarian section were, respectively, 2000mL and 200mL.\nThe cesarean section succeeded with no major bleeding after the hemostatic therapy.\nAdditional hemocomponent transfusion, such as fresh frozen plasma (FFP), cryoprecipitate, platelets or blood concentrates, was not necessary.\nA second thromboelastometry analysis was performed at the end of surgery (Fig.1d-e and Table 1), showing a mild hypocoagulation state.\nThe patient was admitted to the intensive care unit (ICU) and remained stable, with no bleeding during the recovery phase.\nShe was discharged from the ICU 3 days after admission and then 3 days later she was discharged from the hospital.\n","ner_info":[{"text":"previously healthy","label":"HISTORY","start":24,"end":42},{"text":"28-year-old","label":"AGE","start":43,"end":54},{"text":"woman","label":"SEX","start":55,"end":60},{"text":"Afro-Brazilian","label":"PERSONAL_BACKGROUND","start":62,"end":76},{"text":"first pregnancy","label":"HISTORY","start":85,"end":100},{"text":"36th pregnancy week","label":"DATE","start":147,"end":166},{"text":"allergy to diclofenac","label":"HISTORY","start":180,"end":201},{"text":"presented","label":"CLINICAL_EVENT","start":207,"end":216},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":224,"end":244},{"text":"acute","label":"DETAILED_DESCRIPTION","start":253,"end":258},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":268,"end":277},{"text":"pain","label":"SIGN_SYMPTOM","start":278,"end":282},{"text":"jaundice","label":"SIGN_SYMPTOM","start":284,"end":292},{"text":"nausea","label":"SIGN_SYMPTOM","start":294,"end":300},{"text":"vomiting","label":"SIGN_SYMPTOM","start":305,"end":313},{"text":"encephalopathy","label":"DISEASE_DISORDER","start":332,"end":346},{"text":"arterial blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":352,"end":375},{"text":"110\/60mmHg","label":"LAB_VALUE","start":380,"end":390},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":392,"end":402},{"text":"98bpm","label":"LAB_VALUE","start":407,"end":412},{"text":"axillary temperature","label":"DIAGNOSTIC_PROCEDURE","start":414,"end":434},{"text":"35\u00b0C","label":"LAB_VALUE","start":439,"end":443},{"text":"severely","label":"SEVERITY","start":453,"end":461},{"text":"dehydrated","label":"SIGN_SYMPTOM","start":462,"end":472},{"text":"decreased","label":"LAB_VALUE","start":482,"end":491},{"text":"peripheral perfusion","label":"DIAGNOSTIC_PROCEDURE","start":492,"end":512},{"text":"laboratory examinations","label":"DIAGNOSTIC_PROCEDURE","start":518,"end":541},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":551,"end":561},{"text":"12.3g\/dL","label":"LAB_VALUE","start":562,"end":570},{"text":"leukocytes","label":"DIAGNOSTIC_PROCEDURE","start":572,"end":582},{"text":"13\u2009\u00d7\u2009109\/mL","label":"LAB_VALUE","start":583,"end":594},{"text":"platelets","label":"DIAGNOSTIC_PROCEDURE","start":596,"end":605},{"text":"97\u2009\u00d7\u2009103\/mm3","label":"LAB_VALUE","start":606,"end":618},{"text":"international nationalized ratio","label":"DIAGNOSTIC_PROCEDURE","start":620,"end":652},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":654,"end":657},{"text":"6.9","label":"LAB_VALUE","start":659,"end":662},{"text":"fibrinogen","label":"DIAGNOSTIC_PROCEDURE","start":664,"end":674},{"text":"98mg\/dL","label":"LAB_VALUE","start":675,"end":682},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":684,"end":699},{"text":"14.2mg\/dL","label":"LAB_VALUE","start":700,"end":709},{"text":"serum","label":"DETAILED_DESCRIPTION","start":711,"end":716},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":717,"end":727},{"text":"3.4mg\/dL","label":"LAB_VALUE","start":728,"end":736},{"text":"serum","label":"DETAILED_DESCRIPTION","start":738,"end":743},{"text":"aspartate 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complex","label":"MEDICATION","start":1847,"end":1866},{"text":"concentrate","label":"ADMINISTRATION","start":1867,"end":1878},{"text":"Beriplex\u00ae P\/N 500UI, CSL Behring, Marburg, Germany","label":"DETAILED_DESCRIPTION","start":1880,"end":1930},{"text":"cesarean section","label":"THERAPEUTIC_PROCEDURE","start":1974,"end":1990},{"text":"fluid input","label":"MEDICATION","start":1996,"end":2007},{"text":"crystalloids","label":"MEDICATION","start":2009,"end":2021},{"text":"output","label":"DIAGNOSTIC_PROCEDURE","start":2027,"end":2033},{"text":"caesarian section","label":"THERAPEUTIC_PROCEDURE","start":2045,"end":2062},{"text":"2000mL","label":"DOSAGE","start":2083,"end":2089},{"text":"200mL","label":"LAB_VALUE","start":2094,"end":2099},{"text":"cesarean section","label":"THERAPEUTIC_PROCEDURE","start":2105,"end":2121},{"text":"succeeded","label":"LAB_VALUE","start":2122,"end":2131},{"text":"major","label":"SEVERITY","start":2140,"end":2145},{"text":"bleeding","label":"SIGN_SYMPTOM","start":2146,"end":2154},{"text":"hemostatic therapy","label":"THERAPEUTIC_PROCEDURE","start":2165,"end":2183},{"text":"hemocomponent","label":"MEDICATION","start":2196,"end":2209},{"text":"transfusion","label":"ADMINISTRATION","start":2210,"end":2221},{"text":"fresh frozen plasma","label":"MEDICATION","start":2231,"end":2250},{"text":"FFP","label":"MEDICATION","start":2252,"end":2255},{"text":"cryoprecipitate","label":"MEDICATION","start":2258,"end":2273},{"text":"platelets","label":"MEDICATION","start":2275,"end":2284},{"text":"blood concentrates","label":"MEDICATION","start":2288,"end":2306},{"text":"thromboelastometry analysis","label":"DIAGNOSTIC_PROCEDURE","start":2336,"end":2363},{"text":"surgery","label":"COREFERENCE","start":2392,"end":2399},{"text":"mild","label":"SEVERITY","start":2434,"end":2438},{"text":"hypocoagulation state","label":"SIGN_SYMPTOM","start":2439,"end":2460},{"text":"admitted","label":"CLINICAL_EVENT","start":2478,"end":2486},{"text":"intensive care unit","label":"NONBIOLOGICAL_LOCATION","start":2494,"end":2513},{"text":"ICU","label":"NONBIOLOGICAL_LOCATION","start":2515,"end":2518},{"text":"stable","label":"SIGN_SYMPTOM","start":2533,"end":2539},{"text":"bleeding","label":"SIGN_SYMPTOM","start":2549,"end":2557},{"text":"recovery phase","label":"THERAPEUTIC_PROCEDURE","start":2569,"end":2583},{"text":"discharged","label":"CLINICAL_EVENT","start":2593,"end":2603},{"text":"ICU","label":"NONBIOLOGICAL_LOCATION","start":2613,"end":2616},{"text":"3 days after","label":"DATE","start":2617,"end":2629},{"text":"admission","label":"CLINICAL_EVENT","start":2630,"end":2639},{"text":"3 days later","label":"DATE","start":2649,"end":2661},{"text":"discharged","label":"CLINICAL_EVENT","start":2670,"end":2680},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":2690,"end":2698}],"tokens":["We report the case of a ","previously healthy"," ","28-year-old"," ","woman",", ","Afro-Brazilian",", in her ","first pregnancy",".\nOur patient had no medical records until the ","36th pregnancy week"," and reported ","allergy to diclofenac",".\nShe ","presented"," to our ","emergency department"," with an ","acute"," onset of ","abdominal"," ","pain",", ","jaundice",", ","nausea"," and ","vomiting",", with no signs of ","encephalopathy",".\nHer ","arterial blood pressure"," was ","110\/60mmHg",", ","heart rate"," was ","98bpm",", ","axillary temperature"," was ","35\u00b0C",", she was ","severely"," ","dehydrated"," and with ","decreased"," ","peripheral perfusion",".\nThe ","laboratory examinations"," revealed ","hemoglobin"," ","12.3g\/dL",", ","leukocytes"," ","13\u2009\u00d7\u2009109\/mL",", ","platelets"," ","97\u2009\u00d7\u2009103\/mm3",", ","international nationalized ratio"," (","INR",") ","6.9",", ","fibrinogen"," ","98mg\/dL",", ","total bilirubin"," ","14.2mg\/dL",", ","serum"," ","creatinine"," ","3.4mg\/dL",", ","serum"," ","aspartate aminotransferase"," (","AST",") ","306U\/L",", ","serum"," ","alanine aminotransferase"," (","ALP",") ","302U\/L",", ","arterial bicarbonate"," ","11mEq\/L",", ","arterial pH"," ","7.21",", ","blood glucose"," ","65mg\/dL"," and ","ionic calcium"," ","1.02mmol\/L",".\nAn ","abdominal"," ","ultrasound"," depicted ","fatty infiltration"," of the ","liver"," and ","confirmed"," ","fetal viability",".\nOur patient received an initial ","fluid load"," with ","crystalloids",".\nThe ","calcium",", ","glucose"," and ","hypothermia"," were ","reversed",".\nThe diagnosis of ","AFLP"," was confirmed following the ","Swansea\u2019s criteria"," [9].\nTherefore, a ","cesarean section"," was indicated.\nA ","thromboelastometry"," (","ROTEM\u00ae, Pentapharm Co., Munich, Germany",") was performed at the beginning of the ","surgery",".\nThe ","thromboelastometry analysis"," showed an ","intense"," ","kinetic"," and ","structural"," ","hypocoagulable state"," (Fig.1 and Table 1).\nThe ","FIBTEM"," revealed an ","impairment in fibrinogen function quality"," while the ","EXTEM"," depicted a ","coagulation factor deficiency"," (Fig.1a-c and Table 1).\nBased on, respectively, ","FIBTEM"," ","maximum clot firmness"," (","MCF",") (","0mm","; Table 1) and ","EXTEM"," ","clotting time"," (","CT",") (","228s","; Table 1), ","4.0g"," of ","fibrinogen"," ","concentrate"," (","Haemocomplettan\u00ae P, CSL Behring, Marburg, Germany",") and ","1000UI"," of ","prothrombin complex"," ","concentrate"," (","Beriplex\u00ae P\/N 500UI, CSL Behring, Marburg, Germany",") were administered at the beginning of the ","cesarean section",".\nThe ","fluid input"," (","crystalloids",") and ","output"," during the ","caesarian section"," were, respectively, ","2000mL"," and ","200mL",".\nThe ","cesarean section"," ","succeeded"," with no ","major"," ","bleeding"," after the ","hemostatic therapy",".\nAdditional ","hemocomponent"," ","transfusion",", such as ","fresh frozen plasma"," (","FFP","), ","cryoprecipitate",", ","platelets"," or ","blood concentrates",", was not necessary.\nA second ","thromboelastometry analysis"," was performed at the end of ","surgery"," (Fig.1d-e and Table 1), showing a ","mild"," ","hypocoagulation state",".\nThe patient was ","admitted"," to the ","intensive care unit"," (","ICU",") and remained ","stable",", with no ","bleeding"," during the ","recovery phase",".\nShe was ","discharged"," from the ","ICU"," ","3 days after"," ","admission"," and then ","3 days later"," she was ","discharged"," from the ","hospital",".\n"],"ner_labels":[0,39,0,5,0,65,0,58,0,39,0,19,0,39,0,13,0,48,0,22,0,12,0,69,0,69,0,69,0,69,0,26,0,24,0,42,0,24,0,42,0,24,0,42,0,63,0,69,0,42,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,22,0,24,0,24,0,42,0,22,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,12,0,42,0,24,0,46,0,46,0,24,0,24,0,26,0,42,0,26,0,24,0,75,0,75,0,22,0,18,0,24,0,63,0,22,0,22,0,69,0,24,0,26,0,24,0,26,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,42,0,29,0,46,0,4,0,22,0,29,0,46,0,4,0,22,0,75,0,46,0,46,0,24,0,75,0,29,0,42,0,75,0,42,0,63,0,69,0,75,0,46,0,4,0,46,0,46,0,46,0,46,0,46,0,24,0,18,0,63,0,69,0,13,0,48,0,48,0,69,0,69,0,75,0,13,0,48,0,19,0,13,0,19,0,13,0,48,0]}
-{"full_text":"A woman aged 31 years, G2P2, without any pathological past history, with good prenatal care, with a normal prenatal analysis, blood pressure during the follow-up was normal, admitted for elective caesarian section at 38 weeks of amenorrhea.\nDuring realization of the spinal anesthesia the patient presented peak of the hypertensive (180\/100 mm Hg) which normalized after a few minutes without treatment.\nIn post-partum, after 12 hours of the caesarian section the lady presented a severe headache with apyrexia then she developed three episodes of generalized tonico-clonic convulsions.\nThe 1st convulsion ceased 1 min after the measures of resuscitation and injection of diazepam IV.\nThe post-critical clinical examination found an afebrile patient and blood pressure at 140\/90 mmHg and with Glasgow coma scale at 14 without any neurological deficit, there was no neck rigidity, diuresis was preserved.\nThe examination of urines by urinary strip was positive (+ + +).\nThe 2nd and 3th convulsive crisis stoped spontaneously within few seconds.\nLaboratory findings of HELLP syndrome include raised liver enzymes (ASAT 525 IU\/L and ALAT 214 IU\/L), hemolysis (hemoglobinemia in 7 mg\/dl) and low platelet count (44 000 platelet\/mL).\nOther investigations included the renal function tests, the inflammatory markers, the thyroid hormones were normal.\nThe viral serology was negative.\nThe patient was transferred to intensive care unit; she was treated immediately by magnesium sulfate associated to calcium channel blocker (nicardipine), antiepileptic (phenobarbital) and preventive dose of low molecular weight heparin.\nThe anemia and thrombopenia corrected by transfusion of packed red blood cells and platelet respectively.\nThe magnetic resonance imaging (MRI), realized one hour after the first episode of convulsion showed zones in hyposignal T1, hypersignal T2 and flair sequences, interesting the cerebral cortex, parietal and occipital sub-cortical and the white matter.\nIntracranial venous sinuses were permeable.\nThe diagnosis of the PRES syndrome secondary to the severe preeclampsia immediate post-partum was retained (Figure 1).\nThe electroencephalogram (EEG) realized in the second day did not showed anomaly.\nThe evolution was marked by the normalization of blood pressure, the normalization of the neurological state and of the biological analysis.\nThe patient discharged in good condition on day 5, with beta-blocker and sodium valproate maintained during three months.\nTHE MRI of the controle made three months later showed complete resolution of cerebral edema Figure 2.\n","ner_info":[{"text":"woman","label":"SEX","start":2,"end":7},{"text":"aged 31 years","label":"AGE","start":8,"end":21},{"text":"G2P2","label":"HISTORY","start":23,"end":27},{"text":"without any pathological past history","label":"HISTORY","start":29,"end":66},{"text":"good","label":"LAB_VALUE","start":73,"end":77},{"text":"prenatal 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sequences","label":"DIAGNOSTIC_PROCEDURE","start":1865,"end":1880},{"text":"cerebral cortex","label":"BIOLOGICAL_STRUCTURE","start":1898,"end":1913},{"text":"parietal","label":"BIOLOGICAL_STRUCTURE","start":1915,"end":1923},{"text":"occipital sub-cortical","label":"BIOLOGICAL_STRUCTURE","start":1928,"end":1950},{"text":"white matter","label":"BIOLOGICAL_STRUCTURE","start":1959,"end":1971},{"text":"Intracranial venous sinuses","label":"BIOLOGICAL_STRUCTURE","start":1973,"end":2000},{"text":"permeable","label":"SIGN_SYMPTOM","start":2006,"end":2015},{"text":"PRES syndrome","label":"DISEASE_DISORDER","start":2038,"end":2051},{"text":"severe","label":"SEVERITY","start":2069,"end":2075},{"text":"preeclampsia","label":"DISEASE_DISORDER","start":2076,"end":2088},{"text":"electroencephalogram","label":"DIAGNOSTIC_PROCEDURE","start":2140,"end":2160},{"text":"EEG","label":"DIAGNOSTIC_PROCEDURE","start":2162,"end":2165},{"text":"in the second day","label":"DATE","start":2176,"end":2193},{"text":"anomaly","label":"SIGN_SYMPTOM","start":2209,"end":2216},{"text":"normalization","label":"LAB_VALUE","start":2250,"end":2263},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":2267,"end":2281},{"text":"normalization","label":"LAB_VALUE","start":2287,"end":2300},{"text":"neurological state","label":"DIAGNOSTIC_PROCEDURE","start":2308,"end":2326},{"text":"biological analysis","label":"DIAGNOSTIC_PROCEDURE","start":2338,"end":2357},{"text":"discharged","label":"CLINICAL_EVENT","start":2371,"end":2381},{"text":"good","label":"LAB_VALUE","start":2385,"end":2389},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":2390,"end":2399},{"text":"day 5","label":"DATE","start":2403,"end":2408},{"text":"beta-blocker","label":"MEDICATION","start":2415,"end":2427},{"text":"sodium valproate","label":"MEDICATION","start":2432,"end":2448},{"text":"three months","label":"DURATION","start":2467,"end":2479},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":2485,"end":2488},{"text":"three months later","label":"DATE","start":2510,"end":2528},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":2559,"end":2567},{"text":"edema","label":"SIGN_SYMPTOM","start":2568,"end":2573}],"tokens":["A ","woman"," ","aged 31 years",", ","G2P2",", ","without any pathological past history",", with ","good"," ","prenatal care",", with a ","normal"," ","prenatal analysis",", ","blood pressure"," during the ","follow-up"," was ","normal",", admitted for elective ","caesarian section"," at ","38 weeks"," of ","amenorrhea",".\nDuring realization of the ","spinal"," ","anesthesia"," the patient presented peak of the ","hypertensive"," (","180\/100 mm Hg",") which ","normalized"," ","after a few minutes"," without ","treatment",".\nIn ","post-partum",", ","after 12 hours"," of the caesarian section the lady presented a ","severe"," ","headache"," with ","apyrexia"," then she developed ","three episodes"," of ","generalized"," ","tonico-clonic"," ","convulsions",".\nThe ","1st"," ","convulsion"," ceased ","1 min after"," the measures of ","resuscitation"," and ","injection"," of ","diazepam IV",".\nThe post-critical ","clinical examination"," found an ","afebrile"," patient and ","blood pressure"," at ","140\/90 mmHg"," and with ","Glasgow coma scale"," at ","14"," without any ","neurological deficit",", there was no ","neck"," ","rigidity",", ","diuresis"," was preserved.\nThe ","examination of urines"," by ","urinary strip"," was ","positive"," (+ + +).\nThe ","2nd and 3th"," ","convulsive crisis"," stoped spontaneously ","within few seconds",".\n","Laboratory findings"," of ","HELLP syndrome"," include ","raised"," ","liver enzymes"," (","ASAT"," ","525 IU\/L"," and ","ALAT"," ","214 IU\/L","), ","hemolysis"," (","hemoglobinemia"," in ","7 mg\/dl",") and ","low"," ","platelet count"," (","44 000 platelet\/mL",").\nOther investigations included the ","renal function tests",", the ","inflammatory markers",", the ","thyroid hormones"," were ","normal",".\nThe ","viral serology"," was ","negative",".\nThe patient was ","transferred"," to ","intensive care unit","; she was treated immediately by ","magnesium sulfate"," associated to ","calcium channel blocker"," (","nicardipine","), ","antiepileptic"," (","phenobarbital",") and preventive dose of ","low molecular weight"," ","heparin",".\nThe ","anemia"," and ","thrombopenia"," corrected by ","transfusion"," of ","packed red blood cells"," and ","platelet"," respectively.\nThe ","magnetic resonance imaging"," (","MRI","), realized ","one hour after"," the first episode of convulsion showed ","zones"," in ","hyposignal T1",", ","hypersignal T2"," and ","flair sequences",", interesting the ","cerebral cortex",", ","parietal"," and ","occipital sub-cortical"," and the ","white matter",".\n","Intracranial venous sinuses"," were ","permeable",".\nThe diagnosis of the ","PRES syndrome"," secondary to the ","severe"," ","preeclampsia"," immediate post-partum was retained (Figure 1).\nThe ","electroencephalogram"," (","EEG",") realized ","in the second day"," did not showed ","anomaly",".\nThe evolution was marked by the ","normalization"," of ","blood pressure",", the ","normalization"," of the ","neurological state"," and of the ","biological analysis",".\nThe patient ","discharged"," in ","good"," ","condition"," on ","day 5",", with ","beta-blocker"," and ","sodium valproate"," maintained during ","three months",".\nTHE ","MRI"," of the controle made ","three months later"," showed complete resolution of ","cerebral"," ","edema"," Figure 2.\n"],"ner_labels":[0,65,0,5,0,39,0,39,0,42,0,75,0,42,0,24,0,24,0,13,0,42,0,75,0,32,0,69,0,12,0,75,0,69,0,42,0,42,0,78,0,75,0,13,0,78,0,63,0,69,0,69,0,22,0,22,0,22,0,69,0,22,0,69,0,78,0,75,0,4,0,46,0,24,0,69,0,24,0,42,0,24,0,42,0,69,0,12,0,69,0,69,0,24,0,22,0,42,0,22,0,69,0,78,0,24,0,26,0,42,0,24,0,24,0,42,0,24,0,42,0,69,0,69,0,42,0,42,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,42,0,13,0,48,0,46,0,46,0,46,0,46,0,46,0,22,0,46,0,69,0,69,0,75,0,46,0,46,0,24,0,24,0,78,0,69,0,24,0,24,0,24,0,12,0,12,0,12,0,12,0,12,0,69,0,26,0,63,0,26,0,24,0,24,0,19,0,69,0,42,0,24,0,42,0,24,0,24,0,13,0,42,0,24,0,19,0,46,0,46,0,32,0,24,0,19,0,12,0,69,0]}
-{"full_text":"A 58-year-old man had been suffering from general fatigue and severe anemia for several months.\nHis hemoglobin levels were 6.6 g\/dl (normal range: 12\u201316 g\/dl).\nHe had no medical history and did not take any medicine.\nEsophagogastroduodenoscopy and colonoscopy did not reveal any significant bleeding.\nAbdominal computer tomography revealed a 2-cm hypervascular tumor in the small intestine (Fig.1).\nOral DBE detected a 2-cm-diameter reddish, submucosal tumor-like lesion with surface ulceration in the jejunum, approximately 20 cm away from the Treitz ligament (Fig.2).\nWe did not perform biopsy because it can be difficult to stop bleeding in the case of hypervascular lesions.\nUnder the diagnosis of a small bowel tumor, gastrointestinal stromal tumor (GIST), malignant lymphoma, or cancer, we performed laparoscopic-assisted segmental resection of the jejunum with the dissection of lymph nodes.\nExamination of the resected tumor showed that it measured 19\u2009\u00d7\u200916 mm in diameter (Fig.3).\nHistology revealed the proliferation of blood capillaries and granulation tissue, which was consistent with PG (Fig.4).\nThe patient was discharged on postoperative day 9 without complication and his anemia improved gradually without the need for oral iron after surgery.\n","ner_info":[{"text":"58-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"general fatigue","label":"SIGN_SYMPTOM","start":42,"end":57},{"text":"severe","label":"SEVERITY","start":62,"end":68},{"text":"anemia","label":"SIGN_SYMPTOM","start":69,"end":75},{"text":"several months","label":"DURATION","start":80,"end":94},{"text":"hemoglobin levels","label":"DIAGNOSTIC_PROCEDURE","start":100,"end":117},{"text":"6.6 g\/dl","label":"LAB_VALUE","start":123,"end":131},{"text":"no medical history","label":"HISTORY","start":167,"end":185},{"text":"did not take any medicine","label":"HISTORY","start":190,"end":215},{"text":"Esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":217,"end":243},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":248,"end":259},{"text":"bleeding","label":"SIGN_SYMPTOM","start":291,"end":299},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":301,"end":310},{"text":"computer tomography","label":"DIAGNOSTIC_PROCEDURE","start":311,"end":330},{"text":"2-cm","label":"DISTANCE","start":342,"end":346},{"text":"hypervascular","label":"DETAILED_DESCRIPTION","start":347,"end":360},{"text":"tumor","label":"SIGN_SYMPTOM","start":361,"end":366},{"text":"small intestine","label":"BIOLOGICAL_STRUCTURE","start":374,"end":389},{"text":"DBE","label":"DIAGNOSTIC_PROCEDURE","start":404,"end":407},{"text":"2-cm-diameter","label":"DISTANCE","start":419,"end":432},{"text":"reddish","label":"COLOR","start":433,"end":440},{"text":"submucosal","label":"BIOLOGICAL_STRUCTURE","start":442,"end":452},{"text":"tumor-like","label":"DETAILED_DESCRIPTION","start":453,"end":463},{"text":"lesion","label":"SIGN_SYMPTOM","start":464,"end":470},{"text":"surface ulceration","label":"DETAILED_DESCRIPTION","start":476,"end":494},{"text":"jejunum","label":"BIOLOGICAL_STRUCTURE","start":502,"end":509},{"text":"20 cm away from the Treitz ligament","label":"BIOLOGICAL_STRUCTURE","start":525,"end":560},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":589,"end":595},{"text":"small bowel tumor","label":"DISEASE_DISORDER","start":704,"end":721},{"text":"gastrointestinal stromal tumor","label":"DISEASE_DISORDER","start":723,"end":753},{"text":"GIST","label":"DISEASE_DISORDER","start":755,"end":759},{"text":"malignant lymphoma","label":"DISEASE_DISORDER","start":762,"end":780},{"text":"cancer","label":"DISEASE_DISORDER","start":785,"end":791},{"text":"laparoscopic-assisted","label":"DETAILED_DESCRIPTION","start":806,"end":827},{"text":"segmental","label":"DETAILED_DESCRIPTION","start":828,"end":837},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":838,"end":847},{"text":"jejunum","label":"BIOLOGICAL_STRUCTURE","start":855,"end":862},{"text":"dissection of lymph nodes","label":"DETAILED_DESCRIPTION","start":872,"end":897},{"text":"Examination","label":"DIAGNOSTIC_PROCEDURE","start":899,"end":910},{"text":"resected","label":"DETAILED_DESCRIPTION","start":918,"end":926},{"text":"tumor","label":"SIGN_SYMPTOM","start":927,"end":932},{"text":"19\u2009\u00d7\u200916 mm","label":"AREA","start":957,"end":967},{"text":"Histology","label":"DIAGNOSTIC_PROCEDURE","start":989,"end":998},{"text":"proliferation of blood capillaries","label":"SIGN_SYMPTOM","start":1012,"end":1046},{"text":"granulation tissue","label":"SIGN_SYMPTOM","start":1051,"end":1069},{"text":"PG","label":"DISEASE_DISORDER","start":1097,"end":1099},{"text":"discharged","label":"CLINICAL_EVENT","start":1125,"end":1135},{"text":"postoperative day 9","label":"DATE","start":1139,"end":1158},{"text":"complication","label":"SIGN_SYMPTOM","start":1167,"end":1179},{"text":"anemia","label":"SIGN_SYMPTOM","start":1188,"end":1194},{"text":"improved","label":"LAB_VALUE","start":1195,"end":1203},{"text":"oral iron","label":"MEDICATION","start":1235,"end":1244}],"tokens":["A ","58-year-old"," ","man"," had been suffering from ","general fatigue"," and ","severe"," ","anemia"," for ","several months",".\nHis ","hemoglobin levels"," were ","6.6 g\/dl"," (normal range: 12\u201316 g\/dl).\nHe had ","no medical history"," and ","did not take any medicine",".\n","Esophagogastroduodenoscopy"," and ","colonoscopy"," did not reveal any significant ","bleeding",".\n","Abdominal"," ","computer tomography"," revealed a ","2-cm"," ","hypervascular"," ","tumor"," in the ","small intestine"," (Fig.1).\nOral ","DBE"," detected a ","2-cm-diameter"," ","reddish",", ","submucosal"," ","tumor-like"," ","lesion"," with ","surface ulceration"," in the ","jejunum",", approximately ","20 cm away from the Treitz ligament"," (Fig.2).\nWe did not perform ","biopsy"," because it can be difficult to stop bleeding in the case of hypervascular lesions.\nUnder the diagnosis of a ","small bowel tumor",", ","gastrointestinal stromal tumor"," (","GIST","), ","malignant lymphoma",", or ","cancer",", we performed ","laparoscopic-assisted"," ","segmental"," ","resection"," of the ","jejunum"," with the ","dissection of lymph nodes",".\n","Examination"," of the ","resected"," ","tumor"," showed that it measured ","19\u2009\u00d7\u200916 mm"," in diameter (Fig.3).\n","Histology"," revealed the ","proliferation of blood capillaries"," and ","granulation tissue",", which was consistent with ","PG"," (Fig.4).\nThe patient was ","discharged"," on ","postoperative day 9"," without ","complication"," and his ","anemia"," ","improved"," gradually without the need for ","oral iron"," after surgery.\n"],"ner_labels":[0,5,0,65,0,69,0,63,0,69,0,32,0,24,0,42,0,39,0,39,0,24,0,24,0,69,0,12,0,24,0,27,0,22,0,69,0,12,0,24,0,27,0,15,0,12,0,22,0,69,0,22,0,12,0,12,0,24,0,26,0,26,0,26,0,26,0,26,0,22,0,22,0,75,0,12,0,22,0,24,0,22,0,69,0,8,0,24,0,69,0,69,0,26,0,13,0,19,0,69,0,69,0,42,0,46,0]}
-{"full_text":"A 33-year-old man presented with left flank dull ache.\nOn the abdominal computed tomography, a solid renal mass in the upper portion of the left kidney was identified.\nThe mass was measured 2.8 cm\u2009\u00d7\u20092.8 cm\u2009\u00d7\u20092.5 cm in size, was well-defined.\nThe patient had no other abnormal findings, such as suspected distant metastasis or lymph node metastasis.\nRadical nephrectomy was performed on 14\/9\/2005.\nOn gross examination, the nephrectomy specimen measured 11.5 cm\u2009\u00d7\u20096.5 cm\u2009\u00d7\u20094.5 cm and the tumor was a solid, grayish-brown mass measured 3.5 cm\u2009\u00d7\u20092.5 cm\u2009\u00d7\u20092.2 cm in size.\nHistologic examination demonstrated trabecular and ribbonlike patterns with minimal fibrotic stroma.\nThe cytoplasm was granular and eosinophilic with uniform round to oval nuclei with finely stippled chromatin and inconspicuous nucleoli.\nMitoses were not found (0 per 10 high-power fields) on H&E stain.\nThe final pathologic examination revealed a well-differentiated neuroendocrine (carcinoid) tumor confined to the kidney (Fig.1).\nImmunohistochemical stains demonstrated labeling with chromogranin, neuron-specific enolase and synaptophysin (Fig.2), and the proliferation index was less than 2 % as measured by immunohistochemistry for Ki-67.\nFurther radiation and chemotherapy were not received.\nNine years after radical nephrectomy, computed tomography of the abdomen demonstrated a 2 cm\u2009\u00d7\u20091.8 cm cyst mass in the right liver and multiple high density shadow in gallbladder.\nNo enlarged lymph nodes were found in the abdominal cavity.\nCholecystectomy and extirpation for hepatic cyst were performed by laparoscopy surgery.\nHistologic examination demonstrated trabecular and glandlike growth (Fig.3), moderate and uniform nuclei and mitoses weren't found (0 per 10 high-power fields).\nAdvanced immunohistochemistry revealed that the lesion was positive for synaptophysin (Fig.4) and CD56, but negative for chromogranin and neuron-specific enolase.\nThese features are supported in a neuroendocrine tumor.\nDue to the similar pathologic characteristics between the primary renal carcinoid tumor and liver tumor.\nThe final pathology report indicated a carcinoid tumor of the left kidney with liver metastasis.\n","ner_info":[{"text":"33-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"left flank","label":"BIOLOGICAL_STRUCTURE","start":33,"end":43},{"text":"dull","label":"DETAILED_DESCRIPTION","start":44,"end":48},{"text":"ache","label":"SIGN_SYMPTOM","start":49,"end":53},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":62,"end":71},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":72,"end":91},{"text":"solid","label":"DETAILED_DESCRIPTION","start":95,"end":100},{"text":"renal","label":"BIOLOGICAL_STRUCTURE","start":101,"end":106},{"text":"mass","label":"SIGN_SYMPTOM","start":107,"end":111},{"text":"upper portion of the left kidney","label":"BIOLOGICAL_STRUCTURE","start":119,"end":151},{"text":"mass","label":"COREFERENCE","start":172,"end":176},{"text":"2.8 cm\u2009\u00d7\u20092.8 cm\u2009\u00d7\u20092.5 cm","label":"VOLUME","start":190,"end":214},{"text":"well-defined","label":"DETAILED_DESCRIPTION","start":228,"end":240},{"text":"other abnormal findings","label":"SIGN_SYMPTOM","start":261,"end":284},{"text":"distant","label":"DETAILED_DESCRIPTION","start":304,"end":311},{"text":"metastasis","label":"SIGN_SYMPTOM","start":312,"end":322},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":326,"end":336},{"text":"metastasis","label":"SIGN_SYMPTOM","start":337,"end":347},{"text":"Radical","label":"DETAILED_DESCRIPTION","start":349,"end":356},{"text":"nephrectomy","label":"THERAPEUTIC_PROCEDURE","start":357,"end":368},{"text":"14\/9\/2005","label":"DATE","start":386,"end":395},{"text":"gross examination","label":"DIAGNOSTIC_PROCEDURE","start":400,"end":417},{"text":"nephrectomy specimen","label":"DETAILED_DESCRIPTION","start":423,"end":443},{"text":"11.5 cm\u2009\u00d7\u20096.5 cm\u2009\u00d7\u20094.5 cm","label":"VOLUME","start":453,"end":478},{"text":"tumor","label":"COREFERENCE","start":487,"end":492},{"text":"solid","label":"DETAILED_DESCRIPTION","start":499,"end":504},{"text":"grayish-brown","label":"COLOR","start":506,"end":519},{"text":"mass","label":"COREFERENCE","start":520,"end":524},{"text":"3.5 cm\u2009\u00d7\u20092.5 cm\u2009\u00d7\u20092.2 cm","label":"VOLUME","start":534,"end":558},{"text":"Histologic examination","label":"DIAGNOSTIC_PROCEDURE","start":568,"end":590},{"text":"trabecular and ribbonlike patterns","label":"LAB_VALUE","start":604,"end":638},{"text":"minimal fibrotic stroma","label":"LAB_VALUE","start":644,"end":667},{"text":"cytoplasm","label":"DIAGNOSTIC_PROCEDURE","start":673,"end":682},{"text":"granular","label":"LAB_VALUE","start":687,"end":695},{"text":"eosinophilic","label":"LAB_VALUE","start":700,"end":712},{"text":"uniform round to oval nuclei","label":"LAB_VALUE","start":718,"end":746},{"text":"finely stippled chromatin","label":"LAB_VALUE","start":752,"end":777},{"text":"inconspicuous nucleoli","label":"LAB_VALUE","start":782,"end":804},{"text":"Mitoses","label":"DIAGNOSTIC_PROCEDURE","start":806,"end":813},{"text":"not found","label":"LAB_VALUE","start":819,"end":828},{"text":"0 per 10 high-power fields","label":"LAB_VALUE","start":830,"end":856},{"text":"H&E stain","label":"DIAGNOSTIC_PROCEDURE","start":861,"end":870},{"text":"pathologic examination","label":"DIAGNOSTIC_PROCEDURE","start":882,"end":904},{"text":"well-differentiated","label":"DETAILED_DESCRIPTION","start":916,"end":935},{"text":"neuroendocrine (carcinoid) tumor","label":"DISEASE_DISORDER","start":936,"end":968},{"text":"kidney","label":"BIOLOGICAL_STRUCTURE","start":985,"end":991},{"text":"Immunohistochemical stains","label":"DIAGNOSTIC_PROCEDURE","start":1001,"end":1027},{"text":"labeling","label":"LAB_VALUE","start":1041,"end":1049},{"text":"chromogranin","label":"DIAGNOSTIC_PROCEDURE","start":1055,"end":1067},{"text":"neuron-specific enolase","label":"DIAGNOSTIC_PROCEDURE","start":1069,"end":1092},{"text":"synaptophysin","label":"DIAGNOSTIC_PROCEDURE","start":1097,"end":1110},{"text":"proliferation index","label":"DIAGNOSTIC_PROCEDURE","start":1128,"end":1147},{"text":"less than 2 %","label":"LAB_VALUE","start":1152,"end":1165},{"text":"immunohistochemistry for Ki-67","label":"DIAGNOSTIC_PROCEDURE","start":1181,"end":1211},{"text":"radiation","label":"THERAPEUTIC_PROCEDURE","start":1221,"end":1230},{"text":"chemotherapy","label":"MEDICATION","start":1235,"end":1247},{"text":"Nine years after","label":"DATE","start":1267,"end":1283},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1305,"end":1324},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1332,"end":1339},{"text":"2 cm\u2009\u00d7\u20091.8 cm","label":"AREA","start":1355,"end":1368},{"text":"cyst","label":"DETAILED_DESCRIPTION","start":1369,"end":1373},{"text":"mass","label":"SIGN_SYMPTOM","start":1374,"end":1378},{"text":"right liver","label":"BIOLOGICAL_STRUCTURE","start":1386,"end":1397},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1402,"end":1410},{"text":"high density shadow","label":"SIGN_SYMPTOM","start":1411,"end":1430},{"text":"gallbladder","label":"BIOLOGICAL_STRUCTURE","start":1434,"end":1445},{"text":"enlarged","label":"SIGN_SYMPTOM","start":1450,"end":1458},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1459,"end":1470},{"text":"abdominal cavity","label":"BIOLOGICAL_STRUCTURE","start":1489,"end":1505},{"text":"Cholecystectomy","label":"THERAPEUTIC_PROCEDURE","start":1507,"end":1522},{"text":"extirpation","label":"THERAPEUTIC_PROCEDURE","start":1527,"end":1538},{"text":"hepatic cyst","label":"DISEASE_DISORDER","start":1543,"end":1555},{"text":"laparoscopy surgery","label":"THERAPEUTIC_PROCEDURE","start":1574,"end":1593},{"text":"Histologic examination","label":"DIAGNOSTIC_PROCEDURE","start":1595,"end":1617},{"text":"trabecular and glandlike growth","label":"LAB_VALUE","start":1631,"end":1662},{"text":"moderate and uniform nuclei","label":"LAB_VALUE","start":1672,"end":1699},{"text":"mitoses","label":"DIAGNOSTIC_PROCEDURE","start":1704,"end":1711},{"text":"weren't found","label":"LAB_VALUE","start":1712,"end":1725},{"text":"0 per 10 high-power fields","label":"LAB_VALUE","start":1727,"end":1753},{"text":"Advanced","label":"DETAILED_DESCRIPTION","start":1756,"end":1764},{"text":"immunohistochemistry","label":"DIAGNOSTIC_PROCEDURE","start":1765,"end":1785},{"text":"lesion","label":"COREFERENCE","start":1804,"end":1810},{"text":"positive","label":"LAB_VALUE","start":1815,"end":1823},{"text":"synaptophysin","label":"DIAGNOSTIC_PROCEDURE","start":1828,"end":1841},{"text":"negative","label":"LAB_VALUE","start":1864,"end":1872},{"text":"chromogranin","label":"DIAGNOSTIC_PROCEDURE","start":1877,"end":1889},{"text":"neuron-specific enolase","label":"DIAGNOSTIC_PROCEDURE","start":1894,"end":1917},{"text":"neuroendocrine tumor","label":"DISEASE_DISORDER","start":1953,"end":1973},{"text":"carcinoid tumor","label":"DISEASE_DISORDER","start":2119,"end":2134},{"text":"left kidney","label":"BIOLOGICAL_STRUCTURE","start":2142,"end":2153},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2159,"end":2164},{"text":"metastasis","label":"SIGN_SYMPTOM","start":2165,"end":2175}],"tokens":["A ","33-year-old"," ","man"," ","presented"," with ","left flank"," ","dull"," ","ache",".\nOn the ","abdominal"," ","computed tomography",", a ","solid"," ","renal"," ","mass"," in the ","upper portion of the left kidney"," was identified.\nThe ","mass"," was measured ","2.8 cm\u2009\u00d7\u20092.8 cm\u2009\u00d7\u20092.5 cm"," in size, was ","well-defined",".\nThe patient had no ","other abnormal findings",", such as suspected ","distant"," ","metastasis"," or ","lymph node"," ","metastasis",".\n","Radical"," ","nephrectomy"," was performed on ","14\/9\/2005",".\nOn ","gross examination",", the ","nephrectomy specimen"," measured ","11.5 cm\u2009\u00d7\u20096.5 cm\u2009\u00d7\u20094.5 cm"," and the ","tumor"," was a ","solid",", ","grayish-brown"," ","mass"," measured ","3.5 cm\u2009\u00d7\u20092.5 cm\u2009\u00d7\u20092.2 cm"," in size.\n","Histologic examination"," demonstrated ","trabecular and ribbonlike patterns"," with ","minimal fibrotic stroma",".\nThe ","cytoplasm"," was ","granular"," and ","eosinophilic"," with ","uniform round to oval nuclei"," with ","finely stippled chromatin"," and ","inconspicuous nucleoli",".\n","Mitoses"," were ","not found"," (","0 per 10 high-power fields",") on ","H&E stain",".\nThe final ","pathologic examination"," revealed a ","well-differentiated"," ","neuroendocrine (carcinoid) tumor"," confined to the ","kidney"," (Fig.1).\n","Immunohistochemical stains"," demonstrated ","labeling"," with ","chromogranin",", ","neuron-specific enolase"," and ","synaptophysin"," (Fig.2), and the ","proliferation index"," was ","less than 2 %"," as measured by ","immunohistochemistry for Ki-67",".\nFurther ","radiation"," and ","chemotherapy"," were not received.\n","Nine years after"," radical nephrectomy, ","computed tomography"," of the ","abdomen"," demonstrated a ","2 cm\u2009\u00d7\u20091.8 cm"," ","cyst"," ","mass"," in the ","right liver"," and ","multiple"," ","high density shadow"," in ","gallbladder",".\nNo ","enlarged"," ","lymph nodes"," were found in the ","abdominal cavity",".\n","Cholecystectomy"," and ","extirpation"," for ","hepatic cyst"," were performed by ","laparoscopy surgery",".\n","Histologic examination"," demonstrated ","trabecular and glandlike growth"," (Fig.3), ","moderate and uniform nuclei"," and ","mitoses"," ","weren't found"," (","0 per 10 high-power fields",").\n","Advanced"," ","immunohistochemistry"," revealed that the ","lesion"," was ","positive"," for ","synaptophysin"," (Fig.4) and CD56, but ","negative"," for ","chromogranin"," and ","neuron-specific enolase",".\nThese features are supported in a ","neuroendocrine tumor",".\nDue to the similar pathologic characteristics between the primary renal carcinoid tumor and liver tumor.\nThe final pathology report indicated a ","carcinoid tumor"," of the ","left kidney"," with ","liver"," ","metastasis",".\n"],"ner_labels":[0,5,0,65,0,13,0,12,0,22,0,69,0,12,0,24,0,22,0,12,0,69,0,12,0,18,0,79,0,22,0,69,0,22,0,69,0,12,0,69,0,22,0,75,0,19,0,24,0,22,0,79,0,18,0,22,0,15,0,18,0,79,0,24,0,42,0,42,0,24,0,42,0,42,0,42,0,42,0,42,0,24,0,42,0,42,0,24,0,24,0,22,0,26,0,12,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,75,0,46,0,19,0,24,0,12,0,8,0,22,0,69,0,12,0,22,0,69,0,12,0,69,0,12,0,12,0,75,0,75,0,26,0,75,0,24,0,42,0,42,0,24,0,42,0,42,0,22,0,24,0,18,0,42,0,24,0,42,0,24,0,24,0,26,0,26,0,12,0,12,0,69,0]}
-{"full_text":"The patient, a 9 year-old Caucasian female, was first diagnosed with medulloblastoma at age 3 years.\nTreatment included surgical resection of the tumor followed by systemic chemotherapy (Vincristine, Lomustine, Cisplatin, Carboplatin, Cyclophosphamide, Etoposide), and craniospinal radiation (2,340 cGy) with boost to the posterior fossa (total dose 5,900 cGy).\nCis-RA was subsequently administered for eleven, 14-day cycles (180mg\/m2 per day), over a 13-month period for a cumulative dose of 17,360 mg (24,640 mg\/m2).\nShe completed medulloblastoma therapy at age 5.6 years.\nAt age 6 years, she was diagnosed with radiation-induced central hypothyroidism and growth hormone deficiency (GHD).\nShe was treated with levothyroxine with subsequent biochemical euthyroidism.\nGiven tumor remission status and an abnormal height velocity of 0.94 cm\/year, growth hormone (GH) therapy was initiated at age 7 years (0.3 mg\/kg\/week) with subsequent increased height velocity of 3.6 cm growth\/seven months; however, seven months after initiation of GH, increased bony prominence was noted at wrists and knees, concomitant with declining height velocity (1.6 cm growth\/five months).\nPhysical examination and radiographs were significant for leg length discrepancy: the right lower extremity measured 1.75 cm shorter than the left (right femur 24.9 cm, right tibia 19.6 cm, right lower extremity 44.5 cm, left femur 25.25 cm, left tibia 21 cm, and left lower extremity 46.25 cm).\nPrior to initiation of GH, height (102 cm) (Figure 1) and armspan (102 cm) were similar, with upper segment\/lower segment ratio of one; seven months after GH, height increased minimally (105.6 cm) compared to the more significant increase in armspan (109.2 cm), with upper segment\/lower segment ratio remaining at one.\nRadiographs revealed poorly visualized growth plates in both distal and proximal femurs and tibias (Figure 2A-B), raising concern for premature closure of the physes.\nThis lower limb growth plate closure would normally be observed at the time of late-stage puberty.\nBy contrast, all bone ages using left hand and wrist radiographs over the preceding two years displayed open growth plates (Figure 2C-D).\n","ner_info":[{"text":"9 year-old","label":"AGE","start":15,"end":25},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":26,"end":35},{"text":"female","label":"SEX","start":36,"end":42},{"text":"medulloblastoma","label":"DISEASE_DISORDER","start":69,"end":84},{"text":"age 3 years","label":"DATE","start":88,"end":99},{"text":"Treatment","label":"THERAPEUTIC_PROCEDURE","start":101,"end":110},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":120,"end":138},{"text":"tumor","label":"SIGN_SYMPTOM","start":146,"end":151},{"text":"chemotherapy","label":"MEDICATION","start":173,"end":185},{"text":"Vincristine","label":"MEDICATION","start":187,"end":198},{"text":"Lomustine","label":"MEDICATION","start":200,"end":209},{"text":"Cisplatin","label":"MEDICATION","start":211,"end":220},{"text":"Carboplatin","label":"MEDICATION","start":222,"end":233},{"text":"Cyclophosphamide","label":"MEDICATION","start":235,"end":251},{"text":"Etoposide","label":"MEDICATION","start":253,"end":262},{"text":"craniospinal","label":"BIOLOGICAL_STRUCTURE","start":269,"end":281},{"text":"radiation","label":"THERAPEUTIC_PROCEDURE","start":282,"end":291},{"text":"2,340 cGy","label":"DOSAGE","start":293,"end":302},{"text":"boost","label":"THERAPEUTIC_PROCEDURE","start":309,"end":314},{"text":"posterior fossa","label":"BIOLOGICAL_STRUCTURE","start":322,"end":337},{"text":"total dose 5,900 cGy","label":"DOSAGE","start":339,"end":359},{"text":"Cis-RA","label":"MEDICATION","start":362,"end":368},{"text":"eleven, 14-day cycles","label":"DOSAGE","start":403,"end":424},{"text":"180mg\/m2 per day","label":"DOSAGE","start":426,"end":442},{"text":"13-month period","label":"DURATION","start":452,"end":467},{"text":"17,360 mg","label":"DOSAGE","start":493,"end":502},{"text":"24,640 mg\/m2","label":"DOSAGE","start":504,"end":516},{"text":"completed","label":"LAB_VALUE","start":523,"end":532},{"text":"medulloblastoma therapy","label":"THERAPEUTIC_PROCEDURE","start":533,"end":556},{"text":"age 5.6 years","label":"DATE","start":560,"end":573},{"text":"age 6 years","label":"DATE","start":578,"end":589},{"text":"radiation-induced","label":"DETAILED_DESCRIPTION","start":614,"end":631},{"text":"central","label":"DETAILED_DESCRIPTION","start":632,"end":639},{"text":"hypothyroidism","label":"DISEASE_DISORDER","start":640,"end":654},{"text":"growth hormone deficiency","label":"DISEASE_DISORDER","start":659,"end":684},{"text":"GHD","label":"DISEASE_DISORDER","start":686,"end":689},{"text":"levothyroxine","label":"MEDICATION","start":713,"end":726},{"text":"biochemical","label":"DETAILED_DESCRIPTION","start":743,"end":754},{"text":"euthyroidism","label":"SIGN_SYMPTOM","start":755,"end":767},{"text":"tumor remission","label":"SIGN_SYMPTOM","start":775,"end":790},{"text":"abnormal","label":"QUALITATIVE_CONCEPT","start":805,"end":813},{"text":"height velocity","label":"DIAGNOSTIC_PROCEDURE","start":814,"end":829},{"text":"0.94 cm\/year","label":"LAB_VALUE","start":833,"end":845},{"text":"growth hormone","label":"MEDICATION","start":847,"end":861},{"text":"GH","label":"MEDICATION","start":863,"end":865},{"text":"age 7 years","label":"DATE","start":892,"end":903},{"text":"0.3 mg\/kg\/week","label":"DOSAGE","start":905,"end":919},{"text":"increased","label":"QUALITATIVE_CONCEPT","start":937,"end":946},{"text":"height velocity","label":"DIAGNOSTIC_PROCEDURE","start":947,"end":962},{"text":"3.6 cm growth\/seven months","label":"LAB_VALUE","start":966,"end":992},{"text":"seven months after","label":"DATE","start":1003,"end":1021},{"text":"GH","label":"MEDICATION","start":1036,"end":1038},{"text":"increased","label":"QUALITATIVE_CONCEPT","start":1040,"end":1049},{"text":"bony prominence","label":"SIGN_SYMPTOM","start":1050,"end":1065},{"text":"wrists","label":"BIOLOGICAL_STRUCTURE","start":1079,"end":1085},{"text":"knees","label":"BIOLOGICAL_STRUCTURE","start":1090,"end":1095},{"text":"declining","label":"QUALITATIVE_CONCEPT","start":1114,"end":1123},{"text":"height velocity","label":"DIAGNOSTIC_PROCEDURE","start":1124,"end":1139},{"text":"1.6 cm growth\/five months","label":"LAB_VALUE","start":1141,"end":1166},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1169,"end":1189},{"text":"radiographs","label":"DIAGNOSTIC_PROCEDURE","start":1194,"end":1205},{"text":"leg length","label":"DIAGNOSTIC_PROCEDURE","start":1227,"end":1237},{"text":"discrepancy","label":"LAB_VALUE","start":1238,"end":1249},{"text":"right lower extremity","label":"BIOLOGICAL_STRUCTURE","start":1255,"end":1276},{"text":"measured","label":"DIAGNOSTIC_PROCEDURE","start":1277,"end":1285},{"text":"1.75 cm shorter than the left","label":"LAB_VALUE","start":1286,"end":1315},{"text":"right femur 24.9 cm","label":"LAB_VALUE","start":1317,"end":1336},{"text":"right tibia 19.6 cm","label":"LAB_VALUE","start":1338,"end":1357},{"text":"right lower extremity 44.5 cm","label":"LAB_VALUE","start":1359,"end":1388},{"text":"left femur 25.25 cm","label":"LAB_VALUE","start":1390,"end":1409},{"text":"left tibia 21 cm","label":"LAB_VALUE","start":1411,"end":1427},{"text":"left lower extremity 46.25 cm","label":"LAB_VALUE","start":1433,"end":1462},{"text":"GH","label":"MEDICATION","start":1488,"end":1490},{"text":"height","label":"DIAGNOSTIC_PROCEDURE","start":1492,"end":1498},{"text":"102 cm","label":"LAB_VALUE","start":1500,"end":1506},{"text":"armspan","label":"DIAGNOSTIC_PROCEDURE","start":1523,"end":1530},{"text":"102 cm","label":"LAB_VALUE","start":1532,"end":1538},{"text":"upper segment\/lower segment ratio","label":"DIAGNOSTIC_PROCEDURE","start":1559,"end":1592},{"text":"one","label":"LAB_VALUE","start":1596,"end":1599},{"text":"seven months after","label":"DATE","start":1601,"end":1619},{"text":"GH","label":"MEDICATION","start":1620,"end":1622},{"text":"height","label":"DIAGNOSTIC_PROCEDURE","start":1624,"end":1630},{"text":"increased minimally","label":"LAB_VALUE","start":1631,"end":1650},{"text":"105.6 cm","label":"LAB_VALUE","start":1652,"end":1660},{"text":"more significant increase","label":"LAB_VALUE","start":1678,"end":1703},{"text":"armspan","label":"DIAGNOSTIC_PROCEDURE","start":1707,"end":1714},{"text":"109.2 cm","label":"LAB_VALUE","start":1716,"end":1724},{"text":"upper segment\/lower segment ratio","label":"DIAGNOSTIC_PROCEDURE","start":1732,"end":1765},{"text":"one","label":"LAB_VALUE","start":1779,"end":1782},{"text":"Radiographs","label":"DIAGNOSTIC_PROCEDURE","start":1784,"end":1795},{"text":"poorly visualized","label":"LAB_VALUE","start":1805,"end":1822},{"text":"growth plates","label":"DIAGNOSTIC_PROCEDURE","start":1823,"end":1836},{"text":"distal and proximal femurs and tibias","label":"BIOLOGICAL_STRUCTURE","start":1845,"end":1882},{"text":"premature closure of the physes","label":"DISEASE_DISORDER","start":1918,"end":1949},{"text":"bone ages","label":"DIAGNOSTIC_PROCEDURE","start":2067,"end":2076},{"text":"left hand","label":"BIOLOGICAL_STRUCTURE","start":2083,"end":2092},{"text":"wrist","label":"BIOLOGICAL_STRUCTURE","start":2097,"end":2102},{"text":"radiographs","label":"DIAGNOSTIC_PROCEDURE","start":2103,"end":2114},{"text":"preceding two years","label":"DURATION","start":2124,"end":2143},{"text":"open","label":"LAB_VALUE","start":2154,"end":2158},{"text":"growth plates","label":"DIAGNOSTIC_PROCEDURE","start":2159,"end":2172}],"tokens":["The patient, a ","9 year-old"," ","Caucasian"," ","female",", was first diagnosed with ","medulloblastoma"," at ","age 3 years",".\n","Treatment"," included ","surgical resection"," of the ","tumor"," followed by systemic ","chemotherapy"," (","Vincristine",", ","Lomustine",", ","Cisplatin",", ","Carboplatin",", ","Cyclophosphamide",", ","Etoposide","), and ","craniospinal"," ","radiation"," (","2,340 cGy",") with ","boost"," to the ","posterior fossa"," (","total dose 5,900 cGy",").\n","Cis-RA"," was subsequently administered for ","eleven, 14-day cycles"," (","180mg\/m2 per day","), over a ","13-month period"," for a cumulative dose of ","17,360 mg"," (","24,640 mg\/m2",").\nShe ","completed"," ","medulloblastoma therapy"," at ","age 5.6 years",".\nAt ","age 6 years",", she was diagnosed with ","radiation-induced"," ","central"," ","hypothyroidism"," and ","growth hormone deficiency"," (","GHD",").\nShe was treated with ","levothyroxine"," with subsequent ","biochemical"," ","euthyroidism",".\nGiven ","tumor remission"," status and an ","abnormal"," ","height velocity"," of ","0.94 cm\/year",", ","growth hormone"," (","GH",") therapy was initiated at ","age 7 years"," (","0.3 mg\/kg\/week",") with subsequent ","increased"," ","height velocity"," of ","3.6 cm growth\/seven months","; however, ","seven months after"," initiation of ","GH",", ","increased"," ","bony prominence"," was noted at ","wrists"," and ","knees",", concomitant with ","declining"," ","height velocity"," (","1.6 cm growth\/five months",").\n","Physical examination"," and ","radiographs"," were significant for ","leg length"," ","discrepancy",": the ","right lower extremity"," ","measured"," ","1.75 cm shorter than the left"," (","right femur 24.9 cm",", ","right tibia 19.6 cm",", ","right lower extremity 44.5 cm",", ","left femur 25.25 cm",", ","left tibia 21 cm",", and ","left lower extremity 46.25 cm",").\nPrior to initiation of ","GH",", ","height"," (","102 cm",") (Figure 1) and ","armspan"," (","102 cm",") were similar, with ","upper segment\/lower segment ratio"," of ","one","; ","seven months after"," ","GH",", ","height"," ","increased minimally"," (","105.6 cm",") compared to the ","more significant increase"," in ","armspan"," (","109.2 cm","), with ","upper segment\/lower segment ratio"," remaining at ","one",".\n","Radiographs"," revealed ","poorly visualized"," ","growth plates"," in both ","distal and proximal femurs and tibias"," (Figure 2A-B), raising concern for ","premature closure of the physes",".\nThis lower limb growth plate closure would normally be observed at the time of late-stage puberty.\nBy contrast, all ","bone ages"," using ","left hand"," and ","wrist"," ","radiographs"," over the ","preceding two years"," displayed ","open"," ","growth plates"," (Figure 2C-D).\n"],"ner_labels":[0,5,0,58,0,65,0,26,0,19,0,75,0,75,0,69,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,12,0,75,0,29,0,75,0,12,0,29,0,46,0,29,0,29,0,32,0,29,0,29,0,42,0,75,0,19,0,19,0,22,0,22,0,26,0,26,0,26,0,46,0,22,0,69,0,69,0,59,0,24,0,42,0,46,0,46,0,19,0,29,0,59,0,24,0,42,0,19,0,46,0,59,0,69,0,12,0,12,0,59,0,24,0,42,0,24,0,24,0,24,0,42,0,12,0,24,0,42,0,42,0,42,0,42,0,42,0,42,0,42,0,46,0,24,0,42,0,24,0,42,0,24,0,42,0,19,0,46,0,24,0,42,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,12,0,26,0,24,0,12,0,12,0,24,0,32,0,42,0,24,0]}
-{"full_text":"A 73-year-old woman was initially referred 19 months prior to the current presentation, at which time fluorescein and indocyanine green angiography showed a medium-sized subfoveal classic CNV in the left eye, which had not been previously treated.\nShe did not return for treatment until the current presentation, when she noted decreased vision in the left eye.\nThe best-corrected visual acuity (BCVA) was 20\/100.\nSlit lamp examination showed a small yellowish patch in the perifoveal region and retinal edema.\nStructural OCT revealed the retinal elevation, subretinal fluid and a hyper-reflective elongated area above RPE indicating type II CNV.\nAnti-angiogenic treatment with intravitreal aflibercept injections were administered with a treat-and-extend regimen.\nOCT angiograms (Fig.1) showed noticeable reduction in CNV flow area by 1\u20132 days post injection, with continued reduction at 1 week and 2 weeks.\nCNV flow area and vessel density were reduced, probably due to the decreased flow or temporary closure of the smaller anastomoses.\nSignificant re-appearance of CNV was noticeable at 4 weeks after the first injection and again at 6 weeks after the second injection.\nThe vascular pattern of the re-enlarged CNV (Fig.1A) was very similar to the initial pretreatment CNV, suggesting that the recurrence may be reopening of original channels rather than growth of new vessels.\nComparing the CNV network prior to the 3rd injection to the baseline, it is notable that there were fewer smaller channels, while the larger caliber channels remained.\nQuantitative measurements from OCT angiography (Fig.2A) showed reduction in CNV flow area and flow index over the first 2 weeks with subsequent return.\nRetinal thickness (Fig.2B) showed the fluid resorption over the first 4 weeks in the first treatment cycle continuing at least 2 weeks into the second treatment cycle, at which time no fluid remained (Fig.1B).\nBut fluid re-accumulated under the retina 6 weeks after the 2nd injection.\nVisual acuity (Fig.2B) continued to improve over the 3 treatment cycles.\n","ner_info":[{"text":"73-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"referred","label":"CLINICAL_EVENT","start":34,"end":42},{"text":"19 months prio","label":"DATE","start":43,"end":57},{"text":"fluorescein","label":"DETAILED_DESCRIPTION","start":102,"end":113},{"text":"indocyanine green","label":"DETAILED_DESCRIPTION","start":118,"end":135},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":136,"end":147},{"text":"medium-sized","label":"DETAILED_DESCRIPTION","start":157,"end":169},{"text":"subfoveal","label":"DETAILED_DESCRIPTION","start":170,"end":179},{"text":"classic","label":"DETAILED_DESCRIPTION","start":180,"end":187},{"text":"CNV","label":"DISEASE_DISORDER","start":188,"end":191},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":199,"end":207},{"text":"not been previously treated","label":"DETAILED_DESCRIPTION","start":219,"end":246},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":271,"end":280},{"text":"decreased vision","label":"SIGN_SYMPTOM","start":328,"end":344},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":352,"end":360},{"text":"best-corrected visual acuity","label":"DIAGNOSTIC_PROCEDURE","start":366,"end":394},{"text":"BCVA","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":400},{"text":"20\/100","label":"LAB_VALUE","start":406,"end":412},{"text":"Slit lamp examination","label":"DIAGNOSTIC_PROCEDURE","start":414,"end":435},{"text":"small","label":"DETAILED_DESCRIPTION","start":445,"end":450},{"text":"yellowish","label":"COLOR","start":451,"end":460},{"text":"patch","label":"SIGN_SYMPTOM","start":461,"end":466},{"text":"perifoveal region","label":"BIOLOGICAL_STRUCTURE","start":474,"end":491},{"text":"retinal edema","label":"SIGN_SYMPTOM","start":496,"end":509},{"text":"Structural","label":"DETAILED_DESCRIPTION","start":511,"end":521},{"text":"OCT","label":"DIAGNOSTIC_PROCEDURE","start":522,"end":525},{"text":"retinal elevation","label":"SIGN_SYMPTOM","start":539,"end":556},{"text":"subretinal fluid","label":"SIGN_SYMPTOM","start":558,"end":574},{"text":"hyper-reflective","label":"BIOLOGICAL_STRUCTURE","start":581,"end":597},{"text":"elongated area","label":"SIGN_SYMPTOM","start":598,"end":612},{"text":"above RPE","label":"BIOLOGICAL_STRUCTURE","start":613,"end":622},{"text":"type II","label":"LAB_VALUE","start":634,"end":641},{"text":"CNV","label":"DISEASE_DISORDER","start":642,"end":645},{"text":"Anti-angiogenic treatment","label":"THERAPEUTIC_PROCEDURE","start":647,"end":672},{"text":"intravitreal","label":"ADMINISTRATION","start":678,"end":690},{"text":"aflibercept","label":"MEDICATION","start":691,"end":702},{"text":"injections","label":"ADMINISTRATION","start":703,"end":713},{"text":"treat-and-extend regimen","label":"DETAILED_DESCRIPTION","start":739,"end":763},{"text":"OCT","label":"DIAGNOSTIC_PROCEDURE","start":765,"end":768},{"text":"angiograms","label":"DETAILED_DESCRIPTION","start":769,"end":779},{"text":"noticeable reduction","label":"LAB_VALUE","start":795,"end":815},{"text":"CNV flow area","label":"DIAGNOSTIC_PROCEDURE","start":819,"end":832},{"text":"1\u20132 days post","label":"DATE","start":836,"end":849},{"text":"continued reduction","label":"LAB_VALUE","start":866,"end":885},{"text":"1 week and 2 weeks","label":"DATE","start":889,"end":907},{"text":"CNV flow area","label":"DIAGNOSTIC_PROCEDURE","start":909,"end":922},{"text":"vessel density","label":"DIAGNOSTIC_PROCEDURE","start":927,"end":941},{"text":"reduced","label":"LAB_VALUE","start":947,"end":954},{"text":"Significant","label":"SEVERITY","start":1040,"end":1051},{"text":"re-appearance","label":"LAB_VALUE","start":1052,"end":1065},{"text":"CNV","label":"DISEASE_DISORDER","start":1069,"end":1072},{"text":"4 weeks","label":"DATE","start":1091,"end":1098},{"text":"6 weeks","label":"DATE","start":1138,"end":1145},{"text":"re-enlarged","label":"DETAILED_DESCRIPTION","start":1202,"end":1213},{"text":"CNV","label":"DISEASE_DISORDER","start":1214,"end":1217},{"text":"OCT","label":"DIAGNOSTIC_PROCEDURE","start":1580,"end":1583},{"text":"angiography","label":"DETAILED_DESCRIPTION","start":1584,"end":1595},{"text":"reduction","label":"LAB_VALUE","start":1612,"end":1621},{"text":"CNV flow area","label":"DIAGNOSTIC_PROCEDURE","start":1625,"end":1638},{"text":"flow index","label":"DIAGNOSTIC_PROCEDURE","start":1643,"end":1653},{"text":"over the first 2 weeks","label":"DURATION","start":1654,"end":1676},{"text":"Retinal thickness","label":"SIGN_SYMPTOM","start":1701,"end":1718},{"text":"over the first 4 weeks","label":"DURATION","start":1756,"end":1778},{"text":"2 weeks","label":"DATE","start":1828,"end":1835},{"text":"fluid re-accumulated","label":"SIGN_SYMPTOM","start":1915,"end":1935},{"text":"under the retina","label":"BIOLOGICAL_STRUCTURE","start":1936,"end":1952},{"text":"6 weeks","label":"DATE","start":1953,"end":1960},{"text":"Visual acuity","label":"DIAGNOSTIC_PROCEDURE","start":1986,"end":1999},{"text":"continued to improve","label":"LAB_VALUE","start":2009,"end":2029}],"tokens":["A ","73-year-old"," ","woman"," was initially ","referred"," ","19 months prio","r to the current presentation, at which time ","fluorescein"," and ","indocyanine green"," ","angiography"," showed a ","medium-sized"," ","subfoveal"," ","classic"," ","CNV"," in the ","left eye",", which had ","not been previously treated",".\nShe did not return for ","treatment"," until the current presentation, when she noted ","decreased vision"," in the ","left eye",".\nThe ","best-corrected visual acuity"," (","BCVA",") was ","20\/100",".\n","Slit lamp examination"," showed a ","small"," ","yellowish"," ","patch"," in the ","perifoveal region"," and ","retinal edema",".\n","Structural"," ","OCT"," revealed the ","retinal elevation",", ","subretinal fluid"," and a ","hyper-reflective"," ","elongated area"," ","above RPE"," indicating ","type II"," ","CNV",".\n","Anti-angiogenic treatment"," with ","intravitreal"," ","aflibercept"," ","injections"," were administered with a ","treat-and-extend regimen",".\n","OCT"," ","angiograms"," (Fig.1) showed ","noticeable reduction"," in ","CNV flow area"," by ","1\u20132 days post"," injection, with ","continued reduction"," at ","1 week and 2 weeks",".\n","CNV flow area"," and ","vessel density"," were ","reduced",", probably due to the decreased flow or temporary closure of the smaller anastomoses.\n","Significant"," ","re-appearance"," of ","CNV"," was noticeable at ","4 weeks"," after the first injection and again at ","6 weeks"," after the second injection.\nThe vascular pattern of the ","re-enlarged"," ","CNV"," (Fig.1A) was very similar to the initial pretreatment CNV, suggesting that the recurrence may be reopening of original channels rather than growth of new vessels.\nComparing the CNV network prior to the 3rd injection to the baseline, it is notable that there were fewer smaller channels, while the larger caliber channels remained.\nQuantitative measurements from ","OCT"," ","angiography"," (Fig.2A) showed ","reduction"," in ","CNV flow area"," and ","flow index"," ","over the first 2 weeks"," with subsequent return.\n","Retinal thickness"," (Fig.2B) showed the fluid resorption ","over the first 4 weeks"," in the first treatment cycle continuing at least ","2 weeks"," into the second treatment cycle, at which time no fluid remained (Fig.1B).\nBut ","fluid re-accumulated"," ","under the retina"," ","6 weeks"," after the 2nd injection.\n","Visual acuity"," (Fig.2B) ","continued to improve"," over the 3 treatment cycles.\n"],"ner_labels":[0,5,0,65,0,13,0,19,0,22,0,22,0,24,0,22,0,22,0,22,0,26,0,12,0,22,0,75,0,69,0,12,0,24,0,24,0,42,0,24,0,22,0,15,0,69,0,12,0,69,0,22,0,24,0,69,0,69,0,12,0,69,0,12,0,42,0,26,0,75,0,4,0,46,0,4,0,22,0,24,0,22,0,42,0,24,0,19,0,42,0,19,0,24,0,24,0,42,0,63,0,42,0,26,0,19,0,19,0,22,0,26,0,24,0,22,0,42,0,24,0,24,0,32,0,69,0,32,0,19,0,69,0,12,0,19,0,24,0,42,0]}
-{"full_text":"An 8-year-old boy with S549R\/1717-1G\u2009>\u2009A genotype was started on ivacaftor (150 mg b.i.d.) on compassionate use.\nAt the age of 9 months he was diagnosed with CF due to failure to thrive.\nHis previous history was remarkable for recurring nasal polyposis requiring endoscopic surgery and exocrine pancreatic insufficiency necessitating enzyme replacement therapy.\nHe grew with body weight and height along the 10th percentile.\nHe suffered from rather mild respiratory symptoms, primarily intermittent productive cough, and had close to normal lung function parameters in previous years as measured by body plethysmography and spirometry (minimal z-score of FEV1: \u22121.2).\nSputum cultures grew Haemophilus influenzae and Staphylococcus aureus on several occasions.\nAfter 6 weeks of ivacaftor treatment, the patient reported clinical improvements in cough frequency, sputum production, physical performance, and less salt cravings.\nHe gained 1.4 kg in body weight without changing the dose of his pancreatic enzyme replacement therapy.\nHis sweat chloride level (Macroduct\u00ae) decreased from 115 mmol\/l before ivacaftor to 40 mmol\/l after 6 weeks and 52 mmol\/l after 41 weeks (normal\u2009<\u200930 mmol\/l [11]) of treatment.\nHis FEV1 increased from 1.25 L (\u22121.2 z-score) to 1.65 L (+0.5 z-score) after 41 weeks of ivacaftor therapy.\nThe LCI (normal\u2009<\u20098) measured by N2-MBW decreased from 14.5 to 8.3 after 6 weeks and 7.8 after 41 weeks of ivacaftor treatment (Table 1 and Fig.1).\n","ner_info":[{"text":"8-year-old","label":"AGE","start":3,"end":13},{"text":"boy","label":"SEX","start":14,"end":17},{"text":"S549R\/1717-1G\u2009>\u2009A genotype","label":"HISTORY","start":23,"end":49},{"text":"ivacaftor","label":"MEDICATION","start":65,"end":74},{"text":"150 mg b.i.d.","label":"DOSAGE","start":76,"end":89},{"text":"age of 9 months","label":"DATE","start":120,"end":135},{"text":"CF","label":"DISEASE_DISORDER","start":158,"end":160},{"text":"failure to thrive","label":"DISEASE_DISORDER","start":168,"end":185},{"text":"recurring nasal polyposis","label":"HISTORY","start":227,"end":252},{"text":"endoscopic surgery","label":"HISTORY","start":263,"end":281},{"text":"exocrine pancreatic insufficiency","label":"HISTORY","start":286,"end":319},{"text":"enzyme replacement therapy","label":"HISTORY","start":334,"end":360},{"text":"grew with body weight and height along the 10th percentile","label":"HISTORY","start":365,"end":423},{"text":"mild","label":"SEVERITY","start":449,"end":453},{"text":"respiratory symptoms","label":"SIGN_SYMPTOM","start":454,"end":474},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":486,"end":498},{"text":"productive","label":"DETAILED_DESCRIPTION","start":499,"end":509},{"text":"cough","label":"SIGN_SYMPTOM","start":510,"end":515},{"text":"close to normal","label":"LAB_VALUE","start":525,"end":540},{"text":"lung function","label":"DIAGNOSTIC_PROCEDURE","start":541,"end":554},{"text":"previous years","label":"DATE","start":569,"end":583},{"text":"body plethysmography","label":"DIAGNOSTIC_PROCEDURE","start":599,"end":619},{"text":"spirometry","label":"DIAGNOSTIC_PROCEDURE","start":624,"end":634},{"text":"minimal z-score of FEV1: \u22121.2","label":"LAB_VALUE","start":636,"end":665},{"text":"Sputum cultures","label":"DIAGNOSTIC_PROCEDURE","start":668,"end":683},{"text":"Haemophilus influenzae","label":"LAB_VALUE","start":689,"end":711},{"text":"Staphylococcus aureus","label":"LAB_VALUE","start":716,"end":737},{"text":"several occasions","label":"DETAILED_DESCRIPTION","start":741,"end":758},{"text":"6 weeks","label":"DURATION","start":766,"end":773},{"text":"ivacaftor","label":"MEDICATION","start":777,"end":786},{"text":"clinical improvements","label":"LAB_VALUE","start":819,"end":840},{"text":"cough","label":"SIGN_SYMPTOM","start":844,"end":849},{"text":"sputum production","label":"SIGN_SYMPTOM","start":861,"end":878},{"text":"physical performance","label":"DIAGNOSTIC_PROCEDURE","start":880,"end":900},{"text":"salt cravings","label":"SIGN_SYMPTOM","start":911,"end":924},{"text":"gained 1.4 kg","label":"LAB_VALUE","start":929,"end":942},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":946,"end":957},{"text":"pancreatic enzyme replacement","label":"MEDICATION","start":991,"end":1020},{"text":"sweat chloride level","label":"DIAGNOSTIC_PROCEDURE","start":1034,"end":1054},{"text":"115 mmol\/l","label":"LAB_VALUE","start":1083,"end":1093},{"text":"before ivacaftor","label":"DETAILED_DESCRIPTION","start":1094,"end":1110},{"text":"40 mmol\/l","label":"LAB_VALUE","start":1114,"end":1123},{"text":"after 6 weeks","label":"DATE","start":1124,"end":1137},{"text":"52 mmol\/l","label":"LAB_VALUE","start":1142,"end":1151},{"text":"after 41 weeks","label":"DATE","start":1152,"end":1166},{"text":"FEV1","label":"DIAGNOSTIC_PROCEDURE","start":1211,"end":1215},{"text":"1.25 L","label":"LAB_VALUE","start":1231,"end":1237},{"text":"\u22121.2 z-score","label":"LAB_VALUE","start":1239,"end":1251},{"text":"1.65 L","label":"LAB_VALUE","start":1256,"end":1262},{"text":"+0.5 z-score","label":"LAB_VALUE","start":1264,"end":1276},{"text":"after 41 weeks","label":"DATE","start":1278,"end":1292},{"text":"ivacaftor","label":"MEDICATION","start":1296,"end":1305},{"text":"LCI","label":"DIAGNOSTIC_PROCEDURE","start":1319,"end":1322},{"text":"measured by N2-MBW","label":"DETAILED_DESCRIPTION","start":1336,"end":1354},{"text":"14.5","label":"LAB_VALUE","start":1370,"end":1374},{"text":"8.3","label":"LAB_VALUE","start":1378,"end":1381},{"text":"after 6 weeks","label":"DATE","start":1382,"end":1395},{"text":"7.8","label":"LAB_VALUE","start":1400,"end":1403},{"text":"after 41 weeks","label":"DATE","start":1404,"end":1418},{"text":"ivacaftor","label":"MEDICATION","start":1422,"end":1431}],"tokens":["An ","8-year-old"," ","boy"," with ","S549R\/1717-1G\u2009>\u2009A genotype"," was started on ","ivacaftor"," (","150 mg b.i.d.",") on compassionate use.\nAt the ","age of 9 months"," he was diagnosed with ","CF"," due to ","failure to thrive",".\nHis previous history was remarkable for ","recurring nasal polyposis"," requiring ","endoscopic surgery"," and ","exocrine pancreatic insufficiency"," necessitating ","enzyme replacement therapy",".\nHe ","grew with body weight and height along the 10th percentile",".\nHe suffered from rather ","mild"," ","respiratory symptoms",", primarily ","intermittent"," ","productive"," ","cough",", and had ","close to normal"," ","lung function"," parameters in ","previous years"," as measured by ","body plethysmography"," and ","spirometry"," (","minimal z-score of FEV1: \u22121.2",").\n","Sputum cultures"," grew ","Haemophilus influenzae"," and ","Staphylococcus aureus"," on ","several occasions",".\nAfter ","6 weeks"," of ","ivacaftor"," treatment, the patient reported ","clinical improvements"," in ","cough"," frequency, ","sputum production",", ","physical performance",", and less ","salt cravings",".\nHe ","gained 1.4 kg"," in ","body weight"," without changing the dose of his ","pancreatic enzyme replacement"," therapy.\nHis ","sweat chloride level"," (Macroduct\u00ae) decreased from ","115 mmol\/l"," ","before ivacaftor"," to ","40 mmol\/l"," ","after 6 weeks"," and ","52 mmol\/l"," ","after 41 weeks"," (normal\u2009<\u200930 mmol\/l [11]) of treatment.\nHis ","FEV1"," increased from ","1.25 L"," (","\u22121.2 z-score",") to ","1.65 L"," (","+0.5 z-score",") ","after 41 weeks"," of ","ivacaftor"," therapy.\nThe ","LCI"," (normal\u2009<\u20098) ","measured by N2-MBW"," decreased from ","14.5"," to ","8.3"," ","after 6 weeks"," and ","7.8"," ","after 41 weeks"," of ","ivacaftor"," treatment (Table 1 and Fig.1).\n"],"ner_labels":[0,5,0,65,0,39,0,46,0,29,0,19,0,26,0,26,0,39,0,39,0,39,0,39,0,39,0,63,0,69,0,22,0,22,0,69,0,42,0,24,0,19,0,24,0,24,0,42,0,24,0,42,0,42,0,22,0,32,0,46,0,42,0,69,0,69,0,24,0,69,0,42,0,24,0,46,0,24,0,42,0,22,0,42,0,19,0,42,0,19,0,24,0,42,0,42,0,42,0,42,0,19,0,46,0,24,0,22,0,42,0,42,0,19,0,42,0,19,0,46,0]}
-{"full_text":"A 36-year-old female presented at the emergency department with aggravating right upper abdominal pain for 2 hours.\nThe patient was diagnosed hepatitis B virus (HBV) carrier for several years and non-alcoholics.\nNo other specific personal and familial medical history was noted.\nInitial blood pressure was 100\/60 mmHg, pulse rate 70\/min, respiration rate 20\/min, body temperature 37.5\u2103.\nThe laboratory findings were white blood cell 12,000\/mm3 (poly: 70%), hemoglobin 12.8 g\/dL, platelet 198,000\/mm3, prothrombin time 14.3 seconds, international normalized ratio 1.11, aspartate aminotransferase 22 IU\/L, alanine aminotransferase 12 IU\/L, total bilirubin 0.5 mg\/dL, alkaline phosphatase 134 IU\/L, lactate dehydrogenase 295 IU\/L, gamma-glutamyl transpeptidase 26 IU\/L, protein\/albumin 6.4\/4.0 g\/dL, uric acid 5.0 mg\/dL, blood urea nitrogen\/creatinine 16.6\/0.7 mg\/dL.\nAnd serum viral markers were HBsAg (+), anti-HBs (-), anti-HBc (+), HBeAg (-), anti-HBe (+), HBV-DNA <20 IU\/mL, anti-HCV (-) and anti-HIV (-).\nThe patient's serum \u03b1-fetoprotein (AFP) was 676.5 ng\/mL and carbohydrate antigen 19-9 (CA19-9) <0.6 U\/mL.\nShe took an abdominal CT scan, which showed a 9 cm sized necrotic mass with internal hemorrhage at the right hepatic lobe and ruptured to peritoneum (Fig.1A), so an emergency hepatic central bisectionectomy was done (Fig.2A).\nThe initial histological diagnosis was cHCC-CC with spindle cell metaplasia of cholangiocarcinoma element (Fig.2B).\nThe serum AFP was decreased to 7.67 ng\/mL at time of discharge.\nRegarding as cHCC-CC, postoperative adjuvant chemotherapy with tegafur\/uracil (UFT) was administrated for 3 months.\n3 months later, follow-up abdominal CT scanning showed previously unseen a 5.5 cm sized left subphrenic mass with mild enhancement in delayed image (Fig.3A, B) and AFP was increased to 312.06 ng\/mL.\nShe underwent laparoscopic splenectomy with mass excision.\nOn histologic examination, mesenchymal elements consisted of a proliferation of primitive-appearing mesenchymal spindle-shaped cells, intimately admixed with the epithelial elements in a highly cellular pattern.\nCytoplasm was more abundant than that of mature fibroblasts, and the nucleus was elongated and plump.\nThese cells blended progressively with areas of less intense cellular mesenchymal proliferation, and with relatively acellular, fibrous septa.\nOsteoid was present either within the primitive mesenchyme, near the fibrous septa or pseudocapsule, or admixed within the epithelial elements.\nOsteoid foci contained cells morphologically identical to osteoblasts (Fig.4A).\nThe immunohistochemistry stains showed expression of hepatocyte, \u03b2-HCG, AFP, vimentin, CK7, CK19, CD56 and \u03b2-catenin and negativity for CEA.(Fig.4B, C, D, E, F, G).\nMetastatic hepatoblastoma was confirmed by histologic examination with immunohistochemistry stains, so immunohistochemistrically re-examination of previous surgical specimens was also confirmed as hepatoblastoma.\nFollow-up abdominal CT scan performed 1 month after reoperation showed a newly onset 1.7 cm sized subtle enhancing soft tissue mass in splenic bed, and positron emission tomography (PET) showed multiple FDG uptake(max SUV > 3.80) in left upper and lower quadrant area of abdomen, paralumbar area including right subphrenic area (Fig.5A, B, C).\nFollow-up AFP was 162.69 ng\/mL.\nSystemic chemotherapy started with cisplatin (60 mg\/m2), 5-fluorourasil (5-FU) (600 mg\/m2), vincristine (1.5 mg\/m2) and total 3 cycles of chemotherapy were done every 4 week.\nEntecavir 0.5 mg was also started for chemoprophylaxis of CHB.\nAfter the 3rd chemotherapy cycle, follow-up abdominal CT and PET scan showed progression of multiple intraperitoneal metastasis with large amount of intraperitoneal fluid (Fig.6A, B) and follow-up AFP was further increased to 254 ng\/mL.\nSo chemotherapy regimen was changed to carboplatin (350 mg\/m2) with doxorubicin (30 mg\/m2) every 3 weeks.\nThe patient experienced neutropenia after the new regimen, but recovered shortly after treatment with granulocyte colony-stimulating factor (G-CSF).\nAfter second carboplatin with doxorubicin chemotherapy, follow-up AFP was increased 1510.19 ng\/mL, but abdominal CT scan showed that amount of ascites was decreased (Fig.7).\nBecause of radiologic improvements, third and fourth chemotherapy were performed.\nAfter 4th chemotherapy, follow-up abdominal CT revealed progression of multiple intraperitoneal metastatic masses, newly developed hepatic metastasis and large amount of intraperitoneal fluid (Fig.8).\nA diagnostic paracentesis was performed and showed white blood cell 310\/mm3 (poly 20%, lymph 80%), protein 3.6 g\/dL and albumin 2.3 g\/dL on ascitic fluid analysis.\nThe serum albumin was 3.1 g\/dL and serum-ascites albumin gradient (SAAG) was 0.8 g\/dL.\nThe AFB stain and culture were all negative in ascitic fluid.\nThe AFP was 6881.93 ng\/mL on serum.\nRegarded as peritoneal carcinomatosis, the patient underwent conservative treatments including the use of repeated therapeutic paracentesis for 1 month before death.\n","ner_info":[{"text":"36-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":21,"end":30},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":38,"end":58},{"text":"aggravating","label":"DETAILED_DESCRIPTION","start":64,"end":75},{"text":"right upper abdominal","label":"BIOLOGICAL_STRUCTURE","start":76,"end":97},{"text":"pain","label":"SIGN_SYMPTOM","start":98,"end":102},{"text":"2 hours","label":"DURATION","start":107,"end":114},{"text":"hepatitis B virus (HBV) carrier for several years","label":"HISTORY","start":142,"end":191},{"text":"non-alcoholic","label":"HISTORY","start":196,"end":209},{"text":"No other specific personal and familial medical history was noted","label":"HISTORY","start":212,"end":277},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":287,"end":301},{"text":"100\/60 mmHg","label":"LAB_VALUE","start":306,"end":317},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":319,"end":329},{"text":"70\/min","label":"LAB_VALUE","start":330,"end":336},{"text":"respiration rate","label":"DIAGNOSTIC_PROCEDURE","start":338,"end":354},{"text":"20\/min","label":"LAB_VALUE","start":355,"end":361},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":363,"end":379},{"text":"37.5\u2103","label":"LAB_VALUE","start":380,"end":385},{"text":"laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":391,"end":410},{"text":"white blood cell","label":"DIAGNOSTIC_PROCEDURE","start":416,"end":432},{"text":"12,000\/mm3","label":"LAB_VALUE","start":433,"end":443},{"text":"poly","label":"DIAGNOSTIC_PROCEDURE","start":445,"end":449},{"text":"70%","label":"LAB_VALUE","start":451,"end":454},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":457,"end":467},{"text":"12.8 g\/dL","label":"LAB_VALUE","start":468,"end":477},{"text":"platelet","label":"DIAGNOSTIC_PROCEDURE","start":479,"end":487},{"text":"198,000\/mm3","label":"LAB_VALUE","start":488,"end":499},{"text":"prothrombin time","label":"DIAGNOSTIC_PROCEDURE","start":501,"end":517},{"text":"14.3 seconds","label":"LAB_VALUE","start":518,"end":530},{"text":"international normalized ratio","label":"DIAGNOSTIC_PROCEDURE","start":532,"end":562},{"text":"1.11","label":"LAB_VALUE","start":563,"end":567},{"text":"aspartate aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":569,"end":595},{"text":"22 IU\/L","label":"LAB_VALUE","start":596,"end":603},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":605,"end":629},{"text":"12 IU\/L","label":"LAB_VALUE","start":630,"end":637},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":639,"end":654},{"text":"0.5 mg\/dL","label":"LAB_VALUE","start":655,"end":664},{"text":"alkaline phosphatase","label":"DIAGNOSTIC_PROCEDURE","start":666,"end":686},{"text":"134 IU\/L","label":"LAB_VALUE","start":687,"end":695},{"text":"lactate dehydrogenase","label":"DIAGNOSTIC_PROCEDURE","start":697,"end":718},{"text":"295 IU\/L","label":"LAB_VALUE","start":719,"end":727},{"text":"gamma-glutamyl transpeptidase","label":"DIAGNOSTIC_PROCEDURE","start":729,"end":758},{"text":"26 IU\/L","label":"LAB_VALUE","start":759,"end":766},{"text":"protein\/albumin","label":"DIAGNOSTIC_PROCEDURE","start":768,"end":783},{"text":"6.4\/4.0 g\/dL","label":"LAB_VALUE","start":784,"end":796},{"text":"uric acid","label":"DIAGNOSTIC_PROCEDURE","start":798,"end":807},{"text":"5.0 mg\/dL","label":"LAB_VALUE","start":808,"end":817},{"text":"blood urea nitrogen\/creatinine","label":"DIAGNOSTIC_PROCEDURE","start":819,"end":849},{"text":"16.6\/0.7 mg\/dL","label":"LAB_VALUE","start":850,"end":864},{"text":"serum viral markers","label":"DIAGNOSTIC_PROCEDURE","start":870,"end":889},{"text":"HBsAg","label":"DIAGNOSTIC_PROCEDURE","start":895,"end":900},{"text":"+","label":"LAB_VALUE","start":902,"end":903},{"text":"anti-HBs","label":"DIAGNOSTIC_PROCEDURE","start":906,"end":914},{"text":"-","label":"LAB_VALUE","start":916,"end":917},{"text":"anti-HBc","label":"DIAGNOSTIC_PROCEDURE","start":920,"end":928},{"text":"+","label":"LAB_VALUE","start":930,"end":931},{"text":"HBeAg","label":"DIAGNOSTIC_PROCEDURE","start":934,"end":939},{"text":"-","label":"LAB_VALUE","start":941,"end":942},{"text":"anti-HBe","label":"DIAGNOSTIC_PROCEDURE","start":945,"end":953},{"text":"+","label":"LAB_VALUE","start":955,"end":956},{"text":"HBV-DNA","label":"DIAGNOSTIC_PROCEDURE","start":959,"end":966},{"text":"<20 IU\/mL","label":"LAB_VALUE","start":967,"end":976},{"text":"anti-HCV","label":"DIAGNOSTIC_PROCEDURE","start":978,"end":986},{"text":"-","label":"LAB_VALUE","start":988,"end":989},{"text":"anti-HIV","label":"DIAGNOSTIC_PROCEDURE","start":995,"end":1003},{"text":"-","label":"LAB_VALUE","start":1005,"end":1006},{"text":"serum \u03b1-fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":1023,"end":1042},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":1044,"end":1047},{"text":"676.5 ng\/mL","label":"LAB_VALUE","start":1053,"end":1064},{"text":"carbohydrate antigen 19-9","label":"DIAGNOSTIC_PROCEDURE","start":1069,"end":1094},{"text":"CA19-9","label":"DIAGNOSTIC_PROCEDURE","start":1096,"end":1102},{"text":"<0.6 U\/mL","label":"LAB_VALUE","start":1104,"end":1113},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1127,"end":1136},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1137,"end":1139},{"text":"9 cm","label":"DISTANCE","start":1161,"end":1165},{"text":"necrotic","label":"DETAILED_DESCRIPTION","start":1172,"end":1180},{"text":"mass","label":"SIGN_SYMPTOM","start":1181,"end":1185},{"text":"with internal hemorrhage","label":"DETAILED_DESCRIPTION","start":1186,"end":1210},{"text":"right hepatic lobe","label":"BIOLOGICAL_STRUCTURE","start":1218,"end":1236},{"text":"ruptured to peritoneum","label":"BIOLOGICAL_STRUCTURE","start":1241,"end":1263},{"text":"emergency","label":"DETAILED_DESCRIPTION","start":1280,"end":1289},{"text":"hepatic central","label":"BIOLOGICAL_STRUCTURE","start":1290,"end":1305},{"text":"bisectionectomy","label":"THERAPEUTIC_PROCEDURE","start":1306,"end":1321},{"text":"cHCC-CC","label":"DISEASE_DISORDER","start":1380,"end":1387},{"text":"spindle cell metaplasia of cholangiocarcinoma element","label":"DETAILED_DESCRIPTION","start":1393,"end":1446},{"text":"serum AFP","label":"DIAGNOSTIC_PROCEDURE","start":1461,"end":1470},{"text":"decreased","label":"LAB_VALUE","start":1475,"end":1484},{"text":"7.67 ng\/mL","label":"LAB_VALUE","start":1488,"end":1498},{"text":"discharge","label":"CLINICAL_EVENT","start":1510,"end":1519},{"text":"cHCC-CC","label":"DISEASE_DISORDER","start":1534,"end":1541},{"text":"adjuvant","label":"DETAILED_DESCRIPTION","start":1557,"end":1565},{"text":"chemotherapy","label":"MEDICATION","start":1566,"end":1578},{"text":"tegafur\/uracil","label":"MEDICATION","start":1584,"end":1598},{"text":"UFT","label":"MEDICATION","start":1600,"end":1603},{"text":"3 months","label":"DURATION","start":1627,"end":1635},{"text":"3 months later","label":"DATE","start":1637,"end":1651},{"text":"follow-up","label":"CLINICAL_EVENT","start":1653,"end":1662},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1663,"end":1672},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1673,"end":1675},{"text":"5.5 cm","label":"DISTANCE","start":1712,"end":1718},{"text":"left subphrenic","label":"BIOLOGICAL_STRUCTURE","start":1725,"end":1740},{"text":"mass","label":"SIGN_SYMPTOM","start":1741,"end":1745},{"text":"mild","label":"SEVERITY","start":1751,"end":1755},{"text":"enhancement","label":"SIGN_SYMPTOM","start":1756,"end":1767},{"text":"delayed image","label":"DETAILED_DESCRIPTION","start":1771,"end":1784},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":1801,"end":1804},{"text":"increased","label":"LAB_VALUE","start":1809,"end":1818},{"text":"312.06 ng\/mL","label":"LAB_VALUE","start":1822,"end":1834},{"text":"laparoscopic","label":"DETAILED_DESCRIPTION","start":1850,"end":1862},{"text":"splenectomy","label":"THERAPEUTIC_PROCEDURE","start":1863,"end":1874},{"text":"mass excision","label":"THERAPEUTIC_PROCEDURE","start":1880,"end":1893},{"text":"histologic examination","label":"DIAGNOSTIC_PROCEDURE","start":1898,"end":1920},{"text":"mesenchymal elements","label":"DIAGNOSTIC_PROCEDURE","start":1922,"end":1942},{"text":"proliferation of primitive-appearing mesenchymal spindle-shaped cells","label":"LAB_VALUE","start":1958,"end":2027},{"text":"intimately admixed with the epithelial elements in a highly cellular pattern","label":"DETAILED_DESCRIPTION","start":2029,"end":2105},{"text":"Cytoplasm","label":"DIAGNOSTIC_PROCEDURE","start":2107,"end":2116},{"text":"more abundant than that of mature fibroblasts","label":"LAB_VALUE","start":2121,"end":2166},{"text":"nucleus","label":"DIAGNOSTIC_PROCEDURE","start":2176,"end":2183},{"text":"elongated","label":"SHAPE","start":2188,"end":2197},{"text":"plump","label":"SHAPE","start":2202,"end":2207},{"text":"cells blended progressively with areas of less intense cellular mesenchymal proliferation","label":"LAB_VALUE","start":2215,"end":2304},{"text":"relatively acellular, fibrous septa","label":"DETAILED_DESCRIPTION","start":2315,"end":2350},{"text":"Osteoid","label":"DIAGNOSTIC_PROCEDURE","start":2352,"end":2359},{"text":"present","label":"LAB_VALUE","start":2364,"end":2371},{"text":"within the primitive mesenchyme","label":"DETAILED_DESCRIPTION","start":2379,"end":2410},{"text":"near the fibrous septa or pseudocapsule","label":"DETAILED_DESCRIPTION","start":2412,"end":2451},{"text":"admixed within the epithelial elements","label":"DETAILED_DESCRIPTION","start":2456,"end":2494},{"text":"Osteoid foci","label":"DIAGNOSTIC_PROCEDURE","start":2496,"end":2508},{"text":"cells morphologically identical to osteoblasts","label":"LAB_VALUE","start":2519,"end":2565},{"text":"immunohistochemistry stains","label":"DIAGNOSTIC_PROCEDURE","start":2580,"end":2607},{"text":"expression","label":"LAB_VALUE","start":2615,"end":2625},{"text":"hepatocyte","label":"DIAGNOSTIC_PROCEDURE","start":2629,"end":2639},{"text":"\u03b2-HCG","label":"DIAGNOSTIC_PROCEDURE","start":2641,"end":2646},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":2648,"end":2651},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":2653,"end":2661},{"text":"CK7","label":"DIAGNOSTIC_PROCEDURE","start":2663,"end":2666},{"text":"CK19","label":"DIAGNOSTIC_PROCEDURE","start":2668,"end":2672},{"text":"CD56","label":"DIAGNOSTIC_PROCEDURE","start":2674,"end":2678},{"text":"\u03b2-catenin","label":"DIAGNOSTIC_PROCEDURE","start":2683,"end":2692},{"text":"negativity","label":"LAB_VALUE","start":2697,"end":2707},{"text":"CEA","label":"DIAGNOSTIC_PROCEDURE","start":2712,"end":2715},{"text":"Metastatic","label":"DETAILED_DESCRIPTION","start":2741,"end":2751},{"text":"hepatoblastoma","label":"DISEASE_DISORDER","start":2752,"end":2766},{"text":"histologic examination","label":"DIAGNOSTIC_PROCEDURE","start":2784,"end":2806},{"text":"immunohistochemistry stains","label":"DIAGNOSTIC_PROCEDURE","start":2812,"end":2839},{"text":"Follow-up","label":"CLINICAL_EVENT","start":2954,"end":2963},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":2964,"end":2973},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2974,"end":2976},{"text":"1 month after","label":"DATE","start":2992,"end":3005},{"text":"newly onset","label":"DETAILED_DESCRIPTION","start":3027,"end":3038},{"text":"1.7 cm","label":"DISTANCE","start":3039,"end":3045},{"text":"subtle enhancing","label":"DETAILED_DESCRIPTION","start":3052,"end":3068},{"text":"soft tissue","label":"DETAILED_DESCRIPTION","start":3069,"end":3080},{"text":"mass","label":"SIGN_SYMPTOM","start":3081,"end":3085},{"text":"splenic bed","label":"BIOLOGICAL_STRUCTURE","start":3089,"end":3100},{"text":"positron emission tomography","label":"DIAGNOSTIC_PROCEDURE","start":3106,"end":3134},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":3136,"end":3139},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":3148,"end":3156},{"text":"FDG","label":"DETAILED_DESCRIPTION","start":3157,"end":3160},{"text":"uptake","label":"SIGN_SYMPTOM","start":3161,"end":3167},{"text":"max SUV > 3.80","label":"LAB_VALUE","start":3168,"end":3182},{"text":"left upper","label":"DETAILED_DESCRIPTION","start":3187,"end":3197},{"text":"lower quadrant","label":"DETAILED_DESCRIPTION","start":3202,"end":3216},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":3225,"end":3232},{"text":"paralumbar area including right subphrenic area","label":"BIOLOGICAL_STRUCTURE","start":3234,"end":3281},{"text":"Follow-up","label":"CLINICAL_EVENT","start":3298,"end":3307},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":3308,"end":3311},{"text":"162.69 ng\/mL","label":"LAB_VALUE","start":3316,"end":3328},{"text":"Systemic","label":"DETAILED_DESCRIPTION","start":3330,"end":3338},{"text":"chemotherapy","label":"MEDICATION","start":3339,"end":3351},{"text":"cisplatin","label":"MEDICATION","start":3365,"end":3374},{"text":"60 mg\/m2","label":"DOSAGE","start":3376,"end":3384},{"text":"5-fluorourasil","label":"MEDICATION","start":3387,"end":3401},{"text":"5-FU","label":"MEDICATION","start":3403,"end":3407},{"text":"600 mg\/m2","label":"DOSAGE","start":3410,"end":3419},{"text":"vincristine","label":"MEDICATION","start":3422,"end":3433},{"text":"1.5 mg\/m2","label":"DOSAGE","start":3435,"end":3444},{"text":"3 cycles","label":"FREQUENCY","start":3456,"end":3464},{"text":"every 4 week","label":"FREQUENCY","start":3491,"end":3503},{"text":"Entecavir","label":"MEDICATION","start":3505,"end":3514},{"text":"0.5 mg","label":"DOSAGE","start":3515,"end":3521},{"text":"chemoprophylaxis","label":"MEDICATION","start":3543,"end":3559},{"text":"CHB","label":"DISEASE_DISORDER","start":3563,"end":3566},{"text":"follow-up","label":"CLINICAL_EVENT","start":3602,"end":3611},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":3612,"end":3621},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3622,"end":3624},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":3629,"end":3632},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":3660,"end":3668},{"text":"intraperitoneal","label":"BIOLOGICAL_STRUCTURE","start":3669,"end":3684},{"text":"metastasis","label":"SIGN_SYMPTOM","start":3685,"end":3695},{"text":"large amount","label":"SEVERITY","start":3701,"end":3713},{"text":"intraperitoneal","label":"BIOLOGICAL_STRUCTURE","start":3717,"end":3732},{"text":"fluid","label":"SIGN_SYMPTOM","start":3733,"end":3738},{"text":"follow-up","label":"CLINICAL_EVENT","start":3755,"end":3764},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":3765,"end":3768},{"text":"increased","label":"LAB_VALUE","start":3781,"end":3790},{"text":"254 ng\/mL","label":"LAB_VALUE","start":3794,"end":3803},{"text":"chemotherapy","label":"MEDICATION","start":3808,"end":3820},{"text":"carboplatin","label":"MEDICATION","start":3844,"end":3855},{"text":"350 mg\/m2","label":"LAB_VALUE","start":3857,"end":3866},{"text":"doxorubicin","label":"MEDICATION","start":3873,"end":3884},{"text":"30 mg\/m2","label":"LAB_VALUE","start":3886,"end":3894},{"text":"every 3 weeks","label":"FREQUENCY","start":3896,"end":3909},{"text":"neutropenia","label":"SIGN_SYMPTOM","start":3935,"end":3946},{"text":"recovered","label":"SIGN_SYMPTOM","start":3974,"end":3983},{"text":"granulocyte colony-stimulating factor","label":"MEDICATION","start":4013,"end":4050},{"text":"G-CSF","label":"MEDICATION","start":4052,"end":4057},{"text":"follow-up","label":"CLINICAL_EVENT","start":4116,"end":4125},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":4126,"end":4129},{"text":"increased","label":"LAB_VALUE","start":4134,"end":4143},{"text":"1510.19 ng\/mL","label":"LAB_VALUE","start":4144,"end":4157},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":4163,"end":4172},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":4173,"end":4175},{"text":"ascites","label":"SIGN_SYMPTOM","start":4203,"end":4210},{"text":"chemotherapy","label":"MEDICATION","start":4287,"end":4299},{"text":"follow-up","label":"CLINICAL_EVENT","start":4340,"end":4349},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":4350,"end":4359},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":4360,"end":4362},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":4387,"end":4395},{"text":"intraperitoneal","label":"BIOLOGICAL_STRUCTURE","start":4396,"end":4411},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":4412,"end":4422},{"text":"masses","label":"SIGN_SYMPTOM","start":4423,"end":4429},{"text":"hepatic","label":"BIOLOGICAL_STRUCTURE","start":4447,"end":4454},{"text":"metastasis","label":"SIGN_SYMPTOM","start":4455,"end":4465},{"text":"large amount","label":"SEVERITY","start":4470,"end":4482},{"text":"intraperitoneal","label":"BIOLOGICAL_STRUCTURE","start":4486,"end":4501},{"text":"fluid","label":"SIGN_SYMPTOM","start":4502,"end":4507},{"text":"paracentesis","label":"DIAGNOSTIC_PROCEDURE","start":4530,"end":4542},{"text":"white blood cell","label":"DIAGNOSTIC_PROCEDURE","start":4568,"end":4584},{"text":"310\/mm3","label":"LAB_VALUE","start":4585,"end":4592},{"text":"poly","label":"DIAGNOSTIC_PROCEDURE","start":4594,"end":4598},{"text":"20%","label":"LAB_VALUE","start":4599,"end":4602},{"text":"lymph","label":"DIAGNOSTIC_PROCEDURE","start":4604,"end":4609},{"text":"80%","label":"LAB_VALUE","start":4610,"end":4613},{"text":"protein","label":"DIAGNOSTIC_PROCEDURE","start":4616,"end":4623},{"text":"3.6 g\/dL","label":"LAB_VALUE","start":4624,"end":4632},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":4637,"end":4644},{"text":"2.3 g\/dL","label":"LAB_VALUE","start":4645,"end":4653},{"text":"ascitic fluid analysis","label":"DIAGNOSTIC_PROCEDURE","start":4657,"end":4679},{"text":"serum albumin","label":"DIAGNOSTIC_PROCEDURE","start":4685,"end":4698},{"text":"3.1 g\/dL","label":"LAB_VALUE","start":4703,"end":4711},{"text":"serum-ascites albumin gradient","label":"DIAGNOSTIC_PROCEDURE","start":4716,"end":4746},{"text":"SAAG","label":"DIAGNOSTIC_PROCEDURE","start":4748,"end":4752},{"text":"0.8 g\/dL","label":"LAB_VALUE","start":4758,"end":4766},{"text":"AFB stain and culture","label":"DIAGNOSTIC_PROCEDURE","start":4772,"end":4793},{"text":"negative","label":"LAB_VALUE","start":4803,"end":4811},{"text":"ascitic fluid","label":"DETAILED_DESCRIPTION","start":4815,"end":4828},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":4834,"end":4837},{"text":"6881.93 ng\/mL","label":"LAB_VALUE","start":4842,"end":4855},{"text":"serum","label":"DETAILED_DESCRIPTION","start":4859,"end":4864},{"text":"peritoneal","label":"BIOLOGICAL_STRUCTURE","start":4878,"end":4888},{"text":"carcinomatosis","label":"DISEASE_DISORDER","start":4889,"end":4903},{"text":"conservative treatments","label":"THERAPEUTIC_PROCEDURE","start":4927,"end":4950},{"text":"repeated","label":"DETAILED_DESCRIPTION","start":4972,"end":4980},{"text":"therapeutic paracentesis","label":"THERAPEUTIC_PROCEDURE","start":4981,"end":5005},{"text":"1 month","label":"DURATION","start":5010,"end":5017},{"text":"death","label":"OUTCOME","start":5025,"end":5030}],"tokens":["A ","36-year-old"," ","female"," ","presented"," at the ","emergency department"," with ","aggravating"," ","right upper abdominal"," ","pain"," for ","2 hours",".\nThe patient was diagnosed ","hepatitis B virus (HBV) carrier for several years"," and ","non-alcoholic","s.\n","No other specific personal and familial medical history was noted",".\nInitial ","blood pressure"," was ","100\/60 mmHg",", ","pulse rate"," ","70\/min",", ","respiration rate"," ","20\/min",", ","body temperature"," ","37.5\u2103",".\nThe ","laboratory findings"," were ","white blood cell"," ","12,000\/mm3"," (","poly",": ","70%","), ","hemoglobin"," ","12.8 g\/dL",", ","platelet"," ","198,000\/mm3",", ","prothrombin time"," ","14.3 seconds",", ","international normalized ratio"," ","1.11",", ","aspartate aminotransferase"," ","22 IU\/L",", ","alanine aminotransferase"," ","12 IU\/L",", ","total bilirubin"," ","0.5 mg\/dL",", ","alkaline phosphatase"," ","134 IU\/L",", ","lactate dehydrogenase"," ","295 IU\/L",", ","gamma-glutamyl transpeptidase"," ","26 IU\/L",", ","protein\/albumin"," ","6.4\/4.0 g\/dL",", ","uric acid"," ","5.0 mg\/dL",", ","blood urea nitrogen\/creatinine"," ","16.6\/0.7 mg\/dL",".\nAnd ","serum viral markers"," were ","HBsAg"," (","+","), ","anti-HBs"," (","-","), ","anti-HBc"," (","+","), ","HBeAg"," (","-","), ","anti-HBe"," (","+","), ","HBV-DNA"," ","<20 IU\/mL",", ","anti-HCV"," (","-",") and ","anti-HIV"," (","-",").\nThe patient's ","serum \u03b1-fetoprotein"," (","AFP",") was ","676.5 ng\/mL"," and ","carbohydrate antigen 19-9"," (","CA19-9",") ","<0.6 U\/mL",".\nShe took an ","abdominal"," ","CT"," scan, which showed a ","9 cm"," sized ","necrotic"," ","mass"," ","with internal hemorrhage"," at the ","right hepatic lobe"," and ","ruptured to peritoneum"," (Fig.1A), so an ","emergency"," ","hepatic central"," ","bisectionectomy"," was done (Fig.2A).\nThe initial histological diagnosis was ","cHCC-CC"," with ","spindle cell metaplasia of cholangiocarcinoma element"," (Fig.2B).\nThe ","serum AFP"," was ","decreased"," to ","7.67 ng\/mL"," at time of ","discharge",".\nRegarding as ","cHCC-CC",", postoperative ","adjuvant"," ","chemotherapy"," with ","tegafur\/uracil"," (","UFT",") was administrated for ","3 months",".\n","3 months later",", ","follow-up"," ","abdominal"," ","CT"," scanning showed previously unseen a ","5.5 cm"," sized ","left subphrenic"," ","mass"," with ","mild"," ","enhancement"," in ","delayed image"," (Fig.3A, B) and ","AFP"," was ","increased"," to ","312.06 ng\/mL",".\nShe underwent ","laparoscopic"," ","splenectomy"," with ","mass excision",".\nOn ","histologic examination",", ","mesenchymal elements"," consisted of a ","proliferation of primitive-appearing mesenchymal spindle-shaped cells",", ","intimately admixed with the epithelial elements in a highly cellular pattern",".\n","Cytoplasm"," was ","more abundant than that of mature fibroblasts",", and the ","nucleus"," was ","elongated"," and ","plump",".\nThese ","cells blended progressively with areas of less intense cellular mesenchymal proliferation",", and with ","relatively acellular, fibrous septa",".\n","Osteoid"," was ","present"," either ","within the primitive mesenchyme",", ","near the fibrous septa or pseudocapsule",", or ","admixed within the epithelial elements",".\n","Osteoid foci"," contained ","cells morphologically identical to osteoblasts"," (Fig.4A).\nThe ","immunohistochemistry stains"," showed ","expression"," of ","hepatocyte",", ","\u03b2-HCG",", ","AFP",", ","vimentin",", ","CK7",", ","CK19",", ","CD56"," and ","\u03b2-catenin"," and ","negativity"," for ","CEA",".(Fig.4B, C, D, E, F, G).\n","Metastatic"," ","hepatoblastoma"," was confirmed by ","histologic examination"," with ","immunohistochemistry stains",", so immunohistochemistrically re-examination of previous surgical specimens was also confirmed as hepatoblastoma.\n","Follow-up"," ","abdominal"," ","CT"," scan performed ","1 month after"," reoperation showed a ","newly onset"," ","1.7 cm"," sized ","subtle enhancing"," ","soft tissue"," ","mass"," in ","splenic bed",", and ","positron emission tomography"," (","PET",") showed ","multiple"," ","FDG"," ","uptake","(","max SUV > 3.80",") in ","left upper"," and ","lower quadrant"," area of ","abdomen",", ","paralumbar area including right subphrenic area"," (Fig.5A, B, C).\n","Follow-up"," ","AFP"," was ","162.69 ng\/mL",".\n","Systemic"," ","chemotherapy"," started with ","cisplatin"," (","60 mg\/m2","), ","5-fluorourasil"," (","5-FU",") (","600 mg\/m2","), ","vincristine"," (","1.5 mg\/m2",") and total ","3 cycles"," of chemotherapy were done ","every 4 week",".\n","Entecavir"," ","0.5 mg"," was also started for ","chemoprophylaxis"," of ","CHB",".\nAfter the 3rd chemotherapy cycle, ","follow-up"," ","abdominal"," ","CT"," and ","PET"," scan showed progression of ","multiple"," ","intraperitoneal"," ","metastasis"," with ","large amount"," of ","intraperitoneal"," ","fluid"," (Fig.6A, B) and ","follow-up"," ","AFP"," was further ","increased"," to ","254 ng\/mL",".\nSo ","chemotherapy"," regimen was changed to ","carboplatin"," (","350 mg\/m2",") with ","doxorubicin"," (","30 mg\/m2",") ","every 3 weeks",".\nThe patient experienced ","neutropenia"," after the new regimen, but ","recovered"," shortly after treatment with ","granulocyte colony-stimulating factor"," (","G-CSF",").\nAfter second carboplatin with doxorubicin chemotherapy, ","follow-up"," ","AFP"," was ","increased"," ","1510.19 ng\/mL",", but ","abdominal"," ","CT"," scan showed that amount of ","ascites"," was decreased (Fig.7).\nBecause of radiologic improvements, third and fourth ","chemotherapy"," were performed.\nAfter 4th chemotherapy, ","follow-up"," ","abdominal"," ","CT"," revealed progression of ","multiple"," ","intraperitoneal"," ","metastatic"," ","masses",", newly developed ","hepatic"," ","metastasis"," and ","large amount"," of ","intraperitoneal"," ","fluid"," (Fig.8).\nA diagnostic ","paracentesis"," was performed and showed ","white blood cell"," ","310\/mm3"," (","poly"," ","20%",", ","lymph"," ","80%","), ","protein"," ","3.6 g\/dL"," and ","albumin"," ","2.3 g\/dL"," on ","ascitic fluid analysis",".\nThe ","serum albumin"," was ","3.1 g\/dL"," and ","serum-ascites albumin gradient"," (","SAAG",") was ","0.8 g\/dL",".\nThe ","AFB stain and culture"," were all ","negative"," in ","ascitic fluid",".\nThe ","AFP"," was ","6881.93 ng\/mL"," on ","serum",".\nRegarded as ","peritoneal"," ","carcinomatosis",", the patient underwent ","conservative treatments"," including the use of ","repeated"," ","therapeutic paracentesis"," for ","1 month"," before ","death",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,12,0,69,0,32,0,39,0,39,0,39,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,12,0,24,0,27,0,22,0,69,0,22,0,12,0,12,0,22,0,12,0,75,0,26,0,22,0,24,0,42,0,42,0,13,0,26,0,22,0,46,0,46,0,46,0,32,0,19,0,13,0,12,0,24,0,27,0,12,0,69,0,63,0,69,0,22,0,24,0,42,0,42,0,22,0,75,0,75,0,24,0,24,0,42,0,22,0,24,0,42,0,24,0,67,0,67,0,42,0,22,0,24,0,42,0,22,0,22,0,22,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,22,0,26,0,24,0,24,0,13,0,12,0,24,0,19,0,22,0,27,0,22,0,22,0,69,0,12,0,24,0,24,0,22,0,22,0,69,0,42,0,22,0,22,0,12,0,12,0,13,0,24,0,42,0,22,0,46,0,46,0,29,0,46,0,46,0,29,0,46,0,29,0,35,0,35,0,46,0,29,0,46,0,26,0,13,0,12,0,24,0,24,0,22,0,12,0,69,0,63,0,12,0,69,0,13,0,24,0,42,0,42,0,46,0,46,0,42,0,46,0,42,0,35,0,69,0,69,0,46,0,46,0,13,0,24,0,42,0,42,0,12,0,24,0,69,0,46,0,13,0,12,0,24,0,22,0,12,0,22,0,69,0,12,0,69,0,63,0,12,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,22,0,12,0,26,0,75,0,22,0,75,0,32,0,56,0]}
-{"full_text":"A 42-year-old woman presented with a right breast lump, lower back pain, loss of height, marked kyphosis and hepatomegaly.\nCore biopsies from the breast lump showed ductal carcinoma in situ (sample labelled P1.1; Supplementary Fig.1 and Supplementary Table 1).\nAn additional biopsy from an ipsilateral axillary lymph node (P1.2) revealed metastatic ductal adenocarcinoma (ER+ (8\/8) and HER2+ (3+)).\nComputed tomography scan revealed widespread metastatic disease in bones, pleura and liver (Supplementary Fig.2 and Supplementary Table 2).\nThe patient was started on treatment with trastuzumab and taxane-based chemotherapy, with a significant partial response (Supplementary Fig.3).\nAfter induction chemotherapy, she was maintained on tamoxifen and trastuzumab.\nAfter 19 months on treatment, she presented with seizures and head computed tomography revealed a large metastasis in the left frontal lobe (Supplementary Fig.4), which was resected (M2.1).\nTherapy with tamoxifen and trastuzumab was continued and collection of plasma samples was initiated (samples T1\u2013T9).\nFour months after surgery, she had enlarging liver lesions and a new metastatic deposit in the left ovary (Supplementary Fig.5).\nTreatment was switched to a combination of lapatinib and capecitabine, resulting in stable disease for 12 months (Supplementary Fig.6).\nGeneral deterioration then occurred, with disease progression in the chest (new pulmonary nodules, bilateral pleural effusions and posterior chest wall mass, Supplementary Fig.7; Eastern Cooperative Oncology Group performance status 2\u20133).\nTreatment was stopped and the patient died \u223c4 months later.\nTumour samples were obtained at diagnosis from the primary breast site (P1.1) and an axillary lymph node (P1.2); after 19 months from the brain metastasis area (M2.1); and at autopsy after 3 years on treatment (from the primary breast site, and from metastatic deposits in the chest, liver, ovary and vertebrae, labelled P3.1 and M3.1\u2013M3.4, respectively).\nSerial plasma samples were obtained over the last 500 days of clinical follow-up (T1\u2013T9).\nTumour and plasma samples collected and the clinical course are summarized in Fig.1a,b.\n","ner_info":[{"text":"42-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"right breast","label":"BIOLOGICAL_STRUCTURE","start":37,"end":49},{"text":"lump","label":"SIGN_SYMPTOM","start":50,"end":54},{"text":"lower back","label":"BIOLOGICAL_STRUCTURE","start":56,"end":66},{"text":"pain","label":"SIGN_SYMPTOM","start":67,"end":71},{"text":"loss of height","label":"SIGN_SYMPTOM","start":73,"end":87},{"text":"kyphosis","label":"SIGN_SYMPTOM","start":96,"end":104},{"text":"hepatomegaly","label":"SIGN_SYMPTOM","start":109,"end":121},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":128,"end":136},{"text":"breast lump","label":"BIOLOGICAL_STRUCTURE","start":146,"end":157},{"text":"ductal carcinoma","label":"DISEASE_DISORDER","start":165,"end":181},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":275,"end":281},{"text":"ipsilateral axillary lymph node","label":"BIOLOGICAL_STRUCTURE","start":290,"end":321},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":338,"end":348},{"text":"ductal adenocarcinoma","label":"DISEASE_DISORDER","start":349,"end":370},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":399,"end":418},{"text":"widespread","label":"DETAILED_DESCRIPTION","start":433,"end":443},{"text":"metastatic disease","label":"DISEASE_DISORDER","start":444,"end":462},{"text":"bones","label":"BIOLOGICAL_STRUCTURE","start":466,"end":471},{"text":"pleura","label":"BIOLOGICAL_STRUCTURE","start":473,"end":479},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":484,"end":489},{"text":"trastuzumab","label":"MEDICATION","start":581,"end":592},{"text":"taxane-based chemotherapy","label":"MEDICATION","start":597,"end":622},{"text":"significant","label":"DETAILED_DESCRIPTION","start":631,"end":642},{"text":"partial","label":"DETAILED_DESCRIPTION","start":643,"end":650},{"text":"response","label":"SIGN_SYMPTOM","start":651,"end":659},{"text":"induction","label":"DETAILED_DESCRIPTION","start":689,"end":698},{"text":"chemotherapy","label":"MEDICATION","start":699,"end":711},{"text":"tamoxifen","label":"MEDICATION","start":735,"end":744},{"text":"trastuzumab","label":"MEDICATION","start":749,"end":760},{"text":"19 months","label":"DURATION","start":768,"end":777},{"text":"seizures","label":"SIGN_SYMPTOM","start":811,"end":819},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":824,"end":828},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":829,"end":848},{"text":"metastasis","label":"SIGN_SYMPTOM","start":866,"end":876},{"text":"left frontal lobe","label":"BIOLOGICAL_STRUCTURE","start":884,"end":901},{"text":"resected","label":"THERAPEUTIC_PROCEDURE","start":935,"end":943},{"text":"tamoxifen","label":"MEDICATION","start":965,"end":974},{"text":"trastuzumab","label":"MEDICATION","start":979,"end":990},{"text":"plasma samples","label":"DIAGNOSTIC_PROCEDURE","start":1023,"end":1037},{"text":"Four months after","label":"DATE","start":1069,"end":1086},{"text":"enlarging","label":"DETAILED_DESCRIPTION","start":1104,"end":1113},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":1114,"end":1119},{"text":"lesions","label":"SIGN_SYMPTOM","start":1120,"end":1127},{"text":"metastatic deposit","label":"SIGN_SYMPTOM","start":1138,"end":1156},{"text":"left ovary","label":"BIOLOGICAL_STRUCTURE","start":1164,"end":1174},{"text":"lapatinib","label":"MEDICATION","start":1241,"end":1250},{"text":"capecitabine","label":"MEDICATION","start":1255,"end":1267},{"text":"stable disease","label":"SIGN_SYMPTOM","start":1282,"end":1296},{"text":"12 months","label":"DURATION","start":1301,"end":1310},{"text":"General deterioration","label":"SIGN_SYMPTOM","start":1334,"end":1355},{"text":"disease progression","label":"SIGN_SYMPTOM","start":1376,"end":1395},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1403,"end":1408},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1414,"end":1423},{"text":"nodules","label":"SIGN_SYMPTOM","start":1424,"end":1431},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1433,"end":1442},{"text":"pleural effusions","label":"DISEASE_DISORDER","start":1443,"end":1460},{"text":"posterior chest wall","label":"BIOLOGICAL_STRUCTURE","start":1465,"end":1485},{"text":"mass","label":"SIGN_SYMPTOM","start":1486,"end":1490},{"text":"Eastern Cooperative Oncology Group performance status","label":"DIAGNOSTIC_PROCEDURE","start":1513,"end":1566},{"text":"2\u20133","label":"LAB_VALUE","start":1567,"end":1570},{"text":"Treatment","label":"THERAPEUTIC_PROCEDURE","start":1573,"end":1582},{"text":"died","label":"OUTCOME","start":1611,"end":1615},{"text":"4 months later","label":"DATE","start":1617,"end":1631},{"text":"Tumour","label":"SIGN_SYMPTOM","start":1633,"end":1639},{"text":"diagnosis","label":"CLINICAL_EVENT","start":1665,"end":1674},{"text":"breast","label":"BIOLOGICAL_STRUCTURE","start":1692,"end":1698},{"text":"axillary lymph node","label":"BIOLOGICAL_STRUCTURE","start":1718,"end":1737},{"text":"after 19 months","label":"DATE","start":1746,"end":1761},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":1771,"end":1776},{"text":"metastasis","label":"DISEASE_DISORDER","start":1777,"end":1787},{"text":"autopsy","label":"DIAGNOSTIC_PROCEDURE","start":1808,"end":1815},{"text":"after 3 years","label":"DATE","start":1816,"end":1829},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":1833,"end":1842},{"text":"Serial","label":"DETAILED_DESCRIPTION","start":1989,"end":1995},{"text":"plasma","label":"DIAGNOSTIC_PROCEDURE","start":1996,"end":2002},{"text":"last 500 days","label":"DURATION","start":2034,"end":2047},{"text":"follow-up","label":"CLINICAL_EVENT","start":2060,"end":2069}],"tokens":["A ","42-year-old"," ","woman"," ","presented"," with a ","right breast"," ","lump",", ","lower back"," ","pain",", ","loss of height",", marked ","kyphosis"," and ","hepatomegaly",".\nCore ","biopsies"," from the ","breast lump"," showed ","ductal carcinoma"," in situ (sample labelled P1.1; Supplementary Fig.1 and Supplementary Table 1).\nAn additional ","biopsy"," from an ","ipsilateral axillary lymph node"," (P1.2) revealed ","metastatic"," ","ductal adenocarcinoma"," (ER+ (8\/8) and HER2+ (3+)).\n","Computed tomography"," scan revealed ","widespread"," ","metastatic disease"," in ","bones",", ","pleura"," and ","liver"," (Supplementary Fig.2 and Supplementary Table 2).\nThe patient was started on treatment with ","trastuzumab"," and ","taxane-based chemotherapy",", with a ","significant"," ","partial"," ","response"," (Supplementary Fig.3).\nAfter ","induction"," ","chemotherapy",", she was maintained on ","tamoxifen"," and ","trastuzumab",".\nAfter ","19 months"," on treatment, she presented with ","seizures"," and ","head"," ","computed tomography"," revealed a large ","metastasis"," in the ","left frontal lobe"," (Supplementary Fig.4), which was ","resected"," (M2.1).\nTherapy with ","tamoxifen"," and ","trastuzumab"," was continued and collection of ","plasma samples"," was initiated (samples T1\u2013T9).\n","Four months after"," surgery, she had ","enlarging"," ","liver"," ","lesions"," and a new ","metastatic deposit"," in the ","left ovary"," (Supplementary Fig.5).\nTreatment was switched to a combination of ","lapatinib"," and ","capecitabine",", resulting in ","stable disease"," for ","12 months"," (Supplementary Fig.6).\n","General deterioration"," then occurred, with ","disease progression"," in the ","chest"," (new ","pulmonary"," ","nodules",", ","bilateral"," ","pleural effusions"," and ","posterior chest wall"," ","mass",", Supplementary Fig.7; ","Eastern Cooperative Oncology Group performance status"," ","2\u20133",").\n","Treatment"," was stopped and the patient ","died"," \u223c","4 months later",".\n","Tumour"," samples were obtained at ","diagnosis"," from the primary ","breast"," site (P1.1) and an ","axillary lymph node"," (P1.2); ","after 19 months"," from the ","brain"," ","metastasis"," area (M2.1); and at ","autopsy"," ","after 3 years"," on ","treatment"," (from the primary breast site, and from metastatic deposits in the chest, liver, ovary and vertebrae, labelled P3.1 and M3.1\u2013M3.4, respectively).\n","Serial"," ","plasma"," samples were obtained over the ","last 500 days"," of clinical ","follow-up"," (T1\u2013T9).\nTumour and plasma samples collected and the clinical course are summarized in Fig.1a,b.\n"],"ner_labels":[0,5,0,65,0,13,0,12,0,69,0,12,0,69,0,69,0,69,0,69,0,24,0,12,0,26,0,24,0,12,0,22,0,26,0,24,0,22,0,26,0,12,0,12,0,12,0,46,0,46,0,22,0,22,0,69,0,22,0,46,0,46,0,46,0,32,0,69,0,12,0,24,0,69,0,12,0,75,0,46,0,46,0,24,0,19,0,22,0,12,0,69,0,69,0,12,0,46,0,46,0,69,0,32,0,69,0,69,0,12,0,12,0,69,0,22,0,26,0,12,0,69,0,24,0,42,0,75,0,56,0,19,0,69,0,13,0,12,0,12,0,19,0,12,0,26,0,24,0,19,0,75,0,22,0,24,0,32,0,13,0]}
-{"full_text":"We present the case of a 22-year-old woman who was diagnosed in childhood with type IIb VHL, with known multiple retinal angiomas, pancreatic cysts, and spinal and cerebellar hemangioblastomas.\nShe was admitted to our hospital complaining of progressive dyspnea and palpitations.\nOn examination, her blood pressure was 159\/119 mm Hg and her pulse was 123 bpm.\nPhysical examination revealed a systolic murmur at the mitral focus with irradiation to the axilla and pulmonary rales.\nElectrocardiography revealed no remarkable findings, except for sinus tachycardia.\nLaboratory tests showed an elevated N-terminal pro-brain natriuretic peptide and chest X-ray showed signs of pulmonary interstitial edema.\nThe patient was admitted to the Department of Cardiology with the diagnosis of acute decompensated heart failure.\nTransthoracic echocardiography showed a dilated left ventricle with severely depressed ejection fraction due to generalized hypokinesia and a mild mitral regurgitation (fig.1a).\nDuring admission, the patient had several episodes of paroxysmal dyspnea despite treatment with \u03b2-blockers and diuretics.\nDue to the clinical suspicion of adrenal gland disease, 24-hour urinary catecholamine and metanephrine tests were requested.\nCardiac MRI was performed in order to complete the cardiomyopathy study, and confirmed the echocardiographic findings as well as revealed an incidental finding of a great left renal mass.\nThe 24-hour urine laboratory tests showed markedly elevated levels of norepinephrine, total catecholamines, normetanephrine and metanephrine with normal epinephrine values: 24-hour norepinephrine 468 \u03bcg (normal range: 23-105), 24-hour epinephrine 13 \u03bcg (normal range: 4-20), 24-hour total catecholamines 658 \u03bcg (normal range: 217-575), 24-hour normetanephrine 2,988 \u03bcg (normal range: 105-354), 24-hour total metanephrine 3,013 \u03bcg (normal range: 0-1,000).\nTherefore, an abdominal MRI was performed, which showed the presence of two cystic masses (fig.2) located at the left hypochondrium.\nSurgical resection of both masses was performed (after \u03b1-blockade with phenoxybenzamine and \u03b2-blockade with propranolol) through a laparoscopic approach, confirming the diagnosis of pheochromocytoma and clear cell renal carcinoma on histology.\nDuring follow-up, blood pressure and heart rate values normalized (124\/77 mm Hg, 78 bpm), 24-hour urinary catecholamine values returned to normal range (norepinephrine 69 \u03bcg\/24 h, total catecholamine 221 \u03bcg\/24 h, normetanephrine 202 \u03bcg\/24 h and total metanephrine 259 \u03bcg\/24 h) and the patient had no new episodes of palpitations or dyspnea.\nSix months after surgical resection, echocardiography was repeated and showed a left ventricle with normal diameters and preserved ejection fraction (fig.1b).\nGenetic analysis revealed a germline mutation (exon 3 deletion) of the VHL tumor suppressor gene on the short arm of chromosome 3.\nAs the patient had no family history of VHL, it was concluded that it was a de novo mutation.\n","ner_info":[{"text":"22-year-old","label":"AGE","start":25,"end":36},{"text":"woman","label":"SEX","start":37,"end":42},{"text":"diagnosed in childhood with type IIb VHL","label":"HISTORY","start":51,"end":91},{"text":"multiple retinal angiomas","label":"HISTORY","start":104,"end":129},{"text":"pancreatic cysts","label":"HISTORY","start":131,"end":147},{"text":"spinal and cerebellar hemangioblastomas","label":"HISTORY","start":153,"end":192},{"text":"admitted","label":"CLINICAL_EVENT","start":202,"end":210},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":218,"end":226},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":242,"end":253},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":254,"end":261},{"text":"palpitations","label":"SIGN_SYMPTOM","start":266,"end":278},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":283,"end":294},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":300,"end":314},{"text":"159\/119 mm Hg","label":"LAB_VALUE","start":319,"end":332},{"text":"pulse","label":"DIAGNOSTIC_PROCEDURE","start":341,"end":346},{"text":"123 bpm","label":"LAB_VALUE","start":351,"end":358},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":360,"end":380},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":392,"end":400},{"text":"murmur","label":"SIGN_SYMPTOM","start":401,"end":407},{"text":"mitral focus","label":"BIOLOGICAL_STRUCTURE","start":415,"end":427},{"text":"irradiation to the axilla","label":"BIOLOGICAL_STRUCTURE","start":433,"end":458},{"text":"pulmonary rales","label":"SIGN_SYMPTOM","start":463,"end":478},{"text":"Electrocardiography","label":"DIAGNOSTIC_PROCEDURE","start":480,"end":499},{"text":"no remarkable findings","label":"LAB_VALUE","start":509,"end":531},{"text":"sinus","label":"DETAILED_DESCRIPTION","start":544,"end":549},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":550,"end":561},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":563,"end":579},{"text":"elevated","label":"LAB_VALUE","start":590,"end":598},{"text":"N-terminal","label":"DETAILED_DESCRIPTION","start":599,"end":609},{"text":"pro-brain natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":610,"end":639},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":644,"end":649},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":650,"end":655},{"text":"pulmonary interstitial edema","label":"SIGN_SYMPTOM","start":672,"end":700},{"text":"admitted","label":"CLINICAL_EVENT","start":718,"end":726},{"text":"Department of Cardiology","label":"BIOLOGICAL_STRUCTURE","start":734,"end":758},{"text":"acute","label":"DETAILED_DESCRIPTION","start":781,"end":786},{"text":"decompensated","label":"DETAILED_DESCRIPTION","start":787,"end":800},{"text":"heart failure","label":"DISEASE_DISORDER","start":801,"end":814},{"text":"Transthoracic","label":"DETAILED_DESCRIPTION","start":816,"end":829},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":830,"end":846},{"text":"dilated","label":"SIGN_SYMPTOM","start":856,"end":863},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":864,"end":878},{"text":"severely depressed","label":"LAB_VALUE","start":884,"end":902},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":903,"end":920},{"text":"generalized","label":"DETAILED_DESCRIPTION","start":928,"end":939},{"text":"hypokinesia","label":"SIGN_SYMPTOM","start":940,"end":951},{"text":"mild","label":"SEVERITY","start":958,"end":962},{"text":"mitral regurgitation","label":"SIGN_SYMPTOM","start":963,"end":983},{"text":"several episodes","label":"DETAILED_DESCRIPTION","start":1028,"end":1044},{"text":"paroxysmal","label":"DETAILED_DESCRIPTION","start":1048,"end":1058},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1059,"end":1066},{"text":"\u03b2-blockers","label":"MEDICATION","start":1090,"end":1100},{"text":"diuretics","label":"MEDICATION","start":1105,"end":1114},{"text":"adrenal gland disease","label":"DISEASE_DISORDER","start":1149,"end":1170},{"text":"24-hour","label":"DETAILED_DESCRIPTION","start":1172,"end":1179},{"text":"urinary","label":"BIOLOGICAL_STRUCTURE","start":1180,"end":1187},{"text":"catecholamine","label":"DIAGNOSTIC_PROCEDURE","start":1188,"end":1201},{"text":"metanephrine test","label":"DIAGNOSTIC_PROCEDURE","start":1206,"end":1223},{"text":"Cardiac","label":"BIOLOGICAL_STRUCTURE","start":1241,"end":1248},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1249,"end":1252},{"text":"cardiomyopathy study","label":"DIAGNOSTIC_PROCEDURE","start":1292,"end":1312},{"text":"great","label":"DETAILED_DESCRIPTION","start":1406,"end":1411},{"text":"left renal","label":"BIOLOGICAL_STRUCTURE","start":1412,"end":1422},{"text":"mass","label":"SIGN_SYMPTOM","start":1423,"end":1427},{"text":"laboratory tests","label":"COREFERENCE","start":1447,"end":1463},{"text":"markedly elevated","label":"LAB_VALUE","start":1471,"end":1488},{"text":"norepinephrine","label":"DIAGNOSTIC_PROCEDURE","start":1499,"end":1513},{"text":"total catecholamines","label":"DIAGNOSTIC_PROCEDURE","start":1515,"end":1535},{"text":"normetanephrine","label":"DIAGNOSTIC_PROCEDURE","start":1537,"end":1552},{"text":"metanephrine","label":"DIAGNOSTIC_PROCEDURE","start":1557,"end":1569},{"text":"epinephrine","label":"DIAGNOSTIC_PROCEDURE","start":1582,"end":1593},{"text":"norepinephrine","label":"COREFERENCE","start":1610,"end":1624},{"text":"468 \u03bcg","label":"LAB_VALUE","start":1625,"end":1631},{"text":"epinephrine","label":"COREFERENCE","start":1664,"end":1675},{"text":"13 \u03bcg","label":"LAB_VALUE","start":1676,"end":1681},{"text":"total catecholamines","label":"COREFERENCE","start":1712,"end":1732},{"text":"658 \u03bcg","label":"LAB_VALUE","start":1733,"end":1739},{"text":"normetanephrine","label":"COREFERENCE","start":1773,"end":1788},{"text":"2,988 \u03bcg","label":"LAB_VALUE","start":1789,"end":1797},{"text":"total metanephrine","label":"COREFERENCE","start":1831,"end":1849},{"text":"3,013 \u03bcg","label":"LAB_VALUE","start":1850,"end":1858},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1898,"end":1907},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1908,"end":1911},{"text":"two","label":"DETAILED_DESCRIPTION","start":1956,"end":1959},{"text":"cystic","label":"DETAILED_DESCRIPTION","start":1960,"end":1966},{"text":"masses","label":"SIGN_SYMPTOM","start":1967,"end":1973},{"text":"left hypochondrium","label":"BIOLOGICAL_STRUCTURE","start":1997,"end":2015},{"text":"Surgical","label":"DETAILED_DESCRIPTION","start":2017,"end":2025},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":2026,"end":2035},{"text":"both masses","label":"COREFERENCE","start":2039,"end":2050},{"text":"\u03b1-blockade","label":"THERAPEUTIC_PROCEDURE","start":2072,"end":2082},{"text":"phenoxybenzamine","label":"MEDICATION","start":2088,"end":2104},{"text":"\u03b2-blockade","label":"THERAPEUTIC_PROCEDURE","start":2109,"end":2119},{"text":"propranolol","label":"MEDICATION","start":2125,"end":2136},{"text":"laparoscopic approach","label":"THERAPEUTIC_PROCEDURE","start":2148,"end":2169},{"text":"pheochromocytoma","label":"DISEASE_DISORDER","start":2199,"end":2215},{"text":"clear cell","label":"DETAILED_DESCRIPTION","start":2220,"end":2230},{"text":"renal carcinoma","label":"THERAPEUTIC_PROCEDURE","start":2231,"end":2246},{"text":"histology","label":"DIAGNOSTIC_PROCEDURE","start":2250,"end":2259},{"text":"follow-up","label":"CLINICAL_EVENT","start":2268,"end":2277},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":2279,"end":2293},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":2298,"end":2308},{"text":"normalized","label":"LAB_VALUE","start":2316,"end":2326},{"text":"124\/77 mm Hg","label":"LAB_VALUE","start":2328,"end":2340},{"text":"78 bpm","label":"LAB_VALUE","start":2342,"end":2348},{"text":"24-hour","label":"DETAILED_DESCRIPTION","start":2351,"end":2358},{"text":"urinary","label":"BIOLOGICAL_STRUCTURE","start":2359,"end":2366},{"text":"catecholamine","label":"DIAGNOSTIC_PROCEDURE","start":2367,"end":2380},{"text":"normal range","label":"LAB_VALUE","start":2400,"end":2412},{"text":"norepinephrine","label":"DIAGNOSTIC_PROCEDURE","start":2414,"end":2428},{"text":"69 \u03bcg","label":"LAB_VALUE","start":2429,"end":2434},{"text":"total catecholamine","label":"DIAGNOSTIC_PROCEDURE","start":2441,"end":2460},{"text":"221 \u03bcg","label":"LAB_VALUE","start":2461,"end":2467},{"text":"normetanephrine","label":"DIAGNOSTIC_PROCEDURE","start":2474,"end":2489},{"text":"202 \u03bcg","label":"LAB_VALUE","start":2490,"end":2496},{"text":"total metanephrine","label":"DIAGNOSTIC_PROCEDURE","start":2506,"end":2524},{"text":"259 \u03bcg","label":"LAB_VALUE","start":2525,"end":2531},{"text":"palpitations","label":"SIGN_SYMPTOM","start":2577,"end":2589},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2593,"end":2600},{"text":"Six months after","label":"DATE","start":2602,"end":2618},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":2639,"end":2655},{"text":"left ventricle","label":"BIOLOGICAL_STRUCTURE","start":2682,"end":2696},{"text":"normal diameters","label":"SIGN_SYMPTOM","start":2702,"end":2718},{"text":"preserved","label":"LAB_VALUE","start":2723,"end":2732},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":2733,"end":2750},{"text":"Genetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":2761,"end":2777},{"text":"germline mutation","label":"SIGN_SYMPTOM","start":2789,"end":2806},{"text":"exon 3 deletion","label":"DETAILED_DESCRIPTION","start":2808,"end":2823},{"text":"VHL tumor suppressor gene","label":"DETAILED_DESCRIPTION","start":2832,"end":2857},{"text":"short arm of chromosome 3","label":"DETAILED_DESCRIPTION","start":2865,"end":2890},{"text":"no family history of VHL","label":"FAMILY_HISTORY","start":2911,"end":2935},{"text":"de novo mutation","label":"DETAILED_DESCRIPTION","start":2968,"end":2984}],"tokens":["We present the case of a ","22-year-old"," ","woman"," who was ","diagnosed in childhood with type IIb VHL",", with known ","multiple retinal angiomas",", ","pancreatic cysts",", and ","spinal and cerebellar hemangioblastomas",".\nShe was ","admitted"," to our ","hospital"," complaining of ","progressive"," ","dyspnea"," and ","palpitations",".\nOn ","examination",", her ","blood pressure"," was ","159\/119 mm Hg"," and her ","pulse"," was ","123 bpm",".\n","Physical examination"," revealed a ","systolic"," ","murmur"," at the ","mitral focus"," with ","irradiation to the axilla"," and ","pulmonary rales",".\n","Electrocardiography"," revealed ","no remarkable findings",", except for ","sinus"," ","tachycardia",".\n","Laboratory tests"," showed an ","elevated"," ","N-terminal"," ","pro-brain natriuretic peptide"," and ","chest"," ","X-ray"," showed signs of ","pulmonary interstitial edema",".\nThe patient was ","admitted"," to the ","Department of Cardiology"," with the diagnosis of ","acute"," ","decompensated"," ","heart failure",".\n","Transthoracic"," ","echocardiography"," showed a ","dilated"," ","left ventricle"," with ","severely depressed"," ","ejection fraction"," due to ","generalized"," ","hypokinesia"," and a ","mild"," ","mitral regurgitation"," (fig.1a).\nDuring admission, the patient had ","several episodes"," of ","paroxysmal"," ","dyspnea"," despite treatment with ","\u03b2-blockers"," and ","diuretics",".\nDue to the clinical suspicion of ","adrenal gland disease",", ","24-hour"," ","urinary"," ","catecholamine"," and ","metanephrine test","s were requested.\n","Cardiac"," ","MRI"," was performed in order to complete the ","cardiomyopathy study",", and confirmed the echocardiographic findings as well as revealed an incidental finding of a ","great"," ","left renal"," ","mass",".\nThe 24-hour urine ","laboratory tests"," showed ","markedly elevated"," levels of ","norepinephrine",", ","total catecholamines",", ","normetanephrine"," and ","metanephrine"," with normal ","epinephrine"," values: 24-hour ","norepinephrine"," ","468 \u03bcg"," (normal range: 23-105), 24-hour ","epinephrine"," ","13 \u03bcg"," (normal range: 4-20), 24-hour ","total catecholamines"," ","658 \u03bcg"," (normal range: 217-575), 24-hour ","normetanephrine"," ","2,988 \u03bcg"," (normal range: 105-354), 24-hour ","total metanephrine"," ","3,013 \u03bcg"," (normal range: 0-1,000).\nTherefore, an ","abdominal"," ","MRI"," was performed, which showed the presence of ","two"," ","cystic"," ","masses"," (fig.2) located at the ","left hypochondrium",".\n","Surgical"," ","resection"," of ","both masses"," was performed (after ","\u03b1-blockade"," with ","phenoxybenzamine"," and ","\u03b2-blockade"," with ","propranolol",") through a ","laparoscopic approach",", confirming the diagnosis of ","pheochromocytoma"," and ","clear cell"," ","renal carcinoma"," on ","histology",".\nDuring ","follow-up",", ","blood pressure"," and ","heart rate"," values ","normalized"," (","124\/77 mm Hg",", ","78 bpm","), ","24-hour"," ","urinary"," ","catecholamine"," values returned to ","normal range"," (","norepinephrine"," ","69 \u03bcg","\/24 h, ","total catecholamine"," ","221 \u03bcg","\/24 h, ","normetanephrine"," ","202 \u03bcg","\/24 h and ","total metanephrine"," ","259 \u03bcg","\/24 h) and the patient had no new episodes of ","palpitations"," or ","dyspnea",".\n","Six months after"," surgical resection, ","echocardiography"," was repeated and showed a ","left ventricle"," with ","normal diameters"," and ","preserved"," ","ejection fraction"," (fig.1b).\n","Genetic analysis"," revealed a ","germline mutation"," (","exon 3 deletion",") of the ","VHL tumor suppressor gene"," on the ","short arm of chromosome 3",".\nAs the patient had ","no family history of VHL",", it was concluded that it was a ","de novo mutation",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,39,0,39,0,13,0,48,0,22,0,69,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,22,0,69,0,12,0,12,0,69,0,24,0,42,0,22,0,69,0,24,0,42,0,22,0,24,0,12,0,24,0,69,0,13,0,12,0,22,0,22,0,26,0,22,0,24,0,69,0,12,0,42,0,24,0,22,0,69,0,63,0,69,0,22,0,22,0,69,0,46,0,46,0,26,0,22,0,12,0,24,0,24,0,12,0,24,0,24,0,22,0,12,0,69,0,18,0,42,0,24,0,24,0,24,0,24,0,24,0,18,0,42,0,18,0,42,0,18,0,42,0,18,0,42,0,18,0,42,0,12,0,24,0,22,0,22,0,69,0,12,0,22,0,75,0,18,0,75,0,46,0,75,0,46,0,75,0,26,0,22,0,75,0,24,0,13,0,24,0,24,0,42,0,42,0,42,0,22,0,12,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,69,0,69,0,19,0,24,0,12,0,69,0,42,0,24,0,24,0,69,0,22,0,22,0,22,0,34,0,22,0]}
-{"full_text":"A 13 year-old boy presented with a 1 month history of intermittent episodes of small volume epistaxis.\nThere was no significant past medical, surgical or family history.\nPhysical examination revealed a left palatal fleshy mass centered at left posterior molars.\nA nasoendoscopic examination demonstrated a large swelling on the floor of left anterior nasal space, involving the left inferior meatus and abutting the inferior turbinate.\nComputed Tomography (CT) of the paranasal sinuses showed a lobulated, expansile lytic lesion of left maxilla [Fig 1] with a lucent center and peripheral calcifications.\nThe lesion was associated with a large soft tissue component that demonstrated mild heterogeneous contrast enhancement.\nThe lesion was centered at the left maxillary alveolus, involving the left hard palate, inferior part of the anterior left maxillary wall and medial left maxillary wall.\nThe lesion also involved the roots of the left maxillary molars and pre-molars and was abutting the left orbital floor, with no gross orbital invasion.\nThe patient subsequently underwent 18-FDG PET-CT study.\nThe mass centered in left maxilla was hypermetabolic, with index SUVmax 9.7 [Fig 2].\nThere was no FDG-avid metastatic disease.\nA trans-oral incisional biopsy of the left palatal mass was performed and was suggestive of a preliminary diagnosis of mesenchymal chondrosarcoma, as evidenced by a biphasic pattern featuring sheets of small round cells with hemangiopericytoma-like vascular pattern and mature cartilaginous islands.\nThe patient underwent left subtotal maxillectomy via lateral rhinotomy and translabial approach.\nThe final histology was conclusive of a 5cm high-grade (Grade 3) mesenchymal chondrosarcoma.\nOne of the resection margins was positive for tumor involvement and the patient was planned for adjuvant chemotherapy.\n","ner_info":[{"text":"13 year-old","label":"AGE","start":2,"end":13},{"text":"boy","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"1 month","label":"DURATION","start":35,"end":42},{"text":"intermittent","label":"BIOLOGICAL_STRUCTURE","start":54,"end":66},{"text":"small volume","label":"DETAILED_DESCRIPTION","start":79,"end":91},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":92,"end":101},{"text":"no significant past medical, surgical or family history","label":"HISTORY","start":113,"end":168},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":170,"end":190},{"text":"left palatal","label":"BIOLOGICAL_STRUCTURE","start":202,"end":214},{"text":"fleshy","label":"DETAILED_DESCRIPTION","start":215,"end":221},{"text":"mass","label":"SIGN_SYMPTOM","start":222,"end":226},{"text":"left posterior molars","label":"BIOLOGICAL_STRUCTURE","start":239,"end":260},{"text":"nasoendoscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":264,"end":290},{"text":"large","label":"SEVERITY","start":306,"end":311},{"text":"swelling","label":"SIGN_SYMPTOM","start":312,"end":320},{"text":"floor of left anterior nasal space","label":"BIOLOGICAL_STRUCTURE","start":328,"end":362},{"text":"left inferior meatus","label":"BIOLOGICAL_STRUCTURE","start":378,"end":398},{"text":"inferior turbinate","label":"BIOLOGICAL_STRUCTURE","start":416,"end":434},{"text":"Computed Tomography","label":"DIAGNOSTIC_PROCEDURE","start":436,"end":455},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":457,"end":459},{"text":"paranasal sinuses","label":"BIOLOGICAL_STRUCTURE","start":468,"end":485},{"text":"lobulated","label":"DETAILED_DESCRIPTION","start":495,"end":504},{"text":"expansile","label":"DETAILED_DESCRIPTION","start":506,"end":515},{"text":"lytic","label":"DETAILED_DESCRIPTION","start":516,"end":521},{"text":"lesion","label":"SIGN_SYMPTOM","start":522,"end":528},{"text":"left maxilla","label":"BIOLOGICAL_STRUCTURE","start":532,"end":544},{"text":"lucent center","label":"DETAILED_DESCRIPTION","start":560,"end":573},{"text":"peripheral calcifications","label":"DETAILED_DESCRIPTION","start":578,"end":603},{"text":"lesion","label":"COREFERENCE","start":609,"end":615},{"text":"large soft tissue component","label":"DETAILED_DESCRIPTION","start":638,"end":665},{"text":"mild","label":"SEVERITY","start":684,"end":688},{"text":"heterogeneous","label":"DETAILED_DESCRIPTION","start":689,"end":702},{"text":"contrast enhancement","label":"SIGN_SYMPTOM","start":703,"end":723},{"text":"lesion","label":"COREFERENCE","start":729,"end":735},{"text":"left maxillary alveolus","label":"BIOLOGICAL_STRUCTURE","start":756,"end":779},{"text":"left hard palate","label":"BIOLOGICAL_STRUCTURE","start":795,"end":811},{"text":"inferior part of the anterior left maxillary wall","label":"BIOLOGICAL_STRUCTURE","start":813,"end":862},{"text":"medial left maxillary wall","label":"BIOLOGICAL_STRUCTURE","start":867,"end":893},{"text":"lesion","label":"COREFERENCE","start":899,"end":905},{"text":"roots of the left maxillary molars and pre-molars","label":"BIOLOGICAL_STRUCTURE","start":924,"end":973},{"text":"left orbital floor","label":"BIOLOGICAL_STRUCTURE","start":995,"end":1013},{"text":"orbital","label":"BIOLOGICAL_STRUCTURE","start":1029,"end":1036},{"text":"invasion","label":"SIGN_SYMPTOM","start":1037,"end":1045},{"text":"18-FDG PET-CT study","label":"DIAGNOSTIC_PROCEDURE","start":1082,"end":1101},{"text":"mass","label":"COREFERENCE","start":1107,"end":1111},{"text":"left maxilla","label":"BIOLOGICAL_STRUCTURE","start":1124,"end":1136},{"text":"hypermetabolic","label":"DETAILED_DESCRIPTION","start":1141,"end":1155},{"text":"index SUVmax 9.7","label":"LAB_VALUE","start":1162,"end":1178},{"text":"FDG-avid","label":"DETAILED_DESCRIPTION","start":1201,"end":1209},{"text":"metastatic disease","label":"DISEASE_DISORDER","start":1210,"end":1228},{"text":"trans-oral","label":"DETAILED_DESCRIPTION","start":1232,"end":1242},{"text":"incisional biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1243,"end":1260},{"text":"left palatal","label":"BIOLOGICAL_STRUCTURE","start":1268,"end":1280},{"text":"mass","label":"SIGN_SYMPTOM","start":1281,"end":1285},{"text":"mesenchymal chondrosarcoma","label":"DISEASE_DISORDER","start":1349,"end":1375},{"text":"biphasic pattern","label":"DETAILED_DESCRIPTION","start":1395,"end":1411},{"text":"sheets of small round cells","label":"DETAILED_DESCRIPTION","start":1422,"end":1449},{"text":"hemangiopericytoma-like vascular pattern","label":"DETAILED_DESCRIPTION","start":1455,"end":1495},{"text":"mature cartilaginous islands","label":"DETAILED_DESCRIPTION","start":1500,"end":1528},{"text":"left subtotal","label":"DETAILED_DESCRIPTION","start":1552,"end":1565},{"text":"maxillectomy","label":"THERAPEUTIC_PROCEDURE","start":1566,"end":1578},{"text":"lateral","label":"DETAILED_DESCRIPTION","start":1583,"end":1590},{"text":"rhinotomy","label":"THERAPEUTIC_PROCEDURE","start":1591,"end":1600},{"text":"translabial approach","label":"DETAILED_DESCRIPTION","start":1605,"end":1625},{"text":"histology","label":"DIAGNOSTIC_PROCEDURE","start":1637,"end":1646},{"text":"5cm","label":"DISTANCE","start":1667,"end":1670},{"text":"high-grade","label":"LAB_VALUE","start":1671,"end":1681},{"text":"Grade 3","label":"LAB_VALUE","start":1683,"end":1690},{"text":"mesenchymal chondrosarcoma","label":"DISEASE_DISORDER","start":1692,"end":1718},{"text":"resection margins","label":"BIOLOGICAL_STRUCTURE","start":1731,"end":1748},{"text":"tumor involvement","label":"SIGN_SYMPTOM","start":1766,"end":1783},{"text":"adjuvant","label":"DETAILED_DESCRIPTION","start":1816,"end":1824},{"text":"chemotherapy","label":"MEDICATION","start":1825,"end":1837}],"tokens":["A ","13 year-old"," ","boy"," ","presented"," with a ","1 month"," history of ","intermittent"," episodes of ","small volume"," ","epistaxis",".\nThere was ","no significant past medical, surgical or family history",".\n","Physical examination"," revealed a ","left palatal"," ","fleshy"," ","mass"," centered at ","left posterior molars",".\nA ","nasoendoscopic examination"," demonstrated a ","large"," ","swelling"," on the ","floor of left anterior nasal space",", involving the ","left inferior meatus"," and abutting the ","inferior turbinate",".\n","Computed Tomography"," (","CT",") of the ","paranasal sinuses"," showed a ","lobulated",", ","expansile"," ","lytic"," ","lesion"," of ","left maxilla"," [Fig 1] with a ","lucent center"," and ","peripheral calcifications",".\nThe ","lesion"," was associated with a ","large soft tissue component"," that demonstrated ","mild"," ","heterogeneous"," ","contrast enhancement",".\nThe ","lesion"," was centered at the ","left maxillary alveolus",", involving the ","left hard palate",", ","inferior part of the anterior left maxillary wall"," and ","medial left maxillary wall",".\nThe ","lesion"," also involved the ","roots of the left maxillary molars and pre-molars"," and was abutting the ","left orbital floor",", with no gross ","orbital"," ","invasion",".\nThe patient subsequently underwent ","18-FDG PET-CT study",".\nThe ","mass"," centered in ","left maxilla"," was ","hypermetabolic",", with ","index SUVmax 9.7"," [Fig 2].\nThere was no ","FDG-avid"," ","metastatic disease",".\nA ","trans-oral"," ","incisional biopsy"," of the ","left palatal"," ","mass"," was performed and was suggestive of a preliminary diagnosis of ","mesenchymal chondrosarcoma",", as evidenced by a ","biphasic pattern"," featuring ","sheets of small round cells"," with ","hemangiopericytoma-like vascular pattern"," and ","mature cartilaginous islands",".\nThe patient underwent ","left subtotal"," ","maxillectomy"," via ","lateral"," ","rhinotomy"," and ","translabial approach",".\nThe final ","histology"," was conclusive of a ","5cm"," ","high-grade"," (","Grade 3",") ","mesenchymal chondrosarcoma",".\nOne of the ","resection margins"," was positive for ","tumor involvement"," and the patient was planned for ","adjuvant"," ","chemotherapy",".\n"],"ner_labels":[0,5,0,65,0,13,0,32,0,12,0,22,0,69,0,39,0,24,0,12,0,22,0,69,0,12,0,24,0,63,0,69,0,12,0,12,0,12,0,24,0,24,0,12,0,22,0,22,0,22,0,69,0,12,0,22,0,22,0,18,0,22,0,63,0,22,0,69,0,18,0,12,0,12,0,12,0,12,0,18,0,12,0,12,0,12,0,69,0,24,0,18,0,12,0,22,0,42,0,22,0,26,0,22,0,24,0,12,0,69,0,26,0,22,0,22,0,22,0,22,0,22,0,75,0,22,0,75,0,22,0,24,0,27,0,42,0,42,0,26,0,12,0,69,0,22,0,46,0]}
-{"full_text":"This case report was approved by the Review Board of Shandong Power Central Hospital and the patient's parents signed informed consent for publication of the case report and any accompanying images.\nA 4-year-old female child presented at the outpatients department with slowly enlarging, painless, symmetrical swelling of both cheeks.\nWhen the girl was approximately 2 years old, the parents noticed a change in her facial symmetry, which later became more obvious.\nOn palpation, the swellings were bony and hard in consistency.\nThe skin over the swelling was smooth and freely movable, with no increase in temperature (Fig.1).\nThere was no history of any trauma, pain, pus discharge, blood discharge, fever, paresthesia, anorexia, or weight loss.\nNo significant family history was reported.\nPanoramic radiography revealed involvement of both the mandible and the maxilla, and showed a soap bubble-like multilocular radiolucency with thin and expanded cortices.\nUnerupted teeth included: 15, 25, 35, 37, 45, and 47 was impacted (Fig.2).\nMultislice computed tomography showed the presence of multilocular cystic lesions filled with soft-tissue density material and dental anomalies affecting the body and the sides of the mandible.\nSimilar lesions were also observed in the maxilla (Fig.3).\nA biopsy was obtained from the central area of the left rami.\nHistologic examination showed many large multinucleated giant cells in a loose, delicate fibrillar connective tissue stroma containing large numbers of fibroblasts and many small blood vessels (Fig.4).\nAs the child grows older, the lesions often become static and may show regression at puberty.\nIn the current case, no surgical intervention was under taken and the patient was followed up at regular intervals.\n","ner_info":[{"text":"4-year-old","label":"AGE","start":201,"end":211},{"text":"female","label":"SEX","start":212,"end":218},{"text":"presented","label":"CLINICAL_EVENT","start":225,"end":234},{"text":"outpatients department","label":"NONBIOLOGICAL_LOCATION","start":242,"end":264},{"text":"slowly enlarging","label":"DETAILED_DESCRIPTION","start":270,"end":286},{"text":"painless","label":"DETAILED_DESCRIPTION","start":288,"end":296},{"text":"symmetrical","label":"DETAILED_DESCRIPTION","start":298,"end":309},{"text":"swelling","label":"SIGN_SYMPTOM","start":310,"end":318},{"text":"both cheeks","label":"BIOLOGICAL_STRUCTURE","start":322,"end":333},{"text":"When the girl was approximately 2 years old, the parents noticed a change in her facial symmetry, which later became more obvious","label":"HISTORY","start":335,"end":464},{"text":"palpation","label":"DIAGNOSTIC_PROCEDURE","start":469,"end":478},{"text":"swellings","label":"SIGN_SYMPTOM","start":484,"end":493},{"text":"bony","label":"DETAILED_DESCRIPTION","start":499,"end":503},{"text":"hard","label":"DETAILED_DESCRIPTION","start":508,"end":512},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":533,"end":537},{"text":"swelling","label":"SIGN_SYMPTOM","start":547,"end":555},{"text":"smooth","label":"TEXTURE","start":560,"end":566},{"text":"freely movable","label":"DETAILED_DESCRIPTION","start":571,"end":585},{"text":"no increase","label":"LAB_VALUE","start":592,"end":603},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":607,"end":618},{"text":"no history of any trauma, pain, pus discharge, blood discharge, fever, paresthesia, anorexia, or weight loss","label":"HISTORY","start":638,"end":746},{"text":"No significant family history was reported","label":"HISTORY","start":748,"end":790},{"text":"Panoramic","label":"DETAILED_DESCRIPTION","start":792,"end":801},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":802,"end":813},{"text":"involvement","label":"SIGN_SYMPTOM","start":823,"end":834},{"text":"mandible","label":"BIOLOGICAL_STRUCTURE","start":847,"end":855},{"text":"maxilla","label":"BIOLOGICAL_STRUCTURE","start":864,"end":871},{"text":"soap bubble-like","label":"SHAPE","start":886,"end":902},{"text":"multilocular","label":"DETAILED_DESCRIPTION","start":903,"end":915},{"text":"radiolucency","label":"SIGN_SYMPTOM","start":916,"end":928},{"text":"thin and expanded cortices","label":"DETAILED_DESCRIPTION","start":934,"end":960},{"text":"Unerupted teeth","label":"SIGN_SYMPTOM","start":962,"end":977},{"text":"15, 25, 35, 37, 45","label":"BIOLOGICAL_STRUCTURE","start":988,"end":1006},{"text":"47","label":"BIOLOGICAL_STRUCTURE","start":1012,"end":1014},{"text":"impacted","label":"SIGN_SYMPTOM","start":1019,"end":1027},{"text":"Multislice","label":"DETAILED_DESCRIPTION","start":1037,"end":1047},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1048,"end":1067},{"text":"multilocular","label":"DETAILED_DESCRIPTION","start":1091,"end":1103},{"text":"cystic","label":"DETAILED_DESCRIPTION","start":1104,"end":1110},{"text":"lesions","label":"SIGN_SYMPTOM","start":1111,"end":1118},{"text":"soft-tissue density material","label":"DETAILED_DESCRIPTION","start":1131,"end":1159},{"text":"dental","label":"BIOLOGICAL_STRUCTURE","start":1164,"end":1170},{"text":"anomalies","label":"SIGN_SYMPTOM","start":1171,"end":1180},{"text":"body and the sides of the mandible","label":"BIOLOGICAL_STRUCTURE","start":1195,"end":1229},{"text":"lesions","label":"SIGN_SYMPTOM","start":1239,"end":1246},{"text":"maxilla","label":"BIOLOGICAL_STRUCTURE","start":1273,"end":1280},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1292,"end":1298},{"text":"central area of the left rami","label":"BIOLOGICAL_STRUCTURE","start":1321,"end":1350},{"text":"Histologic examination","label":"DIAGNOSTIC_PROCEDURE","start":1352,"end":1374},{"text":"many","label":"DETAILED_DESCRIPTION","start":1382,"end":1386},{"text":"large","label":"DETAILED_DESCRIPTION","start":1387,"end":1392},{"text":"multinucleated","label":"DETAILED_DESCRIPTION","start":1393,"end":1407},{"text":"giant cells","label":"SIGN_SYMPTOM","start":1408,"end":1419},{"text":"loose","label":"DETAILED_DESCRIPTION","start":1425,"end":1430},{"text":"delicate","label":"DETAILED_DESCRIPTION","start":1432,"end":1440},{"text":"fibrillar","label":"DETAILED_DESCRIPTION","start":1441,"end":1450},{"text":"connective tissue stroma","label":"BIOLOGICAL_STRUCTURE","start":1451,"end":1475},{"text":"large numbers of fibroblasts","label":"BIOLOGICAL_STRUCTURE","start":1487,"end":1515},{"text":"many small blood vessels","label":"BIOLOGICAL_STRUCTURE","start":1520,"end":1544},{"text":"surgical intervention","label":"THERAPEUTIC_PROCEDURE","start":1672,"end":1693},{"text":"followed up","label":"CLINICAL_EVENT","start":1730,"end":1741},{"text":"regular intervals","label":"DETAILED_DESCRIPTION","start":1745,"end":1762}],"tokens":["This case report was approved by the Review Board of Shandong Power Central Hospital and the patient's parents signed informed consent for publication of the case report and any accompanying images.\nA ","4-year-old"," ","female"," child ","presented"," at the ","outpatients department"," with ","slowly enlarging",", ","painless",", ","symmetrical"," ","swelling"," of ","both cheeks",".\n","When the girl was approximately 2 years old, the parents noticed a change in her facial symmetry, which later became more obvious",".\nOn ","palpation",", the ","swellings"," were ","bony"," and ","hard"," in consistency.\nThe ","skin"," over the ","swelling"," was ","smooth"," and ","freely movable",", with ","no increase"," in ","temperature"," (Fig.1).\nThere was ","no history of any trauma, pain, pus discharge, blood discharge, fever, paresthesia, anorexia, or weight loss",".\n","No significant family history was reported",".\n","Panoramic"," ","radiography"," revealed ","involvement"," of both the ","mandible"," and the ","maxilla",", and showed a ","soap bubble-like"," ","multilocular"," ","radiolucency"," with ","thin and expanded cortices",".\n","Unerupted teeth"," included: ","15, 25, 35, 37, 45",", and ","47"," was ","impacted"," (Fig.2).\n","Multislice"," ","computed tomography"," showed the presence of ","multilocular"," ","cystic"," ","lesions"," filled with ","soft-tissue density material"," and ","dental"," ","anomalies"," affecting the ","body and the sides of the mandible",".\nSimilar ","lesions"," were also observed in the ","maxilla"," (Fig.3).\nA ","biopsy"," was obtained from the ","central area of the left rami",".\n","Histologic examination"," showed ","many"," ","large"," ","multinucleated"," ","giant cells"," in a ","loose",", ","delicate"," ","fibrillar"," ","connective tissue stroma"," containing ","large numbers of fibroblasts"," and ","many small blood vessels"," (Fig.4).\nAs the child grows older, the lesions often become static and may show regression at puberty.\nIn the current case, no ","surgical intervention"," was under taken and the patient was ","followed up"," at ","regular intervals",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,22,0,22,0,69,0,12,0,39,0,24,0,69,0,22,0,22,0,12,0,69,0,73,0,22,0,42,0,24,0,39,0,39,0,22,0,24,0,69,0,12,0,12,0,67,0,22,0,69,0,22,0,69,0,12,0,12,0,69,0,22,0,24,0,22,0,22,0,69,0,22,0,12,0,69,0,12,0,69,0,12,0,24,0,12,0,24,0,22,0,22,0,22,0,69,0,22,0,22,0,22,0,12,0,12,0,12,0,75,0,13,0,22,0]}
-{"full_text":"A 49-year-old man, with no history of cardiac disease, presented with progressive dyspnea of one month's duration.\nMedical History.\nHis medical history included blunt chest trauma, the result of an accidental fall from scaffolding 15 months earlier.\nHe had fallen approximately 8 feet and had landed on the right side of his back and on his right shoulder.\nThe patient had sustained bilateral pneumothorax, right iliopsoas muscle hematoma, multiple right costal fractures, fracture of the L3 vertebral body and the transverse process, and displaced fractures of the right clavicle.\nThat hospitalization had lasted 40 days, during which time the clinicians had not detected any murmur or requested a cardiac evaluation.\nThe patient returned to normal activities 4 weeks after discharge from the hospital and remained asymptomatic for one year.\nUpon his arrival at our department, auscultation revealed bibasilar rales and a pansystolic murmur.\nChest radiography showed mild lung congestion; and transthoracic echocardiography, limited by suboptimal acoustic windows, revealed severe, eccentric mitral regurgitation.\nThe valvular and subvalvular apparatus appeared to be structurally normal, and the left atrium was only mildly dilated.\nThe patient was treated with intravenous diuretics until the signs and symptoms of congestion were relieved.\nCoronary angiography revealed an absence of substantial coronary disease.\nWe therefore planned an elective surgical procedure for mitral valve repair.\nSurgical Procedure.\nDuring intraoperative transesophageal echocardiography (TEE), we observed both a trivial central mitral regurgitant jet and a severe perivalvular regurgitant jet, this last originating from a ventriculoatrial fistulous communication behind the P1 scallop (Fig.1).\nFurther examination confirmed the absence of structural disease involving the mitral leaflets or subvalvular apparatus.\nAfter surgical exposure of the mitral valve, a small tear (length, 6\u20137 mm) could be seen behind the posterior leaflet, in a lateral position, involving also the annulus and the left atrial wall.\nThe absence of leaflet abnormalities or vegetations suggested the posttraumatic origin of the perivalvular leak.\nValvular repair was successfully achieved by direct suture of the tear with three 5-0 Prolene stitches and by the subsequent insertion of a 30-mm mitral annuloplasty ring.\nThe patient was extubated the next day and his postsurgical course was uncomplicated.\nOne year later, he was asymptomatic, and his one-year follow-up transthoracic echocardiogram confirmed the excellent result of his surgical treatment.\n","ner_info":[{"text":"A 49-year-old","label":"AGE","start":0,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"no history of cardiac disease","label":"HISTORY","start":24,"end":53},{"text":"presented","label":"CLINICAL_EVENT","start":55,"end":64},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":70,"end":81},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":82,"end":89},{"text":"one month's duration","label":"DURATION","start":93,"end":113},{"text":"blunt chest trauma, the result of an accidental fall from scaffolding 15 months earlier","label":"HISTORY","start":161,"end":248},{"text":"He had fallen approximately 8 feet and had landed on the right side of his back and on his right shoulder","label":"HISTORY","start":250,"end":355},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":383,"end":392},{"text":"pneumothorax","label":"SIGN_SYMPTOM","start":393,"end":405},{"text":"right iliopsoas muscle","label":"BIOLOGICAL_STRUCTURE","start":407,"end":429},{"text":"hematoma","label":"SIGN_SYMPTOM","start":430,"end":438},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":440,"end":448},{"text":"right costal","label":"BIOLOGICAL_STRUCTURE","start":449,"end":461},{"text":"fractures","label":"SIGN_SYMPTOM","start":462,"end":471},{"text":"fracture","label":"SIGN_SYMPTOM","start":473,"end":481},{"text":"L3 vertebral body","label":"BIOLOGICAL_STRUCTURE","start":489,"end":506},{"text":"transverse process","label":"BIOLOGICAL_STRUCTURE","start":515,"end":533},{"text":"displaced","label":"DETAILED_DESCRIPTION","start":539,"end":548},{"text":"fractures","label":"SIGN_SYMPTOM","start":549,"end":558},{"text":"right clavicle","label":"BIOLOGICAL_STRUCTURE","start":566,"end":580},{"text":"hospitalization","label":"CLINICAL_EVENT","start":587,"end":602},{"text":"40 days","label":"DURATION","start":614,"end":621},{"text":"murmur","label":"SIGN_SYMPTOM","start":677,"end":683},{"text":"cardiac evaluation","label":"DIAGNOSTIC_PROCEDURE","start":699,"end":717},{"text":"normal activities","label":"ACTIVITY","start":743,"end":760},{"text":"4 weeks after","label":"DATE","start":761,"end":774},{"text":"discharge","label":"CLINICAL_EVENT","start":775,"end":784},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":794,"end":802},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":816,"end":828},{"text":"one year","label":"DURATION","start":833,"end":841},{"text":"arrival","label":"CLINICAL_EVENT","start":852,"end":859},{"text":"department","label":"NONBIOLOGICAL_LOCATION","start":867,"end":877},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":879,"end":891},{"text":"bibasilar","label":"DETAILED_DESCRIPTION","start":901,"end":910},{"text":"rales","label":"SIGN_SYMPTOM","start":911,"end":916},{"text":"pansystolic","label":"DETAILED_DESCRIPTION","start":923,"end":934},{"text":"murmur","label":"SIGN_SYMPTOM","start":935,"end":941},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":943,"end":948},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":949,"end":960},{"text":"mild","label":"SEVERITY","start":968,"end":972},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":973,"end":977},{"text":"congestion","label":"SIGN_SYMPTOM","start":978,"end":988},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":994,"end":1007},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1008,"end":1024},{"text":"limited by suboptimal acoustic windows","label":"DETAILED_DESCRIPTION","start":1026,"end":1064},{"text":"severe","label":"SEVERITY","start":1075,"end":1081},{"text":"eccentric","label":"DETAILED_DESCRIPTION","start":1083,"end":1092},{"text":"mitral regurgitation","label":"SIGN_SYMPTOM","start":1093,"end":1113},{"text":"valvular","label":"BIOLOGICAL_STRUCTURE","start":1119,"end":1127},{"text":"subvalvular apparatus","label":"BIOLOGICAL_STRUCTURE","start":1132,"end":1153},{"text":"structurally normal","label":"SIGN_SYMPTOM","start":1169,"end":1188},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":1198,"end":1209},{"text":"mildly","label":"SEVERITY","start":1219,"end":1225},{"text":"dilated","label":"SIGN_SYMPTOM","start":1226,"end":1233},{"text":"intravenous","label":"ADMINISTRATION","start":1264,"end":1275},{"text":"diuretics","label":"MEDICATION","start":1276,"end":1285},{"text":"signs and symptoms of congestion","label":"SIGN_SYMPTOM","start":1296,"end":1328},{"text":"Coronary","label":"BIOLOGICAL_STRUCTURE","start":1344,"end":1352},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":1353,"end":1364},{"text":"coronary disease","label":"DISEASE_DISORDER","start":1400,"end":1416},{"text":"planned","label":"CLINICAL_EVENT","start":1431,"end":1438},{"text":"mitral valve repair","label":"THERAPEUTIC_PROCEDURE","start":1474,"end":1493},{"text":"intraoperative","label":"DETAILED_DESCRIPTION","start":1522,"end":1536},{"text":"transesophageal echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1537,"end":1569},{"text":"TEE","label":"DIAGNOSTIC_PROCEDURE","start":1571,"end":1574},{"text":"trivial","label":"SEVERITY","start":1596,"end":1603},{"text":"central","label":"DETAILED_DESCRIPTION","start":1604,"end":1611},{"text":"mitral regurgitant jet","label":"SIGN_SYMPTOM","start":1612,"end":1634},{"text":"severe","label":"SEVERITY","start":1641,"end":1647},{"text":"perivalvular regurgitant jet","label":"SIGN_SYMPTOM","start":1648,"end":1676},{"text":"ventriculoatrial","label":"BIOLOGICAL_STRUCTURE","start":1707,"end":1723},{"text":"fistulous communication","label":"SIGN_SYMPTOM","start":1724,"end":1747},{"text":"behind the P1 scallop","label":"BIOLOGICAL_STRUCTURE","start":1748,"end":1769},{"text":"structural disease","label":"DISEASE_DISORDER","start":1824,"end":1842},{"text":"mitral leaflets","label":"BIOLOGICAL_STRUCTURE","start":1857,"end":1872},{"text":"subvalvular apparatus","label":"BIOLOGICAL_STRUCTURE","start":1876,"end":1897},{"text":"surgical exposure","label":"THERAPEUTIC_PROCEDURE","start":1905,"end":1922},{"text":"mitral valve","label":"BIOLOGICAL_STRUCTURE","start":1930,"end":1942},{"text":"small","label":"LAB_VALUE","start":1946,"end":1951},{"text":"tear","label":"SIGN_SYMPTOM","start":1952,"end":1956},{"text":"length, 6\u20137 mm","label":"DISTANCE","start":1958,"end":1972},{"text":"behind the posterior leaflet","label":"BIOLOGICAL_STRUCTURE","start":1988,"end":2016},{"text":"lateral position","label":"DETAILED_DESCRIPTION","start":2023,"end":2039},{"text":"annulus","label":"BIOLOGICAL_STRUCTURE","start":2060,"end":2067},{"text":"left atrial wall","label":"BIOLOGICAL_STRUCTURE","start":2076,"end":2092},{"text":"leaflet","label":"BIOLOGICAL_STRUCTURE","start":2109,"end":2116},{"text":"abnormalities","label":"SIGN_SYMPTOM","start":2117,"end":2130},{"text":"vegetations","label":"SIGN_SYMPTOM","start":2134,"end":2145},{"text":"posttraumatic origin","label":"DETAILED_DESCRIPTION","start":2160,"end":2180},{"text":"perivalvular leak","label":"SIGN_SYMPTOM","start":2188,"end":2205},{"text":"Valvular repair","label":"THERAPEUTIC_PROCEDURE","start":2207,"end":2222},{"text":"suture","label":"THERAPEUTIC_PROCEDURE","start":2259,"end":2265},{"text":"three","label":"DETAILED_DESCRIPTION","start":2283,"end":2288},{"text":"5-0 Prolene","label":"DETAILED_DESCRIPTION","start":2289,"end":2300},{"text":"stitches","label":"THERAPEUTIC_PROCEDURE","start":2301,"end":2309},{"text":"30-mm","label":"DISTANCE","start":2347,"end":2352},{"text":"mitral annuloplasty ring","label":"THERAPEUTIC_PROCEDURE","start":2353,"end":2377},{"text":"extubated","label":"THERAPEUTIC_PROCEDURE","start":2395,"end":2404},{"text":"postsurgical course","label":"THERAPEUTIC_PROCEDURE","start":2426,"end":2445},{"text":"uncomplicated","label":"LAB_VALUE","start":2450,"end":2463},{"text":"One year later","label":"DATE","start":2465,"end":2479},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":2488,"end":2500},{"text":"follow-up","label":"CLINICAL_EVENT","start":2519,"end":2528},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":2529,"end":2542},{"text":"echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":2543,"end":2557},{"text":"confirmed the excellent result","label":"LAB_VALUE","start":2558,"end":2588}],"tokens":["","A 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","asymptomatic"," for ","one year",".\nUpon his ","arrival"," at our ","department",", ","auscultation"," revealed ","bibasilar"," ","rales"," and a ","pansystolic"," ","murmur",".\n","Chest"," ","radiography"," showed ","mild"," ","lung"," ","congestion","; and ","transthoracic"," ","echocardiography",", ","limited by suboptimal acoustic windows",", revealed ","severe",", ","eccentric"," ","mitral regurgitation",".\nThe ","valvular"," and ","subvalvular apparatus"," appeared to be ","structurally normal",", and the ","left atrium"," was only ","mildly"," ","dilated",".\nThe patient was treated with ","intravenous"," ","diuretics"," until the ","signs and symptoms of congestion"," were relieved.\n","Coronary"," ","angiography"," revealed an absence of substantial ","coronary disease",".\nWe therefore ","planned"," an elective surgical procedure for ","mitral valve repair",".\nSurgical Procedure.\nDuring ","intraoperative"," ","transesophageal echocardiography"," (","TEE","), we 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-{"full_text":"A 60-year-old white Brazilian man, with controlled hypertension and stage 2 obesity presented to our institution with a complaint of progressive fatigue with moderate to light exertion of approximately 1 year\u2019s duration.\nDuring that period, he had undergone myocardial perfusion scintigraphy without evidence of obstructive ischemic disease.\nHe had no clinical evidence of systolic heart failure.\nHe had undergone biological mitral valve replacement 3 years previously for mitral valve stenosis and had undergone ablation of atrioventricular nodal reentry tachycardia 18 months previously.\nAt the time of valve replacement, there was no reported evidence of pulmonary arterial hypertension.\nThe patient\u2019s medication list included aspirin 100 mg\/day, carvedilol 50 mg\/day, atorvastatin 10 mg\/day, and losartan 25 mg\/day.\nHis echocardiogram showed normal function of a mitral prosthesis, global left ventricular systolic function within normal limits (left ventricular ejection fraction 62 % measured using the Teichholz method), stage I diastolic dysfunction, and mean pulmonary arterial systolic blood pressure of 50 mmHg.\nIn the 6-minute walk test, the patient walked 104 meters (Table 1).\nCatheterization of his right heart chambers and pulmonary arteries confirmed the diagnosis of pulmonary hypertension (Table 2).\nDuring the follow-up period, therapy with nifedipine and sildenafil was not tolerated secondary to orthostatic hypotension.\nThe patient was referred for radiofrequency ablation of the pulmonary artery trunk for the treatment of refractory pulmonary hypertension.\nThe procedure was performed in the catheterization laboratory with direct visualization using fluoroscopy and radiopaque contrast dye.\nThe patient remained under unconscious sedation.\nCatheterization of the right femoral artery via the standard Seldinger technique was performed using an 8-French valved short sheath after subcutaneous injection of a local anesthetic.\nSubsequently, this sheath was replaced with a steerable long sheath (Agilis\u00ae; St. Jude Medical, St. Paul, MN, USA) using the standard over-the-wire technique.\nUnfractionated heparin was administered intravenously, targeting an activated coagulation time between 250 and 350 seconds.\nElectroanatomic reconstruction of both the right ventricular outflow tract and pulmonary artery was performed using the EnSite Velocity Cardiac Mapping System (St.Jude Medical) under direct fluoroscopic visualization, and a merger was made with the formatted image obtained by performing cardiac computed tomography angiography (Fig.1).\nThe Agilis\u00ae sheath was advanced into the right ventricular outflow tract just before reaching the pulmonary valve.\nThrough this long sheath, we introduced an ablation catheter with an open irrigated tip (St.Jude Medical).\nThe parameters used for each application according to our protocol were as follows: power of 5 W, maximum temperature of 48 \u00b0C, 60-second duration in each spot, maximum impedance variation of 10 % from baseline values, and an irrigation flow rate of 17 ml\/minute, which created a circle in the pulmonary artery trunk.\nThe patient was discharged the next morning.\nNo noteworthy changes before or after the procedure or before discharge in the patient\u2019s radiographic or echocardiographic laboratory parameters were seen.\nThe patient\u2019s blood pressure in both the right heart chambers and the pulmonary artery were determined using catheterization before and at 3 and 6 months after the procedure.\nThe results are shown in Table 2.\nAt the patient\u2019s 3-month follow-up examination, he showed an improvement in functional class for fatigue with major exertion.\nHe also demonstrated an increased distance walked in the 6-minute walk test and reduction of the pressures in both the right cavities and the pulmonary artery.\nCurrently, with 6 months of clinical follow-up, he has maintained his improvement in functional classification and is pedaling his bicycle.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"white","label":"PERSONAL_BACKGROUND","start":14,"end":19},{"text":"Brazilian","label":"PERSONAL_BACKGROUND","start":20,"end":29},{"text":"man","label":"SEX","start":30,"end":33},{"text":"controlled hypertension","label":"HISTORY","start":40,"end":63},{"text":"stage 2 obesity","label":"HISTORY","start":68,"end":83},{"text":"presented","label":"CLINICAL_EVENT","start":84,"end":93},{"text":"institution","label":"NONBIOLOGICAL_LOCATION","start":101,"end":112},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":133,"end":144},{"text":"fatigue","label":"SIGN_SYMPTOM","start":145,"end":152},{"text":"moderate to light exertion","label":"DETAILED_DESCRIPTION","start":158,"end":184},{"text":"approximately 1 year","label":"DURATION","start":188,"end":208},{"text":"myocardial 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previously","label":"DATE","start":568,"end":588},{"text":"valve replacement","label":"COREFERENCE","start":605,"end":622},{"text":"pulmonary arterial hypertension","label":"DISEASE_DISORDER","start":658,"end":689},{"text":"aspirin","label":"MEDICATION","start":730,"end":737},{"text":"100 mg\/day","label":"DOSAGE","start":738,"end":748},{"text":"carvedilol","label":"MEDICATION","start":750,"end":760},{"text":"50 mg\/day","label":"DOSAGE","start":761,"end":770},{"text":"atorvastatin","label":"MEDICATION","start":772,"end":784},{"text":"10 mg\/day","label":"DOSAGE","start":785,"end":794},{"text":"losartan","label":"MEDICATION","start":800,"end":808},{"text":"25 mg\/day","label":"DOSAGE","start":809,"end":818},{"text":"echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":824,"end":838},{"text":"normal function","label":"LAB_VALUE","start":846,"end":861},{"text":"mitral prosthesis","label":"BIOLOGICAL_STRUCTURE","start":867,"end":884},{"text":"global left ventricular systolic function","label":"DIAGNOSTIC_PROCEDURE","start":886,"end":927},{"text":"within normal limits","label":"LAB_VALUE","start":928,"end":948},{"text":"left ventricular ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":950,"end":984},{"text":"62 %","label":"LAB_VALUE","start":985,"end":989},{"text":"using the Teichholz method","label":"DETAILED_DESCRIPTION","start":999,"end":1025},{"text":"stage I","label":"LAB_VALUE","start":1028,"end":1035},{"text":"diastolic dysfunction","label":"DISEASE_DISORDER","start":1036,"end":1057},{"text":"mean","label":"DETAILED_DESCRIPTION","start":1063,"end":1067},{"text":"pulmonary arterial","label":"BIOLOGICAL_STRUCTURE","start":1068,"end":1086},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":1087,"end":1095},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1096,"end":1110},{"text":"50 mmHg","label":"LAB_VALUE","start":1114,"end":1121},{"text":"6-minute","label":"DETAILED_DESCRIPTION","start":1130,"end":1138},{"text":"walk test","label":"DIAGNOSTIC_PROCEDURE","start":1139,"end":1148},{"text":"104 meters","label":"LAB_VALUE","start":1169,"end":1179},{"text":"Catheterization","label":"DIAGNOSTIC_PROCEDURE","start":1191,"end":1206},{"text":"right heart chambers","label":"BIOLOGICAL_STRUCTURE","start":1214,"end":1234},{"text":"pulmonary arteries","label":"BIOLOGICAL_STRUCTURE","start":1239,"end":1257},{"text":"pulmonary hypertension","label":"DISEASE_DISORDER","start":1285,"end":1307},{"text":"follow-up","label":"CLINICAL_EVENT","start":1330,"end":1339},{"text":"nifedipine","label":"MEDICATION","start":1361,"end":1371},{"text":"sildenafil","label":"MEDICATION","start":1376,"end":1386},{"text":"orthostatic","label":"DETAILED_DESCRIPTION","start":1418,"end":1429},{"text":"hypotension","label":"SIGN_SYMPTOM","start":1430,"end":1441},{"text":"referred","label":"CLINICAL_EVENT","start":1459,"end":1467},{"text":"radiofrequency","label":"DETAILED_DESCRIPTION","start":1472,"end":1486},{"text":"ablation","label":"THERAPEUTIC_PROCEDURE","start":1487,"end":1495},{"text":"pulmonary artery trunk","label":"BIOLOGICAL_STRUCTURE","start":1503,"end":1525},{"text":"refractory","label":"DETAILED_DESCRIPTION","start":1547,"end":1557},{"text":"pulmonary hypertension","label":"DISEASE_DISORDER","start":1558,"end":1580},{"text":"catheterization laboratory","label":"NONBIOLOGICAL_LOCATION","start":1617,"end":1643},{"text":"direct visualization using fluoroscopy and radiopaque contrast dye","label":"DETAILED_DESCRIPTION","start":1649,"end":1715},{"text":"sedation","label":"THERAPEUTIC_PROCEDURE","start":1756,"end":1764},{"text":"Catheterization","label":"DIAGNOSTIC_PROCEDURE","start":1766,"end":1781},{"text":"right femoral artery","label":"BIOLOGICAL_STRUCTURE","start":1789,"end":1809},{"text":"standard Seldinger technique","label":"DETAILED_DESCRIPTION","start":1818,"end":1846},{"text":"using an 8-French valved short sheath","label":"DETAILED_DESCRIPTION","start":1861,"end":1898},{"text":"subcutaneous","label":"ADMINISTRATION","start":1905,"end":1917},{"text":"injection","label":"ADMINISTRATION","start":1918,"end":1927},{"text":"local anesthetic","label":"MEDICATION","start":1933,"end":1949},{"text":"sheath was replaced with a steerable long sheath","label":"DETAILED_DESCRIPTION","start":1970,"end":2018},{"text":"Agilis\u00ae; St. Jude Medical, St. Paul, MN, USA","label":"DETAILED_DESCRIPTION","start":2020,"end":2064},{"text":"using the standard over-the-wire technique","label":"DETAILED_DESCRIPTION","start":2066,"end":2108},{"text":"Unfractionated heparin","label":"MEDICATION","start":2110,"end":2132},{"text":"intravenously","label":"ADMINISTRATION","start":2150,"end":2163},{"text":"activated coagulation time","label":"DIAGNOSTIC_PROCEDURE","start":2178,"end":2204},{"text":"between 250 and 350 seconds","label":"LAB_VALUE","start":2205,"end":2232},{"text":"Electroanatomic reconstruction","label":"DIAGNOSTIC_PROCEDURE","start":2234,"end":2264},{"text":"right ventricular outflow tract","label":"BIOLOGICAL_STRUCTURE","start":2277,"end":2308},{"text":"pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":2313,"end":2329},{"text":"EnSite Velocity Cardiac Mapping System","label":"DETAILED_DESCRIPTION","start":2354,"end":2392},{"text":"St.Jude Medical","label":"DETAILED_DESCRIPTION","start":2394,"end":2409},{"text":"direct fluoroscopic visualization","label":"DETAILED_DESCRIPTION","start":2417,"end":2450},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2522,"end":2529},{"text":"computed tomography angiography","label":"DIAGNOSTIC_PROCEDURE","start":2530,"end":2561},{"text":"Agilis\u00ae","label":"DETAILED_DESCRIPTION","start":2575,"end":2582},{"text":"sheath was advanced","label":"DIAGNOSTIC_PROCEDURE","start":2583,"end":2602},{"text":"right ventricular outflow tract","label":"BIOLOGICAL_STRUCTURE","start":2612,"end":2643},{"text":"before reaching the pulmonary valve","label":"BIOLOGICAL_STRUCTURE","start":2649,"end":2684},{"text":"ablation catheter","label":"THERAPEUTIC_PROCEDURE","start":2729,"end":2746},{"text":"open irrigated tip","label":"DETAILED_DESCRIPTION","start":2755,"end":2773},{"text":"St.Jude Medical","label":"DETAILED_DESCRIPTION","start":2775,"end":2790},{"text":"power of 5 W","label":"LAB_VALUE","start":2877,"end":2889},{"text":"maximum temperature of 48 \u00b0C","label":"LAB_VALUE","start":2891,"end":2919},{"text":"60-second duration in each spot","label":"LAB_VALUE","start":2921,"end":2952},{"text":"maximum impedance variation of 10 % from baseline values","label":"LAB_VALUE","start":2954,"end":3010},{"text":"irrigation flow rate of 17 ml\/minute","label":"LAB_VALUE","start":3019,"end":3055},{"text":"created a circle","label":"THERAPEUTIC_PROCEDURE","start":3063,"end":3079},{"text":"pulmonary artery trunk","label":"BIOLOGICAL_STRUCTURE","start":3087,"end":3109},{"text":"discharged","label":"CLINICAL_EVENT","start":3127,"end":3137},{"text":"next morning","label":"TIME","start":3142,"end":3154},{"text":"changes","label":"SIGN_SYMPTOM","start":3170,"end":3177},{"text":"discharge","label":"CLINICAL_EVENT","start":3218,"end":3227},{"text":"radiographic or echocardiographic laboratory parameters","label":"DETAILED_DESCRIPTION","start":3245,"end":3300},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":3326,"end":3340},{"text":"both the right heart chambers","label":"BIOLOGICAL_STRUCTURE","start":3344,"end":3373},{"text":"pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":3382,"end":3398},{"text":"using catheterization","label":"DETAILED_DESCRIPTION","start":3415,"end":3436},{"text":"3 and 6 months after","label":"DATE","start":3451,"end":3471},{"text":"3-month","label":"DATE","start":3538,"end":3545},{"text":"follow-up","label":"CLINICAL_EVENT","start":3546,"end":3555},{"text":"improvement","label":"LAB_VALUE","start":3582,"end":3593},{"text":"functional class for fatigue with major exertion","label":"DIAGNOSTIC_PROCEDURE","start":3597,"end":3645},{"text":"increased distance","label":"LAB_VALUE","start":3671,"end":3689},{"text":"6-minute","label":"DETAILED_DESCRIPTION","start":3704,"end":3712},{"text":"walk test","label":"DIAGNOSTIC_PROCEDURE","start":3713,"end":3722},{"text":"reduction","label":"LAB_VALUE","start":3727,"end":3736},{"text":"pressures","label":"DIAGNOSTIC_PROCEDURE","start":3744,"end":3753},{"text":"right cavities","label":"BIOLOGICAL_STRUCTURE","start":3766,"end":3780},{"text":"pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":3789,"end":3805},{"text":"6 months","label":"DURATION","start":3823,"end":3831},{"text":"follow-up","label":"CLINICAL_EVENT","start":3844,"end":3853},{"text":"improvement","label":"LAB_VALUE","start":3877,"end":3888},{"text":"functional classification","label":"DIAGNOSTIC_PROCEDURE","start":3892,"end":3917},{"text":"pedaling his bicycle","label":"ACTIVITY","start":3925,"end":3945}],"tokens":["A ","60-year-old"," ","white"," ","Brazilian"," ","man",", with ","controlled hypertension"," and ","stage 2 obesity"," ","presented"," to our ","institution"," with a complaint of ","progressive"," ","fatigue"," with ","moderate to light exertion"," of ","approximately 1 year","\u2019s duration.\nDuring that period, he had undergone ","myocardial perfusion"," ","scintigraphy"," without evidence of ","obstructive ischemic disease",".\nHe had no clinical evidence of ","systolic"," ","heart failure",".\nHe had undergone ","biological"," ","mitral valve replacement"," ","3 years previously"," for ","mitral valve stenosis"," and had undergone ","ablation"," of ","atrioventricular nodal reentry"," ","tachycardia"," ","18 months previously",".\nAt the time of ","valve replacement",", there was no reported evidence of ","pulmonary arterial hypertension",".\nThe patient\u2019s medication list included ","aspirin"," ","100 mg\/day",", ","carvedilol"," ","50 mg\/day",", ","atorvastatin"," ","10 mg\/day",", and ","losartan"," ","25 mg\/day",".\nHis ","echocardiogram"," showed ","normal function"," of a ","mitral prosthesis",", ","global left ventricular systolic function"," ","within normal limits"," (","left ventricular ejection fraction"," ","62 %"," measured ","using the Teichholz method","), ","stage I"," ","diastolic dysfunction",", and ","mean"," ","pulmonary arterial"," ","systolic"," ","blood pressure"," of ","50 mmHg",".\nIn the ","6-minute"," ","walk test",", the patient walked ","104 meters"," (Table 1).\n","Catheterization"," of his ","right heart chambers"," and ","pulmonary arteries"," confirmed the diagnosis of ","pulmonary hypertension"," (Table 2).\nDuring the ","follow-up"," period, therapy with ","nifedipine"," and ","sildenafil"," was not tolerated secondary to ","orthostatic"," ","hypotension",".\nThe patient was ","referred"," for ","radiofrequency"," ","ablation"," of the ","pulmonary artery trunk"," for the treatment of ","refractory"," ","pulmonary hypertension",".\nThe procedure was performed in the ","catheterization laboratory"," with ","direct visualization using fluoroscopy and radiopaque contrast dye",".\nThe patient remained under unconscious ","sedation",".\n","Catheterization"," of the ","right femoral artery"," via the ","standard Seldinger technique"," was performed ","using an 8-French valved short sheath"," after ","subcutaneous"," ","injection"," of a ","local anesthetic",".\nSubsequently, this ","sheath was replaced with a steerable long sheath"," (","Agilis\u00ae; St. Jude Medical, St. Paul, MN, USA",") ","using the standard over-the-wire technique",".\n","Unfractionated heparin"," was administered ","intravenously",", targeting an ","activated coagulation time"," ","between 250 and 350 seconds",".\n","Electroanatomic reconstruction"," of both the ","right ventricular outflow tract"," and ","pulmonary artery"," was performed using the ","EnSite Velocity Cardiac Mapping System"," (","St.Jude Medical",") under ","direct fluoroscopic visualization",", and a merger was made with the formatted image obtained by performing ","cardiac"," ","computed tomography angiography"," (Fig.1).\nThe ","Agilis\u00ae"," ","sheath was advanced"," into the ","right ventricular outflow tract"," just ","before reaching the pulmonary valve",".\nThrough this long sheath, we introduced an ","ablation catheter"," with an ","open irrigated tip"," (","St.Jude Medical",").\nThe parameters used for each application according to our protocol were as follows: ","power of 5 W",", ","maximum temperature of 48 \u00b0C",", ","60-second duration in each spot",", ","maximum impedance variation of 10 % from baseline values",", and an ","irrigation flow rate of 17 ml\/minute",", which ","created a circle"," in the ","pulmonary artery trunk",".\nThe patient was ","discharged"," the ","next morning",".\nNo noteworthy ","changes"," before or after the procedure or before ","discharge"," in the patient\u2019s ","radiographic or echocardiographic laboratory parameters"," were seen.\nThe patient\u2019s ","blood pressure"," in ","both the right heart chambers"," and the ","pulmonary artery"," were determined ","using catheterization"," before and at ","3 and 6 months after"," the procedure.\nThe results are shown in Table 2.\nAt the patient\u2019s ","3-month"," ","follow-up"," examination, he showed an ","improvement"," in ","functional class for fatigue with major exertion",".\nHe also demonstrated an ","increased distance"," walked in the ","6-minute"," ","walk test"," and ","reduction"," of the ","pressures"," in both the ","right cavities"," and the ","pulmonary artery",".\nCurrently, with ","6 months"," of clinical ","follow-up",", he has maintained his ","improvement"," in ","functional classification"," and is ","pedaling his bicycle",".\n"],"ner_labels":[0,5,0,58,0,58,0,65,0,39,0,39,0,13,0,48,0,22,0,69,0,22,0,32,0,22,0,24,0,26,0,22,0,26,0,22,0,75,0,19,0,26,0,75,0,12,0,69,0,19,0,18,0,26,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,24,0,42,0,12,0,24,0,42,0,24,0,42,0,22,0,42,0,26,0,22,0,12,0,22,0,24,0,42,0,22,0,24,0,42,0,24,0,12,0,12,0,26,0,13,0,46,0,46,0,22,0,69,0,13,0,22,0,75,0,12,0,22,0,26,0,48,0,22,0,75,0,24,0,12,0,22,0,22,0,4,0,4,0,46,0,22,0,22,0,22,0,46,0,4,0,24,0,42,0,24,0,12,0,12,0,22,0,22,0,22,0,12,0,24,0,22,0,24,0,12,0,12,0,75,0,22,0,22,0,42,0,42,0,42,0,42,0,42,0,75,0,12,0,13,0,78,0,69,0,13,0,22,0,24,0,12,0,12,0,22,0,19,0,19,0,13,0,42,0,24,0,42,0,22,0,24,0,42,0,24,0,12,0,12,0,32,0,13,0,42,0,24,0,1,0]}
-{"full_text":"Our patient was a 50-year old man with bicuspid aortic valve insufficiency and ascending aorta dilatation.\nHe had undergone a free-hand aortic homograft implantation with replacement of the non-coronary sinus using a 24-mm homograft in 2006 (at the age of 41).\nFollow-up evaluations were performed every 6 months and showed mild aortic valve insufficiency.\nAfter 8 years of follow-up, the patient presented to hospital with fever and the echocardiography showed severe aortic insufficiency due to a rupture of one of the cusps of the homograft, worsening of cardiac contractility with left ventricular ejection fraction (LVEF) depression (40\u201345%) and dilatation of the left ventricle (telediastolic\/telesystolic diameters 60\/42 mm, respectively).\nThe patient presented orthopnoea and hypotension, which needed infusion of dopamine and diuretics.\nComputed tomography scan showed calcifications on the homograft, pleural effusions and no signs of pericardial effusion (Fig.1).\nSince the Dukes criteria for endocarditis were not satisfied, the final diagnosis was an early structural deterioration of the homograft, due to a severe calcification process.\nThe operation was performed through median resternotomy and with standard aorta-right atrium central cannulation for the extracorporeal circulation.\nThe leaflets and the annulus of the homograft presented severe calcifications and no signs of endocarditis were found.\nAn Edwards Intuity bioprosthesis (21 mm) was then implanted (Fig.2).\nThe cross-clamping time was 41 min, and the cardiopulmonary bypass time was 64 min.\nThe patient required dopamine and adrenaline at low doses for bypass weaning.\nNo complications occurred during the postoperative period.\nEchocardiography before the discharge showed the absence of paravalvular leaks, a peak\/mean aortic gradient of 34\/20 mmHg and an LVEF of 33%.\nFollow-up echocardiography after 3 months from the operation showed neither leaks nor malfunctions of the Edwards Intuity prosthesis, a peak\/mean gradient of 38\/22 mmHg and initial recovery of the LVEF (valued 47%).\nPatient was asymptomatic again.\n","ner_info":[{"text":"50-year old","label":"AGE","start":18,"end":29},{"text":"man","label":"SEX","start":30,"end":33},{"text":"bicuspid","label":"DETAILED_DESCRIPTION","start":39,"end":47},{"text":"aortic valve insufficiency","label":"SIGN_SYMPTOM","start":48,"end":74},{"text":"ascending","label":"DETAILED_DESCRIPTION","start":79,"end":88},{"text":"aorta dilatation","label":"SIGN_SYMPTOM","start":89,"end":105},{"text":"free-hand","label":"DETAILED_DESCRIPTION","start":126,"end":135},{"text":"aortic","label":"BIOLOGICAL_STRUCTURE","start":136,"end":142},{"text":"homograft implantation","label":"THERAPEUTIC_PROCEDURE","start":143,"end":165},{"text":"replacement","label":"THERAPEUTIC_PROCEDURE","start":171,"end":182},{"text":"non-coronary sinus","label":"BIOLOGICAL_STRUCTURE","start":190,"end":208},{"text":"24-mm homograft","label":"DETAILED_DESCRIPTION","start":217,"end":232},{"text":"2006","label":"DATE","start":236,"end":240},{"text":"Follow-up","label":"CLINICAL_EVENT","start":261,"end":270},{"text":"every 6 months","label":"FREQUENCY","start":298,"end":312},{"text":"mild","label":"SEVERITY","start":324,"end":328},{"text":"aortic valve insufficiency","label":"SIGN_SYMPTOM","start":329,"end":355},{"text":"8 years","label":"DURATION","start":363,"end":370},{"text":"follow-up","label":"CLINICAL_EVENT","start":374,"end":383},{"text":"presented","label":"CLINICAL_EVENT","start":397,"end":406},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":410,"end":418},{"text":"fever","label":"SIGN_SYMPTOM","start":424,"end":429},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":438,"end":454},{"text":"severe","label":"SEVERITY","start":462,"end":468},{"text":"aortic insufficiency","label":"SIGN_SYMPTOM","start":469,"end":489},{"text":"rupture","label":"SIGN_SYMPTOM","start":499,"end":506},{"text":"one of the cusps of the homograft","label":"BIOLOGICAL_STRUCTURE","start":510,"end":543},{"text":"worsening","label":"LAB_VALUE","start":545,"end":554},{"text":"cardiac contractility","label":"DIAGNOSTIC_PROCEDURE","start":558,"end":579},{"text":"left ventricular ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":585,"end":619},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":621,"end":625},{"text":"depression","label":"LAB_VALUE","start":627,"end":637},{"text":"40\u201345%","label":"LAB_VALUE","start":639,"end":645},{"text":"dilatation of the left ventricle","label":"SIGN_SYMPTOM","start":651,"end":683},{"text":"telediastolic\/telesystolic diameters 60\/42 mm","label":"LAB_VALUE","start":685,"end":730},{"text":"orthopnoea","label":"SIGN_SYMPTOM","start":769,"end":779},{"text":"hypotension","label":"SIGN_SYMPTOM","start":784,"end":795},{"text":"infusion","label":"ADMINISTRATION","start":810,"end":818},{"text":"dopamine","label":"MEDICATION","start":822,"end":830},{"text":"diuretics","label":"MEDICATION","start":835,"end":844},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":846,"end":865},{"text":"calcifications","label":"SIGN_SYMPTOM","start":878,"end":892},{"text":"homograft","label":"BIOLOGICAL_STRUCTURE","start":900,"end":909},{"text":"pleural effusions","label":"SIGN_SYMPTOM","start":911,"end":928},{"text":"pericardial effusion","label":"SIGN_SYMPTOM","start":945,"end":965},{"text":"Dukes criteria for endocarditis","label":"DIAGNOSTIC_PROCEDURE","start":985,"end":1016},{"text":"not satisfied","label":"LAB_VALUE","start":1022,"end":1035},{"text":"structural deterioration","label":"DISEASE_DISORDER","start":1070,"end":1094},{"text":"homograft","label":"BIOLOGICAL_STRUCTURE","start":1102,"end":1111},{"text":"severe","label":"SEVERITY","start":1122,"end":1128},{"text":"calcification","label":"SIGN_SYMPTOM","start":1129,"end":1142},{"text":"operation","label":"THERAPEUTIC_PROCEDURE","start":1156,"end":1165},{"text":"median","label":"DETAILED_DESCRIPTION","start":1188,"end":1194},{"text":"resternotomy","label":"THERAPEUTIC_PROCEDURE","start":1195,"end":1207},{"text":"standard","label":"DETAILED_DESCRIPTION","start":1217,"end":1225},{"text":"aorta-right atrium","label":"BIOLOGICAL_STRUCTURE","start":1226,"end":1244},{"text":"central cannulation","label":"THERAPEUTIC_PROCEDURE","start":1245,"end":1264},{"text":"leaflets","label":"BIOLOGICAL_STRUCTURE","start":1305,"end":1313},{"text":"annulus","label":"BIOLOGICAL_STRUCTURE","start":1322,"end":1329},{"text":"homograft","label":"BIOLOGICAL_STRUCTURE","start":1337,"end":1346},{"text":"severe","label":"SEVERITY","start":1357,"end":1363},{"text":"calcifications","label":"SIGN_SYMPTOM","start":1364,"end":1378},{"text":"endocarditis","label":"DISEASE_DISORDER","start":1395,"end":1407},{"text":"Edwards Intuity","label":"DETAILED_DESCRIPTION","start":1423,"end":1438},{"text":"bioprosthesis","label":"THERAPEUTIC_PROCEDURE","start":1439,"end":1452},{"text":"implanted","label":"THERAPEUTIC_PROCEDURE","start":1470,"end":1479},{"text":"cross-clamping","label":"THERAPEUTIC_PROCEDURE","start":1493,"end":1507},{"text":"41 min","label":"DURATION","start":1517,"end":1523},{"text":"cardiopulmonary bypass","label":"THERAPEUTIC_PROCEDURE","start":1533,"end":1555},{"text":"64 min","label":"DURATION","start":1565,"end":1571},{"text":"dopamine","label":"MEDICATION","start":1594,"end":1602},{"text":"adrenaline","label":"MEDICATION","start":1607,"end":1617},{"text":"low doses","label":"DOSAGE","start":1621,"end":1630},{"text":"complications","label":"SIGN_SYMPTOM","start":1654,"end":1667},{"text":"postoperative period","label":"THERAPEUTIC_PROCEDURE","start":1688,"end":1708},{"text":"Echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1710,"end":1726},{"text":"discharge","label":"CLINICAL_EVENT","start":1738,"end":1747},{"text":"paravalvular leaks","label":"SIGN_SYMPTOM","start":1770,"end":1788},{"text":"peak\/mean aortic gradient","label":"DIAGNOSTIC_PROCEDURE","start":1792,"end":1817},{"text":"34\/20 mmHg","label":"LAB_VALUE","start":1821,"end":1831},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":1839,"end":1843},{"text":"33%","label":"LAB_VALUE","start":1847,"end":1850},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1862,"end":1878},{"text":"after 3 months","label":"DATE","start":1879,"end":1893},{"text":"leaks","label":"SIGN_SYMPTOM","start":1928,"end":1933},{"text":"malfunctions","label":"SIGN_SYMPTOM","start":1938,"end":1950},{"text":"Edwards Intuity","label":"DETAILED_DESCRIPTION","start":1958,"end":1973},{"text":"prosthesis","label":"BIOLOGICAL_STRUCTURE","start":1974,"end":1984},{"text":"peak\/mean gradient","label":"DIAGNOSTIC_PROCEDURE","start":1988,"end":2006},{"text":"38\/22 mmHg","label":"LAB_VALUE","start":2010,"end":2020},{"text":"initial recovery","label":"LAB_VALUE","start":2025,"end":2041},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":2049,"end":2053},{"text":"47%","label":"LAB_VALUE","start":2062,"end":2065},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":2080,"end":2092}],"tokens":["Our patient was a ","50-year old"," ","man"," with ","bicuspid"," ","aortic valve insufficiency"," and ","ascending"," ","aorta dilatation",".\nHe had undergone a ","free-hand"," ","aortic"," ","homograft implantation"," with ","replacement"," of the ","non-coronary sinus"," using a ","24-mm homograft"," in ","2006"," (at the age of 41).\n","Follow-up"," evaluations were performed ","every 6 months"," and showed ","mild"," ","aortic valve insufficiency",".\nAfter ","8 years"," of ","follow-up",", the patient ","presented"," to ","hospital"," with ","fever"," and the ","echocardiography"," showed ","severe"," ","aortic insufficiency"," due to a ","rupture"," of ","one of the cusps of the homograft",", ","worsening"," of ","cardiac contractility"," with ","left ventricular ejection fraction"," (","LVEF",") ","depression"," (","40\u201345%",") and ","dilatation of the left ventricle"," (","telediastolic\/telesystolic diameters 60\/42 mm",", respectively).\nThe patient presented ","orthopnoea"," and ","hypotension",", which needed ","infusion"," of ","dopamine"," and ","diuretics",".\n","Computed tomography"," scan showed ","calcifications"," on the ","homograft",", ","pleural effusions"," and no signs of ","pericardial effusion"," (Fig.1).\nSince the ","Dukes criteria for endocarditis"," were ","not satisfied",", the final diagnosis was an early ","structural deterioration"," of the ","homograft",", due to a ","severe"," ","calcification"," process.\nThe ","operation"," was performed through ","median"," ","resternotomy"," and with ","standard"," ","aorta-right atrium"," ","central cannulation"," for the extracorporeal circulation.\nThe ","leaflets"," and the ","annulus"," of the ","homograft"," presented ","severe"," ","calcifications"," and no signs of ","endocarditis"," were found.\nAn ","Edwards Intuity"," ","bioprosthesis"," (21 mm) was then ","implanted"," (Fig.2).\nThe ","cross-clamping"," time was ","41 min",", and the ","cardiopulmonary bypass"," time was ","64 min",".\nThe patient required ","dopamine"," and ","adrenaline"," at ","low doses"," for bypass weaning.\nNo ","complications"," occurred during the ","postoperative period",".\n","Echocardiography"," before the ","discharge"," showed the absence of ","paravalvular leaks",", a ","peak\/mean aortic gradient"," of ","34\/20 mmHg"," and an ","LVEF"," of ","33%",".\nFollow-up ","echocardiography"," ","after 3 months"," from the operation showed neither ","leaks"," nor ","malfunctions"," of the ","Edwards Intuity"," ","prosthesis",", a ","peak\/mean gradient"," of ","38\/22 mmHg"," and ","initial recovery"," of the ","LVEF"," (valued ","47%",").\nPatient was ","asymptomatic"," again.\n"],"ner_labels":[0,5,0,65,0,22,0,69,0,22,0,69,0,22,0,12,0,75,0,75,0,12,0,22,0,19,0,13,0,35,0,63,0,69,0,32,0,13,0,13,0,48,0,69,0,24,0,63,0,69,0,69,0,12,0,42,0,24,0,24,0,24,0,42,0,42,0,69,0,42,0,69,0,69,0,4,0,46,0,46,0,24,0,69,0,12,0,69,0,69,0,24,0,42,0,26,0,12,0,63,0,69,0,75,0,22,0,75,0,22,0,12,0,75,0,12,0,12,0,12,0,63,0,69,0,26,0,22,0,75,0,75,0,75,0,32,0,75,0,32,0,46,0,46,0,29,0,69,0,75,0,24,0,13,0,69,0,24,0,42,0,24,0,42,0,24,0,19,0,69,0,69,0,22,0,12,0,24,0,42,0,42,0,24,0,42,0,69,0]}
-{"full_text":"A 69-year-old woman with a history of hypertension presented with a generalized petechial rash and shortness of breath of 3 days duration.\nThe rash was nonpruritic, painless, and started at the thighs, but rapidly disseminated to the rest of the body.\nShe had progressive dyspnea on exertion, with a significant decrease in exercise tolerance.\nShe denied fever, headache, dizziness, hemoptysis, or bleeding from anywhere.\nThere was no history of new drug use, unusual food intake, contact with any sick persons, or recent travel.\nHer only medication was enalapril, which she had been taking for several years.\nThe patient denied any use of recreational drugs, tobacco, or alcohol.\nOn admission, she was afebrile, normotensive with mild tachypnea (respiratory rate of 22 breaths per minute).\nPhysical examination revealed scattered petechial rash, more prominent in lower extremities, nonpalpable and nonblanching.\nChest auscultation revealed coarse crackles bilaterally.\nCardiovascular, abdominal, and neurological examinations were normal.\nThere was no palpable lymphadenopathy or visceromegaly.\nLaboratory examination revealed thrombocytopenia (platelets 7000\/\u03bcL), anemia (hemoglobin 10.8\u200amg\/dL and hematocrit 34%), and leukocytosis (white blood cells [WBCs] 11,600\/\u03bcL).\nThe coagulation profile was normal, which excluded disseminated intravascular coagulation.\nArterial blood gas on ambient air revealed a partial pressure of oxygen (PaO2) of 64 Torr, a partial pressure of carbon dioxide (PaCO2) of 37 Torr (pH 7.45), and an increased alveolar-arterial gradient (44 Torr).\nDiffuse airspace consolidation was found on chest roentgenogram (Fig.1A).\nComputed tomography (CT) of the chest showed diffuse ground glass alveolar opacities and patchy infiltrates (Fig.1B, C).\nShe was started on broad-spectrum antibiotics and received intravenous steroids.\nPeripheral smear showed giant platelets and occasional small platelet clumps, with no schistocytes.\nA flexible fiber-optic bronchoscopy (FFB) showed normal mucosa with no endobronchial lesions (Fig.2A).\nSerial aliquots of BAL fluid (BALF) turned more hemorrhagic, confirming the bronchoscopic diagnosis of DAH (Fig.2B).\nCytology of BALF showed a substantial amount of hemosiderin-laden macrophages, further supporting the diagnosis.\nAll BALF cultures and gram stains were negative.\nThe patient remained with severe thrombocytopenia and hypoxia despite steroids and platelets transfusion.\nHigh doses of pulse steroids and intravenous immunoglobulins (IVIGs) were added with clinico-radiological improvement.\nA bone marrow aspirate was morphologically normal.\nAdditional laboratory studies failed to reveal an etiology for secondary thrombocytopenia (Table \u200b1), supporting the diagnosis of ITP.\nSteroids were gradually tapered.\nRepeat chest radiograph showed almost complete resolution of bilateral infiltrates (Fig.3).\nPlatelet count returned to normal by week 10 after admission without any additional therapies (Fig.4).\n","ner_info":[{"text":"69-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"hypertension","label":"HISTORY","start":38,"end":50},{"text":"presented","label":"CLINICAL_EVENT","start":51,"end":60},{"text":"generalized","label":"DETAILED_DESCRIPTION","start":68,"end":79},{"text":"petechial","label":"DETAILED_DESCRIPTION","start":80,"end":89},{"text":"rash","label":"SIGN_SYMPTOM","start":90,"end":94},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":99,"end":118},{"text":"3 days duration","label":"DURATION","start":122,"end":137},{"text":"rash","label":"COREFERENCE","start":143,"end":147},{"text":"nonpruritic","label":"DETAILED_DESCRIPTION","start":152,"end":163},{"text":"painless","label":"DETAILED_DESCRIPTION","start":165,"end":173},{"text":"thighs","label":"BIOLOGICAL_STRUCTURE","start":194,"end":200},{"text":"rest of the 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Torr","label":"LAB_VALUE","start":1503,"end":1510},{"text":"pH","label":"DIAGNOSTIC_PROCEDURE","start":1512,"end":1514},{"text":"7.45","label":"LAB_VALUE","start":1515,"end":1519},{"text":"increased","label":"LAB_VALUE","start":1529,"end":1538},{"text":"alveolar-arterial gradient","label":"DIAGNOSTIC_PROCEDURE","start":1539,"end":1565},{"text":"44 Torr","label":"LAB_VALUE","start":1567,"end":1574},{"text":"Diffuse","label":"DETAILED_DESCRIPTION","start":1577,"end":1584},{"text":"airspace consolidation","label":"SIGN_SYMPTOM","start":1585,"end":1607},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1621,"end":1626},{"text":"roentgenogram","label":"DIAGNOSTIC_PROCEDURE","start":1627,"end":1640},{"text":"Computed 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10","label":"DATE","start":2908,"end":2915},{"text":"additional therapies","label":"THERAPEUTIC_PROCEDURE","start":2944,"end":2964}],"tokens":["A ","69-year-old"," ","woman"," with a history of ","hypertension"," ","presented"," with a ","generalized"," ","petechial"," ","rash"," and ","shortness of breath"," of ","3 days duration",".\nThe ","rash"," was ","nonpruritic",", ","painless",", and started at the ","thighs",", but rapidly disseminated to the ","rest of the body",".\nShe had ","progressive"," ","dyspnea"," on ","exertion",", with a significant ","decrease"," in ","exercise tolerance",".\nShe denied ","fever",", ","headache",", ","dizziness",", ","hemoptysis",", or ","bleeding"," from ","anywhere",".\nThere was ","no history of new drug use, unusual food intake, contact with any sick persons, or recent travel",".\nHer only medication was ","enalapril",", which she had been taking for ","several years",".\nThe patient ","denied any use of recreational drugs, tobacco, or alcohol",".\nOn admission, she was ","afebrile",", ","normotensive"," with ","mild"," ","tachypnea"," (","respiratory rate"," of ","22 breaths per minute",").\n","Physical examination"," revealed scattered ","petechial"," ","rash",", more prominent in ","lower extremities",", ","nonpalpable"," and ","nonblanching",".\n","Chest auscultation"," revealed ","coarse"," ","crackles"," ","bilaterally",".\n","Cardiovascular",", ","abdominal",", and ","neurological"," ","examinations"," were ","normal",".\nThere was no palpable ","lymphadenopathy"," or ","visceromegaly",".\n","Laboratory examination"," revealed ","thrombocytopenia"," (","platelets"," ","7000\/\u03bcL","), ","anemia"," (","hemoglobin"," ","10.8\u200amg\/dL"," and ","hematocrit"," ","34%","), and ","leukocytosis"," (","white blood cells"," [","WBCs","] ","11,600\/\u03bcL",").\nThe ","coagulation profile"," was ","normal",", which excluded ","disseminated intravascular coagulation",".\n","Arterial blood gas"," on ","ambient air"," revealed a ","partial pressure of oxygen"," (","PaO2",") of ","64 Torr",", a ","partial pressure of carbon dioxide"," (","PaCO2",") of ","37 Torr"," (","pH"," ","7.45","), and an ","increased"," ","alveolar-arterial gradient"," (","44 Torr",").\n","Diffuse"," ","airspace consolidation"," was found on ","chest"," ","roentgenogram"," (Fig.1A).\n","Computed tomography"," (","CT",") of the ","chest"," showed ","diffuse"," ","ground glass"," ","alveolar"," ","opacities"," and ","patchy"," ","infiltrates"," (Fig.1B, C).\nShe was started on ","broad-spectrum"," ","antibiotics"," and received ","intravenous"," ","steroids",".\n","Peripheral smear"," showed ","giant platelets"," and ","occasional"," ","small"," ","platelet clumps",", with no ","schistocytes",".\nA ","flexible fiber-optic bronchoscopy"," (","FFB",") showed ","normal"," ","mucosa"," with no ","endobronchial"," ","lesions"," (Fig.2A).\nSerial aliquots of ","BAL fluid"," (","BALF",") turned more ","hemorrhagic",", confirming the bronchoscopic diagnosis of ","DAH"," (Fig.2B).\n","Cytology"," of ","BALF"," showed a substantial amount of ","hemosiderin-laden"," ","macrophages",", further supporting the diagnosis.\nAll ","BALF"," ","cultures"," and ","gram stains"," were ","negative",".\nThe patient remained with ","severe"," ","thrombocytopenia"," and ","hypoxia"," despite ","steroids"," and ","platelets transfusion",".\n","High doses"," of pulse ","steroids"," and ","intravenous"," ","immunoglobulins"," (IVIGs) were added with ","clinico-radiological"," ","improvement",".\nA ","bone marrow aspirate"," was ","morphologically normal",".\nAdditional ","laboratory studies"," ","failed to reveal an etiology"," for secondary ","thrombocytopenia"," (Table \u200b1), supporting the diagnosis of ","ITP",".\n","Steroids"," were gradually tapered.\nRepeat ","chest"," ","radiograph"," showed almost complete resolution of ","bilateral"," ","infiltrates"," (Fig.3).\n","Platelet count"," returned to ","normal"," by ","week 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-{"full_text":"A 24-year-old Azeri male presented with a chief complaint of blurred vision in both eyes.\nHe was diagnosed with achondroplasia in early childhood.\nHe was born at term with normal birth weight.\nThere was no history of hereditary ocular or systemic disease.\nThis patient had characteristic features of achondroplasia (i.e., short stature, lumbar lordosis, short proximal long bones, large hands, frontal bossing, and flat nasal bridge) [Figure 1].\nHis height was 108 cm.\nBest corrected visual acuity was 20\/70 in the right eye with \u22120.75 + 1.25 \u00d7 60\u00b0 and 20\/70 in the left eye with OS: +0.25 + 0.50 \u00d7 130\u00b0.\nPupils were equal in size, round and reactive to light with no reverse afferent pupillary defect.\nOcular motility was normal in both eyes and slit lamp examination was unremarkable.\nThe intraocular pressure was 12 mm Hg by Goldmann applanation tonometry.\nCentral corneal thickness values of the right and left eyes were, 561 and 557 \u03bc, respectively.\nDilated fundus examination revealed a well-demarcated circular macular lesion in both eyes.\nIn the right eye, this lesion was approximately 2.5 disc diameters (DD) in width and 2.7 DD in length.\nIn the left eye, this lesion was approximately 2.5 DD in width and 2.8 DD in length.\nThe border of the lesions was pigmented.\nUnderlying choroidal and overlying retinal vasculature appeared normal.\nIn addition, a stalk of tissue emanated from the optic disc and coursed into the vitreous [Figure 2].\nFluorescein angiography of the posterior segment and optical coherence tomography of the optic nerve head (Stratus; Carl Zeiss GmbH, Jena, Germany) were performed [Figures \u200b[Figures3 and 4].\nDue to the background maculopathy, the patient could not appropriately fixate on the target during image acquisition resulting in slightly decentered fluorescein angiography images [Figure 3].\n","ner_info":[{"text":"24-year-old","label":"AGE","start":2,"end":13},{"text":"Azeri","label":"PERSONAL_BACKGROUND","start":14,"end":19},{"text":"male","label":"SEX","start":20,"end":24},{"text":"presented","label":"CLINICAL_EVENT","start":25,"end":34},{"text":"blurred vision","label":"SIGN_SYMPTOM","start":61,"end":75},{"text":"both eyes","label":"BIOLOGICAL_STRUCTURE","start":79,"end":88},{"text":"achondroplasia","label":"HISTORY","start":112,"end":126},{"text":"born at term with normal birth weight","label":"HISTORY","start":154,"end":191},{"text":"no history of hereditary ocular or systemic disease","label":"HISTORY","start":203,"end":254},{"text":"characteristic features of achondroplasia","label":"SIGN_SYMPTOM","start":273,"end":314},{"text":"108 cm","label":"HEIGHT","start":461,"end":467},{"text":"corrected","label":"DETAILED_DESCRIPTION","start":474,"end":483},{"text":"visual 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motility","label":"DIAGNOSTIC_PROCEDURE","start":703,"end":718},{"text":"normal","label":"LAB_VALUE","start":723,"end":729},{"text":"both eyes","label":"BIOLOGICAL_STRUCTURE","start":733,"end":742},{"text":"slit lamp examination","label":"DIAGNOSTIC_PROCEDURE","start":747,"end":768},{"text":"unremarkable","label":"LAB_VALUE","start":773,"end":785},{"text":"intraocular pressure","label":"DIAGNOSTIC_PROCEDURE","start":791,"end":811},{"text":"12 mm Hg","label":"LAB_VALUE","start":816,"end":824},{"text":"Goldmann applanation tonometry","label":"DETAILED_DESCRIPTION","start":828,"end":858},{"text":"Central corneal thickness values","label":"DIAGNOSTIC_PROCEDURE","start":860,"end":892},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":910,"end":918},{"text":"557 \u03bc","label":"LAB_VALUE","start":934,"end":939},{"text":"Dilated fundus examination","label":"DIAGNOSTIC_PROCEDURE","start":955,"end":981},{"text":"well-demarcated","label":"DETAILED_DESCRIPTION","start":993,"end":1008},{"text":"circular","label":"SHAPE","start":1009,"end":1017},{"text":"macular","label":"BIOLOGICAL_STRUCTURE","start":1018,"end":1025},{"text":"lesion","label":"SIGN_SYMPTOM","start":1026,"end":1032},{"text":"both eyes","label":"BIOLOGICAL_STRUCTURE","start":1036,"end":1045},{"text":"right eye","label":"BIOLOGICAL_STRUCTURE","start":1054,"end":1063},{"text":"lesion","label":"SIGN_SYMPTOM","start":1070,"end":1076},{"text":"2.5 disc diameters (DD) in width","label":"DISTANCE","start":1095,"end":1127},{"text":"2.7 DD in length","label":"DISTANCE","start":1132,"end":1148},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":1157,"end":1165},{"text":"lesion","label":"SIGN_SYMPTOM","start":1172,"end":1178},{"text":"2.5 DD in width","label":"DISTANCE","start":1197,"end":1212},{"text":"2.8 DD in length","label":"DISTANCE","start":1217,"end":1233},{"text":"border","label":"DETAILED_DESCRIPTION","start":1239,"end":1245},{"text":"lesions","label":"SIGN_SYMPTOM","start":1253,"end":1260},{"text":"pigmented","label":"DETAILED_DESCRIPTION","start":1265,"end":1274},{"text":"choroidal","label":"BIOLOGICAL_STRUCTURE","start":1287,"end":1296},{"text":"retinal","label":"BIOLOGICAL_STRUCTURE","start":1311,"end":1318},{"text":"vasculature","label":"BIOLOGICAL_STRUCTURE","start":1319,"end":1330},{"text":"normal","label":"LAB_VALUE","start":1340,"end":1346},{"text":"stalk of tissue","label":"SIGN_SYMPTOM","start":1363,"end":1378},{"text":"from the optic disc","label":"BIOLOGICAL_STRUCTURE","start":1388,"end":1407},{"text":"into the vitreous","label":"BIOLOGICAL_STRUCTURE","start":1420,"end":1437},{"text":"Fluorescein","label":"DETAILED_DESCRIPTION","start":1450,"end":1461},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":1462,"end":1473},{"text":"posterior segment","label":"BIOLOGICAL_STRUCTURE","start":1481,"end":1498},{"text":"optical coherence tomography","label":"DIAGNOSTIC_PROCEDURE","start":1503,"end":1531},{"text":"optic nerve head","label":"BIOLOGICAL_STRUCTURE","start":1539,"end":1555}],"tokens":["A ","24-year-old"," ","Azeri"," ","male"," ","presented"," with a chief complaint of ","blurred vision"," in ","both eyes",".\nHe was diagnosed with ","achondroplasia"," in early childhood.\nHe was ","born at term with normal birth weight",".\nThere was ","no history of hereditary ocular or systemic disease",".\nThis patient had ","characteristic features of achondroplasia"," (i.e., short stature, lumbar lordosis, short proximal long bones, large hands, frontal bossing, and flat nasal bridge) [Figure 1].\nHis height was ","108 cm",".\nBest ","corrected"," ","visual acuity"," was ","20\/70"," in the ","right eye"," with ","\u22120.75 + 1.25 \u00d7 60\u00b0"," and ","20\/70"," in the ","left eye"," with ","OS",": ","+0.25 + 0.50 \u00d7 130\u00b0",".\n","Pupils"," were ","equal in size",", ","round"," and ","reactive to light"," with no ","reverse afferent pupillary defect",".\n","Ocular motility"," was ","normal"," in ","both eyes"," and ","slit lamp examination"," was ","unremarkable",".\nThe ","intraocular pressure"," was ","12 mm Hg"," by ","Goldmann applanation tonometry",".\n","Central corneal thickness values"," of the right and ","left eye","s were, 561 and ","557 \u03bc",", respectively.\n","Dilated fundus examination"," revealed a ","well-demarcated"," ","circular"," ","macular"," ","lesion"," in ","both eyes",".\nIn the ","right eye",", this ","lesion"," was approximately ","2.5 disc diameters (DD) in width"," and ","2.7 DD in length",".\nIn the ","left eye",", this ","lesion"," was approximately ","2.5 DD in width"," and ","2.8 DD in length",".\nThe ","border"," of the ","lesions"," was ","pigmented",".\nUnderlying ","choroidal"," and overlying ","retinal"," ","vasculature"," appeared ","normal",".\nIn addition, a ","stalk of tissue"," emanated ","from the optic disc"," and coursed ","into the vitreous"," [Figure 2].\n","Fluorescein"," ","angiography"," of the ","posterior segment"," and ","optical coherence tomography"," of the ","optic nerve head"," (Stratus; Carl Zeiss GmbH, Jena, Germany) were performed [Figures \u200b[Figures3 and 4].\nDue to the background maculopathy, the patient could not appropriately fixate on the target during image acquisition resulting in slightly decentered fluorescein angiography images [Figure 3].\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,69,0,12,0,39,0,39,0,39,0,69,0,38,0,22,0,24,0,42,0,12,0,42,0,42,0,12,0,12,0,42,0,12,0,22,0,22,0,22,0,69,0,24,0,42,0,12,0,24,0,42,0,24,0,42,0,22,0,24,0,12,0,42,0,24,0,22,0,67,0,12,0,69,0,12,0,12,0,69,0,27,0,27,0,12,0,69,0,27,0,27,0,22,0,69,0,22,0,12,0,12,0,12,0,42,0,69,0,12,0,12,0,22,0,24,0,12,0,24,0,12,0]}
-{"full_text":"A 64 year old female known for HHT is referred to our clinic for recurrent epistaxis for nearly 50 years.\nShe has had recurrent symptoms since the age of 16 when her condition was diagnosed.\nAll three of her siblings also were diagnosed with HHT and her mother passed away from an intracranial hemorrhage.\nEight years prior to presentation she had undergone a left-sided septodermoplasty via a lateral rhinotomy approach.\nThis operation had significantly reduced the frequency of her symptoms and for several years her epistaxis was under control with the use of low dose thalidomide.\nHowever, she was referred to our clinic due to increased epistaxis severity and frequency over the prior 12 months necessitating more frequent transfusions.\nAt the time of consultation the patient was concerned about daily severe left sided epistaxis despite several months use of topical bevacizumab and oral tranexamic acid.\nShe required intravenous iron and blood transfusions every two months.\nHer baseline hemoglobin at the time of our consultation was 75 g\/L (normal\u2009=\u2009120 \u2013 160 g\/L).\nHer HHT epistaxis severity score [17] was severe (normalized score 9.49).\nOn examination, she had multiple telangiectasia on her fingers, face, lips and palate.\nHer endoscopic examination revealed bilateral telangiectasia along the nasal septum.\nThere was extensive crusting along the entire left nasal cavity with which any manipulation resulted in immediate profuse epistaxis.\nGiven the severity of the patient\u2019s epistaxis despite medical therapy, she was offered endoscopic left-sided septodermoplasty.\nThe surgical goals were to improve her quality of life by reducing the number and severity of epistaxis episodes while diminishing the need for blood transfusions.\nThe patient was content with the treatment plan and agreed to undergo surgical intervention.\nThe endoscopic procedure was performed under general anesthesia with endotracheal intubation.\nThe nasal cavity was prepared by inserting pledgets soaked in topical adrenaline (1:1000) placed in both nostrils for decongestion.\nUsing a zero degree endoscope the residual STSG and mucosa of the left septum was dissected in a supraperichondrial plane that resulted in the expected significant diffuse hemorrhage.\nImmediate hemostasis was attained using a topical gelatin-thrombin matrix, Floseal (FloSeal Hemostatic Matrix; Baxter Healthcare Corporation, Deerfield, IL, USA) (Fig.1).\nThe mucosal defect (Fig.2) measured approximately 3 cm in anterior-posterior dimension.\nA 4 x 2 cm split thickness skin graft was harvested from the right thigh, pie-crusted with a 15 blade and then placed endoscopically along the length of the septal defect.\nAs seen in Fig.3, the graft was placed with an overlap of the mucosa of the nasal floor and the residual superior septal mucosa.\nFinally, 2 mL of fibrin sealant (TISSEEL fibrin sealant, Baxter Healthcare Corporation, Deerfield, IL, USA) was then applied first to the edges then central portion of the STSG (Fig.4).\nPacking was not used post-operatively and the patient was discharged home on the same day of surgery.\nClinical follow-up two weeks after surgery (Fig.5) showed that the entire graft had taken and the left-sided epistaxis had dramatically diminished.\nThe patient was very content with the results of the procedure.\nAt 6 months follow-up, her baseline hemoglobin had improved to 102 g\/L and she was requiring transfusions every 4 months with her hematologist\u2019s intent to stop the transfusions if her hemoglobin remained greater than 100 g\/L.\nHer epistaxis severity score at 6 month follow up was mild (normalized score 3.05).\n","ner_info":[{"text":"64 year old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"known for HHT","label":"HISTORY","start":21,"end":34},{"text":"referred","label":"CLINICAL_EVENT","start":38,"end":46},{"text":"clinic","label":"NONBIOLOGICAL_LOCATION","start":54,"end":60},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":65,"end":74},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":75,"end":84},{"text":"nearly 50 years","label":"DURATION","start":89,"end":104},{"text":"symptoms","label":"COREFERENCE","start":128,"end":136},{"text":"since the age of 16","label":"DATE","start":137,"end":156},{"text":"condition","label":"COREFERENCE","start":166,"end":175},{"text":"All three of her siblings also were diagnosed with HHT","label":"FAMILY_HISTORY","start":191,"end":245},{"text":"her mother passed away from an intracranial hemorrhage","label":"FAMILY_HISTORY","start":250,"end":304},{"text":"Eight years prior","label":"DATE","start":306,"end":323},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":360,"end":370},{"text":"septodermoplasty","label":"THERAPEUTIC_PROCEDURE","start":371,"end":387},{"text":"lateral","label":"DETAILED_DESCRIPTION","start":394,"end":401},{"text":"rhinotomy","label":"THERAPEUTIC_PROCEDURE","start":402,"end":411},{"text":"operation","label":"COREFERENCE","start":427,"end":436},{"text":"symptoms","label":"SIGN_SYMPTOM","start":484,"end":492},{"text":"for several years","label":"DURATION","start":497,"end":514},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":519,"end":528},{"text":"under control","label":"LAB_VALUE","start":533,"end":546},{"text":"low dose","label":"DOSAGE","start":563,"end":571},{"text":"thalidomide","label":"MEDICATION","start":572,"end":583},{"text":"referred","label":"CLINICAL_EVENT","start":602,"end":610},{"text":"clinic","label":"NONBIOLOGICAL_LOCATION","start":618,"end":624},{"text":"increased","label":"DETAILED_DESCRIPTION","start":632,"end":641},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":642,"end":651},{"text":"severity","label":"SEVERITY","start":652,"end":660},{"text":"frequency","label":"FREQUENCY","start":665,"end":674},{"text":"over the prior 12 months","label":"DURATION","start":675,"end":699},{"text":"transfusions","label":"THERAPEUTIC_PROCEDURE","start":728,"end":740},{"text":"consultation","label":"CLINICAL_EVENT","start":757,"end":769},{"text":"daily","label":"FREQUENCY","start":802,"end":807},{"text":"severe","label":"SEVERITY","start":808,"end":814},{"text":"left sided","label":"BIOLOGICAL_STRUCTURE","start":815,"end":825},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":826,"end":835},{"text":"several months","label":"DURATION","start":844,"end":858},{"text":"topical","label":"ADMINISTRATION","start":866,"end":873},{"text":"bevacizumab","label":"MEDICATION","start":874,"end":885},{"text":"oral","label":"ADMINISTRATION","start":890,"end":894},{"text":"tranexamic acid","label":"MEDICATION","start":895,"end":910},{"text":"intravenous","label":"ADMINISTRATION","start":925,"end":936},{"text":"iron","label":"MEDICATION","start":937,"end":941},{"text":"blood transfusions","label":"THERAPEUTIC_PROCEDURE","start":946,"end":964},{"text":"every two months","label":"FREQUENCY","start":965,"end":981},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":996,"end":1006},{"text":"consultation","label":"CLINICAL_EVENT","start":1026,"end":1038},{"text":"75 g\/L","label":"LAB_VALUE","start":1043,"end":1049},{"text":"HHT epistaxis severity score","label":"DIAGNOSTIC_PROCEDURE","start":1080,"end":1108},{"text":"severe","label":"LAB_VALUE","start":1118,"end":1124},{"text":"normalized score 9.49","label":"LAB_VALUE","start":1126,"end":1147},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":1153,"end":1164},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1174,"end":1182},{"text":"telangiectasia","label":"SIGN_SYMPTOM","start":1183,"end":1197},{"text":"fingers","label":"BIOLOGICAL_STRUCTURE","start":1205,"end":1212},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":1214,"end":1218},{"text":"lips","label":"BIOLOGICAL_STRUCTURE","start":1220,"end":1224},{"text":"palate","label":"BIOLOGICAL_STRUCTURE","start":1229,"end":1235},{"text":"endoscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1241,"end":1263},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1273,"end":1282},{"text":"telangiectasia","label":"SIGN_SYMPTOM","start":1283,"end":1297},{"text":"nasal septum","label":"BIOLOGICAL_STRUCTURE","start":1308,"end":1320},{"text":"extensive","label":"SEVERITY","start":1332,"end":1341},{"text":"crusting","label":"SIGN_SYMPTOM","start":1342,"end":1350},{"text":"left nasal cavity","label":"BIOLOGICAL_STRUCTURE","start":1368,"end":1385},{"text":"manipulation","label":"DIAGNOSTIC_PROCEDURE","start":1401,"end":1413},{"text":"immediate","label":"DETAILED_DESCRIPTION","start":1426,"end":1435},{"text":"profuse","label":"SEVERITY","start":1436,"end":1443},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":1444,"end":1453},{"text":"endoscopic","label":"DETAILED_DESCRIPTION","start":1542,"end":1552},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":1553,"end":1563},{"text":"septodermoplasty","label":"THERAPEUTIC_PROCEDURE","start":1564,"end":1580},{"text":"endoscopic procedure","label":"THERAPEUTIC_PROCEDURE","start":1843,"end":1863},{"text":"general anesthesia","label":"MEDICATION","start":1884,"end":1902},{"text":"endotracheal","label":"DETAILED_DESCRIPTION","start":1908,"end":1920},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":1921,"end":1931},{"text":"nasal cavity","label":"BIOLOGICAL_STRUCTURE","start":1937,"end":1949},{"text":"prepared","label":"THERAPEUTIC_PROCEDURE","start":1954,"end":1962},{"text":"inserting pledgets","label":"DETAILED_DESCRIPTION","start":1966,"end":1984},{"text":"topical","label":"ADMINISTRATION","start":1995,"end":2002},{"text":"adrenaline","label":"MEDICATION","start":2003,"end":2013},{"text":"1:1000","label":"DOSAGE","start":2015,"end":2021},{"text":"both nostrils","label":"BIOLOGICAL_STRUCTURE","start":2033,"end":2046},{"text":"Using a zero degree endoscope","label":"DETAILED_DESCRIPTION","start":2065,"end":2094},{"text":"residual STSG and mucosa of the left septum","label":"BIOLOGICAL_STRUCTURE","start":2099,"end":2142},{"text":"dissected","label":"THERAPEUTIC_PROCEDURE","start":2147,"end":2156},{"text":"in a supraperichondrial plane","label":"DETAILED_DESCRIPTION","start":2157,"end":2186},{"text":"significant","label":"SEVERITY","start":2217,"end":2228},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2229,"end":2236},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":2237,"end":2247},{"text":"Immediate","label":"DETAILED_DESCRIPTION","start":2249,"end":2258},{"text":"hemostasis","label":"THERAPEUTIC_PROCEDURE","start":2259,"end":2269},{"text":"topical gelatin-thrombin matrix","label":"DETAILED_DESCRIPTION","start":2291,"end":2322},{"text":"Floseal","label":"DETAILED_DESCRIPTION","start":2324,"end":2331},{"text":"mucosal defect","label":"SIGN_SYMPTOM","start":2424,"end":2438},{"text":"3 cm","label":"DISTANCE","start":2470,"end":2474},{"text":"anterior-posterior dimension","label":"DETAILED_DESCRIPTION","start":2478,"end":2506},{"text":"4 x 2 cm split thickness","label":"AREA","start":2510,"end":2534},{"text":"skin graft was harvested","label":"THERAPEUTIC_PROCEDURE","start":2535,"end":2559},{"text":"right thigh","label":"BIOLOGICAL_STRUCTURE","start":2569,"end":2580},{"text":"pie-crusted with a 15 blade","label":"DETAILED_DESCRIPTION","start":2582,"end":2609},{"text":"placed endoscopically","label":"DETAILED_DESCRIPTION","start":2619,"end":2640},{"text":"along the length of the septal defect","label":"BIOLOGICAL_STRUCTURE","start":2641,"end":2678},{"text":"graft","label":"COREFERENCE","start":2702,"end":2707},{"text":"overlap of the mucosa of the nasal floor and the residual superior septal mucosa","label":"BIOLOGICAL_STRUCTURE","start":2727,"end":2807},{"text":"2 mL","label":"VOLUME","start":2818,"end":2822},{"text":"fibrin sealant","label":"DETAILED_DESCRIPTION","start":2826,"end":2840},{"text":"applied first to the edges then central portion of the STSG","label":"DETAILED_DESCRIPTION","start":2926,"end":2985},{"text":"Packing","label":"THERAPEUTIC_PROCEDURE","start":2995,"end":3002},{"text":"discharged","label":"CLINICAL_EVENT","start":3053,"end":3063},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":3064,"end":3068},{"text":"on the same day of surgery","label":"DATE","start":3069,"end":3095},{"text":"follow-up","label":"CLINICAL_EVENT","start":3106,"end":3115},{"text":"two weeks after","label":"DATE","start":3116,"end":3131},{"text":"graft had taken","label":"SIGN_SYMPTOM","start":3171,"end":3186},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":3195,"end":3205},{"text":"epistaxis","label":"SIGN_SYMPTOM","start":3206,"end":3215},{"text":"6 months","label":"DATE","start":3312,"end":3320},{"text":"follow-up","label":"CLINICAL_EVENT","start":3321,"end":3330},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":3345,"end":3355},{"text":"102 g\/L","label":"LAB_VALUE","start":3372,"end":3379},{"text":"transfusions","label":"THERAPEUTIC_PROCEDURE","start":3402,"end":3414},{"text":"every 4 months","label":"FREQUENCY","start":3415,"end":3429},{"text":"epistaxis severity score","label":"DIAGNOSTIC_PROCEDURE","start":3539,"end":3563},{"text":"mild","label":"LAB_VALUE","start":3589,"end":3593},{"text":"normalized score 3.05","label":"LAB_VALUE","start":3595,"end":3616}],"tokens":["A ","64 year old"," ","female"," ","known for HHT"," is ","referred"," to our ","clinic"," for ","recurrent"," ","epistaxis"," for ","nearly 50 years",".\nShe has had recurrent ","symptoms"," ","since the age of 16"," when her ","condition"," was diagnosed.\n","All three of her siblings also were diagnosed with HHT"," and ","her mother passed away from an intracranial hemorrhage",".\n","Eight years prior"," to presentation she had undergone a ","left-sided"," ","septodermoplasty"," via a ","lateral"," ","rhinotomy"," approach.\nThis ","operation"," had significantly reduced the frequency of her ","symptoms"," and ","for several years"," her ","epistaxis"," was ","under control"," with the use of ","low dose"," ","thalidomide",".\nHowever, she was ","referred"," to our ","clinic"," due to ","increased"," ","epistaxis"," ","severity"," and ","frequency"," ","over the prior 12 months"," necessitating more frequent ","transfusions",".\nAt the time of ","consultation"," the patient was concerned about ","daily"," ","severe"," ","left sided"," ","epistaxis"," despite ","several months"," use of ","topical"," ","bevacizumab"," and ","oral"," ","tranexamic acid",".\nShe required ","intravenous"," ","iron"," and ","blood transfusions"," ","every two months",".\nHer baseline ","hemoglobin"," at the time of our ","consultation"," was ","75 g\/L"," (normal\u2009=\u2009120 \u2013 160 g\/L).\nHer ","HHT epistaxis severity score"," [17] was ","severe"," (","normalized score 9.49",").\nOn ","examination",", she had ","multiple"," ","telangiectasia"," on her ","fingers",", ","face",", ","lips"," and ","palate",".\nHer ","endoscopic examination"," revealed ","bilateral"," ","telangiectasia"," along the ","nasal septum",".\nThere was ","extensive"," ","crusting"," along the entire ","left nasal cavity"," with which any ","manipulation"," resulted in ","immediate"," ","profuse"," ","epistaxis",".\nGiven the severity of the patient\u2019s epistaxis despite medical therapy, she was offered ","endoscopic"," ","left-sided"," ","septodermoplasty",".\nThe surgical goals were to improve her quality of life by reducing the number and severity of epistaxis episodes while diminishing the need for blood transfusions.\nThe patient was content with the treatment plan and agreed to undergo surgical intervention.\nThe ","endoscopic procedure"," was performed under ","general anesthesia"," with ","endotracheal"," ","intubation",".\nThe ","nasal cavity"," was ","prepared"," by ","inserting pledgets"," soaked in ","topical"," ","adrenaline"," (","1:1000",") placed in ","both nostrils"," for decongestion.\n","Using a zero degree endoscope"," the ","residual STSG and mucosa of the left septum"," was ","dissected"," ","in a supraperichondrial plane"," that resulted in the expected ","significant"," ","diffuse"," ","hemorrhage",".\n","Immediate"," ","hemostasis"," was attained using a ","topical gelatin-thrombin matrix",", ","Floseal"," (FloSeal Hemostatic Matrix; Baxter Healthcare Corporation, Deerfield, IL, USA) (Fig.1).\nThe ","mucosal defect"," (Fig.2) measured approximately ","3 cm"," in ","anterior-posterior dimension",".\nA ","4 x 2 cm split thickness"," ","skin graft was harvested"," from the ","right thigh",", ","pie-crusted with a 15 blade"," and then ","placed endoscopically"," ","along the length of the septal defect",".\nAs seen in Fig.3, the ","graft"," was placed with an ","overlap of the mucosa of the nasal floor and the residual superior septal mucosa",".\nFinally, ","2 mL"," of ","fibrin sealant"," (TISSEEL fibrin sealant, Baxter Healthcare Corporation, Deerfield, IL, USA) was then ","applied first to the edges then central portion of the STSG"," (Fig.4).\n","Packing"," was not used post-operatively and the patient was ","discharged"," ","home"," ","on the same day of surgery",".\nClinical ","follow-up"," ","two weeks after"," surgery (Fig.5) showed that the entire ","graft had taken"," and the ","left-sided"," ","epistaxis"," had dramatically diminished.\nThe patient was very content with the results of the procedure.\nAt ","6 months"," ","follow-up",", her baseline ","hemoglobin"," had improved to ","102 g\/L"," and she was requiring ","transfusions"," ","every 4 months"," with her hematologist\u2019s intent to stop the transfusions if her hemoglobin remained greater than 100 g\/L.\nHer ","epistaxis severity score"," at 6 month follow up was ","mild"," (","normalized score 3.05",").\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,48,0,22,0,69,0,32,0,18,0,19,0,18,0,34,0,34,0,19,0,22,0,75,0,22,0,75,0,18,0,69,0,32,0,69,0,42,0,29,0,46,0,13,0,48,0,22,0,69,0,63,0,35,0,32,0,75,0,13,0,35,0,63,0,12,0,69,0,32,0,4,0,46,0,4,0,46,0,4,0,46,0,75,0,35,0,24,0,13,0,42,0,24,0,42,0,42,0,24,0,22,0,69,0,12,0,12,0,12,0,12,0,24,0,22,0,69,0,12,0,63,0,69,0,12,0,24,0,22,0,63,0,69,0,22,0,22,0,75,0,75,0,46,0,22,0,75,0,12,0,75,0,22,0,4,0,46,0,29,0,12,0,22,0,12,0,75,0,22,0,63,0,22,0,69,0,22,0,75,0,22,0,22,0,69,0,27,0,22,0,8,0,75,0,12,0,22,0,22,0,12,0,18,0,12,0,79,0,22,0,22,0,75,0,13,0,48,0,19,0,13,0,19,0,69,0,22,0,69,0,19,0,13,0,24,0,42,0,75,0,35,0,24,0,42,0,42,0]}
-{"full_text":"A 65-year-old man was admitted to the China-Japan Friendship hospital with a chief complaint of progressive dysphagia for 3 mo.\nHe also complained of a drastic weight loss of 8 kg in the past 2 mo.\nHe denied a history of smoking, alcohol intake and substance abuse, but had a chronic atrophic gastritis for nearly 10 years.\nAlso, there was no family history of genetic defect or malignancy.\nPhysical examination showed no palpable findings.\nAdmission blood test showed a slight decrease in hemoglobin (106 g\/L).\nUpper gastrointestinal (GI) examination using barium contrasts showed a large tumor blocking the esophago-gastric junction (Figure \u200b1).\nComputed tomography (CT) scan revealed a soft mass in the esophago-gastric junction with lymph node metastasis in the lesser curvature of the stomach (Figure \u200b2).\nEndoscopic examination showed a black spot in the lower esophagus and a bulky black mass blocking the esophago-gastric junction, as well as two black crater-like ulcers in the fundus of the stomach (Figure \u200b3).\nBiopsy specimens taken from the tumor were identified as poorly differentiated adenocarcinoma.\nPreoperative nutrition status of this case was scored 2 based on the Nutrition Risk Screening 2002 (NRS 2002)[6].\nBecause of the obstructive symptom caused by the tumor, a debulking surgery of distal esophagectomy and proximal gastrectomy was performed.\nEsophagogastric anastomosis and reconstruction was then completed with stapling device.\nIntraoperatively, the tumor was found located at the esophago-gastric junction and the tumor infiltrated the whole layer with lymph node metastasis at station four.\nNo ascites or dissemination of the tumor was observed in the peritoneal cavity.\nThe tumor measured 3 cm \u00d7 6 cm in size with black pigmentation (Figure \u200b4).\nThere were several pigmented satellite nodules beside the main tumor lesion, the largest one being 1 cm \u00d7 1 cm in diameter.\nMoreover, two ulceration lesions were found at the fundus of the stomach.\nMicroscopically, the excised tumor tissue was composed of non-organized and pleomorphic cells exhibiting atypical nuclei, and abundant melanin granules (Figure \u200b5).\nPathological examination identified this case at a stage of IVA (T4aN1M0).\nImmunohistochemical staining showed that the tumor was positive for S-100, HMB-45, mclean-A and Vimentin, but negative for cytokeratin 7 and cytokeratin 20 (Figure \u200b6).\nBased on these results, a diagnosis of primary advanced esophago-gastric melanoma was established.\nThe postoperative course was smooth and without complications.\nThe patient gradually recovered and was discharged 14 d after surgery.\nAs the patient denied a postoperative adjuvant therapy, abdominal recurrence and hepatic metastases were found within one month by a postoperative follow-up CT.\nNo other effective treatment was administered afterwards.\nThe patient died of diffuse metastatic disease 2 mo later.\n","ner_info":[{"text":"65-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"admitted","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"China-Japan Friendship hospital","label":"NONBIOLOGICAL_LOCATION","start":38,"end":69},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":96,"end":107},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":108,"end":117},{"text":"3 mo","label":"DURATION","start":122,"end":126},{"text":"drastic","label":"SEVERITY","start":152,"end":159},{"text":"weight loss","label":"SIGN_SYMPTOM","start":160,"end":171},{"text":"8 kg","label":"LAB_VALUE","start":175,"end":179},{"text":"past 2 mo","label":"DURATION","start":187,"end":196},{"text":"denied a history of smoking, alcohol intake and substance abuse","label":"HISTORY","start":201,"end":264},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":276,"end":283},{"text":"atrophic","label":"DETAILED_DESCRIPTION","start":284,"end":292},{"text":"gastritis","label":"HISTORY","start":293,"end":302},{"text":"nearly 10 years","label":"DURATION","start":307,"end":322},{"text":"no family history of genetic defect or malignancy","label":"FAMILY_HISTORY","start":340,"end":389},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":391,"end":411},{"text":"no palpable findings","label":"LAB_VALUE","start":419,"end":439},{"text":"blood test","label":"DIAGNOSTIC_PROCEDURE","start":451,"end":461},{"text":"slight decrease","label":"LAB_VALUE","start":471,"end":486},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":490,"end":500},{"text":"106 g\/L","label":"LAB_VALUE","start":502,"end":509},{"text":"Upper gastrointestinal","label":"BIOLOGICAL_STRUCTURE","start":512,"end":534},{"text":"GI","label":"BIOLOGICAL_STRUCTURE","start":536,"end":538},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":540,"end":551},{"text":"barium contrasts","label":"DETAILED_DESCRIPTION","start":558,"end":574},{"text":"large","label":"SEVERITY","start":584,"end":589},{"text":"tumor","label":"SIGN_SYMPTOM","start":590,"end":595},{"text":"blocking","label":"SIGN_SYMPTOM","start":596,"end":604},{"text":"esophago-gastric junction","label":"BIOLOGICAL_STRUCTURE","start":609,"end":634},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":648,"end":667},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":669,"end":671},{"text":"soft","label":"TEXTURE","start":689,"end":693},{"text":"mass","label":"SIGN_SYMPTOM","start":694,"end":698},{"text":"esophago-gastric junction","label":"BIOLOGICAL_STRUCTURE","start":706,"end":731},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":737,"end":747},{"text":"metastasis","label":"SIGN_SYMPTOM","start":748,"end":758},{"text":"lesser curvature of the stomach","label":"BIOLOGICAL_STRUCTURE","start":766,"end":797},{"text":"Endoscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":811,"end":833},{"text":"black","label":"COLOR","start":843,"end":848},{"text":"spot","label":"SIGN_SYMPTOM","start":849,"end":853},{"text":"lower esophagus","label":"BIOLOGICAL_STRUCTURE","start":861,"end":876},{"text":"bulky","label":"DETAILED_DESCRIPTION","start":883,"end":888},{"text":"black","label":"COLOR","start":889,"end":894},{"text":"mass","label":"SIGN_SYMPTOM","start":895,"end":899},{"text":"blocking","label":"SIGN_SYMPTOM","start":900,"end":908},{"text":"esophago-gastric junction","label":"BIOLOGICAL_STRUCTURE","start":913,"end":938},{"text":"two","label":"DETAILED_DESCRIPTION","start":951,"end":954},{"text":"black","label":"COLOR","start":955,"end":960},{"text":"crater-like","label":"SHAPE","start":961,"end":972},{"text":"ulcers","label":"SIGN_SYMPTOM","start":973,"end":979},{"text":"fundus of the stomach","label":"BIOLOGICAL_STRUCTURE","start":987,"end":1008},{"text":"Biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1022,"end":1028},{"text":"tumor","label":"SIGN_SYMPTOM","start":1054,"end":1059},{"text":"poorly differentiated","label":"DETAILED_DESCRIPTION","start":1079,"end":1100},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":1101,"end":1115},{"text":"nutrition status","label":"DIAGNOSTIC_PROCEDURE","start":1130,"end":1146},{"text":"2","label":"LAB_VALUE","start":1171,"end":1172},{"text":"Nutrition Risk Screening 2002","label":"DETAILED_DESCRIPTION","start":1186,"end":1215},{"text":"obstructive symptom","label":"COREFERENCE","start":1246,"end":1265},{"text":"tumor","label":"COREFERENCE","start":1280,"end":1285},{"text":"debulking surgery","label":"THERAPEUTIC_PROCEDURE","start":1289,"end":1306},{"text":"distal","label":"DETAILED_DESCRIPTION","start":1310,"end":1316},{"text":"esophagectomy","label":"THERAPEUTIC_PROCEDURE","start":1317,"end":1330},{"text":"proximal","label":"DETAILED_DESCRIPTION","start":1335,"end":1343},{"text":"gastrectomy","label":"THERAPEUTIC_PROCEDURE","start":1344,"end":1355},{"text":"Esophagogastric","label":"BIOLOGICAL_STRUCTURE","start":1371,"end":1386},{"text":"anastomosis","label":"THERAPEUTIC_PROCEDURE","start":1387,"end":1398},{"text":"reconstruction","label":"THERAPEUTIC_PROCEDURE","start":1403,"end":1417},{"text":"stapling device","label":"THERAPEUTIC_PROCEDURE","start":1442,"end":1457},{"text":"tumor","label":"SIGN_SYMPTOM","start":1481,"end":1486},{"text":"esophago-gastric junction","label":"BIOLOGICAL_STRUCTURE","start":1512,"end":1537},{"text":"tumor","label":"COREFERENCE","start":1546,"end":1551},{"text":"infiltrated","label":"SIGN_SYMPTOM","start":1552,"end":1563},{"text":"whole layer","label":"BIOLOGICAL_STRUCTURE","start":1568,"end":1579},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":1585,"end":1595},{"text":"metastasis","label":"SIGN_SYMPTOM","start":1596,"end":1606},{"text":"station four","label":"BIOLOGICAL_STRUCTURE","start":1610,"end":1622},{"text":"ascites","label":"SIGN_SYMPTOM","start":1627,"end":1634},{"text":"dissemination of the tumor","label":"SIGN_SYMPTOM","start":1638,"end":1664},{"text":"peritoneal cavity","label":"BIOLOGICAL_STRUCTURE","start":1685,"end":1702},{"text":"tumor","label":"SIGN_SYMPTOM","start":1708,"end":1713},{"text":"3 cm \u00d7 6 cm","label":"AREA","start":1723,"end":1734},{"text":"black pigmentation","label":"COLOR","start":1748,"end":1766},{"text":"several","label":"DETAILED_DESCRIPTION","start":1791,"end":1798},{"text":"pigmented","label":"COLOR","start":1799,"end":1808},{"text":"satellite","label":"DETAILED_DESCRIPTION","start":1809,"end":1818},{"text":"nodules","label":"SIGN_SYMPTOM","start":1819,"end":1826},{"text":"main tumor lesion","label":"COREFERENCE","start":1838,"end":1855},{"text":"largest one","label":"COREFERENCE","start":1861,"end":1872},{"text":"1 cm \u00d7 1 cm","label":"AREA","start":1879,"end":1890},{"text":"ulceration","label":"DETAILED_DESCRIPTION","start":1918,"end":1928},{"text":"lesions","label":"SIGN_SYMPTOM","start":1929,"end":1936},{"text":"fundus of the stomach","label":"BIOLOGICAL_STRUCTURE","start":1955,"end":1976},{"text":"Microscopically","label":"DIAGNOSTIC_PROCEDURE","start":1978,"end":1993},{"text":"tumor tissue","label":"BIOLOGICAL_STRUCTURE","start":2007,"end":2019},{"text":"non-organized","label":"LAB_VALUE","start":2036,"end":2049},{"text":"pleomorphic","label":"LAB_VALUE","start":2054,"end":2065},{"text":"cells","label":"DIAGNOSTIC_PROCEDURE","start":2066,"end":2071},{"text":"atypical","label":"LAB_VALUE","start":2083,"end":2091},{"text":"nuclei","label":"DIAGNOSTIC_PROCEDURE","start":2092,"end":2098},{"text":"abundant","label":"LAB_VALUE","start":2104,"end":2112},{"text":"melanin granules","label":"DIAGNOSTIC_PROCEDURE","start":2113,"end":2129},{"text":"Pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":2143,"end":2167},{"text":"stage","label":"DIAGNOSTIC_PROCEDURE","start":2194,"end":2199},{"text":"IVA","label":"LAB_VALUE","start":2203,"end":2206},{"text":"T4aN1M0","label":"LAB_VALUE","start":2208,"end":2215},{"text":"Immunohistochemical staining","label":"DIAGNOSTIC_PROCEDURE","start":2218,"end":2246},{"text":"tumor","label":"COREFERENCE","start":2263,"end":2268},{"text":"positive","label":"LAB_VALUE","start":2273,"end":2281},{"text":"S-100","label":"DIAGNOSTIC_PROCEDURE","start":2286,"end":2291},{"text":"HMB-45","label":"DIAGNOSTIC_PROCEDURE","start":2293,"end":2299},{"text":"mclean-A","label":"DIAGNOSTIC_PROCEDURE","start":2301,"end":2309},{"text":"Vimentin","label":"DIAGNOSTIC_PROCEDURE","start":2314,"end":2322},{"text":"negative","label":"LAB_VALUE","start":2328,"end":2336},{"text":"cytokeratin 7","label":"DIAGNOSTIC_PROCEDURE","start":2341,"end":2354},{"text":"cytokeratin 20","label":"DIAGNOSTIC_PROCEDURE","start":2359,"end":2373},{"text":"primary","label":"DETAILED_DESCRIPTION","start":2426,"end":2433},{"text":"advanced","label":"SEVERITY","start":2434,"end":2442},{"text":"esophago-gastric","label":"DETAILED_DESCRIPTION","start":2443,"end":2459},{"text":"melanoma","label":"DISEASE_DISORDER","start":2460,"end":2468},{"text":"postoperative course","label":"THERAPEUTIC_PROCEDURE","start":2490,"end":2510},{"text":"smooth","label":"LAB_VALUE","start":2515,"end":2521},{"text":"complications","label":"SIGN_SYMPTOM","start":2534,"end":2547},{"text":"recovered","label":"SIGN_SYMPTOM","start":2571,"end":2580},{"text":"discharged","label":"CLINICAL_EVENT","start":2589,"end":2599},{"text":"14 d after","label":"DATE","start":2600,"end":2610},{"text":"adjuvant therapy","label":"MEDICATION","start":2658,"end":2674},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":2676,"end":2685},{"text":"recurrence","label":"SIGN_SYMPTOM","start":2686,"end":2696},{"text":"hepatic","label":"BIOLOGICAL_STRUCTURE","start":2701,"end":2708},{"text":"metastases","label":"SIGN_SYMPTOM","start":2709,"end":2719},{"text":"within one month","label":"DATE","start":2731,"end":2747},{"text":"follow-up","label":"CLINICAL_EVENT","start":2767,"end":2776},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2777,"end":2779},{"text":"other effective treatment","label":"THERAPEUTIC_PROCEDURE","start":2784,"end":2809},{"text":"died","label":"OUTCOME","start":2851,"end":2855},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2859,"end":2866},{"text":"metastatic disease","label":"DISEASE_DISORDER","start":2867,"end":2885},{"text":"2 mo later","label":"DATE","start":2886,"end":2896}],"tokens":["A ","65-year-old"," ","man"," was ","admitted"," to the ","China-Japan Friendship hospital"," with a chief complaint of ","progressive"," ","dysphagia"," for ","3 mo",".\nHe also complained of a ","drastic"," ","weight loss"," of ","8 kg"," in the ","past 2 mo",".\nHe ","denied a history of smoking, alcohol intake and substance abuse",", but had a ","chronic"," ","atrophic"," ","gastritis"," for ","nearly 10 years",".\nAlso, there was ","no family history of genetic defect or malignancy",".\n","Physical examination"," showed ","no palpable findings",".\nAdmission ","blood test"," showed a ","slight decrease"," in ","hemoglobin"," (","106 g\/L",").\n","Upper gastrointestinal"," (","GI",") ","examination"," using ","barium contrasts"," showed a ","large"," ","tumor"," ","blocking"," the ","esophago-gastric junction"," (Figure \u200b1).\n","Computed tomography"," (","CT",") scan revealed a ","soft"," ","mass"," in the ","esophago-gastric junction"," with ","lymph node"," ","metastasis"," in the ","lesser curvature of the stomach"," (Figure \u200b2).\n","Endoscopic examination"," showed a ","black"," ","spot"," in the ","lower esophagus"," and a ","bulky"," ","black"," ","mass"," ","blocking"," the ","esophago-gastric junction",", as well as ","two"," ","black"," ","crater-like"," ","ulcers"," in the ","fundus of the stomach"," (Figure \u200b3).\n","Biopsy"," specimens taken from the ","tumor"," were identified as ","poorly differentiated"," ","adenocarcinoma",".\nPreoperative ","nutrition status"," of this case was scored ","2"," based on the ","Nutrition Risk Screening 2002"," (NRS 2002)[6].\nBecause of the ","obstructive symptom"," caused by the ","tumor",", a ","debulking surgery"," of ","distal"," ","esophagectomy"," and ","proximal"," ","gastrectomy"," was performed.\n","Esophagogastric"," ","anastomosis"," and ","reconstruction"," was then completed with ","stapling device",".\nIntraoperatively, the ","tumor"," was found located at the ","esophago-gastric junction"," and the ","tumor"," ","infiltrated"," the ","whole layer"," with ","lymph node"," ","metastasis"," at ","station four",".\nNo ","ascites"," or ","dissemination of the tumor"," was observed in the ","peritoneal cavity",".\nThe ","tumor"," measured ","3 cm \u00d7 6 cm"," in size with ","black pigmentation"," (Figure \u200b4).\nThere were ","several"," ","pigmented"," ","satellite"," ","nodules"," beside the ","main tumor lesion",", the ","largest one"," being ","1 cm \u00d7 1 cm"," in diameter.\nMoreover, two ","ulceration"," ","lesions"," were found at the ","fundus of the stomach",".\n","Microscopically",", the excised ","tumor tissue"," was composed of ","non-organized"," and ","pleomorphic"," ","cells"," exhibiting ","atypical"," ","nuclei",", and ","abundant"," ","melanin granules"," (Figure \u200b5).\n","Pathological examination"," identified this case at a ","stage"," of ","IVA"," (","T4aN1M0",").\n","Immunohistochemical staining"," showed that the ","tumor"," was ","positive"," for ","S-100",", ","HMB-45",", ","mclean-A"," and ","Vimentin",", but ","negative"," for ","cytokeratin 7"," and ","cytokeratin 20"," (Figure \u200b6).\nBased on these results, a diagnosis of ","primary"," ","advanced"," ","esophago-gastric"," ","melanoma"," was established.\nThe ","postoperative course"," was ","smooth"," and without ","complications",".\nThe patient gradually ","recovered"," and was ","discharged"," ","14 d after"," surgery.\nAs the patient denied a postoperative ","adjuvant therapy",", ","abdominal"," ","recurrence"," and ","hepatic"," ","metastases"," were found ","within one month"," by a postoperative ","follow-up"," ","CT",".\nNo ","other effective treatment"," was administered afterwards.\nThe patient ","died"," of ","diffuse"," ","metastatic disease"," ","2 mo later",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,69,0,32,0,63,0,69,0,42,0,32,0,39,0,22,0,22,0,39,0,32,0,34,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,12,0,24,0,22,0,63,0,69,0,69,0,12,0,24,0,24,0,73,0,69,0,12,0,12,0,69,0,12,0,24,0,15,0,69,0,12,0,22,0,15,0,69,0,69,0,12,0,22,0,15,0,67,0,69,0,12,0,24,0,69,0,22,0,26,0,24,0,42,0,22,0,18,0,18,0,75,0,22,0,75,0,22,0,75,0,12,0,75,0,75,0,75,0,69,0,12,0,18,0,69,0,12,0,12,0,69,0,12,0,69,0,69,0,12,0,69,0,8,0,15,0,22,0,15,0,22,0,69,0,18,0,18,0,8,0,22,0,69,0,12,0,24,0,12,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,42,0,42,0,24,0,18,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,22,0,63,0,22,0,26,0,75,0,42,0,69,0,69,0,13,0,19,0,46,0,12,0,69,0,12,0,69,0,19,0,13,0,24,0,75,0,56,0,22,0,26,0,19,0]}
-{"full_text":"A 65-year-old man was referred to our hospital for evaluation of stuttering chest pain for 10 days, and he was a common worker.\nThere was no positive finding from the relevant physical examination.\nHe has no medical, family, and psychosocial history including co-morbidities, and relevant genetic information.\nHis electrocardiogram showed T-wave inversion over leads V1 to V4 (Figure \u200b1).\nCoronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented (Figure 2).\nT-wave still inversion over leads V1 to V4 after the percutaneous coronary intervention (PCI) (Figure \u200b3).\nThe patient discharged after the PCI in 5 days and recharged in the hospital because of a palpation.\nHis electrocardiogram demonstrated ventricular tachycardia (Figure \u200b4), and severe hypertension, remarkable blood pressure fluctuation between 224\/76 and 70\/50 mm Hg.\nAlthough several antihypertensive drugs were used, ventricular tachycardia still occurred on him for 2 times, each was preceded by a period of blood pressure fluctuation and burst out concomitantly at the peak of a hypertension crisis.\nThe patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor.\nEnhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone (Figure 5).\nThe tumor was removed by laparoscope, and pathological examination showed pheochromocytoma (Figure \u200b6).\nAfter the surgery, the blood pressure turned normal gradually.\nThere was no T-wave inversion in lead V1-V4 (Figure \u200b7).\n","ner_info":[{"text":"65-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":38,"end":46},{"text":"stuttering","label":"DETAILED_DESCRIPTION","start":65,"end":75},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":76,"end":81},{"text":"pain","label":"SIGN_SYMPTOM","start":82,"end":86},{"text":"10 days","label":"DURATION","start":91,"end":98},{"text":"common worker","label":"OCCUPATION","start":113,"end":126},{"text":"no positive finding","label":"LAB_VALUE","start":138,"end":157},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":176,"end":196},{"text":"no medical, family, and psychosocial history including co-morbidities","label":"HISTORY","start":205,"end":274},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":314,"end":331},{"text":"T-wave inversion","label":"SIGN_SYMPTOM","start":339,"end":355},{"text":"leads V1 to V4","label":"DETAILED_DESCRIPTION","start":361,"end":375},{"text":"Coronary angiography","label":"DIAGNOSTIC_PROCEDURE","start":389,"end":409},{"text":"90%","label":"LAB_VALUE","start":417,"end":420},{"text":"stenosis","label":"SIGN_SYMPTOM","start":421,"end":429},{"text":"mid-left anterior descending coronary artery","label":"BIOLOGICAL_STRUCTURE","start":437,"end":481},{"text":"LAD","label":"BIOLOGICAL_STRUCTURE","start":483,"end":486},{"text":"stented","label":"THERAPEUTIC_PROCEDURE","start":499,"end":506},{"text":"T-wave","label":"DETAILED_DESCRIPTION","start":519,"end":525},{"text":"inversion","label":"SIGN_SYMPTOM","start":532,"end":541},{"text":"leads V1 to V4","label":"DETAILED_DESCRIPTION","start":547,"end":561},{"text":"percutaneous coronary intervention","label":"THERAPEUTIC_PROCEDURE","start":572,"end":606},{"text":"PCI","label":"THERAPEUTIC_PROCEDURE","start":608,"end":611},{"text":"discharged","label":"CLINICAL_EVENT","start":638,"end":648},{"text":"5 days","label":"DATE","start":666,"end":672},{"text":"recharged","label":"CLINICAL_EVENT","start":677,"end":686},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":694,"end":702},{"text":"palpation","label":"SIGN_SYMPTOM","start":716,"end":725},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":731,"end":748},{"text":"ventricular tachycardia","label":"DISEASE_DISORDER","start":762,"end":785},{"text":"severe","label":"SEVERITY","start":803,"end":809},{"text":"hypertension","label":"SIGN_SYMPTOM","start":810,"end":822},{"text":"blood pressure fluctuation","label":"SIGN_SYMPTOM","start":835,"end":861},{"text":"between 224\/76 and 70\/50 mm Hg","label":"LAB_VALUE","start":862,"end":892},{"text":"antihypertensive drugs","label":"MEDICATION","start":911,"end":933},{"text":"ventricular tachycardia","label":"DISEASE_DISORDER","start":945,"end":968},{"text":"2 times","label":"DETAILED_DESCRIPTION","start":995,"end":1002},{"text":"blood pressure fluctuation","label":"SIGN_SYMPTOM","start":1037,"end":1063},{"text":"hypertension crisis","label":"DISEASE_DISORDER","start":1109,"end":1128},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1147,"end":1156},{"text":"pain","label":"SIGN_SYMPTOM","start":1157,"end":1161},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1170,"end":1179},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1180,"end":1190},{"text":"right adrenal gland","label":"BIOLOGICAL_STRUCTURE","start":1209,"end":1228},{"text":"tumor","label":"SIGN_SYMPTOM","start":1229,"end":1234},{"text":"Enhanced","label":"DETAILED_DESCRIPTION","start":1236,"end":1244},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1245,"end":1264},{"text":"adrenal gland","label":"BIOLOGICAL_STRUCTURE","start":1268,"end":1281},{"text":"tumor","label":"SIGN_SYMPTOM","start":1309,"end":1314},{"text":"right adrenal gland","label":"BIOLOGICAL_STRUCTURE","start":1318,"end":1337},{"text":"upset","label":"LAB_VALUE","start":1356,"end":1361},{"text":"aldosterone","label":"DIAGNOSTIC_PROCEDURE","start":1371,"end":1382},{"text":"tumor","label":"SIGN_SYMPTOM","start":1399,"end":1404},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":1409,"end":1416},{"text":"laparoscope","label":"THERAPEUTIC_PROCEDURE","start":1420,"end":1431},{"text":"pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":1437,"end":1461},{"text":"pheochromocytoma","label":"DISEASE_DISORDER","start":1469,"end":1485},{"text":"surgery","label":"COREFERENCE","start":1509,"end":1516},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1522,"end":1536},{"text":"normal","label":"LAB_VALUE","start":1544,"end":1550},{"text":"T-wave inversion","label":"SIGN_SYMPTOM","start":1575,"end":1591},{"text":"lead V1-V4","label":"DETAILED_DESCRIPTION","start":1595,"end":1605}],"tokens":["A ","65-year-old"," ","man"," was ","referred"," to our ","hospital"," for evaluation of ","stuttering"," ","chest"," ","pain"," for ","10 days",", and he was a ","common worker",".\nThere was ","no positive finding"," from the relevant ","physical examination",".\nHe has ","no medical, family, and psychosocial history including co-morbidities",", and relevant genetic information.\nHis ","electrocardiogram"," showed ","T-wave inversion"," over ","leads V1 to V4"," (Figure \u200b1).\n","Coronary angiography"," showed ","90%"," ","stenosis"," in the ","mid-left anterior descending coronary artery"," (","LAD","), which was ","stented"," (Figure 2).\n","T-wave"," still ","inversion"," over ","leads V1 to V4"," after the ","percutaneous coronary intervention"," (","PCI",") (Figure \u200b3).\nThe patient ","discharged"," after the PCI in ","5 days"," and ","recharged"," in the ","hospital"," because of a ","palpation",".\nHis ","electrocardiogram"," demonstrated ","ventricular tachycardia"," (Figure \u200b4), and ","severe"," ","hypertension",", remarkable ","blood pressure fluctuation"," ","between 224\/76 and 70\/50 mm Hg",".\nAlthough several ","antihypertensive drugs"," were used, ","ventricular tachycardia"," still occurred on him for ","2 times",", each was preceded by a period of ","blood pressure fluctuation"," and burst out concomitantly at the peak of a ","hypertension crisis",".\nThe patient felt ","abdominal"," ","pain"," and his ","abdominal"," ","ultrasound"," showed suspicious ","right adrenal gland"," ","tumor",".\n","Enhanced"," ","computed tomography"," of ","adrenal gland"," conformed that there was a ","tumor"," in ","right adrenal gland"," accompanied by an ","upset"," level of ","aldosterone"," (Figure 5).\nThe ","tumor"," was ","removed"," by ","laparoscope",", and ","pathological examination"," showed ","pheochromocytoma"," (Figure \u200b6).\nAfter the ","surgery",", the ","blood pressure"," turned ","normal"," gradually.\nThere was no ","T-wave inversion"," in ","lead V1-V4"," (Figure \u200b7).\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,12,0,69,0,32,0,50,0,42,0,24,0,39,0,24,0,69,0,22,0,24,0,42,0,69,0,12,0,12,0,75,0,22,0,69,0,22,0,75,0,75,0,13,0,19,0,13,0,48,0,69,0,24,0,26,0,63,0,69,0,69,0,42,0,46,0,26,0,22,0,69,0,26,0,12,0,69,0,12,0,24,0,12,0,69,0,22,0,24,0,12,0,69,0,12,0,42,0,24,0,69,0,75,0,75,0,24,0,26,0,18,0,24,0,42,0,69,0,22,0]}
-{"full_text":"A 50-year-old lady presented with complaints of pain abdomen and jaundice for one and a half months; she also complained of intermittent type of fever in the last 1 week.\nPhysical examination revealed presence of icterus and a palpable tender globular mass in the right hypochondrium measuring 3\u2009\u00d7\u20093 cm.\nA clinical diagnosis of obstructive jaundice secondary to periampullary carcinoma was made.\nUltrasonographic examination of the abdomen and pelvis revealed dilatation of the intrahepatic biliary radicles (IHBR), with multiple freely mobile gall stones and a dilated common bile duct (CBD) measuring 1.8 cm with sudden narrowing at its distal end.\nCT scan showed moderate dilatation of the extra and intrahepatic biliary radicles, cholelithiasis with suspicious thickening of the gall bladder wall at the fundus, and a distal CBD stricture.\nThere was no evidence of any distant metastasis (Fig.1).\nA preoperative diagnosis of periampullary carcinoma with chronic cholecystitis was made, and the patient planned for a pancreaticoduodenectomy (Whipple\u2019s procedure) after optimization.\nThe patient underwent a classical Whipple\u2019s procedure; table examination of the resected specimen revealed multiple gall stones in the gall bladder with area of mucosal thickening at the fundus and an irregular circumferential growth involving the intrapancreatic portion of the CBD.\nPostoperative period was uneventful, and the patient recovered satisfactorily.\nHistopathological examination of the resected specimen (Figs.2 and \u200b3) revealed thickening of the gall bladder wall at the fundus with multiple small calculi, the largest measuring 1.4 cm (Fig.3).\nSections studied from the area of thickening showed features suggestive of adenocarcinoma limited to the mucosa.\nMicroscopic sections obtained from the distal CBD region showed adenocarcinoma of the common bile duct with invasion into the muscular wall of the duodenum.\nSections studied from the resected lymph nodes were free of tumor cells.\nA pathological staging of pT1aN0M0 for adenocarcinoma of the gall bladder and pT2N0M0 for adenocarcinoma of the distal CBD was made, and the patient was not subjected to any adjuvant therapy.\nThe patient was disease-free 2 years after surgery.\n","ner_info":[{"text":"50-year-old","label":"AGE","start":2,"end":13},{"text":"lady","label":"SEX","start":14,"end":18},{"text":"presented","label":"CLINICAL_EVENT","start":19,"end":28},{"text":"pain","label":"SIGN_SYMPTOM","start":48,"end":52},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":53,"end":60},{"text":"jaundice","label":"SIGN_SYMPTOM","start":65,"end":73},{"text":"one and a half months","label":"DURATION","start":78,"end":99},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":124,"end":136},{"text":"fever","label":"SIGN_SYMPTOM","start":145,"end":150},{"text":"last 1 week","label":"DURATION","start":158,"end":169},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":171,"end":191},{"text":"icterus","label":"SIGN_SYMPTOM","start":213,"end":220},{"text":"palpable","label":"DETAILED_DESCRIPTION","start":227,"end":235},{"text":"tender","label":"DETAILED_DESCRIPTION","start":236,"end":242},{"text":"globular","label":"SHAPE","start":243,"end":251},{"text":"mass","label":"SIGN_SYMPTOM","start":252,"end":256},{"text":"right hypochondrium","label":"BIOLOGICAL_STRUCTURE","start":264,"end":283},{"text":"3\u2009\u00d7\u20093 cm","label":"AREA","start":294,"end":302},{"text":"obstructive","label":"DETAILED_DESCRIPTION","start":328,"end":339},{"text":"jaundice","label":"SIGN_SYMPTOM","start":340,"end":348},{"text":"periampullary carcinoma","label":"DISEASE_DISORDER","start":362,"end":385},{"text":"Ultrasonographic examination","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":424},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":432,"end":439},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":444,"end":450},{"text":"dilatation of the intrahepatic biliary radicles","label":"SIGN_SYMPTOM","start":460,"end":507},{"text":"IHBR","label":"BIOLOGICAL_STRUCTURE","start":509,"end":513},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":521,"end":529},{"text":"mobile","label":"DETAILED_DESCRIPTION","start":537,"end":543},{"text":"gall stones","label":"SIGN_SYMPTOM","start":544,"end":555},{"text":"dilated common bile duct","label":"SIGN_SYMPTOM","start":562,"end":586},{"text":"CBD","label":"BIOLOGICAL_STRUCTURE","start":588,"end":591},{"text":"1.8 cm","label":"DISTANCE","start":603,"end":609},{"text":"sudden narrowing at its distal end","label":"DETAILED_DESCRIPTION","start":615,"end":649},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":651,"end":658},{"text":"moderate","label":"SEVERITY","start":666,"end":674},{"text":"dilatation of the extra and intrahepatic biliary radicles","label":"SIGN_SYMPTOM","start":675,"end":732},{"text":"cholelithiasis","label":"SIGN_SYMPTOM","start":734,"end":748},{"text":"thickening of the gall bladder wall","label":"SIGN_SYMPTOM","start":765,"end":800},{"text":"fundus","label":"BIOLOGICAL_STRUCTURE","start":808,"end":814},{"text":"distal CBD","label":"BIOLOGICAL_ATTRIBUTE","start":822,"end":832},{"text":"stricture","label":"SIGN_SYMPTOM","start":833,"end":842},{"text":"metastasis","label":"SIGN_SYMPTOM","start":881,"end":891},{"text":"periampullary carcinoma","label":"DISEASE_DISORDER","start":929,"end":952},{"text":"chronic cholecystitis","label":"DISEASE_DISORDER","start":958,"end":979},{"text":"planned","label":"CLINICAL_EVENT","start":1006,"end":1013},{"text":"pancreaticoduodenectomy","label":"THERAPEUTIC_PROCEDURE","start":1020,"end":1043},{"text":"Whipple\u2019s procedure","label":"THERAPEUTIC_PROCEDURE","start":1045,"end":1064},{"text":"Whipple\u2019s procedure","label":"THERAPEUTIC_PROCEDURE","start":1120,"end":1139},{"text":"table examination","label":"DIAGNOSTIC_PROCEDURE","start":1141,"end":1158},{"text":"resected specimen","label":"BIOLOGICAL_STRUCTURE","start":1166,"end":1183},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1193,"end":1201},{"text":"gall stones","label":"SIGN_SYMPTOM","start":1202,"end":1213},{"text":"gall bladder","label":"BIOLOGICAL_STRUCTURE","start":1221,"end":1233},{"text":"mucosal thickening","label":"SIGN_SYMPTOM","start":1247,"end":1265},{"text":"fundus","label":"BIOLOGICAL_STRUCTURE","start":1273,"end":1279},{"text":"irregular","label":"DETAILED_DESCRIPTION","start":1287,"end":1296},{"text":"circumferential","label":"DETAILED_DESCRIPTION","start":1297,"end":1312},{"text":"growth","label":"SIGN_SYMPTOM","start":1313,"end":1319},{"text":"intrapancreatic portion of the CBD","label":"BIOLOGICAL_STRUCTURE","start":1334,"end":1368},{"text":"Postoperative period","label":"THERAPEUTIC_PROCEDURE","start":1370,"end":1390},{"text":"uneventful","label":"LAB_VALUE","start":1395,"end":1405},{"text":"recovered","label":"CLINICAL_EVENT","start":1423,"end":1432},{"text":"satisfactorily","label":"LAB_VALUE","start":1433,"end":1447},{"text":"Histopathological examination","label":"DIAGNOSTIC_PROCEDURE","start":1449,"end":1478},{"text":"resected specimen","label":"BIOLOGICAL_STRUCTURE","start":1486,"end":1503},{"text":"thickening of the gall bladder wall","label":"SIGN_SYMPTOM","start":1529,"end":1564},{"text":"fundus","label":"BIOLOGICAL_STRUCTURE","start":1572,"end":1578},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1584,"end":1592},{"text":"small","label":"DETAILED_DESCRIPTION","start":1593,"end":1598},{"text":"calculi","label":"SIGN_SYMPTOM","start":1599,"end":1606},{"text":"1.4 cm","label":"DISTANCE","start":1630,"end":1636},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":1721,"end":1735},{"text":"mucosa","label":"BIOLOGICAL_STRUCTURE","start":1751,"end":1757},{"text":"Microscopic sections","label":"DIAGNOSTIC_PROCEDURE","start":1759,"end":1779},{"text":"distal CBD region","label":"BIOLOGICAL_STRUCTURE","start":1798,"end":1815},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":1823,"end":1837},{"text":"common bile duct","label":"BIOLOGICAL_STRUCTURE","start":1845,"end":1861},{"text":"invasion","label":"DETAILED_DESCRIPTION","start":1867,"end":1875},{"text":"muscular wall of the duodenum","label":"BIOLOGICAL_STRUCTURE","start":1885,"end":1914},{"text":"Sections","label":"DIAGNOSTIC_PROCEDURE","start":1916,"end":1924},{"text":"resected lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1942,"end":1962},{"text":"tumor cells","label":"SIGN_SYMPTOM","start":1976,"end":1987},{"text":"pT1aN0M0","label":"DETAILED_DESCRIPTION","start":2015,"end":2023},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":2028,"end":2042},{"text":"gall bladder","label":"BIOLOGICAL_STRUCTURE","start":2050,"end":2062},{"text":"pT2N0M0","label":"DETAILED_DESCRIPTION","start":2067,"end":2074},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":2079,"end":2093},{"text":"distal CBD","label":"BIOLOGICAL_STRUCTURE","start":2101,"end":2111},{"text":"adjuvant therapy","label":"MEDICATION","start":2163,"end":2179},{"text":"disease","label":"SIGN_SYMPTOM","start":2197,"end":2204},{"text":"2 years after surgery","label":"DATE","start":2210,"end":2231}],"tokens":["A ","50-year-old"," ","lady"," ","presented"," with complaints of ","pain"," ","abdomen"," and ","jaundice"," for ","one and a half months","; she also complained of ","intermittent"," type of ","fever"," in the ","last 1 week",".\n","Physical examination"," revealed presence of ","icterus"," and a ","palpable"," ","tender"," ","globular"," ","mass"," in the ","right hypochondrium"," measuring ","3\u2009\u00d7\u20093 cm",".\nA clinical diagnosis of ","obstructive"," ","jaundice"," secondary to ","periampullary carcinoma"," was made.\n","Ultrasonographic examination"," of the ","abdomen"," and ","pelvis"," revealed ","dilatation of the intrahepatic biliary radicles"," (","IHBR","), with ","multiple"," freely ","mobile"," ","gall stones"," and a ","dilated common bile duct"," (","CBD",") measuring ","1.8 cm"," with ","sudden narrowing at its distal end",".\n","CT scan"," showed ","moderate"," ","dilatation of the extra and intrahepatic biliary radicles",", ","cholelithiasis"," with suspicious ","thickening of the gall bladder wall"," at the ","fundus",", and a ","distal CBD"," ","stricture",".\nThere was no evidence of any distant ","metastasis"," (Fig.1).\nA preoperative diagnosis of ","periampullary carcinoma"," with ","chronic cholecystitis"," was made, and the patient ","planned"," for a ","pancreaticoduodenectomy"," (","Whipple\u2019s procedure",") after optimization.\nThe patient underwent a classical ","Whipple\u2019s procedure","; ","table examination"," of the ","resected specimen"," revealed ","multiple"," ","gall stones"," in the ","gall bladder"," with area of ","mucosal thickening"," at the ","fundus"," and an ","irregular"," ","circumferential"," ","growth"," involving the ","intrapancreatic portion of the CBD",".\n","Postoperative period"," was ","uneventful",", and the patient ","recovered"," ","satisfactorily",".\n","Histopathological examination"," of the ","resected specimen"," (Figs.2 and \u200b3) revealed ","thickening of the gall bladder wall"," at the ","fundus"," with ","multiple"," ","small"," ","calculi",", the largest measuring ","1.4 cm"," (Fig.3).\nSections studied from the area of thickening showed features suggestive of ","adenocarcinoma"," limited to the ","mucosa",".\n","Microscopic sections"," obtained from the ","distal CBD region"," showed ","adenocarcinoma"," of the ","common bile duct"," with ","invasion"," into the ","muscular wall of the duodenum",".\n","Sections"," studied from the ","resected lymph nodes"," were free of ","tumor cells",".\nA pathological staging of ","pT1aN0M0"," for ","adenocarcinoma"," of the ","gall bladder"," and ","pT2N0M0"," for ","adenocarcinoma"," of the ","distal CBD"," was made, and the patient was not subjected to any ","adjuvant therapy",".\nThe patient was ","disease","-free ","2 years after surgery",".\n"],"ner_labels":[0,5,0,65,0,13,0,69,0,12,0,69,0,32,0,22,0,69,0,32,0,24,0,69,0,22,0,22,0,67,0,69,0,12,0,8,0,22,0,69,0,26,0,24,0,12,0,12,0,69,0,12,0,22,0,22,0,69,0,69,0,12,0,27,0,22,0,24,0,63,0,69,0,69,0,69,0,12,0,9,0,69,0,69,0,26,0,26,0,13,0,75,0,75,0,75,0,24,0,12,0,22,0,69,0,12,0,69,0,12,0,22,0,22,0,69,0,12,0,75,0,42,0,13,0,42,0,24,0,12,0,69,0,12,0,22,0,22,0,69,0,27,0,26,0,12,0,24,0,12,0,26,0,12,0,22,0,12,0,24,0,12,0,69,0,22,0,26,0,12,0,22,0,26,0,12,0,46,0,69,0,19,0]}
-{"full_text":"A 53-year-old man came to our hospital with signs and symptoms of acute heart failure after a 2-week history of progressive breathlessness.\nHe had a history of recurrent skin abscesses and atopic dermatitis and regularly visited a dermatologist in our hospital.\nOn arriving at our hospital, his extremities were warm and dry.\nAccording to the New York Heart Association criteria, he had class III congestive heart failure (CHF).\nAn electrocardiogram revealed diffuse nonspecific T-wave changes, low voltage (<5 mm) in the extremity leads and poor R-wave progression in the anterior chest leads.\nMultiple sporadic ventricular premature beats were seen (Figure 1).\nChest x-ray film confirmed right pleural effusion, and mild cardiomegaly but no pulmonary congestion (Figure 2).\nBlood tests showed severely elevated B-type natriuretic peptide (901 pg\/mL) and markedly raised IgE (12 000 IU\/mL) without eosinophilia (eosinophil count of 1.62\u00d7108\/L).\nBiochemical analysis revealed no significant findings: blood urea nitrogen of 14.3 mg\/dL [reference value (RV): 7.00\u201322.00], creatinine of 0.90 mg\/dL (RV: 0.60\u20131.00), C-reactive protein (CRP) of 0.2 mg\/dL (RV: 0.00\u20130.50), serum amyloid A (SAA) of 7.0 \u03bcg\/mL (RV: 0\u20138.0), and troponin T of 0.07 ng\/mL (RV: 0\u20130.1).\nImmunology testing revealed negative perinuclear anti-neutrophil cytoplasmic antibodies and no elevation of myeloperoxidase antibodies.\nThe distribution of albumin and globulin in the serum was normal.\nSerum protein immuno-electrophoresis did not reveal M-protein, and urinalysis revealed no Bence-Jones protein.\nTransthoracic echocardiography (Figure 3) showed concentric mild left ventricular (LV) hypertrophy (12 mm) without the characteristic granular sparkling appearance and pericardial effusion, preserved ejection fraction (60%), and bi-atrial enlargement with normal ventricular chambers.\nDoppler-derived LV diastolic filling demonstrated a restrictive pattern with a trans-mitral early filling wave deceleration time of 160 ms and an elevated E\/A ratio of 2.8.\nA markedly elevation of E\/e\u2019 ratio of 27.3 indicated elevated LV filling pressure.\nOn day 1 of hospitalization, we prescribed an angiotensin-converting enzyme (ACE) inhibitor and low-dose diuretics.\nOn day 3 of hospitalization, after initiating ACE inhibitor and diuretic therapy, the patient\u2019s symptoms resolved.\nThe dermatologists performed a biopsy of a blue macula of the forehead skin.\nOn day 4, we introduced a low-dose \u03b2-blocker and performed an endomyocardial biopsy (EMB), obtaining 3 fragments of the right ventricular septum because diagnostic confirmation of cardiac amyloidosis requires the demonstration of amyloid deposits.\nIn addition, we performed right heart catheterization (RHC), and coronary angiography to exclude obstructive coronary artery disease.\nThe data obtained from the RHC indicated subset type IV according to the Forrester classification.\nThe right ventricular pressure curve did not show a dip-and-plateau configuration.\nSkin biopsy revealed hyperkeratosis in the epidermis and mild inflammatory changes throughout the dermis with an infiltration of lymphocytes.\nThe specimen exhibited apple-green birefringence with polarized light after Congo red staining (Figure 4).\nHistological examination of the myocardial specimen showed no signs suggesting myocarditis, eosinophilic granulomas, or cardiomyopathy with iron deposition, but Congo red staining revealed amyloid deposits (Figure 5).\nIn addition, a strongly positive immunohistochemical reaction to immunoglobulin \u03bb-chain in the myocardial interstitium led us to diagnose this patient\u2019s systemic amyloidosis as AL amyloidosis.\nThe patient generally tolerated the low-dose \u03b2-blocker well and was discharged on day 10 with no complications.\nThe patient is currently being followed-up at 6-month intervals as an out-patient, with no exacerbation of the CHF thus far.\n","ner_info":[{"text":"53-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"came","label":"CLINICAL_EVENT","start":18,"end":22},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":30,"end":38},{"text":"acute","label":"DETAILED_DESCRIPTION","start":66,"end":71},{"text":"heart failure","label":"DISEASE_DISORDER","start":72,"end":85},{"text":"2-week history","label":"DURATION","start":94,"end":108},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":112,"end":123},{"text":"breathlessness","label":"SIGN_SYMPTOM","start":124,"end":138},{"text":"history of recurrent skin abscesses","label":"HISTORY","start":149,"end":184},{"text":"atopic","label":"DETAILED_DESCRIPTION","start":189,"end":195},{"text":"dermatitis","label":"DISEASE_DISORDER","start":196,"end":206},{"text":"regularly","label":"FREQUENCY","start":211,"end":220},{"text":"visited","label":"CLINICAL_EVENT","start":221,"end":228},{"text":"dermatologist","label":"NONBIOLOGICAL_LOCATION","start":231,"end":244},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":252,"end":260},{"text":"arriving","label":"CLINICAL_EVENT","start":265,"end":273},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":281,"end":289},{"text":"extremities","label":"BIOLOGICAL_STRUCTURE","start":295,"end":306},{"text":"warm","label":"SIGN_SYMPTOM","start":312,"end":316},{"text":"dry","label":"SIGN_SYMPTOM","start":321,"end":324},{"text":"New York Heart Association criteria","label":"DIAGNOSTIC_PROCEDURE","start":343,"end":378},{"text":"class III","label":"LAB_VALUE","start":387,"end":396},{"text":"congestive heart failure","label":"DISEASE_DISORDER","start":397,"end":421},{"text":"CHF","label":"DISEASE_DISORDER","start":423,"end":426},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":432,"end":449},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":459,"end":466},{"text":"nonspecific","label":"DETAILED_DESCRIPTION","start":467,"end":478},{"text":"T-wave changes","label":"SIGN_SYMPTOM","start":479,"end":493},{"text":"low","label":"LAB_VALUE","start":495,"end":498},{"text":"voltage","label":"DIAGNOSTIC_PROCEDURE","start":499,"end":506},{"text":"<5 mm","label":"LAB_VALUE","start":508,"end":513},{"text":"extremity leads","label":"DIAGNOSTIC_PROCEDURE","start":522,"end":537},{"text":"poor","label":"LAB_VALUE","start":542,"end":546},{"text":"R-wave progression","label":"DIAGNOSTIC_PROCEDURE","start":547,"end":565},{"text":"anterior chest leads","label":"DIAGNOSTIC_PROCEDURE","start":573,"end":593},{"text":"Multiple","label":"QUANTITATIVE_CONCEPT","start":595,"end":603},{"text":"sporadic","label":"FREQUENCY","start":604,"end":612},{"text":"ventricular","label":"BIOLOGICAL_STRUCTURE","start":613,"end":624},{"text":"premature beats","label":"SIGN_SYMPTOM","start":625,"end":640},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":663,"end":668},{"text":"x-ray","label":"DIAGNOSTIC_PROCEDURE","start":669,"end":674},{"text":"right","label":"DETAILED_DESCRIPTION","start":690,"end":695},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":696,"end":712},{"text":"mild","label":"SEVERITY","start":718,"end":722},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":723,"end":735},{"text":"pulmonary congestion","label":"DISEASE_DISORDER","start":743,"end":763},{"text":"Blood tests","label":"DIAGNOSTIC_PROCEDURE","start":776,"end":787},{"text":"severely elevated","label":"LAB_VALUE","start":795,"end":812},{"text":"B-type natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":813,"end":839},{"text":"901 pg\/mL","label":"LAB_VALUE","start":841,"end":850},{"text":"raised","label":"LAB_VALUE","start":865,"end":871},{"text":"IgE","label":"DIAGNOSTIC_PROCEDURE","start":872,"end":875},{"text":"12 000 IU\/mL","label":"LAB_VALUE","start":877,"end":889},{"text":"eosinophilia","label":"SIGN_SYMPTOM","start":899,"end":911},{"text":"eosinophil count","label":"DIAGNOSTIC_PROCEDURE","start":913,"end":929},{"text":"1.62\u00d7108\/L","label":"LAB_VALUE","start":933,"end":943},{"text":"Biochemical analysis","label":"DIAGNOSTIC_PROCEDURE","start":946,"end":966},{"text":"blood urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":1001,"end":1020},{"text":"14.3 mg\/dL","label":"LAB_VALUE","start":1024,"end":1034},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1071,"end":1081},{"text":"0.90 mg\/dL","label":"LAB_VALUE","start":1085,"end":1095},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1113,"end":1131},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":1133,"end":1136},{"text":"0.2 mg\/dL","label":"LAB_VALUE","start":1141,"end":1150},{"text":"serum amyloid A","label":"DIAGNOSTIC_PROCEDURE","start":1168,"end":1183},{"text":"SAA","label":"DIAGNOSTIC_PROCEDURE","start":1185,"end":1188},{"text":"7.0 \u03bcg\/mL","label":"LAB_VALUE","start":1193,"end":1202},{"text":"troponin T","label":"DIAGNOSTIC_PROCEDURE","start":1220,"end":1230},{"text":"0.07 ng\/mL","label":"LAB_VALUE","start":1234,"end":1244},{"text":"Immunology testing","label":"DIAGNOSTIC_PROCEDURE","start":1258,"end":1276},{"text":"negative","label":"LAB_VALUE","start":1286,"end":1294},{"text":"perinuclear anti-neutrophil cytoplasmic antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1295,"end":1345},{"text":"no elevation","label":"LAB_VALUE","start":1350,"end":1362},{"text":"myeloperoxidase antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1366,"end":1392},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":1414,"end":1421},{"text":"globulin","label":"DIAGNOSTIC_PROCEDURE","start":1426,"end":1434},{"text":"serum","label":"DETAILED_DESCRIPTION","start":1442,"end":1447},{"text":"normal","label":"LAB_VALUE","start":1452,"end":1458},{"text":"Serum","label":"DETAILED_DESCRIPTION","start":1460,"end":1465},{"text":"protein immuno-electrophoresis","label":"DIAGNOSTIC_PROCEDURE","start":1466,"end":1496},{"text":"did not reveal","label":"LAB_VALUE","start":1497,"end":1511},{"text":"M-protein","label":"DIAGNOSTIC_PROCEDURE","start":1512,"end":1521},{"text":"urinalysis","label":"DIAGNOSTIC_PROCEDURE","start":1527,"end":1537},{"text":"no","label":"LAB_VALUE","start":1547,"end":1549},{"text":"Bence-Jones 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biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2482,"end":2503},{"text":"EMB","label":"DIAGNOSTIC_PROCEDURE","start":2505,"end":2508},{"text":"3 fragments","label":"QUANTITATIVE_CONCEPT","start":2521,"end":2532},{"text":"right ventricular septum","label":"BIOLOGICAL_STRUCTURE","start":2540,"end":2564},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":2600,"end":2607},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":2608,"end":2619},{"text":"amyloid deposits","label":"SIGN_SYMPTOM","start":2650,"end":2666},{"text":"right heart catheterization","label":"DIAGNOSTIC_PROCEDURE","start":2694,"end":2721},{"text":"RHC","label":"DIAGNOSTIC_PROCEDURE","start":2723,"end":2726},{"text":"coronary angiography","label":"DIAGNOSTIC_PROCEDURE","start":2733,"end":2753},{"text":"obstructive coronary artery disease","label":"DISEASE_DISORDER","start":2765,"end":2800},{"text":"RHC","label":"DIAGNOSTIC_PROCEDURE","start":2829,"end":2832},{"text":"subset type 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specimen","label":"BIOLOGICAL_STRUCTURE","start":3265,"end":3284},{"text":"myocarditis","label":"DISEASE_DISORDER","start":3312,"end":3323},{"text":"eosinophilic","label":"DETAILED_DESCRIPTION","start":3325,"end":3337},{"text":"granulomas","label":"DISEASE_DISORDER","start":3338,"end":3348},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":3353,"end":3367},{"text":"iron deposition","label":"DETAILED_DESCRIPTION","start":3373,"end":3388},{"text":"Congo red staining","label":"DIAGNOSTIC_PROCEDURE","start":3394,"end":3412},{"text":"amyloid deposits","label":"SIGN_SYMPTOM","start":3422,"end":3438},{"text":"strongly positive","label":"LAB_VALUE","start":3466,"end":3483},{"text":"immunohistochemical reaction","label":"DIAGNOSTIC_PROCEDURE","start":3484,"end":3512},{"text":"immunoglobulin \u03bb-chain","label":"DIAGNOSTIC_PROCEDURE","start":3516,"end":3538},{"text":"myocardial interstitium","label":"BIOLOGICAL_STRUCTURE","start":3546,"end":3569},{"text":"systemic","label":"DETAILED_DESCRIPTION","start":3604,"end":3612},{"text":"amyloidosis","label":"DISEASE_DISORDER","start":3613,"end":3624},{"text":"AL amyloidosis","label":"DISEASE_DISORDER","start":3628,"end":3642},{"text":"\u03b2-blocker","label":"MEDICATION","start":3689,"end":3698},{"text":"discharged","label":"CLINICAL_EVENT","start":3712,"end":3722},{"text":"day 10","label":"DATE","start":3726,"end":3732},{"text":"complications","label":"DISEASE_DISORDER","start":3741,"end":3754},{"text":"followed-up","label":"CLINICAL_EVENT","start":3787,"end":3798},{"text":"6-month intervals","label":"FREQUENCY","start":3802,"end":3819},{"text":"CHF","label":"DISEASE_DISORDER","start":3867,"end":3870}],"tokens":["A ","53-year-old"," ","man"," ","came"," to our ","hospital"," with signs and symptoms of ","acute"," ","heart failure"," after a ","2-week history"," of ","progressive"," ","breathlessness",".\nHe had a ","history of recurrent skin abscesses"," and ","atopic"," ","dermatitis"," and ","regularly"," ","visited"," a ","dermatologist"," in our ","hospital",".\nOn ","arriving"," at our ","hospital",", his ","extremities"," were ","warm"," and ","dry",".\nAccording to the ","New York Heart Association criteria",", he had ","class III"," ","congestive heart failure"," (","CHF",").\nAn ","electrocardiogram"," revealed ","diffuse"," ","nonspecific"," ","T-wave changes",", ","low"," ","voltage"," (","<5 mm",") in the ","extremity leads"," and ","poor"," ","R-wave progression"," in the ","anterior chest leads",".\n","Multiple"," ","sporadic"," ","ventricular"," ","premature beats"," were seen (Figure 1).\n","Chest"," ","x-ray"," film confirmed ","right"," ","pleural effusion",", and ","mild"," ","cardiomegaly"," but no ","pulmonary congestion"," (Figure 2).\n","Blood tests"," showed ","severely elevated"," ","B-type natriuretic peptide"," (","901 pg\/mL",") and markedly ","raised"," ","IgE"," (","12 000 IU\/mL",") without ","eosinophilia"," (","eosinophil count"," of ","1.62\u00d7108\/L",").\n","Biochemical analysis"," revealed no significant findings: ","blood urea nitrogen"," of ","14.3 mg\/dL"," [reference value (RV): 7.00\u201322.00], ","creatinine"," of ","0.90 mg\/dL"," (RV: 0.60\u20131.00), ","C-reactive protein"," (","CRP",") of ","0.2 mg\/dL"," (RV: 0.00\u20130.50), ","serum amyloid A"," (","SAA",") of ","7.0 \u03bcg\/mL"," (RV: 0\u20138.0), and ","troponin T"," of ","0.07 ng\/mL"," (RV: 0\u20130.1).\n","Immunology testing"," revealed ","negative"," ","perinuclear anti-neutrophil cytoplasmic antibodies"," and ","no elevation"," of ","myeloperoxidase antibodies",".\nThe distribution of ","albumin"," and ","globulin"," in the ","serum"," was ","normal",".\n","Serum"," ","protein immuno-electrophoresis"," ","did not reveal"," ","M-protein",", and ","urinalysis"," revealed ","no"," ","Bence-Jones protein",".\n","Transthoracic"," ","echocardiography"," (Figure 3) showed ","concentric"," ","mild"," ","left ventricular"," (","LV",") ","hypertrophy"," (","12 mm",") without the characteristic ","granular sparkling appearance"," and ","pericardial effusion",", ","preserved"," ","ejection fraction"," (","60%","), and ","bi-atrial"," ","enlargement"," with ","normal"," ","ventricular chambers",".\n","Doppler-derived"," ","LV"," ","diastolic filling"," demonstrated a ","restrictive pattern"," with a ","trans-mitral"," ","early filling wave deceleration time"," of ","160 ms"," and an ","elevated"," ","E\/A ratio"," of ","2.8",".\nA markedly ","elevation"," of ","E\/e\u2019 ratio"," of ","27.3"," indicated ","elevated"," ","LV filling pressure",".\nOn ","day 1"," of ","hospitalization",", we prescribed an ","angiotensin-converting enzyme (ACE) inhibitor"," and ","low-dose"," ","diuretics",".\nOn ","day 3"," of ","hospitalization",", after initiating ","ACE inhibitor"," and ","diuretic"," therapy, the patient\u2019s ","symptoms"," resolved.\nThe ","dermatologists"," performed a ","biopsy"," of a ","blue"," ","macula"," of the ","forehead skin",".\nOn ","day 4",", we introduced a ","low-dose"," ","\u03b2-blocker"," and performed an ","endomyocardial biopsy"," (","EMB","), obtaining ","3 fragments"," of the ","right ventricular septum"," because diagnostic confirmation of ","cardiac"," ","amyloidosis"," requires the demonstration of ","amyloid deposits",".\nIn addition, we performed ","right heart catheterization"," (","RHC","), and ","coronary angiography"," to exclude ","obstructive coronary artery disease",".\nThe data obtained from the ","RHC"," indicated ","subset type IV"," according to the ","Forrester classification",".\nThe ","right ventricular"," ","pressure curve"," did not show a ","dip-and-plateau configuration",".\n","Skin"," ","biopsy"," revealed ","hyperkeratosis"," in the ","epidermis"," and ","mild"," ","inflammatory changes"," throughout the ","dermis"," with an ","infiltration"," of ","lymphocytes",".\nThe specimen exhibited ","apple-green"," ","birefringence"," with ","polarized light"," after ","Congo red staining"," (Figure 4).\n","Histological examinatio","n of the ","myocardial specimen"," showed no signs suggesting ","myocarditis",", ","eosinophilic"," ","granulomas",", or ","cardiomyopathy"," with ","iron deposition",", but ","Congo red staining"," revealed ","amyloid deposits"," (Figure 5).\nIn addition, a ","strongly positive"," ","immunohistochemical reaction"," to ","immunoglobulin \u03bb-chain"," in the ","myocardial interstitium"," led us to diagnose this patient\u2019s ","systemic"," ","amyloidosis"," as ","AL amyloidosis",".\nThe patient generally tolerated the low-dose ","\u03b2-blocker"," well and was ","discharged"," on ","day 10"," with no ","complications",".\nThe patient is currently being ","followed-up"," at ","6-month intervals"," as an out-patient, with no exacerbation of the ","CHF"," thus far.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,26,0,32,0,22,0,69,0,39,0,22,0,26,0,35,0,13,0,48,0,48,0,13,0,48,0,12,0,69,0,69,0,24,0,42,0,26,0,26,0,24,0,22,0,22,0,69,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,62,0,35,0,12,0,69,0,12,0,24,0,22,0,26,0,63,0,69,0,26,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,69,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,22,0,42,0,22,0,24,0,42,0,24,0,24,0,42,0,24,0,12,0,24,0,22,0,63,0,12,0,12,0,69,0,27,0,69,0,26,0,42,0,24,0,42,0,12,0,69,0,42,0,24,0,22,0,12,0,24,0,42,0,12,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,19,0,13,0,46,0,29,0,46,0,19,0,13,0,46,0,46,0,69,0,48,0,24,0,15,0,69,0,12,0,19,0,29,0,46,0,24,0,24,0,62,0,12,0,12,0,26,0,69,0,24,0,24,0,24,0,26,0,24,0,42,0,24,0,12,0,24,0,69,0,12,0,24,0,69,0,12,0,63,0,69,0,12,0,69,0,12,0,15,0,42,0,22,0,24,0,24,0,12,0,26,0,22,0,26,0,26,0,22,0,24,0,69,0,42,0,24,0,24,0,12,0,22,0,26,0,26,0,46,0,13,0,19,0,26,0,13,0,35,0,26,0]}
-{"full_text":"The institutional review board (Chengdu Military General Hospital) approved this work and waived the need for informed consent.\nIn 2013, a 66-year-old farmer with a history of ventricular tachycardia (VT) and hypertension presented to the Emergency Department with continuous palpitation, chest tightness, profuse sweating and nausea with no obvious predisposing causes.\nThe patient experienced a sudden drop in blood pressure and acute confusion.\nAfter an immediate electrical conversion, his consciousness was gradually restored, and symptoms relieved.\nThen, this patient was transferred to the Department of Cardiology for further evaluations and treatments.\nThe patient's blood pressure was 105\/75 mm Hg upon admission, with a heart rate of 75 beats\/min, body temperature of 36.6\u00b0C and respiration rate of 18 times\/min.\nThe heart border extended to the left, with the apical impulse located in the left 5th intercostal space, 1.0\u200acm lateral to the midclavicular line.\nThe patient had a history of hypertension over 30 years without regular antihypertensive medication.\nThe highest blood pressure was 170\/110 mm Hg.\nThere was no family history of early coronary artery disease or sudden cardiac death.\nHe did not smoke cigarettes or use illicit drugs, and rarely consumed alcohol.\nHe also reported no known contacts with sick persons and no recent travel.\nTwelve-lead surface electrocardiogram (ECG) of VT indicated that the origin of VT was at the boundary between right ventricular outflow tract (RVOT) and tricuspid valve.\nWhen VT increased to 150 beats\/min or higher, no epsilon waves were found in the precordial leads (Figure1A and B).\nIn contrast, when VT decreased to 120 beats\/min or lower, epsilon waves appeared in leads V1\u2013V2 (Figure1C).\nNotably, the epsilon waves preceded QRS waves in leads V1\u2013V2, while endocardiac tracing confirmed that the corresponding local potential originating from RVOT appeared prior to the ventricular rhythm (Figure \u200b(Figure1D).1D).\nSinus ECG in the year of 2013 suggested a slight left deviation of electric axis, with a heart rate of 87 beats\/min and flat T waves in lead II.\nT wave inversions were found in leads III, avF and V1\u2013V3, meanwhile epsilon waves were found following QRS complex in leads V1\u2013V3 (Figure \u200b(Figure2B).2B).\nWhen the lead avR was amplified, epsilon waves were also found behind QRS waves (Figure \u200b2C).\nAtrial premature beats appeared occasionally.\nMoreover, ventricular premature beats were also found to originate from the right ventricular apex, with epsilon waves appearing behind QRS waves (Figure \u200b(Figure2B).2B).\nIn contrast, sinus ECG obtained in the year of 1999 revealed similar left deviation of electric axis, flat T waves and T wave inversions, but absence of epsilon waves (Figure \u200b(Figure2A).2A).\nData from biochemical assays were as follows: cardiac troponin I level was 0.714\u200a\u03bcg\/L (normal range, 0\u20130.06\u200a\u03bcg\/L), serum B-type natriuretic peptide level was 466.530\u200apg\/mL (normal range, 0\u2013100\u200apg\/mL), serum d-dimer level was 8.14\u200amg\/L (normal range, 0\u20130.55\u200amg\/L), blood urea level was 11.69\u200ammol\/L (normal range, 2.90\u20137.20\u200ammol\/L), serum creatinine level was 144.00\u200a\u03bcmol\/L (normal range, 44\u2013133\u200a\u03bcmol\/L), serum uric acid level was 611.40\u200a\u03bcmol\/L (normal range, 100\u2013432\u200a\u03bcmol\/L), and endogenous creatinine clearing value was 57.90\u200amL\/min (normal range, >80\u200amL\/min).\nEcho data revealed remarkably enlarged right atrium and right ventricle, and widened ROVT.\nUncoordinated motions of the left and right ventricular walls were also detected.\nMoreover, we also found aortic valve degradation with slight regurgitation, slight mitral regurgitation, and moderate to severe tricuspid regurgitation.\nThe left ventricular diastolic function was reduced to 55% (Figure \u200b3A and B).\nThe coronary angiogram revealed no vascular stenosis (Figure \u200b3C\u2013E).\nBased on the above-mentioned examinations, this patient met at least 2 major criteria, the bilateral ventricular dilation and the existence of epsilon waves, providing diagnostic support for ARVC.\nA diet with low salt and low fat was suggested.\nThe patient was also treated with metoprolol succinate sustained-release tablets (23.75\u200amg daily, p.o.), amiodarone (200\u200amg daily, p.o.), furosemide (20\u200amg daily, i.v.), and compound \u03b1-ketoacid tablets (2.52\u200ag daily, p.o.).\nMoreover, VTs with different morphologies and cycle lengths were found during radiofrequency ablation (Figure 4).\nThe substrate voltage mapping revealed that the anterior wall of RVOT was wrapped by circular scar (Figure 5A).\nConsidering the association of VT with scar areas, substrate ablation was chosen for this patient.\nThe residual potentials in the scar areas were searched, and then linear and focal ablations were performed (Figure \u200b5B).\nNeither programmed stimulation nor induced stimulation could induce VT after the procedure was completed, indicating the success of operation.\nThe ECG after radiofrequency ablation showed sinus rhythm, with a heart rate of 61 beats\/min, T wave inversions in leads III and avF, and epsilon waves and T wave inversions in leads V1\u2013V3 (Figure 2D).\nThis patient was discharged from hospital on day 9 with a regimen of metoprolol succinate sustained-release tablets (23.75\u200amg daily, p.o.), amiodarone hydrochloride tablets (200\u200amg daily, p.o.), spironolactone tablets (40\u200amg daily, p.o.), and fosinopril sodium tablets (10\u200amg daily, p.o.).\nThe patient was followed up 3 months after discharge.\nHe had no recurrent palpitation, chest tightness, profuse sweating or nausea.\nAlthough ARVC was the main diagnosis at the time of this patient's initial presentation, it is essential in such cases to perform a reassessment for the presence of structural heart disease, which can evolve over time.\n","ner_info":[{"text":"2013","label":"DATE","start":131,"end":135},{"text":"66-year-old","label":"AGE","start":139,"end":150},{"text":"farmer","label":"OCCUPATION","start":151,"end":157},{"text":"ventricular tachycardia (VT)","label":"HISTORY","start":176,"end":204},{"text":"hypertension","label":"HISTORY","start":209,"end":221},{"text":"presented","label":"CLINICAL_EVENT","start":222,"end":231},{"text":"Emergency Department","label":"NONBIOLOGICAL_LOCATION","start":239,"end":259},{"text":"continuous","label":"DETAILED_DESCRIPTION","start":265,"end":275},{"text":"palpitation","label":"SIGN_SYMPTOM","start":276,"end":287},{"text":"chest 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Cardiology","label":"NONBIOLOGICAL_LOCATION","start":597,"end":621},{"text":"evaluations","label":"DIAGNOSTIC_PROCEDURE","start":634,"end":645},{"text":"treatments","label":"THERAPEUTIC_PROCEDURE","start":650,"end":660},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":676,"end":690},{"text":"105\/75 mm Hg","label":"LAB_VALUE","start":695,"end":707},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":731,"end":741},{"text":"75 beats\/min","label":"LAB_VALUE","start":745,"end":757},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":759,"end":775},{"text":"36.6\u00b0C","label":"LAB_VALUE","start":779,"end":785},{"text":"respiration rate","label":"DIAGNOSTIC_PROCEDURE","start":790,"end":806},{"text":"18 times\/min","label":"LAB_VALUE","start":810,"end":822},{"text":"heart border","label":"BIOLOGICAL_STRUCTURE","start":828,"end":840},{"text":"extended","label":"SIGN_SYMPTOM","start":841,"end":849},{"text":"to the left","label":"LAB_VALUE","start":850,"end":861},{"text":"apical impulse","label":"DIAGNOSTIC_PROCEDURE","start":872,"end":886},{"text":"left 5th intercostal space","label":"LAB_VALUE","start":902,"end":928},{"text":"1.0\u200acm lateral to the midclavicular line","label":"DISTANCE","start":930,"end":970},{"text":"hypertension","label":"DISEASE_DISORDER","start":1001,"end":1013},{"text":"30 years","label":"DURATION","start":1019,"end":1027},{"text":"antihypertensive medication","label":"MEDICATION","start":1044,"end":1071},{"text":"highest","label":"DETAILED_DESCRIPTION","start":1077,"end":1084},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1085,"end":1099},{"text":"170\/110 mm Hg","label":"LAB_VALUE","start":1104,"end":1117},{"text":"no family history of early coronary artery disease or sudden cardiac death","label":"FAMILY_HISTORY","start":1129,"end":1203},{"text":"did not smoke cigarettes or use illicit drugs, and rarely consumed alcohol","label":"HISTORY","start":1208,"end":1282},{"text":"no known contacts with sick persons and no recent travel","label":"HISTORY","start":1301,"end":1357},{"text":"Twelve-lead","label":"DETAILED_DESCRIPTION","start":1359,"end":1370},{"text":"surface","label":"DETAILED_DESCRIPTION","start":1371,"end":1378},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1379,"end":1396},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":1398,"end":1401},{"text":"VT","label":"DISEASE_DISORDER","start":1406,"end":1408},{"text":"boundary between","label":"BIOLOGICAL_STRUCTURE","start":1452,"end":1468},{"text":"right ventricular outflow tract","label":"BIOLOGICAL_STRUCTURE","start":1469,"end":1500},{"text":"RVOT","label":"BIOLOGICAL_STRUCTURE","start":1502,"end":1506},{"text":"tricuspid valve","label":"BIOLOGICAL_STRUCTURE","start":1512,"end":1527},{"text":"VT","label":"DISEASE_DISORDER","start":1534,"end":1536},{"text":"increased","label":"LAB_VALUE","start":1537,"end":1546},{"text":"150 beats\/min or higher","label":"LAB_VALUE","start":1550,"end":1573},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":1578,"end":1591},{"text":"precordial leads","label":"DIAGNOSTIC_PROCEDURE","start":1610,"end":1626},{"text":"VT","label":"DISEASE_DISORDER","start":1663,"end":1665},{"text":"decreased","label":"LAB_VALUE","start":1666,"end":1675},{"text":"120 beats\/min or lower","label":"LAB_VALUE","start":1679,"end":1701},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":1703,"end":1716},{"text":"leads V1\u2013V2","label":"DIAGNOSTIC_PROCEDURE","start":1729,"end":1740},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":1766,"end":1779},{"text":"preceded QRS waves","label":"LAB_VALUE","start":1780,"end":1798},{"text":"leads V1\u2013V2","label":"DIAGNOSTIC_PROCEDURE","start":1802,"end":1813},{"text":"endocardiac tracing","label":"DIAGNOSTIC_PROCEDURE","start":1821,"end":1840},{"text":"local potential","label":"LAB_VALUE","start":1874,"end":1889},{"text":"RVOT","label":"BIOLOGICAL_STRUCTURE","start":1907,"end":1911},{"text":"prior to the ventricular rhythm","label":"DETAILED_DESCRIPTION","start":1921,"end":1952},{"text":"Sinus","label":"DETAILED_DESCRIPTION","start":1978,"end":1983},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":1984,"end":1987},{"text":"year of 2013","label":"DATE","start":1995,"end":2007},{"text":"slight left deviation","label":"LAB_VALUE","start":2020,"end":2041},{"text":"electric axis","label":"DIAGNOSTIC_PROCEDURE","start":2045,"end":2058},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":2067,"end":2077},{"text":"87 beats\/min","label":"LAB_VALUE","start":2081,"end":2093},{"text":"flat T waves","label":"LAB_VALUE","start":2098,"end":2110},{"text":"lead II","label":"DIAGNOSTIC_PROCEDURE","start":2114,"end":2121},{"text":"T wave inversions","label":"SIGN_SYMPTOM","start":2123,"end":2140},{"text":"leads III, avF and V1\u2013V3","label":"DIAGNOSTIC_PROCEDURE","start":2155,"end":2179},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":2191,"end":2204},{"text":"following QRS complex","label":"LAB_VALUE","start":2216,"end":2237},{"text":"leads V1\u2013V3","label":"DIAGNOSTIC_PROCEDURE","start":2241,"end":2252},{"text":"lead avR","label":"DIAGNOSTIC_PROCEDURE","start":2287,"end":2295},{"text":"amplified","label":"DETAILED_DESCRIPTION","start":2300,"end":2309},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":2311,"end":2324},{"text":"behind QRS waves","label":"LAB_VALUE","start":2341,"end":2357},{"text":"Atrial","label":"BIOLOGICAL_STRUCTURE","start":2372,"end":2378},{"text":"premature beats","label":"SIGN_SYMPTOM","start":2379,"end":2394},{"text":"occasionally","label":"FREQUENCY","start":2404,"end":2416},{"text":"ventricular","label":"BIOLOGICAL_STRUCTURE","start":2428,"end":2439},{"text":"premature beats","label":"SIGN_SYMPTOM","start":2440,"end":2455},{"text":"right ventricular apex","label":"BIOLOGICAL_STRUCTURE","start":2494,"end":2516},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":2523,"end":2536},{"text":"behind QRS waves","label":"LAB_VALUE","start":2547,"end":2563},{"text":"sinus","label":"BIOLOGICAL_STRUCTURE","start":2602,"end":2607},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":2608,"end":2611},{"text":"year of 1999","label":"DATE","start":2628,"end":2640},{"text":"left deviation","label":"LAB_VALUE","start":2658,"end":2672},{"text":"electric axis","label":"DIAGNOSTIC_PROCEDURE","start":2676,"end":2689},{"text":"flat T waves","label":"SIGN_SYMPTOM","start":2691,"end":2703},{"text":"T wave inversions","label":"SIGN_SYMPTOM","start":2708,"end":2725},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":2742,"end":2755},{"text":"biochemical assays","label":"DIAGNOSTIC_PROCEDURE","start":2791,"end":2809},{"text":"cardiac troponin I","label":"DIAGNOSTIC_PROCEDURE","start":2827,"end":2845},{"text":"0.714\u200a\u03bcg\/L","label":"LAB_VALUE","start":2856,"end":2866},{"text":"serum B-type natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":2896,"end":2928},{"text":"466.530\u200apg\/mL","label":"LAB_VALUE","start":2939,"end":2952},{"text":"serum d-dimer","label":"DIAGNOSTIC_PROCEDURE","start":2982,"end":2995},{"text":"8.14\u200amg\/L","label":"LAB_VALUE","start":3006,"end":3015},{"text":"blood urea","label":"DIAGNOSTIC_PROCEDURE","start":3045,"end":3055},{"text":"11.69\u200ammol\/L","label":"LAB_VALUE","start":3066,"end":3078},{"text":"serum creatinine","label":"DIAGNOSTIC_PROCEDURE","start":3113,"end":3129},{"text":"144.00\u200a\u03bcmol\/L","label":"LAB_VALUE","start":3140,"end":3153},{"text":"serum uric acid","label":"DIAGNOSTIC_PROCEDURE","start":3185,"end":3200},{"text":"611.40\u200a\u03bcmol\/L","label":"LAB_VALUE","start":3211,"end":3224},{"text":"endogenous creatinine clearing","label":"DIAGNOSTIC_PROCEDURE","start":3261,"end":3291},{"text":"57.90\u200amL\/min","label":"LAB_VALUE","start":3302,"end":3314},{"text":"Echo","label":"DIAGNOSTIC_PROCEDURE","start":3343,"end":3347},{"text":"remarkably","label":"SEVERITY","start":3362,"end":3372},{"text":"enlarged","label":"SIGN_SYMPTOM","start":3373,"end":3381},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":3382,"end":3394},{"text":"right ventricle","label":"BIOLOGICAL_STRUCTURE","start":3399,"end":3414},{"text":"widened","label":"SIGN_SYMPTOM","start":3420,"end":3427},{"text":"ROVT","label":"BIOLOGICAL_STRUCTURE","start":3428,"end":3432},{"text":"Uncoordinated motions","label":"SIGN_SYMPTOM","start":3434,"end":3455},{"text":"left and right ventricular walls","label":"BIOLOGICAL_STRUCTURE","start":3463,"end":3495},{"text":"aortic valve","label":"BIOLOGICAL_STRUCTURE","start":3540,"end":3552},{"text":"degradation","label":"SIGN_SYMPTOM","start":3553,"end":3564},{"text":"slight","label":"SEVERITY","start":3570,"end":3576},{"text":"regurgitation","label":"SIGN_SYMPTOM","start":3577,"end":3590},{"text":"slight","label":"SEVERITY","start":3592,"end":3598},{"text":"mitral","label":"BIOLOGICAL_STRUCTURE","start":3599,"end":3605},{"text":"regurgitation","label":"SIGN_SYMPTOM","start":3606,"end":3619},{"text":"moderate to severe","label":"SEVERITY","start":3625,"end":3643},{"text":"tricuspid","label":"BIOLOGICAL_STRUCTURE","start":3644,"end":3653},{"text":"regurgitation","label":"SIGN_SYMPTOM","start":3654,"end":3667},{"text":"left ventricular diastolic function","label":"DIAGNOSTIC_PROCEDURE","start":3673,"end":3708},{"text":"reduced","label":"LAB_VALUE","start":3713,"end":3720},{"text":"55%","label":"LAB_VALUE","start":3724,"end":3727},{"text":"coronary angiogram","label":"DIAGNOSTIC_PROCEDURE","start":3752,"end":3770},{"text":"vascular stenosis","label":"DISEASE_DISORDER","start":3783,"end":3800},{"text":"ARVC","label":"DISEASE_DISORDER","start":4008,"end":4012},{"text":"diet","label":"THERAPEUTIC_PROCEDURE","start":4016,"end":4020},{"text":"low salt","label":"DETAILED_DESCRIPTION","start":4026,"end":4034},{"text":"low fat","label":"DETAILED_DESCRIPTION","start":4039,"end":4046},{"text":"metoprolol succinate","label":"MEDICATION","start":4096,"end":4116},{"text":"sustained-release tablets","label":"ADMINISTRATION","start":4117,"end":4142},{"text":"23.75\u200amg daily","label":"DOSAGE","start":4144,"end":4158},{"text":"p.o","label":"ADMINISTRATION","start":4160,"end":4163},{"text":"amiodarone","label":"MEDICATION","start":4167,"end":4177},{"text":"200\u200amg daily","label":"DOSAGE","start":4179,"end":4191},{"text":"p.o.","label":"ADMINISTRATION","start":4193,"end":4197},{"text":"furosemide","label":"MEDICATION","start":4200,"end":4210},{"text":"20\u200amg daily","label":"DOSAGE","start":4212,"end":4223},{"text":"i.v.","label":"ADMINISTRATION","start":4225,"end":4229},{"text":"compound","label":"DETAILED_DESCRIPTION","start":4236,"end":4244},{"text":"\u03b1-ketoacid","label":"MEDICATION","start":4245,"end":4255},{"text":"tablets","label":"ADMINISTRATION","start":4256,"end":4263},{"text":"2.52\u200ag daily","label":"DOSAGE","start":4265,"end":4277},{"text":"p.o.","label":"ADMINISTRATION","start":4279,"end":4283},{"text":"VT","label":"DISEASE_DISORDER","start":4296,"end":4298},{"text":"different morphologies and cycle lengths","label":"DETAILED_DESCRIPTION","start":4305,"end":4345},{"text":"radiofrequency ablation","label":"THERAPEUTIC_PROCEDURE","start":4364,"end":4387},{"text":"substrate voltage mapping","label":"DIAGNOSTIC_PROCEDURE","start":4404,"end":4429},{"text":"anterior wall of RVOT","label":"BIOLOGICAL_STRUCTURE","start":4448,"end":4469},{"text":"circular","label":"SHAPE","start":4485,"end":4493},{"text":"scar","label":"SIGN_SYMPTOM","start":4494,"end":4498},{"text":"substrate ablation","label":"THERAPEUTIC_PROCEDURE","start":4563,"end":4581},{"text":"linear","label":"DETAILED_DESCRIPTION","start":4677,"end":4683},{"text":"focal","label":"DETAILED_DESCRIPTION","start":4688,"end":4693},{"text":"ablations","label":"THERAPEUTIC_PROCEDURE","start":4694,"end":4703},{"text":"programmed","label":"DETAILED_DESCRIPTION","start":4741,"end":4751},{"text":"stimulation","label":"DIAGNOSTIC_PROCEDURE","start":4752,"end":4763},{"text":"induced","label":"DETAILED_DESCRIPTION","start":4768,"end":4775},{"text":"stimulation","label":"DIAGNOSTIC_PROCEDURE","start":4776,"end":4787},{"text":"VT","label":"DISEASE_DISORDER","start":4801,"end":4803},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":4880,"end":4883},{"text":"sinus rhythm","label":"SIGN_SYMPTOM","start":4921,"end":4933},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":4942,"end":4952},{"text":"61 beats\/min","label":"LAB_VALUE","start":4956,"end":4968},{"text":"T wave inversions","label":"SIGN_SYMPTOM","start":4970,"end":4987},{"text":"leads III and avF","label":"DIAGNOSTIC_PROCEDURE","start":4991,"end":5008},{"text":"epsilon waves","label":"SIGN_SYMPTOM","start":5014,"end":5027},{"text":"T wave inversions","label":"SIGN_SYMPTOM","start":5032,"end":5049},{"text":"leads V1\u2013V3","label":"DIAGNOSTIC_PROCEDURE","start":5053,"end":5064},{"text":"discharged","label":"CLINICAL_EVENT","start":5095,"end":5105},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":5111,"end":5119},{"text":"day 9","label":"DATE","start":5123,"end":5128},{"text":"metoprolol succinate","label":"MEDICATION","start":5147,"end":5167},{"text":"sustained-release tablets","label":"ADMINISTRATION","start":5168,"end":5193},{"text":"23.75\u200amg daily","label":"DOSAGE","start":5195,"end":5209},{"text":"p.o.","label":"ADMINISTRATION","start":5211,"end":5215},{"text":"amiodarone hydrochloride","label":"MEDICATION","start":5218,"end":5242},{"text":"tablets","label":"ADMINISTRATION","start":5243,"end":5250},{"text":"200\u200amg daily","label":"DOSAGE","start":5252,"end":5264},{"text":"p.o.","label":"ADMINISTRATION","start":5266,"end":5270},{"text":"spironolactone","label":"MEDICATION","start":5273,"end":5287},{"text":"tablets","label":"ADMINISTRATION","start":5288,"end":5295},{"text":"40\u200amg daily","label":"DOSAGE","start":5297,"end":5308},{"text":"p.o.","label":"ADMINISTRATION","start":5310,"end":5314},{"text":"fosinopril sodium","label":"MEDICATION","start":5321,"end":5338},{"text":"tablets","label":"ADMINISTRATION","start":5339,"end":5346},{"text":"10\u200amg daily","label":"DOSAGE","start":5348,"end":5359},{"text":"p.o.","label":"ADMINISTRATION","start":5361,"end":5365},{"text":"followed up","label":"CLINICAL_EVENT","start":5384,"end":5395},{"text":"3 months after","label":"DATE","start":5396,"end":5410},{"text":"palpitation","label":"SIGN_SYMPTOM","start":5442,"end":5453},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":5455,"end":5460},{"text":"tightness","label":"SIGN_SYMPTOM","start":5461,"end":5470},{"text":"profuse","label":"SEVERITY","start":5472,"end":5479},{"text":"sweating","label":"SIGN_SYMPTOM","start":5480,"end":5488},{"text":"nausea","label":"SIGN_SYMPTOM","start":5492,"end":5498},{"text":"Although ARVC was the main diagnosis at the time of this patient's initial presentation, it is essential in such cases to perform a reassessment for the presence of structural heart disease, which can evolve over time","label":"OTHER_ENTITY","start":5500,"end":5717}],"tokens":["The institutional review board (Chengdu Military General Hospital) approved this work and waived the need for informed consent.\nIn ","2013",", a ","66-year-old"," ","farmer"," with a history of ","ventricular tachycardia (VT)"," and ","hypertension"," ","presented"," to the ","Emergency Department"," with ","continuous"," ","palpitation",", ","chest tightness",", ","profuse"," ","sweating"," and ","nausea"," with no obvious predisposing ","causes",".\nThe patient experienced a ","sudden drop"," in ","blood pressure"," and ","acute"," ","confusion",".\nAfter an ","immediate"," ","electrical conversion",", his ","consciousness"," was gradually restored, and ","symptoms"," relieved.\nThen, this patient was ","transferred"," to the ","Department of Cardiology"," for further ","evaluations"," and ","treatments",".\nThe patient's ","blood pressure"," was ","105\/75 mm Hg"," upon admission, with a ","heart rate"," of ","75 beats\/min",", ","body temperature"," of ","36.6\u00b0C"," and ","respiration rate"," of ","18 times\/min",".\nThe ","heart border"," ","extended"," ","to the left",", with the ","apical impulse"," located in the ","left 5th intercostal space",", ","1.0\u200acm lateral to the midclavicular line",".\nThe patient had a history of ","hypertension"," over ","30 years"," without regular ","antihypertensive medication",".\nThe ","highest"," ","blood pressure"," was ","170\/110 mm Hg",".\nThere was ","no family history of early coronary artery disease or sudden cardiac death",".\nHe ","did not smoke cigarettes or use illicit drugs, and rarely consumed alcohol",".\nHe also reported ","no known contacts with sick persons and no recent travel",".\n","Twelve-lead"," ","surface"," ","electrocardiogram"," (","ECG",") of ","VT"," indicated that the origin of VT was at the ","boundary between"," ","right ventricular outflow tract"," (","RVOT",") and ","tricuspid valve",".\nWhen ","VT"," ","increased"," to ","150 beats\/min or higher",", no ","epsilon waves"," were found in the ","precordial leads"," (Figure1A and B).\nIn contrast, when ","VT"," ","decreased"," to ","120 beats\/min or lower",", ","epsilon waves"," appeared in ","leads V1\u2013V2"," (Figure1C).\nNotably, the ","epsilon waves"," ","preceded QRS waves"," in ","leads V1\u2013V2",", while ","endocardiac tracing"," confirmed that the corresponding ","local potential"," originating from ","RVOT"," appeared ","prior to the ventricular rhythm"," (Figure \u200b(Figure1D).1D).\n","Sinus"," ","ECG"," in the ","year of 2013"," suggested a ","slight left deviation"," of ","electric axis",", with a ","heart rate"," of ","87 beats\/min"," and ","flat T waves"," in ","lead II",".\n","T wave inversions"," were found in ","leads III, avF and V1\u2013V3",", meanwhile ","epsilon waves"," were found ","following QRS complex"," in ","leads V1\u2013V3"," (Figure \u200b(Figure2B).2B).\nWhen the ","lead avR"," was ","amplified",", ","epsilon waves"," were also found ","behind QRS waves"," (Figure \u200b2C).\n","Atrial"," ","premature beats"," appeared ","occasionally",".\nMoreover, ","ventricular"," ","premature beats"," were also found to originate from the ","right ventricular apex",", with ","epsilon waves"," appearing ","behind QRS waves"," (Figure \u200b(Figure2B).2B).\nIn contrast, ","sinus"," ","ECG"," obtained in the ","year of 1999"," revealed similar ","left deviation"," of ","electric axis",", ","flat T waves"," and ","T wave inversions",", but absence of ","epsilon waves"," (Figure \u200b(Figure2A).2A).\nData from ","biochemical assays"," were as follows: ","cardiac troponin I"," level was ","0.714\u200a\u03bcg\/L"," (normal range, 0\u20130.06\u200a\u03bcg\/L), ","serum B-type natriuretic peptide"," level was ","466.530\u200apg\/mL"," (normal range, 0\u2013100\u200apg\/mL), ","serum d-dimer"," level was ","8.14\u200amg\/L"," (normal range, 0\u20130.55\u200amg\/L), ","blood urea"," level was ","11.69\u200ammol\/L"," (normal range, 2.90\u20137.20\u200ammol\/L), ","serum creatinine"," level was ","144.00\u200a\u03bcmol\/L"," (normal range, 44\u2013133\u200a\u03bcmol\/L), ","serum uric acid"," level was ","611.40\u200a\u03bcmol\/L"," (normal range, 100\u2013432\u200a\u03bcmol\/L), and ","endogenous creatinine clearing"," value was ","57.90\u200amL\/min"," (normal range, >80\u200amL\/min).\n","Echo"," data revealed ","remarkably"," ","enlarged"," ","right atrium"," and ","right ventricle",", and ","widened"," ","ROVT",".\n","Uncoordinated motions"," of the ","left and right ventricular walls"," were also detected.\nMoreover, we also found ","aortic valve"," ","degradation"," with ","slight"," ","regurgitation",", ","slight"," ","mitral"," ","regurgitation",", and ","moderate to severe"," ","tricuspid"," ","regurgitation",".\nThe ","left ventricular diastolic function"," was ","reduced"," to ","55%"," (Figure \u200b3A and B).\nThe ","coronary angiogram"," revealed no ","vascular stenosis"," (Figure \u200b3C\u2013E).\nBased on the above-mentioned examinations, this patient met at least 2 major criteria, the bilateral ventricular dilation and the existence of epsilon waves, providing diagnostic support for ","ARVC",".\nA ","diet"," with ","low salt"," and ","low fat"," was suggested.\nThe patient was also treated with ","metoprolol succinate"," ","sustained-release tablets"," (","23.75\u200amg daily",", ","p.o",".), ","amiodarone"," (","200\u200amg daily",", ","p.o.","), ","furosemide"," (","20\u200amg daily",", ","i.v.","), and ","compound"," ","\u03b1-ketoacid"," ","tablets"," (","2.52\u200ag daily",", ","p.o.",").\nMoreover, ","VT","s with ","different morphologies and cycle lengths"," were found during ","radiofrequency ablation"," (Figure 4).\nThe ","substrate voltage mapping"," revealed that the ","anterior wall of RVOT"," was wrapped by ","circular"," ","scar"," (Figure 5A).\nConsidering the association of VT with scar areas, ","substrate ablation"," was chosen for this patient.\nThe residual potentials in the scar areas were searched, and then ","linear"," and ","focal"," ","ablations"," were performed (Figure \u200b5B).\nNeither ","programmed"," ","stimulation"," nor ","induced"," ","stimulation"," could induce ","VT"," after the procedure was completed, indicating the success of operation.\nThe ","ECG"," after radiofrequency ablation showed ","sinus rhythm",", with a ","heart rate"," of ","61 beats\/min",", ","T wave inversions"," in ","leads III and avF",", and ","epsilon waves"," and ","T wave inversions"," in ","leads V1\u2013V3"," (Figure 2D).\nThis patient was ","discharged"," from ","hospital"," on ","day 9"," with a regimen of ","metoprolol succinate"," ","sustained-release tablets"," (","23.75\u200amg daily",", ","p.o.","), ","amiodarone hydrochloride"," ","tablets"," (","200\u200amg daily",", ","p.o.","), ","spironolactone"," ","tablets"," (","40\u200amg daily",", ","p.o.","), and ","fosinopril sodium"," ","tablets"," (","10\u200amg daily",", ","p.o.",").\nThe patient was ","followed up"," ","3 months after"," discharge.\nHe had no recurrent ","palpitation",", ","chest"," ","tightness",", ","profuse"," ","sweating"," or ","nausea",".\n","Although ARVC was the main diagnosis at the time of this patient's initial presentation, it is essential in such cases to perform a reassessment for the presence of structural heart disease, which can evolve over time",".\n"],"ner_labels":[0,19,0,5,0,50,0,39,0,39,0,13,0,48,0,22,0,69,0,69,0,63,0,69,0,69,0,26,0,42,0,24,0,22,0,69,0,22,0,75,0,69,0,69,0,13,0,48,0,24,0,75,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,69,0,42,0,24,0,42,0,27,0,26,0,32,0,46,0,22,0,24,0,42,0,34,0,39,0,39,0,22,0,22,0,24,0,24,0,26,0,12,0,12,0,12,0,12,0,26,0,42,0,42,0,69,0,24,0,26,0,42,0,42,0,69,0,24,0,69,0,42,0,24,0,24,0,42,0,12,0,22,0,22,0,24,0,19,0,42,0,24,0,24,0,42,0,42,0,24,0,69,0,24,0,69,0,42,0,24,0,24,0,22,0,69,0,42,0,12,0,69,0,35,0,12,0,69,0,12,0,69,0,42,0,12,0,24,0,19,0,42,0,24,0,69,0,69,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,63,0,69,0,12,0,12,0,69,0,12,0,69,0,12,0,12,0,69,0,63,0,69,0,63,0,12,0,69,0,63,0,12,0,69,0,24,0,42,0,42,0,24,0,26,0,26,0,75,0,22,0,22,0,46,0,4,0,29,0,4,0,46,0,29,0,4,0,46,0,29,0,4,0,22,0,46,0,4,0,29,0,4,0,26,0,22,0,75,0,24,0,12,0,67,0,69,0,75,0,22,0,22,0,75,0,22,0,24,0,22,0,24,0,26,0,24,0,69,0,24,0,42,0,69,0,24,0,69,0,69,0,24,0,13,0,48,0,19,0,46,0,4,0,29,0,4,0,46,0,4,0,29,0,4,0,46,0,4,0,29,0,4,0,46,0,4,0,29,0,4,0,13,0,19,0,69,0,12,0,69,0,63,0,69,0,69,0,51,0]}
-{"full_text":"A 36- year- old white woman at 40 week of gestation was admitted to a local obstetric clinic for elective repeated cesarean delivery due to slanting position of the fetus.\nBoth her previous and current pregnancy were uncomplicated.\nHer past medical history was unremarkable and no family history of cardiac disease was reported.\nThe caesarean delivery was performed following the administration of standard spinal anesthesia.\nDuring surgery the patient became hypotensive and ephedrine was injected to maintain her blood pressure in the normal range.\nThree hours after delivery of healthy male infant, the patient complained of nausea, increasing dyspnoea and palpitations.\nOn physical examination tachycardia with ventricular extra systoles and pulmonary rales were detected.\nHer blood pressure was 80\/40 mmHg and demanded the administration of inotropic agents (initially continuous infusion of norepinephrine 0.5 mg\/h followed by dobutamine 7 \u03bcg\/kg\/min).\nOwing to worsening of oxygen saturation up to 70 % and gradual deterioration of consciousness, mechanical ventilation was applied and the patient was transferred to intensive care unit.\nChest X ray indicated pulmonary congestion.\nEmergency computer tomography excluded pulmonary thromboembolism (PE) and confirmed severe pulmonary oedema (Fig.1).\nThe patient received loop diuretic, furosemide, at initial daily dose 80 mg, which was progressively reduced.\nThe diuretic was discontinued after 12 days of treatment.\nThe electrocardiogram disclosed sinus tachycardia with ST- segment elevation of 1,5 mm with negative T waves in aVL and ST- segment depression of 1 mm in II, III, aVF, V5-V6 (Fig.2).\nLaboratory tests showed elevated troponin up to 908 pg\/ml (normal value <14 pg\/ml), NT- pro BNP 6236 pg\/ml (normal value <125 pg\/ml).\nThe bedside transthoracic echocardiography (TTE) revealed severe left ventricular (LV) systolic dysfunction.\nTherefore the patient was transferred to Intensive Cardiac Therapy Clinic.\nRepeated TTE showed LV ejection fraction 30 % with hypokinesis of the mid and basal segments of posterior, anterior and lateral wall with preserved contractility of the apical segments.\nUrgent coronary angiography presented normal coronary arteries.\nThe diagnosis of inverted stress- induced cardiomyopathy was set upon the overall clinical data.\nAfter 3 days the patient was weaned from respirator and extubated.\nFollowing hemodynamic improvement, inotropic agents were tapered gradually.\nBoth TTE and magnetic resonance imaging (Figs.3 and \u200b4) performed on the fifth day showed complete recovery of myocardial function.\nThe patient was discharged after 15 days in good overall condition.\nAt 12- month follow- up she remained asymptomatic with no echocardiographic abnormalities.\n","ner_info":[{"text":"36- year- old","label":"AGE","start":2,"end":15},{"text":"white","label":"PERSONAL_BACKGROUND","start":16,"end":21},{"text":"woman","label":"SEX","start":22,"end":27},{"text":"40 week","label":"LAB_VALUE","start":31,"end":38},{"text":"gestation","label":"CLINICAL_EVENT","start":42,"end":51},{"text":"admitted","label":"CLINICAL_EVENT","start":56,"end":64},{"text":"local obstetric clinic","label":"NONBIOLOGICAL_LOCATION","start":70,"end":92},{"text":"elective","label":"DETAILED_DESCRIPTION","start":97,"end":105},{"text":"repeated","label":"DETAILED_DESCRIPTION","start":106,"end":114},{"text":"cesarean delivery","label":"THERAPEUTIC_PROCEDURE","start":115,"end":132},{"text":"slanting position","label":"DETAILED_DESCRIPTION","start":140,"end":157},{"text":"fetus","label":"SUBJECT","start":165,"end":170},{"text":"previous and current pregnancy were uncomplicated","label":"HISTORY","start":181,"end":230},{"text":"past medical history was unremarkable","label":"HISTORY","start":236,"end":273},{"text":"no family history of cardiac disease was reported","label":"FAMILY_HISTORY","start":278,"end":327},{"text":"caesarean delivery","label":"THERAPEUTIC_PROCEDURE","start":333,"end":351},{"text":"standard","label":"DETAILED_DESCRIPTION","start":398,"end":406},{"text":"spinal","label":"BIOLOGICAL_STRUCTURE","start":407,"end":413},{"text":"anesthesia","label":"MEDICATION","start":414,"end":424},{"text":"surgery","label":"COREFERENCE","start":433,"end":440},{"text":"hypotensive","label":"SIGN_SYMPTOM","start":460,"end":471},{"text":"ephedrine","label":"MEDICATION","start":476,"end":485},{"text":"injected","label":"ADMINISTRATION","start":490,"end":498},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":515,"end":529},{"text":"normal range","label":"LAB_VALUE","start":537,"end":549},{"text":"Three hours after","label":"TIME","start":551,"end":568},{"text":"delivery","label":"CLINICAL_EVENT","start":569,"end":577},{"text":"healthy","label":"DETAILED_DESCRIPTION","start":581,"end":588},{"text":"male","label":"DETAILED_DESCRIPTION","start":589,"end":593},{"text":"infant","label":"SUBJECT","start":594,"end":600},{"text":"nausea","label":"SIGN_SYMPTOM","start":628,"end":634},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":647,"end":655},{"text":"palpitations","label":"SIGN_SYMPTOM","start":660,"end":672},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":677,"end":697},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":698,"end":709},{"text":"ventricular","label":"BIOLOGICAL_STRUCTURE","start":715,"end":726},{"text":"extra systoles","label":"SIGN_SYMPTOM","start":727,"end":741},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":746,"end":755},{"text":"rales","label":"SIGN_SYMPTOM","start":756,"end":761},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":781,"end":795},{"text":"80\/40 mmHg","label":"LAB_VALUE","start":800,"end":810},{"text":"inotropic agents","label":"MEDICATION","start":846,"end":862},{"text":"continuous infusion","label":"ADMINISTRATION","start":874,"end":893},{"text":"norepinephrine","label":"MEDICATION","start":897,"end":911},{"text":"0.5 mg\/h","label":"DOSAGE","start":912,"end":920},{"text":"dobutamine","label":"MEDICATION","start":933,"end":943},{"text":"7 \u03bcg\/kg\/min","label":"DOSAGE","start":944,"end":955},{"text":"worsening","label":"LAB_VALUE","start":967,"end":976},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":980,"end":997},{"text":"up to 70 %","label":"LAB_VALUE","start":998,"end":1008},{"text":"gradual","label":"SEVERITY","start":1013,"end":1020},{"text":"deterioration of consciousness","label":"SIGN_SYMPTOM","start":1021,"end":1051},{"text":"mechanical ventilation","label":"THERAPEUTIC_PROCEDURE","start":1053,"end":1075},{"text":"transferred","label":"CLINICAL_EVENT","start":1108,"end":1119},{"text":"intensive care unit","label":"NONBIOLOGICAL_LOCATION","start":1123,"end":1142},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1144,"end":1149},{"text":"X ray","label":"DIAGNOSTIC_PROCEDURE","start":1150,"end":1155},{"text":"pulmonary congestion","label":"DISEASE_DISORDER","start":1166,"end":1186},{"text":"Emergency","label":"DETAILED_DESCRIPTION","start":1188,"end":1197},{"text":"computer tomography","label":"DIAGNOSTIC_PROCEDURE","start":1198,"end":1217},{"text":"pulmonary thromboembolism","label":"DISEASE_DISORDER","start":1227,"end":1252},{"text":"PE","label":"DISEASE_DISORDER","start":1254,"end":1256},{"text":"severe","label":"SEVERITY","start":1272,"end":1278},{"text":"pulmonary oedema","label":"DISEASE_DISORDER","start":1279,"end":1295},{"text":"loop diuretic","label":"MEDICATION","start":1326,"end":1339},{"text":"furosemide","label":"MEDICATION","start":1341,"end":1351},{"text":"daily dose 80 mg","label":"DOSAGE","start":1364,"end":1380},{"text":"progressively reduced","label":"LAB_VALUE","start":1392,"end":1413},{"text":"diuretic","label":"COREFERENCE","start":1419,"end":1427},{"text":"after 12 days","label":"DATE","start":1445,"end":1458},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1477,"end":1494},{"text":"sinus tachycardia","label":"SIGN_SYMPTOM","start":1505,"end":1522},{"text":"ST- segment elevation","label":"SIGN_SYMPTOM","start":1528,"end":1549},{"text":"1,5 mm","label":"LAB_VALUE","start":1553,"end":1559},{"text":"negative T waves","label":"SIGN_SYMPTOM","start":1565,"end":1581},{"text":"aVL","label":"DIAGNOSTIC_PROCEDURE","start":1585,"end":1588},{"text":"ST- segment depression","label":"SIGN_SYMPTOM","start":1593,"end":1615},{"text":"1 mm","label":"LAB_VALUE","start":1619,"end":1623},{"text":"II","label":"DIAGNOSTIC_PROCEDURE","start":1627,"end":1629},{"text":"III","label":"DIAGNOSTIC_PROCEDURE","start":1631,"end":1634},{"text":"aVF","label":"DIAGNOSTIC_PROCEDURE","start":1636,"end":1639},{"text":"V5-V6","label":"DIAGNOSTIC_PROCEDURE","start":1641,"end":1646},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":1656,"end":1672},{"text":"elevated","label":"LAB_VALUE","start":1680,"end":1688},{"text":"troponin","label":"DIAGNOSTIC_PROCEDURE","start":1689,"end":1697},{"text":"up to 908 pg\/ml","label":"LAB_VALUE","start":1698,"end":1713},{"text":"NT- pro BNP","label":"DIAGNOSTIC_PROCEDURE","start":1740,"end":1751},{"text":"6236 pg\/ml","label":"LAB_VALUE","start":1752,"end":1762},{"text":"bedside","label":"DETAILED_DESCRIPTION","start":1794,"end":1801},{"text":"transthoracic echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1802,"end":1832},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":1834,"end":1837},{"text":"severe","label":"SEVERITY","start":1848,"end":1854},{"text":"left ventricular","label":"BIOLOGICAL_STRUCTURE","start":1855,"end":1871},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":1873,"end":1875},{"text":"systolic dysfunction","label":"DISEASE_DISORDER","start":1877,"end":1897},{"text":"transferred","label":"CLINICAL_EVENT","start":1925,"end":1936},{"text":"Intensive Cardiac Therapy Clinic","label":"BIOLOGICAL_STRUCTURE","start":1940,"end":1972},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":1983,"end":1986},{"text":"LV","label":"BIOLOGICAL_STRUCTURE","start":1994,"end":1996},{"text":"ejection fraction","label":"DIAGNOSTIC_PROCEDURE","start":1997,"end":2014},{"text":"30 %","label":"LAB_VALUE","start":2015,"end":2019},{"text":"hypokinesis","label":"SIGN_SYMPTOM","start":2025,"end":2036},{"text":"mid and basal segments","label":"DETAILED_DESCRIPTION","start":2044,"end":2066},{"text":"posterior, anterior and lateral wall","label":"BIOLOGICAL_STRUCTURE","start":2070,"end":2106},{"text":"preserved","label":"LAB_VALUE","start":2112,"end":2121},{"text":"contractility","label":"DIAGNOSTIC_PROCEDURE","start":2122,"end":2135},{"text":"apical segments","label":"BIOLOGICAL_STRUCTURE","start":2143,"end":2158},{"text":"Urgent","label":"DETAILED_DESCRIPTION","start":2160,"end":2166},{"text":"coronary angiography","label":"DIAGNOSTIC_PROCEDURE","start":2167,"end":2187},{"text":"normal","label":"LAB_VALUE","start":2198,"end":2204},{"text":"coronary arteries","label":"BIOLOGICAL_STRUCTURE","start":2205,"end":2222},{"text":"inverted","label":"DETAILED_DESCRIPTION","start":2241,"end":2249},{"text":"stress- induced","label":"DETAILED_DESCRIPTION","start":2250,"end":2265},{"text":"cardiomyopathy","label":"DISEASE_DISORDER","start":2266,"end":2280},{"text":"After 3 days","label":"DATE","start":2321,"end":2333},{"text":"respirator","label":"THERAPEUTIC_PROCEDURE","start":2362,"end":2372},{"text":"extubated","label":"THERAPEUTIC_PROCEDURE","start":2377,"end":2386},{"text":"hemodynamic","label":"DIAGNOSTIC_PROCEDURE","start":2398,"end":2409},{"text":"improvement","label":"LAB_VALUE","start":2410,"end":2421},{"text":"inotropic agents","label":"MEDICATION","start":2423,"end":2439},{"text":"TTE","label":"DIAGNOSTIC_PROCEDURE","start":2469,"end":2472},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":2477,"end":2503},{"text":"on the fifth day","label":"DATE","start":2530,"end":2546},{"text":"complete recovery","label":"LAB_VALUE","start":2554,"end":2571},{"text":"myocardial function","label":"DIAGNOSTIC_PROCEDURE","start":2575,"end":2594},{"text":"discharged","label":"CLINICAL_EVENT","start":2612,"end":2622},{"text":"after 15 days","label":"DATE","start":2623,"end":2636},{"text":"good","label":"LAB_VALUE","start":2640,"end":2644},{"text":"overall condition","label":"DIAGNOSTIC_PROCEDURE","start":2645,"end":2662},{"text":"12- month","label":"DATE","start":2667,"end":2676},{"text":"follow- up","label":"CLINICAL_EVENT","start":2677,"end":2687},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":2701,"end":2713},{"text":"echocardiographic abnormalities","label":"SIGN_SYMPTOM","start":2722,"end":2753}],"tokens":["A ","36- year- old"," ","white"," ","woman"," at ","40 week"," of ","gestation"," was ","admitted"," to a ","local obstetric clinic"," for ","elective"," ","repeated"," ","cesarean delivery"," due to ","slanting position"," of the ","fetus",".\nBoth her ","previous and current pregnancy were uncomplicated",".\nHer ","past medical history was unremarkable"," and ","no family history of cardiac disease was reported",".\nThe ","caesarean delivery"," was performed following the administration of ","standard"," ","spinal"," ","anesthesia",".\nDuring ","surgery"," the patient became ","hypotensive"," and ","ephedrine"," was ","injected"," to maintain her ","blood pressure"," in the ","normal range",".\n","Three hours after"," ","delivery"," of ","healthy"," ","male"," ","infant",", the patient complained of ","nausea",", increasing ","dyspnoea"," and ","palpitations",".\nOn ","physical examination"," ","tachycardia"," with ","ventricular"," ","extra systoles"," and ","pulmonary"," ","rales"," were detected.\nHer ","blood pressure"," was ","80\/40 mmHg"," and demanded the administration of ","inotropic agents"," (initially ","continuous infusion"," of ","norepinephrine"," ","0.5 mg\/h"," followed by ","dobutamine"," ","7 \u03bcg\/kg\/min",").\nOwing to ","worsening"," of ","oxygen saturation"," ","up to 70 %"," and ","gradual"," ","deterioration of consciousness",", ","mechanical ventilation"," was applied and the patient was ","transferred"," to ","intensive care unit",".\n","Chest"," ","X ray"," indicated ","pulmonary congestion",".\n","Emergency"," ","computer tomography"," excluded ","pulmonary thromboembolism"," (","PE",") and confirmed ","severe"," ","pulmonary oedema"," (Fig.1).\nThe patient received ","loop diuretic",", ","furosemide",", at initial ","daily dose 80 mg",", which was ","progressively reduced",".\nThe ","diuretic"," was discontinued ","after 12 days"," of treatment.\nThe ","electrocardiogram"," disclosed ","sinus tachycardia"," with ","ST- segment elevation"," of ","1,5 mm"," with ","negative T waves"," in ","aVL"," and ","ST- segment depression"," of ","1 mm"," in ","II",", ","III",", ","aVF",", ","V5-V6"," (Fig.2).\n","Laboratory tests"," showed ","elevated"," ","troponin"," ","up to 908 pg\/ml"," (normal value <14 pg\/ml), ","NT- pro BNP"," ","6236 pg\/ml"," (normal value <125 pg\/ml).\nThe ","bedside"," ","transthoracic echocardiography"," (","TTE",") revealed ","severe"," ","left ventricular"," (","LV",") ","systolic dysfunction",".\nTherefore the patient was ","transferred"," to ","Intensive Cardiac Therapy Clinic",".\nRepeated ","TTE"," showed ","LV"," ","ejection fraction"," ","30 %"," with ","hypokinesis"," of the ","mid and basal segments"," of ","posterior, anterior and lateral wall"," with ","preserved"," ","contractility"," of the ","apical segments",".\n","Urgent"," ","coronary angiography"," presented ","normal"," ","coronary arteries",".\nThe diagnosis of ","inverted"," ","stress- induced"," ","cardiomyopathy"," was set upon the overall clinical data.\n","After 3 days"," the patient was weaned from ","respirator"," and ","extubated",".\nFollowing ","hemodynamic"," ","improvement",", ","inotropic agents"," were tapered gradually.\nBoth ","TTE"," and ","magnetic resonance imaging"," (Figs.3 and \u200b4) performed ","on the fifth day"," showed ","complete recovery"," of ","myocardial function",".\nThe patient was ","discharged"," ","after 15 days"," in ","good"," ","overall condition",".\nAt ","12- month"," ","follow- up"," she remained ","asymptomatic"," with no ","echocardiographic abnormalities",".\n"],"ner_labels":[0,5,0,58,0,65,0,42,0,13,0,13,0,48,0,22,0,22,0,75,0,22,0,71,0,39,0,39,0,34,0,75,0,22,0,12,0,46,0,18,0,69,0,46,0,4,0,24,0,42,0,78,0,13,0,22,0,22,0,71,0,69,0,69,0,69,0,24,0,69,0,12,0,69,0,12,0,69,0,24,0,42,0,46,0,4,0,46,0,29,0,46,0,29,0,42,0,24,0,42,0,63,0,69,0,75,0,13,0,48,0,12,0,24,0,26,0,22,0,24,0,26,0,26,0,63,0,26,0,46,0,46,0,29,0,42,0,18,0,19,0,24,0,69,0,69,0,42,0,69,0,24,0,69,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,24,0,63,0,12,0,12,0,26,0,13,0,12,0,24,0,12,0,24,0,42,0,69,0,22,0,12,0,42,0,24,0,12,0,22,0,24,0,42,0,12,0,22,0,22,0,26,0,19,0,75,0,75,0,24,0,42,0,46,0,24,0,24,0,19,0,42,0,24,0,13,0,19,0,42,0,24,0,19,0,13,0,69,0,69,0]}
-{"full_text":"A 66-year-old man was admitted into our Hospital in November 2008 with splenomegaly, a high red cell count, and subnormal serum erythropoietin levels.\nCytogenetic analysis showed a normal male karyotype.\nMolecular studies were negative for the BCR-ABL1 rearrangement, but revealed the JAK2V617F mutation with an allele burden of 44.9%.\nA diagnosis of PV was made on the basis of a morphological bone marrow analysis according to the WHO 2008 criteria.\nThe patient was started on aspirin, hydroxyurea, and phlebotomies, all of which were well tolerated.\nSix years later, an abdominal ultrasound scan revealed the presence of dense bilateral perinephric infiltration, which was confirmed by a whole-body computed tomography (CT) scan, and a fluotine-18 fluordeoxyglucose positron emission tomography (F-FDG-PET) scan demonstrated increased glucose uptake in the medullary channels of both humeri and femurs.\nMorphological bone marrow analysis confirmed the previous diagnosis of PV and showed no evident change in the grading of bone marrow fibrosis (MF-0 according to the EUMNET consensus),13 whereas cytogenetic analysis revealed the following complex male karyotype: 47,XY,+9[2\/20],47,XY,add(6)(p25),+9[2\/20],46,XY[16\/20].\nThe histological nature of the perinephric infiltration was identified by means of a CT-guided core biopsy of the lesion.\nMorphological analysis demonstrated the accumulation of foamy histiocytes that were positive for CD68 and negative for the dendritic cell markers CD1a and S100, surrounded by fibrosis and a scanty lympho-monocytic infiltrate (Figure \u200b(Figure1).1).\nThe detection of the BRAFV600E mutation led to a diagnosis of ECD.\nCardiac magnetic resonance imaging (MRI) revealed pseudo-tumoral infiltration of the atrioventricular wall,14 and a bone scan showed symmetrically irregular radiotracer uptake in the long bones of the limbs consistent with ECD (Figure \u200b(Figure22)2; the findings of cerebral and pulmonary imaging were negative.\nIn accordance with the most recent guidelines for the treatment of ECD,1 the patient started therapy with pegylated interferon (IFN)-alpha and, after 3 months of treatment, a new abdominal ultrasound scan revealed the complete resolution of the dense bilateral perinephric infiltration, and the normalization of the blood cell counts was achieved.\n","ner_info":[{"text":"66-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"admitted","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"Hospital","label":"NONBIOLOGICAL_LOCATION","start":40,"end":48},{"text":"November 2008","label":"DATE","start":52,"end":65},{"text":"splenomegaly","label":"SIGN_SYMPTOM","start":71,"end":83},{"text":"high","label":"LAB_VALUE","start":87,"end":91},{"text":"red cell count","label":"DIAGNOSTIC_PROCEDURE","start":92,"end":106},{"text":"subnormal","label":"LAB_VALUE","start":112,"end":121},{"text":"serum erythropoietin","label":"DIAGNOSTIC_PROCEDURE","start":122,"end":142},{"text":"Cytogenetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":151,"end":171},{"text":"normal","label":"LAB_VALUE","start":181,"end":187},{"text":"male","label":"LAB_VALUE","start":188,"end":192},{"text":"karyotype","label":"DIAGNOSTIC_PROCEDURE","start":193,"end":202},{"text":"Molecular studies","label":"DIAGNOSTIC_PROCEDURE","start":204,"end":221},{"text":"BCR-ABL1 rearrangement","label":"SIGN_SYMPTOM","start":244,"end":266},{"text":"JAK2V617F mutation","label":"SIGN_SYMPTOM","start":285,"end":303},{"text":"allele burden of 44.9%","label":"LAB_VALUE","start":312,"end":334},{"text":"PV","label":"DISEASE_DISORDER","start":351,"end":353},{"text":"morphological","label":"DETAILED_DESCRIPTION","start":381,"end":394},{"text":"bone marrow analysis","label":"DIAGNOSTIC_PROCEDURE","start":395,"end":415},{"text":"WHO 2008 criteria","label":"DETAILED_DESCRIPTION","start":433,"end":450},{"text":"aspirin","label":"MEDICATION","start":479,"end":486},{"text":"hydroxyurea","label":"MEDICATION","start":488,"end":499},{"text":"phlebotomies","label":"THERAPEUTIC_PROCEDURE","start":505,"end":517},{"text":"Six years later","label":"DATE","start":553,"end":568},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":573,"end":582},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":583,"end":593},{"text":"dense","label":"DETAILED_DESCRIPTION","start":624,"end":629},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":630,"end":639},{"text":"perinephric","label":"BIOLOGICAL_STRUCTURE","start":640,"end":651},{"text":"infiltration","label":"SIGN_SYMPTOM","start":652,"end":664},{"text":"whole-body","label":"BIOLOGICAL_STRUCTURE","start":691,"end":701},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":702,"end":721},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":723,"end":725},{"text":"fluotine-18 fluordeoxyglucose positron emission tomography","label":"DIAGNOSTIC_PROCEDURE","start":739,"end":797},{"text":"F-FDG-PET","label":"DIAGNOSTIC_PROCEDURE","start":799,"end":808},{"text":"increased","label":"LAB_VALUE","start":828,"end":837},{"text":"glucose uptake","label":"DIAGNOSTIC_PROCEDURE","start":838,"end":852},{"text":"medullary channels of both humeri and femurs","label":"BIOLOGICAL_STRUCTURE","start":860,"end":904},{"text":"Morphological","label":"DETAILED_DESCRIPTION","start":906,"end":919},{"text":"bone marrow analysis","label":"DIAGNOSTIC_PROCEDURE","start":920,"end":940},{"text":"PV","label":"DISEASE_DISORDER","start":977,"end":979},{"text":"bone marrow","label":"BIOLOGICAL_STRUCTURE","start":1027,"end":1038},{"text":"fibrosis","label":"DISEASE_DISORDER","start":1039,"end":1047},{"text":"MF-0","label":"LAB_VALUE","start":1049,"end":1053},{"text":"EUMNET consensus","label":"DIAGNOSTIC_PROCEDURE","start":1071,"end":1087},{"text":"cytogenetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":1100,"end":1120},{"text":"male","label":"LAB_VALUE","start":1152,"end":1156},{"text":"karyotype","label":"DIAGNOSTIC_PROCEDURE","start":1157,"end":1166},{"text":"47,XY,+9[2\/20],47,XY,add(6)(p25),+9[2\/20],46,XY[16\/20]","label":"LAB_VALUE","start":1168,"end":1222},{"text":"histological nature","label":"DIAGNOSTIC_PROCEDURE","start":1228,"end":1247},{"text":"perinephric","label":"BIOLOGICAL_STRUCTURE","start":1255,"end":1266},{"text":"infiltration","label":"SIGN_SYMPTOM","start":1267,"end":1279},{"text":"CT-guided","label":"DETAILED_DESCRIPTION","start":1309,"end":1318},{"text":"core","label":"DETAILED_DESCRIPTION","start":1319,"end":1323},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1324,"end":1330},{"text":"lesion","label":"SIGN_SYMPTOM","start":1338,"end":1344},{"text":"Morphological analysis","label":"DIAGNOSTIC_PROCEDURE","start":1346,"end":1368},{"text":"foamy histiocytes","label":"SIGN_SYMPTOM","start":1402,"end":1419},{"text":"positive","label":"LAB_VALUE","start":1430,"end":1438},{"text":"CD68","label":"DIAGNOSTIC_PROCEDURE","start":1443,"end":1447},{"text":"negative","label":"LAB_VALUE","start":1452,"end":1460},{"text":"CD1a","label":"DIAGNOSTIC_PROCEDURE","start":1492,"end":1496},{"text":"S100","label":"DIAGNOSTIC_PROCEDURE","start":1501,"end":1505},{"text":"fibrosis","label":"DISEASE_DISORDER","start":1521,"end":1529},{"text":"scanty","label":"DETAILED_DESCRIPTION","start":1536,"end":1542},{"text":"lympho-monocytic","label":"DETAILED_DESCRIPTION","start":1543,"end":1559},{"text":"infiltrate","label":"SIGN_SYMPTOM","start":1560,"end":1570},{"text":"BRAFV600E mutation","label":"SIGN_SYMPTOM","start":1615,"end":1633},{"text":"ECD","label":"DISEASE_DISORDER","start":1656,"end":1659},{"text":"Cardiac","label":"BIOLOGICAL_STRUCTURE","start":1661,"end":1668},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":1669,"end":1695},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1697,"end":1700},{"text":"pseudo-tumoral","label":"DETAILED_DESCRIPTION","start":1711,"end":1725},{"text":"infiltration","label":"SIGN_SYMPTOM","start":1726,"end":1738},{"text":"atrioventricular wall","label":"BIOLOGICAL_STRUCTURE","start":1746,"end":1767},{"text":"bone scan","label":"DIAGNOSTIC_PROCEDURE","start":1777,"end":1786},{"text":"symmetrically irregular","label":"DETAILED_DESCRIPTION","start":1794,"end":1817},{"text":"uptake","label":"SIGN_SYMPTOM","start":1830,"end":1836},{"text":"long bones of the limbs","label":"BIOLOGICAL_STRUCTURE","start":1844,"end":1867},{"text":"ECD","label":"DISEASE_DISORDER","start":1884,"end":1887},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":1926,"end":1934},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1939,"end":1948},{"text":"imaging","label":"DIAGNOSTIC_PROCEDURE","start":1949,"end":1956},{"text":"negative","label":"LAB_VALUE","start":1962,"end":1970},{"text":"ECD","label":"DISEASE_DISORDER","start":2039,"end":2042},{"text":"pegylated","label":"DETAILED_DESCRIPTION","start":2078,"end":2087},{"text":"interferon (IFN)-alpha","label":"MEDICATION","start":2088,"end":2110},{"text":"after 3 months","label":"DATE","start":2116,"end":2130},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":2151,"end":2160},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2161,"end":2171},{"text":"dense","label":"DETAILED_DESCRIPTION","start":2217,"end":2222},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":2223,"end":2232},{"text":"perinephric","label":"BIOLOGICAL_STRUCTURE","start":2233,"end":2244},{"text":"infiltration","label":"SIGN_SYMPTOM","start":2245,"end":2257},{"text":"normalization","label":"LAB_VALUE","start":2267,"end":2280},{"text":"blood cell counts","label":"DIAGNOSTIC_PROCEDURE","start":2288,"end":2305}],"tokens":["A ","66-year-old"," ","man"," was ","admitted"," into our ","Hospital"," in ","November 2008"," with ","splenomegaly",", a ","high"," ","red cell count",", and ","subnormal"," ","serum erythropoietin"," levels.\n","Cytogenetic analysis"," showed a ","normal"," ","male"," ","karyotype",".\n","Molecular studies"," were negative for the ","BCR-ABL1 rearrangement",", but revealed the ","JAK2V617F mutation"," with an ","allele burden of 44.9%",".\nA diagnosis of ","PV"," was made on the basis of a ","morphological"," ","bone marrow analysis"," according to the ","WHO 2008 criteria",".\nThe patient was started on ","aspirin",", ","hydroxyurea",", and ","phlebotomies",", all of which were well tolerated.\n","Six years later",", an ","abdominal"," ","ultrasound"," scan revealed the presence of ","dense"," ","bilateral"," ","perinephric"," ","infiltration",", which was confirmed by a ","whole-body"," ","computed tomography"," (","CT",") scan, and a ","fluotine-18 fluordeoxyglucose positron emission tomography"," (","F-FDG-PET",") scan demonstrated ","increased"," ","glucose uptake"," in the ","medullary channels of both humeri and femurs",".\n","Morphological"," ","bone marrow analysis"," confirmed the previous diagnosis of ","PV"," and showed no evident change in the grading of ","bone marrow"," ","fibrosis"," (","MF-0"," according to the ","EUMNET consensus","),13 whereas ","cytogenetic analysis"," revealed the following complex ","male"," ","karyotype",": ","47,XY,+9[2\/20],47,XY,add(6)(p25),+9[2\/20],46,XY[16\/20]",".\nThe ","histological nature"," of the ","perinephric"," ","infiltration"," was identified by means of a ","CT-guided"," ","core"," ","biopsy"," of the ","lesion",".\n","Morphological analysis"," demonstrated the accumulation of ","foamy histiocytes"," that were ","positive"," for ","CD68"," and ","negative"," for the dendritic cell markers ","CD1a"," and ","S100",", surrounded by ","fibrosis"," and a ","scanty"," ","lympho-monocytic"," ","infiltrate"," (Figure \u200b(Figure1).1).\nThe detection of the ","BRAFV600E mutation"," led to a diagnosis of ","ECD",".\n","Cardiac"," ","magnetic resonance imaging"," (","MRI",") revealed ","pseudo-tumoral"," ","infiltration"," of the ","atrioventricular wall",",14 and a ","bone scan"," showed ","symmetrically irregular"," radiotracer ","uptake"," in the ","long bones of the limbs"," consistent with ","ECD"," (Figure \u200b(Figure22)2; the findings of ","cerebral"," and ","pulmonary"," ","imaging"," were ","negative",".\nIn accordance with the most recent guidelines for the treatment of ","ECD",",1 the patient started therapy with ","pegylated"," ","interferon (IFN)-alpha"," and, ","after 3 months"," of treatment, a new ","abdominal"," ","ultrasound"," scan revealed the complete resolution of the ","dense"," ","bilateral"," ","perinephric"," ","infiltration",", and the ","normalization"," of the ","blood cell counts"," was achieved.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,19,0,69,0,42,0,24,0,42,0,24,0,24,0,42,0,42,0,24,0,24,0,69,0,69,0,42,0,26,0,22,0,24,0,22,0,46,0,46,0,75,0,19,0,12,0,24,0,22,0,22,0,12,0,69,0,12,0,24,0,24,0,24,0,24,0,42,0,24,0,12,0,22,0,24,0,26,0,12,0,26,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,12,0,69,0,22,0,22,0,24,0,69,0,24,0,69,0,42,0,24,0,42,0,24,0,24,0,26,0,22,0,22,0,69,0,69,0,26,0,12,0,24,0,24,0,22,0,69,0,12,0,24,0,22,0,69,0,12,0,26,0,12,0,12,0,24,0,42,0,26,0,22,0,46,0,19,0,12,0,24,0,22,0,22,0,12,0,69,0,42,0,24,0]}
-{"full_text":"A 50-year old man with a history of metastatic mucinous appendiceal adenocarcinoma presents for evaluation of a desquamating rash on his face that has spread to his scalp, inguinal region, and perineum over the past 4 months (Figure 1).\nThe rash has been accompanied by diffuse alopecia of the face, scalp, axilla, and groin.\nThere was no improvement in the rash despite multiple rounds of oral fluconazole, topical antibiotic ointment, and intravenous antibiotics.\nPrior to the development of his rash, he completed neoadjuvant chemotherapy followed by surgical resection.\nHe underwent colostomy after he failed surgical correction for an enterocutaneous fistula, and he has required total parenteral nutrition (TPN) for the past year.\nHe did not notice any significant changes in ostomy output during this time.\nDermatological examination reveals widespread erythematous plaques on the face, scalp, and medial aspect of thighs bilaterally and scattered papules with scaling on face, scalp, chest, and back.\nDiffuse, non-scarring alopecia is present on the face, scalp, axillae, and groin.\nThe patient had acquired AE, a rare dermatologic condition caused by zinc deficiency.\nThis patient developed acquired zinc deficiency in the setting of inadequate zinc supplementation in TPN.\nThe patient had not received trace elements for approximately one year due to a national shortage.\nThe key to the correct diagnosis of acquired AE is the combination of desquamating rash coupled with alopecia in the setting of chronic supplemental alimentation.\nAlthough it is reasonable to consider a skin biopsy, a skin biopsy would not definitively establish the diagnosis.\nA paraneoplastic panel could be considered, but it would delay diagnosis, and the presentation is most consistent with nutritional deficiency.\nIt is not appropriate to start a topical steroid cream until a diagnosis is determined.\nThe patient had a zinc level of 29 ug\/dL (normal range 56-134 ug\/dL).\nHe received zinc supplementation in his TPN, and within one month, the patient had complete resolution of rash and fatigue, and gradual return of hair growth (Figure 2).\nRepeat zinc level following supplementation was 90 ug\/dL.\nAlthough the patient recovered from his zinc deficiency, he later passed away.\n","ner_info":[{"text":"50-year old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":36,"end":46},{"text":"mucinous","label":"DETAILED_DESCRIPTION","start":47,"end":55},{"text":"appendiceal adenocarcinoma","label":"DISEASE_DISORDER","start":56,"end":82},{"text":"presents","label":"CLINICAL_EVENT","start":83,"end":91},{"text":"desquamating","label":"DETAILED_DESCRIPTION","start":112,"end":124},{"text":"rash","label":"SIGN_SYMPTOM","start":125,"end":129},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":137,"end":141},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":165,"end":170},{"text":"inguinal region","label":"BIOLOGICAL_STRUCTURE","start":172,"end":187},{"text":"perineum","label":"BIOLOGICAL_STRUCTURE","start":193,"end":201},{"text":"over the past 4 months","label":"DURATION","start":202,"end":224},{"text":"rash","label":"SIGN_SYMPTOM","start":241,"end":245},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":270,"end":277},{"text":"alopecia","label":"DISEASE_DISORDER","start":278,"end":286},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":294,"end":298},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":300,"end":305},{"text":"axilla","label":"BIOLOGICAL_STRUCTURE","start":307,"end":313},{"text":"groin","label":"BIOLOGICAL_STRUCTURE","start":319,"end":324},{"text":"rash","label":"SIGN_SYMPTOM","start":358,"end":362},{"text":"multiple rounds","label":"DOSAGE","start":371,"end":386},{"text":"oral","label":"ADMINISTRATION","start":390,"end":394},{"text":"fluconazole","label":"MEDICATION","start":395,"end":406},{"text":"topical","label":"ADMINISTRATION","start":408,"end":415},{"text":"antibiotic","label":"MEDICATION","start":416,"end":426},{"text":"ointment","label":"ADMINISTRATION","start":427,"end":435},{"text":"intravenous","label":"ADMINISTRATION","start":441,"end":452},{"text":"antibiotics","label":"MEDICATION","start":453,"end":464},{"text":"neoadjuvant","label":"DETAILED_DESCRIPTION","start":517,"end":528},{"text":"chemotherapy","label":"MEDICATION","start":529,"end":541},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":554,"end":572},{"text":"colostomy","label":"THERAPEUTIC_PROCEDURE","start":587,"end":596},{"text":"surgical correction","label":"THERAPEUTIC_PROCEDURE","start":613,"end":632},{"text":"enterocutaneous fistula","label":"DISEASE_DISORDER","start":640,"end":663},{"text":"total parenteral nutrition","label":"THERAPEUTIC_PROCEDURE","start":685,"end":711},{"text":"TPN","label":"THERAPEUTIC_PROCEDURE","start":713,"end":716},{"text":"past year","label":"DURATION","start":726,"end":735},{"text":"changes in ostomy output","label":"SIGN_SYMPTOM","start":771,"end":795},{"text":"Dermatological examination","label":"DIAGNOSTIC_PROCEDURE","start":814,"end":840},{"text":"widespread","label":"DETAILED_DESCRIPTION","start":849,"end":859},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":860,"end":872},{"text":"plaques","label":"SIGN_SYMPTOM","start":873,"end":880},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":888,"end":892},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":894,"end":899},{"text":"medial aspect of thighs","label":"BIOLOGICAL_STRUCTURE","start":905,"end":928},{"text":"bilaterally","label":"DETAILED_DESCRIPTION","start":929,"end":940},{"text":"scattered","label":"DETAILED_DESCRIPTION","start":945,"end":954},{"text":"papules","label":"SIGN_SYMPTOM","start":955,"end":962},{"text":"scaling","label":"DETAILED_DESCRIPTION","start":968,"end":975},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":979,"end":983},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":985,"end":990},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":992,"end":997},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":1003,"end":1007},{"text":"Diffuse","label":"DETAILED_DESCRIPTION","start":1009,"end":1016},{"text":"non-scarring","label":"DETAILED_DESCRIPTION","start":1018,"end":1030},{"text":"alopecia","label":"DISEASE_DISORDER","start":1031,"end":1039},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":1058,"end":1062},{"text":"scalp","label":"BIOLOGICAL_STRUCTURE","start":1064,"end":1069},{"text":"axillae","label":"BIOLOGICAL_STRUCTURE","start":1071,"end":1078},{"text":"groin","label":"BIOLOGICAL_STRUCTURE","start":1084,"end":1089},{"text":"AE","label":"DISEASE_DISORDER","start":1116,"end":1118},{"text":"zinc deficiency","label":"DISEASE_DISORDER","start":1160,"end":1175},{"text":"acquired","label":"DETAILED_DESCRIPTION","start":1200,"end":1208},{"text":"zinc deficiency","label":"DISEASE_DISORDER","start":1209,"end":1224},{"text":"inadequate","label":"LAB_VALUE","start":1243,"end":1253},{"text":"zinc supplementation","label":"MEDICATION","start":1254,"end":1274},{"text":"TPN","label":"THERAPEUTIC_PROCEDURE","start":1278,"end":1281},{"text":"trace elements","label":"MEDICATION","start":1312,"end":1326},{"text":"one year","label":"DURATION","start":1345,"end":1353},{"text":"national shortage","label":"OTHER_EVENT","start":1363,"end":1380},{"text":"zinc","label":"DIAGNOSTIC_PROCEDURE","start":1909,"end":1913},{"text":"29 ug\/dL","label":"LAB_VALUE","start":1923,"end":1931},{"text":"zinc supplementation","label":"MEDICATION","start":1973,"end":1993},{"text":"TPN","label":"THERAPEUTIC_PROCEDURE","start":2001,"end":2004},{"text":"one month","label":"DATE","start":2017,"end":2026},{"text":"rash","label":"SIGN_SYMPTOM","start":2067,"end":2071},{"text":"fatigue","label":"SIGN_SYMPTOM","start":2076,"end":2083},{"text":"hair growth","label":"SIGN_SYMPTOM","start":2107,"end":2118},{"text":"zinc level","label":"DIAGNOSTIC_PROCEDURE","start":2138,"end":2148},{"text":"90 ug\/dL","label":"LAB_VALUE","start":2179,"end":2187},{"text":"zinc deficiency","label":"DISEASE_DISORDER","start":2229,"end":2244},{"text":"passed away","label":"OUTCOME","start":2255,"end":2266}],"tokens":["A ","50-year old"," ","man"," with a history of ","metastatic"," ","mucinous"," ","appendiceal adenocarcinoma"," ","presents"," for evaluation of a ","desquamating"," ","rash"," on his ","face"," that has spread to his ","scalp",", ","inguinal region",", and ","perineum"," ","over the past 4 months"," (Figure 1).\nThe ","rash"," has been accompanied by ","diffuse"," ","alopecia"," of the ","face",", ","scalp",", ","axilla",", and ","groin",".\nThere was no improvement in the ","rash"," despite ","multiple rounds"," of ","oral"," ","fluconazole",", ","topical"," ","antibiotic"," ","ointment",", and ","intravenous"," ","antibiotics",".\nPrior to the development of his rash, he completed ","neoadjuvant"," ","chemotherapy"," followed by ","surgical resection",".\nHe underwent ","colostomy"," after he failed ","surgical correction"," for an ","enterocutaneous fistula",", and he has required ","total parenteral nutrition"," (","TPN",") for the ","past year",".\nHe did not notice any significant ","changes in ostomy output"," during this time.\n","Dermatological examination"," reveals ","widespread"," ","erythematous"," ","plaques"," on the ","face",", ","scalp",", and ","medial aspect of thighs"," ","bilaterally"," and ","scattered"," ","papules"," with ","scaling"," on ","face",", ","scalp",", ","chest",", and ","back",".\n","Diffuse",", ","non-scarring"," ","alopecia"," is present on the ","face",", ","scalp",", ","axillae",", and ","groin",".\nThe patient had acquired ","AE",", a rare dermatologic condition caused by ","zinc deficiency",".\nThis patient developed ","acquired"," ","zinc deficiency"," in the setting of ","inadequate"," ","zinc supplementation"," in ","TPN",".\nThe patient had not received ","trace elements"," for approximately ","one year"," due to a ","national shortage",".\nThe key to the correct diagnosis of acquired AE is the combination of desquamating rash coupled with alopecia in the setting of chronic supplemental alimentation.\nAlthough it is reasonable to consider a skin biopsy, a skin biopsy would not definitively establish the diagnosis.\nA paraneoplastic panel could be considered, but it would delay diagnosis, and the presentation is most consistent with nutritional deficiency.\nIt is not appropriate to start a topical steroid cream until a diagnosis is determined.\nThe patient had a ","zinc"," level of ","29 ug\/dL"," (normal range 56-134 ug\/dL).\nHe received ","zinc supplementation"," in his ","TPN",", and within ","one month",", the patient had complete resolution of ","rash"," and ","fatigue",", and gradual return of ","hair growth"," (Figure 2).\nRepeat ","zinc level"," following supplementation was ","90 ug\/dL",".\nAlthough the patient recovered from his ","zinc deficiency",", he later ","passed away",".\n"],"ner_labels":[0,5,0,65,0,22,0,22,0,26,0,13,0,22,0,69,0,12,0,12,0,12,0,12,0,32,0,69,0,22,0,26,0,12,0,12,0,12,0,12,0,69,0,29,0,4,0,46,0,4,0,46,0,4,0,4,0,46,0,22,0,46,0,75,0,75,0,75,0,26,0,75,0,75,0,32,0,69,0,24,0,22,0,22,0,69,0,12,0,12,0,12,0,22,0,22,0,69,0,22,0,12,0,12,0,12,0,12,0,22,0,22,0,26,0,12,0,12,0,12,0,12,0,26,0,26,0,22,0,26,0,42,0,46,0,75,0,46,0,32,0,53,0,24,0,42,0,46,0,75,0,19,0,69,0,69,0,69,0,24,0,42,0,26,0,56,0]}
-{"full_text":"We present the case of a 16-year-old girl, admitted to our clinic with severe abdominal pain, loss of appetite, nausea, and vomiting.\nThe anamnesis revealed that the girl comes from a family of potters, and that she also participated in the process of pottery, her father being diagnosed with lead poisoning 2 years before.\nThe patient's personal history underlined that approximately 1 year ago she presented with severe abdominal pain, being diagnosed with acute appendicitis and she underwent appendectomy, but the pain persisted, thus due to family history of lead poisoning, the suspicion of saturnine colic rose, and she was diagnosed with lead poisoning (urinary lead: 219\u200a\u03bcg\/L), but she received only symptomatic treatment.\nApproximately 3 weeks before admission to our clinic, she was admitted to the regional hospital with another episode of saturnine colic (blood lead: 113.2\u200a\u03bcg\/dL), and chelation therapy with EDTA (4 days before the admission in our clinic) was initiated, with a dose of 2 tablets daily, one in the morning and one in the evening associated with calcium supplements.\nThe clinical examination performed at the time of admission revealed the following pathological elements: influenced general status, ailing face, jaundice of the sclera, blue pigmentation of the nails, painful abdomen at palpation, and weight: 45\u200akg.\nThe laboratory test performed upon admission revealed hypochromic anemia (hemoglobin (Hb): 10.9\u200ag\/dl, hematocrit (Htc): 31.6%, medium cellular volume (MCV): 77.6 fL), increased level of liver transaminases (alanine-aminotransferase (ALAT): 158.9\u200aU\/L, aspartate-aminotransferase (ASAT): 63\u200aU\/L, gamma-glutamyl-transferase (GGT): 128\u200aU\/L), conjugated hyperbilirubinemia (direct bilirubin (DBi): 1.432\u200amg\/dL), hyponatremia (Na: 132\u200ammol\/L), and hypopotassemia (K: 2.85\u200ammol\/L).\nThe systolic arterial pressure was 156 mm Hg, and the diastolic was 96 mm Hg.\nThe blood lead level was 66.28\u200a\u03bcg\/dL, the urinary one was 419.7\u200a\u03bcg\/L (normal <50\u200a\u03bcg\/L) and the value of delta-aminolevulinic acid was 7.66\u200amg\/L (normal <4.5\u200amg\/L).\nWe also performed abdominal ultrasound which revealed a disappearance of the delimitation between the cortical and medullar parts in both kidneys.\nWe requested consultation from an occupational healthcare specialist, who recommended the continuation of chelation therapy with EDTA, increasing the dose at 4\u200atablets\/day.\nWe also required a neurological consultation, and the specialist established the diagnosis of behavioral disorders with depressive elements, and recommended psychotherapy.\nBased on all these clinical and laboratory findings, we established the diagnosis of lead poisoning.\nWe initiated an intense i.v. hydration in order to favor lead elimination, approximately 3 liters per 24\u200ahours initially, and we decreased progressively the quantity once she ceased to vomit, and she was able to consume liquids.\nWe associated diuretics, initially furosemide by vein, but the values of the arterial pressure persisted above the upper limit, therefore we were forced to introduce also an angiotensin-converting enzyme inhibitor, with the remission of arterial hypertension.\nRegarding the liver function, we administered amino acids intravenously, associated with liver protectors by mouth.\nWe also administered vitamins of the B complex in order to improve the neurological impairment.\nThe evolution was slightly favorable, in the first 3 days after the admission, the patient continued to present severe abdominal pain, vomiting, and she also complained of pain in the lumbar area.\nAll the laboratory parameters presented normalization of the values after approximately 10 days of treatment.\nOn the 6th day of admission, we ceased the chelation therapy with EDTA.\nWe also repeated the blood and urinary lead levels.\nThe blood level was 45.57\u200a\u03bcg\/dL, and the urinary one was 836.4\u200a\u03bcg\/L before discharging the patient.\nThe abdominal ultrasound reevaluation revealed no pathological modifications.\nAfter 14 days of admission, the patient was discharged without any complaints, and we recommended no further exposure to lead, avoiding the contact and the working in the pottery process.\nThe long-term outcome of this case depends on further exposure to this heavy metal.\nNevertheless, we intend to repeat the blood lead levels after 12 and 24 months, assessing also the renal (urea, creatinine, urinary exam) and hepatic functions (ASAT, ALAT, GGT, bilirubin).\n","ner_info":[{"text":"16-year-old","label":"AGE","start":25,"end":36},{"text":"girl","label":"SEX","start":37,"end":41},{"text":"admitted","label":"CLINICAL_EVENT","start":43,"end":51},{"text":"clinic","label":"NONBIOLOGICAL_LOCATION","start":59,"end":65},{"text":"severe","label":"SEVERITY","start":71,"end":77},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":78,"end":87},{"text":"pain","label":"SIGN_SYMPTOM","start":88,"end":92},{"text":"loss of appetite","label":"SIGN_SYMPTOM","start":94,"end":110},{"text":"nausea","label":"SIGN_SYMPTOM","start":112,"end":118},{"text":"vomiting","label":"SIGN_SYMPTOM","start":124,"end":132},{"text":"anamnesis","label":"DIAGNOSTIC_PROCEDURE","start":138,"end":147},{"text":"family of potters","label":"FAMILY_HISTORY","start":184,"end":201},{"text":"participated in the process of pottery","label":"OCCUPATION","start":221,"end":259},{"text":"father being diagnosed with lead poisoning 2 years before","label":"FAMILY_HISTORY","start":265,"end":322},{"text":"1 year ago","label":"DATE","start":385,"end":395},{"text":"severe","label":"SEVERITY","start":415,"end":421},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":422,"end":431},{"text":"pain","label":"SIGN_SYMPTOM","start":432,"end":436},{"text":"acute","label":"DETAILED_DESCRIPTION","start":459,"end":464},{"text":"appendicitis","label":"DISEASE_DISORDER","start":465,"end":477},{"text":"appendectomy","label":"THERAPEUTIC_PROCEDURE","start":496,"end":508},{"text":"pain","label":"SIGN_SYMPTOM","start":518,"end":522},{"text":"persisted","label":"DETAILED_DESCRIPTION","start":523,"end":532},{"text":"family history of lead poisoning","label":"FAMILY_HISTORY","start":546,"end":578},{"text":"saturnine colic","label":"DISEASE_DISORDER","start":597,"end":612},{"text":"lead poisoning","label":"DISEASE_DISORDER","start":646,"end":660},{"text":"urinary lead","label":"DIAGNOSTIC_PROCEDURE","start":662,"end":674},{"text":"219\u200a\u03bcg\/L","label":"LAB_VALUE","start":676,"end":684},{"text":"symptomatic treatment","label":"THERAPEUTIC_PROCEDURE","start":709,"end":730},{"text":"3 weeks before","label":"DATE","start":746,"end":760},{"text":"admitted","label":"CLINICAL_EVENT","start":794,"end":802},{"text":"regional hospital","label":"NONBIOLOGICAL_LOCATION","start":810,"end":827},{"text":"saturnine colic","label":"DISEASE_DISORDER","start":852,"end":867},{"text":"blood lead","label":"DIAGNOSTIC_PROCEDURE","start":869,"end":879},{"text":"113.2\u200a\u03bcg\/dL","label":"LAB_VALUE","start":881,"end":892},{"text":"chelation therapy","label":"MEDICATION","start":899,"end":916},{"text":"EDTA","label":"MEDICATION","start":922,"end":926},{"text":"4 days before","label":"DATE","start":928,"end":941},{"text":"2 tablets daily","label":"DOSAGE","start":1001,"end":1016},{"text":"one in the morning and one in the evening","label":"DOSAGE","start":1018,"end":1059},{"text":"calcium supplements","label":"MEDICATION","start":1076,"end":1095},{"text":"clinical examination","label":"DIAGNOSTIC_PROCEDURE","start":1101,"end":1121},{"text":"influenced general status","label":"SIGN_SYMPTOM","start":1203,"end":1228},{"text":"ailing face","label":"SIGN_SYMPTOM","start":1230,"end":1241},{"text":"jaundice","label":"SIGN_SYMPTOM","start":1243,"end":1251},{"text":"sclera","label":"BIOLOGICAL_STRUCTURE","start":1259,"end":1265},{"text":"blue","label":"COLOR","start":1267,"end":1271},{"text":"pigmentation","label":"SIGN_SYMPTOM","start":1272,"end":1284},{"text":"nails","label":"BIOLOGICAL_STRUCTURE","start":1292,"end":1297},{"text":"painful","label":"SIGN_SYMPTOM","start":1299,"end":1306},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1307,"end":1314},{"text":"palpation","label":"DETAILED_DESCRIPTION","start":1318,"end":1327},{"text":"weight","label":"DIAGNOSTIC_PROCEDURE","start":1333,"end":1339},{"text":"45\u200akg","label":"LAB_VALUE","start":1341,"end":1346},{"text":"laboratory test","label":"DIAGNOSTIC_PROCEDURE","start":1352,"end":1367},{"text":"hypochromic","label":"DETAILED_DESCRIPTION","start":1402,"end":1413},{"text":"anemia","label":"SIGN_SYMPTOM","start":1414,"end":1420},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1422,"end":1432},{"text":"Hb","label":"DIAGNOSTIC_PROCEDURE","start":1434,"end":1436},{"text":"10.9\u200ag\/dl","label":"LAB_VALUE","start":1439,"end":1448},{"text":"hematocrit","label":"DIAGNOSTIC_PROCEDURE","start":1450,"end":1460},{"text":"Htc","label":"DIAGNOSTIC_PROCEDURE","start":1462,"end":1465},{"text":"31.6%","label":"LAB_VALUE","start":1468,"end":1473},{"text":"medium cellular volume","label":"DIAGNOSTIC_PROCEDURE","start":1475,"end":1497},{"text":"MCV","label":"DIAGNOSTIC_PROCEDURE","start":1499,"end":1502},{"text":"77.6 fL","label":"LAB_VALUE","start":1505,"end":1512},{"text":"increased","label":"LAB_VALUE","start":1515,"end":1524},{"text":"liver transaminases","label":"DIAGNOSTIC_PROCEDURE","start":1534,"end":1553},{"text":"alanine-aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1555,"end":1579},{"text":"ALAT","label":"DIAGNOSTIC_PROCEDURE","start":1581,"end":1585},{"text":"158.9\u200aU\/L","label":"LAB_VALUE","start":1588,"end":1597},{"text":"aspartate-aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1599,"end":1625},{"text":"ASAT","label":"DIAGNOSTIC_PROCEDURE","start":1627,"end":1631},{"text":"63\u200aU\/L","label":"LAB_VALUE","start":1634,"end":1640},{"text":"gamma-glutamyl-transferase","label":"DIAGNOSTIC_PROCEDURE","start":1642,"end":1668},{"text":"GGT","label":"DIAGNOSTIC_PROCEDURE","start":1670,"end":1673},{"text":"128\u200aU\/L","label":"LAB_VALUE","start":1676,"end":1683},{"text":"conjugated hyperbilirubinemia","label":"SIGN_SYMPTOM","start":1686,"end":1715},{"text":"direct bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1717,"end":1733},{"text":"DBi","label":"DIAGNOSTIC_PROCEDURE","start":1735,"end":1738},{"text":"1.432\u200amg\/dL","label":"LAB_VALUE","start":1741,"end":1752},{"text":"hyponatremia","label":"SIGN_SYMPTOM","start":1755,"end":1767},{"text":"Na","label":"DIAGNOSTIC_PROCEDURE","start":1769,"end":1771},{"text":"132\u200ammol\/L","label":"LAB_VALUE","start":1773,"end":1783},{"text":"hypopotassemia","label":"SIGN_SYMPTOM","start":1790,"end":1804},{"text":"K","label":"DIAGNOSTIC_PROCEDURE","start":1806,"end":1807},{"text":"2.85\u200ammol\/L","label":"LAB_VALUE","start":1809,"end":1820},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":1827,"end":1835},{"text":"arterial pressure","label":"DIAGNOSTIC_PROCEDURE","start":1836,"end":1853},{"text":"156 mm Hg","label":"LAB_VALUE","start":1858,"end":1867},{"text":"diastolic","label":"DETAILED_DESCRIPTION","start":1877,"end":1886},{"text":"96 mm Hg","label":"LAB_VALUE","start":1891,"end":1899},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":1905,"end":1910},{"text":"lead","label":"DIAGNOSTIC_PROCEDURE","start":1911,"end":1915},{"text":"66.28\u200a\u03bcg\/dL","label":"LAB_VALUE","start":1926,"end":1937},{"text":"urinary","label":"BIOLOGICAL_STRUCTURE","start":1943,"end":1950},{"text":"419.7\u200a\u03bcg\/L","label":"LAB_VALUE","start":1959,"end":1969},{"text":"delta-aminolevulinic acid","label":"DIAGNOSTIC_PROCEDURE","start":2005,"end":2030},{"text":"7.66\u200amg\/L","label":"LAB_VALUE","start":2035,"end":2044},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":2083,"end":2092},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2093,"end":2103},{"text":"disappearance","label":"SIGN_SYMPTOM","start":2121,"end":2134},{"text":"delimitation between the cortical and medullar parts","label":"DETAILED_DESCRIPTION","start":2142,"end":2194},{"text":"both kidneys","label":"BIOLOGICAL_STRUCTURE","start":2198,"end":2210},{"text":"consultation","label":"CLINICAL_EVENT","start":2225,"end":2237},{"text":"occupational healthcare specialist","label":"NONBIOLOGICAL_LOCATION","start":2246,"end":2280},{"text":"chelation therapy","label":"MEDICATION","start":2318,"end":2335},{"text":"EDTA","label":"MEDICATION","start":2341,"end":2345},{"text":"4\u200atablets\/day","label":"DOSAGE","start":2370,"end":2383},{"text":"neurological","label":"DETAILED_DESCRIPTION","start":2404,"end":2416},{"text":"consultation","label":"CLINICAL_EVENT","start":2417,"end":2429},{"text":"behavioral disorders","label":"DISEASE_DISORDER","start":2479,"end":2499},{"text":"depressive","label":"DISEASE_DISORDER","start":2505,"end":2515},{"text":"psychotherapy","label":"DIAGNOSTIC_PROCEDURE","start":2542,"end":2555},{"text":"lead poisoning","label":"DISEASE_DISORDER","start":2642,"end":2656},{"text":"i.v.","label":"ADMINISTRATION","start":2682,"end":2686},{"text":"hydration","label":"MEDICATION","start":2687,"end":2696},{"text":"3 liters per 24\u200ahours","label":"DOSAGE","start":2747,"end":2768},{"text":"vomit","label":"SIGN_SYMPTOM","start":2843,"end":2848},{"text":"able to consume liquids","label":"SIGN_SYMPTOM","start":2862,"end":2885},{"text":"diuretics","label":"MEDICATION","start":2901,"end":2910},{"text":"furosemide","label":"MEDICATION","start":2922,"end":2932},{"text":"by vein","label":"ADMINISTRATION","start":2933,"end":2940},{"text":"arterial pressure","label":"DIAGNOSTIC_PROCEDURE","start":2964,"end":2981},{"text":"above the upper limit","label":"LAB_VALUE","start":2992,"end":3013},{"text":"angiotensin-converting enzyme inhibitor","label":"MEDICATION","start":3061,"end":3100},{"text":"arterial hypertension","label":"SIGN_SYMPTOM","start":3124,"end":3145},{"text":"amino acids","label":"MEDICATION","start":3193,"end":3204},{"text":"intravenously","label":"ADMINISTRATION","start":3205,"end":3218},{"text":"liver protectors","label":"MEDICATION","start":3236,"end":3252},{"text":"by mouth","label":"ADMINISTRATION","start":3253,"end":3261},{"text":"vitamins of the B complex","label":"MEDICATION","start":3284,"end":3309},{"text":"evolution","label":"DIAGNOSTIC_PROCEDURE","start":3363,"end":3372},{"text":"slightly favorable","label":"LAB_VALUE","start":3377,"end":3395},{"text":"3 days after","label":"DATE","start":3410,"end":3422},{"text":"severe","label":"SEVERITY","start":3471,"end":3477},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":3478,"end":3487},{"text":"pain","label":"SIGN_SYMPTOM","start":3488,"end":3492},{"text":"vomiting","label":"SIGN_SYMPTOM","start":3494,"end":3502},{"text":"pain","label":"SIGN_SYMPTOM","start":3531,"end":3535},{"text":"lumbar area","label":"BIOLOGICAL_STRUCTURE","start":3543,"end":3554},{"text":"laboratory parameters","label":"DIAGNOSTIC_PROCEDURE","start":3564,"end":3585},{"text":"normalization","label":"LAB_VALUE","start":3596,"end":3609},{"text":"approximately 10 days","label":"DURATION","start":3630,"end":3651},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":3655,"end":3664},{"text":"6th day","label":"DATE","start":3673,"end":3680},{"text":"chelation therapy","label":"MEDICATION","start":3709,"end":3726},{"text":"EDTA","label":"MEDICATION","start":3732,"end":3736},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":3759,"end":3764},{"text":"urinary","label":"BIOLOGICAL_STRUCTURE","start":3769,"end":3776},{"text":"lead","label":"DIAGNOSTIC_PROCEDURE","start":3777,"end":3781},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":3794,"end":3799},{"text":"level","label":"COREFERENCE","start":3800,"end":3805},{"text":"45.57\u200a\u03bcg\/dL","label":"LAB_VALUE","start":3810,"end":3821},{"text":"urinary","label":"BIOLOGICAL_STRUCTURE","start":3831,"end":3838},{"text":"836.4\u200a\u03bcg\/L","label":"LAB_VALUE","start":3847,"end":3857},{"text":"discharging","label":"CLINICAL_EVENT","start":3865,"end":3876},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":3894,"end":3903},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":3904,"end":3914},{"text":"pathological modifications","label":"SIGN_SYMPTOM","start":3940,"end":3966},{"text":"After 14 days","label":"DATE","start":3968,"end":3981},{"text":"discharged","label":"CLINICAL_EVENT","start":4012,"end":4022},{"text":"complaints","label":"SIGN_SYMPTOM","start":4035,"end":4045},{"text":"Nevertheless, we intend to repeat the blood lead levels after 12 and 24 months, assessing also the renal (urea, creatinine, urinary exam) and hepatic functions (ASAT, ALAT, GGT, bilirubin)","label":"OTHER_ENTITY","start":4240,"end":4428}],"tokens":["We present the case of a ","16-year-old"," ","girl",", ","admitted"," to our ","clinic"," with ","severe"," ","abdominal"," ","pain",", ","loss of appetite",", ","nausea",", and ","vomiting",".\nThe ","anamnesis"," revealed that the girl comes from a ","family of potters",", and that she also ","participated in the process of pottery",", her ","father being diagnosed with lead poisoning 2 years before",".\nThe patient's personal history underlined that approximately ","1 year ago"," she presented with ","severe"," ","abdominal"," ","pain",", being diagnosed with ","acute"," ","appendicitis"," and she underwent ","appendectomy",", but the ","pain"," ","persisted",", thus due to ","family history of lead poisoning",", the suspicion of ","saturnine colic"," rose, and she was diagnosed with ","lead poisoning"," (","urinary lead",": ","219\u200a\u03bcg\/L","), but she received only ","symptomatic treatment",".\nApproximately ","3 weeks before"," admission to our clinic, she was ","admitted"," to the ","regional hospital"," with another episode of ","saturnine colic"," (","blood lead",": ","113.2\u200a\u03bcg\/dL","), and ","chelation therapy"," with ","EDTA"," (","4 days before"," the admission in our clinic) was initiated, with a dose of ","2 tablets daily",", ","one in the morning and one in the evening"," associated with ","calcium supplements",".\nThe ","clinical examination"," performed at the time of admission revealed the following pathological elements: ","influenced general status",", ","ailing face",", ","jaundice"," of the ","sclera",", ","blue"," ","pigmentation"," of the ","nails",", ","painful"," ","abdomen"," at ","palpation",", and ","weight",": ","45\u200akg",".\nThe ","laboratory test"," performed upon admission revealed ","hypochromic"," ","anemia"," (","hemoglobin"," (","Hb","): ","10.9\u200ag\/dl",", ","hematocrit"," (","Htc","): ","31.6%",", ","medium cellular volume"," (","MCV","): ","77.6 fL","), ","increased"," level of ","liver transaminases"," (","alanine-aminotransferase"," (","ALAT","): ","158.9\u200aU\/L",", ","aspartate-aminotransferase"," (","ASAT","): ","63\u200aU\/L",", ","gamma-glutamyl-transferase"," (","GGT","): ","128\u200aU\/L","), ","conjugated hyperbilirubinemia"," (","direct bilirubin"," (","DBi","): ","1.432\u200amg\/dL","), ","hyponatremia"," (","Na",": ","132\u200ammol\/L","), and ","hypopotassemia"," (","K",": ","2.85\u200ammol\/L",").\nThe ","systolic"," ","arterial pressure"," was ","156 mm Hg",", and the ","diastolic"," was ","96 mm Hg",".\nThe ","blood"," ","lead"," level was ","66.28\u200a\u03bcg\/dL",", the ","urinary"," one was ","419.7\u200a\u03bcg\/L"," (normal <50\u200a\u03bcg\/L) and the value of ","delta-aminolevulinic acid"," was ","7.66\u200amg\/L"," (normal <4.5\u200amg\/L).\nWe also performed ","abdominal"," ","ultrasound"," which revealed a ","disappearance"," of the ","delimitation between the cortical and medullar parts"," in ","both kidneys",".\nWe requested ","consultation"," from an ","occupational healthcare specialist",", who recommended the continuation of ","chelation therapy"," with ","EDTA",", increasing the dose at ","4\u200atablets\/day",".\nWe also required a ","neurological"," ","consultation",", and the specialist established the diagnosis of ","behavioral disorders"," with ","depressive"," elements, and recommended ","psychotherapy",".\nBased on all these clinical and laboratory findings, we established the diagnosis of ","lead poisoning",".\nWe initiated an intense ","i.v."," ","hydration"," in order to favor lead elimination, approximately ","3 liters per 24\u200ahours"," initially, and we decreased progressively the quantity once she ceased to ","vomit",", and she was ","able to consume liquids",".\nWe associated ","diuretics",", initially ","furosemide"," ","by vein",", but the values of the ","arterial pressure"," persisted ","above the upper limit",", therefore we were forced to introduce also an ","angiotensin-converting enzyme inhibitor",", with the remission of ","arterial hypertension",".\nRegarding the liver function, we administered ","amino acids"," ","intravenously",", associated with ","liver protectors"," ","by mouth",".\nWe also administered ","vitamins of the B complex"," in order to improve the neurological impairment.\nThe ","evolution"," was ","slightly favorable",", in the first ","3 days after"," the admission, the patient continued to present ","severe"," ","abdominal"," ","pain",", ","vomiting",", and she also complained of ","pain"," in the ","lumbar area",".\nAll the ","laboratory parameters"," presented ","normalization"," of the values after ","approximately 10 days"," of ","treatment",".\nOn the ","6th day"," of admission, we ceased the ","chelation therapy"," with ","EDTA",".\nWe also repeated the ","blood"," and ","urinary"," ","lead"," levels.\nThe ","blood"," ","level"," was ","45.57\u200a\u03bcg\/dL",", and the ","urinary"," one was ","836.4\u200a\u03bcg\/L"," before ","discharging"," the patient.\nThe ","abdominal"," ","ultrasound"," reevaluation revealed no ","pathological modifications",".\n","After 14 days"," of admission, the patient was ","discharged"," without any ","complaints",", and we recommended no further exposure to lead, avoiding the contact and the working in the pottery process.\nThe long-term outcome of this case depends on further exposure to this heavy metal.\n","Nevertheless, we intend to repeat the blood lead levels after 12 and 24 months, assessing also the renal (urea, creatinine, urinary exam) and hepatic functions (ASAT, ALAT, GGT, bilirubin)",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,63,0,12,0,69,0,69,0,69,0,69,0,24,0,34,0,50,0,34,0,19,0,63,0,12,0,69,0,22,0,26,0,75,0,69,0,22,0,34,0,26,0,26,0,24,0,42,0,75,0,19,0,13,0,48,0,26,0,24,0,42,0,46,0,46,0,19,0,29,0,29,0,46,0,24,0,69,0,69,0,69,0,12,0,15,0,69,0,12,0,69,0,12,0,22,0,24,0,42,0,24,0,22,0,69,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,42,0,24,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,69,0,24,0,24,0,42,0,69,0,24,0,42,0,69,0,24,0,42,0,22,0,24,0,42,0,22,0,42,0,12,0,24,0,42,0,12,0,42,0,24,0,42,0,12,0,24,0,69,0,22,0,12,0,13,0,48,0,46,0,46,0,29,0,22,0,13,0,26,0,26,0,24,0,26,0,4,0,46,0,29,0,69,0,69,0,46,0,46,0,4,0,24,0,42,0,46,0,69,0,46,0,4,0,46,0,4,0,46,0,24,0,42,0,19,0,63,0,12,0,69,0,69,0,69,0,12,0,24,0,42,0,32,0,75,0,19,0,46,0,46,0,12,0,12,0,24,0,12,0,18,0,42,0,12,0,42,0,13,0,12,0,24,0,69,0,19,0,13,0,69,0,51,0]}
-{"full_text":"The proband is a 19-year-old woman, first child of healthy unrelated parents.\nHer family history was unremarkable.\nShe was born at term after a normal pregnancy.\nThe perinatal period was uneventful and her early development was referred to as normal, but after 1\u2005year of age, psychomotor delay became evident.\nShe started walking autonomously at 22\u2005months, with poor balance and frequent falls.\nAt 3\u2005years of age, she developed a demyelinating sensorimotor neuropathy and a brain MRI disclosed supratentorial leukodystrophy.\nDuring her childhood, the clinical signs remained stable.\nAt 10\u2005years, her walking difficulties worsened, and limb weakness and tremor ensued.\nThe neurological evaluation showed dysarthria, dysmetria, ataxic gait and hyporeflexia in the four limbs with muscle wasting.\nShe was able to walk alone only for a few steps with an ataxic gait.\nMild cognitive impairment was documented (IQ 75, WISC-R scale).\nHistological analysis of a muscle biopsy showed hypo\/atrophy of fibres.\nThe clinical evolution was slowly progressive.\nAt her last follow-up examination, at 19\u2005years of age, she was able to walk alone only with ankle-foot orthotic aids and had developed a marked dorsal-lumbar scoliosis.\nOther clinical signs were stable.\nNeurophysiological studies confirmed worsening of her mixed axonal demyelinating peripheral neuropathy.\nBrain and spinal cord MRI showed mild extension of signal abnormalities and extensive cavitations in the cerebral white matter; the cerebellum and brainstem were spared but the spinal cord was thin with no obvious focal lesions (figure 1A).\nPlasma lactate was 2.9\u2005mM (n.v. <2.1).\n","ner_info":[{"text":"19-year-old","label":"AGE","start":17,"end":28},{"text":"woman","label":"SEX","start":29,"end":34},{"text":"first child of healthy unrelated parents","label":"FAMILY_HISTORY","start":36,"end":76},{"text":"family history was unremarkable","label":"FAMILY_HISTORY","start":82,"end":113},{"text":"born at term after a normal pregnancy","label":"HISTORY","start":123,"end":160},{"text":"perinatal period","label":"DIAGNOSTIC_PROCEDURE","start":166,"end":182},{"text":"uneventful","label":"LAB_VALUE","start":187,"end":197},{"text":"early development","label":"DIAGNOSTIC_PROCEDURE","start":206,"end":223},{"text":"normal","label":"LAB_VALUE","start":243,"end":249},{"text":"1\u2005year of age","label":"DATE","start":261,"end":274},{"text":"psychomotor 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-{"full_text":"A 54-year-old patient was admitted for fever, diarrhea, and acute renal failure.\nHe had no significant medical history, did not take any medication, and had not traveled recently.\nHe had no relevant familial history.\nFifteen days before his admission, he developed fever, fluctuant rash, diarrhea, and pain in the joints.\nOn admission, blood pressure was 140\/70 mm Hg, temperature 39\u00b0C.\nPhysical examination showed severe edema involving both lower and upper limbs, as well as ascites and pleural effusion.\nCervical and axillar infracentimetric lymphadenopathies were present, together with hepatosplenomegaly, confirmed by computed tomography (CT) scan.\nBilateral arthritis of the ankles resolved spontaneously.\nBlood analysis revealed (Table \u200b(Table1):1): leukocytosis, normal hemoglobin and platelet levels with no biologic sign of hemolysis, elevated C-reactive protein, low albumin, elevated serum creatinin, mild proteinuria and no hematuria.\nDespite intravenous rehydration using saline and albumin, renal function worsened and the patient required dialysis.\nWhile diagnostic investigations were performed, hemiplegia occurred: brain MRI showed multifocal ischemic lesions.\nEchographic and rythmologic studies ruled out any cardiologic cause for the stroke.\nA renal biopsy was performed (Fig.1A and B).\nPeriodic acid\u2013Schiff (PAS) staining showed endotheliosis in all glomeruli (Fig.1A, arrows), associated with mesangiolysis and double contours on silver staining (Fig.1B, arrows), and no arteriolar thrombus.\nA moderate CD20+ B lymphocyte infiltrate was present in the interstitium, with a peritubularcapillaritis.\nImmunofluorescence study did not show any deposit.\nLymph node biopsy (Fig.2A and B) showed abnormal follicles with hyalinization of germinal center, and an onion-skin aspect of the mantle zone.\nClinical presentation and lymph node histology were consistent with hyaline-vascular multicentric Castleman disease (MCD).\nHIV and HHV-8 serology, as well as HHV-8 lymph node tissue staining, were negative.\nSerum vascular endothelium growth factor (VEGF) was highly elevated.\nThere was no biologic manifestation of thrombotic microangiopathy (TMA), but the renal biopsy and brain MRI were consistent with glomerular and neurologic TMA lesions.\nNo other apparent cause of thrombotic microvascular involvement was noted.\nNotably, there was no evidence for infection with shiga toxin-producing germs, ADAMTS-13 activity was decreased up to 14% but remained above 5%, and the alternative complement pathway was normal.\nPlasma exchange was initiated due to the kidney histological lesions and the multifocal ischemic brain lesions.\nIt was discontinued after 1 month after the onset of the disease, since the patient's condition remained stable.\nFurthermore, chemotherapy including 6 courses of rituximab (375\u200amg\/m2), cyclophosphamide (750\u200amg\/m2), and dexamethasone (40\u200amg\/day from day 1 to day 4) was started together with plasma exchanges (chemotherapy was performed immediately after plasma exchanges).\nCourses were performed every 3 weeks.\nClinical manifestations of vascular leak syndrome regressed, renal function normalized, and serum VEGF level decreased to 825\u200apg\/mL after 1 course of chemotherapy.\nThe patient was discharged 43 days after admission.\nNo neurological event occurred after initiating the treatment.\nThoraco-abdominal CT scan was performed after 6 courses of chemotherapy, showing a normal liver and spleen size and no lymph node enlargement.\nOne year after the diagnosis, remission of MCD is persistent and plasma creatinine is 86\u200a\u03bcmol\/L, with no 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event","label":"DISEASE_DISORDER","start":3274,"end":3292},{"text":"Thoraco-abdominal","label":"BIOLOGICAL_STRUCTURE","start":3334,"end":3351},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3352,"end":3354},{"text":"6 courses","label":"QUANTITATIVE_CONCEPT","start":3380,"end":3389},{"text":"chemotherapy","label":"MEDICATION","start":3393,"end":3405},{"text":"normal","label":"LAB_VALUE","start":3417,"end":3423},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":3424,"end":3429},{"text":"spleen","label":"BIOLOGICAL_STRUCTURE","start":3434,"end":3440},{"text":"size","label":"DIAGNOSTIC_PROCEDURE","start":3441,"end":3445},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":3453,"end":3463},{"text":"enlargement","label":"SIGN_SYMPTOM","start":3464,"end":3475},{"text":"One year after","label":"DATE","start":3477,"end":3491},{"text":"diagnosis","label":"CLINICAL_EVENT","start":3496,"end":3505},{"text":"MCD","label":"DISEASE_DISORDER","start":3520,"end":3523},{"text":"plasma","label":"DETAILED_DESCRIPTION","start":3542,"end":3548},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":3549,"end":3559},{"text":"86\u200a\u03bcmol\/L","label":"LAB_VALUE","start":3563,"end":3572},{"text":"proteinuria","label":"SIGN_SYMPTOM","start":3582,"end":3593}],"tokens":["A ","54-year-old"," patient was ","admitted"," for ","fever",", ","diarrhea",", and ","acute"," ","renal failure",".\nHe had ","no significant medical history",", did not take any ","medication",", and ","had not traveled recently",".\nHe had ","no relevant familial history",".\n","Fifteen days before"," his ","admission",", he developed ","fever",", ","fluctuant"," ","rash",", ","diarrhea",", and ","pain"," in the ","joints",".\nOn ","admission",", ","blood pressure"," was ","140\/70 mm Hg",", ","temperature"," ","39\u00b0C",".\n","Physical examination"," showed ","severe"," ","edema"," involving both ","lower and upper limbs",", as well as ","ascites"," and ","pleural effusion",".\n","Cervical"," and ","axillar"," ","infracentimetric"," ","lymphadenopathies"," were present, together with ","hepatosplenomegaly",", confirmed by ","computed tomography"," (","CT",") scan.\n","Bilateral"," ","arthritis"," of the ","ankles"," resolved spontaneously.\n","Blood analysis"," revealed (Table \u200b(Table1):1): ","leukocytosis",", ","normal"," ","hemoglobin"," and ","platelet"," levels with no biologic sign of ","hemolysis",", ","elevated"," ","C-reactive protein",", ","low"," ","albumin",", ","elevated"," ","serum"," ","creatinin",", ","mild"," ","proteinuria"," and no ","hematuria",".\nDespite ","intravenous"," ","rehydration"," using ","saline"," and ","albumin",", ","renal function"," ","worsened"," and the patient required ","dialysis",".\nWhile ","diagnostic investigations"," were performed, ","hemiplegia"," occurred: ","brain"," ","MRI"," showed ","multifocal"," ","ischemic"," ","lesions",".\n","Echographic"," and ","rythmologic"," ","studies"," ruled out any ","cardiologic cause"," for the ","stroke",".\nA ","renal"," ","biopsy"," was performed (Fig.1A and B).\n","Periodic acid\u2013Schiff"," (","PAS",") staining showed ","endotheliosis"," in all ","glomeruli"," (Fig.1A, arrows), associated with ","mesangiolysis"," and ","double contours"," on ","silver staining"," (Fig.1B, arrows), and no ","arteriolar"," ","thrombus",".\nA ","moderate"," ","CD20+"," ","B lymphocyte infiltrate"," was present in the ","interstitium",", with a ","peritubularcapillaritis",".\n","Immunofluorescence study"," did not show any ","deposit",".\n","Lymph node"," ","biopsy"," (Fig.2A and B) showed ","abnormal"," ","follicles"," with ","hyalinization"," of ","germinal center",", and an ","onion-skin aspect"," of the ","mantle zone",".\nClinical presentation and ","lymph node"," ","histology"," were consistent with ","hyaline-vascular"," ","multicentric Castleman disease"," (","MCD",").\n","HIV"," and ","HHV-8"," ","serology",", as well as ","HHV-8"," ","lymph node"," ","tissue staining",", were ","negative",".\n","Serum"," ","vascular endothelium growth factor"," (","VEGF",") was ","highly elevated",".\nThere was no biologic manifestation of ","thrombotic microangiopathy"," (","TMA","), but the ","renal"," ","biopsy"," and ","brain"," ","MRI"," were consistent with ","glomerular"," and ","neurologic"," ","TMA"," lesions.\nNo other apparent cause of ","thrombotic"," ","microvascular involvement"," was noted.\nNotably, there was no evidence for infection with ","shiga toxin-producing germs",", ","ADAMTS-13 activity"," was ","decreased"," ","up to 14%"," but remained ","above 5%",", and the ","alternative complement pathway"," was ","normal",".\n","Plasma exchange"," was initiated due to the ","kidney"," histological ","lesions"," and the ","multifocal"," ","ischemic"," ","brain"," ","lesions",".\nIt was ","discontinued"," ","after 1 month"," after the onset of the disease, since the patient's ","condition"," remained ","stable",".\nFurthermore, ","chemotherapy"," including 6 courses of ","rituximab"," (","375\u200amg\/m2","), ","cyclophosphamide"," (","750\u200amg\/m2","), and ","dexamethasone"," (","40\u200amg\/day"," from ","day 1 to day 4",") was started together with ","plasma exchanges"," (chemotherapy was performed immediately after plasma exchanges).\n","Courses"," were performed ","every 3 weeks",".\nClinical manifestations of ","vascular leak syndrome"," regressed, ","renal function"," ","normalized",", and ","serum"," ","VEGF"," level ","decreased"," to ","825\u200apg\/mL"," after ","1 course"," of ","chemotherapy",".\nThe patient was ","discharged"," ","43 days after"," admission.\nNo ","neurological event"," occurred after initiating the treatment.\n","Thoraco-abdominal"," ","CT"," scan was performed after ","6 courses"," of ","chemotherapy",", showing a ","normal"," ","liver"," and ","spleen"," ","size"," and no ","lymph node"," ","enlargement",".\n","One year after"," the ","diagnosis",", remission of ","MCD"," is persistent and ","plasma"," ","creatinine"," is ","86\u200a\u03bcmol\/L",", with no ","proteinuria",".\n"],"ner_labels":[0,5,0,13,0,69,0,69,0,22,0,26,0,39,0,46,0,39,0,34,0,19,0,13,0,69,0,22,0,69,0,69,0,69,0,12,0,13,0,24,0,42,0,24,0,42,0,24,0,63,0,69,0,12,0,69,0,69,0,12,0,12,0,59,0,26,0,26,0,24,0,24,0,22,0,26,0,12,0,24,0,69,0,42,0,24,0,24,0,69,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,63,0,69,0,69,0,22,0,75,0,46,0,46,0,24,0,42,0,75,0,24,0,26,0,12,0,24,0,22,0,22,0,69,0,22,0,22,0,24,0,26,0,26,0,12,0,24,0,24,0,24,0,26,0,12,0,26,0,69,0,24,0,12,0,69,0,63,0,22,0,69,0,12,0,69,0,24,0,69,0,12,0,24,0,69,0,12,0,69,0,12,0,69,0,12,0,12,0,24,0,22,0,26,0,26,0,22,0,22,0,24,0,22,0,12,0,24,0,42,0,22,0,24,0,24,0,42,0,26,0,26,0,12,0,24,0,12,0,24,0,12,0,12,0,26,0,22,0,69,0,26,0,24,0,42,0,42,0,42,0,24,0,42,0,75,0,12,0,69,0,22,0,22,0,12,0,69,0,22,0,19,0,24,0,42,0,46,0,46,0,29,0,46,0,29,0,46,0,29,0,32,0,75,0,18,0,35,0,26,0,24,0,42,0,22,0,24,0,42,0,42,0,62,0,46,0,13,0,19,0,26,0,12,0,24,0,62,0,46,0,42,0,12,0,12,0,24,0,12,0,69,0,19,0,13,0,26,0,22,0,24,0,42,0,69,0]}
-{"full_text":"The patient is an 18-year-old Han female admitted to Peking Union Medical College Hospital due to adrenal crisis triggered by pneumonia.\nShe has developed recurrent respiratory infections since age 5, and failed to respond to multiple hepatitis B virus (HBV) vaccinations.\nReduced serum cortisol and ACTH levels were discovered at 16 when glucocorticoid replacement was initiated.\nIn addition, hair loss started from age 4, and absence of pubic and axillary hair was noticed after development of regular menstruation.\nHer history includes nephrotic syndrome, which was confirmed to be minimal change nephropathy by renal biopsy.\nPhysical examination at admission revealed alopecia totalis, oral candidiasis, hypohidrosis, and trachyonychia.\nFacial or dental abnormalities was not noted.\nShe is the only child in her family.\nSymptom and signs of the above disorders were not identified among her nonconsanguineous parents.\nInitial immunologic tests revealed remarkable panhypogammaglobulinemia and reduced cell counts of B cells, T cells, and natural killer (NK) cells (Table \u200b(Table1).1).\nCD4\/CD8 ratio, as well as expression levels of various T-cell activation markers were in normal range, except increased proportion of CD8+\/HLA-DR+ subset.\nAntinuclear antibodies (ANA) and antineutrophil cytoplasmic antibodies (ANCA) were negative.\nWhen regular hydrocortisone replacement was suspended, her 8:00 am serum cortisol was measured at 0.93\u200a\u03bcg\/dL, with ACTH <5.00\u200apg\/mL.\nSerum levels of other anterior pituitary hormones, as well as serum and urine osmolality were within reference range.\nBoth antiperoxidase antibody and antithyroglobulin antibody were negative.\nShe had positive antiprotein tyrosine phosphatase antibody, with fasting blood glucose at 5.9\u200ammol\/L.\nMagnetic resonance imaging with contrast suggested a normal pituitary.\nShe was diagnosed with CVID, isolated ACTH deficiency, and ectodermal dysplasia.\nSymptoms of fever, cough, and vomiting cleared with antibiotics and stress-dose hydrocortisone treatment.\nIntravenous immunoglobulin (IVIG) therapy was suggested but denied by the parents.\nAt follow-up 1 year after her discharge, she reported no infection events during the previous year as she stayed at home and avoided outdoor activities.\nHer glucocorticoid replacement was withdrawn 4 months after discharge, and she has only received traditional Chinese medicine ever since.\nLymphocyte subsets test done at the follow-up documented increased levels of B cells and T cells, while NK cell count remained below normal limit.\nTo assess her NK-cell activity, a flow cytometric procedure was done following previously described method.[10,11] Effector to target cell ratio was set at 10:1.\nLess apoptosis of target cell line (12.43%, reference range 15.11\u201326.91%) was observed when cocultured with patient's peripheral blood mononuclear cells (PBMC), indicating a deficient NK-cell cytotoxicity.\n","ner_info":[{"text":"18-year-old","label":"AGE","start":18,"end":29},{"text":"Han","label":"PERSONAL_BACKGROUND","start":30,"end":33},{"text":"female","label":"SEX","start":34,"end":40},{"text":"admitted","label":"CLINICAL_EVENT","start":41,"end":49},{"text":"Peking Union Medical College Hospital","label":"NONBIOLOGICAL_LOCATION","start":53,"end":90},{"text":"adrenal crisis","label":"DISEASE_DISORDER","start":98,"end":112},{"text":"pneumonia","label":"DISEASE_DISORDER","start":126,"end":135},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":155,"end":164},{"text":"respiratory","label":"BIOLOGICAL_STRUCTURE","start":165,"end":176},{"text":"infections","label":"DISEASE_DISORDER","start":177,"end":187},{"text":"age 5","label":"DATE","start":194,"end":199},{"text":"failed to respond to multiple hepatitis B virus (HBV) vaccinations","label":"HISTORY","start":205,"end":271},{"text":"Reduced","label":"LAB_VALUE","start":273,"end":280},{"text":"serum","label":"DETAILED_DESCRIPTION","start":281,"end":286},{"text":"cortisol","label":"DIAGNOSTIC_PROCEDURE","start":287,"end":295},{"text":"ACTH","label":"DIAGNOSTIC_PROCEDURE","start":300,"end":304},{"text":"16","label":"DATE","start":331,"end":333},{"text":"glucocorticoid replacement","label":"MEDICATION","start":339,"end":365},{"text":"hair loss","label":"SIGN_SYMPTOM","start":394,"end":403},{"text":"age 4","label":"DATE","start":417,"end":422},{"text":"absence of pubic and axillary hair","label":"SIGN_SYMPTOM","start":428,"end":462},{"text":"development of regular menstruation","label":"OTHER_EVENT","start":481,"end":516},{"text":"nephrotic syndrome","label":"DISEASE_DISORDER","start":539,"end":557},{"text":"minimal change nephropathy","label":"DISEASE_DISORDER","start":585,"end":611},{"text":"renal","label":"BIOLOGICAL_STRUCTURE","start":615,"end":620},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":621,"end":627},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":629,"end":649},{"text":"alopecia totalis","label":"DISEASE_DISORDER","start":672,"end":688},{"text":"oral","label":"BIOLOGICAL_STRUCTURE","start":690,"end":694},{"text":"candidiasis","label":"DISEASE_DISORDER","start":695,"end":706},{"text":"hypohidrosis","label":"DISEASE_DISORDER","start":708,"end":720},{"text":"trachyonychia","label":"SIGN_SYMPTOM","start":726,"end":739},{"text":"Facial","label":"BIOLOGICAL_STRUCTURE","start":741,"end":747},{"text":"dental","label":"BIOLOGICAL_STRUCTURE","start":751,"end":757},{"text":"abnormalities","label":"SIGN_SYMPTOM","start":758,"end":771},{"text":"only child","label":"FAMILY_HISTORY","start":798,"end":808},{"text":"Symptom and signs of the above disorders were not identified among her nonconsanguineous parents","label":"FAMILY_HISTORY","start":824,"end":920},{"text":"immunologic tests","label":"DIAGNOSTIC_PROCEDURE","start":930,"end":947},{"text":"panhypogammaglobulinemia","label":"SIGN_SYMPTOM","start":968,"end":992},{"text":"reduced","label":"LAB_VALUE","start":997,"end":1004},{"text":"cell counts","label":"DIAGNOSTIC_PROCEDURE","start":1005,"end":1016},{"text":"B cells","label":"DIAGNOSTIC_PROCEDURE","start":1020,"end":1027},{"text":"T cells","label":"DIAGNOSTIC_PROCEDURE","start":1029,"end":1036},{"text":"natural killer (NK) cells","label":"DIAGNOSTIC_PROCEDURE","start":1042,"end":1067},{"text":"CD4\/CD8 ratio","label":"DIAGNOSTIC_PROCEDURE","start":1089,"end":1102},{"text":"expression levels","label":"DIAGNOSTIC_PROCEDURE","start":1115,"end":1132},{"text":"T-cell activation markers","label":"DIAGNOSTIC_PROCEDURE","start":1144,"end":1169},{"text":"normal range","label":"LAB_VALUE","start":1178,"end":1190},{"text":"increased","label":"LAB_VALUE","start":1199,"end":1208},{"text":"proportion of CD8+\/HLA-DR+ subset","label":"DIAGNOSTIC_PROCEDURE","start":1209,"end":1242},{"text":"Antinuclear antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1244,"end":1266},{"text":"ANA","label":"DIAGNOSTIC_PROCEDURE","start":1268,"end":1271},{"text":"antineutrophil cytoplasmic antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1277,"end":1314},{"text":"ANCA","label":"DIAGNOSTIC_PROCEDURE","start":1316,"end":1320},{"text":"negative","label":"LAB_VALUE","start":1327,"end":1335},{"text":"hydrocortisone replacement","label":"MEDICATION","start":1350,"end":1376},{"text":"8:00 am","label":"TIME","start":1396,"end":1403},{"text":"serum","label":"DETAILED_DESCRIPTION","start":1404,"end":1409},{"text":"cortisol","label":"DIAGNOSTIC_PROCEDURE","start":1410,"end":1418},{"text":"0.93\u200a\u03bcg\/dL","label":"LAB_VALUE","start":1435,"end":1445},{"text":"ACTH","label":"DIAGNOSTIC_PROCEDURE","start":1452,"end":1456},{"text":"<5.00\u200apg\/mL","label":"LAB_VALUE","start":1457,"end":1468},{"text":"Serum","label":"DETAILED_DESCRIPTION","start":1470,"end":1475},{"text":"anterior pituitary hormones","label":"DIAGNOSTIC_PROCEDURE","start":1492,"end":1519},{"text":"serum","label":"DETAILED_DESCRIPTION","start":1532,"end":1537},{"text":"urine","label":"DETAILED_DESCRIPTION","start":1542,"end":1547},{"text":"osmolality","label":"DIAGNOSTIC_PROCEDURE","start":1548,"end":1558},{"text":"within reference range","label":"LAB_VALUE","start":1564,"end":1586},{"text":"antiperoxidase antibody","label":"DIAGNOSTIC_PROCEDURE","start":1593,"end":1616},{"text":"antithyroglobulin antibody","label":"DIAGNOSTIC_PROCEDURE","start":1621,"end":1647},{"text":"negative","label":"LAB_VALUE","start":1653,"end":1661},{"text":"positive","label":"LAB_VALUE","start":1671,"end":1679},{"text":"antiprotein tyrosine phosphatase antibody","label":"DIAGNOSTIC_PROCEDURE","start":1680,"end":1721},{"text":"fasting blood glucose","label":"DIAGNOSTIC_PROCEDURE","start":1728,"end":1749},{"text":"5.9\u200ammol\/L","label":"LAB_VALUE","start":1753,"end":1763},{"text":"Magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":1765,"end":1791},{"text":"contrast","label":"DETAILED_DESCRIPTION","start":1797,"end":1805},{"text":"normal","label":"LAB_VALUE","start":1818,"end":1824},{"text":"pituitary","label":"DIAGNOSTIC_PROCEDURE","start":1825,"end":1834},{"text":"CVID","label":"DISEASE_DISORDER","start":1859,"end":1863},{"text":"isolated ACTH deficiency","label":"DISEASE_DISORDER","start":1865,"end":1889},{"text":"ectodermal dysplasia","label":"DISEASE_DISORDER","start":1895,"end":1915},{"text":"fever","label":"SIGN_SYMPTOM","start":1929,"end":1934},{"text":"cough","label":"SIGN_SYMPTOM","start":1936,"end":1941},{"text":"vomiting","label":"SIGN_SYMPTOM","start":1947,"end":1955},{"text":"antibiotics","label":"MEDICATION","start":1969,"end":1980},{"text":"stress-dose","label":"DETAILED_DESCRIPTION","start":1985,"end":1996},{"text":"hydrocortisone","label":"MEDICATION","start":1997,"end":2011},{"text":"Intravenous immunoglobulin","label":"MEDICATION","start":2023,"end":2049},{"text":"IVIG","label":"MEDICATION","start":2051,"end":2055},{"text":"follow-up","label":"CLINICAL_EVENT","start":2109,"end":2118},{"text":"1 year after","label":"DATE","start":2119,"end":2131},{"text":"infection","label":"DISEASE_DISORDER","start":2163,"end":2172},{"text":"during the previous year","label":"DURATION","start":2180,"end":2204},{"text":"stayed","label":"CLINICAL_EVENT","start":2212,"end":2218},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":2222,"end":2226},{"text":"outdoor activities","label":"ACTIVITY","start":2239,"end":2257},{"text":"glucocorticoid replacement","label":"MEDICATION","start":2263,"end":2289},{"text":"4 months after","label":"DATE","start":2304,"end":2318},{"text":"traditional Chinese medicine","label":"MEDICATION","start":2356,"end":2384},{"text":"Lymphocyte subsets test","label":"DIAGNOSTIC_PROCEDURE","start":2397,"end":2420},{"text":"increased","label":"LAB_VALUE","start":2454,"end":2463},{"text":"B cells","label":"DIAGNOSTIC_PROCEDURE","start":2474,"end":2481},{"text":"T cells","label":"DIAGNOSTIC_PROCEDURE","start":2486,"end":2493},{"text":"NK cell count","label":"DIAGNOSTIC_PROCEDURE","start":2501,"end":2514},{"text":"below normal limit","label":"LAB_VALUE","start":2524,"end":2542},{"text":"flow cytometric procedure","label":"DIAGNOSTIC_PROCEDURE","start":2578,"end":2603}],"tokens":["The patient is an ","18-year-old"," ","Han"," ","female"," ","admitted"," to ","Peking Union Medical College Hospital"," due to ","adrenal crisis"," triggered by ","pneumonia",".\nShe has developed ","recurrent"," ","respiratory"," ","infections"," since ","age 5",", and ","failed to respond to multiple hepatitis B virus (HBV) vaccinations",".\n","Reduced"," ","serum"," ","cortisol"," and ","ACTH"," levels were discovered at ","16"," when ","glucocorticoid replacement"," was initiated.\nIn addition, ","hair loss"," started from ","age 4",", and ","absence of pubic and axillary hair"," was noticed after ","development of regular menstruation",".\nHer history includes ","nephrotic syndrome",", which was confirmed to be ","minimal change nephropathy"," by ","renal"," ","biopsy",".\n","Physical examination"," at admission revealed ","alopecia totalis",", ","oral"," ","candidiasis",", ","hypohidrosis",", and ","trachyonychia",".\n","Facial"," or ","dental"," ","abnormalities"," was not noted.\nShe is the ","only child"," in her family.\n","Symptom and signs of the above disorders were not identified among her nonconsanguineous parents",".\nInitial ","immunologic tests"," revealed remarkable ","panhypogammaglobulinemia"," and ","reduced"," ","cell counts"," of ","B cells",", ","T cells",", and ","natural killer (NK) cells"," (Table \u200b(Table1).1).\n","CD4\/CD8 ratio",", as well as ","expression levels"," of various ","T-cell activation markers"," were in ","normal range",", except ","increased"," ","proportion of CD8+\/HLA-DR+ subset",".\n","Antinuclear antibodies"," (","ANA",") and ","antineutrophil cytoplasmic antibodies"," (","ANCA",") were ","negative",".\nWhen regular ","hydrocortisone replacement"," was suspended, her ","8:00 am"," ","serum"," ","cortisol"," was measured at ","0.93\u200a\u03bcg\/dL",", with ","ACTH"," ","<5.00\u200apg\/mL",".\n","Serum"," levels of other ","anterior pituitary hormones",", as well as ","serum"," and ","urine"," ","osmolality"," were ","within reference range",".\nBoth ","antiperoxidase antibody"," and ","antithyroglobulin antibody"," were ","negative",".\nShe had ","positive"," ","antiprotein tyrosine phosphatase antibody",", with ","fasting blood glucose"," at ","5.9\u200ammol\/L",".\n","Magnetic resonance imaging"," with ","contrast"," suggested a ","normal"," ","pituitary",".\nShe was diagnosed with ","CVID",", ","isolated ACTH deficiency",", and ","ectodermal dysplasia",".\nSymptoms of ","fever",", ","cough",", and ","vomiting"," cleared with ","antibiotics"," and ","stress-dose"," ","hydrocortisone"," treatment.\n","Intravenous immunoglobulin"," (","IVIG",") therapy was suggested but denied by the parents.\nAt ","follow-up"," ","1 year after"," her discharge, she reported no ","infection"," events ","during the previous year"," as she ","stayed"," at ","home"," and avoided ","outdoor activities",".\nHer ","glucocorticoid replacement"," was withdrawn ","4 months after"," discharge, and she has only received ","traditional Chinese medicine"," ever since.\n","Lymphocyte subsets test"," done at the follow-up documented ","increased"," levels of ","B cells"," and ","T cells",", while ","NK cell count"," remained ","below normal limit",".\nTo assess her NK-cell activity, a ","flow cytometric procedure"," was done following previously described method.[10,11] Effector to target cell ratio was set at 10:1.\nLess apoptosis of target cell line (12.43%, reference range 15.11\u201326.91%) was observed when cocultured with patient's peripheral blood mononuclear cells (PBMC), indicating a deficient NK-cell cytotoxicity.\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,48,0,26,0,26,0,22,0,12,0,26,0,19,0,39,0,42,0,22,0,24,0,24,0,19,0,46,0,69,0,19,0,69,0,53,0,26,0,26,0,12,0,24,0,24,0,26,0,12,0,26,0,26,0,69,0,12,0,12,0,69,0,34,0,34,0,24,0,69,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,46,0,78,0,22,0,24,0,42,0,24,0,42,0,22,0,24,0,22,0,22,0,24,0,42,0,24,0,24,0,42,0,42,0,24,0,24,0,42,0,24,0,22,0,42,0,24,0,26,0,26,0,26,0,69,0,69,0,69,0,46,0,22,0,46,0,46,0,46,0,13,0,19,0,26,0,32,0,13,0,48,0,1,0,46,0,19,0,46,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0]}
-{"full_text":"A 69-year-old male diabetic patient was admitted with acute left ventricular (LV) failure and was treated with intensive decongestive therapy.\nHe had severe peripheral edema and bilateral basal crepitations.\nInitial workup revealed normal levels of troponine (<0.01 ng\/ml) and CPK-MB (4.6 ng\/ml), thereby ruling out acute coronary syndrome.\nThe level of BNP was 1230 pg\/ml confirming the diagnosis of heart failure.\nEchocardiographic assessment revealed LVEF of 10% with dilated cardiac chambers, and estimated pulmonary artery systolic pressure (PASP) was 70 mm of Hg with features of raised LV diastolic pressure.\nAngiography was performed after 3 days of decongestive therapy which revealed critical triple vessel disease with left main coronary artery disease (Fig.1).\nHe was referred for CABG.\nThe patient was put on frusemide infusion with oral ramipril and aldactone.\nHe was taken up for elective OPCAB 1 week after angiography.\nRenal function was monitored regularly to adjust diuretic dose.\nThere was no feature of end organ dysfunction.\nSTS risk of mortality was 2.4%.\nRepeat echocardiographic assessment revealed improvement of LVEF to 15% and decrease in PASP to 30 mm Hg and decrease in LV filling pressure.\nOPCAB was performed through median sternotomy.\nLeft ITA was used for grafting left anterior descending artery (LAD).\nAfter revascularizing LAD, right ITA (RITA) and RA composite, graft was prepared.\nThe distal end of RITA was used for revascularizing the diagonal artery.\nThere was significant improvement in systolic blood pressure after this distal anastomosis.\nAfter these two grafts, heart was lifted for lateral and posterior wall vessels.\nWe make a longer skin incision, open the sternum widely, and release pericardium on the right side to displace the heart gradually.\nThis was supplemented with headlow and lateral tilt position.\nLiberal doses of inotropic support were used.\nRA was used for sequential grafting of obtuse marginal, posterior LV branch, and posterior descending artery.\nAll these five distal anastamoses were performed uneventfully.\nThe patient was electively ventilated for 2 days.\nEchocardiography on 1st POD revealed improvement in LVEF to 20%.\nHe was started on low dose beta blockers after inotropic supports were weaned off.\nHe had slow and uneventful recovery.\nEchocardiography on 4th POD revealed improvement in LVEF to 30% (Table 1).\nHe had persistent pleural drainage requiring prolonged intensive care unit stay.\nAfter pleural drainage subsided and drains were removed, he was discharged on diuretics, low dose beta blocker, and ramipril.\n","ner_info":[{"text":"69-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"diabetic","label":"HISTORY","start":19,"end":27},{"text":"admitted","label":"CLINICAL_EVENT","start":40,"end":48},{"text":"acute","label":"DETAILED_DESCRIPTION","start":54,"end":59},{"text":"left ventricular (LV) 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mortality","label":"DIAGNOSTIC_PROCEDURE","start":1047,"end":1068},{"text":"2.4%","label":"LAB_VALUE","start":1073,"end":1077},{"text":"echocardiographic assessment","label":"DIAGNOSTIC_PROCEDURE","start":1086,"end":1114},{"text":"improvement","label":"LAB_VALUE","start":1124,"end":1135},{"text":"LVEF","label":"DIAGNOSTIC_PROCEDURE","start":1139,"end":1143},{"text":"15%","label":"LAB_VALUE","start":1147,"end":1150},{"text":"decrease","label":"LAB_VALUE","start":1155,"end":1163},{"text":"PASP","label":"DIAGNOSTIC_PROCEDURE","start":1167,"end":1171},{"text":"30 mm Hg","label":"LAB_VALUE","start":1175,"end":1183},{"text":"decrease","label":"LAB_VALUE","start":1188,"end":1196},{"text":"LV filling pressure","label":"DIAGNOSTIC_PROCEDURE","start":1200,"end":1219},{"text":"OPCAB","label":"THERAPEUTIC_PROCEDURE","start":1221,"end":1226},{"text":"median sternotomy","label":"THERAPEUTIC_PROCEDURE","start":1249,"end":1266},{"text":"Left ITA","label":"BIOLOGICAL_STRUCTURE","start":1268,"end":1276},{"text":"grafting","label":"THERAPEUTIC_PROCEDURE","start":1290,"end":1298},{"text":"left anterior descending artery","label":"BIOLOGICAL_STRUCTURE","start":1299,"end":1330},{"text":"LAD","label":"BIOLOGICAL_STRUCTURE","start":1332,"end":1335},{"text":"revascularizing","label":"THERAPEUTIC_PROCEDURE","start":1344,"end":1359},{"text":"LAD","label":"BIOLOGICAL_STRUCTURE","start":1360,"end":1363},{"text":"right ITA","label":"BIOLOGICAL_STRUCTURE","start":1365,"end":1374},{"text":"RITA","label":"BIOLOGICAL_STRUCTURE","start":1376,"end":1380},{"text":"RA","label":"BIOLOGICAL_STRUCTURE","start":1386,"end":1388},{"text":"graft","label":"THERAPEUTIC_PROCEDURE","start":1400,"end":1405},{"text":"distal end of RITA","label":"BIOLOGICAL_STRUCTURE","start":1424,"end":1442},{"text":"revascularizing","label":"THERAPEUTIC_PROCEDURE","start":1456,"end":1471},{"text":"diagonal artery","label":"BIOLOGICAL_STRUCTURE","start":1476,"end":1491},{"text":"significant","label":"DETAILED_DESCRIPTION","start":1503,"end":1514},{"text":"improvement","label":"LAB_VALUE","start":1515,"end":1526},{"text":"systolic","label":"DETAILED_DESCRIPTION","start":1530,"end":1538},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1539,"end":1553},{"text":"distal","label":"DETAILED_DESCRIPTION","start":1565,"end":1571},{"text":"anastomosis","label":"THERAPEUTIC_PROCEDURE","start":1572,"end":1583},{"text":"heart","label":"BIOLOGICAL_STRUCTURE","start":1609,"end":1614},{"text":"lifted for lateral and posterior wall vessels","label":"THERAPEUTIC_PROCEDURE","start":1619,"end":1664},{"text":"skin incision","label":"THERAPEUTIC_PROCEDURE","start":1683,"end":1696},{"text":"open the sternum","label":"THERAPEUTIC_PROCEDURE","start":1698,"end":1714},{"text":"release pericardium","label":"THERAPEUTIC_PROCEDURE","start":1727,"end":1746},{"text":"headlow","label":"DETAILED_DESCRIPTION","start":1825,"end":1832},{"text":"lateral tilt","label":"DETAILED_DESCRIPTION","start":1837,"end":1849},{"text":"position","label":"THERAPEUTIC_PROCEDURE","start":1850,"end":1858},{"text":"Liberal doses","label":"DOSAGE","start":1860,"end":1873},{"text":"inotropic support","label":"MEDICATION","start":1877,"end":1894},{"text":"RA","label":"BIOLOGICAL_STRUCTURE","start":1906,"end":1908},{"text":"sequential","label":"DETAILED_DESCRIPTION","start":1922,"end":1932},{"text":"grafting","label":"THERAPEUTIC_PROCEDURE","start":1933,"end":1941},{"text":"obtuse marginal","label":"BIOLOGICAL_STRUCTURE","start":1945,"end":1960},{"text":"posterior LV branch","label":"BIOLOGICAL_STRUCTURE","start":1962,"end":1981},{"text":"posterior descending 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drainage","label":"SIGN_SYMPTOM","start":2476,"end":2492},{"text":"discharged","label":"CLINICAL_EVENT","start":2534,"end":2544},{"text":"diuretics","label":"MEDICATION","start":2548,"end":2557},{"text":"low dose","label":"DOSAGE","start":2559,"end":2567},{"text":"beta blocker","label":"MEDICATION","start":2568,"end":2580},{"text":"ramipril","label":"MEDICATION","start":2586,"end":2594}],"tokens":["A ","69-year-old"," ","male"," ","diabetic"," patient was ","admitted"," with ","acute"," ","left ventricular (LV) failure"," and was treated with ","intensive"," ","decongestive therapy",".\nHe had ","severe"," ","peripheral"," ","edema"," and ","bilateral"," ","basal"," ","crepitations",".\nInitial ","workup"," revealed ","normal"," levels of ","troponine"," (","<0.01 ng\/ml",") and ","CPK-MB"," (","4.6 ng\/ml","), thereby ruling out ","acute coronary syndrome",".\nThe level of ","BNP"," was ","1230 pg\/ml"," confirming the diagnosis of ","heart failure",".\n","Echocardiographic assessment"," revealed ","LVEF"," of ","10%"," with ","dilated cardiac chambers",", and estimated ","pulmonary artery systolic pressure"," (","PASP",") was ","70 mm of Hg"," with ","features of raised LV diastolic pressure",".\n","Angiography"," was performed ","after 3 days"," of ","decongestive therapy"," which revealed ","critical"," ","triple vessel disease"," with ","left main"," ","coronary artery disease"," (Fig.1).\nHe was ","referred"," for ","CABG",".\nThe patient was put on ","frusemide"," ","infusion"," with ","oral"," ","ramipril"," and ","aldactone",".\nHe was taken up for elective ","OPCAB"," ","1 week after"," ","angiography",".\n","Renal function"," was monitored regularly ","to adjust diuretic dose",".\nThere was no feature of ","end organ dysfunction",".\n","STS risk of mortality"," was ","2.4%",".\nRepeat ","echocardiographic assessment"," revealed ","improvement"," of ","LVEF"," to ","15%"," and ","decrease"," in ","PASP"," to ","30 mm Hg"," and ","decrease"," in ","LV filling pressure",".\n","OPCAB"," was performed through ","median sternotomy",".\n","Left ITA"," was used for ","grafting"," ","left anterior descending artery"," (","LAD",").\nAfter ","revascularizing"," ","LAD",", ","right ITA"," (","RITA",") and ","RA"," composite, ","graft"," was prepared.\nThe ","distal end of RITA"," was used for ","revascularizing"," the ","diagonal artery",".\nThere was ","significant"," ","improvement"," in ","systolic"," ","blood pressure"," after this ","distal"," ","anastomosis",".\nAfter these two grafts, ","heart"," was ","lifted for lateral and posterior wall vessels",".\nWe make a longer ","skin incision",", ","open the sternum"," widely, and ","release pericardium"," on the right side to displace the heart gradually.\nThis was supplemented with ","headlow"," and ","lateral tilt"," ","position",".\n","Liberal doses"," of ","inotropic support"," were used.\n","RA"," was used for ","sequential"," ","grafting"," of ","obtuse marginal",", ","posterior LV branch",", and ","posterior descending artery",".\nAll these ","five"," ","distal"," ","anastamoses"," were performed uneventfully.\nThe patient was electively ","ventilated"," for ","2 days",".\n","Echocardiography"," on ","1st POD"," revealed ","improvement"," in ","LVEF"," to ","20%",".\nHe was started on ","low dose"," ","beta blockers"," after ","inotropic supports"," were weaned off.\nHe had ","slow"," and ","uneventful"," ","recovery",".\n","Echocardiography"," on ","4th POD"," revealed ","improvement"," in ","LVEF"," to ","30%"," (Table 1).\nHe had ","persistent"," ","pleural drainage"," requiring prolonged ","intensive care unit"," ","stay",".\nAfter ","pleural drainage"," subsided and drains were removed, he was ","discharged"," on ","diuretics",", ","low dose"," ","beta blocker",", and 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-{"full_text":"A 70-year-old male was admitted to our hospital for perioperative cardiac evaluation of abdominal aortic aneurysm.\nThe patient had undergone coronary artery bypass grafting (CABG) for severe stenosis of the left main coronary artery (LMCA) 4 years before, which consisted of the right internal thoracic artery (RITA) to the left anterior descending artery (LAD) and saphenous vein graft (SVG) to the left circumflex artery (LCX).\nDue to continual growth of the abdominal aortic aneurysm over the years, surgery was indicated.\nLeft coronary angiogram showed 90 % stenosis of the LMCA and total occlusion of both grafts.\nPCI was performed for LMCA stenosis (Fig.1).\nA 7-Fr sheath was inserted into the right femoral artery, and a CLS4 guiding catheter (Boston Scientific, Natick, MA, USA) was engaged into the left coronary artery (LCA) ostium.\nA guidewire (SION Blue, Asahi Intecc, Aichi, Japan) was inserted into the distal LAD, and another guidewire (Hi-Torque Pilot 50, Abbott Vascular, Santa Clara, California, USA) was inserted into the distal LCX.\nIntravascular ultrasound (IVUS) (Intra-focus WR, Terumo Corp, Tokyo, Japan) demonstrated heavy circumferential calcification in the LMCA lesion.\nAfter a 4.0\u2009\u00d7\u200915-mm Quantum Maverick balloon catheter (Boston Scientific) was inflated in the lesion, LCA angiogram revealed a large dissection (Fig.2).\nA 4.0\u2009\u00d7\u200928-mm Multi-Link Vision stent (Abbott Vascular) was immediately deployed.\nAngiographic image of the residual dissection disappeared and the stent was dilated by a 5.0\u2009\u00d7\u200915-mm Quantum Maverick balloon catheter.\nThe absence of residual dissection was confirmed by angiography after stent implantation.\nNext, LMCA-LAD and LMCA-LCX kissing balloon angioplasty was initiated using a 4.0\u2009\u00d7\u200928-mm stent delivery balloon in the LAD and a 3.0 mm\u2009\u00d7\u200915-mm Ikazuchi balloon (Kaneka Medics, Tokyo, Japan) in the LCX.\nThe final angiographic imaging showed optimal results, and IVUS imaging of the lesion showed completely sealing by the stent (Fig.3).\nA large hematoma at the femoral puncture site and local bleeding was observed after removal of the femoral sheath and manual compression was applied for haemostasis.\nThe hematoma did not appear to have spread the next day and the patient was discharged from the hospital on the fifth day after PCI.\nUnexpectedly, the patient was admitted to our emergency room with new-onset chest pain and dyspnoea the next day after the discharge.\nHis vital signs indicated cardiogenic shock.\nElectrocardiogram showed ST elevation in leads V1-V3.\nAlthough echocardiography could not detect left ventricular asynergy, a large mass on the outflow tract of right ventricular chamber was observed (Fig.4).\nContrast-enhanced computed tomography showed a 40-mm hematoma compressing the main pulmonary artery trunk and the right ventricle (Fig.5).\nDuring examination, the patient suffered sudden cardiopulmonary arrest.\nHe received immediate cardiopulmonary resuscitation and returned to spontaneous circulation after the insertion of a percutaneous cardiopulmonary support device.\nThe patient underwent emergent surgery for the removal of the hematoma after informed consent was obtained from the patient's family.\nDuring surgery, large, dark red clots between the pulmonary artery trunk and aorta were observed.\nThe suspected origin of the epicardial hematoma was blood oozing from the LMCA stent site.\nDespite successful surgical repair, the patient died from aortic rupture induced by external cardiac massage.\n","ner_info":[{"text":"70-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"admitted","label":"CLINICAL_EVENT","start":23,"end":31},{"text":"perioperative","label":"DETAILED_DESCRIPTION","start":52,"end":65},{"text":"cardiac evaluation","label":"DIAGNOSTIC_PROCEDURE","start":66,"end":84},{"text":"abdominal 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graft","label":"THERAPEUTIC_PROCEDURE","start":366,"end":386},{"text":"SVG","label":"THERAPEUTIC_PROCEDURE","start":388,"end":391},{"text":"left circumflex artery","label":"BIOLOGICAL_STRUCTURE","start":400,"end":422},{"text":"LCX","label":"BIOLOGICAL_STRUCTURE","start":424,"end":427},{"text":"abdominal aortic","label":"BIOLOGICAL_STRUCTURE","start":461,"end":477},{"text":"aneurysm","label":"DISEASE_DISORDER","start":478,"end":486},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":503,"end":510},{"text":"Left coronary","label":"BIOLOGICAL_STRUCTURE","start":526,"end":539},{"text":"angiogram","label":"DIAGNOSTIC_PROCEDURE","start":540,"end":549},{"text":"90 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artery","label":"BIOLOGICAL_STRUCTURE","start":700,"end":720},{"text":"CLS4","label":"DETAILED_DESCRIPTION","start":728,"end":732},{"text":"guiding","label":"DETAILED_DESCRIPTION","start":733,"end":740},{"text":"catheter","label":"THERAPEUTIC_PROCEDURE","start":741,"end":749},{"text":"Boston Scientific, Natick, MA, USA","label":"DETAILED_DESCRIPTION","start":751,"end":785},{"text":"left coronary artery","label":"BIOLOGICAL_STRUCTURE","start":808,"end":828},{"text":"LCA","label":"BIOLOGICAL_STRUCTURE","start":830,"end":833},{"text":"ostium","label":"BIOLOGICAL_STRUCTURE","start":835,"end":841},{"text":"guidewire","label":"THERAPEUTIC_PROCEDURE","start":845,"end":854},{"text":"SION Blue","label":"DETAILED_DESCRIPTION","start":856,"end":865},{"text":"Asahi Intecc, Aichi, Japan","label":"DETAILED_DESCRIPTION","start":867,"end":893},{"text":"distal 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ventricle","label":"BIOLOGICAL_STRUCTURE","start":2798,"end":2813},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":2830,"end":2841},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":2864,"end":2870},{"text":"cardiopulmonary arrest","label":"DISEASE_DISORDER","start":2871,"end":2893},{"text":"immediate","label":"DETAILED_DESCRIPTION","start":2907,"end":2916},{"text":"cardiopulmonary resuscitation","label":"THERAPEUTIC_PROCEDURE","start":2917,"end":2946},{"text":"spontaneous circulation","label":"SIGN_SYMPTOM","start":2963,"end":2986},{"text":"percutaneous","label":"DETAILED_DESCRIPTION","start":3012,"end":3024},{"text":"cardiopulmonary support 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site","label":"BIOLOGICAL_STRUCTURE","start":3363,"end":3378},{"text":"surgical repair","label":"THERAPEUTIC_PROCEDURE","start":3399,"end":3414},{"text":"died","label":"OUTCOME","start":3428,"end":3432},{"text":"aortic rupture","label":"DISEASE_DISORDER","start":3438,"end":3452},{"text":"external cardiac massage","label":"THERAPEUTIC_PROCEDURE","start":3464,"end":3488}],"tokens":["A ","70-year-old"," ","male"," was ","admitted"," to our hospital for ","perioperative"," ","cardiac evaluation"," of ","abdominal aortic"," ","aneurysm",".\nThe patient had undergone ","coronary artery bypass grafting"," (","CABG",") for ","severe"," ","stenosis"," of the ","left main coronary artery"," (","LMCA",") ","4 years before",", which consisted of the ","right internal thoracic artery"," (","RITA",") to the ","left anterior descending artery"," (","LAD",") and ","saphenous vein graft"," (","SVG",") to the ","left circumflex artery"," (","LCX",").\nDue to continual growth of the ","abdominal aortic"," ","aneurysm"," over the years, ","surgery"," was indicated.\n","Left coronary"," ","angiogram"," showed ","90 %"," ","stenosis"," of the ","LMCA"," and ","total"," ","occlusion"," of ","both"," ","grafts",".\n","PCI"," was performed for ","LMCA"," ","stenosis"," (Fig.1).\nA ","7-Fr"," ","sheath"," was inserted into the ","right femoral artery",", and a ","CLS4"," ","guiding"," ","catheter"," (","Boston Scientific, Natick, MA, USA",") was engaged into the ","left coronary artery"," (","LCA",") ","ostium",".\nA ","guidewire"," (","SION Blue",", ","Asahi Intecc, Aichi, Japan",") was inserted into the ","distal LAD",", and another ","guidewire"," (","Hi-Torque Pilot 50",", ","Abbott Vascular, Santa Clara, California, USA",") was inserted into the ","distal LCX",".\n","Intravascular ultrasound"," (","IVUS",") (","Intra-focus WR",", ","Terumo Corp, Tokyo, Japan",") demonstrated ","heavy"," ","circumferential"," ","calcification"," in the ","LMCA"," ","lesion",".\nAfter a ","4.0\u2009\u00d7\u200915-mm"," ","Quantum Maverick"," ","balloon"," ","catheter"," (","Boston Scientific",") was inflated in the ","lesion",", ","LCA"," ","angiogram"," revealed a ","large"," ","dissection"," (Fig.2).\nA ","4.0\u2009\u00d7\u200928-mm"," ","Multi-Link Vision"," ","stent"," (","Abbott Vascular",") was immediately deployed.\n","Angiographic"," image of the ","residual"," ","dissection"," disappeared and the ","stent"," was dilated by a ","5.0\u2009\u00d7\u200915-mm"," ","Quantum Maverick"," ","balloon catheter",".\nThe absence of ","residual"," ","dissection"," was confirmed by ","angiography"," after ","stent"," implantation.\nNext, ","LMCA-LAD"," and ","LMCA-LCX"," ","kissing balloon"," ","angioplasty"," was initiated using a ","4.0\u2009\u00d7\u200928-mm"," ","stent delivery"," ","balloon"," in the ","LAD"," and a ","3.0 mm\u2009\u00d7\u200915-mm"," ","Ikazuchi"," ","balloon"," (","Kaneka Medics, Tokyo, Japan",") in the ","LCX",".\nThe final ","angiographic"," imaging showed ","optimal"," ","results",", and ","IVUS"," imaging of the ","lesion"," showed ","completely"," ","sealing"," by the ","stent"," (Fig.3).\nA ","large"," ","hematoma"," at the ","femoral puncture site"," and ","local"," ","bleeding"," was observed after removal of the ","femoral sheath"," and ","manual compression"," was applied for ","haemostasis",".\nThe ","hematoma"," did not appear to have spread ","the next day"," and the patient was ","discharged"," from the ","hospital"," on the ","fifth day after"," ","PCI",".\nUnexpectedly, the patient was ","admitted"," to our ","emergency room"," with new-onset ","chest"," ","pain"," and ","dyspnoea"," the ","next day after"," the ","discharge",".\nHis ","vital signs"," indicated ","cardiogenic shock",".\n","Electrocardiogram"," showed ","ST elevation"," in ","leads V1-V3",".\nAlthough ","echocardiography"," could not detect ","left ventricular"," ","asynergy",", a large ","mass"," on the ","outflow tract of right ventricular chamber"," was observed (Fig.4).\n","Contrast-enhanced"," ","computed tomography"," showed a ","40-mm"," ","hematoma"," ","compressing"," the ","main pulmonary artery trunk"," and the ","right ventricle"," (Fig.5).\nDuring ","examination",", the patient suffered ","sudden"," ","cardiopulmonary arrest",".\nHe received ","immediate"," ","cardiopulmonary resuscitation"," and returned to ","spontaneous circulation"," after the insertion of a ","percutaneous"," ","cardiopulmonary support device",".\nThe patient underwent ","emergent"," ","surgery"," for the removal of the ","hematoma"," after informed consent was obtained from the patient's family.\nDuring ","surgery",", ","large",", ","dark red"," ","clots"," between the ","pulmonary artery trunk"," and ","aorta"," were observed.\nThe suspected origin of the ","epicardial"," ","hematoma"," was ","blood oozing"," from the ","LMCA stent site",".\nDespite successful ","surgical repair",", the patient ","died"," from ","aortic rupture"," induced by ","external cardiac massage",".\n"],"ner_labels":[0,5,0,65,0,13,0,22,0,24,0,12,0,26,0,75,0,75,0,63,0,69,0,12,0,12,0,19,0,12,0,12,0,12,0,12,0,75,0,75,0,12,0,12,0,12,0,26,0,75,0,12,0,24,0,42,0,69,0,12,0,63,0,69,0,22,0,18,0,75,0,12,0,69,0,22,0,75,0,12,0,22,0,22,0,75,0,22,0,12,0,12,0,12,0,75,0,22,0,22,0,12,0,75,0,22,0,22,0,12,0,24,0,24,0,22,0,22,0,63,0,22,0,69,0,12,0,69,0,22,0,22,0,22,0,75,0,22,0,69,0,12,0,24,0,63,0,69,0,22,0,22,0,75,0,22,0,24,0,22,0,69,0,75,0,22,0,22,0,75,0,22,0,69,0,24,0,75,0,12,0,12,0,22,0,75,0,22,0,22,0,75,0,12,0,22,0,22,0,75,0,22,0,12,0,24,0,42,0,24,0,24,0,69,0,42,0,24,0,75,0,63,0,69,0,12,0,22,0,69,0,75,0,75,0,75,0,69,0,19,0,13,0,48,0,19,0,75,0,13,0,48,0,12,0,69,0,69,0,19,0,13,0,24,0,69,0,24,0,69,0,24,0,24,0,12,0,69,0,69,0,12,0,22,0,24,0,27,0,69,0,69,0,12,0,12,0,24,0,22,0,26,0,22,0,75,0,69,0,22,0,75,0,22,0,75,0,69,0,75,0,63,0,15,0,69,0,12,0,12,0,12,0,69,0,69,0,12,0,75,0,56,0,26,0,75,0]}
-{"full_text":"The patient is a 59-year-old man diagnosed with PD at the age of 49 years.\nFluctuations with recurring \u201coff\u201d states and peak dose dyskinesias had severely diminished the patient\u2019s quality of life.\nThus, the patient was deemed a candidate for bilateral subthalamic DBS.\nMultidisciplinary evaluation with 75 % positive response in the standardized levodopa test, exclusion of cognitive decline or psychiatric comorbitity, and absence of structural brain damage potentially relevant to the lead placement led to the unanimous decision for DBS placement.\nWhen decision was made to proceed to surgery the medication consisted of 1112.5 mg of levodopa and 150 mg of piribedil.\nThere was no history of orofacial or cervical dystonia.\nIn the \u201con\u201d state the patient was alert without any signs of psychiatric comorbidity.\nNeuropsychological testing was adequate.\nNo cranial nerve deficits were found and swallowing was normal.\nGait and postural stability was normal with minimal rigidity in the neck and right arm.\nCoordinative motor skills such as rapid pro- and supination were restricted in the left hand.\nDyskinesias were evident with moderate impairment.\nIn the \u201coff\u201d state after the medication was held for 12 h, the patient showed mild dysarthria and dysphonia, resting tremor of the right arm and leg, as well as slight action tremor in the right hand.\nRigidity was severe in the neck, marked in the right, and mild on the left side.\nMotor skills of the hands were markedly impaired.\nGait was slow but unaided and comprised of by intermittent freezing; there was mild dystonic posturing of the right foot.\nThere were no signs of laryngeal spasms, however.\nOn the day before surgery, the last dose of dopaminergic medication was administered at 07:00 p.m., the bedtime dose of levodopa was held to facilitate intraoperative testing.\nOn the day of the operation, the patient underwent placement of the stereotactic frame under local anaesthesia around 09:00 a.m.\nAfter planning standard STN coordinates and trajectories, the patient was placed in a semi-sitting position on the O.R.\ntable, with the frame attached to the table.\nAt the patient\u2019s request, the head was slightly flexed anteriorly for comfort.\nThe left electrode was placed uneventfully.\nWhen performing the bur hole on the right side, the patient complained of cramping in the neck and facial muscles as well as difficulties breathing although at that point, pulse oximetry showed good saturation readings at \u226595 %.\nHe progressed to dystonic dysarthria [6].\nMicroelectrode recordings had already been done and macroelectrode test stimulation was about to begin, when the patient showed high-pitched inspiratory stridor.\nPulse oximetry showed decreasing oxygen saturation at 02:15 p.m.\nand, shortly thereafter, narrow complex tachycardia was noted.\nWithin a minute, the patient became unresponsive.\nCardiac resuscitation was initiated and the patient was fiberoptically intubated after removal of the front bar of the stereotactic frame.\nDuring fiberoptic intubation laryngeal spasm was confirmed visually.\nA transthoracic echocardiogram obtained immediately after successful resuscitation showed no cardiac pathology or any air bubbles.\nStimulation using the implanted lead to resolve the symptoms was not possible as at that time the lead was subcutaneously tunnelled with no impulse generator attached.\nThe right permanent electrode was placed without further testing according to microelectrode recordings.\n50 mg levodopa was administered over a nasogastric tube every two hours during the subsequent postoperative period.\nPostoperative head CT scan done immediately after the procedure was normal.\nThe patient was transferred to the intensive care unit and was extubated at 02:00 p.m.\nthe following day without any neurological deficit or signs of laryngeal spasms.\nBy then, the nasogastric tube was discontinued and the preoperative medication was resumed.\nCardiac workup was negative.\nThe impulse generator was implanted 7 days later and the patient showed good symptom control of PD.\n","ner_info":[{"text":"59-year-old","label":"AGE","start":17,"end":28},{"text":"man","label":"SEX","start":29,"end":32},{"text":"PD","label":"DISEASE_DISORDER","start":48,"end":50},{"text":"age of 49 years","label":"DATE","start":58,"end":73},{"text":"Fluctuations","label":"SIGN_SYMPTOM","start":75,"end":87},{"text":"\u201coff\u201d states","label":"OTHER_EVENT","start":103,"end":115},{"text":"peak dose","label":"DETAILED_DESCRIPTION","start":120,"end":129},{"text":"dyskinesias","label":"DISEASE_DISORDER","start":130,"end":141},{"text":"diminished","label":"LAB_VALUE","start":155,"end":165},{"text":"quality of life","label":"DIAGNOSTIC_PROCEDURE","start":180,"end":195},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":242,"end":251},{"text":"subthalamic","label":"DETAILED_DESCRIPTION","start":252,"end":263},{"text":"DBS","label":"THERAPEUTIC_PROCEDURE","start":264,"end":267},{"text":"Multidisciplinary evaluation","label":"DIAGNOSTIC_PROCEDURE","start":269,"end":297},{"text":"75 % positive","label":"LAB_VALUE","start":303,"end":316},{"text":"standardized levodopa test","label":"DIAGNOSTIC_PROCEDURE","start":333,"end":359},{"text":"cognitive decline","label":"DISEASE_DISORDER","start":374,"end":391},{"text":"psychiatric comorbitity","label":"DISEASE_DISORDER","start":395,"end":418},{"text":"brain damage","label":"DISEASE_DISORDER","start":446,"end":458},{"text":"DBS","label":"THERAPEUTIC_PROCEDURE","start":536,"end":539},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":588,"end":595},{"text":"medication","label":"MEDICATION","start":600,"end":610},{"text":"1112.5 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recordings","label":"DIAGNOSTIC_PROCEDURE","start":3444,"end":3469},{"text":"50 mg","label":"DOSAGE","start":3471,"end":3476},{"text":"levodopa","label":"MEDICATION","start":3477,"end":3485},{"text":"nasogastric tube","label":"ADMINISTRATION","start":3510,"end":3526},{"text":"every two hours","label":"DOSAGE","start":3527,"end":3542},{"text":"postoperative period","label":"DIAGNOSTIC_PROCEDURE","start":3565,"end":3585},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":3601,"end":3605},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3606,"end":3608},{"text":"transferred","label":"CLINICAL_EVENT","start":3679,"end":3690},{"text":"intensive care unit","label":"NONBIOLOGICAL_LOCATION","start":3698,"end":3717},{"text":"extubated","label":"THERAPEUTIC_PROCEDURE","start":3726,"end":3735},{"text":"02:00 p.m","label":"TIME","start":3739,"end":3748},{"text":"following day","label":"DATE","start":3754,"end":3767},{"text":"neurological deficit","label":"SIGN_SYMPTOM","start":3780,"end":3800},{"text":"laryngeal","label":"BIOLOGICAL_STRUCTURE","start":3813,"end":3822},{"text":"spasms","label":"SIGN_SYMPTOM","start":3823,"end":3829},{"text":"nasogastric tube","label":"THERAPEUTIC_PROCEDURE","start":3844,"end":3860},{"text":"medication","label":"MEDICATION","start":3899,"end":3909},{"text":"Cardiac workup","label":"DIAGNOSTIC_PROCEDURE","start":3923,"end":3937},{"text":"negative","label":"LAB_VALUE","start":3942,"end":3950},{"text":"impulse generator","label":"THERAPEUTIC_PROCEDURE","start":3956,"end":3973},{"text":"7 days later","label":"DATE","start":3988,"end":4000},{"text":"good","label":"LAB_VALUE","start":4024,"end":4028},{"text":"symptom control","label":"DIAGNOSTIC_PROCEDURE","start":4029,"end":4044},{"text":"PD","label":"DISEASE_DISORDER","start":4048,"end":4050}],"tokens":["The patient is a ","59-year-old"," ","man"," diagnosed with ","PD"," at the ","age of 49 years",".\n","Fluctuations"," with recurring ","\u201coff\u201d states"," and ","peak dose"," ","dyskinesias"," had severely ","diminished"," the patient\u2019s ","quality of life",".\nThus, the patient was deemed a candidate for ","bilateral"," ","subthalamic"," ","DBS",".\n","Multidisciplinary evaluation"," with ","75 % positive"," response in the ","standardized levodopa test",", exclusion of ","cognitive decline"," or ","psychiatric comorbitity",", and absence of structural ","brain damage"," potentially relevant to the lead placement led to the unanimous decision for ","DBS"," placement.\nWhen decision was made to proceed to ","surgery"," the ","medication"," consisted of ","1112.5 mg"," of ","levodopa"," and ","150 mg"," of ","piribedil",".\nThere was ","no history of orofacial or cervical dystonia",".\nIn the ","\u201con\u201d state"," the patient was ","alert"," without any ","signs of psychiatric comorbidity",".\n","Neuropsychological testing"," was ","adequate",".\nNo ","cranial"," ","nerve deficits"," were found and ","swallowing"," was ","normal",".\n","Gait"," and ","postural stability"," was ","normal"," with ","minimal"," ","rigidity"," in the ","neck"," and ","right arm",".\n","Coordinative motor skills"," such as rapid ","pro- and supination"," were ","restricted"," in the ","left hand",".\n","Dyskinesias"," were evident with ","moderate"," ","impairment",".\nIn the ","\u201coff\u201d state"," after the ","medication"," was held for ","12 h",", the patient showed ","mild"," ","dysarthria"," and ","dysphonia",", ","resting"," ","tremor"," of the ","right arm"," and ","leg",", as well as ","slight"," ","action"," ","tremor"," in the ","right hand",".\n","Rigidity"," was ","severe"," in the ","neck",", ","marked"," in the ","right",", and ","mild"," on the ","left side",".\n","Motor skills"," of the ","hands"," were markedly ","impaired",".\n","Gait"," was ","slow"," but ","unaided"," and comprised of by ","intermittent"," ","freezing","; there was ","mild"," ","dystonic posturing"," of the ","right foot",".\nThere were no signs of ","laryngeal"," ","spasms",", however.\nOn the ","day before"," ","surgery",", the last dose of ","dopaminergic medication"," was administered at ","07:00 p.m","., the ","bedtime dose"," of ","levodopa"," was held to facilitate ","intraoperative testing",".\nOn the ","day of"," the ","operation",", the patient underwent placement of the ","stereotactic frame"," under ","local anaesthesia"," around ","09:00 a.m",".\nAfter planning standard STN coordinates and trajectories, the patient was placed in a ","semi-sitting position"," on the ","O.R.","\ntable, with the frame attached to the table.\nAt the patient\u2019s request, the ","head"," was slightly ","flexed"," ","anteriorly"," for comfort.\nThe ","left"," ","electrode"," was placed uneventfully.\nWhen performing the ","bur hole"," on the ","right side",", the patient complained of ","cramping"," in the ","neck"," and ","facial muscles"," as well as ","difficulties breathing"," although at that point, ","pulse oximetry"," showed ","good saturation"," readings at ","\u226595 %",".\nHe progressed to ","dystonic dysarthria"," [6].\n","Microelectrode recordings"," had already been done and ","macroelectrode test stimulation"," was about to begin, when the patient showed ","high-pitched"," ","inspiratory"," ","stridor",".\n","Pulse oximetry"," showed ","decreasing oxygen saturation"," at ","02:15 p.m",".\nand, shortly thereafter, ","narrow"," ","complex"," ","tachycardia"," was noted.\n","Within a minute",", the patient became ","unresponsive",".\n","Cardiac resuscitation"," was initiated and the patient was ","fiberoptically"," ","intubated"," after removal of the ","front bar"," of the ","stereotactic frame",".\nDuring ","fiberoptic"," ","intubation"," ","laryngeal"," ","spasm"," was confirmed visually.\nA ","transthoracic echocardiogram"," obtained immediately after successful resuscitation showed no ","cardiac"," ","pathology"," or any ","air bubbles",".\n","Stimulation"," using the implanted lead to resolve the symptoms was not possible as at that time the lead was subcutaneously tunnelled with no impulse generator attached.\nThe ","right"," ","permanent"," ","electrode"," was placed without further testing according to ","microelectrode recordings",".\n","50 mg"," ","levodopa"," was administered over a ","nasogastric tube"," ","every two hours"," during the subsequent ","postoperative period",".\nPostoperative ","head"," ","CT"," scan done immediately after the procedure was normal.\nThe patient was ","transferred"," to the ","intensive care unit"," and was ","extubated"," at ","02:00 p.m",".\nthe ","following day"," without any ","neurological deficit"," or signs of ","laryngeal"," ","spasms",".\nBy then, the ","nasogastric tube"," was discontinued and the preoperative ","medication"," was resumed.\n","Cardiac workup"," was ","negative",".\nThe ","impulse generator"," was implanted ","7 days later"," and the patient showed ","good"," ","symptom control"," of ","PD",".\n"],"ner_labels":[0,5,0,65,0,26,0,19,0,69,0,53,0,22,0,26,0,42,0,24,0,22,0,22,0,75,0,24,0,42,0,24,0,26,0,26,0,26,0,75,0,75,0,46,0,29,0,46,0,29,0,46,0,39,0,53,0,69,0,69,0,24,0,42,0,12,0,69,0,24,0,42,0,24,0,24,0,42,0,63,0,69,0,12,0,12,0,24,0,24,0,42,0,12,0,69,0,63,0,69,0,53,0,46,0,32,0,63,0,69,0,69,0,22,0,69,0,12,0,12,0,63,0,22,0,69,0,12,0,69,0,63,0,12,0,63,0,12,0,63,0,12,0,24,0,12,0,42,0,24,0,42,0,42,0,35,0,69,0,63,0,69,0,12,0,12,0,69,0,19,0,75,0,46,0,78,0,4,0,46,0,24,0,19,0,75,0,75,0,46,0,78,0,1,0,48,0,12,0,1,0,22,0,22,0,75,0,75,0,12,0,69,0,12,0,12,0,69,0,24,0,42,0,42,0,69,0,24,0,24,0,22,0,22,0,69,0,24,0,42,0,78,0,22,0,22,0,69,0,78,0,69,0,75,0,22,0,75,0,75,0,75,0,22,0,75,0,12,0,69,0,24,0,12,0,69,0,69,0,75,0,22,0,22,0,75,0,24,0,29,0,46,0,4,0,29,0,24,0,12,0,24,0,13,0,48,0,75,0,78,0,19,0,69,0,12,0,69,0,75,0,46,0,24,0,42,0,75,0,19,0,42,0,24,0,26,0]}
-{"full_text":"A 47-year-old woman presented to the hospital with a 1-month history of abdominal distention.\nPhysical examination revealed a huge mass in the lower abdomen.\nThe peripheral blood test showed elevated levels of carcinoembryonic antigen (CEA, 335.2 ng\/mL [normal, <5 ng\/mL]) and carbohydrate antigen (CA) 125 (219 U\/mL [normal, <45 U\/mL]) but a normal level of CA19-9 (9 U\/mL [normal, <37 U\/mL]).\nComputed tomography (CT) demonstrated a large, round mass with a maximum diameter of 15 cm in the pelvic cavity without the presence of ascites or pleural effusion (Fig.1a, \u200bb).\nColonoscopy identified an elevated lesion with severe stenosis in the sigmoid colon, and histopathological examination of biopsy specimens from the tumor showed moderately differentiated adenocarcinoma.\nAlthough we scheduled an early operation, the patient developed acute dyspnea and general edema 2 weeks after the first CT scan.\nThe second CT scan examination demonstrated massive bilateral pleural effusion with atelectasis and ascites (Fig.2a, b).\nThoracic drainage and laparotomy were emergently performed.\nMacroscopically, the tumor in the sigmoid colon had invaded the serosa, and the huge pelvic mass was found to contain a right ovarian tumor.\nSeveral small nodules of peritoneal dissemination were distributed over the greater omentum.\nPerioperatively, 3800 mL of serous ascitic fluid was drained.\nCytodiagnosis of the fluid drained from the ascites and pleural effusion revealed no tumor cells.\nBilateral oophorectomy, total hysterectomy, omentectomy, and sigmoidectomy with regional node dissection were performed (Fig.3a).\nHistopathological examination of the resected specimens showed moderately differentiated adenocarcinoma in the tumors of both the ovaries and the sigmoid colon (Fig.3b).\nThe dissected paracolic nodes showed malignant cells.\nImmunohistochemically, tumor cells from the ovaries and the colon both showed positive expression of cytokeratin 20 (CK20) but no expression of cytokeratin 7 (CK7), confirming that the ovarian tumors were metastases from primary colon cancer (Fig.4a, \u200bb).\nThe postoperative course was uneventful, and both pleural effusion and ascites rapidly resolved.\nPostoperatively, a regimen of 5-fluorouracil (5-FU), leucovorin, and oxaliplatin (FOLFOX) was administered every 2 weeks for 5 months.\nAt 29 months after the first operation, the patient required curative hepatic resection for liver metastases.\nAt 78 months after the first operation, the patient remains alive with no evidence of a disease.\n","ner_info":[{"text":"47-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":37,"end":45},{"text":"1-month","label":"DURATION","start":53,"end":60},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":72,"end":81},{"text":"distention","label":"SIGN_SYMPTOM","start":82,"end":92},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":94,"end":114},{"text":"huge","label":"SEVERITY","start":126,"end":130},{"text":"mass","label":"SIGN_SYMPTOM","start":131,"end":135},{"text":"lower abdomen","label":"BIOLOGICAL_STRUCTURE","start":143,"end":156},{"text":"peripheral blood test","label":"DIAGNOSTIC_PROCEDURE","start":162,"end":183},{"text":"elevated","label":"LAB_VALUE","start":191,"end":199},{"text":"carcinoembryonic antigen","label":"DIAGNOSTIC_PROCEDURE","start":210,"end":234},{"text":"CEA","label":"DIAGNOSTIC_PROCEDURE","start":236,"end":239},{"text":"335.2 ng\/mL","label":"LAB_VALUE","start":241,"end":252},{"text":"carbohydrate antigen","label":"DIAGNOSTIC_PROCEDURE","start":277,"end":297},{"text":"CA","label":"DIAGNOSTIC_PROCEDURE","start":299,"end":301},{"text":"125","label":"DETAILED_DESCRIPTION","start":303,"end":306},{"text":"219 U\/mL","label":"LAB_VALUE","start":308,"end":316},{"text":"normal","label":"LAB_VALUE","start":343,"end":349},{"text":"CA19-9","label":"DIAGNOSTIC_PROCEDURE","start":359,"end":365},{"text":"9 U\/mL","label":"LAB_VALUE","start":367,"end":373},{"text":"Computed 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identified an ","elevated"," ","lesion"," with ","severe"," ","stenosis"," in the ","sigmoid colon",", and ","histopathological examination"," of ","biopsy specimens"," from the ","tumor"," showed ","moderately differentiated"," ","adenocarcinoma",".\nAlthough we scheduled an early ","operation",", the patient developed ","acute"," ","dyspnea"," and ","general"," ","edema"," ","2 weeks after"," the first CT scan.\nThe second ","CT"," scan examination demonstrated ","massive"," ","bilateral"," ","pleural effusion"," with ","atelectasis"," and ","ascites"," (Fig.2a, b).\n","Thoracic drainage"," and ","laparotomy"," were emergently performed.\n","Macroscopically",", the ","tumor"," in the ","sigmoid colon"," had ","invaded"," the ","serosa",", and the ","huge"," ","pelvic"," ","mass"," was found to contain a ","right"," ","ovarian tumor",".\nSeveral small ","nodules"," of ","peritoneal"," ","dissemination"," were distributed over the ","greater omentum",".\nPerioperatively, ","3800 mL"," of ","serous"," ","ascitic fluid"," was ","drained",".\n","Cytodiagnosis"," of the ","fluid"," drained from the ","ascites"," and ","pleural effusion"," revealed ","no"," ","tumor cells",".\n","Bilateral"," ","oophorectomy",", ","total"," ","hysterectomy",", ","omentectomy",", and ","sigmoidectomy"," with ","regional"," ","node dissection"," were performed (Fig.3a).\n","Histopathological examination"," of the resected specimens showed ","moderately differentiated"," ","adenocarcinoma"," in the ","tumors"," of both the ","ovaries"," and the ","sigmoid colon"," (Fig.3b).\nThe dissected ","paracolic nodes"," showed ","malignant cells",".\n","Immunohistochemically",", ","tumor cells"," from the ","ovaries"," and the ","colon"," both showed ","positive expression"," of ","cytokeratin 20"," (","CK20",") but ","no expression"," of ","cytokeratin 7"," (","CK7","), confirming that the ","ovarian tumors"," were ","metastases"," from ","primary colon cancer"," (Fig.4a, \u200bb).\nThe ","postoperative course"," was ","uneventful",", and both ","pleural effusion"," and ","ascites"," rapidly resolved.\nPostoperatively, a regimen of ","5-fluorouracil"," (","5-FU","), ","leucovorin",", and ","oxaliplatin"," (","FOLFOX",") was administered ","every 2 weeks for 5 months",".\nAt ","29 months after"," the first operation, the patient required curative ","hepatic"," ","resection"," for ","liver"," ","metastases",".\nAt ","78 months after"," the first operation, the patient remains ","alive"," with no evidence of a 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-{"full_text":"A 76-year-old woman presented to our hospital with complaints of epigastralgia since a day prior to admission.\nLaboratory data on admission revealed an elevation of aminotransferase, alanine aminotransferase, \u0264-guanosine triphosphate, and alkaline phosphatase.\nSerum total bilirubin and tumor markers, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), SPan-1, and neuron-specific enolase (NSE), were all within normal ranges.\nAbdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a mass in an enlarged gallbladder and bulky hepatic lymph nodes surrounding the hepatic hilum (Fig.1a, \u200bb).\nThere were also no apparent lesions in upper and lower gastrointestinal endoscopy.\nEndoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed to obtain tissue from the hilar lymph node.\nImmunohistochemical staining of the specimen identified diffuse positivity for keratin, CD56, and synaptophysin in the tumor cells, which is consistent with NEC.\nAn endoscopic naso-gallbladder drainage (ENGBD) catheter was placed, and the bile cytology revealed class V malignant cells.\nTherefore, positron emission tomography\/computed tomography (PET\/CT) examination was performed to evaluate other primary or metastatic lesions.\nIt revealed that no other accumulated lesions were identified, and the accumulation of 18F fluorodeoxyglucose (FDG) was in the gallbladder (SUVmax 7.8) and lymph nodes (SUVmax 13.4) (Fig.1c, d).\nOn the basis of these findings, the most likely diagnosis was a gallbladder NEC that was confined to the regional hepatic hilar lymph nodes metastasis.\nFinally, we decided to perform surgical resection prior to chemotherapy because of concerns about complications developing from mechanical obstruction of the hepatic hilum by the enlarged lymph node.\nShe underwent cholecystectomy, hepatic hilar lymphadenectomy, extrahepatic biliary duct resection, and hepaticojejunostomy.\nThe bulky lymph nodes were totally resected as \u201cen bloc\u201d.\nThere were no apparent residual lesions surgically.\nThe postoperative course was uneventful and she was discharged on the tenth day after surgery.\nMacroscopically, the tumor was 58\u2009\u00d7\u200942 mm in size and was located in the fundus, which contained a yellowish gallstone (Fig.2a).\nA portion of the hepatic hilar lymph nodes (71\u2009\u00d7\u200937 mm) was also excised separately (Fig.2b).\nMicroscopic examination of the gallbladder revealed a moderate to well differentiated tubular adenocarcinoma infiltrating from the mucosa to the muscular layer, but not the serosal surface, without any NEC components (Fig.2c, \u200bd).\nThe tumor cells in the gallbladder are slightly positive for synaptophysin and CD56, but negative for chromogranin A (Fig.2e\u2013g).\nThe resection margin from the liver bed was negative for tumor cells.\nThe epithelium around the carcinoma showed intestinal metaplasia with the goblet cells (Fig.4a), which area was stained by alcian blue (Fig.4b).\nOn the other hand, the hepatic hilar lymph nodes were composed of small round tumor cells with hyperchromatic nuclei and scant cytoplasm (Fig.3a).\nSome of the tumor cells were large and had vesicular nuclei.\nThe tumor cells were arranged in sheets, cords, or in a trabecular or rosette fashion and were interspersed with focal necrosis.\nThey were immunohistochemically positive for CD56, synaptophysin, and chromogranin A (Fig.3b\u20133d).\nThe mitotic count was 24 per 10 high-power microscopic fields, and the Ki-67 proliferation index was 70\u201380%, consistent with NEC.\nThe surgical dissection margin of the hepatic lymph nodes was microscopically cauterized within the tumor cells.\nThere was no invasion to the extrahepatic biliary duct.\nAs the result of thorough pathological re-evaluation by total segmentation, a negligible area of adenocarcinoma was detected in the lymph nodes (Fig.3e, \u200bf).\nThe adenocarcinoma component and the intestinal metaplastic epithelium in the gallbladder were both positive for CDX2 (Fig.4a), but the neuroendocrine component in hilar lymph nodes was negative for CDX2 (Fig.4b).\nPostoperatively, the patient received three cycles of carboplatin (area under the curve of 5 on day 1 repeated every 21 days) and etoposide (80 mg\/m2 on days 1 through 3 repeated every 21 days).\nDuring the first course, grade 4 neutropenia occurred and it was managed with prophylactic fluoroquinolones.\nAfter 4 months, multiple recurrences in the para-aortic lymph nodes were detected, which was pathologically demonstrated via EUS-FNA to be NEC.\nThe patient underwent second-line chemotherapy with amrubicin (24 mg\/m2 on days 1 through 3 repeated every 21 days).\nGrade 4 neutropenia and anemia developed during the courses, and she needed to receive pegylated granulocyte colony-stimulating factor and red blood cell transfusion.\nHowever, she died of progressive disease 8 months after surgery.\n","ner_info":[{"text":"76-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":37,"end":45},{"text":"epigastralgia","label":"SIGN_SYMPTOM","start":65,"end":78},{"text":"a day prior","label":"DATE","start":85,"end":96},{"text":"admission","label":"CLINICAL_EVENT","start":100,"end":109},{"text":"Laboratory data","label":"DIAGNOSTIC_PROCEDURE","start":111,"end":126},{"text":"elevation","label":"LAB_VALUE","start":152,"end":161},{"text":"aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":165,"end":181},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":183,"end":207},{"text":"\u0264-guanosine triphosphate","label":"DIAGNOSTIC_PROCEDURE","start":209,"end":233},{"text":"alkaline 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A","label":"DIAGNOSTIC_PROCEDURE","start":3364,"end":3378},{"text":"mitotic count","label":"DIAGNOSTIC_PROCEDURE","start":3396,"end":3409},{"text":"24 per 10 high-power microscopic fields","label":"LAB_VALUE","start":3414,"end":3453},{"text":"Ki-67 proliferation index","label":"DIAGNOSTIC_PROCEDURE","start":3463,"end":3488},{"text":"70\u201380%","label":"LAB_VALUE","start":3493,"end":3499},{"text":"NEC","label":"DISEASE_DISORDER","start":3517,"end":3520},{"text":"surgical dissection margin","label":"BIOLOGICAL_STRUCTURE","start":3526,"end":3552},{"text":"hepatic lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":3560,"end":3579},{"text":"microscopically","label":"DETAILED_DESCRIPTION","start":3584,"end":3599},{"text":"cauterized","label":"THERAPEUTIC_PROCEDURE","start":3600,"end":3610},{"text":"tumor","label":"SIGN_SYMPTOM","start":3622,"end":3627},{"text":"invasion","label":"SIGN_SYMPTOM","start":3648,"end":3656},{"text":"extrahepatic biliary duct","label":"BIOLOGICAL_STRUCTURE","start":3664,"end":3689},{"text":"pathological re-evaluation","label":"DIAGNOSTIC_PROCEDURE","start":3717,"end":3743},{"text":"total segmentation","label":"DIAGNOSTIC_PROCEDURE","start":3747,"end":3765},{"text":"negligible area","label":"SEVERITY","start":3769,"end":3784},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":3788,"end":3802},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":3823,"end":3834},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":3853,"end":3867},{"text":"intestinal metaplastic epithelium","label":"BIOLOGICAL_STRUCTURE","start":3886,"end":3919},{"text":"gallbladder","label":"BIOLOGICAL_STRUCTURE","start":3927,"end":3938},{"text":"positive","label":"LAB_VALUE","start":3949,"end":3957},{"text":"CDX2","label":"DIAGNOSTIC_PROCEDURE","start":3962,"end":3966},{"text":"hilar lymph 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4","label":"SEVERITY","start":4628,"end":4635},{"text":"neutropenia","label":"SIGN_SYMPTOM","start":4636,"end":4647},{"text":"anemia","label":"SIGN_SYMPTOM","start":4652,"end":4658},{"text":"pegylated","label":"DETAILED_DESCRIPTION","start":4715,"end":4724},{"text":"granulocyte colony-stimulating factor","label":"MEDICATION","start":4725,"end":4762},{"text":"red blood cell","label":"DETAILED_DESCRIPTION","start":4767,"end":4781},{"text":"transfusion","label":"THERAPEUTIC_PROCEDURE","start":4782,"end":4793},{"text":"died","label":"ACTIVITY","start":4808,"end":4812},{"text":"progressive disease","label":"DISEASE_DISORDER","start":4816,"end":4835},{"text":"8 months after","label":"DATE","start":4836,"end":4850}],"tokens":["A ","76-year-old"," ","woman"," ","presented"," to our ","hospital"," with complaints of ","epigastralgia"," since ","a day prior"," to ","admission",".\n","Laboratory data"," on admission revealed an ","elevation"," of ","aminotransferase",", ","alanine aminotransferase",", ","\u0264-guanosine triphosphate",", and ","alkaline phosphatase",".\n","Serum"," ","total bilirubin"," and ","tumor markers",", ","carcinoembryonic antigen"," (","CEA","), ","carbohydrate antigen 19-9"," (","CA19-9","), ","SPan-1",", and ","neuron-specific enolase"," (","NSE","), were all ","within normal ranges",".\nAbdominal ","computed tomography"," (","CT",") and ","magnetic resonance cholangiopancreatography"," (","MRCP",") showed a ","mass"," in an ","enlarged"," ","gallbladder"," and ","bulky"," ","hepatic lymph nodes"," surrounding the ","hepatic hilum"," (Fig.1a, \u200bb).\nThere were also no apparent ","lesions"," in ","upper"," and ","lower"," ","gastrointestinal endoscopy",".\n","Endoscopic ultrasound-guided fine-needle aspiration"," (","EUS-FNA",") was performed to obtain tissue from the ","hilar lymph node",".\n","Immunohistochemical staining"," of the specimen identified diffuse ","positivity"," for ","keratin",", ","CD56",", and ","synaptophysin"," in the ","tumor cells",", which is consistent with ","NEC",".\nAn ","endoscopic naso-gallbladder drainage"," (","ENGBD",") ","catheter"," was placed, and the ","bile cytology"," revealed ","class V malignant cells",".\nTherefore, ","positron emission tomography","\/","computed tomography"," (","PET","\/","CT",") examination was performed to evaluate other ","primary"," or ","metastatic"," ","lesions",".\nIt revealed that no other accumulated ","lesions"," were identified, and the ","accumulation"," of ","18F fluorodeoxyglucose"," (","FDG",") was in the ","gallbladder"," (","SUVmax"," ","7.8",") and ","lymph nodes"," (","SUVmax"," ","13.4",") (Fig.1c, d).\nOn the basis of these findings, the most likely diagnosis was a ","gallbladder"," ","NEC"," that was confined to the regional ","hepatic hilar lymph nodes"," ","metastasis",".\nFinally, we decided to perform ","surgical resection"," prior to ","chemotherapy"," because of concerns about complications developing from ","mechanical"," ","obstruction"," of the ","hepatic hilum"," by the ","enlarged"," ","lymph node",".\nShe underwent ","cholecystectomy",", ","hepatic hilar"," ","lymphadenectomy",", ","extrahepatic biliary duct"," ","resection",", and ","hepaticojejunostomy",".\nThe ","bulky"," ","lymph nodes"," were totally ","resected"," as \u201c","en bloc","\u201d.\nThere were no apparent residual ","lesions"," surgically.\nThe ","postoperative course"," was ","uneventful"," and she was ","discharged"," on the ","tenth day after"," ","surgery",".\n","Macroscopically",", the ","tumor"," was ","58\u2009\u00d7\u200942 mm"," in size and was located in the ","fundus",", which contained a ","yellowish"," ","gallstone"," (Fig.2a).\nA portion of the ","hepatic hilar lymph nodes"," (","71\u2009\u00d7\u200937 mm",") was also ","excised"," separately (Fig.2b).\n","Microscopic examination"," of the ","gallbladder"," revealed a ","moderate to well differentiated"," ","tubular"," ","adenocarcinoma"," infiltrating from the ","mucosa"," to the ","muscular layer",", but ","not the serosal surface",", without any ","NEC"," components (Fig.2c, \u200bd).\nThe ","tumor"," cells in the ","gallbladder"," are ","slightly positive"," for ","synaptophysin"," and ","CD56",", but ","negative"," for ","chromogranin A"," (Fig.2e\u2013g).\nThe ","resection margin"," from the ","liver bed"," was negative for ","tumor"," cells.\nThe ","epithelium"," around the ","carcinoma"," showed ","intestinal"," ","metaplasia"," with the ","goblet cells"," (Fig.4a), which area was stained by ","alcian blue"," (Fig.4b).\nOn the other hand, the ","hepatic hilar lymph nodes"," were composed of ","small"," ","round"," ","tumor"," cells with ","hyperchromatic"," ","nuclei"," and ","scant"," ","cytoplasm"," (Fig.3a).\n","Some"," of the ","tumor"," cells were ","large"," and had ","vesicular"," ","nuclei",".\nThe ","tumor"," cells were arranged in ","sheets",", ","cords",", or in a ","trabecular"," or ","rosette"," fashion and were interspersed with ","focal"," ","necrosis",".\nThey were ","immunohistochemically"," ","positive"," for ","CD56",", ","synaptophysin",", and ","chromogranin A"," (Fig.3b\u20133d).\nThe ","mitotic count"," was ","24 per 10 high-power microscopic fields",", and the ","Ki-67 proliferation index"," was ","70\u201380%",", consistent with ","NEC",".\nThe ","surgical dissection margin"," of the ","hepatic lymph nodes"," was ","microscopically"," ","cauterized"," within the ","tumor"," cells.\nThere was no ","invasion"," to the ","extrahepatic biliary duct",".\nAs the result of thorough ","pathological re-evaluation"," by ","total segmentation",", a ","negligible area"," of ","adenocarcinoma"," was detected in the ","lymph nodes"," (Fig.3e, \u200bf).\nThe ","adenocarcinoma"," component and the ","intestinal metaplastic epithelium"," in the ","gallbladder"," were both ","positive"," for ","CDX2"," (Fig.4a), but the neuroendocrine component in ","hilar lymph nodes"," was ","negative"," for ","CDX2"," (Fig.4b).\nPostoperatively, the patient received ","three cycles"," of ","carboplatin"," (","area under the curve of 5 on day 1 repeated every 21 days",") and ","etoposide"," (","80 mg\/m2 on days 1 through 3 repeated every 21 days",").\n","During the first course",", ","grade 4"," ","neutropenia"," occurred and it was managed with ","prophylactic"," ","fluoroquinolones",".\n","After 4 months",", ","multiple"," ","recurrences"," in the ","para-aortic lymph nodes"," were detected, which was pathologically demonstrated via ","EUS-FNA"," to be ","NEC",".\nThe patient underwent ","second-line"," ","chemotherapy"," with ","amrubicin"," (","24 mg\/m2 on days 1 through 3 repeated every 21 days",").\n","Grade 4"," ","neutropenia"," and ","anemia"," developed during the courses, and she needed to receive ","pegylated"," ","granulocyte colony-stimulating factor"," and ","red blood cell"," ","transfusion",".\nHowever, she ","died"," of ","progressive disease"," ","8 months after"," 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-{"full_text":"A 20-year-old previously healthy Bengali man presented to our hospital with anuria and features of uremic encephalopathy.\nTen days prior to this presentation, he had experienced severe upper abdominal pain and vomiting, and he had been treated in a primary care facility for having a case of acute pancreatitis.\nHis initial symptoms improved; however, he gradually became anuric and disoriented.\nThen he was transferred to our hospital for further management.\nAt presentation to our hospital, he was severely agitated, restless, and disoriented.\nHe was tachypneic with acidotic breath.\nMild pedal edema was present; however, his jugular venous pressure was not raised.\nHis pulse was 112 beats\/minute, his blood pressure was 140\/90 mmHg, and his body temperature was 98 \u00b0F.\nSigns of meningeal irritation were absent, and his plantar response was bilaterally extensor.\nHis fundus could not be evaluated, and examination of his other systems was unremarkable.\nHis laboratory parameters showed features of renal dysfunction (serum creatinine 13 mg\/dl, serum urea 293 mg\/dl), raised pancreatic enzymes (serum amylase 249 U\/L [reference up to 100 U\/L], serum lipase 227 U\/L [reference 13\u201360 U\/L), normal liver function tests (serum bilirubin 0.9 mg\/dl, alanine aminotransferase 38 U\/L, aspartate aminotransferase 35 U\/L, alkaline phosphatase 122 U\/L, serum albumin 37 g\/L), normal potassium (5.1 mmol\/L), normal bicarbonate (19 mmol\/L), and normal triglycerides (173 mg\/dl).\nHis serological markers, including antinuclear antibodies, cytoplasmic antineutrophil cytoplasmic antibodies, perinuclear antineutrophil cytoplasmic antibodies, C3, and C4, were within normal limits.\nAn ultrasonogram of his whole abdomen was unremarkable, but non-contrast-enhanced computed tomography (CT) findings were suggestive of acute pancreatitis (Fig.1).\nHis kidneys were unremarkable, however.\nThe patient was managed as having a case of AKI and acute pancreatitis.\nUrgent hemodialysis was initiated.\nAfter he had received two sessions of hemodialysis, his level of consciousness improved, but he complained of profound visual loss.\nAn assessment revealed only perception of light.\nA funduscopic examination showed retinal whitening and extensive cotton wool exudates as well as Purtscher\u2019s flecken (Fig.2) compatible with Purtscher\u2019s retinopathy.\nHigh-dose parenteral methylprednisolone (1 g intravenously once daily for 3 days) was administered.\nFor evaluation of renal dysfunction, a renal biopsy was done; the histopathological findings were compatible with renal cortical necrosis (Fig.3).\nThe patient denied substance abuse or alcohol ingestion.\nHe did not consume any nephrotoxic drugs or herbal products in the recent past.\nNo history suggesting connective tissue diseases was available, nor did he have a history of hypotension throughout the course of his current illness.\nThe patient was finally diagnosed with acute pancreatitis complicated with renal cortical necrosis leading to AKI and Purtscher\u2019s retinopathy leading to complete bilateral blindness.\nHe died 16 months after his initial presentation as a result of a recurrent attack of acute pancreatitis.\nBefore that, he had been undergoing maintenance hemodialysis; however, his renal function did not recover, though his vision was improved to finger-counting at 2 feet.\n","ner_info":[{"text":"20-year-old","label":"AGE","start":2,"end":13},{"text":"previously healthy","label":"HISTORY","start":14,"end":32},{"text":"Bengali","label":"PERSONAL_BACKGROUND","start":33,"end":40},{"text":"man","label":"SEX","start":41,"end":44},{"text":"presented","label":"CLINICAL_EVENT","start":45,"end":54},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":62,"end":70},{"text":"anuria","label":"SIGN_SYMPTOM","start":76,"end":82},{"text":"uremic","label":"DETAILED_DESCRIPTION","start":99,"end":105},{"text":"encephalopathy","label":"DISEASE_DISORDER","start":106,"end":120},{"text":"Ten days prior","label":"DATE","start":122,"end":136},{"text":"severe","label":"SEVERITY","start":178,"end":184},{"text":"upper abdominal","label":"BIOLOGICAL_STRUCTURE","start":185,"end":200},{"text":"pain","label":"SIGN_SYMPTOM","start":201,"end":205},{"text":"vomiting","label":"SIGN_SYMPTOM","start":210,"end":218},{"text":"treated","label":"THERAPEUTIC_PROCEDURE","start":236,"end":243},{"text":"primary care facility","label":"NONBIOLOGICAL_LOCATION","start":249,"end":270},{"text":"acute","label":"DETAILED_DESCRIPTION","start":292,"end":297},{"text":"pancreatitis","label":"DISEASE_DISORDER","start":298,"end":310},{"text":"initial symptoms","label":"SIGN_SYMPTOM","start":316,"end":332},{"text":"anuric","label":"SIGN_SYMPTOM","start":372,"end":378},{"text":"disoriented","label":"SIGN_SYMPTOM","start":383,"end":394},{"text":"transferred","label":"CLINICAL_EVENT","start":408,"end":419},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":427,"end":435},{"text":"presentation","label":"CLINICAL_EVENT","start":463,"end":475},{"text":"severely","label":"SEVERITY","start":500,"end":508},{"text":"agitated","label":"SIGN_SYMPTOM","start":509,"end":517},{"text":"restless","label":"SIGN_SYMPTOM","start":519,"end":527},{"text":"disoriented","label":"SIGN_SYMPTOM","start":533,"end":544},{"text":"tachypneic","label":"SIGN_SYMPTOM","start":553,"end":563},{"text":"acidotic breath","label":"SIGN_SYMPTOM","start":569,"end":584},{"text":"Mild","label":"SEVERITY","start":586,"end":590},{"text":"pedal","label":"BIOLOGICAL_STRUCTURE","start":591,"end":596},{"text":"edema","label":"SIGN_SYMPTOM","start":597,"end":602},{"text":"jugular venous pressure","label":"DIAGNOSTIC_PROCEDURE","start":629,"end":652},{"text":"not raised","label":"LAB_VALUE","start":657,"end":667},{"text":"pulse","label":"DIAGNOSTIC_PROCEDURE","start":673,"end":678},{"text":"112 beats\/minute","label":"LAB_VALUE","start":683,"end":699},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":705,"end":719},{"text":"140\/90 mmHg","label":"LAB_VALUE","start":724,"end":735},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":745,"end":761},{"text":"98 \u00b0F","label":"LAB_VALUE","start":766,"end":771},{"text":"meningeal","label":"BIOLOGICAL_STRUCTURE","start":782,"end":791},{"text":"irritation","label":"SIGN_SYMPTOM","start":792,"end":802},{"text":"plantar response","label":"DIAGNOSTIC_PROCEDURE","start":824,"end":840},{"text":"bilaterally extensor","label":"LAB_VALUE","start":845,"end":865},{"text":"fundus","label":"DIAGNOSTIC_PROCEDURE","start":871,"end":877},{"text":"could not be evaluated","label":"LAB_VALUE","start":878,"end":900},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":906,"end":917},{"text":"other systems","label":"BIOLOGICAL_STRUCTURE","start":925,"end":938},{"text":"unremarkable","label":"LAB_VALUE","start":943,"end":955},{"text":"laboratory parameters","label":"DIAGNOSTIC_PROCEDURE","start":961,"end":982},{"text":"renal dysfunction","label":"DISEASE_DISORDER","start":1002,"end":1019},{"text":"serum creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1021,"end":1037},{"text":"13 mg\/dl","label":"LAB_VALUE","start":1038,"end":1046},{"text":"serum urea","label":"DIAGNOSTIC_PROCEDURE","start":1048,"end":1058},{"text":"293 mg\/dl","label":"LAB_VALUE","start":1059,"end":1068},{"text":"raised","label":"LAB_VALUE","start":1071,"end":1077},{"text":"pancreatic enzymes","label":"DIAGNOSTIC_PROCEDURE","start":1078,"end":1096},{"text":"serum amylase","label":"DIAGNOSTIC_PROCEDURE","start":1098,"end":1111},{"text":"249 U\/L","label":"LAB_VALUE","start":1112,"end":1119},{"text":"serum lipase","label":"DIAGNOSTIC_PROCEDURE","start":1147,"end":1159},{"text":"227 U\/L","label":"LAB_VALUE","start":1160,"end":1167},{"text":"normal","label":"LAB_VALUE","start":1191,"end":1197},{"text":"liver function","label":"DIAGNOSTIC_PROCEDURE","start":1198,"end":1212},{"text":"serum bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1220,"end":1235},{"text":"0.9 mg\/dl","label":"LAB_VALUE","start":1236,"end":1245},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1247,"end":1271},{"text":"38 U\/L","label":"LAB_VALUE","start":1272,"end":1278},{"text":"aspartate aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1280,"end":1306},{"text":"35 U\/L","label":"LAB_VALUE","start":1307,"end":1313},{"text":"alkaline phosphatase","label":"DIAGNOSTIC_PROCEDURE","start":1315,"end":1335},{"text":"122 U\/L","label":"LAB_VALUE","start":1336,"end":1343},{"text":"serum albumin","label":"DIAGNOSTIC_PROCEDURE","start":1345,"end":1358},{"text":"37 g\/L","label":"LAB_VALUE","start":1359,"end":1365},{"text":"normal","label":"LAB_VALUE","start":1368,"end":1374},{"text":"potassium","label":"DIAGNOSTIC_PROCEDURE","start":1375,"end":1384},{"text":"5.1 mmol\/L","label":"LAB_VALUE","start":1386,"end":1396},{"text":"normal","label":"LAB_VALUE","start":1399,"end":1405},{"text":"bicarbonate","label":"DIAGNOSTIC_PROCEDURE","start":1406,"end":1417},{"text":"19 mmol\/L","label":"LAB_VALUE","start":1419,"end":1428},{"text":"normal","label":"LAB_VALUE","start":1435,"end":1441},{"text":"triglycerides","label":"DIAGNOSTIC_PROCEDURE","start":1442,"end":1455},{"text":"173 mg\/dl","label":"LAB_VALUE","start":1457,"end":1466},{"text":"serological markers","label":"DIAGNOSTIC_PROCEDURE","start":1473,"end":1492},{"text":"antinuclear antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1504,"end":1526},{"text":"cytoplasmic antineutrophil cytoplasmic antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1528,"end":1577},{"text":"perinuclear antineutrophil cytoplasmic antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1579,"end":1628},{"text":"C3","label":"DIAGNOSTIC_PROCEDURE","start":1630,"end":1632},{"text":"C4","label":"DIAGNOSTIC_PROCEDURE","start":1638,"end":1640},{"text":"within normal 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","severely"," ","agitated",", ","restless",", and ","disoriented",".\nHe was ","tachypneic"," with ","acidotic breath",".\n","Mild"," ","pedal"," ","edema"," was present; however, his ","jugular venous pressure"," was ","not raised",".\nHis ","pulse"," was ","112 beats\/minute",", his ","blood pressure"," was ","140\/90 mmHg",", and his ","body temperature"," was ","98 \u00b0F",".\nSigns of ","meningeal"," ","irritation"," were absent, and his ","plantar response"," was ","bilaterally extensor",".\nHis ","fundus"," ","could not be evaluated",", and ","examination"," of his ","other systems"," was ","unremarkable",".\nHis ","laboratory parameters"," showed features of ","renal dysfunction"," (","serum creatinine"," ","13 mg\/dl",", ","serum urea"," ","293 mg\/dl","), ","raised"," ","pancreatic enzymes"," (","serum amylase"," ","249 U\/L"," [reference up to 100 U\/L], ","serum lipase"," ","227 U\/L"," [reference 13\u201360 U\/L), ","normal"," ","liver function"," tests (","serum bilirubin"," ","0.9 mg\/dl",", ","alanine aminotransferase"," ","38 U\/L",", ","aspartate aminotransferase"," ","35 U\/L",", ","alkaline phosphatase"," ","122 U\/L",", ","serum albumin"," ","37 g\/L","), ","normal"," ","potassium"," (","5.1 mmol\/L","), ","normal"," ","bicarbonate"," (","19 mmol\/L","), and ","normal"," ","triglycerides"," (","173 mg\/dl",").\nHis ","serological markers",", including ","antinuclear antibodies",", ","cytoplasmic antineutrophil cytoplasmic antibodies",", ","perinuclear antineutrophil cytoplasmic antibodies",", ","C3",", and ","C4",", were ","within normal limits",".\nAn ","ultrasonogram"," of his whole ","abdomen"," was ","unremarkable",", but ","non-contrast-enhanced"," ","computed tomography"," (","CT",") findings were suggestive of ","acute"," ","pancreatitis"," (Fig.1).\nHis ","kidneys"," were ","unremarkable",", however.\nThe patient was managed as having a case of ","AKI"," and ","acute"," ","pancreatitis",".\n","Urgent"," ","hemodialysis"," was initiated.\nAfter he had received ","two sessions"," of ","hemodialysis",", his ","level of consciousness"," ","improved",", but he complained of ","profound"," ","visual loss",".\nAn assessment revealed only ","perception of light",".\nA ","funduscopic examination"," showed ","retinal whitening"," and ","extensive"," ","cotton wool exudate","s as well as ","Purtscher\u2019s flecken"," (Fig.2) compatible with ","Purtscher\u2019s retinopathy",".\n","High-dose"," ","parenteral"," ","methylprednisolone"," (","1 g"," ","intravenously"," ","once daily"," for ","3 days",") was administered.\nFor ","evaluation of renal dysfunction",", a ","renal"," ","biopsy"," was done; the ","histopathological findings"," were compatible with ","renal cortical necrosis"," (Fig.3).\nThe patient ","denied substance abuse or alcohol ingestion",".\nHe ","did not consume any nephrotoxic drugs or herbal products in the recent past",".\n","No history suggesting connective tissue diseases was available",", nor did he have a history of ","hypotension"," throughout the course of his current illness.\nThe patient was finally diagnosed with ","acute"," ","pancreatitis"," complicated with ","renal cortical necrosis"," leading to ","AKI"," and ","Purtscher\u2019s retinopathy"," leading to ","complete"," ","bilateral"," ","blindness",".\nHe ","died"," ","16 months after"," his initial presentation as a result of a ","recurrent"," attack of ","acute"," ","pancreatitis",".\nBefore that, he had been undergoing ","maintenance"," ","hemodialysis","; however, his ","renal function"," ","did not recover",", though his ","vision"," was ","improved"," to ","finger-counting"," at ","2 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-{"full_text":"A female outpatient in her 50s had routinely visited our hospital because of liver cirrhosis resulting from hepatitis B virus and biliary duct stones.\nAt 65 years of age, she suffered from HCC with BCLC early stage A.\nHer liver function was well preserved, and Child-Pugh score was A.\nShe underwent left lateral segmentectomy for HCC, without other preoperative treatments.\nHistopathological findings revealed bridging fibrosis and pseudolobule formation.\nSerum levels of alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II normalized after primary resection (Figure 1).\nIn imaging studies, no LN metastasis was detected at the time of primary resection of HCC.\nTwo and a half years postoperatively, the patient\u2019s AFP level increased dramatically to 780.2 ng\/ml.\nA lobular lesion with fine enhancement was detected by contrast-enhanced magnetic resonance imaging.\nThe tumor measured 27 mm in diameter and was located caudally on the left kidney.\nIn contrast-enhanced computed tomography, the tumor showed strong enhancement in the arterial phase (Figure 2A, 2B) and a relatively low density in the portal phase (Figure 2C, 2D).\nThese enhancement findings appeared consistent with a typical HCC pattern.\nDetailed imaging studies of both magnetic resonance imaging and computed tomography were performed in this case because a very rare metastatic LN initially seemed to be debatable and we needed to rule out exclusion diagnoses.\nThree-dimensional imaging proved that the tumor was fed by a main vessel from the inferior mesenteric artery (red arrow) and by an accessory feeder from the superior mesenteric artery (Figure 3).\nFluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) and positron emission tomography-computed tomography did not detect the tumor (Figure 4), although we thought positron emission tomography-computed tomography was helpful to identify other metastatic tumors.\nFurther imaging findings revealed no other intrahepatic or extrahepatic metastasis.\nBased on the tumor location, the clinical diagnosis was solitary metastasis to a mesocolic LN or HCC dissemination.\nDetermining the ideal therapeutic strategy for solitary but extrahepatic rare metastasis was difficult.\nAlthough rapid growth was a critical concern in this case, the tumor was solitary and not accompanied by other metastases.\nConsidering both diagnostic and therapeutic viewpoints, we finally chose surgical resection in this case.\nNo disseminative nodules, lymphadenopathy, or ascites was observed during surgery.\nThe tumor was located in the mesocolon nearly at the wall of the descending colon, and partial resection of the descending colon with regional mesocolon was performed.\nThe patient\u2019s postoperative course was uneventful, and she was discharged on postoperative day 8.\nSerum levels of tumor marker decreased immediately after surgery (Figure 1).\nMacroscopically, the mesocolic tumor was a solid and elastic mass with a smooth surface (Figure 5A).\nA yellowish nodule was encapsulated in the cut surface (Figure 5B).\nThe enlarged LN contained metastatic HCC with a ductal structure (Figure 6A), and immunohistochemically, the tumor was positive for AFP and negative for CK-20, which was consistent with the pattern of primary HCC (Figure 6B).\nThe histopathological diagnosis was metastatic HCC to a mesocolic LN.\nAs of the writing of this report, the patient has remained free of recurrence for 13 months after the second surgery, and has also been carefully followed up.\nNo adjuvant therapies have been performed.\n","ner_info":[{"text":"female","label":"SEX","start":2,"end":8},{"text":"her 50s","label":"DATE","start":23,"end":30},{"text":"visited","label":"CLINICAL_EVENT","start":45,"end":52},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":57,"end":65},{"text":"liver cirrhosis","label":"DISEASE_DISORDER","start":77,"end":92},{"text":"hepatitis B 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findings","label":"DIAGNOSTIC_PROCEDURE","start":374,"end":400},{"text":"bridging","label":"DETAILED_DESCRIPTION","start":410,"end":418},{"text":"fibrosis","label":"DISEASE_DISORDER","start":419,"end":427},{"text":"pseudolobule formation","label":"DISEASE_DISORDER","start":432,"end":454},{"text":"Serum","label":"BIOLOGICAL_STRUCTURE","start":456,"end":461},{"text":"alpha-fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":472,"end":489},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":491,"end":494},{"text":"protein induced by vitamin K absence-II","label":"DIAGNOSTIC_PROCEDURE","start":500,"end":539},{"text":"normalized","label":"LAB_VALUE","start":540,"end":550},{"text":"resection","label":"COREFERENCE","start":565,"end":574},{"text":"imaging studies","label":"DIAGNOSTIC_PROCEDURE","start":590,"end":605},{"text":"LN","label":"BIOLOGICAL_STRUCTURE","start":610,"end":612},{"text":"metastasis","label":"SIGN_SYMPTOM","start":613,"end":623},{"text":"resection","label":"COREFERENCE","start":660,"end":669},{"text":"Two and a half years","label":"DATE","start":678,"end":698},{"text":"AFP level","label":"DIAGNOSTIC_PROCEDURE","start":730,"end":739},{"text":"increased dramatically","label":"LAB_VALUE","start":740,"end":762},{"text":"780.2 ng\/ml","label":"LAB_VALUE","start":766,"end":777},{"text":"lobular","label":"SHAPE","start":781,"end":788},{"text":"lesion","label":"SIGN_SYMPTOM","start":789,"end":795},{"text":"fine enhancement","label":"DETAILED_DESCRIPTION","start":801,"end":817},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":834,"end":851},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":852,"end":878},{"text":"tumor","label":"COREFERENCE","start":884,"end":889},{"text":"27 mm in diameter","label":"DISTANCE","start":899,"end":916},{"text":"caudally on the left kidney","label":"BIOLOGICAL_STRUCTURE","start":933,"end":960},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":965,"end":982},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":983,"end":1002},{"text":"tumor","label":"COREFERENCE","start":1008,"end":1013},{"text":"strong","label":"DETAILED_DESCRIPTION","start":1021,"end":1027},{"text":"enhancement","label":"SIGN_SYMPTOM","start":1028,"end":1039},{"text":"arterial phase","label":"BIOLOGICAL_STRUCTURE","start":1047,"end":1061},{"text":"relatively low","label":"DETAILED_DESCRIPTION","start":1084,"end":1098},{"text":"density","label":"SIGN_SYMPTOM","start":1099,"end":1106},{"text":"portal phase","label":"BIOLOGICAL_STRUCTURE","start":1114,"end":1126},{"text":"typical","label":"DETAILED_DESCRIPTION","start":1198,"end":1205},{"text":"HCC","label":"DISEASE_DISORDER","start":1206,"end":1209},{"text":"Three-dimensional 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tomography","label":"DIAGNOSTIC_PROCEDURE","start":1715,"end":1763},{"text":"intrahepatic","label":"BIOLOGICAL_STRUCTURE","start":1962,"end":1974},{"text":"extrahepatic","label":"BIOLOGICAL_STRUCTURE","start":1978,"end":1990},{"text":"metastasis","label":"SIGN_SYMPTOM","start":1991,"end":2001},{"text":"solitary","label":"DETAILED_DESCRIPTION","start":2059,"end":2067},{"text":"metastasis","label":"SIGN_SYMPTOM","start":2068,"end":2078},{"text":"mesocolic LN","label":"BIOLOGICAL_STRUCTURE","start":2084,"end":2096},{"text":"HCC","label":"DISEASE_DISORDER","start":2100,"end":2103},{"text":"dissemination","label":"DETAILED_DESCRIPTION","start":2104,"end":2117},{"text":"tumor","label":"SIGN_SYMPTOM","start":2286,"end":2291},{"text":"solitary","label":"DETAILED_DESCRIPTION","start":2296,"end":2304},{"text":"other","label":"DETAILED_DESCRIPTION","start":2328,"end":2333},{"text":"metastases","label":"SIGN_SYMPTOM","start":2334,"end":2344},{"text":"surgical resection","label":"THERAPEUTIC_PROCEDURE","start":2419,"end":2437},{"text":"disseminative nodules","label":"SIGN_SYMPTOM","start":2455,"end":2476},{"text":"lymphadenopathy","label":"DISEASE_DISORDER","start":2478,"end":2493},{"text":"ascites","label":"SIGN_SYMPTOM","start":2498,"end":2505},{"text":"surgery","label":"COREFERENCE","start":2526,"end":2533},{"text":"tumor","label":"COREFERENCE","start":2539,"end":2544},{"text":"mesocolon","label":"BIOLOGICAL_STRUCTURE","start":2564,"end":2573},{"text":"at the wall of the descending colon","label":"BIOLOGICAL_STRUCTURE","start":2581,"end":2616},{"text":"resection","label":"COREFERENCE","start":2630,"end":2639},{"text":"descending colon","label":"BIOLOGICAL_STRUCTURE","start":2647,"end":2663},{"text":"regional mesocolon","label":"BIOLOGICAL_STRUCTURE","start":2669,"end":2687},{"text":"postoperative course","label":"THERAPEUTIC_PROCEDURE","start":2717,"end":2737},{"text":"uneventful","label":"LAB_VALUE","start":2742,"end":2752},{"text":"discharged","label":"CLINICAL_EVENT","start":2766,"end":2776},{"text":"day 8","label":"DATE","start":2794,"end":2799},{"text":"Serum","label":"BIOLOGICAL_STRUCTURE","start":2801,"end":2806},{"text":"tumor marker","label":"DIAGNOSTIC_PROCEDURE","start":2817,"end":2829},{"text":"decreased immediately","label":"LAB_VALUE","start":2830,"end":2851},{"text":"surgery","label":"COREFERENCE","start":2858,"end":2865},{"text":"Macroscopically","label":"DIAGNOSTIC_PROCEDURE","start":2878,"end":2893},{"text":"mesocolic tumor","label":"COREFERENCE","start":2899,"end":2914},{"text":"solid","label":"LAB_VALUE","start":2921,"end":2926},{"text":"elastic","label":"LAB_VALUE","start":2931,"end":2938},{"text":"smooth 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structure","label":"DETAILED_DESCRIPTION","start":3095,"end":3111},{"text":"immunohistochemically","label":"DIAGNOSTIC_PROCEDURE","start":3129,"end":3150},{"text":"positive","label":"LAB_VALUE","start":3166,"end":3174},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":3179,"end":3182},{"text":"negative","label":"LAB_VALUE","start":3187,"end":3195},{"text":"CK-20","label":"DIAGNOSTIC_PROCEDURE","start":3200,"end":3205},{"text":"primary","label":"DETAILED_DESCRIPTION","start":3248,"end":3255},{"text":"HCC","label":"DISEASE_DISORDER","start":3256,"end":3259},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":3309,"end":3319},{"text":"HCC","label":"DISEASE_DISORDER","start":3320,"end":3323},{"text":"mesocolic LN","label":"BIOLOGICAL_STRUCTURE","start":3329,"end":3341},{"text":"recurrence","label":"SIGN_SYMPTOM","start":3410,"end":3420},{"text":"13 months after","label":"DATE","start":3425,"end":3440},{"text":"followed up","label":"CLINICAL_EVENT","start":3489,"end":3500},{"text":"adjuvant therapies","label":"MEDICATION","start":3505,"end":3523}],"tokens":["A ","female"," outpatient in ","her 50s"," had routinely ","visited"," our ","hospital"," because of ","liver cirrhosis"," resulting from ","hepatitis B virus"," and ","biliary duct stones",".\nAt ","65 years of age",", she suffered from ","HCC"," with ","BCLC early stage A",".\nHer ","liver function"," was ","well preserved",", and ","Child-Pugh score"," was ","A",".\nShe underwent ","left lateral"," ","segmentectomy"," for ","HCC",", without ","other preoperative treatments",".\n","Histopathological findings"," revealed ","bridging"," ","fibrosis"," and ","pseudolobule formation",".\n","Serum"," levels of ","alpha-fetoprotein"," (","AFP",") and ","protein induced by vitamin K absence-II"," ","normalized"," after primary ","resection"," (Figure 1).\nIn ","imaging studies",", no ","LN"," ","metastasis"," was detected at the time of primary ","resection"," of HCC.\n","Two and a half years"," postoperatively, the patient\u2019s ","AFP level"," ","increased dramatically"," to ","780.2 ng\/ml",".\nA ","lobular"," ","lesion"," with ","fine enhancement"," was detected by ","contrast-enhanced"," ","magnetic resonance imaging",".\nThe ","tumor"," measured ","27 mm in diameter"," and was located ","caudally on the left kidney",".\nIn ","contrast-enhanced"," ","computed tomography",", the ","tumor"," showed ","strong"," ","enhancement"," in the ","arterial phase"," (Figure 2A, 2B) and a ","relatively low"," ","density"," in the ","portal phase"," (Figure 2C, 2D).\nThese enhancement findings appeared consistent with a ","typical"," ","HCC"," pattern.\nDetailed imaging studies of both magnetic resonance imaging and computed tomography were performed in this case because a very rare metastatic LN initially seemed to be debatable and we needed to rule out exclusion diagnoses.\n","Three-dimensional imaging"," proved that the ","tumor"," was ","fed by a main vessel from the inferior mesenteric artery"," (red arrow) and by an ","accessory feeder from the superior mesenteric artery"," (Figure 3).\n","Fluorine-18-fluorodeoxyglucose positron emission tomography"," (","FDG-PET",") and ","positron emission tomography-computed tomography"," did not detect the tumor (Figure 4), although we thought positron emission tomography-computed tomography was helpful to identify other metastatic tumors.\nFurther imaging findings revealed no other ","intrahepatic"," or ","extrahepatic"," ","metastasis",".\nBased on the tumor location, the clinical diagnosis was ","solitary"," ","metastasis"," to a ","mesocolic LN"," or ","HCC"," ","dissemination",".\nDetermining the ideal therapeutic strategy for solitary but extrahepatic rare metastasis was difficult.\nAlthough rapid growth was a critical concern in this case, the ","tumor"," was ","solitary"," and not accompanied by ","other"," ","metastases",".\nConsidering both diagnostic and therapeutic viewpoints, we finally chose ","surgical resection"," in this case.\nNo ","disseminative nodules",", ","lymphadenopathy",", or ","ascites"," was observed during ","surgery",".\nThe ","tumor"," was located in the ","mesocolon"," nearly ","at the wall of the descending colon",", and partial ","resection"," of the ","descending colon"," with ","regional mesocolon"," was performed.\nThe patient\u2019s ","postoperative course"," was ","uneventful",", and she was ","discharged"," on postoperative ","day 8",".\n","Serum"," levels of ","tumor marker"," ","decreased immediately"," after ","surgery"," (Figure 1).\n","Macroscopically",", the ","mesocolic tumor"," was a ","solid"," and ","elastic"," mass with a ","smooth surface"," (Figure 5A).\nA ","yellowish"," ","nodule"," was ","encapsulated in the cut surface"," (Figure 5B).\nThe ","enlarged LN"," contained ","metastatic"," ","HCC"," with a ","ductal structure"," (Figure 6A), and ","immunohistochemically",", the tumor was ","positive"," for ","AFP"," and ","negative"," for ","CK-20",", which was consistent with the pattern of ","primary"," ","HCC"," (Figure 6B).\nThe histopathological diagnosis was ","metastatic"," ","HCC"," to a ","mesocolic LN",".\nAs of the writing of this report, the patient has remained free of ","recurrence"," for ","13 months after"," the second surgery, and has also been carefully ","followed up",".\nNo ","adjuvant therapies"," have been performed.\n"],"ner_labels":[0,65,0,19,0,13,0,48,0,26,0,26,0,26,0,5,0,26,0,42,0,24,0,42,0,24,0,42,0,22,0,75,0,26,0,75,0,24,0,22,0,26,0,26,0,12,0,24,0,24,0,24,0,42,0,18,0,24,0,12,0,69,0,18,0,19,0,24,0,42,0,42,0,67,0,69,0,22,0,22,0,24,0,18,0,27,0,12,0,22,0,24,0,18,0,22,0,69,0,12,0,22,0,69,0,12,0,22,0,26,0,24,0,18,0,12,0,12,0,24,0,24,0,24,0,12,0,12,0,69,0,22,0,69,0,12,0,26,0,22,0,69,0,22,0,22,0,69,0,75,0,69,0,26,0,69,0,18,0,18,0,12,0,12,0,18,0,12,0,12,0,75,0,42,0,13,0,19,0,12,0,24,0,42,0,18,0,24,0,18,0,42,0,42,0,73,0,15,0,69,0,22,0,22,0,22,0,26,0,22,0,24,0,42,0,24,0,42,0,24,0,22,0,26,0,22,0,26,0,12,0,69,0,19,0,13,0,46,0]}
-{"full_text":"This is the case of a 58-year-old white Hispanic woman with a history of uveal melanoma in her right eye (Fig.1).\nShe was admitted to the hospital with jaundice and abdominal pain for 10 days.\nOn admission, laboratory tests were obtained (a complete blood count was within normal limits, amylase: 136 U\/L, total bilirubin: 6.37 mg\/dL with a direct fraction of 5.30 mg\/dL).\nCross-sectional, abdominal computed tomography (CT) with contrast, showed a low-attenuating lesion localized in the pancreatic head (measuring 4\u2009\u00d7\u20093 cm) and a thinner section of the distal bile duct suspicious for compression).\nAfter a multidisciplinary meeting, our patient was scheduled for EUS-FNA.\nEUS showed a solid, heteroechoic with predominantly hypoechoic areas, well-defined lesion with regular contours (measuring 3.1\u2009\u00d7\u20092.6 cm), localized between the head and neck of the pancreas (Fig.2).\nThere was no vascular or lymph node invasion identified.\nEUS-FNA was performed with a 22G needle using the fanning technique.\nIn the cytology specimens (Fig.3), the cells presented have a discohesive dispersed pattern, with marked variation in size and shape including epithelioid and spindle-shaped cells with plasmacytoid and round nuclei.\nThe nuclear chromatin is clumping and irregular with excessive parachromatin clearing, there are single or multiple macronucleoli, and abundant cytoplasm with deep brownish-black granules obscuring the cell details.\nThe background shows necrosis and hemorrhage.\nOur patient underwent right orbital exenteration and followed by duodenopancreatectomy (the Whipple procedure), without any complications (Fig.4).\nThe surgical specimen showed undifferentiated cells, with extended disposition of brown pigment, infiltrating the pancreas and the serosa of the duodenal wall.\nImmunohistochemistry was positive for Melan-A, HMB45, vimentin, S-100 protein and negative for cytokeratin, all consistent with metastatic malignant melanoma.\nAt the moment, our patient is receiving adjuvant chemotherapy at an outside oncology clinic.\n","ner_info":[{"text":"58-year-old","label":"AGE","start":22,"end":33},{"text":"white","label":"PERSONAL_BACKGROUND","start":34,"end":39},{"text":"Hispanic","label":"PERSONAL_BACKGROUND","start":40,"end":48},{"text":"woman","label":"SEX","start":49,"end":54},{"text":"history of uveal melanoma in her right eye","label":"HISTORY","start":62,"end":104},{"text":"admitted","label":"CLINICAL_EVENT","start":122,"end":130},{"text":"jaundice","label":"SIGN_SYMPTOM","start":152,"end":160},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":165,"end":174},{"text":"pain","label":"SIGN_SYMPTOM","start":175,"end":179},{"text":"10 days","label":"DURATION","start":184,"end":191},{"text":"laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":207,"end":223},{"text":"complete blood count","label":"DIAGNOSTIC_PROCEDURE","start":241,"end":261},{"text":"within normal limits","label":"LAB_VALUE","start":266,"end":286},{"text":"amylase","label":"DIAGNOSTIC_PROCEDURE","start":288,"end":295},{"text":"136 U\/L","label":"LAB_VALUE","start":297,"end":304},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":306,"end":321},{"text":"6.37 mg\/dL","label":"LAB_VALUE","start":323,"end":333},{"text":"direct fraction","label":"DIAGNOSTIC_PROCEDURE","start":341,"end":356},{"text":"5.30 mg\/dL","label":"LAB_VALUE","start":360,"end":370},{"text":"Cross-sectional","label":"DETAILED_DESCRIPTION","start":373,"end":388},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":390,"end":399},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":400,"end":419},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":421,"end":423},{"text":"with contrast","label":"DETAILED_DESCRIPTION","start":425,"end":438},{"text":"low-attenuating","label":"DETAILED_DESCRIPTION","start":449,"end":464},{"text":"lesion","label":"SIGN_SYMPTOM","start":465,"end":471},{"text":"pancreatic head","label":"BIOLOGICAL_STRUCTURE","start":489,"end":504},{"text":"4\u2009\u00d7\u20093 cm","label":"AREA","start":516,"end":524},{"text":"thinner section of the distal bile duct","label":"BIOLOGICAL_STRUCTURE","start":532,"end":571},{"text":"multidisciplinary meeting","label":"CLINICAL_EVENT","start":609,"end":634},{"text":"EUS-FNA","label":"DIAGNOSTIC_PROCEDURE","start":666,"end":673},{"text":"EUS","label":"COREFERENCE","start":675,"end":678},{"text":"solid","label":"DETAILED_DESCRIPTION","start":688,"end":693},{"text":"heteroechoic","label":"DETAILED_DESCRIPTION","start":695,"end":707},{"text":"predominantly hypoechoic areas","label":"DETAILED_DESCRIPTION","start":713,"end":743},{"text":"well-defined","label":"DETAILED_DESCRIPTION","start":745,"end":757},{"text":"lesion","label":"SIGN_SYMPTOM","start":758,"end":764},{"text":"regular contours","label":"TEXTURE","start":770,"end":786},{"text":"3.1\u2009\u00d7\u20092.6 cm","label":"AREA","start":798,"end":810},{"text":"between the head and neck of the pancreas","label":"BIOLOGICAL_STRUCTURE","start":823,"end":864},{"text":"vascular or lymph node invasion","label":"SIGN_SYMPTOM","start":887,"end":918},{"text":"EUS-FNA","label":"COREFERENCE","start":931,"end":938},{"text":"with a 22G needle","label":"DETAILED_DESCRIPTION","start":953,"end":970},{"text":"using the fanning technique","label":"DETAILED_DESCRIPTION","start":971,"end":998},{"text":"cytology specimens","label":"DIAGNOSTIC_PROCEDURE","start":1007,"end":1025},{"text":"cells","label":"BIOLOGICAL_STRUCTURE","start":1039,"end":1044},{"text":"discohesive dispersed pattern","label":"LAB_VALUE","start":1062,"end":1091},{"text":"variation in size and shape","label":"LAB_VALUE","start":1105,"end":1132},{"text":"epithelioid","label":"SHAPE","start":1143,"end":1154},{"text":"spindle-shaped","label":"SHAPE","start":1159,"end":1173},{"text":"cells","label":"BIOLOGICAL_STRUCTURE","start":1174,"end":1179},{"text":"plasmacytoid","label":"SHAPE","start":1185,"end":1197},{"text":"round","label":"SHAPE","start":1202,"end":1207},{"text":"nuclei","label":"BIOLOGICAL_STRUCTURE","start":1208,"end":1214},{"text":"nuclear chromatin","label":"DIAGNOSTIC_PROCEDURE","start":1220,"end":1237},{"text":"clumping","label":"LAB_VALUE","start":1241,"end":1249},{"text":"irregular","label":"LAB_VALUE","start":1254,"end":1263},{"text":"excessive parachromatin clearing","label":"LAB_VALUE","start":1269,"end":1301},{"text":"single","label":"DETAILED_DESCRIPTION","start":1313,"end":1319},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1323,"end":1331},{"text":"macronucleoli","label":"BIOLOGICAL_STRUCTURE","start":1332,"end":1345},{"text":"abundant","label":"DETAILED_DESCRIPTION","start":1351,"end":1359},{"text":"cytoplasm","label":"BIOLOGICAL_STRUCTURE","start":1360,"end":1369},{"text":"deep brownish-black granules","label":"LAB_VALUE","start":1375,"end":1403},{"text":"background","label":"DIAGNOSTIC_PROCEDURE","start":1436,"end":1446},{"text":"necrosis","label":"SIGN_SYMPTOM","start":1453,"end":1461},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":1466,"end":1476},{"text":"right orbital","label":"BIOLOGICAL_STRUCTURE","start":1500,"end":1513},{"text":"exenteration","label":"THERAPEUTIC_PROCEDURE","start":1514,"end":1526},{"text":"duodenopancreatectomy","label":"THERAPEUTIC_PROCEDURE","start":1543,"end":1564},{"text":"Whipple procedure","label":"DETAILED_DESCRIPTION","start":1570,"end":1587},{"text":"complications","label":"SIGN_SYMPTOM","start":1602,"end":1615},{"text":"surgical specimen","label":"DIAGNOSTIC_PROCEDURE","start":1629,"end":1646},{"text":"undifferentiated","label":"DETAILED_DESCRIPTION","start":1654,"end":1670},{"text":"cells","label":"BIOLOGICAL_STRUCTURE","start":1671,"end":1676},{"text":"extended disposition of brown pigment","label":"LAB_VALUE","start":1683,"end":1720},{"text":"infiltrating","label":"SIGN_SYMPTOM","start":1722,"end":1734},{"text":"pancreas","label":"BIOLOGICAL_STRUCTURE","start":1739,"end":1747},{"text":"serosa of the duodenal wall","label":"BIOLOGICAL_STRUCTURE","start":1756,"end":1783},{"text":"Immunohistochemistry","label":"DIAGNOSTIC_PROCEDURE","start":1785,"end":1805},{"text":"positive","label":"LAB_VALUE","start":1810,"end":1818},{"text":"Melan-A","label":"DIAGNOSTIC_PROCEDURE","start":1823,"end":1830},{"text":"HMB45","label":"DIAGNOSTIC_PROCEDURE","start":1832,"end":1837},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":1839,"end":1847},{"text":"S-100 protein","label":"DIAGNOSTIC_PROCEDURE","start":1849,"end":1862},{"text":"negative","label":"LAB_VALUE","start":1867,"end":1875},{"text":"cytokeratin","label":"DIAGNOSTIC_PROCEDURE","start":1880,"end":1891},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":1913,"end":1923},{"text":"malignant","label":"DETAILED_DESCRIPTION","start":1924,"end":1933},{"text":"melanoma","label":"DISEASE_DISORDER","start":1934,"end":1942},{"text":"At the moment","label":"DATE","start":1944,"end":1957},{"text":"adjuvant","label":"DETAILED_DESCRIPTION","start":1984,"end":1992},{"text":"chemotherapy","label":"MEDICATION","start":1993,"end":2005},{"text":"outside oncology clinic","label":"NONBIOLOGICAL_LOCATION","start":2012,"end":2035}],"tokens":["This is the case of a ","58-year-old"," ","white"," ","Hispanic"," ","woman"," with a ","history of uveal melanoma in her right eye"," (Fig.1).\nShe was ","admitted"," to the hospital with ","jaundice"," and ","abdominal"," ","pain"," for ","10 days",".\nOn admission, ","laboratory tests"," were obtained (a ","complete blood count"," was ","within normal limits",", ","amylase",": ","136 U\/L",", ","total bilirubin",": ","6.37 mg\/dL"," with a ","direct fraction"," of ","5.30 mg\/dL",").\n","Cross-sectional",", ","abdominal"," ","computed tomography"," (","CT",") ","with contrast",", showed a ","low-attenuating"," ","lesion"," localized in the ","pancreatic head"," (measuring ","4\u2009\u00d7\u20093 cm",") and a ","thinner section of the distal bile duct"," suspicious for compression).\nAfter a ","multidisciplinary meeting",", our patient was scheduled for ","EUS-FNA",".\n","EUS"," showed a ","solid",", ","heteroechoic"," with ","predominantly hypoechoic areas",", ","well-defined"," ","lesion"," with ","regular contours"," (measuring ","3.1\u2009\u00d7\u20092.6 cm","), localized ","between the head and neck of the pancreas"," (Fig.2).\nThere was no ","vascular or lymph node invasion"," identified.\n","EUS-FNA"," was performed ","with a 22G needle"," ","using the fanning technique",".\nIn the ","cytology specimens"," (Fig.3), the ","cells"," presented have a ","discohesive dispersed pattern",", with marked ","variation in size and shape"," including ","epithelioid"," and ","spindle-shaped"," ","cells"," with ","plasmacytoid"," and ","round"," ","nuclei",".\nThe ","nuclear chromatin"," is ","clumping"," and ","irregular"," with ","excessive parachromatin clearing",", there are ","single"," or ","multiple"," ","macronucleoli",", and ","abundant"," ","cytoplasm"," with ","deep brownish-black granules"," obscuring the cell details.\nThe ","background"," shows ","necrosis"," and ","hemorrhage",".\nOur patient underwent ","right orbital"," ","exenteration"," and followed by ","duodenopancreatectomy"," (the ","Whipple procedure","), without any ","complications"," (Fig.4).\nThe ","surgical specimen"," showed ","undifferentiated"," ","cells",", with ","extended disposition of brown pigment",", ","infiltrating"," the ","pancreas"," and the ","serosa of the duodenal wall",".\n","Immunohistochemistry"," was ","positive"," for ","Melan-A",", ","HMB45",", ","vimentin",", ","S-100 protein"," and ","negative"," for ","cytokeratin",", all consistent with ","metastatic"," ","malignant"," ","melanoma",".\n","At the moment",", our patient is receiving ","adjuvant"," ","chemotherapy"," at an ","outside oncology clinic",".\n"],"ner_labels":[0,5,0,58,0,58,0,65,0,39,0,13,0,69,0,12,0,69,0,32,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,12,0,24,0,24,0,22,0,22,0,69,0,12,0,8,0,12,0,13,0,24,0,18,0,22,0,22,0,22,0,22,0,69,0,73,0,8,0,12,0,69,0,18,0,22,0,22,0,24,0,12,0,42,0,42,0,67,0,67,0,12,0,67,0,67,0,12,0,24,0,42,0,42,0,42,0,22,0,22,0,12,0,22,0,12,0,42,0,24,0,69,0,69,0,12,0,75,0,75,0,22,0,69,0,24,0,22,0,12,0,42,0,69,0,12,0,12,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,22,0,22,0,26,0,19,0,22,0,46,0,48,0]}
-{"full_text":"A 28-year-old African American woman presented to the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, for evaluation of right-sided paralysis and left-sided paresthesias after being found down in her home between her nightstand and her bed.\nThe symptoms began after eating at a local restaurant chain, consuming alcohol, and smoking one cigarette dipped in liquid phencyclidine (PCP).\nShe was asymptomatic that night and went to bed without complications.\nShe was found down next to the bed the following morning unable to move.\nThe patient denied any physical trauma other than falling from the bed.\nShe had no history of seizures, sickle cell anemia, fever, urinary or bowel incontinence, or pain.\nThe patient had a history of viral meningitis without residual deficits eight years prior, gastric bypass surgery, and cholecystectomy, and she was treated for a presumed urinary tract infection five days prior to admission at an outside institution.\nHer triage vital signs were as follows: temperature 36.8\u00b0C, blood pressure 155\/100 mm Hg, heart rate 90 beats per minute, respiratory rate 16 breaths per minute, and an oxygen saturation of 95% on room air.\nOn physical exam, the patient was alert and oriented to person, place, and time.\nHer cranial nerves II\u2013XII were grossly intact.\nShe had 2\/5 strength in her right lower extremity, 3\/5 in her left lower extremity, and 4\/5 bilaterally in her upper extremities.\nHer sensation was intact.\nShe opened her eyes spontaneously, her verbal response was oriented and appropriate, and she obeyed commands, resulting in a Glasgow Coma Scale score of 15.\nPupils were equal, round, and reactive to light.\nShe had tenderness to palpation over the cervical, thoracic, and lumbar spine without obvious external signs of trauma.\nHer anal sphincter tone was intact.\nMultiple laboratory abnormalities were noted on admission, including hyperlactemia, elevated liver function tests, and electrolyte derangements.\nHer complete blood count and remainder of her complete metabolic panel were within normal limits.\nThese values are summarized along with reference ranges in Table 1.\nHer toxicology screen was positive for PCP.\nBlood cultures drawn on admission grew the aerobic bacteria Salmonella enterica serotype 4,12: i, and then repeat cultures drawn two days later grew group B streptococcus (aerobic and non-aerobic).\nSubsequent blood cultures were negative, as were stool cultures.\nMetronidazole and vancomycin therapy was initiated empirically, with transition to ceftriaxone upon learning of the culture results.\nIn addition, she had a detailed autoimmunity workup including anti-nuclear antibody (ANA) and HLA-B27, all of which returned within normal limits.\nAdmission computerized tomography scan of her cervical, thoracic, and lumbar spine revealed no spinal fractures.\nMagnetic resonance imaging (MRI) revealed no acute intracranial abnormalities, but enhancement within the central aspect of C3\u2013T2 suggested spinal cord edema, disc protrusions at C3\u20134, C4\u20135, and C5\u20136, and bilateral posterior neck muscle edema.\nA lumbar puncture was not initially performed upon patient admission due to concerns about raised intracranial pressure from suspected trauma.\nFour hours after presentation, her strength had progressively deteriorated to 1\/5 in all extremities.\nShe lost proprioception in her toes bilaterally and developed absent anal sphincter tone.\nThe patient was admitted to the neurotrauma intensive care unit with further deterioration ultimately requiring endotracheal intubation due to respiratory failure.\nUpon her positive blood culture results, lumbar puncture was performed, which demonstrated a pattern consistent with ATM, the results of which are summarized in Table 2.\nAn extensive workup for infectious etiologies was also completed, with the results summarized in Table 3.\nPlasma exchange therapy was initiated with a suspected diagnosis of ATM.\nDespite maximal medical therapy, the patient remains quadriplegic, is experiencing neurologic pain, received a tracheostomy due to prolonged respiratory failure, and required a feeding jejunostomy tube placement at the time of this report.\n","ner_info":[{"text":"28-year-old","label":"AGE","start":2,"end":13},{"text":"African American","label":"PERSONAL_BACKGROUND","start":14,"end":30},{"text":"woman","label":"SEX","start":31,"end":36},{"text":"presented","label":"CLINICAL_EVENT","start":37,"end":46},{"text":"R Adams Cowley Shock Trauma Center","label":"NONBIOLOGICAL_LOCATION","start":54,"end":88},{"text":"Baltimore, Maryland","label":"NONBIOLOGICAL_LOCATION","start":92,"end":111},{"text":"evaluation","label":"DIAGNOSTIC_PROCEDURE","start":117,"end":127},{"text":"right-sided","label":"DETAILED_DESCRIPTION","start":131,"end":142},{"text":"paralysis","label":"DISEASE_DISORDER","start":143,"end":152},{"text":"left-sided","label":"DETAILED_DESCRIPTION","start":157,"end":167},{"text":"paresthesias","label":"SIGN_SYMPTOM","start":168,"end":180},{"text":"found","label":"CLINICAL_EVENT","start":193,"end":198},{"text":"down","label":"DETAILED_DESCRIPTION","start":199,"end":203},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":211,"end":215},{"text":"between her nightstand and her bed","label":"DETAILED_DESCRIPTION","start":216,"end":250},{"text":"eating","label":"ACTIVITY","start":277,"end":283},{"text":"local restaurant chain","label":"NONBIOLOGICAL_LOCATION","start":289,"end":311},{"text":"consuming alcohol","label":"ACTIVITY","start":313,"end":330},{"text":"smoking","label":"ACTIVITY","start":336,"end":343},{"text":"cigarette","label":"DETAILED_DESCRIPTION","start":348,"end":357},{"text":"liquid","label":"DETAILED_DESCRIPTION","start":368,"end":374},{"text":"phencyclidine","label":"DETAILED_DESCRIPTION","start":375,"end":388},{"text":"PCP","label":"DETAILED_DESCRIPTION","start":390,"end":393},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":404,"end":416},{"text":"that night","label":"TIME","start":417,"end":427},{"text":"went to bed","label":"ACTIVITY","start":432,"end":443},{"text":"complications","label":"SIGN_SYMPTOM","start":452,"end":465},{"text":"found","label":"CLINICAL_EVENT","start":475,"end":480},{"text":"down","label":"DETAILED_DESCRIPTION","start":481,"end":485},{"text":"next to the bed","label":"NONBIOLOGICAL_LOCATION","start":486,"end":501},{"text":"the following morning","label":"TIME","start":502,"end":523},{"text":"unable to move","label":"SIGN_SYMPTOM","start":524,"end":538},{"text":"physical trauma","label":"DISEASE_DISORDER","start":563,"end":578},{"text":"falling","label":"SIGN_SYMPTOM","start":590,"end":597},{"text":"no history of seizures, sickle cell anemia, fever, urinary or bowel incontinence, or pain","label":"HISTORY","start":620,"end":709},{"text":"viral meningitis","label":"DISEASE_DISORDER","start":740,"end":756},{"text":"without residual deficits","label":"DETAILED_DESCRIPTION","start":757,"end":782},{"text":"eight years prior","label":"DATE","start":783,"end":800},{"text":"gastric bypass surgery","label":"HISTORY","start":802,"end":824},{"text":"cholecystectomy","label":"HISTORY","start":830,"end":845},{"text":"treated","label":"THERAPEUTIC_PROCEDURE","start":859,"end":866},{"text":"urinary tract infection","label":"DISEASE_DISORDER","start":882,"end":905},{"text":"five days prior","label":"DATE","start":906,"end":921},{"text":"outside institution","label":"NONBIOLOGICAL_LOCATION","start":941,"end":960},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":973,"end":984},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":1002,"end":1013},{"text":"36.8\u00b0C","label":"LAB_VALUE","start":1014,"end":1020},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1022,"end":1036},{"text":"155\/100 mm Hg","label":"LAB_VALUE","start":1037,"end":1050},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":1052,"end":1062},{"text":"90 beats per minute","label":"LAB_VALUE","start":1063,"end":1082},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":1084,"end":1100},{"text":"16 breaths per minute","label":"LAB_VALUE","start":1101,"end":1122},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":1131,"end":1148},{"text":"95%","label":"LAB_VALUE","start":1152,"end":1155},{"text":"room air","label":"DETAILED_DESCRIPTION","start":1159,"end":1167},{"text":"physical exam","label":"DIAGNOSTIC_PROCEDURE","start":1172,"end":1185},{"text":"alert","label":"SIGN_SYMPTOM","start":1203,"end":1208},{"text":"oriented","label":"SIGN_SYMPTOM","start":1213,"end":1221},{"text":"person","label":"DETAILED_DESCRIPTION","start":1225,"end":1231},{"text":"place","label":"DETAILED_DESCRIPTION","start":1233,"end":1238},{"text":"time","label":"DETAILED_DESCRIPTION","start":1244,"end":1248},{"text":"cranial nerves II\u2013XII","label":"DIAGNOSTIC_PROCEDURE","start":1254,"end":1275},{"text":"grossly intact","label":"LAB_VALUE","start":1281,"end":1295},{"text":"2\/5","label":"LAB_VALUE","start":1305,"end":1308},{"text":"strength","label":"DIAGNOSTIC_PROCEDURE","start":1309,"end":1317},{"text":"right lower extremity","label":"BIOLOGICAL_STRUCTURE","start":1325,"end":1346},{"text":"3\/5","label":"LAB_VALUE","start":1348,"end":1351},{"text":"left lower extremity","label":"BIOLOGICAL_STRUCTURE","start":1359,"end":1379},{"text":"4\/5","label":"LAB_VALUE","start":1385,"end":1388},{"text":"bilaterally in her upper extremities","label":"BIOLOGICAL_STRUCTURE","start":1389,"end":1425},{"text":"sensation","label":"DIAGNOSTIC_PROCEDURE","start":1431,"end":1440},{"text":"intact","label":"LAB_VALUE","start":1445,"end":1451},{"text":"opened","label":"LAB_VALUE","start":1457,"end":1463},{"text":"eyes","label":"DIAGNOSTIC_PROCEDURE","start":1468,"end":1472},{"text":"spontaneously","label":"DETAILED_DESCRIPTION","start":1473,"end":1486},{"text":"verbal response","label":"DIAGNOSTIC_PROCEDURE","start":1492,"end":1507},{"text":"oriented","label":"LAB_VALUE","start":1512,"end":1520},{"text":"appropriate","label":"LAB_VALUE","start":1525,"end":1536},{"text":"obeyed","label":"LAB_VALUE","start":1546,"end":1552},{"text":"commands","label":"DIAGNOSTIC_PROCEDURE","start":1553,"end":1561},{"text":"Glasgow Coma Scale","label":"DIAGNOSTIC_PROCEDURE","start":1578,"end":1596},{"text":"15","label":"LAB_VALUE","start":1606,"end":1608},{"text":"Pupils","label":"DIAGNOSTIC_PROCEDURE","start":1610,"end":1616},{"text":"equal","label":"DETAILED_DESCRIPTION","start":1622,"end":1627},{"text":"round","label":"SHAPE","start":1629,"end":1634},{"text":"reactive to light","label":"LAB_VALUE","start":1640,"end":1657},{"text":"tenderness","label":"SIGN_SYMPTOM","start":1667,"end":1677},{"text":"palpation","label":"DETAILED_DESCRIPTION","start":1681,"end":1690},{"text":"cervical","label":"BIOLOGICAL_STRUCTURE","start":1700,"end":1708},{"text":"thoracic","label":"BIOLOGICAL_STRUCTURE","start":1710,"end":1718},{"text":"lumbar","label":"BIOLOGICAL_STRUCTURE","start":1724,"end":1730},{"text":"spine","label":"BIOLOGICAL_STRUCTURE","start":1731,"end":1736},{"text":"signs of trauma","label":"SIGN_SYMPTOM","start":1762,"end":1777},{"text":"anal sphincter tone","label":"DIAGNOSTIC_PROCEDURE","start":1783,"end":1802},{"text":"intact","label":"LAB_VALUE","start":1807,"end":1813},{"text":"laboratory","label":"DIAGNOSTIC_PROCEDURE","start":1824,"end":1834},{"text":"abnormalities","label":"LAB_VALUE","start":1835,"end":1848},{"text":"hyperlactemia","label":"SIGN_SYMPTOM","start":1884,"end":1897},{"text":"elevated","label":"LAB_VALUE","start":1899,"end":1907},{"text":"liver function","label":"DIAGNOSTIC_PROCEDURE","start":1908,"end":1922},{"text":"electrolyte derangements","label":"SIGN_SYMPTOM","start":1934,"end":1958},{"text":"complete blood count","label":"DIAGNOSTIC_PROCEDURE","start":1964,"end":1984},{"text":"complete metabolic panel","label":"DIAGNOSTIC_PROCEDURE","start":2006,"end":2030},{"text":"within normal limits","label":"LAB_VALUE","start":2036,"end":2056},{"text":"These values are summarized along with reference ranges in Table 1","label":"OTHER_ENTITY","start":2058,"end":2124},{"text":"toxicology screen","label":"DIAGNOSTIC_PROCEDURE","start":2130,"end":2147},{"text":"positive","label":"LAB_VALUE","start":2152,"end":2160},{"text":"PCP","label":"DIAGNOSTIC_PROCEDURE","start":2165,"end":2168},{"text":"Blood cultures","label":"DIAGNOSTIC_PROCEDURE","start":2170,"end":2184},{"text":"aerobic bacteria","label":"DETAILED_DESCRIPTION","start":2213,"end":2229},{"text":"Salmonella enterica","label":"DISEASE_DISORDER","start":2230,"end":2249},{"text":"serotype 4,12: i","label":"DETAILED_DESCRIPTION","start":2250,"end":2266},{"text":"repeat cultures","label":"DIAGNOSTIC_PROCEDURE","start":2277,"end":2292},{"text":"two days later","label":"DATE","start":2299,"end":2313},{"text":"group B","label":"DETAILED_DESCRIPTION","start":2319,"end":2326},{"text":"streptococcus","label":"DISEASE_DISORDER","start":2327,"end":2340},{"text":"aerobic","label":"DETAILED_DESCRIPTION","start":2342,"end":2349},{"text":"non-aerobic","label":"DETAILED_DESCRIPTION","start":2354,"end":2365},{"text":"blood cultures","label":"DIAGNOSTIC_PROCEDURE","start":2379,"end":2393},{"text":"negative","label":"LAB_VALUE","start":2399,"end":2407},{"text":"stool cultures","label":"DIAGNOSTIC_PROCEDURE","start":2417,"end":2431},{"text":"Metronidazole","label":"MEDICATION","start":2433,"end":2446},{"text":"vancomycin","label":"MEDICATION","start":2451,"end":2461},{"text":"ceftriaxone","label":"MEDICATION","start":2516,"end":2527},{"text":"autoimmunity workup","label":"DIAGNOSTIC_PROCEDURE","start":2598,"end":2617},{"text":"anti-nuclear antibody","label":"DIAGNOSTIC_PROCEDURE","start":2628,"end":2649},{"text":"ANA","label":"DIAGNOSTIC_PROCEDURE","start":2651,"end":2654},{"text":"HLA-B27","label":"DIAGNOSTIC_PROCEDURE","start":2660,"end":2667},{"text":"within normal limits","label":"LAB_VALUE","start":2691,"end":2711},{"text":"computerized tomography","label":"DIAGNOSTIC_PROCEDURE","start":2723,"end":2746},{"text":"cervical","label":"BIOLOGICAL_STRUCTURE","start":2759,"end":2767},{"text":"thoracic","label":"BIOLOGICAL_STRUCTURE","start":2769,"end":2777},{"text":"lumbar","label":"BIOLOGICAL_STRUCTURE","start":2783,"end":2789},{"text":"spine","label":"BIOLOGICAL_STRUCTURE","start":2790,"end":2795},{"text":"spinal","label":"BIOLOGICAL_STRUCTURE","start":2808,"end":2814},{"text":"fractures","label":"DISEASE_DISORDER","start":2815,"end":2824},{"text":"Magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":2826,"end":2852},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":2854,"end":2857},{"text":"intracranial","label":"BIOLOGICAL_STRUCTURE","start":2877,"end":2889},{"text":"abnormalities","label":"SIGN_SYMPTOM","start":2890,"end":2903},{"text":"enhancement within the central aspect of C3\u2013T2","label":"DIAGNOSTIC_PROCEDURE","start":2909,"end":2955},{"text":"spinal cord","label":"BIOLOGICAL_STRUCTURE","start":2966,"end":2977},{"text":"edema","label":"SIGN_SYMPTOM","start":2978,"end":2983},{"text":"disc protrusions","label":"SIGN_SYMPTOM","start":2985,"end":3001},{"text":"C3\u20134","label":"BIOLOGICAL_STRUCTURE","start":3005,"end":3009},{"text":"C4\u20135","label":"BIOLOGICAL_STRUCTURE","start":3011,"end":3015},{"text":"C5\u20136","label":"BIOLOGICAL_STRUCTURE","start":3021,"end":3025},{"text":"bilateral posterior neck muscle","label":"BIOLOGICAL_STRUCTURE","start":3031,"end":3062},{"text":"edema","label":"SIGN_SYMPTOM","start":3063,"end":3068},{"text":"lumbar puncture","label":"THERAPEUTIC_PROCEDURE","start":3072,"end":3087},{"text":"Four hours after","label":"TIME","start":3213,"end":3229},{"text":"strength","label":"DIAGNOSTIC_PROCEDURE","start":3248,"end":3256},{"text":"deteriorated","label":"LAB_VALUE","start":3275,"end":3287},{"text":"1\/5","label":"LAB_VALUE","start":3291,"end":3294},{"text":"all extremities","label":"BIOLOGICAL_STRUCTURE","start":3298,"end":3313},{"text":"lost","label":"LAB_VALUE","start":3319,"end":3323},{"text":"proprioception","label":"DIAGNOSTIC_PROCEDURE","start":3324,"end":3338},{"text":"toes","label":"BIOLOGICAL_STRUCTURE","start":3346,"end":3350},{"text":"bilaterally","label":"DETAILED_DESCRIPTION","start":3351,"end":3362},{"text":"absent","label":"LAB_VALUE","start":3377,"end":3383},{"text":"anal sphincter tone","label":"DIAGNOSTIC_PROCEDURE","start":3384,"end":3403},{"text":"admitted","label":"CLINICAL_EVENT","start":3421,"end":3429},{"text":"neurotrauma intensive care unit","label":"NONBIOLOGICAL_LOCATION","start":3437,"end":3468},{"text":"endotracheal","label":"DETAILED_DESCRIPTION","start":3517,"end":3529},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":3530,"end":3540},{"text":"respiratory failure","label":"DISEASE_DISORDER","start":3548,"end":3567},{"text":"lumbar puncture","label":"THERAPEUTIC_PROCEDURE","start":3610,"end":3625},{"text":"ATM","label":"DISEASE_DISORDER","start":3686,"end":3689},{"text":"workup for infectious etiologies","label":"DIAGNOSTIC_PROCEDURE","start":3752,"end":3784},{"text":"Plasma exchange therapy","label":"THERAPEUTIC_PROCEDURE","start":3845,"end":3868},{"text":"ATM","label":"DISEASE_DISORDER","start":3913,"end":3916},{"text":"maximal","label":"DETAILED_DESCRIPTION","start":3926,"end":3933},{"text":"therapy","label":"THERAPEUTIC_PROCEDURE","start":3942,"end":3949},{"text":"quadriplegic","label":"DISEASE_DISORDER","start":3971,"end":3983},{"text":"neurologic","label":"BIOLOGICAL_STRUCTURE","start":4001,"end":4011},{"text":"pain","label":"SIGN_SYMPTOM","start":4012,"end":4016},{"text":"tracheostomy","label":"THERAPEUTIC_PROCEDURE","start":4029,"end":4041},{"text":"prolonged","label":"DETAILED_DESCRIPTION","start":4049,"end":4058},{"text":"respiratory failure","label":"DISEASE_DISORDER","start":4059,"end":4078},{"text":"jejunostomy tube","label":"THERAPEUTIC_PROCEDURE","start":4103,"end":4119}],"tokens":["A ","28-year-old"," ","African American"," ","woman"," ","presented"," to the ","R Adams Cowley Shock Trauma Center"," in ","Baltimore, Maryland",", for ","evaluation"," of ","right-sided"," ","paralysis"," and ","left-sided"," ","paresthesias"," after being ","found"," ","down"," in her ","home"," ","between her nightstand and her bed",".\nThe symptoms began after ","eating"," at a ","local restaurant chain",", ","consuming alcohol",", and ","smoking"," one ","cigarette"," dipped in ","liquid"," ","phencyclidine"," (","PCP",").\nShe was ","asymptomatic"," ","that night"," and ","went to bed"," without ","complications",".\nShe was ","found"," ","down"," ","next to the bed"," ","the following morning"," ","unable to move",".\nThe patient denied any ","physical trauma"," other than ","falling"," from the bed.\nShe had ","no history of seizures, sickle cell anemia, fever, urinary or bowel incontinence, or pain",".\nThe patient had a history of ","viral meningitis"," ","without residual deficits"," ","eight years prior",", ","gastric bypass surgery",", and ","cholecystectomy",", and she was ","treated"," for a presumed ","urinary tract infection"," ","five days prior"," to admission at an ","outside institution",".\nHer triage ","vital signs"," were as follows: ","temperature"," ","36.8\u00b0C",", ","blood pressure"," ","155\/100 mm Hg",", ","heart rate"," ","90 beats per minute",", ","respiratory rate"," ","16 breaths per minute",", and an ","oxygen saturation"," of ","95%"," on ","room air",".\nOn ","physical exam",", the patient was ","alert"," and ","oriented"," to ","person",", ","place",", and ","time",".\nHer ","cranial nerves II\u2013XII"," were ","grossly intact",".\nShe had ","2\/5"," ","strength"," in her ","right lower extremity",", ","3\/5"," in her ","left lower extremity",", and ","4\/5"," ","bilaterally in her upper extremities",".\nHer ","sensation"," was ","intact",".\nShe ","opened"," her ","eyes"," ","spontaneously",", her ","verbal response"," was ","oriented"," and ","appropriate",", and she ","obeyed"," ","commands",", resulting in a ","Glasgow Coma Scale"," score of ","15",".\n","Pupils"," were ","equal",", ","round",", and ","reactive to light",".\nShe had ","tenderness"," to ","palpation"," over the ","cervical",", ","thoracic",", and ","lumbar"," ","spine"," without obvious external ","signs of trauma",".\nHer ","anal sphincter tone"," was ","intact",".\nMultiple ","laboratory"," ","abnormalities"," were noted on admission, including ","hyperlactemia",", ","elevated"," ","liver function"," tests, and ","electrolyte derangements",".\nHer ","complete blood count"," and remainder of her ","complete metabolic panel"," were ","within normal limits",".\n","These values are summarized along with reference ranges in Table 1",".\nHer ","toxicology screen"," was ","positive"," for ","PCP",".\n","Blood cultures"," drawn on admission grew the ","aerobic bacteria"," ","Salmonella enterica"," ","serotype 4,12: i",", and then ","repeat cultures"," drawn ","two days later"," grew ","group B"," ","streptococcus"," (","aerobic"," and ","non-aerobic",").\nSubsequent ","blood cultures"," were ","negative",", as were ","stool cultures",".\n","Metronidazole"," and ","vancomycin"," therapy was initiated empirically, with transition to ","ceftriaxone"," upon learning of the culture results.\nIn addition, she had a detailed ","autoimmunity workup"," including ","anti-nuclear antibody"," (","ANA",") and ","HLA-B27",", all of which returned ","within normal limits",".\nAdmission ","computerized tomography"," scan of her ","cervical",", ","thoracic",", and ","lumbar"," ","spine"," revealed no ","spinal"," ","fractures",".\n","Magnetic resonance imaging"," (","MRI",") revealed no acute ","intracranial"," ","abnormalities",", but ","enhancement within the central aspect of C3\u2013T2"," suggested ","spinal cord"," ","edema",", ","disc protrusions"," at ","C3\u20134",", ","C4\u20135",", and ","C5\u20136",", and ","bilateral posterior neck muscle"," ","edema",".\nA ","lumbar puncture"," was not initially performed upon patient admission due to concerns about raised intracranial pressure from suspected trauma.\n","Four hours after"," presentation, her ","strength"," had progressively ","deteriorated"," to ","1\/5"," in ","all extremities",".\nShe ","lost"," ","proprioception"," in her ","toes"," ","bilaterally"," and developed ","absent"," ","anal sphincter tone",".\nThe patient was ","admitted"," to the ","neurotrauma intensive care unit"," with further deterioration ultimately requiring ","endotracheal"," ","intubation"," due to ","respiratory failure",".\nUpon her positive blood culture results, ","lumbar puncture"," was performed, which demonstrated a pattern consistent with ","ATM",", the results of which are summarized in Table 2.\nAn extensive ","workup for infectious etiologies"," was also completed, with the results summarized in Table 3.\n","Plasma exchange therapy"," was initiated with a suspected diagnosis of ","ATM",".\nDespite ","maximal"," medical ","therapy",", the patient remains ","quadriplegic",", is experiencing ","neurologic"," ","pain",", received a ","tracheostomy"," due to ","prolonged"," ","respiratory failure",", and required a feeding ","jejunostomy tube"," placement at the time of this report.\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,48,0,48,0,24,0,22,0,26,0,22,0,69,0,13,0,22,0,48,0,22,0,1,0,48,0,1,0,1,0,22,0,22,0,22,0,22,0,69,0,78,0,1,0,69,0,13,0,22,0,48,0,78,0,69,0,26,0,69,0,39,0,26,0,22,0,19,0,39,0,39,0,75,0,26,0,19,0,48,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,69,0,69,0,22,0,22,0,22,0,24,0,42,0,42,0,24,0,12,0,42,0,12,0,42,0,12,0,24,0,42,0,42,0,24,0,22,0,24,0,42,0,42,0,42,0,24,0,24,0,42,0,24,0,22,0,67,0,42,0,69,0,22,0,12,0,12,0,12,0,12,0,69,0,24,0,42,0,24,0,42,0,69,0,42,0,24,0,69,0,24,0,24,0,42,0,51,0,24,0,42,0,24,0,24,0,22,0,26,0,22,0,24,0,19,0,22,0,26,0,22,0,22,0,24,0,42,0,24,0,46,0,46,0,46,0,24,0,24,0,24,0,24,0,42,0,24,0,12,0,12,0,12,0,12,0,12,0,26,0,24,0,24,0,12,0,69,0,24,0,12,0,69,0,69,0,12,0,12,0,12,0,12,0,69,0,75,0,78,0,24,0,42,0,42,0,12,0,42,0,24,0,12,0,22,0,42,0,24,0,13,0,48,0,22,0,75,0,26,0,75,0,26,0,24,0,75,0,26,0,22,0,75,0,26,0,12,0,69,0,75,0,22,0,26,0,75,0]}
-{"full_text":"The 21-year-old patient presented to the closest emergency department at 8 PM for nausea, numbness of the left limbs, incoordination of walking and dysarthria, with the symptomatology installed in a progressive mode 4 hours before presentation.\nThe nausea was the initial symptom, starting at 4 PM (without headache, nuchal pain, or vomit) and then, after 5.30 PM, the numbness of the left limbs and the incoordination of walking and by 7 PM dysarthria was added to the entire clinical constellation.\nThe patient did not have a medical history or a current medication.\nHe was a student.\nHe did not smoke and did not use recreational drugs.\nHe only drank alcohol occasionally.\nThere was no family history of thromboembolism, cardiovascular problems, or hematologic diseases.\nHe was first evaluated by a neurosurgeon in the emergency unit and had a brain CT scan that highlighted infracentimetric hypodensity in the thalamic nucleus, on the left side and at the level of the right cerebellar hemisphere in the PICA territory, and also a chest X-ray that revealed a widened projection area of the right side hilum, without any other pathological findings.\nFollowing this evaluation, he was sent to the National Institute of Neurology and Cerebrovascular Diseases for consultation and special treatment.\nDuring the ambulance transportation, he had repeated episodes of vomiting.\nThe initial physical examination (at 10 P.M) showed normal vital signs: blood pressure 130\/ 80mmHg, heart rate 100 beats per minute and normal body temperature 36,8\u00b0C.\nThe cardiopulmonary exam was normal.\nNo carotid bruits were registered.\nThe neurological examination was notable for normal orientation.\nThe patient had equal, reactive pupils, divergent strabismus to the left eye, horizontal nystagmus, normal deglutition, mild paresis of the left arm, ataxia of all limbs, with an accent on the left extremities, numbness of the left limbs, bilateral response present at all deep tendons reflex, Babinski sign on the left side, stereotypical language.\nThe patient was able to repeat a few words and fragment of phrases and to perform simple commands of medium complexity.\nThe laboratory analysis highlighted a normal hemoleucogram, normal blood glucose level 9,11 mmol\/ L (normal range 3,9-5,8mmol\/ L), serum creatinine 0,69mmol\/ L (range 0,5-0,9mmol\/ L), total serum cholesterol 5,2mmol\/ L (normal range < 5,2 mmol\/ L).\nThe tests for thrombophilia were negative.\nHe also presented a normal sinus rhythm on the ECG.\nThe brain CT performed at the first emergency unit, as mentioned above, revealed a infracentimetric hypodensity at the level of the left thalamic nucleus and at the level of the right cerebellar hemisphere in the PICA territory.\nDoppler ultrasound for cerebral and cervical blood vessels highlighted the marked frena in the flow velocities of the V2 segment of the right vertebral artery, an accentuated aspect in the high V2 segments with the complete disappearance of the flow in the V3 segment, without carotid atheromatous lesions or modifications of the trajectories or the arterial caliber.\nOverall, there was a possibility of a dissection of the right vertebral artery in the higher segments with indication of cerebral and angio MRI.\nCerebral and angio MRI showed: areas with T2, FLAIR hypersignal, with an important restriction of diffusion and low ADC, situated in the right cerebellar area of the postero-inferior territory, anterior bilateral cerebellar territory, left cerebellar peduncle, both right > left thalamic nuclei, as well as subcortical occipital bilateral, with an ischemic aspect that was recently constituted in the vertebrobasilar territory.\nT1 FS hypersignal was present on the entire intracranial segment of the right vertebral artery and the cranio-spinal junction.\nOn the angiographic arterial 3D TOF sequence, the presence of the rapid flow of the right vertebral artery could be viewed, up to the C2 segment, where there was a progressive pinch out with an aspect of flute beak shape.\nDistal of this level, there was an absence of the rapid flow signal and also a lack of right PICA visualization.\nThe MRI aspect suggested a subacute dissection of the right vertebral artery.\nThe cerebral ventricular system had normal dimensions, shape, and topography.\nThe pericerebral fluid spaces and the basal cisterns were normal.\nConclusions: there were some ischemic lesions recently constituted in the vertebrobasilar territory and also a subacute dissection of the right vertebral artery.\nHeparin administration was started immediately in the process of hospitalization because of the dissection.\nThe APTT value was kept in the range of 50-70 seconds.\nAlso, the prophylactic therapy for stress ulcer was performed.\nAfter 7 days from the debut, the patient was transitioned to acenocumarol for long-term anticoagulation.\nThe treatment with acenocumarol was instituted with the heparin overlap until getting the INR therapeutic in the 2-3 intervals.\nThe evolution was favorable, the patient regaining the verbal fluency and the capacity for autonomy in movement.\nThe ataxia was remitted at the right limbs and persisted at the left extremities, but registered a lot of improvement.\nThe patient was discharged home with the recommendation to continue the treatment with Acenocumarol for 6 months with clinical, paraclinical and treatment reevaluation at 6 months.\nThe follow up was not possible because the patient did not return to the hospital after 6 months.\n","ner_info":[{"text":"21-year-old","label":"AGE","start":4,"end":15},{"text":"presented","label":"CLINICAL_EVENT","start":24,"end":33},{"text":"closest emergency department","label":"NONBIOLOGICAL_LOCATION","start":41,"end":69},{"text":"8 PM","label":"TIME","start":73,"end":77},{"text":"nausea","label":"SIGN_SYMPTOM","start":82,"end":88},{"text":"numbness","label":"SIGN_SYMPTOM","start":90,"end":98},{"text":"left limbs","label":"BIOLOGICAL_STRUCTURE","start":106,"end":116},{"text":"incoordination of walking","label":"SIGN_SYMPTOM","start":118,"end":143},{"text":"dysarthria","label":"SIGN_SYMPTOM","start":148,"end":158},{"text":"symptomatology","label":"SIGN_SYMPTOM","start":169,"end":183},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":199,"end":210},{"text":"4 hours before","label":"TIME","start":216,"end":230},{"text":"nausea","label":"SIGN_SYMPTOM","start":249,"end":255},{"text":"4 PM","label":"TIME","start":293,"end":297},{"text":"headache","label":"SIGN_SYMPTOM","start":307,"end":315},{"text":"nuchal","label":"BIOLOGICAL_STRUCTURE","start":317,"end":323},{"text":"pain","label":"SIGN_SYMPTOM","start":324,"end":328},{"text":"vomit","label":"SIGN_SYMPTOM","start":333,"end":338},{"text":"after 5.30 PM","label":"TIME","start":350,"end":363},{"text":"numbness","label":"SIGN_SYMPTOM","start":369,"end":377},{"text":"left limbs","label":"BIOLOGICAL_STRUCTURE","start":385,"end":395},{"text":"incoordination of walking","label":"SIGN_SYMPTOM","start":404,"end":429},{"text":"7 PM","label":"TIME","start":437,"end":441},{"text":"dysarthria","label":"SIGN_SYMPTOM","start":442,"end":452},{"text":"The patient did not have a medical history or a current medication","label":"HISTORY","start":501,"end":567},{"text":"student","label":"OCCUPATION","start":578,"end":585},{"text":"He did not smoke and did not use recreational drugs","label":"HISTORY","start":587,"end":638},{"text":"He only drank alcohol occasionally","label":"HISTORY","start":640,"end":674},{"text":"There was no family history of thromboembolism, cardiovascular problems, or hematologic diseases","label":"FAMILY_HISTORY","start":676,"end":772},{"text":"evaluated","label":"DIAGNOSTIC_PROCEDURE","start":787,"end":796},{"text":"neurosurgeon","label":"NONBIOLOGICAL_LOCATION","start":802,"end":814},{"text":"emergency unit","label":"NONBIOLOGICAL_LOCATION","start":822,"end":836},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":847,"end":852},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":853,"end":855},{"text":"infracentimetric","label":"DETAILED_DESCRIPTION","start":878,"end":894},{"text":"hypodensity","label":"SIGN_SYMPTOM","start":895,"end":906},{"text":"thalamic nucleus","label":"BIOLOGICAL_STRUCTURE","start":914,"end":930},{"text":"left side","label":"DETAILED_DESCRIPTION","start":939,"end":948},{"text":"level of the right cerebellar hemisphere","label":"BIOLOGICAL_STRUCTURE","start":960,"end":1000},{"text":"PICA territory","label":"BIOLOGICAL_STRUCTURE","start":1008,"end":1022},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1035,"end":1040},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":1041,"end":1046},{"text":"widened projection area","label":"SIGN_SYMPTOM","start":1063,"end":1086},{"text":"right side hilum","label":"BIOLOGICAL_STRUCTURE","start":1094,"end":1110},{"text":"other pathological findings","label":"SIGN_SYMPTOM","start":1124,"end":1151},{"text":"sent","label":"CLINICAL_EVENT","start":1187,"end":1191},{"text":"National Institute of Neurology and Cerebrovascular Diseases","label":"NONBIOLOGICAL_LOCATION","start":1199,"end":1259},{"text":"consultation","label":"CLINICAL_EVENT","start":1264,"end":1276},{"text":"special treatment","label":"THERAPEUTIC_PROCEDURE","start":1281,"end":1298},{"text":"ambulance","label":"DETAILED_DESCRIPTION","start":1311,"end":1320},{"text":"transportation","label":"CLINICAL_EVENT","start":1321,"end":1335},{"text":"repeated","label":"DETAILED_DESCRIPTION","start":1344,"end":1352},{"text":"vomiting","label":"SIGN_SYMPTOM","start":1365,"end":1373},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1387,"end":1407},{"text":"10 P.M","label":"TIME","start":1412,"end":1418},{"text":"normal","label":"LAB_VALUE","start":1427,"end":1433},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":1434,"end":1445},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1447,"end":1461},{"text":"130\/ 80mmHg","label":"LAB_VALUE","start":1462,"end":1473},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":1475,"end":1485},{"text":"100 beats per minute","label":"LAB_VALUE","start":1486,"end":1506},{"text":"normal","label":"LAB_VALUE","start":1511,"end":1517},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":1518,"end":1534},{"text":"36,8\u00b0C","label":"LAB_VALUE","start":1535,"end":1541},{"text":"cardiopulmonary exam","label":"DIAGNOSTIC_PROCEDURE","start":1547,"end":1567},{"text":"normal","label":"LAB_VALUE","start":1572,"end":1578},{"text":"carotid bruits","label":"SIGN_SYMPTOM","start":1583,"end":1597},{"text":"neurological examination","label":"DIAGNOSTIC_PROCEDURE","start":1619,"end":1643},{"text":"normal orientation","label":"LAB_VALUE","start":1660,"end":1678},{"text":"equal","label":"LAB_VALUE","start":1696,"end":1701},{"text":"reactive","label":"LAB_VALUE","start":1703,"end":1711},{"text":"pupils","label":"DIAGNOSTIC_PROCEDURE","start":1712,"end":1718},{"text":"divergent","label":"DETAILED_DESCRIPTION","start":1720,"end":1729},{"text":"strabismus","label":"SIGN_SYMPTOM","start":1730,"end":1740},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":1748,"end":1756},{"text":"horizontal","label":"DETAILED_DESCRIPTION","start":1758,"end":1768},{"text":"nystagmus","label":"SIGN_SYMPTOM","start":1769,"end":1778},{"text":"normal","label":"LAB_VALUE","start":1780,"end":1786},{"text":"deglutition","label":"DIAGNOSTIC_PROCEDURE","start":1787,"end":1798},{"text":"mild","label":"SEVERITY","start":1800,"end":1804},{"text":"paresis","label":"DISEASE_DISORDER","start":1805,"end":1812},{"text":"left arm","label":"BIOLOGICAL_STRUCTURE","start":1820,"end":1828},{"text":"ataxia","label":"DISEASE_DISORDER","start":1830,"end":1836},{"text":"all limbs","label":"BIOLOGICAL_STRUCTURE","start":1840,"end":1849},{"text":"accent on the left extremities","label":"BIOLOGICAL_STRUCTURE","start":1859,"end":1889},{"text":"numbness","label":"SIGN_SYMPTOM","start":1891,"end":1899},{"text":"left limbs","label":"BIOLOGICAL_STRUCTURE","start":1907,"end":1917},{"text":"bilateral response","label":"LAB_VALUE","start":1919,"end":1937},{"text":"all deep tendons","label":"BIOLOGICAL_STRUCTURE","start":1949,"end":1965},{"text":"reflex","label":"DIAGNOSTIC_PROCEDURE","start":1966,"end":1972},{"text":"Babinski sign","label":"SIGN_SYMPTOM","start":1974,"end":1987},{"text":"left side","label":"DETAILED_DESCRIPTION","start":1995,"end":2004},{"text":"stereotypical","label":"LAB_VALUE","start":2006,"end":2019},{"text":"language","label":"DIAGNOSTIC_PROCEDURE","start":2020,"end":2028},{"text":"able to repeat a few words and fragment of phrases","label":"DETAILED_DESCRIPTION","start":2046,"end":2096},{"text":"perform simple commands of medium complexity","label":"DETAILED_DESCRIPTION","start":2104,"end":2148},{"text":"laboratory analysis","label":"DIAGNOSTIC_PROCEDURE","start":2154,"end":2173},{"text":"normal","label":"LAB_VALUE","start":2188,"end":2194},{"text":"hemoleucogram","label":"DIAGNOSTIC_PROCEDURE","start":2195,"end":2208},{"text":"normal","label":"LAB_VALUE","start":2210,"end":2216},{"text":"blood glucose","label":"DIAGNOSTIC_PROCEDURE","start":2217,"end":2230},{"text":"9,11 mmol\/ L","label":"LAB_VALUE","start":2237,"end":2249},{"text":"serum creatinine","label":"DIAGNOSTIC_PROCEDURE","start":2281,"end":2297},{"text":"0,69mmol\/ L","label":"LAB_VALUE","start":2298,"end":2309},{"text":"total serum cholesterol","label":"DIAGNOSTIC_PROCEDURE","start":2334,"end":2357},{"text":"5,2mmol\/ L","label":"LAB_VALUE","start":2358,"end":2368},{"text":"thrombophilia","label":"DIAGNOSTIC_PROCEDURE","start":2413,"end":2426},{"text":"negative","label":"LAB_VALUE","start":2432,"end":2440},{"text":"normal","label":"LAB_VALUE","start":2462,"end":2468},{"text":"sinus rhythm","label":"DIAGNOSTIC_PROCEDURE","start":2469,"end":2481},{"text":"ECG","label":"DETAILED_DESCRIPTION","start":2489,"end":2492},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":2498,"end":2503},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2504,"end":2506},{"text":"infracentimetric","label":"DETAILED_DESCRIPTION","start":2577,"end":2593},{"text":"hypodensity","label":"SIGN_SYMPTOM","start":2594,"end":2605},{"text":"level of the left thalamic nucleus","label":"BIOLOGICAL_STRUCTURE","start":2613,"end":2647},{"text":"level of the right cerebellar hemisphere","label":"BIOLOGICAL_STRUCTURE","start":2659,"end":2699},{"text":"PICA territory","label":"BIOLOGICAL_STRUCTURE","start":2707,"end":2721},{"text":"Doppler","label":"DETAILED_DESCRIPTION","start":2723,"end":2730},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2731,"end":2741},{"text":"cerebral and cervical blood vessels","label":"BIOLOGICAL_STRUCTURE","start":2746,"end":2781},{"text":"frena","label":"LAB_VALUE","start":2805,"end":2810},{"text":"flow velocities","label":"DIAGNOSTIC_PROCEDURE","start":2818,"end":2833},{"text":"V2 segment of the right vertebral artery","label":"BIOLOGICAL_STRUCTURE","start":2841,"end":2881},{"text":"accentuated aspect","label":"SIGN_SYMPTOM","start":2886,"end":2904},{"text":"high V2 segments","label":"BIOLOGICAL_STRUCTURE","start":2912,"end":2928},{"text":"complete disappearance","label":"LAB_VALUE","start":2938,"end":2960},{"text":"flow","label":"DIAGNOSTIC_PROCEDURE","start":2968,"end":2972},{"text":"V3 segment","label":"BIOLOGICAL_STRUCTURE","start":2980,"end":2990},{"text":"carotid","label":"BIOLOGICAL_STRUCTURE","start":3000,"end":3007},{"text":"atheromatous","label":"DETAILED_DESCRIPTION","start":3008,"end":3020},{"text":"lesions","label":"SIGN_SYMPTOM","start":3021,"end":3028},{"text":"modifications of the trajectories or the arterial caliber","label":"SIGN_SYMPTOM","start":3032,"end":3089},{"text":"dissection","label":"DISEASE_DISORDER","start":3129,"end":3139},{"text":"right vertebral artery","label":"BIOLOGICAL_STRUCTURE","start":3147,"end":3169},{"text":"higher segments","label":"DETAILED_DESCRIPTION","start":3177,"end":3192},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":3212,"end":3220},{"text":"angio","label":"BIOLOGICAL_STRUCTURE","start":3225,"end":3230},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":3231,"end":3234},{"text":"MRI","label":"COREFERENCE","start":3255,"end":3258},{"text":"T2","label":"DETAILED_DESCRIPTION","start":3278,"end":3280},{"text":"FLAIR","label":"DIAGNOSTIC_PROCEDURE","start":3282,"end":3287},{"text":"hypersignal","label":"LAB_VALUE","start":3288,"end":3299},{"text":"restriction of diffusion","label":"SIGN_SYMPTOM","start":3319,"end":3343},{"text":"low","label":"LAB_VALUE","start":3348,"end":3351},{"text":"ADC","label":"DIAGNOSTIC_PROCEDURE","start":3352,"end":3355},{"text":"right cerebellar area of the postero-inferior territory","label":"BIOLOGICAL_STRUCTURE","start":3373,"end":3428},{"text":"anterior bilateral cerebellar territory","label":"BIOLOGICAL_STRUCTURE","start":3430,"end":3469},{"text":"left cerebellar peduncle","label":"BIOLOGICAL_STRUCTURE","start":3471,"end":3495},{"text":"both right > left thalamic nuclei","label":"BIOLOGICAL_STRUCTURE","start":3497,"end":3530},{"text":"subcortical occipital bilateral","label":"BIOLOGICAL_STRUCTURE","start":3543,"end":3574},{"text":"ischemic aspect","label":"SIGN_SYMPTOM","start":3584,"end":3599},{"text":"in the vertebrobasilar territory","label":"BIOLOGICAL_STRUCTURE","start":3630,"end":3662},{"text":"T1 FS","label":"DIAGNOSTIC_PROCEDURE","start":3664,"end":3669},{"text":"hypersignal","label":"LAB_VALUE","start":3670,"end":3681},{"text":"entire intracranial segment of the right vertebral artery","label":"BIOLOGICAL_STRUCTURE","start":3701,"end":3758},{"text":"cranio-spinal junction","label":"BIOLOGICAL_STRUCTURE","start":3767,"end":3789},{"text":"angiographic","label":"DIAGNOSTIC_PROCEDURE","start":3798,"end":3810},{"text":"arterial","label":"DETAILED_DESCRIPTION","start":3811,"end":3819},{"text":"3D","label":"DETAILED_DESCRIPTION","start":3820,"end":3822},{"text":"TOF","label":"DETAILED_DESCRIPTION","start":3823,"end":3826},{"text":"rapid","label":"LAB_VALUE","start":3857,"end":3862},{"text":"flow","label":"DIAGNOSTIC_PROCEDURE","start":3863,"end":3867},{"text":"right vertebral artery","label":"BIOLOGICAL_STRUCTURE","start":3875,"end":3897},{"text":"up to the C2 segment","label":"BIOLOGICAL_STRUCTURE","start":3915,"end":3935},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":3955,"end":3966},{"text":"pinch out","label":"SIGN_SYMPTOM","start":3967,"end":3976},{"text":"flute beak shape","label":"SHAPE","start":3995,"end":4011},{"text":"Distal of this level","label":"BIOLOGICAL_STRUCTURE","start":4013,"end":4033},{"text":"absence","label":"LAB_VALUE","start":4048,"end":4055},{"text":"rapid flow","label":"DIAGNOSTIC_PROCEDURE","start":4063,"end":4073},{"text":"lack","label":"LAB_VALUE","start":4092,"end":4096},{"text":"right PICA","label":"BIOLOGICAL_STRUCTURE","start":4100,"end":4110},{"text":"visualization","label":"DIAGNOSTIC_PROCEDURE","start":4111,"end":4124},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":4130,"end":4133},{"text":"subacute","label":"DETAILED_DESCRIPTION","start":4153,"end":4161},{"text":"dissection","label":"DISEASE_DISORDER","start":4162,"end":4172},{"text":"right vertebral artery","label":"BIOLOGICAL_STRUCTURE","start":4180,"end":4202},{"text":"cerebral ventricular system","label":"BIOLOGICAL_STRUCTURE","start":4208,"end":4235},{"text":"normal","label":"LAB_VALUE","start":4240,"end":4246},{"text":"dimensions","label":"DIAGNOSTIC_PROCEDURE","start":4247,"end":4257},{"text":"shape","label":"DIAGNOSTIC_PROCEDURE","start":4259,"end":4264},{"text":"topography","label":"DIAGNOSTIC_PROCEDURE","start":4270,"end":4280},{"text":"pericerebral fluid spaces","label":"DIAGNOSTIC_PROCEDURE","start":4286,"end":4311},{"text":"basal cisterns","label":"DIAGNOSTIC_PROCEDURE","start":4320,"end":4334},{"text":"normal","label":"LAB_VALUE","start":4340,"end":4346},{"text":"ischemic","label":"DETAILED_DESCRIPTION","start":4377,"end":4385},{"text":"lesions","label":"SIGN_SYMPTOM","start":4386,"end":4393},{"text":"vertebrobasilar territory","label":"BIOLOGICAL_STRUCTURE","start":4422,"end":4447},{"text":"subacute","label":"DETAILED_DESCRIPTION","start":4459,"end":4467},{"text":"dissection","label":"DISEASE_DISORDER","start":4468,"end":4478},{"text":"right vertebral artery","label":"BIOLOGICAL_STRUCTURE","start":4486,"end":4508},{"text":"Heparin","label":"MEDICATION","start":4510,"end":4517},{"text":"APTT value","label":"DIAGNOSTIC_PROCEDURE","start":4622,"end":4632},{"text":"range of 50-70 seconds","label":"LAB_VALUE","start":4649,"end":4671},{"text":"prophylactic therapy","label":"THERAPEUTIC_PROCEDURE","start":4683,"end":4703},{"text":"stress ulcer","label":"DETAILED_DESCRIPTION","start":4708,"end":4720},{"text":"After 7 days","label":"DATE","start":4736,"end":4748},{"text":"acenocumarol","label":"MEDICATION","start":4797,"end":4809},{"text":"acenocumarol","label":"MEDICATION","start":4860,"end":4872},{"text":"heparin","label":"MEDICATION","start":4897,"end":4904},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":4931,"end":4934},{"text":"therapeutic","label":"LAB_VALUE","start":4935,"end":4946},{"text":"2-3 intervals","label":"DETAILED_DESCRIPTION","start":4954,"end":4967},{"text":"evolution","label":"DIAGNOSTIC_PROCEDURE","start":4973,"end":4982},{"text":"favorable","label":"LAB_VALUE","start":4987,"end":4996},{"text":"regaining","label":"LAB_VALUE","start":5010,"end":5019},{"text":"verbal fluency","label":"DIAGNOSTIC_PROCEDURE","start":5024,"end":5038},{"text":"autonomy in movement","label":"SIGN_SYMPTOM","start":5060,"end":5080},{"text":"ataxia","label":"DISEASE_DISORDER","start":5086,"end":5092},{"text":"remitted at the right limbs","label":"DETAILED_DESCRIPTION","start":5097,"end":5124},{"text":"persisted at the left extremities","label":"DETAILED_DESCRIPTION","start":5129,"end":5162},{"text":"improvement","label":"LAB_VALUE","start":5188,"end":5199},{"text":"discharged","label":"CLINICAL_EVENT","start":5217,"end":5227},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":5228,"end":5232},{"text":"recommendation to continue the treatment with Acenocumarol for 6 months with clinical, paraclinical and treatment reevaluation at 6 months","label":"OTHER_ENTITY","start":5242,"end":5380},{"text":"follow up","label":"CLINICAL_EVENT","start":5386,"end":5395},{"text":"return","label":"CLINICAL_EVENT","start":5441,"end":5447},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":5455,"end":5463},{"text":"after 6 months","label":"DATE","start":5464,"end":5478}],"tokens":["The ","21-year-old"," patient ","presented"," to the ","closest emergency department"," at ","8 PM"," for ","nausea",", ","numbness"," of the ","left limbs",", ","incoordination of walking"," and ","dysarthria",", with the ","symptomatology"," installed in a ","progressive"," mode ","4 hours before"," presentation.\nThe ","nausea"," was the initial symptom, starting at ","4 PM"," (without ","headache",", ","nuchal"," ","pain",", or ","vomit",") and then, ","after 5.30 PM",", the ","numbness"," of the ","left limbs"," and the ","incoordination of walking"," and by ","7 PM"," ","dysarthria"," was added to the entire clinical constellation.\n","The patient did not have a medical history or a current medication",".\nHe was a ","student",".\n","He did not smoke and did not use recreational drugs",".\n","He only drank alcohol occasionally",".\n","There was no family history of thromboembolism, cardiovascular problems, or hematologic diseases",".\nHe was first ","evaluated"," by a ","neurosurgeon"," in the ","emergency unit"," and had a ","brain"," ","CT"," scan that highlighted ","infracentimetric"," ","hypodensity"," in the ","thalamic nucleus",", on the ","left side"," and at the ","level of the right cerebellar hemisphere"," in the ","PICA territory",", and also a ","chest"," ","X-ray"," that revealed a ","widened projection area"," of the ","right side hilum",", without any ","other pathological findings",".\nFollowing this evaluation, he was ","sent"," to the ","National Institute of Neurology and Cerebrovascular Diseases"," for ","consultation"," and ","special treatment",".\nDuring the ","ambulance"," ","transportation",", he had ","repeated"," episodes of ","vomiting",".\nThe initial ","physical examination"," (at ","10 P.M",") showed ","normal"," ","vital signs",": ","blood pressure"," ","130\/ 80mmHg",", ","heart rate"," ","100 beats per minute"," and ","normal"," ","body temperature"," ","36,8\u00b0C",".\nThe ","cardiopulmonary exam"," was ","normal",".\nNo ","carotid bruits"," were registered.\nThe ","neurological examination"," was notable for ","normal orientation",".\nThe patient had ","equal",", ","reactive"," ","pupils",", ","divergent"," ","strabismus"," to the ","left eye",", ","horizontal"," ","nystagmus",", ","normal"," ","deglutition",", ","mild"," ","paresis"," of the ","left arm",", ","ataxia"," of ","all limbs",", with an ","accent on the left extremities",", ","numbness"," of the ","left limbs",", ","bilateral response"," present at ","all deep tendons"," ","reflex",", ","Babinski sign"," on the ","left side",", ","stereotypical"," ","language",".\nThe patient was ","able to repeat a few words and fragment of phrases"," and to ","perform simple commands of medium complexity",".\nThe ","laboratory analysis"," highlighted a ","normal"," ","hemoleucogram",", ","normal"," ","blood glucose"," level ","9,11 mmol\/ L"," (normal range 3,9-5,8mmol\/ L), ","serum creatinine"," ","0,69mmol\/ L"," (range 0,5-0,9mmol\/ L), ","total serum cholesterol"," ","5,2mmol\/ L"," (normal range < 5,2 mmol\/ L).\nThe tests for ","thrombophilia"," were ","negative",".\nHe also presented a ","normal"," ","sinus rhythm"," on the ","ECG",".\nThe ","brain"," ","CT"," performed at the first emergency unit, as mentioned above, revealed a ","infracentimetric"," ","hypodensity"," at the ","level of the left thalamic nucleus"," and at the ","level of the right cerebellar hemisphere"," in the ","PICA territory",".\n","Doppler"," ","ultrasound"," for ","cerebral and cervical blood vessels"," highlighted the marked ","frena"," in the ","flow velocities"," of the ","V2 segment of the right vertebral artery",", an ","accentuated aspect"," in the ","high V2 segments"," with the ","complete disappearance"," of the ","flow"," in the ","V3 segment",", without ","carotid"," ","atheromatous"," ","lesions"," or ","modifications of the trajectories or the arterial caliber",".\nOverall, there was a possibility of a ","dissection"," of the ","right vertebral artery"," in the ","higher segments"," with indication of ","cerebral"," and ","angio"," ","MRI",".\nCerebral and angio ","MRI"," showed: areas with ","T2",", ","FLAIR"," ","hypersignal",", with an important ","restriction of diffusion"," and ","low"," ","ADC",", situated in the ","right cerebellar area of the postero-inferior territory",", ","anterior bilateral cerebellar territory",", ","left cerebellar peduncle",", ","both right > left thalamic nuclei",", as well as ","subcortical occipital bilateral",", with an ","ischemic aspect"," that was recently constituted ","in the vertebrobasilar territory",".\n","T1 FS"," ","hypersignal"," was present on the ","entire intracranial segment of the right vertebral artery"," and the ","cranio-spinal junction",".\nOn the ","angiographic"," ","arterial"," ","3D"," ","TOF"," sequence, the presence of the ","rapid"," ","flow"," of the ","right vertebral artery"," could be viewed, ","up to the C2 segment",", where there was a ","progressive"," ","pinch out"," with an aspect of ","flute beak shape",".\n","Distal of this level",", there was an ","absence"," of the ","rapid flow"," signal and also a ","lack"," of ","right PICA"," ","visualization",".\nThe ","MRI"," aspect suggested a ","subacute"," ","dissection"," of the ","right vertebral artery",".\nThe ","cerebral ventricular system"," had ","normal"," ","dimensions",", ","shape",", and ","topography",".\nThe ","pericerebral fluid spaces"," and the ","basal cisterns"," were ","normal",".\nConclusions: there were some ","ischemic"," ","lesions"," recently constituted in the ","vertebrobasilar territory"," and also a ","subacute"," ","dissection"," of the ","right vertebral artery",".\n","Heparin"," administration was started immediately in the process of hospitalization because of the dissection.\nThe ","APTT value"," was kept in the ","range of 50-70 seconds",".\nAlso, the ","prophylactic therapy"," for ","stress ulcer"," was performed.\n","After 7 days"," from the debut, the patient was transitioned to ","acenocumarol"," for long-term anticoagulation.\nThe treatment with ","acenocumarol"," was instituted with the ","heparin"," overlap until getting the ","INR"," ","therapeutic"," in the ","2-3 intervals",".\nThe ","evolution"," was ","favorable",", the patient ","regaining"," the ","verbal fluency"," and the capacity for ","autonomy in movement",".\nThe ","ataxia"," was ","remitted at the right limbs"," and ","persisted at the left extremities",", but registered a lot of ","improvement",".\nThe patient was ","discharged"," ","home"," with the ","recommendation to continue the treatment with Acenocumarol for 6 months with clinical, paraclinical and treatment reevaluation at 6 months",".\nThe ","follow up"," was not possible because the patient did not ","return"," to the ","hospital"," ","after 6 months",".\n"],"ner_labels":[0,5,0,13,0,48,0,78,0,69,0,69,0,12,0,69,0,69,0,69,0,22,0,78,0,69,0,78,0,69,0,12,0,69,0,69,0,78,0,69,0,12,0,69,0,78,0,69,0,39,0,50,0,39,0,39,0,34,0,24,0,48,0,48,0,12,0,24,0,22,0,69,0,12,0,22,0,12,0,12,0,12,0,24,0,69,0,12,0,69,0,13,0,48,0,13,0,75,0,22,0,13,0,22,0,69,0,24,0,78,0,42,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,69,0,24,0,42,0,42,0,42,0,24,0,22,0,69,0,12,0,22,0,69,0,42,0,24,0,63,0,26,0,12,0,26,0,12,0,12,0,69,0,12,0,42,0,12,0,24,0,69,0,22,0,42,0,24,0,22,0,22,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,22,0,12,0,24,0,22,0,69,0,12,0,12,0,12,0,22,0,24,0,12,0,42,0,24,0,12,0,69,0,12,0,42,0,24,0,12,0,12,0,22,0,69,0,69,0,26,0,12,0,22,0,12,0,12,0,24,0,18,0,22,0,24,0,42,0,69,0,42,0,24,0,12,0,12,0,12,0,12,0,12,0,69,0,12,0,24,0,42,0,12,0,12,0,24,0,22,0,22,0,22,0,42,0,24,0,12,0,12,0,22,0,69,0,67,0,12,0,42,0,24,0,42,0,12,0,24,0,24,0,22,0,26,0,12,0,12,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,22,0,69,0,12,0,22,0,26,0,12,0,46,0,24,0,42,0,75,0,22,0,19,0,46,0,46,0,46,0,24,0,42,0,22,0,24,0,42,0,42,0,24,0,69,0,26,0,22,0,22,0,42,0,13,0,48,0,51,0,13,0,13,0,48,0,19,0]}
-{"full_text":"A 73-year-old man who had been transferred to our emergency room due to sudden chest pain was diagnosed with ST-segment elevation myocardial infarction (STEMI).\nHe had no coronary risk factors except for a history of smoking for 50 years.\nPrimary percutaneous coronary intervention was performed, and a long, string-shaped contrast defect was observed in the left anterior descending artery (Fig.1A).\nOptical coherence tomography (OCT) imaging revealed an odd, smooth-surfaced 50-mm long object (Fig.1B).\nA long, white object which looked like a parasitic worm was retrieved via intracoronary aspiration and revascularization was successfully completed since neither plaque rupture or the presence of thrombus was detected by OCT (Fig.1C).\nOn the eleventh hospital day, transthoracic echocardiography revealed a new floating object in the left atrium.\nContrast computed tomography revealed a huge 7\u00d76 cm mass that was recognized at admission in the right upper pulmonary lobe with direct pulmonary vein invasion (Fig.1D).\nAlthough the bronchoscopic findings were negative for a lung tumor, a histopathologic examination of the aspirated coronary object revealed pleomorphic lung carcinoma (Fig.2).\nThe patient was diagnosed with STEMI due to coronary embolization associated with lung carcinoma.\nBrain MRI revealed that the patient had an asymptomatic cerebral infarction in the right frontal lobe and a small parietal lobe lesion was diagnosed to be metastasis.\nGiven all these observations, he was diagnosed with right lung carcinoma, stage IV (c-T2bN2M1b).\nHe was treated according to the chemotherapy regimens (carboplatin & paclitaxel) known to be effective for the treatment of advanced non-small cell lung cancer.\nHe responded to the treatment and showed a good clinical course afterwards (Fig.3).\nChemotherapy with a total of 9 cycles of the same regimen was used and the carcinoma progression was suppressed.\nHe has been doing well for more than two years of PCI and has been followed-up regularly.\n","ner_info":[{"text":"73-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"transferred","label":"CLINICAL_EVENT","start":31,"end":42},{"text":"emergency room","label":"NONBIOLOGICAL_LOCATION","start":50,"end":64},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":72,"end":78},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":79,"end":84},{"text":"pain","label":"SIGN_SYMPTOM","start":85,"end":89},{"text":"ST-segment elevation myocardial infarction","label":"DISEASE_DISORDER","start":109,"end":151},{"text":"STEMI","label":"DISEASE_DISORDER","start":153,"end":158},{"text":"history of smoking for 50 years","label":"HISTORY","start":206,"end":237},{"text":"Primary","label":"DETAILED_DESCRIPTION","start":239,"end":246},{"text":"percutaneous","label":"BIOLOGICAL_STRUCTURE","start":247,"end":259},{"text":"coronary intervention","label":"THERAPEUTIC_PROCEDURE","start":260,"end":281},{"text":"long","label":"DETAILED_DESCRIPTION","start":303,"end":307},{"text":"string-shaped","label":"SHAPE","start":309,"end":322},{"text":"contrast defect","label":"SIGN_SYMPTOM","start":323,"end":338},{"text":"left anterior descending artery","label":"BIOLOGICAL_STRUCTURE","start":359,"end":390},{"text":"Optical coherence tomography","label":"DIAGNOSTIC_PROCEDURE","start":401,"end":429},{"text":"OCT","label":"DIAGNOSTIC_PROCEDURE","start":431,"end":434},{"text":"odd","label":"DETAILED_DESCRIPTION","start":456,"end":459},{"text":"smooth-surfaced","label":"TEXTURE","start":461,"end":476},{"text":"50-mm long","label":"DISTANCE","start":477,"end":487},{"text":"object","label":"SIGN_SYMPTOM","start":488,"end":494},{"text":"long","label":"DETAILED_DESCRIPTION","start":507,"end":511},{"text":"white","label":"COLOR","start":513,"end":518},{"text":"object","label":"SIGN_SYMPTOM","start":519,"end":525},{"text":"looked like a parasitic worm","label":"DETAILED_DESCRIPTION","start":532,"end":560},{"text":"intracoronary aspiration","label":"THERAPEUTIC_PROCEDURE","start":579,"end":603},{"text":"revascularization","label":"THERAPEUTIC_PROCEDURE","start":608,"end":625},{"text":"successfully completed","label":"LAB_VALUE","start":630,"end":652},{"text":"plaque rupture","label":"SIGN_SYMPTOM","start":667,"end":681},{"text":"thrombus","label":"SIGN_SYMPTOM","start":701,"end":709},{"text":"OCT","label":"COREFERENCE","start":726,"end":729},{"text":"eleventh hospital day","label":"DATE","start":747,"end":768},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":770,"end":783},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":784,"end":800},{"text":"floating","label":"DETAILED_DESCRIPTION","start":816,"end":824},{"text":"object","label":"SIGN_SYMPTOM","start":825,"end":831},{"text":"left atrium","label":"BIOLOGICAL_STRUCTURE","start":839,"end":850},{"text":"Contrast computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":852,"end":880},{"text":"huge","label":"DETAILED_DESCRIPTION","start":892,"end":896},{"text":"7\u00d76 cm","label":"AREA","start":897,"end":903},{"text":"mass","label":"SIGN_SYMPTOM","start":904,"end":908},{"text":"right upper pulmonary lobe","label":"BIOLOGICAL_STRUCTURE","start":949,"end":975},{"text":"direct pulmonary vein invasion","label":"DETAILED_DESCRIPTION","start":981,"end":1011},{"text":"bronchoscopic findings","label":"DIAGNOSTIC_PROCEDURE","start":1035,"end":1057},{"text":"lung tumor","label":"SIGN_SYMPTOM","start":1078,"end":1088},{"text":"histopathologic examination","label":"DIAGNOSTIC_PROCEDURE","start":1092,"end":1119},{"text":"aspirated","label":"DETAILED_DESCRIPTION","start":1127,"end":1136},{"text":"coronary","label":"BIOLOGICAL_STRUCTURE","start":1137,"end":1145},{"text":"object","label":"COREFERENCE","start":1146,"end":1152},{"text":"pleomorphic","label":"DETAILED_DESCRIPTION","start":1162,"end":1173},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":1174,"end":1178},{"text":"carcinoma","label":"DISEASE_DISORDER","start":1179,"end":1188},{"text":"STEMI","label":"DISEASE_DISORDER","start":1229,"end":1234},{"text":"coronary","label":"BIOLOGICAL_STRUCTURE","start":1242,"end":1250},{"text":"embolization","label":"SIGN_SYMPTOM","start":1251,"end":1263},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":1280,"end":1284},{"text":"carcinoma","label":"DISEASE_DISORDER","start":1285,"end":1294},{"text":"Brain","label":"BIOLOGICAL_STRUCTURE","start":1296,"end":1301},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1302,"end":1305},{"text":"asymptomatic","label":"DETAILED_DESCRIPTION","start":1339,"end":1351},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":1352,"end":1360},{"text":"infarction","label":"SIGN_SYMPTOM","start":1361,"end":1371},{"text":"right frontal lobe","label":"BIOLOGICAL_STRUCTURE","start":1379,"end":1397},{"text":"small","label":"DETAILED_DESCRIPTION","start":1404,"end":1409},{"text":"parietal lobe","label":"BIOLOGICAL_STRUCTURE","start":1410,"end":1423},{"text":"lesion","label":"SIGN_SYMPTOM","start":1424,"end":1430},{"text":"metastasis","label":"SIGN_SYMPTOM","start":1451,"end":1461},{"text":"right lung","label":"BIOLOGICAL_STRUCTURE","start":1515,"end":1525},{"text":"carcinoma","label":"DISEASE_DISORDER","start":1526,"end":1535},{"text":"stage IV","label":"DETAILED_DESCRIPTION","start":1537,"end":1545},{"text":"c-T2bN2M1b","label":"DETAILED_DESCRIPTION","start":1547,"end":1557},{"text":"chemotherapy","label":"MEDICATION","start":1592,"end":1604},{"text":"carboplatin","label":"MEDICATION","start":1615,"end":1626},{"text":"paclitaxel","label":"MEDICATION","start":1629,"end":1639},{"text":"good","label":"LAB_VALUE","start":1764,"end":1768},{"text":"clinical course","label":"DIAGNOSTIC_PROCEDURE","start":1769,"end":1784},{"text":"Chemotherapy","label":"MEDICATION","start":1805,"end":1817},{"text":"9 cycles","label":"DOSAGE","start":1834,"end":1842},{"text":"carcinoma progression","label":"DIAGNOSTIC_PROCEDURE","start":1880,"end":1901},{"text":"suppressed","label":"LAB_VALUE","start":1906,"end":1916},{"text":"doing well","label":"SIGN_SYMPTOM","start":1930,"end":1940},{"text":"more than two years","label":"DURATION","start":1945,"end":1964},{"text":"PCI","label":"THERAPEUTIC_PROCEDURE","start":1968,"end":1971},{"text":"followed-up","label":"CLINICAL_EVENT","start":1985,"end":1996},{"text":"regularly","label":"DETAILED_DESCRIPTION","start":1997,"end":2006}],"tokens":["A ","73-year-old"," ","man"," who had been ","transferred"," to our ","emergency room"," due to ","sudden"," ","chest"," ","pain"," was diagnosed with ","ST-segment elevation myocardial infarction"," (","STEMI",").\nHe had no coronary risk factors except for a ","history of smoking for 50 years",".\n","Primary"," ","percutaneous"," ","coronary intervention"," was performed, and a ","long",", ","string-shaped"," ","contrast defect"," was observed in the ","left anterior descending artery"," (Fig.1A).\n","Optical coherence tomography"," (","OCT",") imaging revealed an ","odd",", ","smooth-surfaced"," ","50-mm long"," ","object"," (Fig.1B).\nA ","long",", ","white"," ","object"," which ","looked like a parasitic worm"," was retrieved via ","intracoronary aspiration"," and ","revascularization"," was ","successfully completed"," since neither ","plaque rupture"," or the presence of ","thrombus"," was detected by ","OCT"," (Fig.1C).\nOn the ","eleventh hospital day",", ","transthoracic"," ","echocardiography"," revealed a new ","floating"," ","object"," in the ","left atrium",".\n","Contrast computed tomography"," revealed a ","huge"," ","7\u00d76 cm"," ","mass"," that was recognized at admission in the ","right upper pulmonary lobe"," with ","direct pulmonary vein invasion"," (Fig.1D).\nAlthough the ","bronchoscopic findings"," were negative for a ","lung tumor",", a ","histopathologic examination"," of the ","aspirated"," ","coronary"," ","object"," revealed ","pleomorphic"," ","lung"," ","carcinoma"," (Fig.2).\nThe patient was diagnosed with ","STEMI"," due to ","coronary"," ","embolization"," associated with ","lung"," ","carcinoma",".\n","Brain"," ","MRI"," revealed that the patient had an ","asymptomatic"," ","cerebral"," ","infarction"," in the ","right frontal lobe"," and a ","small"," ","parietal lobe"," ","lesion"," was diagnosed to be ","metastasis",".\nGiven all these observations, he was diagnosed with ","right lung"," ","carcinoma",", ","stage IV"," (","c-T2bN2M1b",").\nHe was treated according to the ","chemotherapy"," regimens (","carboplatin"," & ","paclitaxel",") known to be effective for the treatment of advanced non-small cell lung cancer.\nHe responded to the treatment and showed a ","good"," ","clinical course"," afterwards (Fig.3).\n","Chemotherapy"," with a total of ","9 cycles"," of the same regimen was used and the ","carcinoma progression"," was ","suppressed",".\nHe has been ","doing well"," for ","more than two years"," of ","PCI"," and has been ","followed-up"," ","regularly",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,12,0,69,0,26,0,26,0,39,0,22,0,12,0,75,0,22,0,67,0,69,0,12,0,24,0,24,0,22,0,73,0,27,0,69,0,22,0,15,0,69,0,22,0,75,0,75,0,42,0,69,0,69,0,18,0,19,0,12,0,24,0,22,0,69,0,12,0,24,0,22,0,8,0,69,0,12,0,22,0,24,0,69,0,24,0,22,0,12,0,18,0,22,0,12,0,26,0,26,0,12,0,69,0,12,0,26,0,12,0,24,0,22,0,12,0,69,0,12,0,22,0,12,0,69,0,69,0,12,0,26,0,22,0,22,0,46,0,46,0,46,0,42,0,24,0,46,0,29,0,24,0,42,0,69,0,32,0,75,0,13,0,22,0]}
-{"full_text":"A 76-year-old Japanese man had experienced a decreased appetite, nausea, and abdominal distension since late February 2011.\nThe patient passed loose, soft stools that were not watery once daily.\nThe results of blood tests performed by the primary care physician (PCP) between April and June were all normal, but upper and lower gastrointestinal endoscopy showed atrophic gastritis.\nTherefore, we assessed the patient for Helicobacter pylori antibodies and performed the rapid urease test and a histopathological evaluation, all of which were negative.\nIn June, the patient received medication from a mental health clinic, but because the symptoms did not improve and his body weight further decreased by 23 kg, he stopped the medication; he was referred to our department in November.\nThe patient had been suffering from hypertension since his 30s.\nAmlodipine (5 mg\/day) administration was initiated in 2005, and olmesartan from May 2008; the patient is currently receiving 30 mg\/day of olmesartan.\nHe denied the use of any other new medications or nonsteroidal anti-inflammatory drugs.\nHe had no history of smoking or alcohol consumption.\nPhysical examination showed that the patient had a height of 165 cm, a body weight of 47 kg, and body mass index of 17 kg\/m2.\nHis body temperature was 36.3\u2103; pulse rate, 101\/min; blood pressure, 101\/81 mmHg; respiratory rate, 12 breaths\/min; and saturation from pulse oximetry (SpO2) was 98%.\nThe patient had no heart murmur, third heart sound or jugular venous distension.\nThe patient had bilateral pitting edema on his lower legs and presented with unilateral gaze-evoked nystagmus as well as a mildly reduced tactile sensation and thermal nociception in the toes and dorsal regions of both feet.\nMoreover, the finger-to-nose test results and tandem gait were poor, and his patellar and Achilles tendon reflexes had disappeared.\nConfabulation was observed in the patient, and the revised Hasegawa Dementia Scale (HDS-R) score was 17\/30 (cut-off point: 20).\nThe hematologic findings were as follows: white blood cell count, 6,200 \/\u03bcL; hemoglobin level, 12.5 g\/dL; mean corpuscular volume, 88.4; platelet count, 230,000 \/\u03bcL; sodium level, 136 mEq\/L; potassium level, 3.8 mEq\/L; chlorine level, 103 mEq\/L; iron level, 57 \u03bcg\/dL (reference value: 64-187 \u03bcg\/dL); ferritin level, 366 ng\/mL (reference value: 50-200 ng\/mL); B-type natriuretic peptide (BNP) level, 125.3 pg\/mL (reference value: -18.4 pg\/mL); and vitamin B1 level, 8 ng\/mL (reference value: 24-66 ng\/mL).\nAn electrocardiogram was normal and chest X-rays showed a normal cardiothoracic ratio (40.8%) without either pulmonary congestion or pleural effusion.\nCranial fluid-attenuated inversion recovery-magnetic resonance imaging findings revealed periaqueductal hyperintensities (Fig.1); therefore, Wernicke encephalopathy was diagnosed.\nMoreover, as sinus tachycardia and a tendency towards hypotension were noted, no clear symptoms of heart failure or dehydration were observed; it was thus inferred that the vitamin B1 deficiency had likely played a role in both of the conditions.\nThe antihypertensive agents were discontinued, and 10 days after the intravenous administration of vitamin B1, the patient's loss of appetite, nausea, and gait disturbance disappeared, and his body weight increased by 3 kg.\nNystagmus was ameliorated on physical examination, but the patient still had confabulations, and the HDS-R score and absence of deep tendon reflexes did not improve.\nSince the gastrointestinal symptoms were ameliorated and his blood pressure increased to 160\/90 mmHg, the PCP resumed the administration of olmesartan on late December, 2011.\nOne week later, the patient complained of recurrent decreased appetite and nausea.\nAfter experiencing diarrhea (five bowel movements during a 2-day period), he passed soft stools once daily, and his body weight decreased to 47 kg so he came to our hospital again 3 weeks after the resumption of olmesartan for treatment.\nHis vital signs were as follows: body temperature, 35.1\u2103; pulse rate, 93\/min; and blood pressure, 132\/75 mmHg.\nThe neurologic findings showed no worsening of his symptoms.\nThe laboratory findings were as follows: sodium level, 139 mEq\/L; potassium level, 2.9 mEq\/L; and chlorine level, 116 mEq\/L.\nHyperchloremia was noted, and the serum sodium level minus chloride level (139-116) was 23 mEq\/L; additionally, the arterial blood gas findings were as follows: pH, 7.25; PCO2, 25 mmHg, and HCO3, 11 mmol\/L.\nThe urinalysis findings were as follows: sodium level, 15 mEq\/L; potassium level, 13 mEq\/L; chlorine level, 100 mEq\/L; and urine anion gap, -72 mEq\/L, and there was no apparent increase in bowel movements; however, this seemed to be due to the absence of HCO3- from the gastrointestinal tract (6).\nPlain abdominal radiography and abdominal computed tomography findings revealed the continuous dilation of the entire intestinal tract (Fig.2); therefore, the patient was diagnosed with intestinal pseudo-obstruction.\nAfter discontinuing olmesartan, the nausea and body weight decreases were promptly ameliorated.\nDuodenal biopsy findings after discontinuing olmesartan showed that the inflammation observed before discontinuation as well as the fold structure had both clearly ameliorated (Fig.3).\n","ner_info":[{"text":"76-year-old","label":"AGE","start":2,"end":13},{"text":"Japanese","label":"PERSONAL_BACKGROUND","start":14,"end":22},{"text":"man","label":"SEX","start":23,"end":26},{"text":"decreased appetite","label":"SIGN_SYMPTOM","start":45,"end":63},{"text":"nausea","label":"SIGN_SYMPTOM","start":65,"end":71},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":77,"end":86},{"text":"distension","label":"SIGN_SYMPTOM","start":87,"end":97},{"text":"since late February 2011","label":"DATE","start":98,"end":122},{"text":"loose","label":"LAB_VALUE","start":143,"end":148},{"text":"soft","label":"LAB_VALUE","start":150,"end":154},{"text":"stools","label":"DIAGNOSTIC_PROCEDURE","start":155,"end":161},{"text":"not watery","label":"LAB_VALUE","start":172,"end":182},{"text":"once daily","label":"FREQUENCY","start":183,"end":193},{"text":"blood tests","label":"DIAGNOSTIC_PROCEDURE","start":210,"end":221},{"text":"primary care physician","label":"NONBIOLOGICAL_LOCATION","start":239,"end":261},{"text":"PCP","label":"NONBIOLOGICAL_LOCATION","start":263,"end":266},{"text":"between April and June","label":"DATE","start":268,"end":290},{"text":"normal","label":"LAB_VALUE","start":300,"end":306},{"text":"upper and lower","label":"DETAILED_DESCRIPTION","start":312,"end":327},{"text":"gastrointestinal endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":328,"end":354},{"text":"atrophic","label":"DETAILED_DESCRIPTION","start":362,"end":370},{"text":"gastritis","label":"DISEASE_DISORDER","start":371,"end":380},{"text":"Helicobacter pylori antibodies","label":"DIAGNOSTIC_PROCEDURE","start":421,"end":451},{"text":"rapid urease test","label":"DIAGNOSTIC_PROCEDURE","start":470,"end":487},{"text":"histopathological evaluation","label":"DIAGNOSTIC_PROCEDURE","start":494,"end":522},{"text":"negative","label":"LAB_VALUE","start":542,"end":550},{"text":"June","label":"DATE","start":555,"end":559},{"text":"medication","label":"MEDICATION","start":582,"end":592},{"text":"mental health clinic","label":"NONBIOLOGICAL_LOCATION","start":600,"end":620},{"text":"symptoms","label":"SIGN_SYMPTOM","start":638,"end":646},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":671,"end":682},{"text":"decreased by 23 kg","label":"LAB_VALUE","start":691,"end":709},{"text":"medication","label":"MEDICATION","start":726,"end":736},{"text":"referred","label":"CLINICAL_EVENT","start":745,"end":753},{"text":"department","label":"NONBIOLOGICAL_LOCATION","start":761,"end":771},{"text":"November","label":"DATE","start":775,"end":783},{"text":"hypertension since his 30s","label":"HISTORY","start":821,"end":847},{"text":"Amlodipine","label":"MEDICATION","start":849,"end":859},{"text":"5 mg\/day","label":"DOSAGE","start":861,"end":869},{"text":"2005","label":"DATE","start":903,"end":907},{"text":"olmesartan","label":"MEDICATION","start":913,"end":923},{"text":"May 2008","label":"DATE","start":929,"end":937},{"text":"30 mg\/day","label":"DOSAGE","start":974,"end":983},{"text":"olmesartan","label":"COREFERENCE","start":987,"end":997},{"text":"new medications","label":"MEDICATION","start":1030,"end":1045},{"text":"nonsteroidal anti-inflammatory drugs","label":"MEDICATION","start":1049,"end":1085},{"text":"no history of smoking or alcohol consumption","label":"HISTORY","start":1094,"end":1138},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1140,"end":1160},{"text":"165 cm","label":"HEIGHT","start":1201,"end":1207},{"text":"47 kg","label":"WEIGHT","start":1226,"end":1231},{"text":"body mass index","label":"DIAGNOSTIC_PROCEDURE","start":1237,"end":1252},{"text":"17 kg\/m2","label":"LAB_VALUE","start":1256,"end":1264},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":1270,"end":1286},{"text":"36.3\u2103","label":"LAB_VALUE","start":1291,"end":1296},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":1298,"end":1308},{"text":"101\/min","label":"LAB_VALUE","start":1310,"end":1317},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1319,"end":1333},{"text":"101\/81 mmHg","label":"LAB_VALUE","start":1335,"end":1346},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":1348,"end":1364},{"text":"12 breaths\/min","label":"LAB_VALUE","start":1366,"end":1380},{"text":"saturation from pulse oximetry","label":"DIAGNOSTIC_PROCEDURE","start":1386,"end":1416},{"text":"SpO2","label":"DIAGNOSTIC_PROCEDURE","start":1418,"end":1422},{"text":"98%","label":"LAB_VALUE","start":1428,"end":1431},{"text":"heart murmur","label":"SIGN_SYMPTOM","start":1452,"end":1464},{"text":"third heart sound","label":"SIGN_SYMPTOM","start":1466,"end":1483},{"text":"jugular venous","label":"BIOLOGICAL_STRUCTURE","start":1487,"end":1501},{"text":"distension","label":"SIGN_SYMPTOM","start":1502,"end":1512},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1530,"end":1539},{"text":"pitting","label":"DETAILED_DESCRIPTION","start":1540,"end":1547},{"text":"edema","label":"SIGN_SYMPTOM","start":1548,"end":1553},{"text":"lower legs","label":"BIOLOGICAL_STRUCTURE","start":1561,"end":1571},{"text":"unilateral","label":"DETAILED_DESCRIPTION","start":1591,"end":1601},{"text":"gaze-evoked","label":"DETAILED_DESCRIPTION","start":1602,"end":1613},{"text":"nystagmus","label":"SIGN_SYMPTOM","start":1614,"end":1623},{"text":"mildly","label":"SEVERITY","start":1637,"end":1643},{"text":"reduced tactile sensation","label":"SIGN_SYMPTOM","start":1644,"end":1669},{"text":"thermal","label":"DETAILED_DESCRIPTION","start":1674,"end":1681},{"text":"nociception","label":"SIGN_SYMPTOM","start":1682,"end":1693},{"text":"toes","label":"BIOLOGICAL_STRUCTURE","start":1701,"end":1705},{"text":"dorsal regions of both feet","label":"BIOLOGICAL_STRUCTURE","start":1710,"end":1737},{"text":"finger-to-nose test","label":"DIAGNOSTIC_PROCEDURE","start":1753,"end":1772},{"text":"tandem gait","label":"DIAGNOSTIC_PROCEDURE","start":1785,"end":1796},{"text":"poor","label":"LAB_VALUE","start":1802,"end":1806},{"text":"patellar","label":"BIOLOGICAL_STRUCTURE","start":1816,"end":1824},{"text":"Achilles tendon","label":"BIOLOGICAL_STRUCTURE","start":1829,"end":1844},{"text":"reflexes","label":"DIAGNOSTIC_PROCEDURE","start":1845,"end":1853},{"text":"disappeared","label":"LAB_VALUE","start":1858,"end":1869},{"text":"Confabulation","label":"SIGN_SYMPTOM","start":1871,"end":1884},{"text":"Hasegawa Dementia Scale","label":"DIAGNOSTIC_PROCEDURE","start":1930,"end":1953},{"text":"HDS-R","label":"DIAGNOSTIC_PROCEDURE","start":1955,"end":1960},{"text":"17\/30","label":"LAB_VALUE","start":1972,"end":1977},{"text":"hematologic findings","label":"DIAGNOSTIC_PROCEDURE","start":2003,"end":2023},{"text":"white blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":2041,"end":2063},{"text":"6,200 \/\u03bcL","label":"LAB_VALUE","start":2065,"end":2074},{"text":"hemoglobin level","label":"DIAGNOSTIC_PROCEDURE","start":2076,"end":2092},{"text":"12.5 g\/dL","label":"LAB_VALUE","start":2094,"end":2103},{"text":"mean corpuscular volume","label":"DIAGNOSTIC_PROCEDURE","start":2105,"end":2128},{"text":"88.4","label":"LAB_VALUE","start":2130,"end":2134},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2136,"end":2150},{"text":"230,000 \/\u03bcL","label":"LAB_VALUE","start":2152,"end":2163},{"text":"sodium level","label":"DIAGNOSTIC_PROCEDURE","start":2165,"end":2177},{"text":"136 mEq\/L","label":"LAB_VALUE","start":2179,"end":2188},{"text":"potassium level","label":"DIAGNOSTIC_PROCEDURE","start":2190,"end":2205},{"text":"3.8 mEq\/L","label":"LAB_VALUE","start":2207,"end":2216},{"text":"chlorine level","label":"DIAGNOSTIC_PROCEDURE","start":2218,"end":2232},{"text":"103 mEq\/L","label":"LAB_VALUE","start":2234,"end":2243},{"text":"iron level","label":"DIAGNOSTIC_PROCEDURE","start":2245,"end":2255},{"text":"57 \u03bcg\/dL","label":"LAB_VALUE","start":2257,"end":2265},{"text":"ferritin level","label":"DIAGNOSTIC_PROCEDURE","start":2299,"end":2313},{"text":"366 ng\/mL","label":"LAB_VALUE","start":2315,"end":2324},{"text":"B-type natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":2358,"end":2384},{"text":"BNP","label":"DIAGNOSTIC_PROCEDURE","start":2386,"end":2389},{"text":"125.3 pg\/mL","label":"LAB_VALUE","start":2398,"end":2409},{"text":"vitamin B1 level","label":"DIAGNOSTIC_PROCEDURE","start":2446,"end":2462},{"text":"8 ng\/mL","label":"LAB_VALUE","start":2464,"end":2471},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":2507,"end":2524},{"text":"normal","label":"LAB_VALUE","start":2529,"end":2535},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2540,"end":2545},{"text":"X-rays","label":"DIAGNOSTIC_PROCEDURE","start":2546,"end":2552},{"text":"normal","label":"LAB_VALUE","start":2562,"end":2568},{"text":"cardiothoracic ratio","label":"DIAGNOSTIC_PROCEDURE","start":2569,"end":2589},{"text":"40.8%","label":"LAB_VALUE","start":2591,"end":2596},{"text":"pulmonary congestion","label":"SIGN_SYMPTOM","start":2613,"end":2633},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":2637,"end":2653},{"text":"Cranial","label":"BIOLOGICAL_STRUCTURE","start":2655,"end":2662},{"text":"fluid-attenuated inversion recovery","label":"DETAILED_DESCRIPTION","start":2663,"end":2698},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":2699,"end":2725},{"text":"periaqueductal","label":"BIOLOGICAL_STRUCTURE","start":2744,"end":2758},{"text":"hyperintensities","label":"SIGN_SYMPTOM","start":2759,"end":2775},{"text":"Wernicke encephalopathy","label":"DISEASE_DISORDER","start":2796,"end":2819},{"text":"sinus","label":"DETAILED_DESCRIPTION","start":2848,"end":2853},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":2854,"end":2865},{"text":"hypotension","label":"SIGN_SYMPTOM","start":2889,"end":2900},{"text":"heart failure","label":"DISEASE_DISORDER","start":2934,"end":2947},{"text":"dehydration","label":"SIGN_SYMPTOM","start":2951,"end":2962},{"text":"vitamin B1 deficiency","label":"DISEASE_DISORDER","start":3008,"end":3029},{"text":"antihypertensive agents","label":"MEDICATION","start":3086,"end":3109},{"text":"10 days after","label":"DATE","start":3133,"end":3146},{"text":"intravenous","label":"ADMINISTRATION","start":3151,"end":3162},{"text":"vitamin B1","label":"MEDICATION","start":3181,"end":3191},{"text":"loss of appetite","label":"SIGN_SYMPTOM","start":3207,"end":3223},{"text":"nausea","label":"SIGN_SYMPTOM","start":3225,"end":3231},{"text":"gait disturbance","label":"SIGN_SYMPTOM","start":3237,"end":3253},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":3275,"end":3286},{"text":"increased by 3 kg","label":"LAB_VALUE","start":3287,"end":3304},{"text":"Nystagmus","label":"SIGN_SYMPTOM","start":3306,"end":3315},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":3335,"end":3355},{"text":"confabulations","label":"SIGN_SYMPTOM","start":3383,"end":3397},{"text":"HDS-R score","label":"DIAGNOSTIC_PROCEDURE","start":3407,"end":3418},{"text":"absence","label":"LAB_VALUE","start":3423,"end":3430},{"text":"deep tendon","label":"BIOLOGICAL_STRUCTURE","start":3434,"end":3445},{"text":"reflexes","label":"DIAGNOSTIC_PROCEDURE","start":3446,"end":3454},{"text":"did not improve","label":"LAB_VALUE","start":3455,"end":3470},{"text":"gastrointestinal symptoms","label":"SIGN_SYMPTOM","start":3482,"end":3507},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":3533,"end":3547},{"text":"increased","label":"LAB_VALUE","start":3548,"end":3557},{"text":"160\/90 mmHg","label":"LAB_VALUE","start":3561,"end":3572},{"text":"PCP","label":"NONBIOLOGICAL_LOCATION","start":3578,"end":3581},{"text":"olmesartan","label":"MEDICATION","start":3612,"end":3622},{"text":"late December, 2011","label":"DATE","start":3626,"end":3645},{"text":"One week later","label":"DATE","start":3647,"end":3661},{"text":"decreased appetite","label":"SIGN_SYMPTOM","start":3699,"end":3717},{"text":"nausea","label":"SIGN_SYMPTOM","start":3722,"end":3728},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":3749,"end":3757},{"text":"five bowel movements during a 2-day period","label":"LAB_VALUE","start":3759,"end":3801},{"text":"soft","label":"LAB_VALUE","start":3814,"end":3818},{"text":"stools","label":"DIAGNOSTIC_PROCEDURE","start":3819,"end":3825},{"text":"once daily","label":"FREQUENCY","start":3826,"end":3836},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":3846,"end":3857},{"text":"decreased","label":"LAB_VALUE","start":3858,"end":3867},{"text":"47 kg","label":"LAB_VALUE","start":3871,"end":3876},{"text":"came","label":"CLINICAL_EVENT","start":3883,"end":3887},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":3895,"end":3903},{"text":"3 weeks after","label":"DATE","start":3910,"end":3923},{"text":"olmesartan","label":"MEDICATION","start":3942,"end":3952},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":3972,"end":3983},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":4001,"end":4017},{"text":"35.1\u2103","label":"LAB_VALUE","start":4019,"end":4024},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":4026,"end":4036},{"text":"93\/min","label":"LAB_VALUE","start":4038,"end":4044},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":4050,"end":4064},{"text":"132\/75 mmHg","label":"LAB_VALUE","start":4066,"end":4077},{"text":"neurologic findings","label":"DIAGNOSTIC_PROCEDURE","start":4083,"end":4102},{"text":"no worsening","label":"LAB_VALUE","start":4110,"end":4122},{"text":"laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":4144,"end":4163},{"text":"sodium level","label":"DIAGNOSTIC_PROCEDURE","start":4181,"end":4193},{"text":"139 mEq\/L","label":"LAB_VALUE","start":4195,"end":4204},{"text":"potassium level","label":"DIAGNOSTIC_PROCEDURE","start":4206,"end":4221},{"text":"2.9 mEq\/L","label":"LAB_VALUE","start":4223,"end":4232},{"text":"chlorine level","label":"DIAGNOSTIC_PROCEDURE","start":4238,"end":4252},{"text":"116 mEq\/L","label":"LAB_VALUE","start":4254,"end":4263},{"text":"Hyperchloremia","label":"SIGN_SYMPTOM","start":4265,"end":4279},{"text":"serum sodium level minus chloride level (139-116) was 23 mEq\/L","label":"LAB_VALUE","start":4299,"end":4361},{"text":"arterial blood gas findings","label":"DIAGNOSTIC_PROCEDURE","start":4381,"end":4408},{"text":"pH","label":"DIAGNOSTIC_PROCEDURE","start":4426,"end":4428},{"text":"7.25","label":"LAB_VALUE","start":4430,"end":4434},{"text":"PCO2","label":"DIAGNOSTIC_PROCEDURE","start":4436,"end":4440},{"text":"25 mmHg","label":"LAB_VALUE","start":4442,"end":4449},{"text":"HCO3","label":"DIAGNOSTIC_PROCEDURE","start":4455,"end":4459},{"text":"11 mmol\/L","label":"LAB_VALUE","start":4461,"end":4470},{"text":"urinalysis","label":"DIAGNOSTIC_PROCEDURE","start":4476,"end":4486},{"text":"sodium level","label":"DIAGNOSTIC_PROCEDURE","start":4513,"end":4525},{"text":"15 mEq\/L","label":"LAB_VALUE","start":4527,"end":4535},{"text":"potassium level","label":"DIAGNOSTIC_PROCEDURE","start":4537,"end":4552},{"text":"13 mEq\/L","label":"LAB_VALUE","start":4554,"end":4562},{"text":"chlorine level","label":"DIAGNOSTIC_PROCEDURE","start":4564,"end":4578},{"text":"100 mEq\/L","label":"LAB_VALUE","start":4580,"end":4589},{"text":"urine anion gap","label":"DIAGNOSTIC_PROCEDURE","start":4595,"end":4610},{"text":"-72 mEq\/L","label":"LAB_VALUE","start":4612,"end":4621},{"text":"no apparent increase","label":"LAB_VALUE","start":4637,"end":4657},{"text":"bowel movements","label":"DIAGNOSTIC_PROCEDURE","start":4661,"end":4676},{"text":"absence of HCO3-","label":"SIGN_SYMPTOM","start":4716,"end":4732},{"text":"gastrointestinal tract","label":"BIOLOGICAL_STRUCTURE","start":4742,"end":4764},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":4776,"end":4785},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":4786,"end":4797},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":4802,"end":4811},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":4812,"end":4831},{"text":"continuous","label":"DETAILED_DESCRIPTION","start":4854,"end":4864},{"text":"dilation","label":"SIGN_SYMPTOM","start":4865,"end":4873},{"text":"entire intestinal tract","label":"BIOLOGICAL_STRUCTURE","start":4881,"end":4904},{"text":"intestinal pseudo-obstruction","label":"DISEASE_DISORDER","start":4956,"end":4985},{"text":"olmesartan","label":"MEDICATION","start":5007,"end":5017},{"text":"nausea","label":"SIGN_SYMPTOM","start":5023,"end":5029},{"text":"body weight decreases","label":"SIGN_SYMPTOM","start":5034,"end":5055},{"text":"Duodenal","label":"BIOLOGICAL_STRUCTURE","start":5083,"end":5091},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":5092,"end":5098},{"text":"olmesartan","label":"MEDICATION","start":5128,"end":5138},{"text":"inflammation","label":"SIGN_SYMPTOM","start":5155,"end":5167},{"text":"fold structure","label":"SIGN_SYMPTOM","start":5215,"end":5229}],"tokens":["A ","76-year-old"," ","Japanese"," ","man"," had experienced a ","decreased appetite",", ","nausea",", and ","abdominal"," ","distension"," ","since late February 2011",".\nThe patient passed ","loose",", ","soft"," ","stools"," that were ","not watery"," ","once daily",".\nThe results of ","blood tests"," performed by the ","primary care physician"," (","PCP",") ","between April and June"," were all ","normal",", but ","upper and lower"," ","gastrointestinal endoscopy"," showed ","atrophic"," ","gastritis",".\nTherefore, we assessed the patient for ","Helicobacter pylori antibodies"," and performed the ","rapid urease test"," and a ","histopathological evaluation",", all of which were ","negative",".\nIn ","June",", the patient received ","medication"," from a ","mental health clinic",", but because the ","symptoms"," did not improve and his ","body weight"," further ","decreased by 23 kg",", he stopped the ","medication","; he was ","referred"," to our ","department"," in ","November",".\nThe patient had been suffering from ","hypertension since his 30s",".\n","Amlodipine"," (","5 mg\/day",") administration was initiated in ","2005",", and ","olmesartan"," from ","May 2008","; the patient is currently receiving ","30 mg\/day"," of ","olmesartan",".\nHe denied the use of any other ","new medications"," or ","nonsteroidal anti-inflammatory drugs",".\nHe had ","no history of smoking or alcohol consumption",".\n","Physical examination"," showed that the patient had a height of ","165 cm",", a body weight of ","47 kg",", and ","body mass index"," of ","17 kg\/m2",".\nHis ","body temperature"," was ","36.3\u2103","; ","pulse rate",", ","101\/min","; ","blood pressure",", ","101\/81 mmHg","; ","respiratory rate",", ","12 breaths\/min","; and ","saturation from pulse oximetry"," (","SpO2",") was ","98%",".\nThe patient had no ","heart murmur",", ","third heart sound"," or ","jugular venous"," ","distension",".\nThe patient had ","bilateral"," ","pitting"," ","edema"," on his ","lower legs"," and presented with ","unilateral"," ","gaze-evoked"," ","nystagmus"," as well as a ","mildly"," ","reduced tactile sensation"," and ","thermal"," ","nociception"," in the ","toes"," and ","dorsal regions of both feet",".\nMoreover, the ","finger-to-nose test"," results and ","tandem gait"," were ","poor",", and his ","patellar"," and ","Achilles tendon"," ","reflexes"," had ","disappeared",".\n","Confabulation"," was observed in the patient, and the revised ","Hasegawa Dementia Scale"," (","HDS-R",") score was ","17\/30"," (cut-off point: 20).\nThe ","hematologic findings"," were as follows: ","white blood cell count",", ","6,200 \/\u03bcL","; ","hemoglobin level",", ","12.5 g\/dL","; ","mean corpuscular volume",", ","88.4","; ","platelet count",", ","230,000 \/\u03bcL","; ","sodium level",", ","136 mEq\/L","; ","potassium level",", ","3.8 mEq\/L","; ","chlorine level",", ","103 mEq\/L","; ","iron level",", ","57 \u03bcg\/dL"," (reference value: 64-187 \u03bcg\/dL); ","ferritin level",", ","366 ng\/mL"," (reference value: 50-200 ng\/mL); ","B-type natriuretic peptide"," (","BNP",") level, ","125.3 pg\/mL"," (reference value: -18.4 pg\/mL); and ","vitamin B1 level",", ","8 ng\/mL"," (reference value: 24-66 ng\/mL).\nAn ","electrocardiogram"," was ","normal"," and ","chest"," ","X-rays"," showed a ","normal"," ","cardiothoracic ratio"," (","40.8%",") without either ","pulmonary congestion"," or ","pleural effusion",".\n","Cranial"," ","fluid-attenuated inversion recovery","-","magnetic resonance imaging"," findings revealed ","periaqueductal"," ","hyperintensities"," (Fig.1); therefore, ","Wernicke encephalopathy"," was diagnosed.\nMoreover, as ","sinus"," ","tachycardia"," and a tendency towards ","hypotension"," were noted, no clear symptoms of ","heart failure"," or ","dehydration"," were observed; it was thus inferred that the ","vitamin B1 deficiency"," had likely played a role in both of the conditions.\nThe ","antihypertensive agents"," were discontinued, and ","10 days after"," the ","intravenous"," administration of ","vitamin B1",", the patient's ","loss of appetite",", ","nausea",", and ","gait disturbance"," disappeared, and his ","body weight"," ","increased by 3 kg",".\n","Nystagmus"," was ameliorated on ","physical examination",", but the patient still had ","confabulations",", and the ","HDS-R score"," and ","absence"," of ","deep tendon"," ","reflexes"," ","did not improve",".\nSince the ","gastrointestinal symptoms"," were ameliorated and his ","blood pressure"," ","increased"," to ","160\/90 mmHg",", the ","PCP"," resumed the administration of ","olmesartan"," on ","late December, 2011",".\n","One week later",", the patient complained of recurrent ","decreased appetite"," and ","nausea",".\nAfter experiencing ","diarrhea"," (","five bowel movements during a 2-day period","), he passed ","soft"," ","stools"," ","once daily",", and his ","body weight"," ","decreased"," to ","47 kg"," so he ","came"," to our ","hospital"," again ","3 weeks after"," the resumption of ","olmesartan"," for treatment.\nHis ","vital signs"," were as follows: ","body temperature",", ","35.1\u2103","; ","pulse rate",", ","93\/min","; and ","blood pressure",", ","132\/75 mmHg",".\nThe ","neurologic findings"," showed ","no worsening"," of his symptoms.\nThe ","laboratory findings"," were as follows: ","sodium level",", ","139 mEq\/L","; ","potassium level",", ","2.9 mEq\/L","; and ","chlorine level",", ","116 mEq\/L",".\n","Hyperchloremia"," was noted, and the ","serum sodium level minus chloride level (139-116) was 23 mEq\/L","; additionally, the ","arterial blood gas findings"," were as follows: ","pH",", ","7.25","; ","PCO2",", ","25 mmHg",", and ","HCO3",", ","11 mmol\/L",".\nThe ","urinalysis"," findings were as follows: ","sodium level",", ","15 mEq\/L","; ","potassium level",", ","13 mEq\/L","; ","chlorine level",", ","100 mEq\/L","; and ","urine anion gap",", ","-72 mEq\/L",", and there was ","no apparent increase"," in ","bowel movements","; however, this seemed to be due to the ","absence of HCO3-"," from the ","gastrointestinal tract"," (6).\nPlain ","abdominal"," ","radiography"," and ","abdominal"," ","computed tomography"," findings revealed the ","continuous"," ","dilation"," of the ","entire intestinal tract"," (Fig.2); therefore, the patient was diagnosed with ","intestinal pseudo-obstruction",".\nAfter discontinuing ","olmesartan",", the ","nausea"," and ","body weight decreases"," were promptly ameliorated.\n","Duodenal"," ","biopsy"," findings after discontinuing ","olmesartan"," showed that the ","inflammation"," observed before discontinuation as well as the ","fold structure"," had both clearly ameliorated (Fig.3).\n"],"ner_labels":[0,5,0,58,0,65,0,69,0,69,0,12,0,69,0,19,0,42,0,42,0,24,0,42,0,35,0,24,0,48,0,48,0,19,0,42,0,22,0,24,0,22,0,26,0,24,0,24,0,24,0,42,0,19,0,46,0,48,0,69,0,24,0,42,0,46,0,13,0,48,0,19,0,39,0,46,0,29,0,19,0,46,0,19,0,29,0,18,0,46,0,46,0,39,0,24,0,38,0,82,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,69,0,69,0,12,0,69,0,22,0,22,0,69,0,12,0,22,0,22,0,69,0,63,0,69,0,22,0,69,0,12,0,12,0,24,0,24,0,42,0,12,0,12,0,24,0,42,0,69,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,42,0,24,0,42,0,69,0,26,0,12,0,22,0,24,0,12,0,69,0,26,0,22,0,69,0,69,0,26,0,69,0,26,0,46,0,19,0,4,0,46,0,69,0,69,0,69,0,24,0,42,0,69,0,24,0,69,0,24,0,42,0,12,0,24,0,42,0,69,0,24,0,42,0,42,0,48,0,46,0,19,0,19,0,69,0,69,0,69,0,42,0,42,0,24,0,35,0,24,0,42,0,42,0,13,0,48,0,19,0,46,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,69,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,69,0,12,0,12,0,24,0,12,0,24,0,22,0,69,0,12,0,26,0,46,0,69,0,69,0,12,0,24,0,46,0,69,0,69,0]}
-{"full_text":"A 73-year-old Hispanic male with a history of stage IV chronic kidney disease and three-vessel coronary artery disease was admitted for coronary artery bypass graft surgery and mitral valve repair.\nOn post-operative day two, the patient developed cardiac tamponade and subsequently progressed to a cardiac arrest while temporary pacing wires were being removed.\nAdvanced cardiovascular life support and emergent exploratory sternotomy were performed, and the patient was transferred to the intensive care unit (ICU) for further care.\nDuring the patient\u2019s ICU admission, his renal failure progressed, requiring hemodialysis.\nA nasogastric tube was placed on post-operative day two for establishing early enteral nutrition.\nPEG tube insertion was suggested given his cognitive impairment and poor swallowing function on the Modified Barium Swallow test.\nHis coagulation profile prior to the procedure revealed an international normalized ratio of 1.04 and partial thromboplastin time of 36 seconds.\nA complete blood count showed a hemoglobin of 11.6 grams per deciliter, a hematocrit of 34.9%, and 281\u00d7103 platelets per microliter.\nHis blood urea nitrogen was 55 milligrams\/deciliter, and his serum creatinine was 5.22 milligrams\/deciliter.\nThe patient was taking aspirin 81 mg per day due to recent cardiac surgery, but was not on any anticoagulant agents.\nHe also did not have a history of coagulopathy.\nPEG tube insertion was performed on post-operative day eight under intravenous anesthesia.\nThe esophagogastroduodenoscopy (EGD) was accomplished without difficulty, revealing diffuse moderately erythematous mucosa without bleeding in the gastric antrum.\nWhile attempting PEG tube placement, a rapidly expanding hematoma (Figure 1) developed at the needle insertion site.\nThe procedure was stopped and the patient was sent back to the ICU with a nasogastric tube.\nA single dose of intravenous desmopressin (0.3 microgram\/kilogram) was administered under the suspicion of uremic bleeding.\nNo further gastrointestinal bleeding events were noted.\nTo assess platelet function, a platelet function assay (PFA) was ordered after desmopressin injection.\nPFA collagen\/epinephrine closure time was 195 seconds (normal <174 seconds), and collagen\/ADP closure time was 76 seconds (normal <120 seconds), indicating platelet dysfunction due to either aspirin or uremia.\nAspirin was discontinued, and he was monitored with a daily complete blood count and metabolic panel.\nThree days later the patient underwent a second attempt at PEG tube placement.\nPFA collagen\/epinephrine closure time prior to this procedure had gone down to 141 seconds, possibly due to withholding aspirin and an improvement in renal function.\nEGD showed an area of flat, bluish gastric submucosal bruising at the site of the previous hematoma (Figure 2).\nThe PEG tube was placed successfully at an adjacent site.\nOver the course of the following month, the patient continued to undergo feeding through the PEG tube with no adverse events.\n","ner_info":[{"text":"73-year-old","label":"AGE","start":2,"end":13},{"text":"Hispanic","label":"PERSONAL_BACKGROUND","start":14,"end":22},{"text":"male","label":"SEX","start":23,"end":27},{"text":"stage IV","label":"DETAILED_DESCRIPTION","start":46,"end":54},{"text":"chronic kidney disease","label":"DISEASE_DISORDER","start":55,"end":77},{"text":"three-vessel","label":"DETAILED_DESCRIPTION","start":82,"end":94},{"text":"coronary artery disease","label":"DISEASE_DISORDER","start":95,"end":118},{"text":"admitted","label":"CLINICAL_EVENT","start":123,"end":131},{"text":"coronary artery bypass graft surgery","label":"THERAPEUTIC_PROCEDURE","start":136,"end":172},{"text":"mitral valve repair","label":"THERAPEUTIC_PROCEDURE","start":177,"end":196},{"text":"day two","label":"DATE","start":216,"end":223},{"text":"cardiac tamponade","label":"SIGN_SYMPTOM","start":247,"end":264},{"text":"cardiac 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seconds","label":"LAB_VALUE","start":985,"end":995},{"text":"complete blood count","label":"DIAGNOSTIC_PROCEDURE","start":999,"end":1019},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1029,"end":1039},{"text":"11.6 grams per deciliter","label":"LAB_VALUE","start":1043,"end":1067},{"text":"hematocrit","label":"DIAGNOSTIC_PROCEDURE","start":1071,"end":1081},{"text":"34.9%","label":"LAB_VALUE","start":1085,"end":1090},{"text":"281\u00d7103","label":"LAB_VALUE","start":1096,"end":1103},{"text":"platelets","label":"DIAGNOSTIC_PROCEDURE","start":1104,"end":1113},{"text":"per microliter","label":"DETAILED_DESCRIPTION","start":1114,"end":1128},{"text":"blood urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":1134,"end":1153},{"text":"55 milligrams\/deciliter","label":"LAB_VALUE","start":1158,"end":1181},{"text":"serum","label":"DETAILED_DESCRIPTION","start":1191,"end":1196},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1197,"end":1207},{"text":"5.22 milligrams\/deciliter","label":"LAB_VALUE","start":1212,"end":1237},{"text":"aspirin","label":"MEDICATION","start":1262,"end":1269},{"text":"81 mg per day","label":"DOSAGE","start":1270,"end":1283},{"text":"cardiac surgery","label":"THERAPEUTIC_PROCEDURE","start":1298,"end":1313},{"text":"anticoagulant agents","label":"MEDICATION","start":1334,"end":1354},{"text":"did not have a history of coagulopathy","label":"HISTORY","start":1364,"end":1402},{"text":"PEG tube insertion","label":"THERAPEUTIC_PROCEDURE","start":1404,"end":1422},{"text":"day eight","label":"DATE","start":1455,"end":1464},{"text":"intravenous","label":"ADMINISTRATION","start":1471,"end":1482},{"text":"anesthesia","label":"MEDICATION","start":1483,"end":1493},{"text":"esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1499,"end":1525},{"text":"EGD","label":"DIAGNOSTIC_PROCEDURE","start":1527,"end":1530},{"text":"difficulty","label":"OTHER_EVENT","start":1557,"end":1567},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1579,"end":1586},{"text":"moderately","label":"SEVERITY","start":1587,"end":1597},{"text":"erythematous","label":"SIGN_SYMPTOM","start":1598,"end":1610},{"text":"mucosa","label":"BIOLOGICAL_STRUCTURE","start":1611,"end":1617},{"text":"bleeding","label":"SIGN_SYMPTOM","start":1626,"end":1634},{"text":"gastric antrum","label":"BIOLOGICAL_STRUCTURE","start":1642,"end":1656},{"text":"PEG tube placemen","label":"THERAPEUTIC_PROCEDURE","start":1675,"end":1692},{"text":"rapidly expanding","label":"SEVERITY","start":1697,"end":1714},{"text":"hematoma","label":"SIGN_SYMPTOM","start":1715,"end":1723},{"text":"needle insertion site","label":"BIOLOGICAL_STRUCTURE","start":1752,"end":1773},{"text":"procedure","label":"COREFERENCE","start":1779,"end":1788},{"text":"sent back","label":"CLINICAL_EVENT","start":1821,"end":1830},{"text":"ICU","label":"NONBIOLOGICAL_LOCATION","start":1838,"end":1841},{"text":"nasogastric tube","label":"THERAPEUTIC_PROCEDURE","start":1849,"end":1865},{"text":"single dose","label":"DOSAGE","start":1869,"end":1880},{"text":"intravenous","label":"ADMINISTRATION","start":1884,"end":1895},{"text":"desmopressin","label":"MEDICATION","start":1896,"end":1908},{"text":"0.3 microgram\/kilogram","label":"DOSAGE","start":1910,"end":1932},{"text":"uremic bleeding","label":"SIGN_SYMPTOM","start":1974,"end":1989},{"text":"gastrointestinal","label":"BIOLOGICAL_STRUCTURE","start":2002,"end":2018},{"text":"bleeding","label":"SIGN_SYMPTOM","start":2019,"end":2027},{"text":"platelet function","label":"DIAGNOSTIC_PROCEDURE","start":2057,"end":2074},{"text":"platelet function assay","label":"DIAGNOSTIC_PROCEDURE","start":2078,"end":2101},{"text":"PFA","label":"DIAGNOSTIC_PROCEDURE","start":2103,"end":2106},{"text":"desmopressin","label":"MEDICATION","start":2126,"end":2138},{"text":"injection","label":"ADMINISTRATION","start":2139,"end":2148},{"text":"PFA","label":"DIAGNOSTIC_PROCEDURE","start":2150,"end":2153},{"text":"collagen\/epinephrine closure time","label":"DIAGNOSTIC_PROCEDURE","start":2154,"end":2187},{"text":"195 seconds","label":"LAB_VALUE","start":2192,"end":2203},{"text":"collagen\/ADP closure time","label":"DIAGNOSTIC_PROCEDURE","start":2231,"end":2256},{"text":"76 seconds","label":"LAB_VALUE","start":2261,"end":2271},{"text":"platelet dysfunction","label":"DISEASE_DISORDER","start":2306,"end":2326},{"text":"aspirin","label":"MEDICATION","start":2341,"end":2348},{"text":"uremia","label":"DISEASE_DISORDER","start":2352,"end":2358},{"text":"Aspirin","label":"MEDICATION","start":2360,"end":2367},{"text":"monitored","label":"THERAPEUTIC_PROCEDURE","start":2397,"end":2406},{"text":"daily","label":"FREQUENCY","start":2414,"end":2419},{"text":"complete blood count","label":"DIAGNOSTIC_PROCEDURE","start":2420,"end":2440},{"text":"metabolic panel","label":"DIAGNOSTIC_PROCEDURE","start":2445,"end":2460},{"text":"Three days later","label":"DATE","start":2462,"end":2478},{"text":"PEG tube placement","label":"THERAPEUTIC_PROCEDURE","start":2521,"end":2539},{"text":"PFA","label":"DIAGNOSTIC_PROCEDURE","start":2541,"end":2544},{"text":"collagen\/epinephrine closure time","label":"DIAGNOSTIC_PROCEDURE","start":2545,"end":2578},{"text":"procedure","label":"COREFERENCE","start":2593,"end":2602},{"text":"gone down","label":"LAB_VALUE","start":2607,"end":2616},{"text":"141 seconds","label":"LAB_VALUE","start":2620,"end":2631},{"text":"aspirin","label":"MEDICATION","start":2661,"end":2668},{"text":"improvement","label":"LAB_VALUE","start":2676,"end":2687},{"text":"renal function","label":"DIAGNOSTIC_PROCEDURE","start":2691,"end":2705},{"text":"EGD","label":"DIAGNOSTIC_PROCEDURE","start":2707,"end":2710},{"text":"flat","label":"TEXTURE","start":2729,"end":2733},{"text":"bluish","label":"COLOR","start":2735,"end":2741},{"text":"gastric submucosal","label":"BIOLOGICAL_STRUCTURE","start":2742,"end":2760},{"text":"bruising","label":"SIGN_SYMPTOM","start":2761,"end":2769},{"text":"hematoma","label":"SIGN_SYMPTOM","start":2798,"end":2806},{"text":"PEG tube","label":"THERAPEUTIC_PROCEDURE","start":2823,"end":2831},{"text":"adjacent site","label":"BIOLOGICAL_STRUCTURE","start":2862,"end":2875},{"text":"following month","label":"DURATION","start":2900,"end":2915},{"text":"feeding","label":"THERAPEUTIC_PROCEDURE","start":2950,"end":2957},{"text":"PEG tube","label":"THERAPEUTIC_PROCEDURE","start":2970,"end":2978},{"text":"adverse events","label":"SIGN_SYMPTOM","start":2987,"end":3001}],"tokens":["A ","73-year-old"," ","Hispanic"," ","male"," with a history of ","stage IV"," ","chronic kidney disease"," and ","three-vessel"," ","coronary artery disease"," was ","admitted"," for ","coronary artery bypass graft surgery"," and ","mitral valve repair",".\nOn post-operative ","day two",", the patient developed ","cardiac tamponade"," and subsequently progressed to a ","cardiac arrest"," while ","temporary pacing wires"," were being removed.\nAdvanced ","cardiovascular life support"," and emergent ","exploratory"," ","sternotomy"," were performed, and the patient was ","transferred"," to the ","intensive care unit"," (","ICU",") for further care.\nDuring the patient\u2019s ","ICU"," ","admission",", his ","renal failure"," progressed, requiring ","hemodialysis",".\nA ","nasogastric tube"," was placed on post-operative ","day two"," for establishing early ","enteral nutrition",".\n","PEG tube insertion"," was suggested given his ","cognitive impairment"," and ","poor"," ","swallowing function"," on the ","Modified Barium Swallow test",".\nHis ","coagulation profile"," prior to the procedure revealed an ","international normalized ratio"," of ","1.04"," and ","partial thromboplastin time"," of ","36 seconds",".\nA ","complete blood count"," showed a ","hemoglobin"," of ","11.6 grams per deciliter",", a ","hematocrit"," of ","34.9%",", and ","281\u00d7103"," ","platelets"," ","per microliter",".\nHis ","blood urea nitrogen"," was ","55 milligrams\/deciliter",", and his ","serum"," ","creatinine"," was ","5.22 milligrams\/deciliter",".\nThe patient was taking ","aspirin"," ","81 mg per day"," due to recent ","cardiac surgery",", but was not on any ","anticoagulant agents",".\nHe also ","did not have a history of coagulopathy",".\n","PEG tube insertion"," was performed on post-operative ","day eight"," under ","intravenous"," ","anesthesia",".\nThe ","esophagogastroduodenoscopy"," (","EGD",") was accomplished without ","difficulty",", revealing ","diffuse"," ","moderately"," ","erythematous"," ","mucosa"," without ","bleeding"," in the ","gastric antrum",".\nWhile attempting ","PEG tube placemen","t, a ","rapidly expanding"," ","hematoma"," (Figure 1) developed at the ","needle insertion site",".\nThe ","procedure"," was stopped and the patient was ","sent back"," to the ","ICU"," with a ","nasogastric tube",".\nA ","single dose"," of ","intravenous"," ","desmopressin"," (","0.3 microgram\/kilogram",") was administered under the suspicion of ","uremic bleeding",".\nNo further ","gastrointestinal"," ","bleeding"," events were noted.\nTo assess ","platelet function",", a ","platelet function assay"," (","PFA",") was ordered after ","desmopressin"," ","injection",".\n","PFA"," ","collagen\/epinephrine closure time"," was ","195 seconds"," (normal <174 seconds), and ","collagen\/ADP closure time"," was ","76 seconds"," (normal <120 seconds), indicating ","platelet dysfunction"," due to either ","aspirin"," or ","uremia",".\n","Aspirin"," was discontinued, and he was ","monitored"," with a ","daily"," ","complete blood count"," and ","metabolic panel",".\n","Three days later"," the patient underwent a second attempt at ","PEG tube placement",".\n","PFA"," ","collagen\/epinephrine closure time"," prior to this ","procedure"," had ","gone down"," to ","141 seconds",", possibly due to withholding ","aspirin"," and an ","improvement"," in ","renal function",".\n","EGD"," showed an area of ","flat",", ","bluish"," ","gastric submucosal"," ","bruising"," at the site of the previous ","hematoma"," (Figure 2).\nThe ","PEG tube"," was placed successfully at an ","adjacent site",".\nOver the course of the ","following month",", the patient continued to undergo ","feeding"," through the ","PEG tube"," with no ","adverse events",".\n"],"ner_labels":[0,5,0,58,0,65,0,22,0,26,0,22,0,26,0,13,0,75,0,75,0,19,0,69,0,26,0,75,0,75,0,22,0,75,0,13,0,48,0,48,0,48,0,13,0,26,0,75,0,75,0,19,0,75,0,75,0,69,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,22,0,24,0,42,0,22,0,24,0,42,0,46,0,29,0,75,0,46,0,39,0,75,0,19,0,4,0,46,0,24,0,24,0,53,0,22,0,63,0,69,0,12,0,69,0,12,0,75,0,63,0,69,0,12,0,18,0,13,0,48,0,75,0,29,0,4,0,46,0,29,0,69,0,12,0,69,0,24,0,24,0,24,0,46,0,4,0,24,0,24,0,42,0,24,0,42,0,26,0,46,0,26,0,46,0,75,0,35,0,24,0,24,0,19,0,75,0,24,0,24,0,18,0,42,0,42,0,46,0,42,0,24,0,24,0,73,0,15,0,12,0,69,0,69,0,75,0,12,0,32,0,75,0,75,0,69,0]}
-{"full_text":"A 46-year-old Caucasian woman with type 2 diabetes mellitus and bipolar disorder presented to our emergency department with vague abdominal symptoms and vomiting.\nHer pertinent history includes left below knee amputation and right toes amputation for complications secondary to diabetic neuropathy.\nAt the time of admission, she was undergoing care for an infected diabetic ulcer of her right foot.\nOf note, she did not have a history of CAPD or a history of renal disease: creatinine 1.23 mg\/dL, blood urea nitrogen (BUN) 16 mg\/dL.\nHer blood glucose levels were poorly controlled via subcutaneous insulin injection; she reported a range of 400 to 500 mg\/dL at home (due to poor drug compliance).\nHer blood glucose levels were decreased to a range of 175 to 378 mg\/dL after implementation of a stricter insulin regimen upon admission.\nA non-contrast CT scan showed confluent, bilobar geographic regions of hypoattenuation in a subcapsular distribution throughout her liver (Fig.1).\nA MRI liver protocol was performed for further evaluation of these indeterminate findings to assess for possible vascular etiology as areas of infarction could also be possible in this patient.\nIn-phase gradient echo images demonstrated hyperintense foci in her liver in a distribution corresponding to the hypoattenuating regions seen on CT.\nOn the opposed-phase sequence, there was loss in signal within these areas indicating the presence of intracellular fat and water (Fig.2).\nIn addition, these areas were hypointense to the remaining hepatic parenchyma on the fat suppression MR sequences, confirming presence of fat and thus establishing a diagnosis of SHS.\nFurthermore, a follow-up CT of her abdomen and pelvis was performed 3 months later, which showed near complete resolution of these findings (Fig.3).\nOf note, stricter glucose control had decreased her average blood glucose level to below 200 mg\/dL.\n","ner_info":[{"text":"46-year-old","label":"AGE","start":2,"end":13},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":14,"end":23},{"text":"woman","label":"SEX","start":24,"end":29},{"text":"type 2 diabetes mellitus","label":"HISTORY","start":35,"end":59},{"text":"bipolar disorder","label":"HISTORY","start":64,"end":80},{"text":"presented","label":"CLINICAL_EVENT","start":81,"end":90},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":98,"end":118},{"text":"vague","label":"DETAILED_DESCRIPTION","start":124,"end":129},{"text":"abdominal symptoms","label":"SIGN_SYMPTOM","start":130,"end":148},{"text":"vomiting","label":"SIGN_SYMPTOM","start":153,"end":161},{"text":"left below knee amputation","label":"HISTORY","start":194,"end":220},{"text":"right toes amputation","label":"HISTORY","start":225,"end":246},{"text":"complications secondary to diabetic neuropathy","label":"HISTORY","start":251,"end":297},{"text":"infected","label":"DETAILED_DESCRIPTION","start":356,"end":364},{"text":"diabetic","label":"DETAILED_DESCRIPTION","start":365,"end":373},{"text":"ulcer","label":"SIGN_SYMPTOM","start":374,"end":379},{"text":"right foot","label":"BIOLOGICAL_STRUCTURE","start":387,"end":397},{"text":"CAPD","label":"DISEASE_DISORDER","start":438,"end":442},{"text":"renal disease","label":"DISEASE_DISORDER","start":459,"end":472},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":474,"end":484},{"text":"1.23 mg\/dL","label":"LAB_VALUE","start":485,"end":495},{"text":"blood urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":497,"end":516},{"text":"(BUN)","label":"DIAGNOSTIC_PROCEDURE","start":517,"end":522},{"text":"16 mg\/dL","label":"LAB_VALUE","start":523,"end":531},{"text":"blood glucose levels","label":"DIAGNOSTIC_PROCEDURE","start":537,"end":557},{"text":"poorly controlled","label":"LAB_VALUE","start":563,"end":580},{"text":"subcutaneous","label":"ADMINISTRATION","start":585,"end":597},{"text":"insulin","label":"MEDICATION","start":598,"end":605},{"text":"injection","label":"ADMINISTRATION","start":606,"end":615},{"text":"range of 400 to 500 mg\/dL at home","label":"LAB_VALUE","start":632,"end":665},{"text":"poor drug compliance","label":"CLINICAL_EVENT","start":674,"end":694},{"text":"blood glucose levels","label":"DIAGNOSTIC_PROCEDURE","start":701,"end":721},{"text":"175 to 378 mg\/dL","label":"LAB_VALUE","start":751,"end":767},{"text":"stricter","label":"DETAILED_DESCRIPTION","start":794,"end":802},{"text":"insulin","label":"MEDICATION","start":803,"end":810},{"text":"regimen","label":"DETAILED_DESCRIPTION","start":811,"end":818},{"text":"non-contrast","label":"DETAILED_DESCRIPTION","start":837,"end":849},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":850,"end":857},{"text":"confluent","label":"DETAILED_DESCRIPTION","start":865,"end":874},{"text":"bilobar","label":"BIOLOGICAL_STRUCTURE","start":876,"end":883},{"text":"hypoattenuation","label":"SIGN_SYMPTOM","start":906,"end":921},{"text":"subcapsular distribution","label":"DETAILED_DESCRIPTION","start":927,"end":951},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":967,"end":972},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":984,"end":987},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":988,"end":993},{"text":"In-phase","label":"DETAILED_DESCRIPTION","start":1176,"end":1184},{"text":"gradient echo","label":"DIAGNOSTIC_PROCEDURE","start":1185,"end":1198},{"text":"hyperintense","label":"DETAILED_DESCRIPTION","start":1219,"end":1231},{"text":"foci","label":"SIGN_SYMPTOM","start":1232,"end":1236},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":1244,"end":1249},{"text":"opposed-phase sequence","label":"DIAGNOSTIC_PROCEDURE","start":1332,"end":1354},{"text":"loss in signal","label":"LAB_VALUE","start":1366,"end":1380},{"text":"presence of intracellular fat and water","label":"SIGN_SYMPTOM","start":1415,"end":1454},{"text":"hepatic parenchyma","label":"BIOLOGICAL_STRUCTURE","start":1523,"end":1541},{"text":"MR sequences","label":"COREFERENCE","start":1565,"end":1577},{"text":"presence of fat","label":"SIGN_SYMPTOM","start":1590,"end":1605},{"text":"SHS","label":"DISEASE_DISORDER","start":1643,"end":1646},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1673,"end":1675},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1683,"end":1690},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":1695,"end":1701},{"text":"3 months later","label":"DATE","start":1716,"end":1730},{"text":"near complete resolution","label":"SIGN_SYMPTOM","start":1745,"end":1769},{"text":"glucose control","label":"THERAPEUTIC_PROCEDURE","start":1815,"end":1830},{"text":"blood glucose level","label":"DIAGNOSTIC_PROCEDURE","start":1857,"end":1876},{"text":"below 200 mg\/dL","label":"LAB_VALUE","start":1880,"end":1895}],"tokens":["A ","46-year-old"," ","Caucasian"," ","woman"," with ","type 2 diabetes mellitus"," and ","bipolar disorder"," ","presented"," to our ","emergency department"," with ","vague"," ","abdominal symptoms"," and ","vomiting",".\nHer pertinent history includes ","left below knee amputation"," and ","right toes amputation"," for ","complications secondary to diabetic neuropathy",".\nAt the time of admission, she was undergoing care for an ","infected"," ","diabetic"," ","ulcer"," of her ","right foot",".\nOf note, she did not have a history of ","CAPD"," or a history of ","renal disease",": ","creatinine"," ","1.23 mg\/dL",", ","blood urea nitrogen"," ","(BUN)"," ","16 mg\/dL",".\nHer ","blood glucose levels"," were ","poorly controlled"," via ","subcutaneous"," ","insulin"," ","injection","; she reported a ","range of 400 to 500 mg\/dL at home"," (due to ","poor drug compliance",").\nHer ","blood glucose levels"," were decreased to a range of ","175 to 378 mg\/dL"," after implementation of a ","stricter"," ","insulin"," ","regimen"," upon admission.\nA ","non-contrast"," ","CT scan"," showed ","confluent",", ","bilobar"," geographic regions of ","hypoattenuation"," in a ","subcapsular distribution"," throughout her ","liver"," (Fig.1).\nA ","MRI"," ","liver"," protocol was performed for further evaluation of these indeterminate findings to assess for possible vascular etiology as areas of infarction could also be possible in this patient.\n","In-phase"," ","gradient echo"," images demonstrated ","hyperintense"," ","foci"," in her ","liver"," in a distribution corresponding to the hypoattenuating regions seen on CT.\nOn the ","opposed-phase sequence",", there was ","loss in signal"," within these areas indicating the ","presence of intracellular fat and water"," (Fig.2).\nIn addition, these areas were hypointense to the remaining ","hepatic parenchyma"," on the fat suppression ","MR sequences",", confirming ","presence of fat"," and thus establishing a diagnosis of ","SHS",".\nFurthermore, a follow-up ","CT"," of her ","abdomen"," and ","pelvis"," was performed ","3 months later",", which showed ","near complete resolution"," of these findings (Fig.3).\nOf note, stricter ","glucose control"," had decreased her average ","blood glucose level"," to ","below 200 mg\/dL",".\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,39,0,13,0,48,0,22,0,69,0,69,0,39,0,39,0,39,0,22,0,22,0,69,0,12,0,26,0,26,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,4,0,46,0,4,0,42,0,13,0,24,0,42,0,22,0,46,0,22,0,22,0,24,0,22,0,12,0,69,0,22,0,12,0,24,0,12,0,22,0,24,0,22,0,69,0,12,0,24,0,42,0,69,0,12,0,18,0,69,0,26,0,24,0,12,0,12,0,19,0,69,0,75,0,24,0,42,0]}
-{"full_text":"The 36-year-old male patient in this case had a 6-year history of diffuse cutaneous SSc (Fig.1) and had not received regular follow-up or medication therapy.\nHe had experienced malaise, poor appetite, and progressive shortness of breath for 1 month and oligouria for 3 days.\nHe was admitted to our hospital with renal failure and pulmonary edema.\nIn the emergency department, his blood pressure, pulse rate, and respiratory rate were 174\/127 mm Hg, 88\/min, and 22\/min, respectively.\nLaboratory analysis revealed the following values: white blood cell count, 7730\/\u03bcL (3500\u201311,000\/\u03bcL); hemoglobin, 8.6\u200ag\/dL (12\u201316\u200ag\/dL): platelet count, 87000\/\u03bcL (150,000\u2013400,000\/\u03bcL); blood urea nitrogen, 78\u200amg\/dL (6\u201321\u200amg\/dL); creatinine, 8.9\u200amg\/dL (1.1\u20131.5\u200amg\/dL); calcium, 8.2\u200amg\/dL (8.8\u201310.3\u200amg\/dL); phosphorus, 5.4\u200amg\/dL (2.7\u20134.5\u200amg\/dL); haptoglobin, <6.56\u200amg\/dL (30\u2013200\u200amg\/dL); and lactate dehydrogenase, 547\u200aU\/L (106\u2013211\u200aU\/L).\nA routine urinalysis revealed a proteinuria score of 2+ (200\u200amg\/dL), white blood cell count of 3\u20135\/high power field, and red blood cell count of 25\u201350\/high power field.\nThe autoimmune profile indicated an antinuclear antibody level of 1:320 (speckles; normal, <1:40).\nTests for anti-Scl70, anti-double-stranded DNA, anti-Ro, anti-La, and anticardiolipin antibodies were all negative.\nKidney echogram showed a decreased bilateral kidney size without hydronephrosis.\nDespite the chronic changes visible on the echogram, the patient had developed acute pulmonary edema and oligouria only 3 days before admission.\nAccordingly, a clinical diagnosis of acute-on-chronic renal failure was made.\nA further diagnosis of SRC was supported by the presence of renal failure with microangiopathic hemolytic anemia and hypertension, and the patient was started on captopril therapy.\nThe sustained deterioration in renal function and anuria had led to a requirement for regular hemodialysis from admission.\nAfter 3 days, captopril was changed to amlodipine because the patient developed a severe, intolerable cough thought to be associated with captopril.\nHis systolic blood pressure was controlled between 140 and 180 mm Hg.\nAt approximately 3 weeks after the initiation of maintenance hemodialysis, the patient newly developed a generalized tonic-clonic seizure disorder.\nA brain computed tomography (CT) scan revealed a small lacunar infarct over the left basal ganglion without intracranial hemorrhage or large infarct.\nThe seizure resolved spontaneously without anticonvulsants, and the patient was finally discharged home without incident and scheduled for regular hemodialysis thrice weekly.\nHowever, at 1 week after discharge, the patient developed a sudden-onset headache and vomiting with confusion and recurrence of the generalized tonic-clonic seizure.\nHe presented at the emergency department with a blood pressure of 183\/100 mm Hg, platelet count of 149,000\/\u03bcL, serum LDH of 332\u200aU\/L, and a peripheral blood smear containing 2\u20133\u200aschizocytes\/HPF (Fig.2).\nBrain CT revealed no interval change, and lumbar puncture revealed traumatic tapping only.\nCerebrospinal fluid cultures were negative for bacteria, mycobacteria, and viruses.\nBrain magnetic resonance imaging (MRI) showed bilateral hyperintensity in the occipital and parietal lobes on a fluid-attenuated inversion recovery (FLAIR) sequence (Fig.3).\nFinally, the patient was diagnosed with PRES.\nWe resumed captopril therapy at a dose of 25\u200amg thrice daily.\nAs it was difficult to differentiate SRC from TTP, we also considered plasma exchange treatment.\nHowever, the patient's mental status returned to normal within 3 days in the absence of plasma exchange, and a follow-up MRI of the brain 2 months later showed complete resolution of cerebral edema (Fig.4).\nTherefore, SRC-related PRES was confirmed.\nAlthough the patient experienced a full neurologic recovery, his renal function did not improve and he remained dialysis dependent.\n","ner_info":[{"text":"36-year-old","label":"AGE","start":4,"end":15},{"text":"male","label":"SEX","start":16,"end":20},{"text":"6-year","label":"DURATION","start":48,"end":54},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":66,"end":73},{"text":"cutaneous","label":"BIOLOGICAL_STRUCTURE","start":74,"end":83},{"text":"SSc","label":"DISEASE_DISORDER","start":84,"end":87},{"text":"follow-up","label":"CLINICAL_EVENT","start":125,"end":134},{"text":"medication","label":"MEDICATION","start":138,"end":148},{"text":"malaise","label":"SIGN_SYMPTOM","start":177,"end":184},{"text":"poor appetite","label":"SIGN_SYMPTOM","start":186,"end":199},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":205,"end":216},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":217,"end":236},{"text":"1 month","label":"DURATION","start":241,"end":248},{"text":"oligouria","label":"SIGN_SYMPTOM","start":253,"end":262},{"text":"3 days","label":"DURATION","start":267,"end":273},{"text":"admitted","label":"CLINICAL_EVENT","start":282,"end":290},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":298,"end":306},{"text":"renal failure","label":"DISEASE_DISORDER","start":312,"end":325},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":330,"end":339},{"text":"edema","label":"SIGN_SYMPTOM","start":340,"end":345},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":380,"end":394},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":406},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":412,"end":428},{"text":"174\/127 mm Hg","label":"LAB_VALUE","start":434,"end":447},{"text":"88\/min","label":"LAB_VALUE","start":449,"end":455},{"text":"22\/min","label":"LAB_VALUE","start":461,"end":467},{"text":"Laboratory analysis","label":"DIAGNOSTIC_PROCEDURE","start":483,"end":502},{"text":"white blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":534,"end":556},{"text":"7730\/\u03bcL","label":"LAB_VALUE","start":558,"end":565},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":584,"end":594},{"text":"8.6\u200ag\/dL","label":"LAB_VALUE","start":596,"end":604},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":619,"end":633},{"text":"87000\/\u03bcL","label":"LAB_VALUE","start":635,"end":643},{"text":"blood urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":666,"end":685},{"text":"78\u200amg\/dL","label":"LAB_VALUE","start":687,"end":695},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":710,"end":720},{"text":"8.9\u200amg\/dL","label":"LAB_VALUE","start":722,"end":731},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":749,"end":756},{"text":"8.2\u200amg\/dL","label":"LAB_VALUE","start":758,"end":767},{"text":"phosphorus","label":"DIAGNOSTIC_PROCEDURE","start":786,"end":796},{"text":"5.4\u200amg\/dL","label":"LAB_VALUE","start":798,"end":807},{"text":"haptoglobin","label":"DIAGNOSTIC_PROCEDURE","start":825,"end":836},{"text":"<6.56\u200amg\/dL","label":"LAB_VALUE","start":838,"end":849},{"text":"lactate dehydrogenase","label":"DIAGNOSTIC_PROCEDURE","start":870,"end":891},{"text":"547\u200aU\/L","label":"LAB_VALUE","start":893,"end":900},{"text":"urinalysis","label":"DIAGNOSTIC_PROCEDURE","start":926,"end":936},{"text":"proteinuria score of 2+","label":"LAB_VALUE","start":948,"end":971},{"text":"200\u200amg\/dL","label":"LAB_VALUE","start":973,"end":982},{"text":"white blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":985,"end":1007},{"text":"3\u20135\/high power field","label":"LAB_VALUE","start":1011,"end":1031},{"text":"red blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":1037,"end":1057},{"text":"25\u201350\/high power field","label":"LAB_VALUE","start":1061,"end":1083},{"text":"autoimmune profile","label":"DIAGNOSTIC_PROCEDURE","start":1089,"end":1107},{"text":"antinuclear antibody","label":"DIAGNOSTIC_PROCEDURE","start":1121,"end":1141},{"text":"1:320","label":"LAB_VALUE","start":1151,"end":1156},{"text":"speckles; normal","label":"LAB_VALUE","start":1158,"end":1174},{"text":"<1:40","label":"LAB_VALUE","start":1176,"end":1181},{"text":"anti-Scl70","label":"DIAGNOSTIC_PROCEDURE","start":1194,"end":1204},{"text":"anti-double-stranded DNA","label":"DIAGNOSTIC_PROCEDURE","start":1206,"end":1230},{"text":"anti-Ro","label":"DIAGNOSTIC_PROCEDURE","start":1232,"end":1239},{"text":"anti-La","label":"DIAGNOSTIC_PROCEDURE","start":1241,"end":1248},{"text":"anticardiolipin antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1254,"end":1280},{"text":"negative","label":"LAB_VALUE","start":1290,"end":1298},{"text":"Kidney","label":"BIOLOGICAL_STRUCTURE","start":1300,"end":1306},{"text":"echogram","label":"DIAGNOSTIC_PROCEDURE","start":1307,"end":1315},{"text":"decreased bilateral kidney size","label":"SIGN_SYMPTOM","start":1325,"end":1356},{"text":"hydronephrosis","label":"SIGN_SYMPTOM","start":1365,"end":1379},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1466,"end":1475},{"text":"edema","label":"SIGN_SYMPTOM","start":1476,"end":1481},{"text":"oligouria","label":"SIGN_SYMPTOM","start":1486,"end":1495},{"text":"3 days before","label":"DATE","start":1501,"end":1514},{"text":"acute-on-chronic","label":"DETAILED_DESCRIPTION","start":1563,"end":1579},{"text":"renal failure","label":"DISEASE_DISORDER","start":1580,"end":1593},{"text":"SRC","label":"DISEASE_DISORDER","start":1627,"end":1630},{"text":"renal failure","label":"DISEASE_DISORDER","start":1664,"end":1677},{"text":"microangiopathic","label":"DETAILED_DESCRIPTION","start":1683,"end":1699},{"text":"hemolytic","label":"DETAILED_DESCRIPTION","start":1700,"end":1709},{"text":"anemia","label":"SIGN_SYMPTOM","start":1710,"end":1716},{"text":"hypertension","label":"SIGN_SYMPTOM","start":1721,"end":1733},{"text":"captopril","label":"MEDICATION","start":1766,"end":1775},{"text":"deterioration in renal function","label":"SIGN_SYMPTOM","start":1799,"end":1830},{"text":"anuria","label":"SIGN_SYMPTOM","start":1835,"end":1841},{"text":"regular","label":"DETAILED_DESCRIPTION","start":1871,"end":1878},{"text":"hemodialysis","label":"THERAPEUTIC_PROCEDURE","start":1879,"end":1891},{"text":"After 3 days","label":"DATE","start":1908,"end":1920},{"text":"captopril","label":"MEDICATION","start":1922,"end":1931},{"text":"amlodipine","label":"MEDICATION","start":1947,"end":1957},{"text":"severe","label":"SEVERITY","start":1990,"end":1996},{"text":"intolerable","label":"DETAILED_DESCRIPTION","start":1998,"end":2009},{"text":"cough","label":"SIGN_SYMPTOM","start":2010,"end":2015},{"text":"systolic blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":2061,"end":2084},{"text":"controlled","label":"LAB_VALUE","start":2089,"end":2099},{"text":"between 140 and 180 mm Hg","label":"LAB_VALUE","start":2100,"end":2125},{"text":"3 weeks after","label":"DATE","start":2144,"end":2157},{"text":"hemodialysis","label":"COREFERENCE","start":2188,"end":2200},{"text":"generalized","label":"DETAILED_DESCRIPTION","start":2232,"end":2243},{"text":"tonic-clonic","label":"DETAILED_DESCRIPTION","start":2244,"end":2256},{"text":"seizure disorder","label":"DISEASE_DISORDER","start":2257,"end":2273},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":2277,"end":2282},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":2283,"end":2302},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2304,"end":2306},{"text":"small","label":"SEVERITY","start":2324,"end":2329},{"text":"lacunar","label":"DETAILED_DESCRIPTION","start":2330,"end":2337},{"text":"infarct","label":"DISEASE_DISORDER","start":2338,"end":2345},{"text":"left basal ganglion","label":"BIOLOGICAL_STRUCTURE","start":2355,"end":2374},{"text":"intracranial","label":"BIOLOGICAL_STRUCTURE","start":2383,"end":2395},{"text":"hemorrhage","label":"DISEASE_DISORDER","start":2396,"end":2406},{"text":"large","label":"SEVERITY","start":2410,"end":2415},{"text":"infarct","label":"DISEASE_DISORDER","start":2416,"end":2423},{"text":"seizure","label":"SIGN_SYMPTOM","start":2429,"end":2436},{"text":"anticonvulsants","label":"MEDICATION","start":2468,"end":2483},{"text":"discharged","label":"CLINICAL_EVENT","start":2513,"end":2523},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":2524,"end":2528},{"text":"hemodialysis","label":"THERAPEUTIC_PROCEDURE","start":2572,"end":2584},{"text":"thrice weekly","label":"FREQUENCY","start":2585,"end":2598},{"text":"1 week after","label":"DATE","start":2612,"end":2624},{"text":"sudden-onset","label":"DETAILED_DESCRIPTION","start":2660,"end":2672},{"text":"headache","label":"SIGN_SYMPTOM","start":2673,"end":2681},{"text":"vomiting","label":"SIGN_SYMPTOM","start":2686,"end":2694},{"text":"confusion","label":"SIGN_SYMPTOM","start":2700,"end":2709},{"text":"generalized","label":"DETAILED_DESCRIPTION","start":2732,"end":2743},{"text":"tonic-clonic","label":"DETAILED_DESCRIPTION","start":2744,"end":2756},{"text":"seizure","label":"SIGN_SYMPTOM","start":2757,"end":2764},{"text":"presented","label":"CLINICAL_EVENT","start":2769,"end":2778},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":2786,"end":2806},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":2814,"end":2828},{"text":"183\/100 mm Hg","label":"LAB_VALUE","start":2832,"end":2845},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2847,"end":2861},{"text":"149,000\/\u03bcL","label":"LAB_VALUE","start":2865,"end":2875},{"text":"serum LDH","label":"DIAGNOSTIC_PROCEDURE","start":2877,"end":2886},{"text":"332\u200aU\/L","label":"LAB_VALUE","start":2890,"end":2897},{"text":"peripheral blood smear","label":"DIAGNOSTIC_PROCEDURE","start":2905,"end":2927},{"text":"containing 2\u20133\u200aschizocytes\/HPF","label":"LAB_VALUE","start":2928,"end":2958},{"text":"Brain","label":"BIOLOGICAL_STRUCTURE","start":2968,"end":2973},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2974,"end":2976},{"text":"no interval change","label":"LAB_VALUE","start":2986,"end":3004},{"text":"lumbar puncture","label":"DIAGNOSTIC_PROCEDURE","start":3010,"end":3025},{"text":"traumatic tapping only","label":"LAB_VALUE","start":3035,"end":3057},{"text":"Cerebrospinal","label":"BIOLOGICAL_STRUCTURE","start":3059,"end":3072},{"text":"fluid cultures","label":"DIAGNOSTIC_PROCEDURE","start":3073,"end":3087},{"text":"negative","label":"LAB_VALUE","start":3093,"end":3101},{"text":"bacteria","label":"DETAILED_DESCRIPTION","start":3106,"end":3114},{"text":"mycobacteria","label":"DETAILED_DESCRIPTION","start":3116,"end":3128},{"text":"viruses","label":"DETAILED_DESCRIPTION","start":3134,"end":3141},{"text":"Brain","label":"BIOLOGICAL_STRUCTURE","start":3143,"end":3148},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":3149,"end":3175},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":3177,"end":3180},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":3189,"end":3198},{"text":"hyperintensity","label":"SIGN_SYMPTOM","start":3199,"end":3213},{"text":"occipital and parietal lobes","label":"BIOLOGICAL_STRUCTURE","start":3221,"end":3249},{"text":"fluid-attenuated inversion recovery (FLAIR) sequence","label":"DETAILED_DESCRIPTION","start":3255,"end":3307},{"text":"PRES","label":"DISEASE_DISORDER","start":3357,"end":3361},{"text":"captopril","label":"MEDICATION","start":3374,"end":3383},{"text":"25\u200amg thrice daily","label":"DOSAGE","start":3405,"end":3423},{"text":"mental status","label":"DIAGNOSTIC_PROCEDURE","start":3545,"end":3558},{"text":"normal","label":"LAB_VALUE","start":3571,"end":3577},{"text":"3 days","label":"DATE","start":3585,"end":3591},{"text":"plasma exchange","label":"THERAPEUTIC_PROCEDURE","start":3610,"end":3625},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":3643,"end":3646},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":3654,"end":3659},{"text":"2 months later","label":"DATE","start":3660,"end":3674},{"text":"cerebral","label":"BIOLOGICAL_STRUCTURE","start":3705,"end":3713},{"text":"edema","label":"SIGN_SYMPTOM","start":3714,"end":3719},{"text":"SRC-related","label":"DETAILED_DESCRIPTION","start":3740,"end":3751},{"text":"PRES","label":"DISEASE_DISORDER","start":3752,"end":3756},{"text":"full neurologic recovery","label":"SIGN_SYMPTOM","start":3807,"end":3831},{"text":"renal function","label":"DIAGNOSTIC_PROCEDURE","start":3837,"end":3851},{"text":"did not improve","label":"LAB_VALUE","start":3852,"end":3867},{"text":"dialysis","label":"THERAPEUTIC_PROCEDURE","start":3884,"end":3892},{"text":"dependent","label":"DETAILED_DESCRIPTION","start":3893,"end":3902}],"tokens":["The ","36-year-old"," ","male"," patient in this case had a ","6-year"," history of ","diffuse"," ","cutaneous"," ","SSc"," (Fig.1) and had not received regular ","follow-up"," or ","medication"," therapy.\nHe had experienced ","malaise",", ","poor appetite",", and ","progressive"," ","shortness of breath"," for ","1 month"," and ","oligouria"," for ","3 days",".\nHe was ","admitted"," to our ","hospital"," with ","renal failure"," and ","pulmonary"," ","edema",".\nIn the emergency department, his ","blood pressure",", ","pulse rate",", and ","respiratory rate"," were ","174\/127 mm Hg",", ","88\/min",", and ","22\/min",", respectively.\n","Laboratory analysis"," revealed the following values: ","white blood cell count",", ","7730\/\u03bcL"," (3500\u201311,000\/\u03bcL); ","hemoglobin",", ","8.6\u200ag\/dL"," (12\u201316\u200ag\/dL): ","platelet count",", ","87000\/\u03bcL"," (150,000\u2013400,000\/\u03bcL); ","blood urea nitrogen",", ","78\u200amg\/dL"," (6\u201321\u200amg\/dL); ","creatinine",", ","8.9\u200amg\/dL"," (1.1\u20131.5\u200amg\/dL); ","calcium",", ","8.2\u200amg\/dL"," (8.8\u201310.3\u200amg\/dL); ","phosphorus",", ","5.4\u200amg\/dL"," (2.7\u20134.5\u200amg\/dL); ","haptoglobin",", ","<6.56\u200amg\/dL"," (30\u2013200\u200amg\/dL); and ","lactate dehydrogenase",", ","547\u200aU\/L"," (106\u2013211\u200aU\/L).\nA routine ","urinalysis"," revealed a ","proteinuria score of 2+"," (","200\u200amg\/dL","), ","white blood cell count"," of ","3\u20135\/high power field",", and ","red blood cell count"," of ","25\u201350\/high power field",".\nThe ","autoimmune profile"," indicated an ","antinuclear antibody"," level of ","1:320"," (","speckles; normal",", ","<1:40",").\nTests for ","anti-Scl70",", ","anti-double-stranded DNA",", ","anti-Ro",", ","anti-La",", and ","anticardiolipin antibodies"," were all ","negative",".\n","Kidney"," ","echogram"," showed a ","decreased bilateral kidney size"," without ","hydronephrosis",".\nDespite the chronic changes visible on the echogram, the patient had developed acute ","pulmonary"," ","edema"," and ","oligouria"," only ","3 days before"," admission.\nAccordingly, a clinical diagnosis of ","acute-on-chronic"," ","renal failure"," was made.\nA further diagnosis of ","SRC"," was supported by the presence of ","renal failure"," with ","microangiopathic"," ","hemolytic"," ","anemia"," and ","hypertension",", and the patient was started on ","captopril"," therapy.\nThe sustained ","deterioration in renal function"," and ","anuria"," had led to a requirement for ","regular"," ","hemodialysis"," from admission.\n","After 3 days",", ","captopril"," was changed to ","amlodipine"," because the patient developed a ","severe",", ","intolerable"," ","cough"," thought to be associated with captopril.\nHis ","systolic blood pressure"," was ","controlled"," ","between 140 and 180 mm Hg",".\nAt approximately ","3 weeks after"," the initiation of maintenance ","hemodialysis",", the patient newly developed a ","generalized"," ","tonic-clonic"," ","seizure disorder",".\nA ","brain"," ","computed tomography"," (","CT",") scan revealed a ","small"," ","lacunar"," ","infarct"," over the ","left basal ganglion"," without ","intracranial"," ","hemorrhage"," or ","large"," ","infarct",".\nThe ","seizure"," resolved spontaneously without ","anticonvulsants",", and the patient was finally ","discharged"," ","home"," without incident and scheduled for regular ","hemodialysis"," ","thrice weekly",".\nHowever, at ","1 week after"," discharge, the patient developed a ","sudden-onset"," ","headache"," and ","vomiting"," with ","confusion"," and recurrence of the ","generalized"," ","tonic-clonic"," ","seizure",".\nHe ","presented"," at the ","emergency department"," with a ","blood pressure"," of ","183\/100 mm Hg",", ","platelet count"," of ","149,000\/\u03bcL",", ","serum LDH"," of ","332\u200aU\/L",", and a ","peripheral blood smear"," ","containing 2\u20133\u200aschizocytes\/HPF"," (Fig.2).\n","Brain"," ","CT"," revealed ","no interval change",", and ","lumbar puncture"," revealed ","traumatic tapping only",".\n","Cerebrospinal"," ","fluid cultures"," were ","negative"," for ","bacteria",", ","mycobacteria",", and ","viruses",".\n","Brain"," ","magnetic resonance imaging"," (","MRI",") showed ","bilateral"," ","hyperintensity"," in the ","occipital and parietal lobes"," on a ","fluid-attenuated inversion recovery (FLAIR) sequence"," (Fig.3).\nFinally, the patient was diagnosed with ","PRES",".\nWe resumed ","captopril"," therapy at a dose of ","25\u200amg thrice daily",".\nAs it was difficult to differentiate SRC from TTP, we also considered plasma exchange treatment.\nHowever, the patient's ","mental status"," returned to ","normal"," within ","3 days"," in the absence of ","plasma exchange",", and a follow-up ","MRI"," of the ","brain"," ","2 months later"," showed complete resolution of ","cerebral"," ","edema"," (Fig.4).\nTherefore, ","SRC-related"," ","PRES"," was confirmed.\nAlthough the patient experienced a ","full neurologic recovery",", his ","renal function"," ","did not improve"," and he remained ","dialysis"," ","dependent",".\n"],"ner_labels":[0,5,0,65,0,32,0,22,0,12,0,26,0,13,0,46,0,69,0,69,0,22,0,69,0,32,0,69,0,32,0,13,0,48,0,26,0,12,0,69,0,24,0,24,0,24,0,42,0,42,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,42,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,12,0,24,0,69,0,69,0,12,0,69,0,69,0,19,0,22,0,26,0,26,0,26,0,22,0,22,0,69,0,69,0,46,0,69,0,69,0,22,0,75,0,19,0,46,0,46,0,63,0,22,0,69,0,24,0,42,0,42,0,19,0,18,0,22,0,22,0,26,0,12,0,24,0,24,0,63,0,22,0,26,0,12,0,12,0,26,0,63,0,26,0,69,0,46,0,13,0,48,0,75,0,35,0,19,0,22,0,69,0,69,0,69,0,22,0,22,0,69,0,13,0,48,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,42,0,24,0,42,0,12,0,24,0,42,0,22,0,22,0,22,0,12,0,24,0,24,0,22,0,69,0,12,0,22,0,26,0,46,0,29,0,24,0,42,0,19,0,75,0,24,0,12,0,19,0,12,0,69,0,22,0,26,0,69,0,24,0,42,0,75,0,22,0]}
-{"full_text":"A 53-year-old woman presented to our institution with progressive abdominal distention and irregular vaginal bleeding of several weeks\u2019 duration.\nA contrast CT abdomen and pelvis revealed an ill-defined, irregular mass in the lower uterine\/cervical region (Figure 1).\nThere were multiple peritoneal and omental masses, enlarged pelvic and paraaortic lymph nodes, and large-volume ascites.\nThe initial CBC was significant for hemoglobin of 9.2 g\/dL, leukocytosis of 36 790 per microliter, and thrombocytosis of 625 000 per microliter.\nSerum calcium was elevated at 13.1 mg\/dL.\nBUN and creatinine were within normal limits.\nHepatic function was within normal limits.\nA pelvic exam revealed a fungating vaginal mass.\nThe patient underwent biopsies of the endometrium and the vaginal mass, which revealed a high-grade tumor with predominantly oval-shaped cells.\nImmunohistochemical staining was positive for vimentin, CD10, and cyclin D1, consistent with a diagnosis of high-grade endometrial stromal sarcoma (Figure 2).\nThe tumor was negative for ER, with rare cells positive for PR.\nAlthough immunohistochemical staining for cytokeratins was negative, a biphasic component could not be entirely ruled out given the small size of the biopsy specimen relative to the tumor.\nThe patient\u2019s Ca125 was markedly elevated at 1624 U\/mL (nl \u226434).\nContrast CT chest revealed a right-sided pleural effusion but no suspicious nodules or lymphadenopathy.\nThe patient was deemed to have operable disease and was scheduled for debulking surgery.\nHowever, preoperative laboratory studies showed that her serum calcium had further increased to 19.2 mg\/dL.\nShe had also developed evidence of acute kidney injury, with her BUN rising to 37 mg\/dL and creatinine to 1.81 mg\/dL.\nOn physical exam, she was noted to be lethargic, with dry mucous membranes.\nThe surgery was cancelled due to the patient\u2019s medical instability.\nFurther workup revealed an elevated PTHrP of 301 pg\/mL (nl 14\u201327), a depressed PTH level of 3 pg\/mL (nl 15\u201365), and a depressed 25-OH vitamin D level of 16 ng\/mL (nl 30\u2013100), consistent with humoral hypercalcemia of malignancy.\nThe patient was treated with pamidronate, calcitonin, and intravenous fluids.\nShe eventually required temporary hemodialysis and denosumab for refractory hypercalcemia.\nThe patient improved with regard to her electrolyte abnormalities.\nGiven the extent of her disease, she was planned for neoadjuvant chemotherapy followed by surgery if a good response was achieved.\nShe was started on a regimen of carboplatin and paclitaxel, which she received for 3 cycles.\nShe also had palliative radiation to the uterus to control bleeding.\nHowever, her disease failed to respond significantly to chemotherapy, and she ultimately died from complications of malignancy.\n","ner_info":[{"text":"53-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"presented","label":"CLINICAL_EVENT","start":20,"end":29},{"text":"institution","label":"NONBIOLOGICAL_LOCATION","start":37,"end":48},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":54,"end":65},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":66,"end":75},{"text":"distention","label":"SIGN_SYMPTOM","start":76,"end":86},{"text":"irregular","label":"DETAILED_DESCRIPTION","start":91,"end":100},{"text":"vaginal","label":"BIOLOGICAL_STRUCTURE","start":101,"end":108},{"text":"bleeding","label":"SIGN_SYMPTOM","start":109,"end":117},{"text":"several weeks","label":"DURATION","start":121,"end":134},{"text":"contrast","label":"DETAILED_DESCRIPTION","start":148,"end":156},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":157,"end":159},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":160,"end":167},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":172,"end":178},{"text":"ill-defined","label":"DETAILED_DESCRIPTION","start":191,"end":202},{"text":"irregular","label":"DETAILED_DESCRIPTION","start":204,"end":213},{"text":"mass","label":"SIGN_SYMPTOM","start":214,"end":218},{"text":"lower uterine","label":"BIOLOGICAL_STRUCTURE","start":226,"end":239},{"text":"cervical region","label":"BIOLOGICAL_STRUCTURE","start":240,"end":255},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":279,"end":287},{"text":"peritoneal","label":"BIOLOGICAL_STRUCTURE","start":288,"end":298},{"text":"omental","label":"BIOLOGICAL_STRUCTURE","start":303,"end":310},{"text":"masses","label":"SIGN_SYMPTOM","start":311,"end":317},{"text":"enlarged","label":"SIGN_SYMPTOM","start":319,"end":327},{"text":"pelvic","label":"BIOLOGICAL_STRUCTURE","start":328,"end":334},{"text":"paraaortic","label":"BIOLOGICAL_STRUCTURE","start":339,"end":349},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":350,"end":361},{"text":"large-volume","label":"DETAILED_DESCRIPTION","start":367,"end":379},{"text":"ascites","label":"SIGN_SYMPTOM","start":380,"end":387},{"text":"CBC","label":"DIAGNOSTIC_PROCEDURE","start":401,"end":404},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":425,"end":435},{"text":"9.2 g\/dL","label":"LAB_VALUE","start":439,"end":447},{"text":"leukocytosis","label":"SIGN_SYMPTOM","start":449,"end":461},{"text":"36 790 per microliter","label":"LAB_VALUE","start":465,"end":486},{"text":"thrombocytosis","label":"SIGN_SYMPTOM","start":492,"end":506},{"text":"625 000 per microliter","label":"LAB_VALUE","start":510,"end":532},{"text":"Serum","label":"BIOLOGICAL_STRUCTURE","start":534,"end":539},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":540,"end":547},{"text":"elevated","label":"LAB_VALUE","start":552,"end":560},{"text":"13.1 mg\/dL","label":"LAB_VALUE","start":564,"end":574},{"text":"BUN","label":"DIAGNOSTIC_PROCEDURE","start":576,"end":579},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":584,"end":594},{"text":"within normal limits","label":"LAB_VALUE","start":600,"end":620},{"text":"Hepatic function","label":"DIAGNOSTIC_PROCEDURE","start":622,"end":638},{"text":"within normal limits","label":"LAB_VALUE","start":643,"end":663},{"text":"pelvic exam","label":"DIAGNOSTIC_PROCEDURE","start":667,"end":678},{"text":"fungating","label":"DETAILED_DESCRIPTION","start":690,"end":699},{"text":"vaginal","label":"BIOLOGICAL_STRUCTURE","start":700,"end":707},{"text":"mass","label":"SIGN_SYMPTOM","start":708,"end":712},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":736,"end":744},{"text":"endometrium","label":"BIOLOGICAL_STRUCTURE","start":752,"end":763},{"text":"vaginal","label":"BIOLOGICAL_STRUCTURE","start":772,"end":779},{"text":"mass","label":"COREFERENCE","start":780,"end":784},{"text":"high-grade","label":"SEVERITY","start":803,"end":813},{"text":"tumor","label":"SIGN_SYMPTOM","start":814,"end":819},{"text":"predominantly oval-shaped cells","label":"DETAILED_DESCRIPTION","start":825,"end":856},{"text":"Immunohistochemical staining","label":"DIAGNOSTIC_PROCEDURE","start":858,"end":886},{"text":"positive","label":"LAB_VALUE","start":891,"end":899},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":904,"end":912},{"text":"CD10","label":"DIAGNOSTIC_PROCEDURE","start":914,"end":918},{"text":"cyclin D1","label":"DIAGNOSTIC_PROCEDURE","start":924,"end":933},{"text":"high-grade","label":"SEVERITY","start":966,"end":976},{"text":"endometrial stromal sarcoma","label":"DISEASE_DISORDER","start":977,"end":1004},{"text":"tumor","label":"COREFERENCE","start":1021,"end":1026},{"text":"negative","label":"LAB_VALUE","start":1031,"end":1039},{"text":"ER","label":"DIAGNOSTIC_PROCEDURE","start":1044,"end":1046},{"text":"rare cells","label":"DETAILED_DESCRIPTION","start":1053,"end":1063},{"text":"positive","label":"LAB_VALUE","start":1064,"end":1072},{"text":"PR","label":"DIAGNOSTIC_PROCEDURE","start":1077,"end":1079},{"text":"immunohistochemical staining","label":"DIAGNOSTIC_PROCEDURE","start":1090,"end":1118},{"text":"cytokeratins","label":"DIAGNOSTIC_PROCEDURE","start":1123,"end":1135},{"text":"negative","label":"LAB_VALUE","start":1140,"end":1148},{"text":"biphasic component","label":"SIGN_SYMPTOM","start":1152,"end":1170},{"text":"Ca125","label":"DIAGNOSTIC_PROCEDURE","start":1284,"end":1289},{"text":"elevated","label":"LAB_VALUE","start":1303,"end":1311},{"text":"1624 U\/mL","label":"LAB_VALUE","start":1315,"end":1324},{"text":"Contrast","label":"DETAILED_DESCRIPTION","start":1335,"end":1343},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1344,"end":1346},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1347,"end":1352},{"text":"right-sided","label":"DETAILED_DESCRIPTION","start":1364,"end":1375},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":1376,"end":1392},{"text":"suspicious","label":"DETAILED_DESCRIPTION","start":1400,"end":1410},{"text":"nodules","label":"SIGN_SYMPTOM","start":1411,"end":1418},{"text":"lymphadenopathy","label":"DISEASE_DISORDER","start":1422,"end":1437},{"text":"operable disease","label":"DISEASE_DISORDER","start":1470,"end":1486},{"text":"debulking surgery","label":"THERAPEUTIC_PROCEDURE","start":1509,"end":1526},{"text":"laboratory studies","label":"DIAGNOSTIC_PROCEDURE","start":1550,"end":1568},{"text":"serum","label":"BIOLOGICAL_STRUCTURE","start":1585,"end":1590},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":1591,"end":1598},{"text":"increased","label":"LAB_VALUE","start":1611,"end":1620},{"text":"19.2 mg\/dL","label":"LAB_VALUE","start":1624,"end":1634},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1671,"end":1676},{"text":"kidney","label":"BIOLOGICAL_STRUCTURE","start":1677,"end":1683},{"text":"injury","label":"DISEASE_DISORDER","start":1684,"end":1690},{"text":"BUN","label":"DIAGNOSTIC_PROCEDURE","start":1701,"end":1704},{"text":"rising","label":"LAB_VALUE","start":1705,"end":1711},{"text":"37 mg\/dL","label":"LAB_VALUE","start":1715,"end":1723},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1728,"end":1738},{"text":"1.81 mg\/dL","label":"LAB_VALUE","start":1742,"end":1752},{"text":"physical exam","label":"DIAGNOSTIC_PROCEDURE","start":1757,"end":1770},{"text":"lethargic","label":"SIGN_SYMPTOM","start":1792,"end":1801},{"text":"dry","label":"SIGN_SYMPTOM","start":1808,"end":1811},{"text":"mucous membranes","label":"BIOLOGICAL_STRUCTURE","start":1812,"end":1828},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":1834,"end":1841},{"text":"cancelled","label":"CLINICAL_EVENT","start":1846,"end":1855},{"text":"medical instability","label":"DISEASE_DISORDER","start":1877,"end":1896},{"text":"elevated","label":"LAB_VALUE","start":1925,"end":1933},{"text":"PTHrP","label":"DIAGNOSTIC_PROCEDURE","start":1934,"end":1939},{"text":"301 pg\/mL","label":"LAB_VALUE","start":1943,"end":1952},{"text":"depressed","label":"LAB_VALUE","start":1967,"end":1976},{"text":"PTH","label":"DIAGNOSTIC_PROCEDURE","start":1977,"end":1980},{"text":"3 pg\/mL","label":"LAB_VALUE","start":1990,"end":1997},{"text":"depressed","label":"LAB_VALUE","start":2016,"end":2025},{"text":"25-OH vitamin D","label":"DIAGNOSTIC_PROCEDURE","start":2026,"end":2041},{"text":"16 ng\/mL","label":"LAB_VALUE","start":2051,"end":2059},{"text":"humoral hypercalcemia of malignancy","label":"DISEASE_DISORDER","start":2089,"end":2124},{"text":"pamidronate","label":"MEDICATION","start":2155,"end":2166},{"text":"calcitonin","label":"MEDICATION","start":2168,"end":2178},{"text":"intravenous","label":"ADMINISTRATION","start":2184,"end":2195},{"text":"fluids","label":"MEDICATION","start":2196,"end":2202},{"text":"temporary","label":"DETAILED_DESCRIPTION","start":2228,"end":2237},{"text":"hemodialysis","label":"THERAPEUTIC_PROCEDURE","start":2238,"end":2250},{"text":"denosumab","label":"MEDICATION","start":2255,"end":2264},{"text":"refractory","label":"DETAILED_DESCRIPTION","start":2269,"end":2279},{"text":"hypercalcemia","label":"SIGN_SYMPTOM","start":2280,"end":2293},{"text":"electrolyte abnormalities","label":"COREFERENCE","start":2335,"end":2360},{"text":"chemotherapy","label":"MEDICATION","start":2427,"end":2439},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":2452,"end":2459},{"text":"carboplatin","label":"MEDICATION","start":2525,"end":2536},{"text":"paclitaxel","label":"MEDICATION","start":2541,"end":2551},{"text":"3 cycles","label":"DOSAGE","start":2576,"end":2584},{"text":"radiation","label":"THERAPEUTIC_PROCEDURE","start":2610,"end":2619},{"text":"uterus","label":"BIOLOGICAL_STRUCTURE","start":2627,"end":2633},{"text":"bleeding","label":"SIGN_SYMPTOM","start":2645,"end":2653},{"text":"died","label":"OUTCOME","start":2744,"end":2748},{"text":"complications of malignancy","label":"DISEASE_DISORDER","start":2754,"end":2781}],"tokens":["A ","53-year-old"," ","woman"," ","presented"," to our ","institution"," with ","progressive"," ","abdominal"," ","distention"," and ","irregular"," ","vaginal"," ","bleeding"," of ","several weeks","\u2019 duration.\nA ","contrast"," ","CT"," ","abdomen"," and ","pelvis"," revealed an ","ill-defined",", ","irregular"," ","mass"," in the ","lower uterine","\/","cervical region"," (Figure 1).\nThere were ","multiple"," ","peritoneal"," and ","omental"," ","masses",", ","enlarged"," ","pelvic"," and ","paraaortic"," ","lymph nodes",", and ","large-volume"," ","ascites",".\nThe initial ","CBC"," was significant for ","hemoglobin"," of ","9.2 g\/dL",", ","leukocytosis"," of ","36 790 per microliter",", and ","thrombocytosis"," of ","625 000 per microliter",".\n","Serum"," ","calcium"," was ","elevated"," at ","13.1 mg\/dL",".\n","BUN"," and ","creatinine"," were ","within normal limits",".\n","Hepatic function"," was ","within normal limits",".\nA ","pelvic exam"," revealed a ","fungating"," ","vaginal"," ","mass",".\nThe patient underwent ","biopsies"," of the ","endometrium"," and the ","vaginal"," ","mass",", which revealed a ","high-grade"," ","tumor"," with ","predominantly oval-shaped cells",".\n","Immunohistochemical staining"," was ","positive"," for ","vimentin",", ","CD10",", and ","cyclin D1",", consistent with a diagnosis of ","high-grade"," ","endometrial stromal sarcoma"," (Figure 2).\nThe ","tumor"," was ","negative"," for ","ER",", with ","rare cells"," ","positive"," for ","PR",".\nAlthough ","immunohistochemical staining"," for ","cytokeratins"," was ","negative",", a ","biphasic component"," could not be entirely ruled out given the small size of the biopsy specimen relative to the tumor.\nThe patient\u2019s ","Ca125"," was markedly ","elevated"," at ","1624 U\/mL"," (nl \u226434).\n","Contrast"," ","CT"," ","chest"," revealed a ","right-sided"," ","pleural effusion"," but no ","suspicious"," ","nodules"," or ","lymphadenopathy",".\nThe patient was deemed to have ","operable disease"," and was scheduled for ","debulking surgery",".\nHowever, preoperative ","laboratory studies"," showed that her ","serum"," ","calcium"," had further ","increased"," to ","19.2 mg\/dL",".\nShe had also developed evidence of ","acute"," ","kidney"," ","injury",", with her ","BUN"," ","rising"," to ","37 mg\/dL"," and ","creatinine"," to ","1.81 mg\/dL",".\nOn ","physical exam",", she was noted to be ","lethargic",", with ","dry"," ","mucous membranes",".\nThe ","surgery"," was ","cancelled"," due to the patient\u2019s ","medical instability",".\nFurther workup revealed an ","elevated"," ","PTHrP"," of ","301 pg\/mL"," (nl 14\u201327), a ","depressed"," ","PTH"," level of ","3 pg\/mL"," (nl 15\u201365), and a ","depressed"," ","25-OH vitamin D"," level of ","16 ng\/mL"," (nl 30\u2013100), consistent with ","humoral hypercalcemia of malignancy",".\nThe patient was treated with ","pamidronate",", ","calcitonin",", and ","intravenous"," ","fluids",".\nShe eventually required ","temporary"," ","hemodialysis"," and ","denosumab"," for ","refractory"," ","hypercalcemia",".\nThe patient improved with regard to her ","electrolyte abnormalities",".\nGiven the extent of her disease, she was planned for neoadjuvant ","chemotherapy"," followed by ","surgery"," if a good response was achieved.\nShe was started on a regimen of ","carboplatin"," and ","paclitaxel",", which she received for ","3 cycles",".\nShe also had palliative ","radiation"," to the ","uterus"," to control ","bleeding",".\nHowever, her disease failed to respond significantly to chemotherapy, and she ultimately ","died"," from ","complications of malignancy",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,22,0,12,0,69,0,22,0,12,0,69,0,32,0,22,0,24,0,12,0,12,0,22,0,22,0,69,0,12,0,12,0,22,0,12,0,12,0,69,0,69,0,12,0,12,0,12,0,22,0,69,0,24,0,24,0,42,0,69,0,42,0,69,0,42,0,12,0,24,0,42,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,22,0,12,0,69,0,24,0,12,0,12,0,18,0,63,0,69,0,22,0,24,0,42,0,24,0,24,0,24,0,63,0,26,0,18,0,42,0,24,0,22,0,42,0,24,0,24,0,24,0,42,0,69,0,24,0,42,0,42,0,22,0,24,0,12,0,22,0,26,0,22,0,69,0,26,0,26,0,75,0,24,0,12,0,24,0,42,0,42,0,22,0,12,0,26,0,24,0,42,0,42,0,24,0,42,0,24,0,69,0,69,0,12,0,75,0,13,0,26,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,26,0,46,0,46,0,4,0,46,0,22,0,75,0,46,0,22,0,69,0,18,0,46,0,75,0,46,0,46,0,29,0,75,0,12,0,69,0,56,0,26,0]}
-{"full_text":"A 67-year-old woman was sent to emergency department because of fever and sore throat.\nHer medical history included ESRD with regular hemodialysis 3 times per week for 15 years, hyperuricemia and gout.\nShe also had comorbidity such as dyslipidemia, hypertension, secondary hyperparathyroidism, and diabetes.\nThe hemogram revealed a white blood cell count (WBC) of 700\/\u03bcL, with 2% neutrophils, 94% lymphocytes and 2% monocytes, hemoglobin 11.1\u200ag\/dL, and platelet count, 131,000\/\u03bcL.\nUnder the impression of febrile neutropenia and acute pharyngitis, she was admitted to our hematologic ward for further survey and management.\nBroad-spectrum antibiotics with piperacillin 2\u200ag and tazobactam 0.25\u200agm i.v.\nq8h had been administered and her infection sign resolved gradually.\nUpon admission, we reviewed her oral medication: glipizide 5\u200amg tid, saxagliptin 2.5\u200amg qd, fenofibrate 600\u200amg qd, aluminum hydroxide 324\u200amg tid, folic acid 5\u200amg qd, calcium carbonate 1000\u200amg tid, and febuxostat 40\u200amg qd.\nBesides, she also received epoetin-beta 2000 iu i.v.tiw.\nExcept for febuxostat, all the other drugs had been used for more than 1 year.\nFebuxostat was administered 2\u00bd months before admission for inadequate serum uric acid control by allopurinol 50\u200amg qd.\nTwo weeks before febuxostat exposure, routine laboratory test revealed WBC 6000\/\u03bcL and serum uric acid level 9.8\u200amg\/dL.\nFebuxostat was discontinued thereafter due to the causal relationship of agranulocytosis cannot be excluded.\nBesides, we also surveyed viral infection and autoimmune disorder.\nThere were no clinical or laboratory evidence of Epstein\u2013Barr virus, cytomegalovirus, or human immunodeficiency virus infections; antinuclear antibody (ANA) and antiextractable nuclear antigen (anti-ENA) were both negative.\nBone marrow examination during hospitalization showed hypocellular marrow with a marked decrease in myeloid component but no evidence of hematologic neoplasms.\nChromosome analysis of bone marrow was normal karyotype.\nThe patient denied history of radiation or chemicals exposure.\nAfter stopping febuxostat for 17 days, her neutropenia improved significantly (WBC 2100\/\u03bcL, and neutrophil 66%), without any granulocyte colony-stimulating factor (G-CSF) support.\nAfter discharge, her WBC and differential count was completely normal during follow-up (Fig.1).\nThis study was approved by our institutional review board.\n","ner_info":[{"text":"67-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"sent","label":"CLINICAL_EVENT","start":24,"end":28},{"text":"emergency 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","admitted"," to our ","hematologic ward"," for further survey and management.\n","Broad-spectrum"," ","antibiotics"," with ","piperacillin"," ","2\u200ag"," and ","tazobactam"," ","0.25\u200agm"," ","i.v.","\n","q8h"," had been administered and her ","infection sign"," resolved gradually.\nUpon admission, we reviewed her oral medication: ","glipizide"," ","5\u200amg tid",", ","saxagliptin"," ","2.5\u200amg qd",", ","fenofibrate"," ","600\u200amg qd",", ","aluminum hydroxide"," ","324\u200amg tid",", ","folic acid"," ","5\u200amg qd",", ","calcium carbonate"," ","1000\u200amg tid",", and ","febuxostat"," ","40\u200amg qd",".\nBesides, she also received ","epoetin-beta"," ","2000 iu"," ","i.v.","","tiw",".\nExcept for ","febuxostat",", all the other drugs had been used for ","more than 1 year",".\n","Febuxostat"," was administered ","2\u00bd months before"," admission for inadequate serum uric acid control by ","allopurinol"," ","50\u200amg qd",".\n","Two weeks before"," febuxostat exposure, routine ","laboratory test"," revealed ","WBC"," ","6000\/\u03bcL"," and ","serum"," ","uric acid"," level ","9.8\u200amg\/dL",".\n","Febuxostat"," was discontinued thereafter due to the causal relationship of ","agranulocytosis"," cannot be excluded.\nBesides, we also surveyed viral infection and autoimmune disorder.\nThere were no clinical or laboratory evidence of ","Epstein\u2013Barr virus",", ","cytomegalovirus",", or ","human immunodeficiency virus"," ","infections","; ","antinuclear antibody"," (","ANA",") and ","antiextractable nuclear antigen"," (","anti-ENA",") were both ","negative",".\n","Bone marrow examination"," during hospitalization showed ","hypocellular"," ","marrow"," with a marked ","decrease"," in ","myeloid component"," but no evidence of ","hematologic"," ","neoplasms",".\n","Chromosome analysis"," of ","bone marrow"," was ","normal karyotype",".\nThe patient ","denied history of radiation or chemicals exposure",".\nAfter stopping ","febuxostat"," for ","17 days",", her ","neutropenia"," improved significantly (","WBC"," ","2100\/\u03bcL",", and ","neutrophil"," ","66%","), without any ","granulocyte colony-stimulating factor"," (G-CSF) support.\nAfter ","discharge",", her ","WBC"," and ","differential count"," was completely ","normal"," during ","follow-up"," (Fig.1).\nThis study was approved by our institutional review board.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,69,0,12,0,39,0,75,0,35,0,32,0,26,0,26,0,26,0,69,0,22,0,26,0,26,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,22,0,69,0,22,0,26,0,13,0,48,0,22,0,46,0,46,0,29,0,46,0,29,0,4,0,29,0,69,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,4,0,29,0,46,0,32,0,46,0,19,0,46,0,29,0,19,0,24,0,24,0,42,0,22,0,24,0,42,0,46,0,26,0,22,0,22,0,22,0,26,0,24,0,24,0,24,0,24,0,42,0,24,0,69,0,12,0,42,0,24,0,12,0,69,0,24,0,12,0,42,0,39,0,46,0,32,0,69,0,24,0,42,0,24,0,42,0,46,0,13,0,24,0,24,0,42,0,13,0]}
-{"full_text":"A 46-year-old woman with a history of Graves' disease (GD) was transferred to our emergency department on suspicion of DKA.\nShe had noticed polydipsia, polyuria, and fatigue approximately four months prior to admission.\nShe had also been suffering from a 1-month complaint of appetite loss, approximately 7 kg weight loss, fatigue, nausea, and sweating.\nHer medical history included GD, diagnosed at 42 years of age and managed with methimazole.\nHowever, she had poor compliance with anti-thyroid drugs.\nShe denied a family history of thyroid diseases or diabetes.\nThree days before admission, she was also diagnosed with influenza A at a nearby hospital, and oseltamivir phosphate was prescribed.\nAt the emergency department, she presented with drowsiness and a body temperature of 37.0\u2103, blood pressure of 90\/60 mmHg, heart rate of 200 bpm, respiratory rate of 32 breaths\/min, oxygen saturation of 99% in 5 L nasal air, and a Glasgow coma scale (GCS) score of 14.\nHer clinical examination revealed a diffuse goiter with bilateral exophthalmoses.\nHer lungs were clear when auscultated.\nHer abdomen was soft and non-tender.\nHer skin was warm and wet.\nShe had no lower extremity edema.\nThe electrocardiogram showed marked tachycardia with atrial fibrillation, and a chest radiograph was normal.\nThe laboratory data are shown in Table 1.\nHer initial laboratory data demonstrated marked metabolic acidosis, an increased plasma glucose level of 472 mg\/dL, an increased HbA1c level of 13.7%, an increased free triiodothyronine level of 6.440 pg\/mL, and a free thyroxine level of 2.830 ng\/dL, with a suppressed thyrotropin (TSH) level of 0.005 \u03bcIU\/mL.\nShe scored 55 on the diagnostic criteria of Burch & Wartofsky for thyroid storm, and the diagnostic criteria of the Japan Thyroid Association for thyroid storm were also satisfied, since she had thyrotoxicosis, symptoms involving the central nervous system, tachycardia, and gastrointestinal symptoms (4).\nAccordingly, she was diagnosed with DKA and thyroid storm and admitted to the medical intensive care unit for further monitoring and treatment.\nThe clinical course is shown in Figure.\nShe was treated with an intravenous insulin drip and aggressive intravenous fluid therapy.\nThe thyroid storm with GD was treated with intravenous hydrocortisone 100 mg every 8 hours, oral potassium iodine 50 mg every 6 hours, and oral methimazole 20 mg every 6 hours.\nSince she had a history of asthma, landiolol hydrochloride, a short-acting beta-adrenoceptor blocker, was used at 4-12 \u03bcg\/kg\/min to control her heart rate.\nBy Day 3, her tachycardia had resolved, and landiolol hydrochloride was discontinued.\nOn Day 6, the white blood cell count had decreased to 2,800 cells\/mm3 [neutrophils, 44.2% (1,238 cells\/mm3)].\nMethimazole was discontinued because methimazole-induced neutropenia was suspected.\nThe patient was referred to an endocrine surgeon, and thyroidectomy was performed on Day 32.\nShe was discharged from the hospital on Day 37 and maintained on multiple daily insulin infusion and levothyroxine sodium hydrate.\nFurther immunological investigation revealed elevated levels of anti-glutamic acid decarboxylase (GAD) antibody, anti-insulinoma antigen 2 (IA-2) antibody, and insulin autoantibody, consistent with T1D.\nThe intravenous glucagon stimulation test was performed with blood samples for glucose and C-peptide taken at baseline and 6 minutes.\nHer plasma glucose levels were 139 and 152 mg\/dL at baseline and 6 minutes, respectively.\nThe corresponding serum C-peptide levels were 0.8 and 1.3 ng\/mL at baseline and 6 minutes, respectively.\n","ner_info":[{"text":"46-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"Graves' disease (GD)","label":"HISTORY","start":38,"end":58},{"text":"transferred","label":"CLINICAL_EVENT","start":63,"end":74},{"text":"emergency 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samples","label":"BIOLOGICAL_STRUCTURE","start":3328,"end":3341},{"text":"for glucose and C-peptide taken at baseline and 6 minutes","label":"DETAILED_DESCRIPTION","start":3342,"end":3399},{"text":"plasma glucose","label":"DIAGNOSTIC_PROCEDURE","start":3405,"end":3419},{"text":"139","label":"LAB_VALUE","start":3432,"end":3435},{"text":"152 mg\/dL","label":"LAB_VALUE","start":3440,"end":3449},{"text":"baseline","label":"DETAILED_DESCRIPTION","start":3453,"end":3461},{"text":"6 minutes","label":"DETAILED_DESCRIPTION","start":3466,"end":3475},{"text":"serum C-peptide","label":"DIAGNOSTIC_PROCEDURE","start":3509,"end":3524},{"text":"0.8","label":"LAB_VALUE","start":3537,"end":3540},{"text":"1.3 ng\/mL","label":"LAB_VALUE","start":3545,"end":3554},{"text":"baseline","label":"DETAILED_DESCRIPTION","start":3558,"end":3566},{"text":"6 minutes","label":"DETAILED_DESCRIPTION","start":3571,"end":3580}],"tokens":["A ","46-year-old"," ","woman"," with a history of ","Graves' disease (GD)"," was ","transferred"," to our ","emergency department"," on suspicion of ","DKA",".\nShe had noticed ","polydipsia",", ","polyuria",", and ","fatigue"," approximately ","four months prior to admission",".\nShe had also been suffering from a ","1-month"," complaint of ","appetite loss",", approximately ","7 kg"," ","weight loss",", ","fatigue",", ","nausea",", and ","sweating",".\nHer medical history included ","GD, diagnosed at 42 years of age and managed with methimazole",".\nHowever, she had ","poor compliance"," with ","anti-thyroid drugs",".\nShe ","denied a family history of thyroid diseases or diabetes",".\n","Three days before admission",", she was also ","diagnosed"," with ","influenza A"," at a ","nearby hospital",", and ","oseltamivir phosphate"," was prescribed.\nAt the ","emergency department",", she ","presented"," with ","drowsiness"," and a ","body temperature"," of ","37.0\u2103",", ","blood pressure"," of ","90\/60 mmHg",", ","heart rate"," of ","200 bpm",", ","respiratory rate"," of ","32 breaths\/min",", ","oxygen saturation"," of ","99%"," in ","5 L nasal air",", and a ","Glasgow coma scale"," (","GCS",") score of ","14",".\nHer ","clinical examination"," revealed a ","diffuse"," ","goiter"," with ","bilateral exophthalmoses",".\nHer ","lungs"," were ","clear"," when ","auscultated",".\nHer ","abdomen"," was ","soft"," and non-","tender",".\nHer ","skin"," was ","warm"," and ","wet",".\nShe had no ","lower extremity"," ","edema",".\nThe ","electrocardiogram"," showed ","marked"," ","tachycardia"," with ","atrial fibrillation",", and a ","chest"," ","radiograph"," was ","normal",".\nThe ","laboratory data"," are shown in Table 1.\nHer initial ","laboratory data"," demonstrated marked ","metabolic acidosis",", an ","increased"," ","plasma glucose"," level of ","472 mg\/dL",", an ","increased"," ","HbA1c"," level of ","13.7%",", an ","increased"," ","free triiodothyronine"," level of ","6.440 pg\/mL",", and a ","free thyroxine"," level of ","2.830 ng\/dL",", with a ","suppressed thyrotropin"," (TSH) level of ","0.005 \u03bcIU\/mL",".\nShe scored ","55"," on the ","diagnostic criteria of Burch & Wartofsky for thyroid storm",", and the ","diagnostic criteria of the Japan Thyroid Association for thyroid storm"," were also ","satisfied",", since she had ","thyrotoxicosis",", ","symptoms involving the central nervous system",", ","tachycardia",", and ","gastrointestinal symptoms"," (4).\nAccordingly, she was ","diagnosed"," with ","DKA"," and ","thyroid storm"," and ","admitted"," to the ","medical intensive care unit"," for further ","monitoring"," and ","treatment",".\nThe clinical course is shown in Figure.\nShe was treated with an ","intravenous"," ","insulin"," ","drip"," and ","aggressive"," ","intravenous"," ","fluid therapy",".\nThe ","thyroid storm"," with ","GD"," was treated with ","intravenous"," ","hydrocortisone"," ","100 mg every 8 hours",", ","oral"," ","potassium iodine"," ","50 mg every 6 hours",", and ","oral"," ","methimazole"," ","20 mg every 6 hours",".\nSince she had a history of ","asthma",", ","landiolol hydrochloride",", a short-acting beta-adrenoceptor blocker, was used at ","4-12 \u03bcg\/kg\/min"," to control her heart rate.\nBy ","Day 3",", her ","tachycardia"," had resolved, and ","landiolol hydrochloride"," was discontinued.\nOn ","Day 6",", the ","white blood cell count"," had decreased to ","2,800 cells\/mm3"," [","neutrophils, 44.2% (1,238 cells\/mm3)","].\n","Methimazole"," was discontinued because ","methimazole-induced"," ","neutropenia"," was suspected.\nThe patient was ","referred"," to an ","endocrine surgeon",", and ","thyroidectomy"," was performed on ","Day 32",".\nShe was ","discharged"," from the ","hospital"," on ","Day 37"," and maintained on ","multiple daily"," ","insulin"," ","infusion"," and ","levothyroxine sodium hydrate",".\nFurther ","immunological investigation"," revealed ","elevated levels"," of ","anti-glutamic acid decarboxylase (GAD) antibody",", ","anti-insulinoma antigen 2 (IA-2) antibody",", and ","insulin autoantibody",", consistent with ","T1D",".\nThe ","intravenous glucagon stimulation test"," was performed with ","blood samples"," ","for glucose and C-peptide taken at baseline and 6 minutes",".\nHer ","plasma glucose"," levels were ","139"," and ","152 mg\/dL"," at ","baseline"," and ","6 minutes",", respectively.\nThe corresponding ","serum C-peptide"," levels were ","0.8"," and ","1.3 ng\/mL"," at ","baseline"," and ","6 minutes",", respectively.\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,48,0,26,0,69,0,69,0,69,0,32,0,32,0,69,0,42,0,69,0,69,0,69,0,69,0,39,0,42,0,46,0,39,0,19,0,13,0,26,0,48,0,46,0,48,0,13,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,24,0,42,0,24,0,22,0,69,0,22,0,12,0,42,0,24,0,12,0,42,0,69,0,12,0,42,0,42,0,12,0,69,0,24,0,22,0,69,0,26,0,12,0,24,0,42,0,24,0,24,0,69,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,24,0,42,0,26,0,69,0,69,0,69,0,13,0,26,0,26,0,13,0,48,0,24,0,75,0,4,0,46,0,4,0,22,0,4,0,75,0,26,0,26,0,4,0,46,0,29,0,4,0,46,0,29,0,4,0,46,0,29,0,39,0,46,0,29,0,19,0,69,0,46,0,19,0,24,0,42,0,42,0,46,0,22,0,69,0,13,0,48,0,75,0,19,0,13,0,48,0,19,0,29,0,46,0,4,0,46,0,24,0,42,0,24,0,24,0,24,0,26,0,24,0,12,0,22,0,24,0,42,0,42,0,22,0,22,0,24,0,42,0,42,0,22,0,22,0]}
-{"full_text":"A 61-year-old male was referred to the emergency department by his general practitioner in April 2010 for investigation of loose bowel motions and an episode of black stool.\nThe patient had a history of insulin-dependent type II diabetes mellitus, hypertension, ischaemic heart disease with two previous ischaemic events, obstructive sleep apnoea, depression, schizophrenia and a previous incisional hernia repair.\nOn examination, he was morbidly obese (BMI 45) and was noted to have marked hepatomegaly.\nThis was not associated with any recent weight loss, haematemesis, jaundice or abdominal pain.\nThe patient denied previous blood transfusions, usage of intravenous drugs and did not drink alcohol.\nA faecal occult blood test was negative, and the patient\u2019s last colonoscopy 2 years prior was unremarkable.\nHe was referred to our tertiary centre for further management after an ultrasound scan (USS) displayed an ovoid mass of mixed echogenicity arising from the liver, measuring 12\u2009\u00d7\u20099 cm.\nA computed tomography (CT) scan confirmed a malignant appearing, pedunculated lesion attached to segment IV (Fig.1).\nA subsequent magnetic resonance imaging (MRI) confirmed that on T2 weighted imaging (WI), the lesion was isointense to the liver peripherally with central branching hyperintensities (Fig.2a) which corresponded to the hypointensities seen on T1WI (Fig.2b).\nEnhancement of the lesion was noted in arterial phase (Fig.3a), during portal venous phase (Fig.3b) and at 2 min (Fig.3c), with some central areas of non-enhancement.\nThe lesion becomes slightly hypointense on delayed images at 10 (Fig.3d) and 20 min compared to the surrounding liver.\nLaboratory investigations revealed a mildly elevated gamma-glutamyl transpeptidase of 137 IU\/L (normal 5\u201350 IU\/L).\nHepatitis screen, alpha-fetoprotein, carcinoembryonic antigen and cancer antigen 19\u20139 were all unremarkable.\nThe patient underwent a subsegmental resection of the 15 cm segment IVb mass in June 2010.\nThere was severe hepatic steatosis, but no cirrhosis.\nThe patient was discharged postoperative day seven without complications.\nPathology of the resection specimen confirmed SFTL.\nThe specimen displayed a pale tan nodular appearance with a firm and rubbery cut surface.\nHistological examination revealed fascicles of spindle cells in storiform arrangement with a pushing margin.\nThere was evidence of extracellular collagen deposition, areas of myxoid stroma and branching vessels with hyalinisation.\nThe specimen displayed a high mitotic rate of up to 9 per 10 high-power fields (HPF) with no necrotic or haemorrhagic features.\nImmunohistochemistry showed positive staining for CD34, CD99 and BCL-2.\nThe tumour was negative for c-Kit, CD31, SMA, desmin, cytokeratins (AE1\/AE3, MNF116 and Cam 5.2), EMA and S100.\nThe margins were clear.\nThe non-neoplastic remainder of the liver displayed pericellular fibrosis indicative of steatohepatitis.\nThe patient was followed-up regularly every 4 to 6 months with CT scans by the local general practitioner who liaised with the consultant surgeon.\nThere were two episodes of re-admissions for further investigation of recurrent right upper quadrant pain between 2011 and 2013.\nMultiple MRI scans performed during this period revealed expected postsurgical changes with no tumour recurrence.\nHowever, in May 2016, the patient presented to his local emergency department with progressively worsening right upper quadrant pain and increasing dyspnoea with an oxygen demand.\nCT of his chest, abdomen and pelvis revealed extensive tumour recurrence adjacent to the previous resection site (Fig.4).\nIn addition, there was a clinically significant right-sided pleural effusion and a pleural mass at the right lung base measuring 3.8 cm (Fig.5).\nPleurocentesis was performed, draining 1400 ml of serosanguineous fluid.\nCytology was negative for malignant cells.\nThe case was discussed extensively in a multi-disciplinary setting, and it was decided given the patient\u2019s two sites of disease and significant perioperative risk that he was not a candidate for radical reoperation.\nThere were also no suitable chemo- or radiotherapeutic therapies available.\nThe patient was subsequently referred to the palliative team for management of his symptoms and discharged back to the community.\nHe was still alive 1 month after discharge.\n","ner_info":[{"text":"61-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"referred","label":"CLINICAL_EVENT","start":23,"end":31},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":39,"end":59},{"text":"April 2010","label":"DATE","start":91,"end":101},{"text":"loose bowel motions","label":"SIGN_SYMPTOM","start":123,"end":142},{"text":"black stool","label":"SIGN_SYMPTOM","start":161,"end":172},{"text":"insulin-dependent type II diabetes 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imaging","label":"DIAGNOSTIC_PROCEDURE","start":1124,"end":1150},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1152,"end":1155},{"text":"T2","label":"DETAILED_DESCRIPTION","start":1175,"end":1177},{"text":"weighted imaging","label":"DIAGNOSTIC_PROCEDURE","start":1178,"end":1194},{"text":"WI","label":"DIAGNOSTIC_PROCEDURE","start":1196,"end":1198},{"text":"lesion","label":"SIGN_SYMPTOM","start":1205,"end":1211},{"text":"isointense","label":"DETAILED_DESCRIPTION","start":1216,"end":1226},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":1234,"end":1239},{"text":"central branching hyperintensities","label":"DETAILED_DESCRIPTION","start":1258,"end":1292},{"text":"hypointensities","label":"SIGN_SYMPTOM","start":1328,"end":1343},{"text":"T1WI","label":"DIAGNOSTIC_PROCEDURE","start":1352,"end":1356},{"text":"Enhancement","label":"DETAILED_DESCRIPTION","start":1367,"end":1378},{"text":"lesion","label":"SIGN_SYMPTOM","start":1386,"end":1392},{"text":"arterial 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5.2","label":"DETAILED_DESCRIPTION","start":2737,"end":2764},{"text":"EMA","label":"DIAGNOSTIC_PROCEDURE","start":2767,"end":2770},{"text":"S100","label":"DIAGNOSTIC_PROCEDURE","start":2775,"end":2779},{"text":"margins","label":"DIAGNOSTIC_PROCEDURE","start":2785,"end":2792},{"text":"clear","label":"LAB_VALUE","start":2798,"end":2803},{"text":"remainder of the liver","label":"BIOLOGICAL_STRUCTURE","start":2824,"end":2846},{"text":"pericellular","label":"DETAILED_DESCRIPTION","start":2857,"end":2869},{"text":"fibrosis","label":"SIGN_SYMPTOM","start":2870,"end":2878},{"text":"steatohepatitis","label":"DISEASE_DISORDER","start":2893,"end":2908},{"text":"followed-up","label":"CLINICAL_EVENT","start":2926,"end":2937},{"text":"every 4 to 6 months","label":"FREQUENCY","start":2948,"end":2967},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2973,"end":2975},{"text":"local general practitioner","label":"NONBIOLOGICAL_LOCATION","start":2989,"end":3015},{"text":"consultant 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department","label":"NONBIOLOGICAL_LOCATION","start":3351,"end":3377},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":3407,"end":3427},{"text":"pain","label":"SIGN_SYMPTOM","start":3428,"end":3432},{"text":"dyspnoea","label":"SIGN_SYMPTOM","start":3448,"end":3456},{"text":"oxygen demand","label":"THERAPEUTIC_PROCEDURE","start":3465,"end":3478},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3480,"end":3482},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":3490,"end":3495},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":3497,"end":3504},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":3509,"end":3515},{"text":"extensive","label":"DETAILED_DESCRIPTION","start":3525,"end":3534},{"text":"tumour recurrence","label":"SIGN_SYMPTOM","start":3535,"end":3552},{"text":"adjacent to the previous resection 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cells","label":"DIAGNOSTIC_PROCEDURE","start":3846,"end":3861},{"text":"discussed","label":"CLINICAL_EVENT","start":3876,"end":3885},{"text":"multi-disciplinary setting","label":"NONBIOLOGICAL_LOCATION","start":3903,"end":3929},{"text":"reoperation","label":"THERAPEUTIC_PROCEDURE","start":4066,"end":4077},{"text":"chemo","label":"MEDICATION","start":4107,"end":4112},{"text":"radiotherapeutic therapies","label":"THERAPEUTIC_PROCEDURE","start":4117,"end":4143},{"text":"referred","label":"CLINICAL_EVENT","start":4184,"end":4192},{"text":"palliative team","label":"NONBIOLOGICAL_LOCATION","start":4200,"end":4215},{"text":"discharged","label":"CLINICAL_EVENT","start":4251,"end":4261},{"text":"community","label":"NONBIOLOGICAL_LOCATION","start":4274,"end":4283},{"text":"alive","label":"SIGN_SYMPTOM","start":4298,"end":4303},{"text":"1 month after","label":"DATE","start":4304,"end":4317}],"tokens":["A ","61-year-old"," ","male"," was ","referred"," to the ","emergency department"," by his general practitioner in ","April 2010"," for investigation of ","loose bowel motions"," and an episode of ","black stool",".\nThe patient had a history of ","insulin-dependent type II diabetes mellitus",", ","hypertension",", ","ischaemic heart disease with two previous ischaemic events",", ","obstructive sleep apnoea",", ","depression",", ","schizophrenia"," and a ","previous incisional hernia repair",".\nOn examination, he was ","morbidly obese"," (","BMI"," ","45",") and was noted to have marked ","hepatomegaly",".\nThis was not associated with any recent ","weight loss",", ","haematemesis",", ","jaundice"," or ","abdominal"," ","pain",".\nThe patient ","denied previous blood transfusions, usage of intravenous drugs and did not drink alcohol",".\nA ","faecal occult blood test"," was ","negative",", and the patient\u2019s last ","colonoscopy"," ","2 years prior"," was ","unremarkable",".\nHe was ","referred"," to our ","tertiary centre"," for further management after an ","ultrasound scan"," (","USS",") displayed an ","ovoid"," ","mass"," of ","mixed echogenicity"," arising from the ","liver",", measuring ","12\u2009\u00d7\u20099 cm",".\nA ","computed tomography"," (","CT",") scan confirmed a ","malignant appearing",", ","pedunculated"," ","lesion"," attached to ","segment IV"," (Fig.1).\nA subsequent ","magnetic resonance imaging"," (","MRI",") confirmed that on ","T2"," ","weighted imaging"," (","WI","), the ","lesion"," was ","isointense"," to the ","liver"," peripherally with ","central branching hyperintensities"," (Fig.2a) which corresponded to the ","hypointensities"," seen on ","T1WI"," (Fig.2b).\n","Enhancement"," of the ","lesion"," was noted in ","arterial phase"," (Fig.3a), during ","portal venous phase"," (Fig.3b) and ","at 2 min"," (Fig.3c), with some ","central areas of non-enhancement",".\nThe ","lesion"," becomes ","slightly hypointense"," on ","delayed images"," at ","10"," (Fig.3d) and ","20 min"," compared to the surrounding ","liver",".\n","Laboratory investigations"," revealed a ","mildly elevated"," ","gamma-glutamyl transpeptidase"," of ","137 IU\/L"," (normal 5\u201350 IU\/L).\n","Hepatitis screen",", ","alpha-fetoprotein",", ","carcinoembryonic antigen"," and ","cancer antigen 19\u20139"," were all ","unremarkable",".\nThe patient underwent a ","subsegmental"," ","resection"," of the ","15 cm"," ","segment IVb"," ","mass"," in ","June 2010",".\nThere was ","severe"," ","hepatic steatosis",", but no ","cirrhosis",".\nThe patient was ","discharged"," postoperative ","day seven"," without ","complications",".\n","Pathology"," of the ","resection specimen"," confirmed ","SFTL",".\nThe specimen displayed a ","pale tan"," ","nodular appearance"," with a ","firm and rubbery cut surface",".\n","Histological examination"," revealed ","fascicles of spindle cells"," in ","storiform arrangement"," with a ","pushing margin",".\nThere was ","evidence of extracellular collagen deposition",", ","areas of myxoid stroma"," and ","branching vessels with hyalinisation",".\nThe ","specimen"," displayed a ","high"," ","mitotic rate"," of up to ","9 per 10 high-power fields"," (HPF) with ","no necrotic or haemorrhagic features",".\n","Immunohistochemistry"," showed ","positive"," staining for ","CD34",", ","CD99"," and ","BCL-2",".\nThe tumour was ","negative"," for ","c-Kit",", ","CD31",", ","SMA",", ","desmin",", ","cytokeratins"," (","AE1\/AE3, MNF116 and Cam 5.2","), ","EMA"," and ","S100",".\nThe ","margins"," were ","clear",".\nThe non-neoplastic ","remainder of the liver"," displayed ","pericellular"," ","fibrosis"," indicative of ","steatohepatitis",".\nThe patient was ","followed-up"," regularly ","every 4 to 6 months"," with ","CT"," scans by the ","local general practitioner"," who liaised with the ","consultant surgeon",".\nThere were ","two"," episodes of ","re-admissions"," for further investigation of ","recurrent"," ","right upper quadrant"," ","pain"," ","between 2011 and 2013",".\n","Multiple"," ","MRI"," scans performed during this period revealed ","expected postsurgical changes"," with no ","tumour recurrence",".\nHowever, in ","May 2016",", the patient ","presented"," to his ","local emergency department"," with progressively worsening ","right upper quadrant"," ","pain"," and increasing ","dyspnoea"," with an ","oxygen demand",".\n","CT"," of his ","chest",", ","abdomen"," and ","pelvis"," revealed ","extensive"," ","tumour recurrence"," ","adjacent to the previous resection site"," (Fig.4).\nIn addition, there was a clinically significant ","right-sided"," ","pleural effusion"," and a ","pleural"," ","mass"," at the ","right lung base"," measuring ","3.8 cm"," (Fig.5).\n","Pleurocentesis"," was performed, draining ","1400 ml"," of ","serosanguineous fluid",".\n","Cytology"," was ","negative"," for ","malignant cells",".\nThe case was ","discussed"," extensively in a ","multi-disciplinary setting",", and it was decided given the patient\u2019s two sites of disease and significant perioperative risk that he was not a candidate for radical ","reoperation",".\nThere were also no suitable ","chemo","- or ","radiotherapeutic therapies"," available.\nThe patient was subsequently ","referred"," to the ","palliative team"," for management of his symptoms and ","discharged"," back to the ","community",".\nHe was still ","alive"," ","1 month after"," discharge.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,19,0,69,0,69,0,39,0,39,0,39,0,39,0,39,0,39,0,39,0,26,0,24,0,42,0,26,0,69,0,69,0,69,0,12,0,69,0,39,0,24,0,42,0,24,0,19,0,42,0,13,0,48,0,24,0,24,0,67,0,69,0,22,0,12,0,8,0,24,0,24,0,22,0,22,0,69,0,12,0,24,0,24,0,22,0,24,0,24,0,69,0,22,0,12,0,22,0,69,0,24,0,22,0,69,0,22,0,22,0,22,0,22,0,69,0,22,0,22,0,22,0,22,0,12,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,22,0,75,0,27,0,12,0,69,0,19,0,63,0,26,0,26,0,13,0,19,0,69,0,24,0,12,0,26,0,15,0,67,0,73,0,24,0,42,0,22,0,22,0,42,0,42,0,42,0,12,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,22,0,24,0,24,0,24,0,42,0,12,0,22,0,69,0,26,0,13,0,35,0,24,0,48,0,48,0,42,0,13,0,22,0,12,0,69,0,19,0,22,0,24,0,69,0,69,0,19,0,13,0,48,0,12,0,69,0,69,0,75,0,24,0,12,0,12,0,12,0,22,0,69,0,12,0,22,0,26,0,12,0,69,0,12,0,19,0,75,0,79,0,12,0,24,0,42,0,24,0,13,0,48,0,75,0,46,0,75,0,13,0,48,0,13,0,48,0,69,0,19,0]}
-{"full_text":"A 39-year-old Korean male come to our hospital complaining of cough, myalgia, and fever that had lasted for 5 days.\nHe was a company worker and denied any previous medical histories.\nHe was a current smoker and drank alcohol about once a month.\nHis vital signs were: blood pressure, 100\/60 mmHg, heart rate, 100\/min, respiratory rate, 25 breaths\/min, and body temperature, 39 \u00b0C.\nOn the physical examination, decreased breathing sound was noted in the right lower lung.\nLaboratory tests revealed a c-reactive protein (CRP) level of 119 mg\/dL, a total bilirubin level of 1.8 mg\/dL, and alanine transaminase and aspartate transaminase levels of 250 and 172 IU\/L, respectively.\nHis platelet count was 98,000\/mm3, while his white cell count was 8150\/mm3 (neutrophil: 85%).\nIn the arterial blood gas analysis checked in room air, pH, PaCO2, PaO2, bicarbonate, and oxygen saturation levels were 7.50, 34 mmHg, 67 mmHg, 26.5 mmol\/L, and 95%, respectively.\nA test for the human immunodeficiency virus was negative.\nMycoplasma and Chlamydia antibodies were negative.\nStreptococcal and Legionella urinary antigens were negative.\nAnti-nuclear and anti-neutrophilic cytoplasmic antibodies were also negative.\nA chest X-ray showed consolidation in the right mid to lower lung fields.\nChest computed tomography showed consolidation with surrounding ground glass opacity in the right middle lobe with a small amount of pleural effusion in the right hemithorax (Fig.1).\nAbdominal sonography revealed no abnormal finding in the hepatobiliary system.\nWe began to administer 4 L\/min of oxygen nasally and empirical antibiotics with third generation cephalosporin and macrolide following a diagnosis of community-acquired pneumonia.\nOn the second day in the hospital, the patient\u2019s fever was sustained and he complained of dyspnea.\nHis hypoxemia was aggravated such that he required 7 L\/min of oxygen via a simple mask and the consolidation and pleural effusion had markedly progressed (Fig.2a).\nWe performed bronchoscopy and thoracentesis.\nMultiplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) for respiratory viruses using bronchoalveolar lavage fluid was positive for human adenovirus while other microbiological studies were negative.\nPleural fluid was lymphocyte-dominant exudate and was also positive for human adenovirus.\nUnder the diagnosis of adenovirus pneumonia, we started antiviral therapy with oral ribavirin 400 mg q 12 h while maintaining antibiotics.\nOn hospital day 4, his fever had subsided and symptoms were much improved.\nThe transaminase levels, CRP and platelet counts gradually normalized (Fig.3).\nA follow-up chest X-ray was clear (Fig.2b) and he was discharged in hospital day 13 without any complications.\n","ner_info":[{"text":"39-year-old","label":"AGE","start":2,"end":13},{"text":"Korean","label":"PERSONAL_BACKGROUND","start":14,"end":20},{"text":"male","label":"SEX","start":21,"end":25},{"text":"come","label":"CLINICAL_EVENT","start":26,"end":30},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":38,"end":46},{"text":"cough","label":"SIGN_SYMPTOM","start":62,"end":67},{"text":"myalgia","label":"SIGN_SYMPTOM","start":69,"end":76},{"text":"fever","label":"SIGN_SYMPTOM","start":82,"end":87},{"text":"lasted for 5 days","label":"DURATION","start":97,"end":114},{"text":"company worker","label":"OCCUPATION","start":125,"end":139},{"text":"denied any previous medical histories","label":"HISTORY","start":144,"end":181},{"text":"current smoker","label":"HISTORY","start":192,"end":206},{"text":"drank alcohol about once a month","label":"HISTORY","start":211,"end":243},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":249,"end":260},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":267,"end":281},{"text":"100\/60 mmHg","label":"LAB_VALUE","start":283,"end":294},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":296,"end":306},{"text":"100\/min","label":"LAB_VALUE","start":308,"end":315},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":317,"end":333},{"text":"25 breaths\/min","label":"LAB_VALUE","start":335,"end":349},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":355,"end":371},{"text":"39 \u00b0C","label":"LAB_VALUE","start":373,"end":378},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":387,"end":407},{"text":"decreased","label":"LAB_VALUE","start":409,"end":418},{"text":"breathing sound","label":"DIAGNOSTIC_PROCEDURE","start":419,"end":434},{"text":"right lower lung","label":"BIOLOGICAL_STRUCTURE","start":452,"end":468},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":470,"end":486},{"text":"c-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":498,"end":516},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":518,"end":521},{"text":"119 mg\/dL","label":"LAB_VALUE","start":532,"end":541},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":545,"end":560},{"text":"1.8 mg\/dL","label":"LAB_VALUE","start":570,"end":579},{"text":"alanine transaminase","label":"DIAGNOSTIC_PROCEDURE","start":585,"end":605},{"text":"aspartate transaminase","label":"DIAGNOSTIC_PROCEDURE","start":610,"end":632},{"text":"250","label":"LAB_VALUE","start":643,"end":646},{"text":"172 IU\/L","label":"LAB_VALUE","start":651,"end":659},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":679,"end":693},{"text":"98,000\/mm3","label":"LAB_VALUE","start":698,"end":708},{"text":"white cell count","label":"DIAGNOSTIC_PROCEDURE","start":720,"end":736},{"text":"8150\/mm3","label":"LAB_VALUE","start":741,"end":749},{"text":"neutrophil: 85%","label":"LAB_VALUE","start":751,"end":766},{"text":"arterial blood gas analysis","label":"DIAGNOSTIC_PROCEDURE","start":776,"end":803},{"text":"in room air","label":"DETAILED_DESCRIPTION","start":812,"end":823},{"text":"pH","label":"DIAGNOSTIC_PROCEDURE","start":825,"end":827},{"text":"PaCO2","label":"DIAGNOSTIC_PROCEDURE","start":829,"end":834},{"text":"PaO2","label":"DIAGNOSTIC_PROCEDURE","start":836,"end":840},{"text":"bicarbonate","label":"DIAGNOSTIC_PROCEDURE","start":842,"end":853},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":859,"end":876},{"text":"7.50","label":"LAB_VALUE","start":889,"end":893},{"text":"34 mmHg","label":"LAB_VALUE","start":895,"end":902},{"text":"67 mmHg","label":"LAB_VALUE","start":904,"end":911},{"text":"26.5 mmol\/L","label":"LAB_VALUE","start":913,"end":924},{"text":"95%","label":"LAB_VALUE","start":930,"end":933},{"text":"test for the human immunodeficiency virus","label":"DIAGNOSTIC_PROCEDURE","start":951,"end":992},{"text":"negative","label":"LAB_VALUE","start":997,"end":1005},{"text":"Mycoplasma","label":"DETAILED_DESCRIPTION","start":1007,"end":1017},{"text":"Chlamydia","label":"DETAILED_DESCRIPTION","start":1022,"end":1031},{"text":"antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1032,"end":1042},{"text":"negative","label":"LAB_VALUE","start":1048,"end":1056},{"text":"Streptococcal","label":"DETAILED_DESCRIPTION","start":1058,"end":1071},{"text":"Legionella","label":"DETAILED_DESCRIPTION","start":1076,"end":1086},{"text":"urinary antigens","label":"DIAGNOSTIC_PROCEDURE","start":1087,"end":1103},{"text":"negative","label":"LAB_VALUE","start":1109,"end":1117},{"text":"Anti-nuclear","label":"DETAILED_DESCRIPTION","start":1119,"end":1131},{"text":"anti-neutrophilic","label":"DETAILED_DESCRIPTION","start":1136,"end":1153},{"text":"cytoplasmic antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1154,"end":1176},{"text":"negative","label":"LAB_VALUE","start":1187,"end":1195},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1199,"end":1204},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":1205,"end":1210},{"text":"consolidation","label":"SIGN_SYMPTOM","start":1218,"end":1231},{"text":"right mid to lower lung fields","label":"BIOLOGICAL_STRUCTURE","start":1239,"end":1269},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1271,"end":1276},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1277,"end":1296},{"text":"consolidation","label":"SIGN_SYMPTOM","start":1304,"end":1317},{"text":"surrounding ground glass opacity","label":"TEXTURE","start":1323,"end":1355},{"text":"right middle lobe","label":"BIOLOGICAL_STRUCTURE","start":1363,"end":1380},{"text":"small amount","label":"SEVERITY","start":1388,"end":1400},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":1404,"end":1420},{"text":"right hemithorax","label":"BIOLOGICAL_STRUCTURE","start":1428,"end":1444},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":1454,"end":1463},{"text":"sonography","label":"DIAGNOSTIC_PROCEDURE","start":1464,"end":1474},{"text":"no abnormal finding","label":"LAB_VALUE","start":1484,"end":1503},{"text":"hepatobiliary system","label":"BIOLOGICAL_STRUCTURE","start":1511,"end":1531},{"text":"4 L\/min","label":"DOSAGE","start":1556,"end":1563},{"text":"oxygen","label":"MEDICATION","start":1567,"end":1573},{"text":"nasally","label":"ADMINISTRATION","start":1574,"end":1581},{"text":"antibiotics","label":"MEDICATION","start":1596,"end":1607},{"text":"cephalosporin","label":"MEDICATION","start":1630,"end":1643},{"text":"macrolide","label":"MEDICATION","start":1648,"end":1657},{"text":"community-acquired","label":"DETAILED_DESCRIPTION","start":1683,"end":1701},{"text":"pneumonia","label":"DISEASE_DISORDER","start":1702,"end":1711},{"text":"second day","label":"DATE","start":1720,"end":1730},{"text":"fever","label":"SIGN_SYMPTOM","start":1762,"end":1767},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1803,"end":1810},{"text":"hypoxemia","label":"SIGN_SYMPTOM","start":1816,"end":1825},{"text":"7 L\/min","label":"DOSAGE","start":1863,"end":1870},{"text":"oxygen","label":"MEDICATION","start":1874,"end":1880},{"text":"simple 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studies","label":"DIAGNOSTIC_PROCEDURE","start":2203,"end":2226},{"text":"negative","label":"LAB_VALUE","start":2232,"end":2240},{"text":"Pleural fluid","label":"DIAGNOSTIC_PROCEDURE","start":2242,"end":2255},{"text":"lymphocyte-dominant exudate","label":"LAB_VALUE","start":2260,"end":2287},{"text":"positive for human adenovirus","label":"LAB_VALUE","start":2301,"end":2330},{"text":"adenovirus pneumonia","label":"DISEASE_DISORDER","start":2355,"end":2375},{"text":"antiviral therapy","label":"MEDICATION","start":2388,"end":2405},{"text":"oral","label":"ADMINISTRATION","start":2411,"end":2415},{"text":"ribavirin","label":"MEDICATION","start":2416,"end":2425},{"text":"400 mg q 12 h","label":"DOSAGE","start":2426,"end":2439},{"text":"antibiotics","label":"MEDICATION","start":2458,"end":2469},{"text":"day 4","label":"DATE","start":2483,"end":2488},{"text":"fever","label":"SIGN_SYMPTOM","start":2494,"end":2499},{"text":"symptoms","label":"SIGN_SYMPTOM","start":2517,"end":2525},{"text":"transaminase","label":"DIAGNOSTIC_PROCEDURE","start":2550,"end":2562},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":2571,"end":2574},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":2579,"end":2593},{"text":"normalized","label":"LAB_VALUE","start":2605,"end":2615},{"text":"follow-up","label":"CLINICAL_EVENT","start":2627,"end":2636},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2637,"end":2642},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":2643,"end":2648},{"text":"clear","label":"LAB_VALUE","start":2653,"end":2658},{"text":"discharged","label":"CLINICAL_EVENT","start":2679,"end":2689},{"text":"day 13","label":"DATE","start":2702,"end":2708},{"text":"complications","label":"SIGN_SYMPTOM","start":2721,"end":2734}],"tokens":["A ","39-year-old"," ","Korean"," ","male"," ","come"," to our ","hospital"," complaining of ","cough",", ","myalgia",", and ","fever"," that had ","lasted for 5 days",".\nHe was a ","company worker"," and ","denied any previous medical histories",".\nHe was a ","current smoker"," and ","drank alcohol about once a month",".\nHis ","vital signs"," were: ","blood pressure",", ","100\/60 mmHg",", ","heart rate",", ","100\/min",", ","respiratory rate",", ","25 breaths\/min",", and ","body temperature",", ","39 \u00b0C",".\nOn the ","physical examination",", ","decreased"," ","breathing sound"," was noted in the ","right lower lung",".\n","Laboratory tests"," revealed a ","c-reactive protein"," (","CRP",") level of ","119 mg\/dL",", a ","total bilirubin"," level of ","1.8 mg\/dL",", and ","alanine transaminase"," and ","aspartate transaminase"," levels of ","250"," and ","172 IU\/L",", respectively.\nHis ","platelet count"," was ","98,000\/mm3",", while his ","white cell count"," was ","8150\/mm3"," (","neutrophil: 85%",").\nIn the ","arterial blood gas analysis"," checked ","in room air",", ","pH",", ","PaCO2",", ","PaO2",", ","bicarbonate",", and ","oxygen saturation"," levels were ","7.50",", ","34 mmHg",", ","67 mmHg",", ","26.5 mmol\/L",", and ","95%",", respectively.\nA ","test for the human immunodeficiency virus"," was ","negative",".\n","Mycoplasma"," and ","Chlamydia"," ","antibodies"," were ","negative",".\n","Streptococcal"," and ","Legionella"," ","urinary antigens"," were ","negative",".\n","Anti-nuclear"," and ","anti-neutrophilic"," ","cytoplasmic antibodies"," were also ","negative",".\nA ","chest"," ","X-ray"," showed ","consolidation"," in the ","right mid to lower lung fields",".\n","Chest"," ","computed tomography"," showed ","consolidation"," with ","surrounding ground glass opacity"," in the ","right middle lobe"," with a ","small amount"," of ","pleural effusion"," in the ","right hemithorax"," (Fig.1).\n","Abdominal"," ","sonography"," revealed ","no abnormal finding"," in the ","hepatobiliary system",".\nWe began to administer ","4 L\/min"," of ","oxygen"," ","nasally"," and empirical ","antibiotics"," with third generation ","cephalosporin"," and ","macrolide"," following a diagnosis of ","community-acquired"," ","pneumonia",".\nOn the ","second day"," in the hospital, the patient\u2019s ","fever"," was sustained and he complained of ","dyspnea",".\nHis ","hypoxemia"," was aggravated such that he required ","7 L\/min"," of ","oxygen"," via a ","simple mask"," and the ","consolidation"," and ","pleural effusion"," had markedly progressed (Fig.2a).\nWe performed ","bronchoscopy"," and ","thoracentesis",".\n","Multiplex"," ","real-time reverse transcriptase polymerase chain reaction"," (","RT-PCR",") ","for respiratory viruses"," ","using bronchoalveolar lavage fluid"," was ","positive for human adenovirus"," while other ","microbiological studies"," were ","negative",".\n","Pleural fluid"," was ","lymphocyte-dominant exudate"," and was also ","positive for human adenovirus",".\nUnder the diagnosis of ","adenovirus pneumonia",", we started ","antiviral therapy"," with ","oral"," ","ribavirin"," ","400 mg q 12 h"," while maintaining ","antibiotics",".\nOn hospital ","day 4",", his ","fever"," had subsided and ","symptoms"," were much improved.\nThe ","transaminase"," levels, ","CRP"," and ","platelet count","s gradually ","normalized"," (Fig.3).\nA ","follow-up"," ","chest"," ","X-ray"," was ","clear"," (Fig.2b) and he was ","discharged"," in hospital ","day 13"," without any ","complications",".\n"],"ner_labels":[0,5,0,58,0,65,0,13,0,48,0,69,0,69,0,69,0,32,0,50,0,39,0,39,0,39,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,12,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,22,0,24,0,24,0,24,0,24,0,24,0,42,0,42,0,42,0,42,0,42,0,24,0,42,0,22,0,22,0,24,0,42,0,22,0,22,0,24,0,42,0,22,0,22,0,24,0,42,0,12,0,24,0,69,0,12,0,12,0,24,0,69,0,73,0,12,0,63,0,26,0,12,0,12,0,24,0,42,0,12,0,29,0,46,0,4,0,46,0,46,0,46,0,22,0,26,0,19,0,69,0,69,0,69,0,29,0,46,0,4,0,69,0,26,0,24,0,75,0,22,0,24,0,24,0,22,0,22,0,42,0,24,0,42,0,24,0,42,0,42,0,26,0,46,0,4,0,46,0,29,0,46,0,19,0,69,0,69,0,24,0,24,0,24,0,42,0,13,0,12,0,24,0,42,0,13,0,19,0,69,0]}
-{"full_text":"Our patient was a 7-year-old Italian boy born after an uneventful gestation of normal duration.\nAt the age of 16 months, he presented with a clinically evident enlarged abdomen and was referred for oncological examination.\nInitial tests revealed anemia, thrombocytopenia, and splenomegaly.\nA bone marrow biopsy revealed the presence of foam cells, which led to suspicion of lysosomal storage disease.\nBiochemical testing revealed elevated level of acid phosphatase (47.8 IU\/L [normal range 5\u20137 IU\/L]) and chitotriosidase activity (508 nmol\/mg protein [normal range 5.9\u201341.0 nmol\/mg protein]), as well as reduced beta-glucosidase activity (2 nmol\/mg\/protein [normal range 4.5\u201318.0 nmol\/mg\/protein]).\nMolecular analysis showed homozygous L444P mutations in the GBA gene (OMIM reference 606463), confirming the diagnosis of chronic NGD.\nThe patient began ERT at a dosage of 60 U\/kg every 2 weeks at the age of 18 months.\nThereafter, when the patient reached the age of 30 months, we decided to combine ERT with SRT with miglustat.\nThis clinical decision was approved by our institution\u2019s ethics committee, and informed consent was obtained from the patient\u2019s parents before commencing combination therapy.\nThe dose of miglustat was adjusted according to the patient\u2019s body surface area and was uptitrated during the first 4 weeks with the following scheme: one-third of target dose during weeks 1 and 2, two-thirds of target dose during weeks 3 and 4, and target dose (100 mg three times daily) after 1 month.\nFrom 2 weeks before starting miglustat therapy, the patient also followed specific dietary modifications, avoiding high intake of carbohydrate-containing food in single meals, especially foods high in disaccharides, such as sucrose and maltose, to ensure acceptable gastrointestinal tolerability.\nHe experienced mild episodes of diarrhea after commencing miglustat therapy, which decreased in frequency\/severity over time.\nFrom the start of ERT\/miglustat combination treatment, we observed a reduction in splenomegaly and a gradual normalization of hematological values and plasma angiotensin-converting enzyme activity (Table 1).\nPlasma chitotriosidase was evaluated at the time of diagnosis and then approximately every 6 months during follow-up.\nValues showed an initial reduction after the start of ERT, with a further, substantial, and sustained decrease after commencement of miglustat treatment (Fig.1).\nThe patient has been followed according to recommended guidelines for GD, which specify a complete neurological examination, clinical evaluation of ocular movements, and psychological evaluations every 6\u201312 months [10].\nAfter 5 years of combination therapy and follow-up, the patient did not show any signs of neurological impairment.\nAs of February 2016, he had not displayed any epileptic crises and had demonstrated clinical performance and cooperation.\nHe showed good muscular tone and trophism, normal reflexes with a slight hyperreflexia in his legs, and a negative Romberg sign.\nHis toe and heel deambulation was normal.\nIn particular, ocular evaluations revealed no evidence of saccadic movement velocity reduction and normal visual evoked potentials.\nThe patient\u2019s auditory brain responses were also normal.\nIn addition, he has not demonstrated any cognitive impairment, and he has regularly attended school with good performance since the age of 5 years.\n","ner_info":[{"text":"7-year-old","label":"AGE","start":18,"end":28},{"text":"Italian","label":"PERSONAL_BACKGROUND","start":29,"end":36},{"text":"boy","label":"SEX","start":37,"end":40},{"text":"born after an uneventful gestation of normal duration","label":"HISTORY","start":41,"end":94},{"text":"At the age of 16 months","label":"DATE","start":96,"end":119},{"text":"presented","label":"CLINICAL_EVENT","start":124,"end":133},{"text":"clinically evident","label":"DETAILED_DESCRIPTION","start":141,"end":159},{"text":"enlarged","label":"SIGN_SYMPTOM","start":160,"end":168},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":169,"end":176},{"text":"referred","label":"CLINICAL_EVENT","start":185,"end":193},{"text":"oncological examination","label":"NONBIOLOGICAL_LOCATION","start":198,"end":221},{"text":"anemia","label":"SIGN_SYMPTOM","start":246,"end":252},{"text":"thrombocytopenia","label":"SIGN_SYMPTOM","start":254,"end":270},{"text":"splenomegaly","label":"SIGN_SYMPTOM","start":276,"end":288},{"text":"bone marrow","label":"BIOLOGICAL_STRUCTURE","start":292,"end":303},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":304,"end":310},{"text":"foam cells","label":"SIGN_SYMPTOM","start":336,"end":346},{"text":"lysosomal storage disease","label":"DISEASE_DISORDER","start":374,"end":399},{"text":"Biochemical testing","label":"DIAGNOSTIC_PROCEDURE","start":401,"end":420},{"text":"elevated","label":"LAB_VALUE","start":430,"end":438},{"text":"acid phosphatase","label":"DIAGNOSTIC_PROCEDURE","start":448,"end":464},{"text":"47.8 IU\/L","label":"LAB_VALUE","start":466,"end":475},{"text":"chitotriosidase activity","label":"DIAGNOSTIC_PROCEDURE","start":505,"end":529},{"text":"508 nmol\/mg protein","label":"LAB_VALUE","start":531,"end":550},{"text":"reduced","label":"LAB_VALUE","start":604,"end":611},{"text":"beta-glucosidase activity","label":"DIAGNOSTIC_PROCEDURE","start":612,"end":637},{"text":"2 nmol\/mg\/protein","label":"LAB_VALUE","start":639,"end":656},{"text":"Molecular analysis","label":"DIAGNOSTIC_PROCEDURE","start":699,"end":717},{"text":"homozygous","label":"DETAILED_DESCRIPTION","start":725,"end":735},{"text":"L444P","label":"DETAILED_DESCRIPTION","start":736,"end":741},{"text":"mutations in the GBA gene","label":"SIGN_SYMPTOM","start":742,"end":767},{"text":"NGD","label":"DISEASE_DISORDER","start":829,"end":832},{"text":"ERT","label":"THERAPEUTIC_PROCEDURE","start":852,"end":855},{"text":"60 U\/kg every 2 weeks","label":"DOSAGE","start":871,"end":892},{"text":"at the age of 18 months","label":"DATE","start":893,"end":916},{"text":"age of 30 months","label":"DATE","start":959,"end":975},{"text":"ERT","label":"THERAPEUTIC_PROCEDURE","start":999,"end":1002},{"text":"SRT","label":"THERAPEUTIC_PROCEDURE","start":1008,"end":1011},{"text":"miglustat","label":"MEDICATION","start":1017,"end":1026},{"text":"miglustat","label":"MEDICATION","start":1215,"end":1224},{"text":"adjusted according to the patient\u2019s body surface area","label":"DETAILED_DESCRIPTION","start":1229,"end":1282},{"text":"100 mg three times daily","label":"DOSAGE","start":1466,"end":1490},{"text":"after 1 month","label":"DATE","start":1492,"end":1505},{"text":"From 2 weeks before","label":"DATE","start":1507,"end":1526},{"text":"miglustat","label":"MEDICATION","start":1536,"end":1545},{"text":"dietary modifications","label":"THERAPEUTIC_PROCEDURE","start":1590,"end":1611},{"text":"avoiding high intake of carbohydrate-containing food in single meals","label":"DETAILED_DESCRIPTION","start":1613,"end":1681},{"text":"foods high in disaccharides, such as sucrose and maltose","label":"DETAILED_DESCRIPTION","start":1694,"end":1750},{"text":"mild","label":"SEVERITY","start":1819,"end":1823},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":1836,"end":1844},{"text":"miglustat","label":"MEDICATION","start":1862,"end":1871},{"text":"decreased in frequency\/severity over time","label":"LAB_VALUE","start":1887,"end":1928},{"text":"splenomegaly","label":"SIGN_SYMPTOM","start":2012,"end":2024},{"text":"normalization","label":"LAB_VALUE","start":2039,"end":2052},{"text":"hematological values","label":"DIAGNOSTIC_PROCEDURE","start":2056,"end":2076},{"text":"plasma angiotensin-converting enzyme activity","label":"DIAGNOSTIC_PROCEDURE","start":2081,"end":2126},{"text":"Plasma chitotriosidase","label":"DIAGNOSTIC_PROCEDURE","start":2138,"end":2160},{"text":"every 6 months","label":"FREQUENCY","start":2223,"end":2237},{"text":"follow-up","label":"CLINICAL_EVENT","start":2245,"end":2254},{"text":"initial reduction","label":"LAB_VALUE","start":2273,"end":2290},{"text":"after the start of ERT","label":"DETAILED_DESCRIPTION","start":2291,"end":2313},{"text":"sustained decrease","label":"LAB_VALUE","start":2348,"end":2366},{"text":"after commencement of miglustat","label":"DETAILED_DESCRIPTION","start":2367,"end":2398},{"text":"followed","label":"CLINICAL_EVENT","start":2439,"end":2447},{"text":"according to recommended guidelines for GD","label":"DETAILED_DESCRIPTION","start":2448,"end":2490},{"text":"neurological examination","label":"DIAGNOSTIC_PROCEDURE","start":2517,"end":2541},{"text":"evaluation of ocular movements","label":"DIAGNOSTIC_PROCEDURE","start":2552,"end":2582},{"text":"psychological evaluations","label":"DIAGNOSTIC_PROCEDURE","start":2588,"end":2613},{"text":"every 6\u201312 months","label":"FREQUENCY","start":2614,"end":2631},{"text":"5 years","label":"DURATION","start":2644,"end":2651},{"text":"combination therapy","label":"THERAPEUTIC_PROCEDURE","start":2655,"end":2674},{"text":"follow-up","label":"CLINICAL_EVENT","start":2679,"end":2688},{"text":"neurological impairment","label":"SIGN_SYMPTOM","start":2728,"end":2751},{"text":"February 2016","label":"DATE","start":2759,"end":2772},{"text":"epileptic crises","label":"SIGN_SYMPTOM","start":2799,"end":2815},{"text":"clinical performance","label":"SIGN_SYMPTOM","start":2837,"end":2857},{"text":"cooperation","label":"ACTIVITY","start":2862,"end":2873},{"text":"good","label":"LAB_VALUE","start":2885,"end":2889},{"text":"muscular tone and trophism","label":"DIAGNOSTIC_PROCEDURE","start":2890,"end":2916},{"text":"normal","label":"LAB_VALUE","start":2918,"end":2924},{"text":"reflexes","label":"DIAGNOSTIC_PROCEDURE","start":2925,"end":2933},{"text":"slight","label":"SEVERITY","start":2941,"end":2947},{"text":"hyperreflexia","label":"SIGN_SYMPTOM","start":2948,"end":2961},{"text":"legs","label":"BIOLOGICAL_STRUCTURE","start":2969,"end":2973},{"text":"negative","label":"LAB_VALUE","start":2981,"end":2989},{"text":"Romberg sign","label":"DIAGNOSTIC_PROCEDURE","start":2990,"end":3002},{"text":"toe and heel deambulation","label":"DIAGNOSTIC_PROCEDURE","start":3008,"end":3033},{"text":"normal","label":"LAB_VALUE","start":3038,"end":3044},{"text":"ocular evaluations","label":"DIAGNOSTIC_PROCEDURE","start":3061,"end":3079},{"text":"saccadic movement velocity reduction","label":"SIGN_SYMPTOM","start":3104,"end":3140},{"text":"normal","label":"LAB_VALUE","start":3145,"end":3151},{"text":"visual evoked potentials","label":"DIAGNOSTIC_PROCEDURE","start":3152,"end":3176},{"text":"auditory brain responses","label":"DIAGNOSTIC_PROCEDURE","start":3192,"end":3216},{"text":"normal","label":"LAB_VALUE","start":3227,"end":3233},{"text":"cognitive impairment","label":"SIGN_SYMPTOM","start":3276,"end":3296},{"text":"regularly","label":"DETAILED_DESCRIPTION","start":3309,"end":3318},{"text":"attended school","label":"ACTIVITY","start":3319,"end":3334},{"text":"good performance","label":"DETAILED_DESCRIPTION","start":3340,"end":3356},{"text":"since the age of 5 years","label":"DATE","start":3357,"end":3381}],"tokens":["Our patient was a ","7-year-old"," ","Italian"," ","boy"," ","born after an uneventful gestation of normal duration",".\n","At the age of 16 months",", he ","presented"," with a ","clinically evident"," ","enlarged"," ","abdomen"," and was ","referred"," for ","oncological examination",".\nInitial tests revealed ","anemia",", ","thrombocytopenia",", and ","splenomegaly",".\nA ","bone marrow"," ","biopsy"," revealed the presence of ","foam cells",", which led to suspicion of ","lysosomal storage disease",".\n","Biochemical testing"," revealed ","elevated"," level of ","acid phosphatase"," (","47.8 IU\/L"," [normal range 5\u20137 IU\/L]) and ","chitotriosidase activity"," (","508 nmol\/mg protein"," [normal range 5.9\u201341.0 nmol\/mg protein]), as well as ","reduced"," ","beta-glucosidase activity"," (","2 nmol\/mg\/protein"," [normal range 4.5\u201318.0 nmol\/mg\/protein]).\n","Molecular analysis"," showed ","homozygous"," ","L444P"," ","mutations in the GBA gene"," (OMIM reference 606463), confirming the diagnosis of chronic ","NGD",".\nThe patient began ","ERT"," at a dosage of ","60 U\/kg every 2 weeks"," ","at the age of 18 months",".\nThereafter, when the patient reached the ","age of 30 months",", we decided to combine ","ERT"," with ","SRT"," with ","miglustat",".\nThis clinical decision was approved by our institution\u2019s ethics committee, and informed consent was obtained from the patient\u2019s parents before commencing combination therapy.\nThe dose of ","miglustat"," was ","adjusted according to the patient\u2019s body surface area"," and was uptitrated during the first 4 weeks with the following scheme: one-third of target dose during weeks 1 and 2, two-thirds of target dose during weeks 3 and 4, and target dose (","100 mg three times daily",") ","after 1 month",".\n","From 2 weeks before"," starting ","miglustat"," therapy, the patient also followed specific ","dietary modifications",", ","avoiding high intake of carbohydrate-containing food in single meals",", especially ","foods high in disaccharides, such as sucrose and maltose",", to ensure acceptable gastrointestinal tolerability.\nHe experienced ","mild"," episodes of ","diarrhea"," after commencing ","miglustat"," therapy, which ","decreased in frequency\/severity over time",".\nFrom the start of ERT\/miglustat combination treatment, we observed a reduction in ","splenomegaly"," and a gradual ","normalization"," of ","hematological values"," and ","plasma angiotensin-converting enzyme activity"," (Table 1).\n","Plasma chitotriosidase"," was evaluated at the time of diagnosis and then approximately ","every 6 months"," during ","follow-up",".\nValues showed an ","initial reduction"," ","after the start of ERT",", with a further, substantial, and ","sustained decrease"," ","after commencement of miglustat"," treatment (Fig.1).\nThe patient has been ","followed"," ","according to recommended guidelines for GD",", which specify a complete ","neurological examination",", clinical ","evaluation of ocular movements",", and ","psychological evaluations"," ","every 6\u201312 months"," [10].\nAfter ","5 years"," of ","combination therapy"," and ","follow-up",", the patient did not show any signs of ","neurological impairment",".\nAs of ","February 2016",", he had not displayed any ","epileptic crises"," and had demonstrated ","clinical performance"," and ","cooperation",".\nHe showed ","good"," ","muscular tone and trophism",", ","normal"," ","reflexes"," with a ","slight"," ","hyperreflexia"," in his ","legs",", and a ","negative"," ","Romberg sign",".\nHis ","toe and heel deambulation"," was ","normal",".\nIn particular, ","ocular evaluations"," revealed no evidence of ","saccadic movement velocity reduction"," and ","normal"," ","visual evoked potentials",".\nThe patient\u2019s ","auditory brain responses"," were also ","normal",".\nIn addition, he has not demonstrated any ","cognitive impairment",", and he has ","regularly"," ","attended school"," with ","good performance"," ","since the age of 5 years",".\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,19,0,13,0,22,0,69,0,12,0,13,0,48,0,69,0,69,0,69,0,12,0,24,0,69,0,26,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,22,0,22,0,69,0,26,0,75,0,29,0,19,0,19,0,75,0,75,0,46,0,46,0,22,0,29,0,19,0,19,0,46,0,75,0,22,0,22,0,63,0,69,0,46,0,42,0,69,0,42,0,24,0,24,0,24,0,35,0,13,0,42,0,22,0,42,0,22,0,13,0,22,0,24,0,24,0,24,0,35,0,32,0,75,0,13,0,69,0,19,0,69,0,69,0,1,0,42,0,24,0,42,0,24,0,63,0,69,0,12,0,42,0,24,0,24,0,42,0,24,0,69,0,42,0,24,0,24,0,42,0,69,0,22,0,1,0,22,0,19,0]}
-{"full_text":"A 64-year-old female was found lying down after 10\u201312 hours of binge drinking.\nShe was taken to an outlying emergency department (ED), and subsequently transferred to our hospital with mental status changes and respiratory distress and hypoxia for further management.\nShe had a past history of rheumatoid arthritis, congestive heart failure, controlled hypertension, and alcoholism.\nShe smoked two packs a day for the past 50 years.\nOn presentation, she had a blood pressure of 176\/80 mm\/Hg, heart rate of 80 bpm, respirations 24 bpm, temperature 98\u00b0F (36.7\u00b0C).\nArterial blood gases on room air showed a pH of 7.30, PaCO2 60, PaO2 61 mm\/Hg, H\u2212CO3 29 mEq\/L, and saturation 92% which improved to 95% with oxygen by a high flow non-rebreather mask.\nOn physical examination she was lethargic, disoriented, dysarthritic, but without neurological focalization.\nScattered expiratory wheezes were noted bilaterally along with normal heart sounds.\nThe remaining results of her physical examination and routine laboratory results were unremarkable with the exception of a leukocyte count of 14,000\/dL with 88% neutrophils.\nRepeated vitals signs were consistent with a normal blood pressure but evidence of tachycardia in the monitor.\nRepeated ABG\u2019s on the non-rebreather mask showed: pH 7.22, PaCO2 78, PaO2 140 mm Hg, H\u2212CO3 30 mEq\/L, and hemoglobin SaO2 97%.\nIn the ED she was started on IV steroids and antibiotics for a COPD exacerbation.\nAs part of the diagnostic workup, she underwent a chest x ray that did not show any infiltrates or any major abnormal findings.\nThe ECG was only significant for sinus tachycardia.\nGiven the negative findings on chest x ray, sinus tachycardia on ECG, and an increased A-a gradient, the patient was sent for a spiral chest CT with contrast to rule out a pulmonary embolism.\nDuring CT about 100\u2013150 mL of air was inadvertently injected through the right antecubital vein using a power contrast injector (estimated by the technician and approximation of volumes on available imaging).\nConcurrent imaging (CT) showed a significant amount of air in the right atrium and right ventricular cavity (Figure 1), and air mixed with contrast in the main pulmonary artery and its proximal branches divisions of the pulmonary circulation (Figure 2).\nConcurrently, a filling defect was noted in the right lower lobe artery consistent with pulmonary thromboembolism (Figures 3, \u200b,4).4).\nThe patient maintained hemodynamic stability with Trendelenburg, and left lateral decubitus positioning (Durant\u2019s maneuver), and supportive care alone and she was transferred to the intensive care unit (ICU) for observation.\nHer respiratory distress worsened, and she was placed temporarily on non-invasive positive pressure ventilation (NIPPV) without improvement and a few hours later she was intubated and placed on mechanical ventilation.\nIntravenous full dose heparin infusion (initial bolus, 80 units\/kg, followed by 18 units\/kg\/hour) was initiated for treatment of concurrent thromboembolism.\nEchocardiography did not show any evidence of right or left ventricular failure.\nSubsequent echocardiography done 24 hours later did not show any evidence of intracardiac air and complete resolution of the air embolism.\nDuring the next 48 hours, she remained hemodynamically stable with no requirements of vasoactive agents.\nShe was finally extubated 48 hours after the initial presentation.\nShe was later discharged home on warfarin with subsequent outpatient follow-up.\n","ner_info":[{"text":"64-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"lying down","label":"ACTIVITY","start":31,"end":41},{"text":"10\u201312 hours","label":"DURATION","start":48,"end":59},{"text":"binge drinking","label":"ACTIVITY","start":63,"end":77},{"text":"taken","label":"CLINICAL_EVENT","start":87,"end":92},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":108,"end":128},{"text":"ED","label":"NONBIOLOGICAL_LOCATION","start":130,"end":132},{"text":"transferred","label":"CLINICAL_EVENT","start":152,"end":163},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":171,"end":179},{"text":"mental status changes","label":"SIGN_SYMPTOM","start":185,"end":206},{"text":"respiratory distress","label":"SIGN_SYMPTOM","start":211,"end":231},{"text":"hypoxia","label":"SIGN_SYMPTOM","start":236,"end":243},{"text":"rheumatoid arthritis","label":"HISTORY","start":294,"end":314},{"text":"congestive heart failure","label":"HISTORY","start":316,"end":340},{"text":"controlled hypertension","label":"HISTORY","start":342,"end":365},{"text":"alcoholism","label":"HISTORY","start":371,"end":381},{"text":"smoked two packs a day for the past 50 years","label":"HISTORY","start":387,"end":431},{"text":"presentation","label":"CLINICAL_EVENT","start":436,"end":448},{"text":"blood 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ray","label":"DIAGNOSTIC_PROCEDURE","start":1488,"end":1493},{"text":"infiltrates","label":"SIGN_SYMPTOM","start":1516,"end":1527},{"text":"abnormal findings","label":"SIGN_SYMPTOM","start":1541,"end":1558},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":1564,"end":1567},{"text":"sinus","label":"BIOLOGICAL_STRUCTURE","start":1593,"end":1598},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":1599,"end":1610},{"text":"spiral","label":"DETAILED_DESCRIPTION","start":1740,"end":1746},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1747,"end":1752},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1753,"end":1755},{"text":"with contrast","label":"DETAILED_DESCRIPTION","start":1756,"end":1769},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1784,"end":1793},{"text":"embolism","label":"DISEASE_DISORDER","start":1794,"end":1802},{"text":"CT","label":"COREFERENCE","start":1811,"end":1813},{"text":"100\u2013150 mL","label":"VOLUME","start":1820,"end":1830},{"text":"air was inadvertently injected","label":"CLINICAL_EVENT","start":1834,"end":1864},{"text":"right antecubital vein","label":"BIOLOGICAL_STRUCTURE","start":1877,"end":1899},{"text":"power contrast injector","label":"DETAILED_DESCRIPTION","start":1908,"end":1931},{"text":"Concurrent","label":"DETAILED_DESCRIPTION","start":2013,"end":2023},{"text":"imaging","label":"DIAGNOSTIC_PROCEDURE","start":2024,"end":2031},{"text":"significant","label":"SEVERITY","start":2046,"end":2057},{"text":"amount of air","label":"SIGN_SYMPTOM","start":2058,"end":2071},{"text":"right atrium","label":"BIOLOGICAL_STRUCTURE","start":2079,"end":2091},{"text":"right ventricular cavity","label":"BIOLOGICAL_STRUCTURE","start":2096,"end":2120},{"text":"air mixed with contrast","label":"SIGN_SYMPTOM","start":2137,"end":2160},{"text":"main pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":2168,"end":2189},{"text":"proximal branches divisions of the pulmonary circulation","label":"BIOLOGICAL_STRUCTURE","start":2198,"end":2254},{"text":"filling defect","label":"SIGN_SYMPTOM","start":2283,"end":2297},{"text":"right lower lobe artery","label":"BIOLOGICAL_STRUCTURE","start":2315,"end":2338},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":2355,"end":2364},{"text":"thromboembolism","label":"DISEASE_DISORDER","start":2365,"end":2380},{"text":"hemodynamic stability","label":"DIAGNOSTIC_PROCEDURE","start":2425,"end":2446},{"text":"Trendelenburg","label":"THERAPEUTIC_PROCEDURE","start":2452,"end":2465},{"text":"left lateral decubitus positioning","label":"THERAPEUTIC_PROCEDURE","start":2471,"end":2505},{"text":"Durant\u2019s maneuver","label":"THERAPEUTIC_PROCEDURE","start":2507,"end":2524},{"text":"supportive care","label":"THERAPEUTIC_PROCEDURE","start":2531,"end":2546},{"text":"transferred","label":"CLINICAL_EVENT","start":2565,"end":2576},{"text":"intensive care 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bolus, 80 units\/kg, followed by 18 units\/kg\/hour","label":"DOSAGE","start":2885,"end":2941},{"text":"thromboembolism","label":"DISEASE_DISORDER","start":2985,"end":3000},{"text":"Echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":3002,"end":3018},{"text":"right or left ventricular failure","label":"SIGN_SYMPTOM","start":3048,"end":3081},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":3094,"end":3110},{"text":"24 hours later","label":"TIME","start":3116,"end":3130},{"text":"intracardiac","label":"BIOLOGICAL_STRUCTURE","start":3160,"end":3172},{"text":"air","label":"SIGN_SYMPTOM","start":3173,"end":3176},{"text":"embolism","label":"DISEASE_DISORDER","start":3212,"end":3220},{"text":"During the next 48 hours","label":"DURATION","start":3222,"end":3246},{"text":"hemodynamically","label":"DIAGNOSTIC_PROCEDURE","start":3261,"end":3276},{"text":"stable","label":"LAB_VALUE","start":3277,"end":3283},{"text":"vasoactive 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","alcoholism",".\nShe ","smoked two packs a day for the past 50 years",".\nOn ","presentation",", she had a ","blood pressure"," of ","176\/80 mm\/Hg",", ","heart rate"," of ","80 bpm",", ","respirations"," ","24 bpm",", ","temperature"," ","98\u00b0F"," (","36.7\u00b0C",").\n","Arterial blood gases"," on ","room air"," showed a ","pH"," of ","7.30",", ","PaCO2"," ","60",", ","PaO2"," ","61 mm\/Hg",", ","H\u2212CO3"," ","29 mEq\/L",", and ","saturation"," ","92%"," which improved to ","95%"," with ","oxygen"," by a ","high flow non-rebreather mask",".\nOn ","physical examination"," she was ","lethargic",", ","disoriented",", ","dysarthritic",", but without ","neurological focalization",".\n","Scattered"," ","expiratory wheezes"," were noted ","bilaterally"," along with ","normal"," ","heart sounds",".\nThe remaining results of her physical examination and routine ","laboratory results"," were ","unremarkable"," with the exception of a ","leukocyte count"," of ","14,000\/dL"," with ","88% neutrophils",".\nRepeated ","vitals signs"," were consistent with a ","normal"," ","blood pressure"," but evidence of ","tachycardia"," in the monitor.\nRepeated ","ABG\u2019s"," on the ","non-rebreather mask"," showed: ","pH"," ","7.22",", ","PaCO2"," ","78",", ","PaO2"," ","140 mm Hg",", ","H\u2212CO3"," ","30 mEq\/L",", and ","hemoglobin SaO2"," ","97%",".\nIn the ","ED"," she was started on ","IV"," ","steroids"," and ","antibiotics"," for a ","COPD"," ","exacerbation",".\nAs part of the ","diagnostic workup",", she underwent a ","chest"," ","x ray"," that did not show any ","infiltrates"," or any major ","abnormal findings",".\nThe ","ECG"," was only significant for ","sinus"," ","tachycardia",".\nGiven the negative findings on chest x ray, sinus tachycardia on ECG, and an increased A-a gradient, the patient was sent for a ","spiral"," ","chest"," ","CT"," ","with contrast"," to rule out a ","pulmonary"," ","embolism",".\nDuring ","CT"," about ","100\u2013150 mL"," of ","air was inadvertently injected"," through the ","right antecubital vein"," using a ","power contrast injector"," (estimated by the technician and approximation of volumes on available imaging).\n","Concurrent"," ","imaging"," (CT) showed a ","significant"," ","amount of air"," in the ","right atrium"," and ","right ventricular cavity"," (Figure 1), and ","air mixed with contrast"," in the ","main pulmonary artery"," and its ","proximal branches divisions of the pulmonary circulation"," (Figure 2).\nConcurrently, a ","filling defect"," was noted in the ","right lower lobe artery"," consistent with ","pulmonary"," ","thromboembolism"," (Figures 3, \u200b,4).4).\nThe patient maintained ","hemodynamic stability"," with ","Trendelenburg",", and ","left lateral decubitus positioning"," (","Durant\u2019s maneuver","), and ","supportive care"," alone and she was ","transferred"," to the ","intensive care unit"," (","ICU",") for observation.\nHer ","respiratory distress"," worsened, and she was placed temporarily on ","non-invasive positive pressure ventilation"," (","NIPPV",") without ","improvement"," and ","a few hours later"," she was ","intubated"," and placed on ","mechanical ventilation",".\n","Intravenous"," ","full dose"," ","heparin"," ","infusion"," (","initial bolus, 80 units\/kg, followed by 18 units\/kg\/hour",") was initiated for treatment of concurrent ","thromboembolism",".\n","Echocardiography"," did not show any evidence of ","right or left ventricular failure",".\nSubsequent ","echocardiography"," done ","24 hours later"," did not show any evidence of ","intracardiac"," ","air"," and complete resolution of the air ","embolism",".\n","During the next 48 hours",", she remained ","hemodynamically"," ","stable"," with no requirements of ","vasoactive agents",".\nShe was finally ","extubated"," ","48 hours after the initial presentation",".\nShe was later ","discharged"," ","home"," on ","warfarin"," with subsequent outpatient 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-{"full_text":"This 73-year-old female, with a history of coronary artery disease and situs inversus, had recently noticed left arm exercise weakness.\nThe magnetic resonance angiogram and computer tomography of the upper limb vessels showed critical stenosis of the left-side SCA with calcification near the orifice (Fig.1).\nPercutaneous revascularization was done via right femoral artery approach, and severe left SCA stenosis was confirmed (Fig.2A) (Supplementary Video 1, only online).\nDirect stenting in the left SCA was carried out with a balloon-expansible Express LD 10\u00d725 mm stent (Boston Scientific Corporation, Natick, MA, USA) (Fig.2B) up to 8 atmospheres for 13 seconds.\nHowever, severe shortness of breath and hypotension developed after stenting.\nThe blood pressure was down to 88\/56, and the heart rate was up to 90.\nThe oxygen saturation was down to 74%.\nEmergent intubation, fluid infusion, inotropic agent with norepinephrine were given.\nThe immediate angiography showed vascular perforation in the stented segment of left SCA (Fig.2C) (Supplementary Video 2, only online).\nEmergency balloon inflation within the stent was done with an 8\u00d740 mm balloon.\nThe cardiovascular surgeon was also consulted.\nHowever, due to the high surgical risk of bypass, endovascular treatment was suggested.\nWe decided to do a retrograde approach through the left brachial artery by surgical cut-down.\nSince there was no suitable graft stent in our cath lab, we modified and cut the iliac extension of self-expanding Endurant II graft stent 10\u00d782 mm (Medtronic, Inc., Minneapolis, MN, USA), which was originally designed to treat abdominal aortic aneurysms (AAA), to a suitable length (around 30 mm) (Fig.3).\nAfter retrograde wiring, an operator-modified Endurant II graft stent was deployed in the stent segment (Fig.2D) and the perforation was sealed successfully.\nAfter stenting of the graft stent, however, slow flow of left common carotid artery (LCCA) was noted, and angiography confirmed the near total occlusion of the LCCA, occluded by the SCA graft stent (Fig.2E) (Supplementary Video 3, only online).\nA firm wire (Conquest pro, Asahi Inc, Seto, Japan) was successfully advanced outside the graft stent and into the LCCA.\nDespite sequent balloon dilations at the bifurcation site, the flow to the LCCA was still poor.\nIntravascular ultrasound also confirmed the severe compromise of the LCCA ostium which was caused by the graft stent (Fig.2F).\nTherefore, we put a balloon-expansible carotid stent, Express 7\u00d737 mm (Boston Scientific Corporation), from the LCCA to the left brachiocephalic artery (Fig.4A).\nTIMI III flow of the LCCA was restored after stenting (Fig.4B-E) (Supplementary Video 4, only online).\nIntravascular ultrasound also confirmed proper expansion of the LCCA stent (Fig.4F).\nThe follow-up chest radiography revealed left-side hemothorax.\nAfter thoracocentesis with drainage and proper care, the patient was discharged.\nTill now, the patient has been free from symptoms for six months.\n","ner_info":[{"text":"73-year-old","label":"AGE","start":5,"end":16},{"text":"female","label":"SEX","start":17,"end":23},{"text":"history of coronary artery disease","label":"HISTORY","start":32,"end":66},{"text":"situs inversus","label":"HISTORY","start":71,"end":85},{"text":"left arm","label":"BIOLOGICAL_STRUCTURE","start":108,"end":116},{"text":"exercise","label":"DETAILED_DESCRIPTION","start":117,"end":125},{"text":"weakness","label":"SIGN_SYMPTOM","start":126,"end":134},{"text":"magnetic resonance angiogram","label":"DIAGNOSTIC_PROCEDURE","start":140,"end":168},{"text":"computer tomography","label":"DIAGNOSTIC_PROCEDURE","start":173,"end":192},{"text":"upper limb vessels","label":"BIOLOGICAL_STRUCTURE","start":200,"end":218},{"text":"critical","label":"SEVERITY","start":226,"end":234},{"text":"stenosis","label":"SIGN_SYMPTOM","start":235,"end":243},{"text":"left-side SCA","label":"BIOLOGICAL_STRUCTURE","start":251,"end":264},{"text":"calcification","label":"SIGN_SYMPTOM","start":270,"end":283},{"text":"orifice","label":"BIOLOGICAL_STRUCTURE","start":293,"end":300},{"text":"Percutaneous","label":"DETAILED_DESCRIPTION","start":310,"end":322},{"text":"revascularization","label":"THERAPEUTIC_PROCEDURE","start":323,"end":340},{"text":"right femoral artery approach","label":"DETAILED_DESCRIPTION","start":354,"end":383},{"text":"severe","label":"SEVERITY","start":389,"end":395},{"text":"left SCA","label":"BIOLOGICAL_STRUCTURE","start":396,"end":404},{"text":"stenosis","label":"SIGN_SYMPTOM","start":405,"end":413},{"text":"Direct","label":"DETAILED_DESCRIPTION","start":475,"end":481},{"text":"stenting","label":"THERAPEUTIC_PROCEDURE","start":482,"end":490},{"text":"left SCA","label":"BIOLOGICAL_STRUCTURE","start":498,"end":506},{"text":"balloon-expansible Express LD 10\u00d725 mm stent","label":"DETAILED_DESCRIPTION","start":530,"end":574},{"text":"Boston Scientific Corporation, Natick, MA, USA","label":"DETAILED_DESCRIPTION","start":576,"end":622},{"text":"8 atmospheres for 13 seconds","label":"LAB_VALUE","start":639,"end":667},{"text":"severe","label":"SEVERITY","start":678,"end":684},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":685,"end":704},{"text":"hypotension","label":"SIGN_SYMPTOM","start":709,"end":720},{"text":"stenting","label":"COREFERENCE","start":737,"end":745},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":751,"end":765},{"text":"88\/56","label":"LAB_VALUE","start":778,"end":783},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":793,"end":803},{"text":"90","label":"LAB_VALUE","start":814,"end":816},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":822,"end":839},{"text":"74%","label":"LAB_VALUE","start":852,"end":855},{"text":"Emergent","label":"DETAILED_DESCRIPTION","start":857,"end":865},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":866,"end":876},{"text":"fluid infusion","label":"THERAPEUTIC_PROCEDURE","start":878,"end":892},{"text":"inotropic agent","label":"MEDICATION","start":894,"end":909},{"text":"norepinephrine","label":"MEDICATION","start":915,"end":929},{"text":"immediate","label":"DETAILED_DESCRIPTION","start":946,"end":955},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":956,"end":967},{"text":"vascular perforation","label":"SIGN_SYMPTOM","start":975,"end":995},{"text":"stented segment of left SCA","label":"BIOLOGICAL_STRUCTURE","start":1003,"end":1030},{"text":"balloon inflation","label":"THERAPEUTIC_PROCEDURE","start":1088,"end":1105},{"text":"within the stent","label":"BIOLOGICAL_STRUCTURE","start":1106,"end":1122},{"text":"8\u00d740 mm balloon","label":"DETAILED_DESCRIPTION","start":1140,"end":1155},{"text":"cardiovascular surgeon","label":"NONBIOLOGICAL_LOCATION","start":1161,"end":1183},{"text":"consulted","label":"CLINICAL_EVENT","start":1193,"end":1202},{"text":"endovascular treatment","label":"THERAPEUTIC_PROCEDURE","start":1254,"end":1276},{"text":"retrograde approach","label":"THERAPEUTIC_PROCEDURE","start":1311,"end":1330},{"text":"left brachial artery","label":"BIOLOGICAL_STRUCTURE","start":1343,"end":1363},{"text":"by surgical cut-down","label":"DETAILED_DESCRIPTION","start":1364,"end":1384},{"text":"modified and cut the iliac extension","label":"DETAILED_DESCRIPTION","start":1446,"end":1482},{"text":"self-expanding","label":"DETAILED_DESCRIPTION","start":1486,"end":1500},{"text":"Endurant II graft stent","label":"DETAILED_DESCRIPTION","start":1501,"end":1524},{"text":"10\u00d782 mm","label":"AREA","start":1525,"end":1533},{"text":"Medtronic, Inc., Minneapolis, MN, USA","label":"DETAILED_DESCRIPTION","start":1535,"end":1572},{"text":"around 30 mm","label":"DETAILED_DESCRIPTION","start":1670,"end":1682},{"text":"graft stent","label":"THERAPEUTIC_PROCEDURE","start":1751,"end":1762},{"text":"perforation was sealed","label":"THERAPEUTIC_PROCEDURE","start":1814,"end":1836},{"text":"slow","label":"LAB_VALUE","start":1895,"end":1899},{"text":"flow","label":"DIAGNOSTIC_PROCEDURE","start":1900,"end":1904},{"text":"left common carotid artery","label":"BIOLOGICAL_STRUCTURE","start":1908,"end":1934},{"text":"LCCA","label":"BIOLOGICAL_STRUCTURE","start":1936,"end":1940},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":1957,"end":1968},{"text":"near total","label":"SEVERITY","start":1983,"end":1993},{"text":"occlusion","label":"SIGN_SYMPTOM","start":1994,"end":2003},{"text":"LCCA","label":"BIOLOGICAL_STRUCTURE","start":2011,"end":2015},{"text":"occluded by the SCA graft stent","label":"DETAILED_DESCRIPTION","start":2017,"end":2048},{"text":"firm wire","label":"THERAPEUTIC_PROCEDURE","start":2098,"end":2107},{"text":"advanced","label":"DETAILED_DESCRIPTION","start":2164,"end":2172},{"text":"outside the graft stent","label":"BIOLOGICAL_STRUCTURE","start":2173,"end":2196},{"text":"LCCA","label":"BIOLOGICAL_STRUCTURE","start":2210,"end":2214},{"text":"balloon dilations","label":"THERAPEUTIC_PROCEDURE","start":2232,"end":2249},{"text":"bifurcation site","label":"BIOLOGICAL_STRUCTURE","start":2257,"end":2273},{"text":"flow","label":"DIAGNOSTIC_PROCEDURE","start":2279,"end":2283},{"text":"LCCA","label":"BIOLOGICAL_STRUCTURE","start":2291,"end":2295},{"text":"poor","label":"LAB_VALUE","start":2306,"end":2310},{"text":"Intravascular","label":"DETAILED_DESCRIPTION","start":2312,"end":2325},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2326,"end":2336},{"text":"severe","label":"SEVERITY","start":2356,"end":2362},{"text":"compromise","label":"SIGN_SYMPTOM","start":2363,"end":2373},{"text":"LCCA ostium","label":"BIOLOGICAL_STRUCTURE","start":2381,"end":2392},{"text":"caused by the graft stent","label":"DETAILED_DESCRIPTION","start":2403,"end":2428},{"text":"balloon-expansible","label":"DETAILED_DESCRIPTION","start":2459,"end":2477},{"text":"carotid stent","label":"THERAPEUTIC_PROCEDURE","start":2478,"end":2491},{"text":"Express 7\u00d737 mm","label":"DETAILED_DESCRIPTION","start":2493,"end":2508},{"text":"Boston Scientific Corporation","label":"DETAILED_DESCRIPTION","start":2510,"end":2539},{"text":"from the LCCA","label":"BIOLOGICAL_STRUCTURE","start":2542,"end":2555},{"text":"left brachiocephalic artery","label":"BIOLOGICAL_STRUCTURE","start":2563,"end":2590},{"text":"TIMI III flow","label":"DIAGNOSTIC_PROCEDURE","start":2601,"end":2614},{"text":"LCCA","label":"BIOLOGICAL_STRUCTURE","start":2622,"end":2626},{"text":"restored","label":"LAB_VALUE","start":2631,"end":2639},{"text":"Intravascular","label":"DETAILED_DESCRIPTION","start":2704,"end":2717},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2718,"end":2728},{"text":"proper","label":"LAB_VALUE","start":2744,"end":2750},{"text":"expansion","label":"SIGN_SYMPTOM","start":2751,"end":2760},{"text":"LCCA stent","label":"BIOLOGICAL_STRUCTURE","start":2768,"end":2778},{"text":"follow-up","label":"CLINICAL_EVENT","start":2793,"end":2802},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2803,"end":2808},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":2809,"end":2820},{"text":"left-side","label":"DETAILED_DESCRIPTION","start":2830,"end":2839},{"text":"hemothorax","label":"SIGN_SYMPTOM","start":2840,"end":2850},{"text":"thoracocentesis","label":"THERAPEUTIC_PROCEDURE","start":2858,"end":2873},{"text":"drainage","label":"DETAILED_DESCRIPTION","start":2879,"end":2887},{"text":"proper care","label":"THERAPEUTIC_PROCEDURE","start":2892,"end":2903},{"text":"discharged","label":"CLINICAL_EVENT","start":2921,"end":2931},{"text":"symptoms","label":"SIGN_SYMPTOM","start":2974,"end":2982},{"text":"six months","label":"DURATION","start":2987,"end":2997}],"tokens":["This ","73-year-old"," ","female",", with a ","history of coronary artery disease"," and ","situs inversus",", had recently noticed ","left arm"," ","exercise"," ","weakness",".\nThe ","magnetic resonance angiogram"," and ","computer tomography"," of the ","upper limb vessels"," showed ","critical"," ","stenosis"," of the ","left-side SCA"," with ","calcification"," near the ","orifice"," (Fig.1).\n","Percutaneous"," ","revascularization"," was done via ","right femoral artery approach",", and ","severe"," ","left SCA"," ","stenosis"," was confirmed (Fig.2A) (Supplementary Video 1, only online).\n","Direct"," ","stenting"," in the ","left SCA"," was carried out with a ","balloon-expansible Express LD 10\u00d725 mm stent"," (","Boston Scientific Corporation, Natick, MA, USA",") (Fig.2B) up to ","8 atmospheres for 13 seconds",".\nHowever, ","severe"," ","shortness of breath"," and ","hypotension"," developed after ","stenting",".\nThe ","blood pressure"," was down to ","88\/56",", and the ","heart rate"," was up to ","90",".\nThe ","oxygen saturation"," was down to ","74%",".\n","Emergent"," ","intubation",", ","fluid infusion",", ","inotropic agent"," with ","norepinephrine"," were given.\nThe ","immediate"," ","angiography"," showed ","vascular perforation"," in the ","stented segment of left SCA"," (Fig.2C) (Supplementary Video 2, only online).\nEmergency ","balloon inflation"," ","within the stent"," was done with an ","8\u00d740 mm balloon",".\nThe ","cardiovascular surgeon"," was also ","consulted",".\nHowever, due to the high surgical risk of bypass, ","endovascular treatment"," was suggested.\nWe decided to do a ","retrograde approach"," through the ","left brachial artery"," ","by surgical cut-down",".\nSince there was no suitable graft stent in our cath lab, we ","modified and cut the iliac extension"," of ","self-expanding"," ","Endurant II graft stent"," ","10\u00d782 mm"," (","Medtronic, Inc., Minneapolis, MN, USA","), which was originally designed to treat abdominal aortic aneurysms (AAA), to a suitable length (","around 30 mm",") (Fig.3).\nAfter retrograde wiring, an operator-modified Endurant II ","graft stent"," was deployed in the stent segment (Fig.2D) and the ","perforation was sealed"," successfully.\nAfter stenting of the graft stent, however, ","slow"," ","flow"," of ","left common carotid artery"," (","LCCA",") was noted, and ","angiography"," confirmed the ","near total"," ","occlusion"," of the ","LCCA",", ","occluded by the SCA graft stent"," (Fig.2E) (Supplementary Video 3, only online).\nA ","firm wire"," (Conquest pro, Asahi Inc, Seto, Japan) was successfully ","advanced"," ","outside the graft stent"," and into the ","LCCA",".\nDespite sequent ","balloon dilations"," at the ","bifurcation site",", the ","flow"," to the ","LCCA"," was still ","poor",".\n","Intravascular"," ","ultrasound"," also confirmed the ","severe"," ","compromise"," of the ","LCCA ostium"," which was ","caused by the graft stent"," (Fig.2F).\nTherefore, we put a ","balloon-expansible"," ","carotid stent",", ","Express 7\u00d737 mm"," (","Boston Scientific Corporation","), ","from the LCCA"," to the ","left brachiocephalic artery"," (Fig.4A).\n","TIMI III flow"," of the ","LCCA"," was ","restored"," after stenting (Fig.4B-E) (Supplementary Video 4, only online).\n","Intravascular"," ","ultrasound"," also confirmed ","proper"," ","expansion"," of the ","LCCA stent"," (Fig.4F).\nThe ","follow-up"," ","chest"," ","radiography"," revealed ","left-side"," ","hemothorax",".\nAfter ","thoracocentesis"," with ","drainage"," and ","proper care",", the patient was ","discharged",".\nTill now, the patient has been free from ","symptoms"," for ","six months",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,12,0,22,0,69,0,24,0,24,0,12,0,63,0,69,0,12,0,69,0,12,0,22,0,75,0,22,0,63,0,12,0,69,0,22,0,75,0,12,0,22,0,22,0,42,0,63,0,69,0,69,0,18,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,75,0,75,0,46,0,46,0,22,0,24,0,69,0,12,0,75,0,12,0,22,0,48,0,13,0,75,0,75,0,12,0,22,0,22,0,22,0,22,0,8,0,22,0,22,0,75,0,75,0,42,0,24,0,12,0,12,0,24,0,63,0,69,0,12,0,22,0,75,0,22,0,12,0,12,0,75,0,12,0,24,0,12,0,42,0,22,0,24,0,63,0,69,0,12,0,22,0,22,0,75,0,22,0,22,0,12,0,12,0,24,0,12,0,42,0,22,0,24,0,42,0,69,0,12,0,13,0,12,0,24,0,22,0,69,0,75,0,22,0,75,0,13,0,69,0,32,0]}
-{"full_text":"A 68-year-old female smoker with a history of pulmonary embolism and diabetes mellitus was diagnosed with Stage IIIB (T4N2M0) squamous NSCLC.\nShe was treated by definitive chemoradiotherapy with cisplatin and vinorelbine until September 2014.\nIn October 2014, positron emission tomography\u2013computed tomography (PET-CT) scan demonstrated a good response in the primary lesion; however, new metastases in the right adrenal gland and right femur developed and were irradiated in November 2014.\nA month later the disease progressed with development of multiple bone and subcutaneous metastases.\nAt that point, the patient suffered from severe dyspnea and was oxygen-dependent.\nShe received one cycle of carboplatin and gemcitabine followed by severe pancytopenia, and treatment was switched to nivolumab 3\u200amg\/kg q14 days in January 2015.\nOne week after the first cycle of nivolumab, a subcutaneous lesion in her upper back grew substantially, accompanied by severe pain and significant inflammatory reaction (Fig.1).\nOther subcutaneous metastases grew slightly as well.\nAfter the second cycle of treatment marked symptomatic improvement was observed, including improvement in general appearance and dyspnea and reduction of the bone pain.\nThe patient no longer required oxygen supplementation.\nThe subcutaneous lesions started to regress too, with complete resolution by the 12th week as well as improvement in all bone lesions (Figs.1 \u200band 2).\nThe patient continued on nivolumab until June 2015, and tolerated the treatment well.\nUnfortunately, she developed bacterial aspiration pneumonia and passed away in June 2015.\n","ner_info":[{"text":"68-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"smoker","label":"HISTORY","start":21,"end":27},{"text":"pulmonary embolism","label":"HISTORY","start":46,"end":64},{"text":"diabetes mellitus","label":"HISTORY","start":69,"end":86},{"text":"Stage IIIB","label":"DETAILED_DESCRIPTION","start":106,"end":116},{"text":"T4N2M0","label":"DETAILED_DESCRIPTION","start":118,"end":124},{"text":"squamous","label":"DETAILED_DESCRIPTION","start":126,"end":134},{"text":"NSCLC","label":"DISEASE_DISORDER","start":135,"end":140},{"text":"definitive","label":"DETAILED_DESCRIPTION","start":161,"end":171},{"text":"chemoradiotherapy","label":"THERAPEUTIC_PROCEDURE","start":172,"end":189},{"text":"cisplatin","label":"MEDICATION","start":195,"end":204},{"text":"vinorelbine","label":"MEDICATION","start":209,"end":220},{"text":"until September 2014","label":"DATE","start":221,"end":241},{"text":"In October 2014","label":"DATE","start":243,"end":258},{"text":"positron emission tomography\u2013computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":260,"end":308},{"text":"(PET-CT)","label":"DIAGNOSTIC_PROCEDURE","start":309,"end":317},{"text":"good response","label":"LAB_VALUE","start":338,"end":351},{"text":"primary lesion","label":"BIOLOGICAL_STRUCTURE","start":359,"end":373},{"text":"metastases","label":"SIGN_SYMPTOM","start":388,"end":398},{"text":"right adrenal gland","label":"BIOLOGICAL_STRUCTURE","start":406,"end":425},{"text":"right femur","label":"BIOLOGICAL_STRUCTURE","start":430,"end":441},{"text":"irradiated","label":"THERAPEUTIC_PROCEDURE","start":461,"end":471},{"text":"in November 2014","label":"DATE","start":472,"end":488},{"text":"A month later","label":"DATE","start":490,"end":503},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":547,"end":555},{"text":"bone","label":"BIOLOGICAL_STRUCTURE","start":556,"end":560},{"text":"subcutaneous","label":"BIOLOGICAL_STRUCTURE","start":565,"end":577},{"text":"metastases","label":"SIGN_SYMPTOM","start":578,"end":588},{"text":"severe","label":"SEVERITY","start":631,"end":637},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":638,"end":645},{"text":"oxygen-dependent","label":"THERAPEUTIC_PROCEDURE","start":654,"end":670},{"text":"one cycle","label":"DOSAGE","start":685,"end":694},{"text":"carboplatin","label":"MEDICATION","start":698,"end":709},{"text":"gemcitabine","label":"MEDICATION","start":714,"end":725},{"text":"severe","label":"SEVERITY","start":738,"end":744},{"text":"pancytopenia","label":"SIGN_SYMPTOM","start":745,"end":757},{"text":"nivolumab","label":"MEDICATION","start":789,"end":798},{"text":"3\u200amg\/kg q14 days","label":"DOSAGE","start":799,"end":815},{"text":"in January 2015","label":"DATE","start":816,"end":831},{"text":"One week after the first cycle of nivolumab","label":"DATE","start":833,"end":876},{"text":"subcutaneous","label":"BIOLOGICAL_STRUCTURE","start":880,"end":892},{"text":"lesion","label":"SIGN_SYMPTOM","start":893,"end":899},{"text":"upper back","label":"BIOLOGICAL_STRUCTURE","start":907,"end":917},{"text":"grew substantially","label":"DETAILED_DESCRIPTION","start":918,"end":936},{"text":"severe","label":"SEVERITY","start":953,"end":959},{"text":"pain","label":"SIGN_SYMPTOM","start":960,"end":964},{"text":"significant","label":"SEVERITY","start":969,"end":980},{"text":"inflammatory reaction","label":"SIGN_SYMPTOM","start":981,"end":1002},{"text":"subcutaneous","label":"BIOLOGICAL_STRUCTURE","start":1018,"end":1030},{"text":"metastases","label":"SIGN_SYMPTOM","start":1031,"end":1041},{"text":"grew slightly","label":"DETAILED_DESCRIPTION","start":1042,"end":1055},{"text":"symptomatic improvement","label":"SIGN_SYMPTOM","start":1108,"end":1131},{"text":"improvement in general appearance","label":"SIGN_SYMPTOM","start":1156,"end":1189},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1194,"end":1201},{"text":"bone","label":"BIOLOGICAL_STRUCTURE","start":1223,"end":1227},{"text":"pain","label":"SIGN_SYMPTOM","start":1228,"end":1232},{"text":"oxygen supplementation","label":"THERAPEUTIC_PROCEDURE","start":1265,"end":1287},{"text":"subcutaneous","label":"BIOLOGICAL_STRUCTURE","start":1293,"end":1305},{"text":"lesions","label":"SIGN_SYMPTOM","start":1306,"end":1313},{"text":"complete resolution","label":"LAB_VALUE","start":1343,"end":1362},{"text":"by the 12th week","label":"DATE","start":1363,"end":1379},{"text":"bone","label":"BIOLOGICAL_STRUCTURE","start":1410,"end":1414},{"text":"lesions","label":"SIGN_SYMPTOM","start":1415,"end":1422},{"text":"nivolumab","label":"MEDICATION","start":1465,"end":1474},{"text":"until June 2015","label":"DATE","start":1475,"end":1490},{"text":"bacterial aspiration","label":"DETAILED_DESCRIPTION","start":1555,"end":1575},{"text":"pneumonia","label":"SIGN_SYMPTOM","start":1576,"end":1585},{"text":"passed away","label":"OUTCOME","start":1590,"end":1601},{"text":"June 2015","label":"DATE","start":1605,"end":1614}],"tokens":["A ","68-year-old"," ","female"," ","smoker"," with a history of ","pulmonary embolism"," and ","diabetes mellitus"," was diagnosed with ","Stage IIIB"," (","T4N2M0",") ","squamous"," ","NSCLC",".\nShe was treated by ","definitive"," ","chemoradiotherapy"," with ","cisplatin"," and ","vinorelbine"," ","until September 2014",".\n","In October 2014",", ","positron emission tomography\u2013computed tomography"," ","(PET-CT)"," scan demonstrated a ","good response"," in the ","primary lesion","; however, new ","metastases"," in the ","right adrenal gland"," and ","right femur"," developed and were ","irradiated"," ","in November 2014",".\n","A month later"," the disease progressed with development of ","multiple"," ","bone"," and ","subcutaneous"," ","metastases",".\nAt that point, the patient suffered from ","severe"," ","dyspnea"," and was ","oxygen-dependent",".\nShe received ","one cycle"," of ","carboplatin"," and ","gemcitabine"," followed by ","severe"," ","pancytopenia",", and treatment was switched to ","nivolumab"," ","3\u200amg\/kg q14 days"," ","in January 2015",".\n","One week after the first cycle of nivolumab",", a ","subcutaneous"," ","lesion"," in her ","upper back"," ","grew substantially",", accompanied by ","severe"," ","pain"," and ","significant"," ","inflammatory reaction"," (Fig.1).\nOther ","subcutaneous"," ","metastases"," ","grew slightly"," as well.\nAfter the second cycle of treatment marked ","symptomatic improvement"," was observed, including ","improvement in general appearance"," and ","dyspnea"," and reduction of the ","bone"," ","pain",".\nThe patient no longer required ","oxygen supplementation",".\nThe ","subcutaneous"," ","lesions"," started to regress too, with ","complete resolution"," ","by the 12th week"," as well as improvement in all ","bone"," ","lesions"," (Figs.1 \u200band 2).\nThe patient continued on ","nivolumab"," ","until June 2015",", and tolerated the treatment well.\nUnfortunately, she developed ","bacterial aspiration"," ","pneumonia"," and ","passed away"," in ","June 2015",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,39,0,22,0,22,0,22,0,26,0,22,0,75,0,46,0,46,0,19,0,19,0,24,0,24,0,42,0,12,0,69,0,12,0,12,0,75,0,19,0,19,0,22,0,12,0,12,0,69,0,63,0,69,0,75,0,29,0,46,0,46,0,63,0,69,0,46,0,29,0,19,0,19,0,12,0,69,0,12,0,22,0,63,0,69,0,63,0,69,0,12,0,69,0,22,0,69,0,69,0,69,0,12,0,69,0,75,0,12,0,69,0,42,0,19,0,12,0,69,0,46,0,19,0,22,0,69,0,56,0,19,0]}
-{"full_text":"A 60-year-old woman patient was admitted to our hospital on Feb. 18, 2016 because of frequent episodes of hemoptysis for 2 weeks.\nIn the previous decade, the patient had frequent but less severe episodes of hemoptysis, which typically ensued following an upper respiratory tract infection.\nEar, nose, and throat examination and laryngoscope failed to identify an apparent source of bleeding.\nCT chest scan revealed no abnormality.\nThe most recent episode occurred after an upper respiratory tract infection 2 weeks ago.\nThe patient coughed up as much as about 500\u200amL of fresh blood in an episode of hemoptysis, which was alleviated by anti-tussive therapy.\nThe patient denied a history of smoking and illicit drug use.\nDiagnostic workup revealed no evidence of coagulopathy.\nUpon admission, physical examination revealed signs of rhonchi and reduced breath sounds.\nBronchoscopy showed a 1-cm lesion at the membranous trachea 2\u200acm to the carina.\nTortuous blood vessels were observed running in the submucosa of the trachea (Fig.1).\nCT angiography was performed, demonstrating an artery extending into the submucosa from the descending aorta (Fig.2).\nA diagnosis of Dieulafoy disease of the trachea was entertained.\nSince the blood vessel was considered to be the culprit of hemoptysis, selective arterial embolization was performed 1 week later.\nNo fresh episode of acute hemoptysis was observed and the patient was still being followed up at the time of writing this report.\nThis study was approved by Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital, and also got an informed written consent from the patient.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"admitted","label":"CLINICAL_EVENT","start":32,"end":40},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":48,"end":56},{"text":"Feb. 18, 2016","label":"DATE","start":60,"end":73},{"text":"frequent","label":"FREQUENCY","start":85,"end":93},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":106,"end":116},{"text":"2 weeks","label":"DURATION","start":121,"end":128},{"text":"previous decade","label":"DATE","start":137,"end":152},{"text":"frequent","label":"FREQUENCY","start":170,"end":178},{"text":"less severe","label":"SEVERITY","start":183,"end":194},{"text":"hemoptysis","label":"HISTORY","start":207,"end":217},{"text":"upper respiratory tract","label":"BIOLOGICAL_STRUCTURE","start":255,"end":278},{"text":"infection","label":"DISEASE_DISORDER","start":279,"end":288},{"text":"Ear, nose, and throat examination","label":"DIAGNOSTIC_PROCEDURE","start":290,"end":323},{"text":"laryngoscope","label":"DIAGNOSTIC_PROCEDURE","start":328,"end":340},{"text":"source of bleeding","label":"SIGN_SYMPTOM","start":372,"end":390},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":392,"end":394},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":395,"end":400},{"text":"abnormality","label":"SIGN_SYMPTOM","start":418,"end":429},{"text":"upper respiratory tract","label":"BIOLOGICAL_STRUCTURE","start":473,"end":496},{"text":"infection","label":"DISEASE_DISORDER","start":497,"end":506},{"text":"2 weeks ago","label":"DATE","start":507,"end":518},{"text":"coughed","label":"SIGN_SYMPTOM","start":532,"end":539},{"text":"500\u200amL","label":"VOLUME","start":560,"end":566},{"text":"fresh blood","label":"SIGN_SYMPTOM","start":570,"end":581},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":599,"end":609},{"text":"anti-tussive therapy","label":"MEDICATION","start":635,"end":655},{"text":"denied a history of smoking and illicit drug use","label":"HISTORY","start":669,"end":717},{"text":"Diagnostic workup","label":"DIAGNOSTIC_PROCEDURE","start":719,"end":736},{"text":"coagulopathy","label":"DISEASE_DISORDER","start":761,"end":773},{"text":"admission","label":"CLINICAL_EVENT","start":780,"end":789},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":791,"end":811},{"text":"rhonchi","label":"SIGN_SYMPTOM","start":830,"end":837},{"text":"reduced","label":"LAB_VALUE","start":842,"end":849},{"text":"breath sounds","label":"DIAGNOSTIC_PROCEDURE","start":850,"end":863},{"text":"Bronchoscopy","label":"DIAGNOSTIC_PROCEDURE","start":865,"end":877},{"text":"1-cm","label":"DISTANCE","start":887,"end":891},{"text":"lesion","label":"SIGN_SYMPTOM","start":892,"end":898},{"text":"membranous trachea","label":"BIOLOGICAL_STRUCTURE","start":906,"end":924},{"text":"2\u200acm","label":"DISTANCE","start":925,"end":929},{"text":"carina","label":"BIOLOGICAL_STRUCTURE","start":937,"end":943},{"text":"Tortuous blood vessels","label":"SIGN_SYMPTOM","start":945,"end":967},{"text":"submucosa of the trachea","label":"BIOLOGICAL_STRUCTURE","start":997,"end":1021},{"text":"CT angiography","label":"DIAGNOSTIC_PROCEDURE","start":1031,"end":1045},{"text":"artery extending","label":"SIGN_SYMPTOM","start":1078,"end":1094},{"text":"submucosa","label":"BIOLOGICAL_STRUCTURE","start":1104,"end":1113},{"text":"descending aorta","label":"BIOLOGICAL_STRUCTURE","start":1123,"end":1139},{"text":"Dieulafoy disease","label":"THERAPEUTIC_PROCEDURE","start":1164,"end":1181},{"text":"trachea","label":"BIOLOGICAL_STRUCTURE","start":1189,"end":1196},{"text":"blood vessel","label":"COREFERENCE","start":1224,"end":1236},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":1273,"end":1283},{"text":"selective","label":"DETAILED_DESCRIPTION","start":1285,"end":1294},{"text":"arterial embolization","label":"THERAPEUTIC_PROCEDURE","start":1295,"end":1316},{"text":"1 week later","label":"DATE","start":1331,"end":1343},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1365,"end":1370},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":1371,"end":1381},{"text":"followed up","label":"CLINICAL_EVENT","start":1427,"end":1438},{"text":"the time of writing this report","label":"DATE","start":1442,"end":1473}],"tokens":["A ","60-year-old"," ","woman"," patient was ","admitted"," to our ","hospital"," on ","Feb. 18, 2016"," because of ","frequent"," episodes of ","hemoptysis"," for ","2 weeks",".\nIn the ","previous decade",", the patient had ","frequent"," but ","less severe"," episodes of ","hemoptysis",", which typically ensued following an ","upper respiratory tract"," ","infection",".\n","Ear, nose, and throat examination"," and ","laryngoscope"," failed to identify an apparent ","source of bleeding",".\n","CT"," ","chest"," scan revealed no ","abnormality",".\nThe most recent episode occurred after an ","upper respiratory tract"," ","infection"," ","2 weeks ago",".\nThe patient ","coughed"," up as much as about ","500\u200amL"," of ","fresh blood"," in an episode of ","hemoptysis",", which was alleviated by ","anti-tussive therapy",".\nThe patient ","denied a history of smoking and illicit drug use",".\n","Diagnostic workup"," revealed no evidence of ","coagulopathy",".\nUpon ","admission",", ","physical examination"," revealed signs of ","rhonchi"," and ","reduced"," ","breath sounds",".\n","Bronchoscopy"," showed a ","1-cm"," ","lesion"," at the ","membranous trachea"," ","2\u200acm"," to the ","carina",".\n","Tortuous blood vessels"," were observed running in the ","submucosa of the trachea"," (Fig.1).\n","CT angiography"," was performed, demonstrating an ","artery extending"," into the ","submucosa"," from the ","descending aorta"," (Fig.2).\nA diagnosis of ","Dieulafoy disease"," of the ","trachea"," was entertained.\nSince the ","blood vessel"," was considered to be the culprit of ","hemoptysis",", ","selective"," ","arterial embolization"," was performed ","1 week later",".\nNo fresh episode of ","acute"," ","hemoptysis"," was observed and the patient was still being ","followed up"," at ","the time of writing this report",".\nThis study was approved by Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital, and also got an informed written consent from the patient.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,19,0,35,0,69,0,32,0,19,0,35,0,63,0,39,0,12,0,26,0,24,0,24,0,69,0,24,0,12,0,69,0,12,0,26,0,19,0,69,0,79,0,69,0,69,0,46,0,39,0,24,0,26,0,13,0,24,0,69,0,42,0,24,0,24,0,27,0,69,0,12,0,27,0,12,0,69,0,12,0,24,0,69,0,12,0,12,0,75,0,12,0,18,0,69,0,22,0,75,0,19,0,22,0,69,0,13,0,19,0]}
-{"full_text":"A 65-year-old woman reported persistent back pain for almost 3 months.\nThe symptoms would be severe after walking or changing positions and would be slightly relieve after taking painkillers.\nThe patient described no pain or numbness in her legs.\nShe also described no bowel or bladder voiding difficulties.\nThe patient reported past medical history of hypertension, coronary heart disease, cerebral infarction, and asthma, all of which were well controlled.\nPhysical exam demonstrated kyphosis of the thoracic spine in standing position and lumbar vertebra bend forward and backward straight activities were limited.\nThere is obvious rap pain in back about T12 level.\nThe patient's general medical examination was unremarkable in upper and lower extremity motor, stretch reflex, and sensory examinations.\nX-ray, computed tomography (CT), and magnetic resonance imaging (MRI) exams were performed after the patient in hospital (Fig.1).\nThe lateral X-ray showed T12 fracture with 40\u00b0 kyphotic cobb angle.\nCT showed an intravertebral vacuum sign.\nSagittal T1-weighted MRI showed a decreased signal intravertebral vacuum cleft and posterior cortex breakage with cord compression in T12.\nSagittal T2-weighted MRI showed an increased signal in the intravertebral vacuum cleft.\nThe patient was diagnosed with K\u00fcmmell disease (Stage III).[9]\nThe operation was performed under general anesthesia and prone position.\nA standard posterior exposure of the spine was given, pedicle screws were inserted in target vertebrae T10, T11, L1, and L2 under C-arm guidance.[10] The screws were connected on the left side with a temporary stabilizing rod.\nLaminectomy was performed to decompress and fully visualize the spinal cord.[10] Careful subperiosteal dissection was carried out on the right side to exposure the lateral wall of the T12 vertebral body until the anterior aspect was reached.\nThe right side pedicle and articular process of the T12 vertebral body were removed.\nT11\/T12 and T12\/L1 intervertebral disks were also removed.\nThen, the temporary stabilizing rod was replaced by rod bended to the desired contour.\nAutologous bone graft and titanium mesh were placed in the intervertebral space.\nAnother rod with the desired contour was connected on the right side.\nAdequate hemostasis was ensured and wound was thoroughly irrigated with saline.\nDrainage tube was inserted and the surgical wound was closed layer-by-layer.[10] Time from skin incision to completion of wound closure lasted 150\u200aminutes, and estimated blood loss totaled 600\u200amL.\nPostoperatively, the patient was given preventive antibiotic treatment for 1 day, pain treatment for 3 days, and anticoagulant therapy for 1 week.\nThe drainage tube was removed at 3 days postoperative when volume of drainage was less than 50\u200amL per 24\u200ahours.\nPatient was allowed out of bed with a custom-made plastic orthosis at 1 week after operation.\nThe plastic orthosis was kept for at least 3 months.\nThe patient was allowed out of hospital at 12 days after operation when surgical suture had been removed.\nPain assessments were conducted using the visual analogue scale (VAS).\nVAS for preoperative, 1 week after operation, and 1 year after operation were 9 score, 3 score, and 2 score, respectively, which demonstrated significant improvement.\nThe patient resumed normal activities and returned to work at 3 months after operation.\nKyphotic Cobb angle for preoperative, 1 week after operation, and 1 year after operation were 40\u00b0, 8\u00b0, and 17\u00b0, respectively, which demonstrated significant improvement (Fig.2).\n","ner_info":[{"text":"65-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":29,"end":39},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":40,"end":44},{"text":"pain","label":"SIGN_SYMPTOM","start":45,"end":49},{"text":"almost 3 months","label":"DURATION","start":54,"end":69},{"text":"symptoms","label":"COREFERENCE","start":75,"end":83},{"text":"severe","label":"SEVERITY","start":93,"end":99},{"text":"walking","label":"ACTIVITY","start":106,"end":113},{"text":"changing positions","label":"ACTIVITY","start":117,"end":135},{"text":"relieve","label":"SIGN_SYMPTOM","start":158,"end":165},{"text":"painkillers","label":"MEDICATION","start":179,"end":190},{"text":"pain","label":"SIGN_SYMPTOM","start":217,"end":221},{"text":"numbness","label":"SIGN_SYMPTOM","start":225,"end":233},{"text":"legs","label":"BIOLOGICAL_STRUCTURE","start":241,"end":245},{"text":"bowel","label":"BIOLOGICAL_STRUCTURE","start":269,"end":274},{"text":"bladder","label":"BIOLOGICAL_STRUCTURE","start":278,"end":285},{"text":"voiding difficulties","label":"SIGN_SYMPTOM","start":286,"end":306},{"text":"hypertension, coronary heart disease, cerebral infarction, and asthma, all of which were well controlled","label":"HISTORY","start":353,"end":457},{"text":"Physical exam","label":"DIAGNOSTIC_PROCEDURE","start":459,"end":472},{"text":"kyphosis","label":"DISEASE_DISORDER","start":486,"end":494},{"text":"thoracic spine","label":"BIOLOGICAL_STRUCTURE","start":502,"end":516},{"text":"in standing position","label":"DETAILED_DESCRIPTION","start":517,"end":537},{"text":"lumbar vertebra bend forward and backward","label":"DETAILED_DESCRIPTION","start":542,"end":583},{"text":"rap","label":"DETAILED_DESCRIPTION","start":635,"end":638},{"text":"pain","label":"SIGN_SYMPTOM","start":639,"end":643},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":647,"end":651},{"text":"T12","label":"BIOLOGICAL_STRUCTURE","start":658,"end":661},{"text":"general medical examination","label":"DIAGNOSTIC_PROCEDURE","start":683,"end":710},{"text":"unremarkable","label":"LAB_VALUE","start":715,"end":727},{"text":"upper and lower extremity motor","label":"BIOLOGICAL_STRUCTURE","start":731,"end":762},{"text":"stretch reflex","label":"DETAILED_DESCRIPTION","start":764,"end":778},{"text":"sensory","label":"BIOLOGICAL_STRUCTURE","start":784,"end":791},{"text":"examinations","label":"DIAGNOSTIC_PROCEDURE","start":792,"end":804},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":806,"end":811},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":813,"end":832},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":834,"end":836},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":843,"end":869},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":871,"end":874},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":918,"end":926},{"text":"lateral","label":"DETAILED_DESCRIPTION","start":940,"end":947},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":948,"end":953},{"text":"T12","label":"BIOLOGICAL_STRUCTURE","start":961,"end":964},{"text":"fracture","label":"DISEASE_DISORDER","start":965,"end":973},{"text":"40\u00b0 kyphotic","label":"LAB_VALUE","start":979,"end":991},{"text":"cobb angle","label":"DIAGNOSTIC_PROCEDURE","start":992,"end":1002},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1004,"end":1006},{"text":"intravertebral vacuum sign","label":"SIGN_SYMPTOM","start":1017,"end":1043},{"text":"Sagittal T1-weighted","label":"DETAILED_DESCRIPTION","start":1045,"end":1065},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1066,"end":1069},{"text":"decreased signal","label":"DETAILED_DESCRIPTION","start":1079,"end":1095},{"text":"intravertebral vacuum cleft","label":"SIGN_SYMPTOM","start":1096,"end":1123},{"text":"posterior cortex","label":"BIOLOGICAL_STRUCTURE","start":1128,"end":1144},{"text":"breakage","label":"DISEASE_DISORDER","start":1145,"end":1153},{"text":"cord compression","label":"SIGN_SYMPTOM","start":1159,"end":1175},{"text":"T12","label":"BIOLOGICAL_STRUCTURE","start":1179,"end":1182},{"text":"Sagittal T2-weighted","label":"DETAILED_DESCRIPTION","start":1184,"end":1204},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1205,"end":1208},{"text":"increased signal","label":"DETAILED_DESCRIPTION","start":1219,"end":1235},{"text":"intravertebral vacuum cleft","label":"SIGN_SYMPTOM","start":1243,"end":1270},{"text":"K\u00fcmmell disease","label":"DISEASE_DISORDER","start":1303,"end":1318},{"text":"Stage III","label":"LAB_VALUE","start":1320,"end":1329},{"text":"operation","label":"THERAPEUTIC_PROCEDURE","start":1339,"end":1348},{"text":"general anesthesia","label":"MEDICATION","start":1369,"end":1387},{"text":"prone position","label":"DETAILED_DESCRIPTION","start":1392,"end":1406},{"text":"standard","label":"DETAILED_DESCRIPTION","start":1410,"end":1418},{"text":"posterior exposure","label":"THERAPEUTIC_PROCEDURE","start":1419,"end":1437},{"text":"spine","label":"BIOLOGICAL_STRUCTURE","start":1445,"end":1450},{"text":"pedicle screws","label":"THERAPEUTIC_PROCEDURE","start":1462,"end":1476},{"text":"vertebrae","label":"BIOLOGICAL_STRUCTURE","start":1501,"end":1510},{"text":"T10","label":"BIOLOGICAL_STRUCTURE","start":1511,"end":1514},{"text":"T11","label":"BIOLOGICAL_STRUCTURE","start":1516,"end":1519},{"text":"L1","label":"BIOLOGICAL_STRUCTURE","start":1521,"end":1523},{"text":"L2","label":"BIOLOGICAL_STRUCTURE","start":1529,"end":1531},{"text":"C-arm guidance","label":"DETAILED_DESCRIPTION","start":1538,"end":1552},{"text":"connected on the left side with a temporary stabilizing rod","label":"DETAILED_DESCRIPTION","start":1574,"end":1633},{"text":"Laminectomy","label":"THERAPEUTIC_PROCEDURE","start":1635,"end":1646},{"text":"subperiosteal dissection","label":"THERAPEUTIC_PROCEDURE","start":1724,"end":1748},{"text":"right side","label":"DETAILED_DESCRIPTION","start":1772,"end":1782},{"text":"lateral wall of the T12 vertebral body","label":"BIOLOGICAL_STRUCTURE","start":1799,"end":1837},{"text":"right side pedicle","label":"BIOLOGICAL_STRUCTURE","start":1881,"end":1899},{"text":"articular process","label":"BIOLOGICAL_STRUCTURE","start":1904,"end":1921},{"text":"T12 vertebral body","label":"BIOLOGICAL_STRUCTURE","start":1929,"end":1947},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":1953,"end":1960},{"text":"T11\/T12","label":"BIOLOGICAL_STRUCTURE","start":1962,"end":1969},{"text":"T12\/L1","label":"BIOLOGICAL_STRUCTURE","start":1974,"end":1980},{"text":"intervertebral disks","label":"BIOLOGICAL_STRUCTURE","start":1981,"end":2001},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":2012,"end":2019},{"text":"temporary stabilizing","label":"DETAILED_DESCRIPTION","start":2031,"end":2052},{"text":"rod","label":"THERAPEUTIC_PROCEDURE","start":2053,"end":2056},{"text":"rod","label":"THERAPEUTIC_PROCEDURE","start":2073,"end":2076},{"text":"bended to the desired contour","label":"DETAILED_DESCRIPTION","start":2077,"end":2106},{"text":"Autologous","label":"DETAILED_DESCRIPTION","start":2108,"end":2118},{"text":"bone graft","label":"THERAPEUTIC_PROCEDURE","start":2119,"end":2129},{"text":"titanium mesh","label":"THERAPEUTIC_PROCEDURE","start":2134,"end":2147},{"text":"intervertebral space","label":"BIOLOGICAL_STRUCTURE","start":2167,"end":2187},{"text":"Another","label":"DETAILED_DESCRIPTION","start":2189,"end":2196},{"text":"rod","label":"THERAPEUTIC_PROCEDURE","start":2197,"end":2200},{"text":"with the desired contour","label":"DETAILED_DESCRIPTION","start":2201,"end":2225},{"text":"right side","label":"DETAILED_DESCRIPTION","start":2247,"end":2257},{"text":"hemostasis","label":"THERAPEUTIC_PROCEDURE","start":2268,"end":2278},{"text":"wound","label":"BIOLOGICAL_STRUCTURE","start":2295,"end":2300},{"text":"irrigated with saline","label":"THERAPEUTIC_PROCEDURE","start":2316,"end":2337},{"text":"Drainage tube","label":"THERAPEUTIC_PROCEDURE","start":2339,"end":2352},{"text":"surgical wound","label":"BIOLOGICAL_STRUCTURE","start":2374,"end":2388},{"text":"closed","label":"THERAPEUTIC_PROCEDURE","start":2393,"end":2399},{"text":"layer-by-layer","label":"DETAILED_DESCRIPTION","start":2400,"end":2414},{"text":"150\u200aminutes","label":"DURATION","start":2482,"end":2493},{"text":"blood loss","label":"DISEASE_DISORDER","start":2509,"end":2519},{"text":"600\u200amL","label":"VOLUME","start":2528,"end":2534},{"text":"antibiotic","label":"MEDICATION","start":2586,"end":2596},{"text":"1 day","label":"DURATION","start":2611,"end":2616},{"text":"pain treatment","label":"MEDICATION","start":2618,"end":2632},{"text":"3 days","label":"DURATION","start":2637,"end":2643},{"text":"anticoagulant","label":"MEDICATION","start":2649,"end":2662},{"text":"1 week","label":"DURATION","start":2675,"end":2681},{"text":"drainage tube","label":"THERAPEUTIC_PROCEDURE","start":2687,"end":2700},{"text":"3 days","label":"DATE","start":2716,"end":2722},{"text":"volume of drainage","label":"DIAGNOSTIC_PROCEDURE","start":2742,"end":2760},{"text":"less than 50\u200amL per 24\u200ahours","label":"LAB_VALUE","start":2765,"end":2793},{"text":"allowed out","label":"CLINICAL_EVENT","start":2807,"end":2818},{"text":"bed","label":"NONBIOLOGICAL_LOCATION","start":2822,"end":2825},{"text":"custom-made","label":"DETAILED_DESCRIPTION","start":2833,"end":2844},{"text":"plastic","label":"DETAILED_DESCRIPTION","start":2845,"end":2852},{"text":"orthosis","label":"THERAPEUTIC_PROCEDURE","start":2853,"end":2861},{"text":"1 week after","label":"DATE","start":2865,"end":2877},{"text":"orthosis","label":"COREFERENCE","start":2901,"end":2909},{"text":"at least 3 months","label":"DURATION","start":2923,"end":2940},{"text":"allowed out","label":"CLINICAL_EVENT","start":2958,"end":2969},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":2973,"end":2981},{"text":"12 days after","label":"DATE","start":2985,"end":2998},{"text":"surgical suture","label":"THERAPEUTIC_PROCEDURE","start":3014,"end":3029},{"text":"Pain assessments","label":"DIAGNOSTIC_PROCEDURE","start":3048,"end":3064},{"text":"visual analogue scale","label":"DIAGNOSTIC_PROCEDURE","start":3090,"end":3111},{"text":"VAS","label":"DIAGNOSTIC_PROCEDURE","start":3113,"end":3116},{"text":"VAS","label":"COREFERENCE","start":3119,"end":3122},{"text":"preoperative","label":"DATE","start":3127,"end":3139},{"text":"1 week after","label":"DATE","start":3141,"end":3153},{"text":"1 year after","label":"DATE","start":3169,"end":3181},{"text":"9 score","label":"LAB_VALUE","start":3197,"end":3204},{"text":"3 score","label":"LAB_VALUE","start":3206,"end":3213},{"text":"2 score","label":"LAB_VALUE","start":3219,"end":3226},{"text":"improvement","label":"LAB_VALUE","start":3273,"end":3284},{"text":"normal activities","label":"ACTIVITY","start":3306,"end":3323},{"text":"returned to work","label":"ACTIVITY","start":3328,"end":3344},{"text":"3 months after","label":"DATE","start":3348,"end":3362},{"text":"Kyphotic","label":"LAB_VALUE","start":3374,"end":3382},{"text":"Cobb angle","label":"DIAGNOSTIC_PROCEDURE","start":3383,"end":3393},{"text":"preoperative","label":"DATE","start":3398,"end":3410},{"text":"1 week after","label":"DATE","start":3412,"end":3424},{"text":"1 year after","label":"DATE","start":3440,"end":3452},{"text":"40\u00b0","label":"LAB_VALUE","start":3468,"end":3471},{"text":"8\u00b0","label":"LAB_VALUE","start":3473,"end":3475},{"text":"17\u00b0","label":"LAB_VALUE","start":3481,"end":3484},{"text":"improvement","label":"LAB_VALUE","start":3531,"end":3542}],"tokens":["A ","65-year-old"," ","woman"," reported ","persistent"," ","back"," ","pain"," for ","almost 3 months",".\nThe ","symptoms"," would be ","severe"," after ","walking"," or ","changing positions"," and would be slightly ","relieve"," after taking ","painkillers",".\nThe patient described no ","pain"," or ","numbness"," in her ","legs",".\nShe also described no ","bowel"," or ","bladder"," ","voiding difficulties",".\nThe patient reported past medical history of ","hypertension, coronary heart disease, cerebral infarction, and asthma, all of which were well controlled",".\n","Physical exam"," demonstrated ","kyphosis"," of the ","thoracic spine"," ","in standing position"," and ","lumbar vertebra bend forward and backward"," straight activities were limited.\nThere is obvious ","rap"," ","pain"," in ","back"," about ","T12"," level.\nThe patient's ","general medical examination"," was ","unremarkable"," in ","upper and lower extremity motor",", ","stretch reflex",", and ","sensory"," ","examinations",".\n","X-ray",", ","computed tomography"," (","CT","), and ","magnetic resonance imaging"," (","MRI",") exams were performed after the patient in ","hospital"," (Fig.1).\nThe ","lateral"," ","X-ray"," showed ","T12"," ","fracture"," with ","40\u00b0 kyphotic"," ","cobb angle",".\n","CT"," showed an ","intravertebral vacuum sign",".\n","Sagittal T1-weighted"," ","MRI"," showed a ","decreased signal"," ","intravertebral vacuum cleft"," and ","posterior cortex"," ","breakage"," with ","cord compression"," in ","T12",".\n","Sagittal T2-weighted"," ","MRI"," showed an ","increased signal"," in the ","intravertebral vacuum cleft",".\nThe patient was diagnosed with ","K\u00fcmmell disease"," (","Stage III",").[9]\nThe ","operation"," was performed under ","general anesthesia"," and ","prone position",".\nA ","standard"," ","posterior exposure"," of the ","spine"," was given, ","pedicle screws"," were inserted in target ","vertebrae"," ","T10",", ","T11",", ","L1",", and ","L2"," under ","C-arm guidance",".[10] The screws were ","connected on the left side with a temporary stabilizing rod",".\n","Laminectomy"," was performed to decompress and fully visualize the spinal cord.[10] Careful ","subperiosteal dissection"," was carried out on the ","right side"," to exposure the ","lateral wall of the T12 vertebral body"," until the anterior aspect was reached.\nThe ","right side pedicle"," and ","articular process"," of the ","T12 vertebral body"," were ","removed",".\n","T11\/T12"," and ","T12\/L1"," ","intervertebral disks"," were also ","removed",".\nThen, the ","temporary stabilizing"," ","rod"," was replaced by ","rod"," ","bended to the desired contour",".\n","Autologous"," ","bone graft"," and ","titanium mesh"," were placed in the ","intervertebral space",".\n","Another"," ","rod"," ","with the desired contour"," was connected on the ","right side",".\nAdequate ","hemostasis"," was ensured and ","wound"," was thoroughly ","irrigated with saline",".\n","Drainage tube"," was inserted and the ","surgical wound"," was ","closed"," ","layer-by-layer",".[10] Time from skin incision to completion of wound closure lasted ","150\u200aminutes",", and estimated ","blood loss"," totaled ","600\u200amL",".\nPostoperatively, the patient was given preventive ","antibiotic"," treatment for ","1 day",", ","pain treatment"," for ","3 days",", and ","anticoagulant"," therapy for ","1 week",".\nThe ","drainage tube"," was removed at ","3 days"," postoperative when ","volume of drainage"," was ","less than 50\u200amL per 24\u200ahours",".\nPatient was ","allowed out"," of ","bed"," with a ","custom-made"," ","plastic"," ","orthosis"," at ","1 week after"," operation.\nThe plastic ","orthosis"," was kept for ","at least 3 months",".\nThe patient was ","allowed out"," of ","hospital"," at ","12 days after"," operation when ","surgical suture"," had been removed.\n","Pain assessments"," were conducted using the ","visual analogue scale"," (","VAS",").\n","VAS"," for ","preoperative",", ","1 week after"," operation, and ","1 year after"," operation were ","9 score",", ","3 score",", and ","2 score",", respectively, which demonstrated significant ","improvement",".\nThe patient resumed ","normal activities"," and ","returned to work"," at ","3 months after"," operation.\n","Kyphotic"," ","Cobb angle"," for ","preoperative",", ","1 week after"," operation, and ","1 year after"," operation were ","40\u00b0",", ","8\u00b0",", and ","17\u00b0",", respectively, which demonstrated significant ","improvement"," (Fig.2).\n"],"ner_labels":[0,5,0,65,0,22,0,12,0,69,0,32,0,18,0,63,0,1,0,1,0,69,0,46,0,69,0,69,0,12,0,12,0,12,0,69,0,39,0,24,0,26,0,12,0,22,0,22,0,22,0,69,0,12,0,12,0,24,0,42,0,12,0,22,0,12,0,24,0,24,0,24,0,24,0,24,0,24,0,48,0,22,0,24,0,12,0,26,0,42,0,24,0,24,0,69,0,22,0,24,0,22,0,69,0,12,0,26,0,69,0,12,0,22,0,24,0,22,0,69,0,26,0,42,0,75,0,46,0,22,0,22,0,75,0,12,0,75,0,12,0,12,0,12,0,12,0,12,0,22,0,22,0,75,0,75,0,22,0,12,0,12,0,12,0,12,0,75,0,12,0,12,0,12,0,75,0,22,0,75,0,75,0,22,0,22,0,75,0,75,0,12,0,22,0,75,0,22,0,22,0,75,0,12,0,75,0,75,0,12,0,75,0,22,0,32,0,26,0,79,0,46,0,32,0,46,0,32,0,46,0,32,0,75,0,19,0,24,0,42,0,13,0,48,0,22,0,22,0,75,0,19,0,18,0,32,0,13,0,48,0,19,0,75,0,24,0,24,0,24,0,18,0,19,0,19,0,19,0,42,0,42,0,42,0,42,0,1,0,1,0,19,0,42,0,24,0,19,0,19,0,19,0,42,0,42,0,42,0,42,0]}
-{"full_text":"A 18-year-old man presented with a history of a palpable lump in the presternal area, which was found incidentally after weight reduction.\nThe patient had no other relevant medical or trauma history.\nOn physical examination, the lesion was found to be a nonmovable, firm mass with no tenderness or associated skin changes, detected at the midline position over the sternum (at the manubrium level).\nThere was no visible fistulous opening or discharge from the lesion.\nOn ultrasonography, we detected a well-circumscribed, oval, anechoic mass, with posterior acoustic enhancement, that measured about 3.3\u200a\u00d7\u200a1.7\u200a\u00d7\u200a3.1\u200acm, and was located in the subcutaneous fat layer over the sternum.\nIn the dependent portion of the mass was an internal, well-circumscribed, heterogeneously hypoechoic, egg-shaped lesion (Fig.1A and B) showing a movement according to patient movement.\nThe mass could be compressed using the linear transducer (Fig.2A and B).\nA color Doppler study showed no vascularity within the cystic mass or the internal hypoechoic lesion (Fig.1C).\nSurgical excision of the mass was performed without postoperative complications.\nGrossly, the excised mass was a well-defined, ovoid, cystic mass gray-tan in color.\nOn section, it was found to be a unilocular cyst filled with whitish mucous material.\nMicroscopically, the mass was lined with ciliated pseudostratified columnar epithelium suggestive of respiratory type-mucosa (Fig.3).\nThere was nonspecific collagenous fibrosis around the cyst.\nThe differential diagnosis of subcutaneous cyst included epidermal inclusion cyst, thyroglossal duct cyst, branchial cleft cyst, and dermoid cyst.\nThere was no histological evidence of squamous epithelium, keratin, thyroid tissue, or skin appendage in the cystic wall of the present case.\nThe mass was diagnosed as a bronchogenic cyst.\n","ner_info":[{"text":"18-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"palpable","label":"DETAILED_DESCRIPTION","start":48,"end":56},{"text":"lump","label":"SIGN_SYMPTOM","start":57,"end":61},{"text":"presternal area","label":"BIOLOGICAL_STRUCTURE","start":69,"end":84},{"text":"weight reduction","label":"SIGN_SYMPTOM","start":121,"end":137},{"text":"no other relevant medical or trauma history","label":"HISTORY","start":155,"end":198},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":203,"end":223},{"text":"lesion","label":"COREFERENCE","start":229,"end":235},{"text":"nonmovable","label":"DETAILED_DESCRIPTION","start":254,"end":264},{"text":"firm","label":"TEXTURE","start":266,"end":270},{"text":"mass","label":"SIGN_SYMPTOM","start":271,"end":275},{"text":"tenderness","label":"SIGN_SYMPTOM","start":284,"end":294},{"text":"skin changes","label":"SIGN_SYMPTOM","start":309,"end":321},{"text":"midline position over the sternum","label":"BIOLOGICAL_STRUCTURE","start":339,"end":372},{"text":"manubrium level","label":"BIOLOGICAL_STRUCTURE","start":381,"end":396},{"text":"fistulous opening","label":"SIGN_SYMPTOM","start":420,"end":437},{"text":"discharge","label":"SIGN_SYMPTOM","start":441,"end":450},{"text":"lesion","label":"COREFERENCE","start":460,"end":466},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":471,"end":486},{"text":"well-circumscribed","label":"DETAILED_DESCRIPTION","start":502,"end":520},{"text":"oval","label":"SHAPE","start":522,"end":526},{"text":"anechoic","label":"LAB_VALUE","start":528,"end":536},{"text":"mass","label":"SIGN_SYMPTOM","start":537,"end":541},{"text":"posterior acoustic enhancement","label":"DETAILED_DESCRIPTION","start":548,"end":578},{"text":"3.3\u200a\u00d7\u200a1.7\u200a\u00d7\u200a3.1\u200acm","label":"VOLUME","start":600,"end":618},{"text":"subcutaneous fat layer","label":"BIOLOGICAL_STRUCTURE","start":643,"end":665},{"text":"sternum","label":"BIOLOGICAL_STRUCTURE","start":675,"end":682},{"text":"dependent portion","label":"BIOLOGICAL_STRUCTURE","start":691,"end":708},{"text":"mass","label":"COREFERENCE","start":716,"end":720},{"text":"internal","label":"DETAILED_DESCRIPTION","start":728,"end":736},{"text":"well-circumscribed","label":"DETAILED_DESCRIPTION","start":738,"end":756},{"text":"heterogeneously","label":"DETAILED_DESCRIPTION","start":758,"end":773},{"text":"hypoechoic","label":"LAB_VALUE","start":774,"end":784},{"text":"egg-shaped","label":"SHAPE","start":786,"end":796},{"text":"lesion","label":"SIGN_SYMPTOM","start":797,"end":803},{"text":"movement according to patient movement","label":"DETAILED_DESCRIPTION","start":829,"end":867},{"text":"mass","label":"COREFERENCE","start":873,"end":877},{"text":"compressed","label":"LAB_VALUE","start":887,"end":897},{"text":"linear transducer","label":"THERAPEUTIC_PROCEDURE","start":908,"end":925},{"text":"color","label":"DETAILED_DESCRIPTION","start":944,"end":949},{"text":"Doppler study","label":"DIAGNOSTIC_PROCEDURE","start":950,"end":963},{"text":"vascularity","label":"SIGN_SYMPTOM","start":974,"end":985},{"text":"cystic mass","label":"COREFERENCE","start":997,"end":1008},{"text":"internal","label":"DETAILED_DESCRIPTION","start":1016,"end":1024},{"text":"hypoechoic","label":"LAB_VALUE","start":1025,"end":1035},{"text":"lesion","label":"COREFERENCE","start":1036,"end":1042},{"text":"Surgical excision","label":"THERAPEUTIC_PROCEDURE","start":1053,"end":1070},{"text":"mass","label":"SIGN_SYMPTOM","start":1078,"end":1082},{"text":"postoperative complications","label":"DISEASE_DISORDER","start":1105,"end":1132},{"text":"mass","label":"COREFERENCE","start":1155,"end":1159},{"text":"well-defined","label":"LAB_VALUE","start":1166,"end":1178},{"text":"ovoid","label":"SHAPE","start":1180,"end":1185},{"text":"cystic","label":"LAB_VALUE","start":1187,"end":1193},{"text":"gray-tan","label":"COLOR","start":1199,"end":1207},{"text":"it","label":"COREFERENCE","start":1230,"end":1232},{"text":"unilocular","label":"LAB_VALUE","start":1251,"end":1261},{"text":"cyst","label":"SIGN_SYMPTOM","start":1262,"end":1266},{"text":"whitish","label":"COLOR","start":1279,"end":1286},{"text":"mucous material","label":"SIGN_SYMPTOM","start":1287,"end":1302},{"text":"mass","label":"COREFERENCE","start":1325,"end":1329},{"text":"nonspecific","label":"LAB_VALUE","start":1448,"end":1459},{"text":"collagenous","label":"DETAILED_DESCRIPTION","start":1460,"end":1471},{"text":"fibrosis","label":"SIGN_SYMPTOM","start":1472,"end":1480},{"text":"epidermal inclusion cyst","label":"DISEASE_DISORDER","start":1555,"end":1579},{"text":"thyroglossal duct cyst","label":"DISEASE_DISORDER","start":1581,"end":1603},{"text":"branchial cleft cyst","label":"DISEASE_DISORDER","start":1605,"end":1625},{"text":"dermoid cyst","label":"DISEASE_DISORDER","start":1631,"end":1643},{"text":"histological evidence","label":"SIGN_SYMPTOM","start":1658,"end":1679},{"text":"squamous epithelium","label":"DETAILED_DESCRIPTION","start":1683,"end":1702},{"text":"keratin","label":"DETAILED_DESCRIPTION","start":1704,"end":1711},{"text":"thyroid tissue","label":"DETAILED_DESCRIPTION","start":1713,"end":1727},{"text":"skin appendage","label":"DETAILED_DESCRIPTION","start":1732,"end":1746},{"text":"bronchogenic cyst","label":"DISEASE_DISORDER","start":1815,"end":1832}],"tokens":["A ","18-year-old"," ","man"," ","presented"," with a history of a ","palpable"," ","lump"," in the ","presternal area",", which was found incidentally after ","weight reduction",".\nThe patient had ","no other relevant medical or trauma history",".\nOn ","physical examination",", the ","lesion"," was found to be a ","nonmovable",", ","firm"," ","mass"," with no ","tenderness"," or associated ","skin changes",", detected at the ","midline position over the sternum"," (at the ","manubrium level",").\nThere was no visible ","fistulous opening"," or ","discharge"," from the ","lesion",".\nOn ","ultrasonography",", we detected a ","well-circumscribed",", ","oval",", ","anechoic"," ","mass",", with ","posterior acoustic enhancement",", that measured about ","3.3\u200a\u00d7\u200a1.7\u200a\u00d7\u200a3.1\u200acm",", and was located in the ","subcutaneous fat layer"," over the ","sternum",".\nIn the ","dependent portion"," of the ","mass"," was an ","internal",", ","well-circumscribed",", ","heterogeneously"," ","hypoechoic",", ","egg-shaped"," ","lesion"," (Fig.1A and B) showing a ","movement according to patient movement",".\nThe ","mass"," could be ","compressed"," using the ","linear transducer"," (Fig.2A and B).\nA ","color"," ","Doppler study"," showed no ","vascularity"," within the ","cystic mass"," or the ","internal"," ","hypoechoic"," ","lesion"," (Fig.1C).\n","Surgical excision"," of the ","mass"," was performed without ","postoperative complications",".\nGrossly, the excised ","mass"," was a ","well-defined",", ","ovoid",", ","cystic"," mass ","gray-tan"," in color.\nOn section, ","it"," was found to be a ","unilocular"," ","cyst"," filled with ","whitish"," ","mucous material",".\nMicroscopically, the ","mass"," was lined with ciliated pseudostratified columnar epithelium suggestive of respiratory type-mucosa (Fig.3).\nThere was ","nonspecific"," ","collagenous"," ","fibrosis"," around the cyst.\nThe differential diagnosis of subcutaneous cyst included ","epidermal inclusion cyst",", ","thyroglossal duct cyst",", ","branchial cleft cyst",", and ","dermoid cyst",".\nThere was no ","histological evidence"," of ","squamous epithelium",", ","keratin",", ","thyroid tissue",", or ","skin appendage"," in the cystic wall of the present case.\nThe mass was diagnosed as a ","bronchogenic cyst",".\n"],"ner_labels":[0,5,0,65,0,13,0,22,0,69,0,12,0,69,0,39,0,24,0,18,0,22,0,73,0,69,0,69,0,69,0,12,0,12,0,69,0,69,0,18,0,24,0,22,0,67,0,42,0,69,0,22,0,79,0,12,0,12,0,12,0,18,0,22,0,22,0,22,0,42,0,67,0,69,0,22,0,18,0,42,0,75,0,22,0,24,0,69,0,18,0,22,0,42,0,18,0,75,0,69,0,26,0,18,0,42,0,67,0,42,0,15,0,18,0,42,0,69,0,15,0,69,0,18,0,42,0,22,0,69,0,26,0,26,0,26,0,26,0,69,0,22,0,22,0,22,0,22,0,26,0]}
-{"full_text":"A 23-year-old man with a history of severe aplastic anemia (SAA) underwent bone marrow transplantation from his HLA-haploidentical mother in January 2014.\nThe conditioning regimens consisted of busulphan cyclophosphamide and antithymocyte globulin (BUCY+ATG) (10).\nCyclosporine A (CsA) and short-term methotrexate (MTX) plus mycophenolate mofetil (MMF) were used as prophylaxis against graft-versus-host disease (GVHD) (11).\nStandard measures were adopted for the prevention of infectious complications, which included fluconazole for antifungal prophylaxis and acyclovir to prevent herpes-related infections.\nA hemogram revealed the reconstruction of granulocytes (ANC>0.5\u00d7109\/L) on day +12 post-transplantation.\nThe patient developed grade II acute GVHD of the skin on day +42 post-transplantation.\nThis was treated by treatment with a standard-dose of methyl-prednisolone, which achieved a complete response (CR).\nThe patient's chronic GVHD (cGVHD) of the skin gradually progressed from day +100 post-transplantation and he was treated with prednisolone and CsA.\nOn day 120 post-transplantation, he complained of a cough and antibiotics were administered.\nA blood analysis revealed the following: WBC, 2.34\u00d7109\/L; ANC, 1.72\u00d7109\/L; hemoglobin, 85 g\/L; and platelets, 72\u00d7109\/L.\nAlthough both a chest computed tomography (CT) scan and tests for pathogens via routine culturing, including blood tests for Beta-D glucan (G-test) and Galactomannan (GM-test) were all negative, the patient's cough did not respond to antibiotics and we empirically initiated treatment with voriconazole (6 mg\/kg\/12h for the first day, followed by 4 mg\/kg\/12h).\nLiver toxicity occurred during voriconazole treatment, thus the anti-fungal regimen was changed to micafungin (100 mg\/d).\nHowever, the persistent cough did not improve and hoarseness developed after two weeks of treatment - ulcers were then observed in the throat by laryngoscopy (Fig.1a).\nThe patient developed severe dyspnea in the following week when anti-infection and topical treatments were applied.\nFiberoptic bronchoscopy revealed an irregular, nodular material with white moss, which nearly obstructed the bronchus; however, chest CT imaging was negative (Fig.1b and c).\nThe histopathological examination of biopsy specimens revealed an Aspergillus species (Fig.1d).\nThe patient was diagnosed with pseudomembranous Aspergillus tracheobronchitis type ITBA based on the results of bronchoscopy and a pathological examination (12).\nThe antibiotic and micafungin treatments were ceased and liposomal amphotericin B (liposomal AmB) was administered daily at a target dose of 3 mg\/kg.\nThe patient's serum creatinine level rose from 60.4 \u03bcmol\/L to 168 \u03bcmol\/L during the first 7 days of liposomal AmB treatment.\nDue to progressive renal dysfunction, the anti-fungal regimen was switched to a combination of posaconazole (400 mg\/12 h) and caspofungin [50 mg, daily (70 mg for the first dose)].\nThe combination therapy continued for 2 weeks, until the previous nodules in the throat completely disappeared under bronchoscopy (Fig.2a); however, a repeat chest CT scan showed progression (Fig.2b).\nThe symptom of dyspnea gradually progressed, thus fiberoptic bronchoscopy was performed to remove the obstructive material from the patient's airways once a week for two weeks.\nAll of the symptoms were relieved and the final chest CT scan showed negative results before the discontinuation of anti-fungal therapy, and all of the tests were negative for Aspergillus.\nPosaconazole was administered as a secondary prophylactic treatment and the patient was discharged from hospital.\nThe patient is still being followed and remains free of any recurrence of invasive fungal infection.\n","ner_info":[{"text":"23-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"severe aplastic anemia","label":"DISEASE_DISORDER","start":36,"end":58},{"text":"SAA","label":"DISEASE_DISORDER","start":60,"end":63},{"text":"bone marrow transplantation","label":"THERAPEUTIC_PROCEDURE","start":75,"end":102},{"text":"HLA-haploidentical","label":"DETAILED_DESCRIPTION","start":112,"end":130},{"text":"mother","label":"SUBJECT","start":131,"end":137},{"text":"January 2014","label":"DATE","start":141,"end":153},{"text":"busulphan cyclophosphamide","label":"MEDICATION","start":194,"end":220},{"text":"antithymocyte globulin","label":"MEDICATION","start":225,"end":247},{"text":"BUCY","label":"MEDICATION","start":249,"end":253},{"text":"ATG","label":"MEDICATION","start":254,"end":257},{"text":"Cyclosporine A","label":"MEDICATION","start":265,"end":279},{"text":"CsA","label":"MEDICATION","start":281,"end":284},{"text":"short-term","label":"DETAILED_DESCRIPTION","start":290,"end":300},{"text":"methotrexate","label":"MEDICATION","start":301,"end":313},{"text":"MTX","label":"MEDICATION","start":315,"end":318},{"text":"mycophenolate mofetil","label":"MEDICATION","start":325,"end":346},{"text":"MMF","label":"MEDICATION","start":348,"end":351},{"text":"graft-versus-host disease","label":"DISEASE_DISORDER","start":386,"end":411},{"text":"GVHD","label":"DISEASE_DISORDER","start":413,"end":417},{"text":"infectious complications","label":"DISEASE_DISORDER","start":478,"end":502},{"text":"fluconazole","label":"MEDICATION","start":519,"end":530},{"text":"antifungal","label":"DETAILED_DESCRIPTION","start":535,"end":545},{"text":"prophylaxis","label":"THERAPEUTIC_PROCEDURE","start":546,"end":557},{"text":"acyclovir","label":"MEDICATION","start":562,"end":571},{"text":"herpes-related","label":"DETAILED_DESCRIPTION","start":583,"end":597},{"text":"infections","label":"DISEASE_DISORDER","start":598,"end":608},{"text":"hemogram","label":"DIAGNOSTIC_PROCEDURE","start":612,"end":620},{"text":"reconstruction of granulocytes","label":"SIGN_SYMPTOM","start":634,"end":664},{"text":"ANC","label":"DIAGNOSTIC_PROCEDURE","start":666,"end":669},{"text":">0.5\u00d7109\/L","label":"LAB_VALUE","start":669,"end":679},{"text":"day +12","label":"DATE","start":684,"end":691},{"text":"transplantation","label":"THERAPEUTIC_PROCEDURE","start":697,"end":712},{"text":"grade II","label":"DETAILED_DESCRIPTION","start":736,"end":744},{"text":"acute","label":"DETAILED_DESCRIPTION","start":745,"end":750},{"text":"GVHD","label":"DISEASE_DISORDER","start":751,"end":755},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":763,"end":767},{"text":"day +42","label":"DATE","start":771,"end":778},{"text":"transplantation","label":"THERAPEUTIC_PROCEDURE","start":784,"end":799},{"text":"standard-dose","label":"DOSAGE","start":838,"end":851},{"text":"methyl-prednisolone","label":"MEDICATION","start":855,"end":874},{"text":"complete response","label":"SIGN_SYMPTOM","start":893,"end":910},{"text":"CR","label":"SIGN_SYMPTOM","start":912,"end":914},{"text":"chronic GVHD","label":"DISEASE_DISORDER","start":931,"end":943},{"text":"cGVHD","label":"DISEASE_DISORDER","start":945,"end":950},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":959,"end":963},{"text":"day +100","label":"DATE","start":990,"end":998},{"text":"transplantation","label":"THERAPEUTIC_PROCEDURE","start":1004,"end":1019},{"text":"prednisolone","label":"MEDICATION","start":1044,"end":1056},{"text":"CsA","label":"MEDICATION","start":1061,"end":1064},{"text":"day 120","label":"DATE","start":1069,"end":1076},{"text":"transplantation","label":"THERAPEUTIC_PROCEDURE","start":1082,"end":1097},{"text":"cough","label":"SIGN_SYMPTOM","start":1118,"end":1123},{"text":"antibiotics","label":"MEDICATION","start":1128,"end":1139},{"text":"blood analysis","label":"DIAGNOSTIC_PROCEDURE","start":1161,"end":1175},{"text":"WBC","label":"DIAGNOSTIC_PROCEDURE","start":1200,"end":1203},{"text":"2.34\u00d7109\/L","label":"LAB_VALUE","start":1205,"end":1215},{"text":"ANC","label":"DIAGNOSTIC_PROCEDURE","start":1217,"end":1220},{"text":"1.72\u00d7109\/L","label":"LAB_VALUE","start":1222,"end":1232},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1234,"end":1244},{"text":"85 g\/L","label":"LAB_VALUE","start":1246,"end":1252},{"text":"platelets","label":"DIAGNOSTIC_PROCEDURE","start":1258,"end":1267},{"text":"72\u00d7109\/L","label":"LAB_VALUE","start":1269,"end":1277},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1295,"end":1300},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1301,"end":1320},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1322,"end":1324},{"text":"tests for pathogens","label":"DIAGNOSTIC_PROCEDURE","start":1335,"end":1354},{"text":"via routine culturing","label":"DETAILED_DESCRIPTION","start":1355,"end":1376},{"text":"blood","label":"DETAILED_DESCRIPTION","start":1388,"end":1393},{"text":"Beta-D glucan","label":"DIAGNOSTIC_PROCEDURE","start":1404,"end":1417},{"text":"G-test","label":"DIAGNOSTIC_PROCEDURE","start":1419,"end":1425},{"text":"Galactomannan","label":"DIAGNOSTIC_PROCEDURE","start":1431,"end":1444},{"text":"GM-test","label":"DIAGNOSTIC_PROCEDURE","start":1446,"end":1453},{"text":"negative","label":"LAB_VALUE","start":1464,"end":1472},{"text":"cough","label":"SIGN_SYMPTOM","start":1488,"end":1493},{"text":"antibiotics","label":"MEDICATION","start":1513,"end":1524},{"text":"voriconazole","label":"MEDICATION","start":1569,"end":1581},{"text":"6 mg\/kg\/12h for the first day","label":"DOSAGE","start":1583,"end":1612},{"text":"4 mg\/kg\/12h","label":"DOSAGE","start":1626,"end":1637},{"text":"Liver","label":"BIOLOGICAL_STRUCTURE","start":1640,"end":1645},{"text":"toxicity","label":"SIGN_SYMPTOM","start":1646,"end":1654},{"text":"voriconazole","label":"MEDICATION","start":1671,"end":1683},{"text":"anti-fungal regimen","label":"THERAPEUTIC_PROCEDURE","start":1704,"end":1723},{"text":"micafungin","label":"MEDICATION","start":1739,"end":1749},{"text":"100 mg\/d","label":"DOSAGE","start":1751,"end":1759},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":1775,"end":1785},{"text":"cough","label":"SIGN_SYMPTOM","start":1786,"end":1791},{"text":"hoarseness","label":"SIGN_SYMPTOM","start":1812,"end":1822},{"text":"after two weeks","label":"DATE","start":1833,"end":1848},{"text":"ulcers","label":"SIGN_SYMPTOM","start":1864,"end":1870},{"text":"throat","label":"BIOLOGICAL_STRUCTURE","start":1897,"end":1903},{"text":"laryngoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1907,"end":1919},{"text":"severe","label":"SEVERITY","start":1952,"end":1958},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1959,"end":1966},{"text":"in the following 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moss","label":"DETAILED_DESCRIPTION","start":2115,"end":2125},{"text":"nearly","label":"DETAILED_DESCRIPTION","start":2133,"end":2139},{"text":"obstructed","label":"SIGN_SYMPTOM","start":2140,"end":2150},{"text":"bronchus","label":"BIOLOGICAL_STRUCTURE","start":2155,"end":2163},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2174,"end":2179},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2180,"end":2182},{"text":"negative","label":"LAB_VALUE","start":2195,"end":2203},{"text":"histopathological examination","label":"DIAGNOSTIC_PROCEDURE","start":2224,"end":2253},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":2257,"end":2263},{"text":"Aspergillus","label":"DISEASE_DISORDER","start":2286,"end":2297},{"text":"pseudomembranous","label":"DETAILED_DESCRIPTION","start":2347,"end":2363},{"text":"Aspergillus","label":"DISEASE_DISORDER","start":2364,"end":2375},{"text":"tracheobronchitis","label":"DISEASE_DISORDER","start":2376,"end":2393},{"text":"type ITBA","label":"DETAILED_DESCRIPTION","start":2394,"end":2403},{"text":"bronchoscopy","label":"DIAGNOSTIC_PROCEDURE","start":2428,"end":2440},{"text":"pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":2447,"end":2471},{"text":"antibiotic","label":"MEDICATION","start":2482,"end":2492},{"text":"micafungin","label":"MEDICATION","start":2497,"end":2507},{"text":"liposomal","label":"DETAILED_DESCRIPTION","start":2535,"end":2544},{"text":"amphotericin B","label":"MEDICATION","start":2545,"end":2559},{"text":"liposomal","label":"DETAILED_DESCRIPTION","start":2561,"end":2570},{"text":"AmB","label":"MEDICATION","start":2571,"end":2574},{"text":"daily","label":"DOSAGE","start":2593,"end":2598},{"text":"3 mg\/kg","label":"DOSAGE","start":2619,"end":2626},{"text":"serum","label":"DETAILED_DESCRIPTION","start":2642,"end":2647},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":2648,"end":2658},{"text":"rose","label":"LAB_VALUE","start":2665,"end":2669},{"text":"60.4 \u03bcmol\/L","label":"LAB_VALUE","start":2675,"end":2686},{"text":"168 \u03bcmol\/L","label":"LAB_VALUE","start":2690,"end":2700},{"text":"during the first 7 days","label":"DATE","start":2701,"end":2724},{"text":"liposomal","label":"DETAILED_DESCRIPTION","start":2728,"end":2737},{"text":"AmB","label":"MEDICATION","start":2738,"end":2741},{"text":"progressive","label":"SEVERITY","start":2760,"end":2771},{"text":"renal dysfunction","label":"DISEASE_DISORDER","start":2772,"end":2789},{"text":"anti-fungal","label":"MEDICATION","start":2795,"end":2806},{"text":"posaconazole","label":"MEDICATION","start":2848,"end":2860},{"text":"400 mg\/12 h","label":"DOSAGE","start":2862,"end":2873},{"text":"caspofungin","label":"MEDICATION","start":2879,"end":2890},{"text":"50 mg, daily","label":"DOSAGE","start":2892,"end":2904},{"text":"70 mg for the first dose","label":"DOSAGE","start":2906,"end":2930},{"text":"combination therapy","label":"MEDICATION","start":2938,"end":2957},{"text":"2 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week","label":"FREQUENCY","start":3285,"end":3296},{"text":"two weeks","label":"DURATION","start":3301,"end":3310},{"text":"symptoms","label":"SIGN_SYMPTOM","start":3323,"end":3331},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":3360,"end":3365},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3366,"end":3368},{"text":"negative","label":"LAB_VALUE","start":3381,"end":3389},{"text":"anti-fungal","label":"MEDICATION","start":3428,"end":3439},{"text":"tests","label":"DIAGNOSTIC_PROCEDURE","start":3464,"end":3469},{"text":"negative","label":"LAB_VALUE","start":3475,"end":3483},{"text":"Aspergillus","label":"DISEASE_DISORDER","start":3488,"end":3499},{"text":"Posaconazole","label":"MEDICATION","start":3501,"end":3513},{"text":"prophylactic treatment","label":"THERAPEUTIC_PROCEDURE","start":3546,"end":3568},{"text":"discharged","label":"CLINICAL_EVENT","start":3589,"end":3599},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":3605,"end":3613},{"text":"followed","label":"CLINICAL_EVENT","start":3642,"end":3650},{"text":"invasive","label":"DETAILED_DESCRIPTION","start":3689,"end":3697},{"text":"fungal","label":"DETAILED_DESCRIPTION","start":3698,"end":3704},{"text":"infection","label":"DISEASE_DISORDER","start":3705,"end":3714}],"tokens":["A ","23-year-old"," ","man"," with a history of ","severe aplastic anemia"," (","SAA",") underwent ","bone marrow transplantation"," from his ","HLA-haploidentical"," ","mother"," in ","January 2014",".\nThe conditioning regimens consisted of ","busulphan cyclophosphamide"," and ","antithymocyte globulin"," (","BUCY","+","ATG",") (10).\n","Cyclosporine A"," (","CsA",") and ","short-term"," ","methotrexate"," (","MTX",") plus ","mycophenolate mofetil"," (","MMF",") were used as prophylaxis against ","graft-versus-host disease"," (","GVHD",") (11).\nStandard measures were adopted for the prevention of ","infectious complications",", which included ","fluconazole"," for ","antifungal"," ","prophylaxis"," and ","acyclovir"," to prevent ","herpes-related"," ","infections",".\nA ","hemogram"," revealed the ","reconstruction of granulocytes"," (","ANC","",">0.5\u00d7109\/L",") on ","day +12"," post-","transplantation",".\nThe patient developed ","grade II"," ","acute"," ","GVHD"," of the ","skin"," on ","day +42"," post-","transplantation",".\nThis was treated by treatment with a ","standard-dose"," of ","methyl-prednisolone",", which achieved a ","complete response"," (","CR",").\nThe patient's ","chronic GVHD"," (","cGVHD",") of the ","skin"," gradually progressed from ","day +100"," post-","transplantation"," and he was treated with ","prednisolone"," and ","CsA",".\nOn ","day 120"," post-","transplantation",", he complained of a ","cough"," and ","antibiotics"," were administered.\nA ","blood analysis"," revealed the following: ","WBC",", ","2.34\u00d7109\/L","; ","ANC",", ","1.72\u00d7109\/L","; ","hemoglobin",", ","85 g\/L","; and ","platelets",", ","72\u00d7109\/L",".\nAlthough both a ","chest"," ","computed tomography"," (","CT",") scan and ","tests for pathogens"," ","via routine culturing",", including ","blood"," tests for ","Beta-D glucan"," (","G-test",") and ","Galactomannan"," (","GM-test",") were all ","negative",", the patient's ","cough"," did not respond to ","antibiotics"," and we empirically initiated treatment with ","voriconazole"," (","6 mg\/kg\/12h for the first day",", followed by ","4 mg\/kg\/12h",").\n","Liver"," ","toxicity"," occurred during ","voriconazole"," treatment, thus the ","anti-fungal regimen"," was changed to ","micafungin"," (","100 mg\/d",").\nHowever, the ","persistent"," ","cough"," did not improve and ","hoarseness"," developed ","after two weeks"," of treatment - ","ulcers"," were then observed in the ","throat"," by ","laryngoscopy"," (Fig.1a).\nThe patient developed ","severe"," ","dyspnea"," ","in the following week"," when ","anti-infection"," and ","topical"," ","treatments"," were applied.\n","Fiberoptic"," ","bronchoscopy"," revealed an ","irregular",", ","nodular"," ","material"," with ","white moss",", which ","nearly"," ","obstructed"," the ","bronchus","; however, ","chest"," ","CT"," imaging was ","negative"," (Fig.1b and c).\nThe ","histopathological examination"," of ","biopsy"," specimens revealed an ","Aspergillus"," species (Fig.1d).\nThe patient was diagnosed with ","pseudomembranous"," ","Aspergillus"," ","tracheobronchitis"," ","type ITBA"," based on the results of ","bronchoscopy"," and a ","pathological examination"," (12).\nThe ","antibiotic"," and ","micafungin"," treatments were ceased and ","liposomal"," ","amphotericin B"," (","liposomal"," ","AmB",") was administered ","daily"," at a target dose of ","3 mg\/kg",".\nThe patient's ","serum"," ","creatinine"," level ","rose"," from ","60.4 \u03bcmol\/L"," to ","168 \u03bcmol\/L"," ","during the first 7 days"," of ","liposomal"," ","AmB"," treatment.\nDue to ","progressive"," ","renal dysfunction",", the ","anti-fungal"," regimen was switched to a combination of ","posaconazole"," (","400 mg\/12 h",") and ","caspofungin"," [","50 mg, daily"," (","70 mg for the first dose",")].\nThe ","combination therapy"," continued for ","2 weeks",", until the previous ","nodules"," in the ","throat"," completely disappeared under ","bronchoscopy"," (Fig.2a); however, a repeat ","chest"," ","CT"," scan showed ","progression"," (Fig.2b).\nThe symptom of ","dyspnea"," gradually progressed, thus ","fiberoptic"," ","bronchoscopy"," was performed to ","remove"," the ","obstructive material"," from the patient's ","airways"," ","once a week"," for ","two weeks",".\nAll of the ","symptoms"," were relieved and the final ","chest"," ","CT"," scan showed ","negative"," results before the discontinuation of ","anti-fungal"," therapy, and all of the ","tests"," were ","negative"," for ","Aspergillus",".\n","Posaconazole"," was administered as a secondary ","prophylactic treatment"," and the patient was ","discharged"," from ","hospital",".\nThe patient is still being ","followed"," and remains free of any recurrence of ","invasive"," ","fungal"," ","infection",".\n"],"ner_labels":[0,5,0,65,0,26,0,26,0,75,0,22,0,71,0,19,0,46,0,46,0,46,0,46,0,46,0,46,0,22,0,46,0,46,0,46,0,46,0,26,0,26,0,26,0,46,0,22,0,75,0,46,0,22,0,26,0,24,0,69,0,24,0,42,0,19,0,75,0,22,0,22,0,26,0,12,0,19,0,75,0,29,0,46,0,69,0,69,0,26,0,26,0,12,0,19,0,75,0,46,0,46,0,19,0,75,0,69,0,46,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,24,0,24,0,22,0,22,0,24,0,24,0,24,0,24,0,42,0,69,0,46,0,46,0,29,0,29,0,12,0,69,0,46,0,75,0,46,0,29,0,22,0,69,0,69,0,19,0,69,0,12,0,24,0,63,0,69,0,19,0,22,0,22,0,75,0,22,0,24,0,22,0,67,0,69,0,22,0,22,0,69,0,12,0,12,0,24,0,42,0,24,0,24,0,26,0,22,0,26,0,26,0,22,0,24,0,24,0,46,0,46,0,22,0,46,0,22,0,46,0,29,0,29,0,22,0,24,0,42,0,42,0,42,0,19,0,22,0,46,0,63,0,26,0,46,0,46,0,29,0,46,0,29,0,29,0,46,0,32,0,69,0,12,0,24,0,12,0,24,0,69,0,69,0,22,0,24,0,75,0,69,0,12,0,35,0,32,0,69,0,12,0,24,0,42,0,46,0,24,0,42,0,26,0,46,0,75,0,13,0,48,0,13,0,22,0,22,0,26,0]}
-{"full_text":"A 73-year-old man who had been diagnosed with type 2 diabetes mellitus at 35 year of age, who had severe diabetic neuropathy and diabetic-ESRD complained of respiratory distress and sudden chest pain.\nOn the first day of treatment, he visited the emergency room.\nA physical examination revealed that his body temperature was 35.4\u00b0C, his heart rate was 90 beats\/min with a regular rhythm; and his blood pressure was 130\/77 mmHg.\nA physical examination revealed coarse crackles on bilateral lung auscultation.\nThe laboratory data showed a WBC count of 8,800\/\u03bcL with a shift to the left (neutrophils 82%), Hb 10.2 g\/dL, blood urea nitrogen (BUN) 82.2 mg\/dL, creatinine (Cre) 6.50 mg\/dL, HbA1c 5.9%, creatine kinase (CK) 189 IU\/L, C-reactive protein (CRP) 8.51 mg\/dL, brain-type natriuretic peptide (BNP) 127.4 pg\/mL.\nA chest radiograph revealed perihilar consolidations and air bronchograms (Fig.1).\nAn electrocardiogram revealed ST-segment elevation and poor R-wave progression in leads V1-V3, and echocardiography revealed apical and ventricular asynergy.\nThe patient was therefore diagnosed with acute myocardial infarction and congestive heart failure.\nCoronary angiography was performed, revealing severe angiostenosis in the septal branch.\nPCI was therefore performed.\nThe patient required continuous maintenance dialysis.\nOn the following day, the patient went into cardiorespiratory arrest and cardiopulmonary resuscitation was performed, followed by mechanical ventilation.\nOn day 8, ventilator assistance was discontinued.\nHowever, the patient produced an increasing volume of sputum, which began to appear purulent.\nPseudomonas aeruginosa was identified from a sputum culture, and tazobactam\/piperacillin (TAZ\/PIPC) (4.5g q12h) was administered.\nDespite this therapy, the patient's respiratory condition worsened and a chest computed tomography (CT) scan on day 15 revealed bilateral perihilar opacities, pleural effusion, and atelectasis.(Fig.2).\nWe suspected the development of complications such as microbial substitution, pneumomycosis and thus performed sputum culturing and serum fungal antigen tests.\nThe administration of TAZ\/PIPC was changed to meropenem (0.5 g\/day).\nOn day 16, the patient's serum tested positive for Cryptococcus antigen.\nOn day 21, cryptococcal bodies were identified in two sets of blood cultures and liposomal amphotericin B (L-AMB) (3 mg\/kg\/day) was administered.\nOn day 23, cryptococcal bodies were identified in the sputum, cerebrospinal fluid, and bilateral pleural effusion (Fig.3).\nThe patient was therefore diagnosed with disseminated cryptococcosis.\nOn day 25, brain CT revealed the absence of intracranial hypertension and a brain abscess.\nThe patient was not infected with human immunodeficiency virus (HIV).\nThe administration of L-AMB (3 mg\/kg\/day) was continued.\nOn day 31, chest CT revealed a solitary nodule in the left lingular segment for the first time, which was suspected to be a pulmonary cryptococcus lesion (Fig.4a).\nAfter several days, all of the sputum, blood, bilateral pleural effusion, and cerebrospinal fluid cultures tested negative.\nOn day 52, chest CT revealed another lung nodule in the right pulmonary apical region.\nThese nodules gradually decreased in size until day 79 (Fig.4b and c).\nAlthough L-AMB was considered effective, the C-reactive protein level remained elevated and the bilateral pleural effusion continuously increased.\nThe patient lost consciousness because of decreased vital capacity with increasing bilateral pleural effusion and was diagnosed with CO2 narcosis.\nThe patient's general condition deteriorated.\nOn day 87, ventricular fibrillation occurred and the patient died.\nAutopsy was not performed.\nAt a later date, the Cryptococcus isolate was identified and classified as Cryptococcus neoformans var. grubii (serotype A) by a genetic analysis.\n","ner_info":[{"text":"73-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"type 2 diabetes mellitus at 35 year of age","label":"HISTORY","start":46,"end":88},{"text":"severe diabetic neuropathy","label":"HISTORY","start":98,"end":124},{"text":"diabetic-ESRD","label":"HISTORY","start":129,"end":142},{"text":"respiratory distress","label":"SIGN_SYMPTOM","start":157,"end":177},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":182,"end":188},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":189,"end":194},{"text":"pain","label":"SIGN_SYMPTOM","start":195,"end":199},{"text":"first day","label":"DATE","start":208,"end":217},{"text":"visited","label":"CLINICAL_EVENT","start":235,"end":242},{"text":"emergency room","label":"NONBIOLOGICAL_LOCATION","start":247,"end":261},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":265,"end":285},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":304,"end":320},{"text":"35.4\u00b0C","label":"LAB_VALUE","start":325,"end":331},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":337,"end":347},{"text":"90 beats\/min","label":"LAB_VALUE","start":352,"end":364},{"text":"regular rhythm","label":"LAB_VALUE","start":372,"end":386},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":410},{"text":"130\/77 mmHg","label":"LAB_VALUE","start":415,"end":426},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":430,"end":450},{"text":"coarse","label":"DETAILED_DESCRIPTION","start":460,"end":466},{"text":"crackles","label":"SIGN_SYMPTOM","start":467,"end":475},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":479,"end":488},{"text":"lung auscultation","label":"DIAGNOSTIC_PROCEDURE","start":489,"end":506},{"text":"laboratory data","label":"DIAGNOSTIC_PROCEDURE","start":512,"end":527},{"text":"WBC","label":"DIAGNOSTIC_PROCEDURE","start":537,"end":540},{"text":"8,800\/\u03bcL","label":"LAB_VALUE","start":550,"end":558},{"text":"shift to the left","label":"LAB_VALUE","start":566,"end":583},{"text":"neutrophils","label":"DIAGNOSTIC_PROCEDURE","start":585,"end":596},{"text":"82%","label":"LAB_VALUE","start":597,"end":600},{"text":"Hb","label":"DIAGNOSTIC_PROCEDURE","start":603,"end":605},{"text":"10.2 g\/dL","label":"LAB_VALUE","start":606,"end":615},{"text":"blood urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":617,"end":636},{"text":"BUN","label":"DIAGNOSTIC_PROCEDURE","start":638,"end":641},{"text":"82.2 mg\/dL","label":"LAB_VALUE","start":643,"end":653},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":655,"end":665},{"text":"Cre","label":"DIAGNOSTIC_PROCEDURE","start":667,"end":670},{"text":"6.50 mg\/dL","label":"LAB_VALUE","start":672,"end":682},{"text":"HbA1c","label":"DIAGNOSTIC_PROCEDURE","start":684,"end":689},{"text":"5.9%","label":"LAB_VALUE","start":690,"end":694},{"text":"creatine kinase","label":"DIAGNOSTIC_PROCEDURE","start":696,"end":711},{"text":"CK","label":"DIAGNOSTIC_PROCEDURE","start":713,"end":715},{"text":"189 IU\/L","label":"LAB_VALUE","start":717,"end":725},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":727,"end":745},{"text":"CRP","label":"DIAGNOSTIC_PROCEDURE","start":747,"end":750},{"text":"8.51 mg\/dL","label":"LAB_VALUE","start":752,"end":762},{"text":"brain-type natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":764,"end":794},{"text":"BNP","label":"DIAGNOSTIC_PROCEDURE","start":796,"end":799},{"text":"127.4 pg\/mL","label":"LAB_VALUE","start":801,"end":812},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":816,"end":821},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":822,"end":832},{"text":"perihilar","label":"DETAILED_DESCRIPTION","start":842,"end":851},{"text":"consolidations","label":"SIGN_SYMPTOM","start":852,"end":866},{"text":"air","label":"DETAILED_DESCRIPTION","start":871,"end":874},{"text":"bronchograms","label":"SIGN_SYMPTOM","start":875,"end":887},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":900,"end":917},{"text":"ST-segment elevation","label":"SIGN_SYMPTOM","start":927,"end":947},{"text":"poor R-wave progression","label":"SIGN_SYMPTOM","start":952,"end":975},{"text":"leads V1-V3","label":"DETAILED_DESCRIPTION","start":979,"end":990},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":996,"end":1012},{"text":"apical and ventricular asynergy","label":"SIGN_SYMPTOM","start":1022,"end":1053},{"text":"acute","label":"DETAILED_DESCRIPTION","start":1096,"end":1101},{"text":"myocardial infarction","label":"DISEASE_DISORDER","start":1102,"end":1123},{"text":"congestive","label":"DETAILED_DESCRIPTION","start":1128,"end":1138},{"text":"heart failure","label":"DISEASE_DISORDER","start":1139,"end":1152},{"text":"Coronary","label":"BIOLOGICAL_STRUCTURE","start":1154,"end":1162},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":1163,"end":1174},{"text":"angiostenosis","label":"SIGN_SYMPTOM","start":1207,"end":1220},{"text":"septal branch","label":"BIOLOGICAL_STRUCTURE","start":1228,"end":1241},{"text":"PCI","label":"THERAPEUTIC_PROCEDURE","start":1243,"end":1246},{"text":"continuous","label":"DETAILED_DESCRIPTION","start":1293,"end":1303},{"text":"maintenance","label":"DETAILED_DESCRIPTION","start":1304,"end":1315},{"text":"dialysis","label":"THERAPEUTIC_PROCEDURE","start":1316,"end":1324},{"text":"following day","label":"DATE","start":1333,"end":1346},{"text":"cardiorespiratory arrest","label":"DISEASE_DISORDER","start":1370,"end":1394},{"text":"cardiopulmonary resuscitation","label":"THERAPEUTIC_PROCEDURE","start":1399,"end":1428},{"text":"mechanical","label":"DETAILED_DESCRIPTION","start":1456,"end":1466},{"text":"ventilation","label":"THERAPEUTIC_PROCEDURE","start":1467,"end":1478},{"text":"day 8","label":"DATE","start":1483,"end":1488},{"text":"ventilator","label":"THERAPEUTIC_PROCEDURE","start":1490,"end":1500},{"text":"increasing volume","label":"LAB_VALUE","start":1563,"end":1580},{"text":"sputum","label":"SIGN_SYMPTOM","start":1584,"end":1590},{"text":"purulent","label":"LAB_VALUE","start":1614,"end":1622},{"text":"Pseudomonas aeruginosa","label":"SIGN_SYMPTOM","start":1624,"end":1646},{"text":"sputum culture","label":"DIAGNOSTIC_PROCEDURE","start":1669,"end":1683},{"text":"tazobactam\/piperacillin","label":"MEDICATION","start":1689,"end":1712},{"text":"TAZ\/PIPC","label":"MEDICATION","start":1714,"end":1722},{"text":"4.5g q12h","label":"DOSAGE","start":1725,"end":1734},{"text":"respiratory condition","label":"DIAGNOSTIC_PROCEDURE","start":1790,"end":1811},{"text":"worsened","label":"LAB_VALUE","start":1812,"end":1820},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1827,"end":1832},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1833,"end":1852},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1854,"end":1856},{"text":"day 15","label":"DATE","start":1866,"end":1872},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1882,"end":1891},{"text":"perihilar","label":"DETAILED_DESCRIPTION","start":1892,"end":1901},{"text":"opacities","label":"SIGN_SYMPTOM","start":1902,"end":1911},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":1913,"end":1929},{"text":"atelectasis","label":"DISEASE_DISORDER","start":1935,"end":1946},{"text":"microbial substitution","label":"DISEASE_DISORDER","start":2010,"end":2032},{"text":"pneumomycosis","label":"DISEASE_DISORDER","start":2034,"end":2047},{"text":"sputum culturing","label":"DIAGNOSTIC_PROCEDURE","start":2067,"end":2083},{"text":"serum fungal antigen","label":"DIAGNOSTIC_PROCEDURE","start":2088,"end":2108},{"text":"TAZ\/PIPC","label":"MEDICATION","start":2138,"end":2146},{"text":"meropenem","label":"MEDICATION","start":2162,"end":2171},{"text":"0.5 g\/day","label":"DOSAGE","start":2173,"end":2182},{"text":"day 16","label":"DATE","start":2188,"end":2194},{"text":"serum","label":"DIAGNOSTIC_PROCEDURE","start":2210,"end":2215},{"text":"positive","label":"LAB_VALUE","start":2223,"end":2231},{"text":"Cryptococcus antigen","label":"DIAGNOSTIC_PROCEDURE","start":2236,"end":2256},{"text":"day 21","label":"DATE","start":2261,"end":2267},{"text":"cryptococcal bodies","label":"SIGN_SYMPTOM","start":2269,"end":2288},{"text":"two sets","label":"DETAILED_DESCRIPTION","start":2308,"end":2316},{"text":"blood cultures","label":"DIAGNOSTIC_PROCEDURE","start":2320,"end":2334},{"text":"liposomal amphotericin B","label":"MEDICATION","start":2339,"end":2363},{"text":"L-AMB","label":"MEDICATION","start":2365,"end":2370},{"text":"3 mg\/kg\/day","label":"DOSAGE","start":2373,"end":2384},{"text":"day 23","label":"DATE","start":2407,"end":2413},{"text":"cryptococcal bodies","label":"SIGN_SYMPTOM","start":2415,"end":2434},{"text":"sputum","label":"DIAGNOSTIC_PROCEDURE","start":2458,"end":2464},{"text":"cerebrospinal fluid","label":"DIAGNOSTIC_PROCEDURE","start":2466,"end":2485},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":2491,"end":2500},{"text":"pleural effusion","label":"DIAGNOSTIC_PROCEDURE","start":2501,"end":2517},{"text":"disseminated","label":"DETAILED_DESCRIPTION","start":2568,"end":2580},{"text":"cryptococcosis","label":"DISEASE_DISORDER","start":2581,"end":2595},{"text":"day 25","label":"DATE","start":2600,"end":2606},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":2608,"end":2613},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2614,"end":2616},{"text":"intracranial","label":"BIOLOGICAL_STRUCTURE","start":2641,"end":2653},{"text":"hypertension","label":"SIGN_SYMPTOM","start":2654,"end":2666},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":2673,"end":2678},{"text":"abscess","label":"DISEASE_DISORDER","start":2679,"end":2686},{"text":"human immunodeficiency virus","label":"DISEASE_DISORDER","start":2722,"end":2750},{"text":"HIV","label":"DISEASE_DISORDER","start":2752,"end":2755},{"text":"L-AMB","label":"MEDICATION","start":2780,"end":2785},{"text":"3 mg\/kg\/day","label":"DOSAGE","start":2787,"end":2798},{"text":"day 31","label":"DATE","start":2818,"end":2824},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2826,"end":2831},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2832,"end":2834},{"text":"solitary","label":"DETAILED_DESCRIPTION","start":2846,"end":2854},{"text":"nodule","label":"SIGN_SYMPTOM","start":2855,"end":2861},{"text":"left lingular segment","label":"BIOLOGICAL_STRUCTURE","start":2869,"end":2890},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":2939,"end":2948},{"text":"cryptococcus lesion","label":"DISEASE_DISORDER","start":2949,"end":2968},{"text":"After several days","label":"DATE","start":2979,"end":2997},{"text":"sputum","label":"DIAGNOSTIC_PROCEDURE","start":3010,"end":3016},{"text":"blood","label":"DIAGNOSTIC_PROCEDURE","start":3018,"end":3023},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":3025,"end":3034},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":3035,"end":3051},{"text":"cerebrospinal","label":"DIAGNOSTIC_PROCEDURE","start":3057,"end":3070},{"text":"fluid cultures","label":"DIAGNOSTIC_PROCEDURE","start":3071,"end":3085},{"text":"negative","label":"LAB_VALUE","start":3093,"end":3101},{"text":"day 52","label":"DATE","start":3106,"end":3112},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":3114,"end":3119},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3120,"end":3122},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":3140,"end":3144},{"text":"nodule","label":"SIGN_SYMPTOM","start":3145,"end":3151},{"text":"right pulmonary apical region","label":"BIOLOGICAL_STRUCTURE","start":3159,"end":3188},{"text":"nodules","label":"SIGN_SYMPTOM","start":3196,"end":3203},{"text":"decreased in size","label":"LAB_VALUE","start":3214,"end":3231},{"text":"day 79","label":"DATE","start":3238,"end":3244},{"text":"L-AMB","label":"MEDICATION","start":3270,"end":3275},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":3306,"end":3324},{"text":"elevated","label":"LAB_VALUE","start":3340,"end":3348},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":3357,"end":3366},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":3367,"end":3383},{"text":"lost consciousness","label":"SIGN_SYMPTOM","start":3420,"end":3438},{"text":"decreased","label":"LAB_VALUE","start":3450,"end":3459},{"text":"vital capacity","label":"DIAGNOSTIC_PROCEDURE","start":3460,"end":3474},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":3491,"end":3500},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":3501,"end":3517},{"text":"CO2 narcosis","label":"DISEASE_DISORDER","start":3541,"end":3553},{"text":"general condition","label":"DIAGNOSTIC_PROCEDURE","start":3569,"end":3586},{"text":"deteriorated","label":"LAB_VALUE","start":3587,"end":3599},{"text":"day 87","label":"DATE","start":3604,"end":3610},{"text":"ventricular fibrillation","label":"DISEASE_DISORDER","start":3612,"end":3636},{"text":"died","label":"CLINICAL_EVENT","start":3662,"end":3666},{"text":"Autopsy","label":"DIAGNOSTIC_PROCEDURE","start":3668,"end":3675},{"text":"At a later date","label":"DATE","start":3695,"end":3710},{"text":"Cryptococcus isolate","label":"DETAILED_DESCRIPTION","start":3716,"end":3736},{"text":"Cryptococcus neoformans var. grubii (serotype A)","label":"DISEASE_DISORDER","start":3770,"end":3818},{"text":"genetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":3824,"end":3840}],"tokens":["A ","73-year-old"," ","man"," who had been diagnosed with ","type 2 diabetes mellitus at 35 year of age",", who had ","severe diabetic neuropathy"," and ","diabetic-ESRD"," complained of ","respiratory distress"," and ","sudden"," ","chest"," ","pain",".\nOn the ","first day"," of treatment, he ","visited"," the ","emergency room",".\nA ","physical examination"," revealed that his ","body temperature"," was ","35.4\u00b0C",", his ","heart rate"," was ","90 beats\/min"," with a ","regular rhythm","; and his ","blood pressure"," was ","130\/77 mmHg",".\nA ","physical examination"," revealed ","coarse"," ","crackles"," on ","bilateral"," ","lung auscultation",".\nThe ","laboratory data"," showed a ","WBC"," count of ","8,800\/\u03bcL"," with a ","shift to the left"," (","neutrophils"," ","82%","), ","Hb"," ","10.2 g\/dL",", ","blood urea nitrogen"," (","BUN",") ","82.2 mg\/dL",", ","creatinine"," (","Cre",") ","6.50 mg\/dL",", ","HbA1c"," ","5.9%",", ","creatine kinase"," (","CK",") ","189 IU\/L",", ","C-reactive protein"," (","CRP",") ","8.51 mg\/dL",", ","brain-type natriuretic peptide"," (","BNP",") ","127.4 pg\/mL",".\nA ","chest"," ","radiograph"," revealed ","perihilar"," ","consolidations"," and ","air"," ","bronchograms"," (Fig.1).\nAn ","electrocardiogram"," revealed ","ST-segment elevation"," and ","poor R-wave progression"," in ","leads V1-V3",", and ","echocardiography"," revealed ","apical and ventricular asynergy",".\nThe patient was therefore diagnosed with ","acute"," ","myocardial infarction"," and ","congestive"," ","heart failure",".\n","Coronary"," ","angiography"," was performed, revealing severe ","angiostenosis"," in the ","septal branch",".\n","PCI"," was therefore performed.\nThe patient required ","continuous"," ","maintenance"," ","dialysis",".\nOn the ","following day",", the patient went into ","cardiorespiratory arrest"," and ","cardiopulmonary resuscitation"," was performed, followed by ","mechanical"," ","ventilation",".\nOn ","day 8",", ","ventilator"," assistance was discontinued.\nHowever, the patient produced an ","increasing volume"," of ","sputum",", which began to appear ","purulent",".\n","Pseudomonas aeruginosa"," was identified from a ","sputum culture",", and ","tazobactam\/piperacillin"," (","TAZ\/PIPC",") (","4.5g q12h",") was administered.\nDespite this therapy, the patient's ","respiratory condition"," ","worsened"," and a ","chest"," ","computed tomography"," (","CT",") scan on ","day 15"," revealed ","bilateral"," ","perihilar"," ","opacities",", ","pleural effusion",", and ","atelectasis",".(Fig.2).\nWe suspected the development of complications such as ","microbial substitution",", ","pneumomycosis"," and thus performed ","sputum culturing"," and ","serum fungal antigen"," tests.\nThe administration of ","TAZ\/PIPC"," was changed to ","meropenem"," (","0.5 g\/day",").\nOn ","day 16",", the patient's ","serum"," tested ","positive"," for ","Cryptococcus antigen",".\nOn ","day 21",", ","cryptococcal bodies"," were identified in ","two sets"," of ","blood cultures"," and ","liposomal amphotericin B"," (","L-AMB",") (","3 mg\/kg\/day",") was administered.\nOn ","day 23",", ","cryptococcal bodies"," were identified in the ","sputum",", ","cerebrospinal fluid",", and ","bilateral"," ","pleural effusion"," (Fig.3).\nThe patient was therefore diagnosed with ","disseminated"," ","cryptococcosis",".\nOn ","day 25",", ","brain"," ","CT"," revealed the absence of ","intracranial"," ","hypertension"," and a ","brain"," ","abscess",".\nThe patient was not infected with ","human immunodeficiency virus"," (","HIV",").\nThe administration of ","L-AMB"," (","3 mg\/kg\/day",") was continued.\nOn ","day 31",", ","chest"," ","CT"," revealed a ","solitary"," ","nodule"," in the ","left lingular segment"," for the first time, which was suspected to be a ","pulmonary"," ","cryptococcus lesion"," (Fig.4a).\n","After several days",", all of the ","sputum",", ","blood",", ","bilateral"," ","pleural effusion",", and ","cerebrospinal"," ","fluid cultures"," tested ","negative",".\nOn ","day 52",", ","chest"," ","CT"," revealed another ","lung"," ","nodule"," in the ","right pulmonary apical region",".\nThese ","nodules"," gradually ","decreased in size"," until ","day 79"," (Fig.4b and c).\nAlthough ","L-AMB"," was considered effective, the ","C-reactive protein"," level remained ","elevated"," and the ","bilateral"," ","pleural effusion"," continuously increased.\nThe patient ","lost consciousness"," because of ","decreased"," ","vital capacity"," with increasing ","bilateral"," ","pleural effusion"," and was diagnosed with ","CO2 narcosis",".\nThe patient's ","general condition"," ","deteriorated",".\nOn ","day 87",", ","ventricular fibrillation"," occurred and the patient ","died",".\n","Autopsy"," was not performed.\n","At a later date",", the ","Cryptococcus isolate"," was identified and classified as ","Cryptococcus neoformans var. grubii (serotype A)"," by a ","genetic analysis",".\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,39,0,69,0,22,0,12,0,69,0,19,0,13,0,48,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,22,0,69,0,22,0,24,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,12,0,24,0,22,0,69,0,22,0,69,0,24,0,69,0,69,0,22,0,24,0,69,0,22,0,26,0,22,0,26,0,12,0,24,0,69,0,12,0,75,0,22,0,22,0,75,0,19,0,26,0,75,0,22,0,75,0,19,0,75,0,42,0,69,0,42,0,69,0,24,0,46,0,46,0,29,0,24,0,42,0,12,0,24,0,24,0,19,0,22,0,22,0,69,0,26,0,26,0,26,0,26,0,24,0,24,0,46,0,46,0,29,0,19,0,24,0,42,0,24,0,19,0,69,0,22,0,24,0,46,0,46,0,29,0,19,0,69,0,24,0,24,0,22,0,24,0,22,0,26,0,19,0,12,0,24,0,12,0,69,0,12,0,26,0,26,0,26,0,46,0,29,0,19,0,12,0,24,0,22,0,69,0,12,0,12,0,26,0,19,0,24,0,24,0,22,0,26,0,24,0,24,0,42,0,19,0,12,0,24,0,12,0,69,0,12,0,69,0,42,0,19,0,46,0,24,0,42,0,22,0,26,0,69,0,42,0,24,0,22,0,26,0,26,0,24,0,42,0,19,0,26,0,13,0,24,0,19,0,22,0,26,0,24,0]}
-{"full_text":"An 82-year-old male was admitted in our outside hospital\u2019s emergency room due to abdominal pain and faint.\nHe had a previous history of auricular fibrillation in treatment with a dicumarinic anticoagulant and a previous episode of abdominal pain which was diagnosed as spontaneous mesenchimal haematoma and treated non operatively.\nHe denied any kind of trauma, and had no hematemesis or melena.\nAt physical examination the patient was stable and suffered from intense pain at the right lower abdomen with no defense.\nBlood tests showed a haemoglobin level of 10 g\/dl.\nCoagulation was altered as expected.\nCT scan showed massive hemoperitoneum (Figure 1) and the already known mesenteric hematoma (Figure 2).\nAssuming the diagnosis of expansive mesenteric hematoma plus ongoing bleeding a laparotomy was performed.\nDuring first exploration, 3 liters of fresh and old blood clots were found.\nAt 90cm from the ileocecal valve a torsionated and perforated meckel diverticulum with intradiverticular bleeding was found (Figure 3) and a diverticular resection was performed.\nThe postoperatory was uneventful and the patient was discharged home at the 9th postoperative day.\n","ner_info":[{"text":"82-year-old","label":"AGE","start":3,"end":14},{"text":"male","label":"SEX","start":15,"end":19},{"text":"admitted","label":"CLINICAL_EVENT","start":24,"end":32},{"text":"outside hospital\u2019s emergency room","label":"NONBIOLOGICAL_LOCATION","start":40,"end":73},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":81,"end":90},{"text":"pain","label":"SIGN_SYMPTOM","start":91,"end":95},{"text":"faint","label":"SIGN_SYMPTOM","start":100,"end":105},{"text":"auricular fibrillation","label":"HISTORY","start":136,"end":158},{"text":"dicumarinic anticoagulant","label":"MEDICATION","start":179,"end":204},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":231,"end":240},{"text":"pain","label":"SIGN_SYMPTOM","start":241,"end":245},{"text":"spontaneous","label":"DETAILED_DESCRIPTION","start":269,"end":280},{"text":"mesenchimal haematoma","label":"DISEASE_DISORDER","start":281,"end":302},{"text":"treated non operatively","label":"THERAPEUTIC_PROCEDURE","start":307,"end":330},{"text":"trauma","label":"SIGN_SYMPTOM","start":354,"end":360},{"text":"hematemesis","label":"SIGN_SYMPTOM","start":373,"end":384},{"text":"melena","label":"SIGN_SYMPTOM","start":388,"end":394},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":399,"end":419},{"text":"stable","label":"LAB_VALUE","start":436,"end":442},{"text":"intense","label":"SEVERITY","start":461,"end":468},{"text":"pain","label":"SIGN_SYMPTOM","start":469,"end":473},{"text":"right lower abdomen","label":"BIOLOGICAL_STRUCTURE","start":481,"end":500},{"text":"Blood tests","label":"DIAGNOSTIC_PROCEDURE","start":518,"end":529},{"text":"haemoglobin level","label":"DIAGNOSTIC_PROCEDURE","start":539,"end":556},{"text":"10 g\/dl","label":"LAB_VALUE","start":560,"end":567},{"text":"Coagulation","label":"DIAGNOSTIC_PROCEDURE","start":569,"end":580},{"text":"altered","label":"LAB_VALUE","start":585,"end":592},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":606,"end":613},{"text":"massive","label":"SEVERITY","start":621,"end":628},{"text":"hemoperitoneum","label":"SIGN_SYMPTOM","start":629,"end":643},{"text":"mesenteric hematoma","label":"DISEASE_DISORDER","start":677,"end":696},{"text":"expansive","label":"DETAILED_DESCRIPTION","start":735,"end":744},{"text":"mesenteric hematoma","label":"DISEASE_DISORDER","start":745,"end":764},{"text":"ongoing","label":"DETAILED_DESCRIPTION","start":770,"end":777},{"text":"bleeding","label":"SIGN_SYMPTOM","start":778,"end":786},{"text":"laparotomy","label":"THERAPEUTIC_PROCEDURE","start":789,"end":799},{"text":"3 liters","label":"VOLUME","start":841,"end":849},{"text":"fresh and old blood clots","label":"SIGN_SYMPTOM","start":853,"end":878},{"text":"90cm from","label":"DISTANCE","start":894,"end":903},{"text":"ileocecal valve","label":"BIOLOGICAL_STRUCTURE","start":908,"end":923},{"text":"torsionated","label":"DETAILED_DESCRIPTION","start":926,"end":937},{"text":"perforated","label":"DETAILED_DESCRIPTION","start":942,"end":952},{"text":"meckel diverticulum","label":"DISEASE_DISORDER","start":953,"end":972},{"text":"intradiverticular","label":"BIOLOGICAL_STRUCTURE","start":978,"end":995},{"text":"bleeding","label":"SIGN_SYMPTOM","start":996,"end":1004},{"text":"diverticular","label":"BIOLOGICAL_STRUCTURE","start":1032,"end":1044},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1045,"end":1054},{"text":"postoperatory","label":"THERAPEUTIC_PROCEDURE","start":1074,"end":1087},{"text":"uneventful","label":"LAB_VALUE","start":1092,"end":1102},{"text":"discharged home","label":"CLINICAL_EVENT","start":1123,"end":1138},{"text":"9th postoperative day","label":"DATE","start":1146,"end":1167}],"tokens":["An ","82-year-old"," ","male"," was ","admitted"," in our ","outside hospital\u2019s emergency room"," due to ","abdominal"," ","pain"," and ","faint",".\nHe had a previous history of ","auricular fibrillation"," in treatment with a ","dicumarinic anticoagulant"," and a previous episode of ","abdominal"," ","pain"," which was diagnosed as ","spontaneous"," ","mesenchimal haematoma"," and ","treated non operatively",".\nHe denied any kind of ","trauma",", and had no ","hematemesis"," or ","melena",".\nAt ","physical examination"," the patient was ","stable"," and suffered from ","intense"," ","pain"," at the ","right lower abdomen"," with no defense.\n","Blood tests"," showed a ","haemoglobin level"," of ","10 g\/dl",".\n","Coagulation"," was ","altered"," as expected.\n","CT scan"," showed ","massive"," ","hemoperitoneum"," (Figure 1) and the already known ","mesenteric hematoma"," (Figure 2).\nAssuming the diagnosis of ","expansive"," ","mesenteric hematoma"," plus ","ongoing"," ","bleeding"," a ","laparotomy"," was performed.\nDuring first exploration, ","3 liters"," of ","fresh and old blood clots"," were found.\nAt ","90cm from"," the ","ileocecal valve"," a ","torsionated"," and ","perforated"," ","meckel diverticulum"," with ","intradiverticular"," ","bleeding"," was found (Figure 3) and a ","diverticular"," ","resection"," was performed.\nThe ","postoperatory"," was ","uneventful"," and the patient was ","discharged home"," at the ","9th postoperative day",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,12,0,69,0,69,0,39,0,46,0,12,0,69,0,22,0,26,0,75,0,69,0,69,0,69,0,24,0,42,0,63,0,69,0,12,0,24,0,24,0,42,0,24,0,42,0,24,0,63,0,69,0,26,0,22,0,26,0,22,0,69,0,75,0,79,0,69,0,27,0,12,0,22,0,22,0,26,0,12,0,69,0,12,0,75,0,75,0,42,0,13,0,19,0]}
-{"full_text":"We present a case of pancreatic tumor without a history of trauma or panceratitis.\nA 47-year-old Tunisian man with a history of Crohn's disease was admitted to the University Hospital in 2015 because of fluid chronic diarrhea with 4 stools per day daytime only with out ooddebr is associated with vomiting with out abdominal pain or fever with a weight loss not encrypted dating from 6 months.\nLaboratory tests were normal.\nNonspecific elevations of serum pancreatic enzymes.\nPatient underwent an abdominal ultrasound and computed tomography (CT) that revealed: Aspect of ileitis of the last ileal loop extended by 300 mm with distended ileal loops upstream, cystic image at the tail of the pancreas with clean wall uncalcified and hypodense content of fluid density without endoluminal bourgeon or pancreatic duct dilatation, measuring 28 x 22mm (Figure 1).\nThe size of the head was normal.\nThere were no enlarged lymph nodes (Figure 2).\nAspect of bilateral sacroiliitis and bilateral coxarthrosis.\nMRI show an aspect of ileitis of the last ileal loop and the cystic nature of a pancreatic lesion, with parietal enhancement at the caudal portion of the pancreas with a slight dilation of the Wirsung.\nOtherwise, gallbladder contains multiple gallstones and biliary sludge.\nTumor markers are normal.on the other hand, in colonoscopy terminal ileum appears swollen, inflamed, with frequent ulcerations and biopsies were made.\nThe biopsies were taken and show a subacute and ulcerative ileitis compatible with Crohn's disease.\nEsophagogastroduodenoscopy was normal.\nThe patient was operated by laparoscopy, he had a caudal pancreatectomy and cholecystectomy .1.5 cm cystic tumor in the tail of pancreas was resected and sent for pathological examination.\nThe post-operative course was uneventful.\nPatient was discharged home within 7 days in a good general condition.\nThere were no symptoms of glucose intolerance after normal diet administration.\nThe microscopic examination revealed well differentiated cystic neuro endocrine tumor of the tail of the pancreas grade I according to the classification of WHO 2010 (mitosis <2\/10CFG and Ki67<2% ) associated with neuroendocrine hyperplasia lesions of islets of Langerhans, surgical limit was healthy, pTNM pT2, ectopic spleen, chronic cholecystitis.\nthe patient come for out-patient consultations at the hospital, he felt well, with no severe complaints and with correct periodic findings and normal glucose metabolism.\n","ner_info":[{"text":"pancreatic tumor","label":"DISEASE_DISORDER","start":21,"end":37},{"text":"without a history of trauma or panceratitis","label":"HISTORY","start":38,"end":81},{"text":"47-year-old","label":"AGE","start":85,"end":96},{"text":"Tunisian","label":"PERSONAL_BACKGROUND","start":97,"end":105},{"text":"man","label":"SEX","start":106,"end":109},{"text":"Crohn's disease","label":"HISTORY","start":128,"end":143},{"text":"admitted","label":"CLINICAL_EVENT","start":148,"end":156},{"text":"University Hospital","label":"NONBIOLOGICAL_LOCATION","start":164,"end":183},{"text":"2015","label":"DATE","start":187,"end":191},{"text":"fluid","label":"DETAILED_DESCRIPTION","start":203,"end":208},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":209,"end":216},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":217,"end":225},{"text":"4","label":"QUANTITATIVE_CONCEPT","start":231,"end":232},{"text":"stools per day","label":"DIAGNOSTIC_PROCEDURE","start":233,"end":247},{"text":"daytime only","label":"QUALITATIVE_CONCEPT","start":248,"end":260},{"text":"ooddebr","label":"OTHER_EVENT","start":270,"end":277},{"text":"vomiting","label":"SIGN_SYMPTOM","start":297,"end":305},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":315,"end":324},{"text":"pain","label":"SIGN_SYMPTOM","start":325,"end":329},{"text":"fever","label":"SIGN_SYMPTOM","start":333,"end":338},{"text":"weight loss","label":"SIGN_SYMPTOM","start":346,"end":357},{"text":"from 6 months","label":"DURATION","start":379,"end":392},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":394,"end":410},{"text":"normal","label":"QUALITATIVE_CONCEPT","start":416,"end":422},{"text":"elevations","label":"QUALITATIVE_CONCEPT","start":436,"end":446},{"text":"serum","label":"BIOLOGICAL_STRUCTURE","start":450,"end":455},{"text":"pancreatic enzymes","label":"DIAGNOSTIC_PROCEDURE","start":456,"end":474},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":497,"end":506},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":507,"end":517},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":522,"end":541},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":543,"end":545},{"text":"ileitis","label":"DISEASE_DISORDER","start":572,"end":579},{"text":"last ileal loop","label":"BIOLOGICAL_STRUCTURE","start":587,"end":602},{"text":"extended","label":"SIGN_SYMPTOM","start":603,"end":611},{"text":"300 mm","label":"DISTANCE","start":615,"end":621},{"text":"distended","label":"SIGN_SYMPTOM","start":627,"end":636},{"text":"ileal loops","label":"BIOLOGICAL_STRUCTURE","start":637,"end":648},{"text":"upstream","label":"DETAILED_DESCRIPTION","start":649,"end":657},{"text":"cystic","label":"DETAILED_DESCRIPTION","start":659,"end":665},{"text":"image","label":"SIGN_SYMPTOM","start":666,"end":671},{"text":"tail of the pancreas","label":"BIOLOGICAL_STRUCTURE","start":679,"end":699},{"text":"uncalcified","label":"SIGN_SYMPTOM","start":716,"end":727},{"text":"endoluminal","label":"BIOLOGICAL_STRUCTURE","start":775,"end":786},{"text":"bourgeon","label":"SIGN_SYMPTOM","start":787,"end":795},{"text":"pancreatic duct","label":"BIOLOGICAL_STRUCTURE","start":799,"end":814},{"text":"dilatation","label":"SIGN_SYMPTOM","start":815,"end":825},{"text":"28 x 22mm","label":"AREA","start":837,"end":846},{"text":"size","label":"DIAGNOSTIC_PROCEDURE","start":863,"end":867},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":875,"end":879},{"text":"normal","label":"QUALITATIVE_CONCEPT","start":884,"end":890},{"text":"enlarged","label":"SIGN_SYMPTOM","start":906,"end":914},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":915,"end":926},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":949,"end":958},{"text":"sacroiliitis","label":"DISEASE_DISORDER","start":959,"end":971},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":976,"end":985},{"text":"coxarthrosis","label":"DISEASE_DISORDER","start":986,"end":998},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":1000,"end":1003},{"text":"ileitis","label":"DISEASE_DISORDER","start":1022,"end":1029},{"text":"last ileal loop","label":"BIOLOGICAL_STRUCTURE","start":1037,"end":1052},{"text":"cystic nature","label":"DETAILED_DESCRIPTION","start":1061,"end":1074},{"text":"pancreatic","label":"BIOLOGICAL_STRUCTURE","start":1080,"end":1090},{"text":"lesion","label":"SIGN_SYMPTOM","start":1091,"end":1097},{"text":"parietal","label":"DETAILED_DESCRIPTION","start":1104,"end":1112},{"text":"enhancement","label":"SIGN_SYMPTOM","start":1113,"end":1124},{"text":"caudal portion of the pancreas","label":"BIOLOGICAL_STRUCTURE","start":1132,"end":1162},{"text":"slight","label":"SEVERITY","start":1170,"end":1176},{"text":"dilation","label":"SIGN_SYMPTOM","start":1177,"end":1185},{"text":"Wirsung","label":"BIOLOGICAL_STRUCTURE","start":1193,"end":1200},{"text":"gallbladder","label":"BIOLOGICAL_STRUCTURE","start":1213,"end":1224},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1234,"end":1242},{"text":"gallstones","label":"SIGN_SYMPTOM","start":1243,"end":1253},{"text":"biliary sludge","label":"SIGN_SYMPTOM","start":1258,"end":1272},{"text":"Tumor markers","label":"DIAGNOSTIC_PROCEDURE","start":1274,"end":1287},{"text":"normal","label":"LAB_VALUE","start":1292,"end":1298},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1321,"end":1332},{"text":"terminal ileum","label":"BIOLOGICAL_STRUCTURE","start":1333,"end":1347},{"text":"swollen","label":"SIGN_SYMPTOM","start":1356,"end":1363},{"text":"inflamed","label":"SIGN_SYMPTOM","start":1365,"end":1373},{"text":"ulcerations","label":"SIGN_SYMPTOM","start":1389,"end":1400},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1405,"end":1413},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1429,"end":1437},{"text":"subacute","label":"DETAILED_DESCRIPTION","start":1460,"end":1468},{"text":"ulcerative","label":"DETAILED_DESCRIPTION","start":1473,"end":1483},{"text":"ileitis","label":"DISEASE_DISORDER","start":1484,"end":1491},{"text":"Crohn's disease","label":"DISEASE_DISORDER","start":1508,"end":1523},{"text":"Esophagogastroduodenoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1525,"end":1551},{"text":"normal","label":"LAB_VALUE","start":1556,"end":1562},{"text":"laparoscopy","label":"THERAPEUTIC_PROCEDURE","start":1592,"end":1603},{"text":"caudal","label":"DETAILED_DESCRIPTION","start":1614,"end":1620},{"text":"pancreatectomy","label":"THERAPEUTIC_PROCEDURE","start":1621,"end":1635},{"text":"cholecystectomy","label":"THERAPEUTIC_PROCEDURE","start":1640,"end":1655},{"text":"1.5 cm","label":"DISTANCE","start":1657,"end":1663},{"text":"cystic","label":"DETAILED_DESCRIPTION","start":1664,"end":1670},{"text":"tumor","label":"SIGN_SYMPTOM","start":1671,"end":1676},{"text":"tail of pancreas","label":"BIOLOGICAL_STRUCTURE","start":1684,"end":1700},{"text":"resected","label":"THERAPEUTIC_PROCEDURE","start":1705,"end":1713},{"text":"pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":1727,"end":1751},{"text":"post-operative course","label":"DIAGNOSTIC_PROCEDURE","start":1757,"end":1778},{"text":"uneventful","label":"LAB_VALUE","start":1783,"end":1793},{"text":"discharged","label":"CLINICAL_EVENT","start":1807,"end":1817},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":1818,"end":1822},{"text":"within 7 days","label":"DATE","start":1823,"end":1836},{"text":"good","label":"LAB_VALUE","start":1842,"end":1846},{"text":"general condition","label":"DIAGNOSTIC_PROCEDURE","start":1847,"end":1864},{"text":"symptoms of glucose intolerance","label":"SIGN_SYMPTOM","start":1880,"end":1911},{"text":"normal","label":"QUALITATIVE_CONCEPT","start":1918,"end":1924},{"text":"diet","label":"THERAPEUTIC_PROCEDURE","start":1925,"end":1929},{"text":"microscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1950,"end":1973},{"text":"well differentiated","label":"DETAILED_DESCRIPTION","start":1983,"end":2002},{"text":"cystic","label":"DETAILED_DESCRIPTION","start":2003,"end":2009},{"text":"neuro endocrine tumor","label":"DISEASE_DISORDER","start":2010,"end":2031},{"text":"tail of the pancreas","label":"BIOLOGICAL_STRUCTURE","start":2039,"end":2059},{"text":"grade I","label":"QUALITATIVE_CONCEPT","start":2060,"end":2067},{"text":"mitosis","label":"DIAGNOSTIC_PROCEDURE","start":2113,"end":2120},{"text":"<2\/10CFG","label":"LAB_VALUE","start":2121,"end":2129},{"text":"Ki67","label":"DIAGNOSTIC_PROCEDURE","start":2134,"end":2138},{"text":"<2%","label":"LAB_VALUE","start":2138,"end":2141},{"text":"neuroendocrine hyperplasia lesions","label":"DISEASE_DISORDER","start":2160,"end":2194},{"text":"islets of Langerhans","label":"BIOLOGICAL_STRUCTURE","start":2198,"end":2218},{"text":"surgical limit","label":"DIAGNOSTIC_PROCEDURE","start":2220,"end":2234},{"text":"healthy","label":"LAB_VALUE","start":2239,"end":2246},{"text":"pTNM","label":"DIAGNOSTIC_PROCEDURE","start":2248,"end":2252},{"text":"pT2","label":"LAB_VALUE","start":2253,"end":2256},{"text":"ectopic","label":"SIGN_SYMPTOM","start":2258,"end":2265},{"text":"spleen","label":"BIOLOGICAL_STRUCTURE","start":2266,"end":2272},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":2274,"end":2281},{"text":"cholecystitis","label":"DISEASE_DISORDER","start":2282,"end":2295},{"text":"out-patient consultations","label":"CLINICAL_EVENT","start":2318,"end":2343},{"text":"hospital","label":"BIOLOGICAL_STRUCTURE","start":2351,"end":2359},{"text":"felt well","label":"OUTCOME","start":2364,"end":2373},{"text":"severe","label":"SEVERITY","start":2383,"end":2389},{"text":"complaints","label":"SIGN_SYMPTOM","start":2390,"end":2400},{"text":"correct","label":"LAB_VALUE","start":2410,"end":2417},{"text":"periodic findings","label":"DIAGNOSTIC_PROCEDURE","start":2418,"end":2435},{"text":"normal","label":"LAB_VALUE","start":2440,"end":2446},{"text":"glucose metabolism","label":"DIAGNOSTIC_PROCEDURE","start":2447,"end":2465}],"tokens":["We present a case of ","pancreatic tumor"," ","without a history of trauma or panceratitis",".\nA ","47-year-old"," ","Tunisian"," ","man"," with a history of ","Crohn's disease"," was ","admitted"," to the ","University Hospital"," in ","2015"," because of ","fluid"," ","chronic"," ","diarrhea"," with ","4"," ","stools per day"," ","daytime only"," with out ","ooddebr"," is associated with ","vomiting"," with out ","abdominal"," ","pain"," or ","fever"," with a ","weight loss"," not encrypted dating ","from 6 months",".\n","Laboratory tests"," were ","normal",".\nNonspecific ","elevations"," of ","serum"," ","pancreatic enzymes",".\nPatient underwent an ","abdominal"," ","ultrasound"," and ","computed tomography"," (","CT",") that revealed: Aspect of ","ileitis"," of the ","last ileal loop"," ","extended"," by ","300 mm"," with ","distended"," ","ileal loops"," ","upstream",", ","cystic"," ","image"," at the ","tail of the pancreas"," with clean wall ","uncalcified"," and hypodense content of fluid density without ","endoluminal"," ","bourgeon"," or ","pancreatic duct"," ","dilatation",", measuring ","28 x 22mm"," (Figure 1).\nThe ","size"," of the ","head"," was ","normal",".\nThere were no ","enlarged"," ","lymph nodes"," (Figure 2).\nAspect of ","bilateral"," ","sacroiliitis"," and ","bilateral"," ","coxarthrosis",".\n","MRI"," show an aspect of ","ileitis"," of the ","last ileal loop"," and the ","cystic nature"," of a ","pancreatic"," ","lesion",", with ","parietal"," ","enhancement"," at the ","caudal portion of the pancreas"," with a ","slight"," ","dilation"," of the ","Wirsung",".\nOtherwise, ","gallbladder"," contains ","multiple"," ","gallstones"," and ","biliary sludge",".\n","Tumor markers"," are ","normal",".on the other hand, in ","colonoscopy"," ","terminal ileum"," appears ","swollen",", ","inflamed",", with frequent ","ulcerations"," and ","biopsies"," were made.\nThe ","biopsies"," were taken and show a ","subacute"," and ","ulcerative"," ","ileitis"," compatible with ","Crohn's disease",".\n","Esophagogastroduodenoscopy"," was ","normal",".\nThe patient was operated by ","laparoscopy",", he had a ","caudal"," ","pancreatectomy"," and ","cholecystectomy"," .","1.5 cm"," ","cystic"," ","tumor"," in the ","tail of pancreas"," was ","resected"," and sent for ","pathological examination",".\nThe ","post-operative course"," was ","uneventful",".\nPatient was ","discharged"," ","home"," ","within 7 days"," in a ","good"," ","general condition",".\nThere were no ","symptoms of glucose intolerance"," after ","normal"," ","diet"," administration.\nThe ","microscopic examination"," revealed ","well differentiated"," ","cystic"," ","neuro endocrine tumor"," of the ","tail of the pancreas"," ","grade I"," according to the classification of WHO 2010 (","mitosis"," ","<2\/10CFG"," and ","Ki67","","<2%"," ) associated with ","neuroendocrine hyperplasia lesions"," of ","islets of Langerhans",", ","surgical limit"," was ","healthy",", ","pTNM"," ","pT2",", ","ectopic"," ","spleen",", ","chronic"," ","cholecystitis",".\nthe patient come for ","out-patient consultations"," at the ","hospital",", he ","felt well",", with no ","severe"," ","complaints"," and with ","correct"," ","periodic findings"," and ","normal"," ","glucose metabolism",".\n"],"ner_labels":[0,26,0,39,0,5,0,58,0,65,0,39,0,13,0,48,0,19,0,22,0,22,0,69,0,62,0,24,0,59,0,53,0,69,0,12,0,69,0,69,0,69,0,32,0,24,0,59,0,59,0,12,0,24,0,12,0,24,0,24,0,24,0,26,0,12,0,69,0,27,0,69,0,12,0,22,0,22,0,69,0,12,0,69,0,12,0,69,0,12,0,69,0,8,0,24,0,12,0,59,0,69,0,12,0,22,0,26,0,22,0,26,0,24,0,26,0,12,0,22,0,12,0,69,0,22,0,69,0,12,0,63,0,69,0,12,0,12,0,22,0,69,0,69,0,24,0,42,0,24,0,12,0,69,0,69,0,69,0,24,0,24,0,22,0,22,0,26,0,26,0,24,0,42,0,75,0,22,0,75,0,75,0,27,0,22,0,69,0,12,0,75,0,24,0,24,0,42,0,13,0,48,0,19,0,42,0,24,0,69,0,59,0,75,0,24,0,22,0,22,0,26,0,12,0,59,0,24,0,42,0,24,0,42,0,26,0,12,0,24,0,42,0,24,0,42,0,69,0,12,0,22,0,26,0,13,0,12,0,56,0,63,0,69,0,42,0,24,0,42,0,24,0]}
-{"full_text":"A 54-year-old Asian man with IgA nephropathy underwent living-donor kidney transplantation 14 years previously.\nHis medical condition had been almost stable for 14 years.\nHe developed multifocal salmon-pink skin discoloration, and swelling and spontaneous pain in the left knee and leg.\nThe symptoms had gradually expanded across the right forearm and outside of the right thigh.\nHe was admitted to our hospital for the evaluation of fever (39 \u00b0C) and multifocal cellulitis (Fig.1).\nTwo months before admission, he had developed chronic diarrhea.\nHis serum creatinine level was stabilized at 1.7 mg\/dL with maintenance immunosuppressive therapy comprising tacrolimus (3 mg\/day), mycophenolate mofetil (1500 mg\/day), and prednisone (4 mg every other day).\nThe tacrolimus trough concentration was 6.3 ng\/mL.\nThe patient had been a dog breeder for 12 years.\nOn admission, his white blood cell count was 12,400\/\u03bcL and his C-reactive protein level was 3.9 mg\/dL.\nThe patient was initially treated with ampicillin\/sulbactam (9 g\/day intravenously).\nTwo days after the initiation of this therapy, he was afebrile.\nFour days later, an automated blood culture (Bactec FX\u00ae; Becton\u2013Dickinson and Company, Sparks, MD, USA) showed positivity for gram-negative spiral bacilli.\nA colony obtained from the patient\u2019s blood culture was analyzed by MALDI-TOF MS (Biotyper ver. 3.0\u00ae; Bruker Corporation, Germany).\nThe identification score was 2.064 (>2.0), indicating accurate identification of H. cinaedi (Fig.2).\nAdditional evaluation of the patient\u2019s blood specifically for H.\ncinaedi by means of gyrase subunit B (gyrB)-targeted PCR assays (using the forward primer AGGGATTCCACAAAGTGAGC and the reverse primer TCTTGTCCTGTGCGTTCATC to amplify the region of the gyrB gene) yielded positive results.\nWe performed gyrB-targeted PCR using a single colony isolated from a blood culture.\nWe used distilled water (DNA- and DNase-free water) as a negative control to prevent contamination of gyrB-targeted PCR (Fig.3).\nIn addition, we performed 16S rRNA gene sequencing of this strain, and the results were > 99% consistent with the existing sequence (Fig.4).\nGiven these results, we diagnosed the patient with H.\ncinaedi bacteremia with cellulitis.\nWe examined the genomic heat shock protein (HSP) 60 sequence of the blood culture isolate, which resulted in identification of cluster B H. cinaedi.\nA blood culture obtained at 11 days was positive for H.\ncinaedi, but a culture obtained at 15 days was negative.\nThe patient\u2019s cellulitis gradually resolved.\nThe patient continued antibiotic treatment for a total of 6 weeks (ampicillin-sulbactam in a drip for 2 weeks and oral levofloxacin for 4 weeks), and he had no recurrence 6 months after this therapy.\nHis stool culture was negative, although it was taken after treatment.\nWe did not apply enteric bacteria elimination in this case.\n","ner_info":[{"text":"54-year-old","label":"AGE","start":2,"end":13},{"text":"Asian","label":"PERSONAL_BACKGROUND","start":14,"end":19},{"text":"man","label":"SEX","start":20,"end":23},{"text":"IgA nephropathy","label":"HISTORY","start":29,"end":44},{"text":"living-donor","label":"DETAILED_DESCRIPTION","start":55,"end":67},{"text":"kidney transplantation","label":"THERAPEUTIC_PROCEDURE","start":68,"end":90},{"text":"14 years previously","label":"DATE","start":91,"end":110},{"text":"medical condition","label":"DIAGNOSTIC_PROCEDURE","start":116,"end":133},{"text":"almost stable","label":"LAB_VALUE","start":143,"end":156},{"text":"14 years","label":"DURATION","start":161,"end":169},{"text":"multifocal","label":"DETAILED_DESCRIPTION","start":184,"end":194},{"text":"salmon-pink","label":"COLOR","start":195,"end":206},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":207,"end":211},{"text":"discoloration","label":"SIGN_SYMPTOM","start":212,"end":225},{"text":"swelling","label":"SIGN_SYMPTOM","start":231,"end":239},{"text":"spontaneous","label":"DETAILED_DESCRIPTION","start":244,"end":255},{"text":"pain","label":"SIGN_SYMPTOM","start":256,"end":260},{"text":"left knee","label":"BIOLOGICAL_STRUCTURE","start":268,"end":277},{"text":"leg","label":"BIOLOGICAL_STRUCTURE","start":282,"end":285},{"text":"right forearm","label":"BIOLOGICAL_STRUCTURE","start":334,"end":347},{"text":"outside of the right thigh","label":"BIOLOGICAL_STRUCTURE","start":352,"end":378},{"text":"admitted","label":"CLINICAL_EVENT","start":387,"end":395},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":403,"end":411},{"text":"fever","label":"SIGN_SYMPTOM","start":434,"end":439},{"text":"39 \u00b0C","label":"LAB_VALUE","start":441,"end":446},{"text":"multifocal","label":"DETAILED_DESCRIPTION","start":452,"end":462},{"text":"cellulitis","label":"DISEASE_DISORDER","start":463,"end":473},{"text":"Two months before","label":"DATE","start":483,"end":500},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":529,"end":536},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":537,"end":545},{"text":"serum creatinine","label":"DIAGNOSTIC_PROCEDURE","start":551,"end":567},{"text":"stabilized","label":"LAB_VALUE","start":578,"end":588},{"text":"1.7 mg\/dL","label":"LAB_VALUE","start":592,"end":601},{"text":"immunosuppressive therapy","label":"THERAPEUTIC_PROCEDURE","start":619,"end":644},{"text":"tacrolimus","label":"MEDICATION","start":656,"end":666},{"text":"3 mg\/day","label":"DOSAGE","start":668,"end":676},{"text":"mycophenolate mofetil","label":"MEDICATION","start":679,"end":700},{"text":"1500 mg\/day","label":"DOSAGE","start":702,"end":713},{"text":"prednisone","label":"MEDICATION","start":720,"end":730},{"text":"4 mg every other day","label":"DOSAGE","start":732,"end":752},{"text":"tacrolimus trough concentration","label":"DIAGNOSTIC_PROCEDURE","start":759,"end":790},{"text":"6.3 ng\/mL","label":"LAB_VALUE","start":795,"end":804},{"text":"a dog breeder for 12 years","label":"OCCUPATION","start":827,"end":853},{"text":"white blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":873,"end":895},{"text":"12,400\/\u03bcL","label":"LAB_VALUE","start":900,"end":909},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":918,"end":936},{"text":"3.9 mg\/dL","label":"LAB_VALUE","start":947,"end":956},{"text":"ampicillin\/sulbactam","label":"MEDICATION","start":997,"end":1017},{"text":"9 g\/day","label":"DOSAGE","start":1019,"end":1026},{"text":"intravenously","label":"ADMINISTRATION","start":1027,"end":1040},{"text":"Two days after","label":"DATE","start":1043,"end":1057},{"text":"afebrile","label":"SIGN_SYMPTOM","start":1097,"end":1105},{"text":"Four days later","label":"DATE","start":1107,"end":1122},{"text":"blood culture","label":"DIAGNOSTIC_PROCEDURE","start":1137,"end":1150},{"text":"Bactec FX\u00ae","label":"DETAILED_DESCRIPTION","start":1152,"end":1162},{"text":"Becton\u2013Dickinson and Company, Sparks, MD, USA","label":"DETAILED_DESCRIPTION","start":1164,"end":1209},{"text":"positivity","label":"LAB_VALUE","start":1218,"end":1228},{"text":"gram-negative spiral bacilli","label":"DIAGNOSTIC_PROCEDURE","start":1233,"end":1261},{"text":"colony obtained from the patient\u2019s blood culture","label":"DETAILED_DESCRIPTION","start":1265,"end":1313},{"text":"MALDI-TOF","label":"DETAILED_DESCRIPTION","start":1330,"end":1339},{"text":"MS","label":"DIAGNOSTIC_PROCEDURE","start":1340,"end":1342},{"text":"Biotyper ver. 3.0\u00ae","label":"DETAILED_DESCRIPTION","start":1344,"end":1362},{"text":"Bruker Corporation, Germany","label":"DETAILED_DESCRIPTION","start":1364,"end":1391},{"text":"identification score was 2.064","label":"LAB_VALUE","start":1398,"end":1428},{"text":"H. cinaedi","label":"SIGN_SYMPTOM","start":1475,"end":1485},{"text":"evaluation","label":"DIAGNOSTIC_PROCEDURE","start":1506,"end":1516},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":1534,"end":1539},{"text":"gyrase subunit B (gyrB)-targeted","label":"DETAILED_DESCRIPTION","start":1580,"end":1612},{"text":"PCR assays","label":"DIAGNOSTIC_PROCEDURE","start":1613,"end":1623},{"text":"using the forward primer AGGGATTCCACAAAGTGAGC and the reverse primer TCTTGTCCTGTGCGTTCATC to amplify the region of the gyrB gene","label":"DETAILED_DESCRIPTION","start":1625,"end":1753},{"text":"positive","label":"LAB_VALUE","start":1763,"end":1771},{"text":"gyrB-targeted","label":"DETAILED_DESCRIPTION","start":1794,"end":1807},{"text":"PCR","label":"DIAGNOSTIC_PROCEDURE","start":1808,"end":1811},{"text":"single colony isolated from a blood culture","label":"DETAILED_DESCRIPTION","start":1820,"end":1863},{"text":"distilled water (DNA- and DNase-free water) as a negative control","label":"DETAILED_DESCRIPTION","start":1873,"end":1938},{"text":"16S rRNA gene sequencing","label":"DIAGNOSTIC_PROCEDURE","start":2020,"end":2044},{"text":"bacteremia","label":"DISEASE_DISORDER","start":2197,"end":2207},{"text":"cellulitis","label":"DISEASE_DISORDER","start":2213,"end":2223},{"text":"examined the genomic heat shock protein (HSP) 60 sequence","label":"DIAGNOSTIC_PROCEDURE","start":2228,"end":2285},{"text":"blood culture isolate","label":"DETAILED_DESCRIPTION","start":2293,"end":2314},{"text":"cluster B","label":"DETAILED_DESCRIPTION","start":2352,"end":2361},{"text":"H. cinaedi","label":"SIGN_SYMPTOM","start":2362,"end":2372},{"text":"blood culture","label":"DIAGNOSTIC_PROCEDURE","start":2376,"end":2389},{"text":"at 11 days","label":"DATE","start":2399,"end":2409},{"text":"positive","label":"LAB_VALUE","start":2414,"end":2422},{"text":"culture","label":"DIAGNOSTIC_PROCEDURE","start":2445,"end":2452},{"text":"at 15 days","label":"DATE","start":2462,"end":2472},{"text":"negative","label":"LAB_VALUE","start":2477,"end":2485},{"text":"cellulitis","label":"DISEASE_DISORDER","start":2501,"end":2511},{"text":"antibiotic","label":"MEDICATION","start":2554,"end":2564},{"text":"6 weeks","label":"DURATION","start":2590,"end":2597},{"text":"ampicillin-sulbactam","label":"MEDICATION","start":2599,"end":2619},{"text":"drip","label":"ADMINISTRATION","start":2625,"end":2629},{"text":"2 weeks","label":"DURATION","start":2634,"end":2641},{"text":"oral","label":"ADMINISTRATION","start":2646,"end":2650},{"text":"levofloxacin","label":"MEDICATION","start":2651,"end":2663},{"text":"4 weeks","label":"DURATION","start":2668,"end":2675},{"text":"recurrence","label":"SIGN_SYMPTOM","start":2692,"end":2702},{"text":"6 months after","label":"DATE","start":2703,"end":2717},{"text":"stool culture","label":"DIAGNOSTIC_PROCEDURE","start":2736,"end":2749},{"text":"negative","label":"LAB_VALUE","start":2754,"end":2762},{"text":"taken after treatment","label":"DETAILED_DESCRIPTION","start":2780,"end":2801},{"text":"enteric bacteria elimination","label":"MEDICATION","start":2820,"end":2848}],"tokens":["A ","54-year-old"," ","Asian"," ","man"," with ","IgA nephropathy"," underwent ","living-donor"," ","kidney transplantation"," ","14 years previously",".\nHis ","medical condition"," had been ","almost stable"," for ","14 years",".\nHe developed ","multifocal"," ","salmon-pink"," ","skin"," ","discoloration",", and ","swelling"," and ","spontaneous"," ","pain"," in the ","left knee"," and ","leg",".\nThe symptoms had gradually expanded across the ","right forearm"," and ","outside of the right thigh",".\nHe was ","admitted"," to our ","hospital"," for the evaluation of ","fever"," (","39 \u00b0C",") and ","multifocal"," ","cellulitis"," (Fig.1).\n","Two months before"," admission, he had developed ","chronic"," ","diarrhea",".\nHis ","serum creatinine"," level was ","stabilized"," at ","1.7 mg\/dL"," with maintenance ","immunosuppressive therapy"," comprising ","tacrolimus"," (","3 mg\/day","), ","mycophenolate mofetil"," (","1500 mg\/day","), and ","prednisone"," (","4 mg every other day",").\nThe ","tacrolimus trough concentration"," was ","6.3 ng\/mL",".\nThe patient had been ","a dog breeder for 12 years",".\nOn admission, his ","white blood cell count"," was ","12,400\/\u03bcL"," and his ","C-reactive protein"," level was ","3.9 mg\/dL",".\nThe patient was initially treated with ","ampicillin\/sulbactam"," (","9 g\/day"," ","intravenously",").\n","Two days after"," the initiation of this therapy, he was ","afebrile",".\n","Four days later",", an automated ","blood culture"," (","Bactec FX\u00ae","; ","Becton\u2013Dickinson and Company, Sparks, MD, USA",") showed ","positivity"," for ","gram-negative spiral bacilli",".\nA ","colony obtained from the patient\u2019s blood culture"," was analyzed by ","MALDI-TOF"," ","MS"," (","Biotyper ver. 3.0\u00ae","; ","Bruker Corporation, Germany",").\nThe ","identification score was 2.064"," (>2.0), indicating accurate identification of ","H. cinaedi"," (Fig.2).\nAdditional ","evaluation"," of the patient\u2019s ","blood"," specifically for H.\ncinaedi by means of ","gyrase subunit B (gyrB)-targeted"," ","PCR assays"," (","using the forward primer AGGGATTCCACAAAGTGAGC and the reverse primer TCTTGTCCTGTGCGTTCATC to amplify the region of the gyrB gene",") yielded ","positive"," results.\nWe performed ","gyrB-targeted"," ","PCR"," using a ","single colony isolated from a blood culture",".\nWe used ","distilled water (DNA- and DNase-free water) as a negative control"," to prevent contamination of gyrB-targeted PCR (Fig.3).\nIn addition, we performed ","16S rRNA gene sequencing"," of this strain, and the results were > 99% consistent with the existing sequence (Fig.4).\nGiven these results, we diagnosed the patient with H.\ncinaedi ","bacteremia"," with ","cellulitis",".\nWe ","examined the genomic heat shock protein (HSP) 60 sequence"," of the ","blood culture isolate",", which resulted in identification of ","cluster B"," ","H. cinaedi",".\nA ","blood culture"," obtained ","at 11 days"," was ","positive"," for H.\ncinaedi, but a ","culture"," obtained ","at 15 days"," was ","negative",".\nThe patient\u2019s ","cellulitis"," gradually resolved.\nThe patient continued ","antibiotic"," treatment for a total of ","6 weeks"," (","ampicillin-sulbactam"," in a ","drip"," for ","2 weeks"," and ","oral"," ","levofloxacin"," for ","4 weeks","), and he had no ","recurrence"," ","6 months after"," this therapy.\nHis ","stool culture"," was ","negative",", although it was ","taken after treatment",".\nWe did not apply ","enteric bacteria elimination"," in this case.\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,22,0,75,0,19,0,24,0,42,0,32,0,22,0,15,0,12,0,69,0,69,0,22,0,69,0,12,0,12,0,12,0,12,0,13,0,48,0,69,0,42,0,22,0,26,0,19,0,22,0,69,0,24,0,42,0,42,0,75,0,46,0,29,0,46,0,29,0,46,0,29,0,24,0,42,0,50,0,24,0,42,0,24,0,42,0,46,0,29,0,4,0,19,0,69,0,19,0,24,0,22,0,22,0,42,0,24,0,22,0,22,0,24,0,22,0,22,0,42,0,69,0,24,0,12,0,22,0,24,0,22,0,42,0,22,0,24,0,22,0,22,0,24,0,26,0,26,0,24,0,22,0,22,0,69,0,24,0,19,0,42,0,24,0,19,0,42,0,26,0,46,0,32,0,46,0,4,0,32,0,4,0,46,0,32,0,69,0,19,0,24,0,42,0,22,0,46,0]}
-{"full_text":"A 37-year-old African American female with a past medical history significant for stage 1 sarcoidosis presented to our facility with a chief complaint of shortness of breath.\nTen years prior, she presented with bilateral uveitis and lupus pernio (LP) on her right ear and was subsequently diagnosed with sarcoidosis.\nShe was successfully treated for these conditions and her sarcoidosis remained quiescent until three years ago, when, at an outside institution, she was discovered to have laryngeal involvement.\nShe was treated with prednisone 60 mg daily for several months and eventually tapered to 10 mg daily.\nHer sarcoidosis remained well-controlled on this maintenance dose of prednisone until six months prior, at which time she self-discontinued her prednisone in favor of the homeopathic treatment Nopalea cactus juice, which unsubstantially claimed to have anti-inflammatory properties [4].\nSubsequently, she developed dyspnea on exertion progressing to dyspnea at rest.\nDuring this time her voice became increasingly hoarse and she experienced frequent episodes of difficulty swallowing.\nIn our emergency department, her physical examination was concerning for respiratory distress as she presented with inspiratory stridor and hoarseness.\nShe also had chronic-appearing, indurated lesions on her right ear.\nGiven that she had signs of upper airway disease for impending respiratory failure, an emergent bedside laryngoscopy was performed, revealing an obstructed airway with the epiglottis retroflexed over the glottis and significant edema in the arytenoids and aryepiglottic folds.\nShe was immediately treated with high-dose intravenous dexamethasone and taken emergently to the operating room (OR) to secure her airway for concern for complete upper airway obstruction, which was confirmed with direct visualization of her larynx in the OR.\nShe was intubated for a surgical airway, and after taking biopsies from the lingual surface of her epiglottis, a #4 cuffed Shiley\u2122 tracheostomy was placed.\nHer respiratory status immediately stabilized, was extubated, and transferred to our medical intensive care unit.\nHer tracheostomy was exchanged to a #4 cuffless Shiley on postoperative day 5.\nDuring this time she was transitioned from intravenous dexamethasone to prednisone 60 mg daily.\nBiopsies ultimately revealed non-necrotizing epithelioid granulomas consistent with sarcoidosis (Figure 1).\nShe was prescribed this high-dose prednisone for three months, and after receiving education for self-tracheostomy care, she was discharged home.\nAt her subsequent one-month and three-month follow-up visits, she denied any further respiratory issues.\nRepeat laryngoscopies showed significant improvement in the edema in the arytenoids and aryepiglottic folds, but the epiglottis continued to obscure the glottis despite therapy with high-dose prednisone.\nMethotrexate was initiated while prednisone was tapered to 10 mg daily; however, this regimen failed and her prednisone dosage was increased to 20 mg daily to reduce edema.\nBecause she declined surgical treatment, she will continue with medical management with immunosuppressive therapy to facilitate eventual de-cannulation.\n","ner_info":[{"text":"37-year-old","label":"AGE","start":2,"end":13},{"text":"African American","label":"PERSONAL_BACKGROUND","start":14,"end":30},{"text":"female","label":"SEX","start":31,"end":37},{"text":"stage 1 sarcoidosis","label":"HISTORY","start":82,"end":101},{"text":"presented","label":"CLINICAL_EVENT","start":102,"end":111},{"text":"facility","label":"NONBIOLOGICAL_LOCATION","start":119,"end":127},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":154,"end":173},{"text":"Ten years prior","label":"DATE","start":175,"end":190},{"text":"presented","label":"CLINICAL_EVENT","start":196,"end":205},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":211,"end":220},{"text":"uveitis","label":"DISEASE_DISORDER","start":221,"end":228},{"text":"lupus pernio","label":"SIGN_SYMPTOM","start":233,"end":245},{"text":"LP","label":"SIGN_SYMPTOM","start":247,"end":249},{"text":"right ear","label":"BIOLOGICAL_STRUCTURE","start":258,"end":267},{"text":"sarcoidosis","label":"DISEASE_DISORDER","start":304,"end":315},{"text":"successfully","label":"LAB_VALUE","start":325,"end":337},{"text":"treated","label":"THERAPEUTIC_PROCEDURE","start":338,"end":345},{"text":"sarcoidosis","label":"DISEASE_DISORDER","start":375,"end":386},{"text":"quiescent","label":"LAB_VALUE","start":396,"end":405},{"text":"three years ago","label":"DATE","start":412,"end":427},{"text":"outside institution","label":"NONBIOLOGICAL_LOCATION","start":441,"end":460},{"text":"discovered","label":"CLINICAL_EVENT","start":470,"end":480},{"text":"laryngeal","label":"BIOLOGICAL_STRUCTURE","start":489,"end":498},{"text":"involvement","label":"SIGN_SYMPTOM","start":499,"end":510},{"text":"treated","label":"THERAPEUTIC_PROCEDURE","start":520,"end":527},{"text":"prednisone","label":"MEDICATION","start":533,"end":543},{"text":"60 mg daily","label":"DOSAGE","start":544,"end":555},{"text":"several months","label":"DURATION","start":560,"end":574},{"text":"eventually","label":"DATE","start":579,"end":589},{"text":"10 mg daily","label":"DOSAGE","start":601,"end":612},{"text":"sarcoidosis","label":"DISEASE_DISORDER","start":618,"end":629},{"text":"well-controlled","label":"LAB_VALUE","start":639,"end":654},{"text":"maintenance dose","label":"DOSAGE","start":663,"end":679},{"text":"prednisone","label":"MEDICATION","start":683,"end":693},{"text":"six months prior","label":"DATE","start":700,"end":716},{"text":"self-discontinued","label":"LAB_VALUE","start":736,"end":753},{"text":"prednisone","label":"MEDICATION","start":758,"end":768},{"text":"homeopathic treatment","label":"THERAPEUTIC_PROCEDURE","start":785,"end":806},{"text":"Nopalea cactus juice","label":"MEDICATION","start":807,"end":827},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":929,"end":936},{"text":"on exertion","label":"DETAILED_DESCRIPTION","start":937,"end":948},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":964,"end":971},{"text":"at rest","label":"DETAILED_DESCRIPTION","start":972,"end":979},{"text":"voice","label":"ACTIVITY","start":1002,"end":1007},{"text":"hoarse","label":"SIGN_SYMPTOM","start":1028,"end":1034},{"text":"frequent","label":"FREQUENCY","start":1055,"end":1063},{"text":"difficulty swallowing","label":"SIGN_SYMPTOM","start":1076,"end":1097},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":1106,"end":1126},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1132,"end":1152},{"text":"respiratory distress","label":"SIGN_SYMPTOM","start":1172,"end":1192},{"text":"inspiratory stridor","label":"SIGN_SYMPTOM","start":1215,"end":1234},{"text":"hoarseness","label":"SIGN_SYMPTOM","start":1239,"end":1249},{"text":"chronic-appearing","label":"LAB_VALUE","start":1264,"end":1281},{"text":"indurated","label":"LAB_VALUE","start":1283,"end":1292},{"text":"lesions","label":"SIGN_SYMPTOM","start":1293,"end":1300},{"text":"right ear","label":"BIOLOGICAL_STRUCTURE","start":1308,"end":1317},{"text":"upper airway disease","label":"DISEASE_DISORDER","start":1347,"end":1367},{"text":"impending","label":"LAB_VALUE","start":1372,"end":1381},{"text":"respiratory failure","label":"DISEASE_DISORDER","start":1382,"end":1401},{"text":"emergent","label":"DETAILED_DESCRIPTION","start":1406,"end":1414},{"text":"bedside","label":"DETAILED_DESCRIPTION","start":1415,"end":1422},{"text":"laryngoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1423,"end":1435},{"text":"obstructed","label":"DISEASE_DISORDER","start":1464,"end":1474},{"text":"airway","label":"BIOLOGICAL_STRUCTURE","start":1475,"end":1481},{"text":"epiglottis","label":"BIOLOGICAL_STRUCTURE","start":1491,"end":1501},{"text":"retroflexed","label":"SIGN_SYMPTOM","start":1502,"end":1513},{"text":"glottis","label":"BIOLOGICAL_STRUCTURE","start":1523,"end":1530},{"text":"significant","label":"LAB_VALUE","start":1535,"end":1546},{"text":"edema","label":"SIGN_SYMPTOM","start":1547,"end":1552},{"text":"arytenoids","label":"BIOLOGICAL_STRUCTURE","start":1560,"end":1570},{"text":"aryepiglottic folds","label":"BIOLOGICAL_STRUCTURE","start":1575,"end":1594},{"text":"high-dose","label":"DOSAGE","start":1629,"end":1638},{"text":"intravenous","label":"ADMINISTRATION","start":1639,"end":1650},{"text":"dexamethasone","label":"MEDICATION","start":1651,"end":1664},{"text":"taken","label":"CLINICAL_EVENT","start":1669,"end":1674},{"text":"operating room","label":"NONBIOLOGICAL_LOCATION","start":1693,"end":1707},{"text":"OR","label":"NONBIOLOGICAL_LOCATION","start":1709,"end":1711},{"text":"secure","label":"THERAPEUTIC_PROCEDURE","start":1716,"end":1722},{"text":"airway","label":"BIOLOGICAL_STRUCTURE","start":1727,"end":1733},{"text":"complete","label":"LAB_VALUE","start":1750,"end":1758},{"text":"upper airway","label":"BIOLOGICAL_STRUCTURE","start":1759,"end":1771},{"text":"obstruction","label":"DISEASE_DISORDER","start":1772,"end":1783},{"text":"direct visualization","label":"DIAGNOSTIC_PROCEDURE","start":1810,"end":1830},{"text":"larynx","label":"BIOLOGICAL_STRUCTURE","start":1838,"end":1844},{"text":"OR","label":"NONBIOLOGICAL_LOCATION","start":1852,"end":1854},{"text":"intubated","label":"THERAPEUTIC_PROCEDURE","start":1864,"end":1873},{"text":"surgical airway","label":"THERAPEUTIC_PROCEDURE","start":1880,"end":1895},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1914,"end":1922},{"text":"lingual surface","label":"BIOLOGICAL_STRUCTURE","start":1932,"end":1947},{"text":"epiglottis","label":"BIOLOGICAL_STRUCTURE","start":1955,"end":1965},{"text":"#4 cuffed","label":"DETAILED_DESCRIPTION","start":1969,"end":1978},{"text":"Shiley","label":"DETAILED_DESCRIPTION","start":1979,"end":1985},{"text":"tracheostomy","label":"THERAPEUTIC_PROCEDURE","start":1987,"end":1999},{"text":"respiratory status","label":"DIAGNOSTIC_PROCEDURE","start":2016,"end":2034},{"text":"stabilized","label":"LAB_VALUE","start":2047,"end":2057},{"text":"extubated","label":"THERAPEUTIC_PROCEDURE","start":2063,"end":2072},{"text":"transferred","label":"CLINICAL_EVENT","start":2078,"end":2089},{"text":"medical intensive care unit","label":"NONBIOLOGICAL_LOCATION","start":2097,"end":2124},{"text":"tracheostomy","label":"THERAPEUTIC_PROCEDURE","start":2130,"end":2142},{"text":"#4 cuffless","label":"DETAILED_DESCRIPTION","start":2162,"end":2173},{"text":"Shiley","label":"DETAILED_DESCRIPTION","start":2174,"end":2180},{"text":"day 5","label":"DATE","start":2198,"end":2203},{"text":"intravenous","label":"ADMINISTRATION","start":2248,"end":2259},{"text":"dexamethasone","label":"MEDICATION","start":2260,"end":2273},{"text":"prednisone","label":"MEDICATION","start":2277,"end":2287},{"text":"60 mg daily","label":"DOSAGE","start":2288,"end":2299},{"text":"Biopsies","label":"DIAGNOSTIC_PROCEDURE","start":2301,"end":2309},{"text":"non-necrotizing","label":"DETAILED_DESCRIPTION","start":2330,"end":2345},{"text":"epithelioid","label":"DETAILED_DESCRIPTION","start":2346,"end":2357},{"text":"granulomas","label":"SIGN_SYMPTOM","start":2358,"end":2368},{"text":"sarcoidosis","label":"DISEASE_DISORDER","start":2385,"end":2396},{"text":"high-dose","label":"DOSAGE","start":2433,"end":2442},{"text":"prednisone","label":"MEDICATION","start":2443,"end":2453},{"text":"three months","label":"DURATION","start":2458,"end":2470},{"text":"education","label":"CLINICAL_EVENT","start":2492,"end":2501},{"text":"self-tracheostomy care","label":"THERAPEUTIC_PROCEDURE","start":2506,"end":2528},{"text":"discharged","label":"CLINICAL_EVENT","start":2538,"end":2548},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":2549,"end":2553},{"text":"one-month","label":"DATE","start":2573,"end":2582},{"text":"three-month","label":"DATE","start":2587,"end":2598},{"text":"follow-up","label":"CLINICAL_EVENT","start":2599,"end":2608},{"text":"respiratory issues","label":"SIGN_SYMPTOM","start":2640,"end":2658},{"text":"laryngoscopies","label":"DIAGNOSTIC_PROCEDURE","start":2667,"end":2681},{"text":"improvement","label":"LAB_VALUE","start":2701,"end":2712},{"text":"edema","label":"SIGN_SYMPTOM","start":2720,"end":2725},{"text":"arytenoids","label":"BIOLOGICAL_STRUCTURE","start":2733,"end":2743},{"text":"aryepiglottic folds","label":"BIOLOGICAL_STRUCTURE","start":2748,"end":2767},{"text":"epiglottis","label":"BIOLOGICAL_STRUCTURE","start":2777,"end":2787},{"text":"obscure","label":"DISEASE_DISORDER","start":2801,"end":2808},{"text":"glottis","label":"BIOLOGICAL_STRUCTURE","start":2813,"end":2820},{"text":"high-dose","label":"DOSAGE","start":2842,"end":2851},{"text":"prednisone","label":"MEDICATION","start":2852,"end":2862},{"text":"Methotrexate","label":"MEDICATION","start":2864,"end":2876},{"text":"prednisone","label":"MEDICATION","start":2897,"end":2907},{"text":"10 mg daily","label":"DOSAGE","start":2923,"end":2934},{"text":"prednisone","label":"MEDICATION","start":2973,"end":2983},{"text":"20 mg daily","label":"DOSAGE","start":3008,"end":3019},{"text":"surgical treatment","label":"THERAPEUTIC_PROCEDURE","start":3058,"end":3076},{"text":"medical management","label":"THERAPEUTIC_PROCEDURE","start":3101,"end":3119},{"text":"immunosuppressive therapy","label":"THERAPEUTIC_PROCEDURE","start":3125,"end":3150}],"tokens":["A ","37-year-old"," ","African American"," ","female"," with a past medical history significant for ","stage 1 sarcoidosis"," ","presented"," to our ","facility"," with a chief complaint of ","shortness of breath",".\n","Ten years prior",", she ","presented"," with ","bilateral"," ","uveitis"," and ","lupus pernio"," (","LP",") on her ","right ear"," and was subsequently diagnosed with ","sarcoidosis",".\nShe was ","successfully"," ","treated"," for these conditions and her ","sarcoidosis"," remained ","quiescent"," until ","three years ago",", when, at an ","outside institution",", she was ","discovered"," to have ","laryngeal"," ","involvement",".\nShe was ","treated"," with ","prednisone"," ","60 mg daily"," for ","several months"," and ","eventually"," tapered to ","10 mg daily",".\nHer ","sarcoidosis"," remained ","well-controlled"," on this ","maintenance dose"," of ","prednisone"," until ","six months prior",", at which time she ","self-discontinued"," her ","prednisone"," in favor of the ","homeopathic treatment"," ","Nopalea cactus juice",", which unsubstantially claimed to have anti-inflammatory properties [4].\nSubsequently, she developed ","dyspnea"," ","on exertion"," progressing to ","dyspnea"," ","at rest",".\nDuring this time her ","voice"," became increasingly ","hoarse"," and she experienced ","frequent"," episodes of ","difficulty swallowing",".\nIn our ","emergency department",", her ","physical examination"," was concerning for ","respiratory distress"," as she presented with ","inspiratory stridor"," and ","hoarseness",".\nShe also had ","chronic-appearing",", ","indurated"," ","lesions"," on her ","right ear",".\nGiven that she had signs of ","upper airway disease"," for ","impending"," ","respiratory failure",", an ","emergent"," ","bedside"," ","laryngoscopy"," was performed, revealing an ","obstructed"," ","airway"," with the ","epiglottis"," ","retroflexed"," over the ","glottis"," and ","significant"," ","edema"," in the ","arytenoids"," and ","aryepiglottic folds",".\nShe was immediately treated with ","high-dose"," ","intravenous"," ","dexamethasone"," and ","taken"," emergently to the ","operating room"," (","OR",") to ","secure"," her ","airway"," for concern for ","complete"," ","upper airway"," ","obstruction",", which was confirmed with ","direct visualization"," of her ","larynx"," in the ","OR",".\nShe was ","intubated"," for a ","surgical airway",", and after taking ","biopsies"," from the ","lingual surface"," of her ","epiglottis",", a ","#4 cuffed"," ","Shiley","\u2122 ","tracheostomy"," was placed.\nHer ","respiratory status"," immediately ","stabilized",", was ","extubated",", and ","transferred"," to our ","medical intensive care unit",".\nHer ","tracheostomy"," was exchanged to a ","#4 cuffless"," ","Shiley"," on postoperative ","day 5",".\nDuring this time she was transitioned from ","intravenous"," ","dexamethasone"," to ","prednisone"," ","60 mg daily",".\n","Biopsies"," ultimately revealed ","non-necrotizing"," ","epithelioid"," ","granulomas"," consistent with ","sarcoidosis"," (Figure 1).\nShe was prescribed this ","high-dose"," ","prednisone"," for ","three months",", and after receiving ","education"," for ","self-tracheostomy care",", she was ","discharged"," ","home",".\nAt her subsequent ","one-month"," and ","three-month"," ","follow-up"," visits, she denied any further ","respiratory issues",".\nRepeat ","laryngoscopies"," showed significant ","improvement"," in the ","edema"," in the ","arytenoids"," and ","aryepiglottic folds",", but the ","epiglottis"," continued to ","obscure"," the ","glottis"," despite therapy with ","high-dose"," ","prednisone",".\n","Methotrexate"," was initiated while ","prednisone"," was tapered to ","10 mg daily","; however, this regimen failed and her ","prednisone"," dosage was increased to ","20 mg daily"," to reduce edema.\nBecause she declined ","surgical treatment",", she will continue with ","medical management"," with ","immunosuppressive therapy"," to facilitate eventual de-cannulation.\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,13,0,48,0,69,0,19,0,13,0,22,0,26,0,69,0,69,0,12,0,26,0,42,0,75,0,26,0,42,0,19,0,48,0,13,0,12,0,69,0,75,0,46,0,29,0,32,0,19,0,29,0,26,0,42,0,29,0,46,0,19,0,42,0,46,0,75,0,46,0,69,0,22,0,69,0,22,0,1,0,69,0,35,0,69,0,48,0,24,0,69,0,69,0,69,0,42,0,42,0,69,0,12,0,26,0,42,0,26,0,22,0,22,0,24,0,26,0,12,0,12,0,69,0,12,0,42,0,69,0,12,0,12,0,29,0,4,0,46,0,13,0,48,0,48,0,75,0,12,0,42,0,12,0,26,0,24,0,12,0,48,0,75,0,75,0,24,0,12,0,12,0,22,0,22,0,75,0,24,0,42,0,75,0,13,0,48,0,75,0,22,0,22,0,19,0,4,0,46,0,46,0,29,0,24,0,22,0,22,0,69,0,26,0,29,0,46,0,32,0,13,0,75,0,13,0,48,0,19,0,19,0,13,0,69,0,24,0,42,0,69,0,12,0,12,0,12,0,26,0,12,0,29,0,46,0,46,0,46,0,29,0,46,0,29,0,75,0,75,0,75,0]}
-{"full_text":"A 62-year-old female presented to the outpatient department of Wuhan Central Hospital of Tongji Medical College in September 2015with a complaint of recurrent infections in the umbilical region.\nShe reported abdominal pain similar to a burning sensation that accompanied the discharge of faecal matter.\nThese symptoms and signs waxed and waned but lasted for 5years.\nOur attention was piqued by the fact that the patient\u2019s family described the patient as an individual who cried easily.\nThe patient had no history of diarrhoea, constipation or other abdominal disturbances.\nNo surgical treatment was mentioned in her prior medical history.\nAcoordinated physical examination revealed normal vital signs.\nAn external fistula was located in the umbilical region with redness of the surrounding skin.\nMorphological examination indicated that fistula secretions mainly consisted of small intestinal juice.\nThe abdominal wall was soft, with no tenderness.\nBowel sounds were regular.\nEscherichia coli and Enterococcus faecalis were detected in the fistula secretion culture.\nOther findings from laboratory examinations were normal.\nA CT scan of the abdomen revealed that part of the intestinal wall was adhered to the abdominal wall in the navel region, although no bowel obstruction was detected (Fig.1).\nA presumptive diagnosis of ECF was reached; this diagnosis was mainly based on digital radiography of the fistulous tract conducted using iopamidol-370 as a contrast agent.\nThis procedure was performed under local anaesthesia and revealed that the distal ileum approximately 40 cm from the ileocaecal junction was entrapped (Fig.2).\nThe patient agreed to surgery after a clear preoperative conversation.\nShe understood the operative risk factors and signed an informed consent.\nAfter bowel preparation, the patient received an exploratory laparotomy.\nThe abdominal cavity was completely exposed, and a loop of the terminal ileum (approximately 40 cm proximal to the ileocaecal junction) was found entrapped in the internal hernia ring; this finding was consistent with the preoperative contrast image.\nThe defect in the abdominal wall was less than 1.0 cm, and an extremely small portion of the bowel wall was stuck and could not be retrieved back into the cavity (Fig.3).\nNonetheless, this defect resulted in perforation over the loop (Fig.4).\nSide-to-side ileo-ileal anastomosis was completed by utilizing a 75 mm linear stapler to remove the affected ileum segment.\nThe internal hernia ring was closed with plication sutures instead of via mesh repair due to the patient\u2019s small defect and infection risk.\nThe abdominal cavity was thoroughly cleaned with saline solution, and a rubber drainage tube was placed in the pelvis.\nThe scar tissue was removed to improve wound healing; subsequently, relaxation sutures were available to close the abdomen in layers.\nA final diagnosis of Richter\u2019s hernia presenting as spontaneous ECF was reached.\nThe patient was discharged 2 weeks after surgery without serious complications.\nNo hernia recurrence was observed during 10 months of follow-up.\n","ner_info":[{"text":"62-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":21,"end":30},{"text":"outpatient department","label":"NONBIOLOGICAL_LOCATION","start":38,"end":59},{"text":"Wuhan Central Hospital of Tongji Medical College","label":"NONBIOLOGICAL_LOCATION","start":63,"end":111},{"text":"September 2015","label":"DATE","start":115,"end":129},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":149,"end":158},{"text":"infections","label":"DISEASE_DISORDER","start":159,"end":169},{"text":"umbilical region","label":"BIOLOGICAL_STRUCTURE","start":177,"end":193},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":208,"end":217},{"text":"pain","label":"SIGN_SYMPTOM","start":218,"end":222},{"text":"burning sensation","label":"DETAILED_DESCRIPTION","start":236,"end":253},{"text":"discharge of faecal matter","label":"ACTIVITY","start":275,"end":301},{"text":"symptoms and signs","label":"COREFERENCE","start":309,"end":327},{"text":"waxed and waned","label":"FREQUENCY","start":328,"end":343},{"text":"lasted for 5years","label":"DURATION","start":348,"end":365},{"text":"cried easily","label":"HISTORY","start":473,"end":485},{"text":"no history of diarrhoea, constipation or other abdominal disturbances","label":"HISTORY","start":503,"end":572},{"text":"No surgical treatment","label":"HISTORY","start":574,"end":595},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":653,"end":673},{"text":"normal","label":"QUALITATIVE_CONCEPT","start":683,"end":689},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":690,"end":701},{"text":"external","label":"DETAILED_DESCRIPTION","start":706,"end":714},{"text":"fistula","label":"SIGN_SYMPTOM","start":715,"end":722},{"text":"umbilical region","label":"BIOLOGICAL_STRUCTURE","start":742,"end":758},{"text":"redness","label":"SIGN_SYMPTOM","start":764,"end":771},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":791,"end":795},{"text":"Morphological examination","label":"DIAGNOSTIC_PROCEDURE","start":797,"end":822},{"text":"fistula secretions","label":"SIGN_SYMPTOM","start":838,"end":856},{"text":"small intestinal juice","label":"DETAILED_DESCRIPTION","start":877,"end":899},{"text":"abdominal wall","label":"BIOLOGICAL_STRUCTURE","start":905,"end":919},{"text":"soft","label":"SIGN_SYMPTOM","start":924,"end":928},{"text":"tenderness","label":"SIGN_SYMPTOM","start":938,"end":948},{"text":"Bowel sounds","label":"DIAGNOSTIC_PROCEDURE","start":950,"end":962},{"text":"regular","label":"LAB_VALUE","start":968,"end":975},{"text":"Escherichia coli","label":"DISEASE_DISORDER","start":977,"end":993},{"text":"Enterococcus faecalis","label":"DISEASE_DISORDER","start":998,"end":1019},{"text":"fistula secretion","label":"DETAILED_DESCRIPTION","start":1041,"end":1058},{"text":"culture","label":"DIAGNOSTIC_PROCEDURE","start":1059,"end":1066},{"text":"laboratory examinations","label":"DIAGNOSTIC_PROCEDURE","start":1088,"end":1111},{"text":"normal","label":"LAB_VALUE","start":1117,"end":1123},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1127,"end":1129},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1142,"end":1149},{"text":"intestinal wall","label":"BIOLOGICAL_STRUCTURE","start":1176,"end":1191},{"text":"adhered","label":"SIGN_SYMPTOM","start":1196,"end":1203},{"text":"abdominal wall","label":"BIOLOGICAL_STRUCTURE","start":1211,"end":1225},{"text":"navel region","label":"BIOLOGICAL_STRUCTURE","start":1233,"end":1245},{"text":"bowel","label":"BIOLOGICAL_STRUCTURE","start":1259,"end":1264},{"text":"obstruction","label":"SIGN_SYMPTOM","start":1265,"end":1276},{"text":"ECF","label":"DISEASE_DISORDER","start":1326,"end":1329},{"text":"digital","label":"DETAILED_DESCRIPTION","start":1378,"end":1385},{"text":"radiography","label":"DIAGNOSTIC_PROCEDURE","start":1386,"end":1397},{"text":"iopamidol-370 as a contrast agent","label":"DETAILED_DESCRIPTION","start":1437,"end":1470},{"text":"local","label":"DETAILED_DESCRIPTION","start":1507,"end":1512},{"text":"anaesthesia","label":"MEDICATION","start":1513,"end":1524},{"text":"distal ileum","label":"BIOLOGICAL_STRUCTURE","start":1547,"end":1559},{"text":"40 cm","label":"DISTANCE","start":1574,"end":1579},{"text":"ileocaecal junction","label":"BIOLOGICAL_STRUCTURE","start":1589,"end":1608},{"text":"entrapped","label":"SIGN_SYMPTOM","start":1613,"end":1622},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":1654,"end":1661},{"text":"preoperative conversation","label":"CLINICAL_EVENT","start":1676,"end":1701},{"text":"bowel preparation","label":"THERAPEUTIC_PROCEDURE","start":1783,"end":1800},{"text":"laparotomy","label":"THERAPEUTIC_PROCEDURE","start":1838,"end":1848},{"text":"abdominal cavity","label":"BIOLOGICAL_STRUCTURE","start":1854,"end":1870},{"text":"exposed","label":"THERAPEUTIC_PROCEDURE","start":1886,"end":1893},{"text":"terminal ileum","label":"BIOLOGICAL_STRUCTURE","start":1913,"end":1927},{"text":"40 cm","label":"DISTANCE","start":1943,"end":1948},{"text":"proximal to the ileocaecal junction","label":"BIOLOGICAL_STRUCTURE","start":1949,"end":1984},{"text":"entrapped","label":"SIGN_SYMPTOM","start":1996,"end":2005},{"text":"internal hernia ring","label":"BIOLOGICAL_STRUCTURE","start":2013,"end":2033},{"text":"defect","label":"SIGN_SYMPTOM","start":2105,"end":2111},{"text":"abdominal wall","label":"BIOLOGICAL_STRUCTURE","start":2119,"end":2133},{"text":"less than 1.0 cm","label":"DISTANCE","start":2138,"end":2154},{"text":"bowel wall","label":"BIOLOGICAL_STRUCTURE","start":2194,"end":2204},{"text":"stuck","label":"SIGN_SYMPTOM","start":2209,"end":2214},{"text":"defect","label":"COREFERENCE","start":2290,"end":2296},{"text":"perforation","label":"DISEASE_DISORDER","start":2309,"end":2320},{"text":"Side-to-side","label":"DETAILED_DESCRIPTION","start":2344,"end":2356},{"text":"ileo-ileal","label":"DETAILED_DESCRIPTION","start":2357,"end":2367},{"text":"anastomosis","label":"THERAPEUTIC_PROCEDURE","start":2368,"end":2379},{"text":"75 mm","label":"DISTANCE","start":2409,"end":2414},{"text":"linear stapler","label":"THERAPEUTIC_PROCEDURE","start":2415,"end":2429},{"text":"remove","label":"THERAPEUTIC_PROCEDURE","start":2433,"end":2439},{"text":"ileum segment","label":"BIOLOGICAL_STRUCTURE","start":2453,"end":2466},{"text":"internal hernia ring","label":"BIOLOGICAL_STRUCTURE","start":2472,"end":2492},{"text":"closed","label":"THERAPEUTIC_PROCEDURE","start":2497,"end":2503},{"text":"plication","label":"DETAILED_DESCRIPTION","start":2509,"end":2518},{"text":"sutures","label":"THERAPEUTIC_PROCEDURE","start":2519,"end":2526},{"text":"cleaned","label":"THERAPEUTIC_PROCEDURE","start":2644,"end":2651},{"text":"saline solution","label":"MEDICATION","start":2657,"end":2672},{"text":"rubber","label":"DETAILED_DESCRIPTION","start":2680,"end":2686},{"text":"drainage tube","label":"THERAPEUTIC_PROCEDURE","start":2687,"end":2700},{"text":"pelvis","label":"BIOLOGICAL_STRUCTURE","start":2719,"end":2725},{"text":"scar tissue","label":"BIOLOGICAL_STRUCTURE","start":2731,"end":2742},{"text":"removed","label":"THERAPEUTIC_PROCEDURE","start":2747,"end":2754},{"text":"relaxation","label":"DETAILED_DESCRIPTION","start":2795,"end":2805},{"text":"sutures","label":"THERAPEUTIC_PROCEDURE","start":2806,"end":2813},{"text":"Richter\u2019s hernia","label":"DISEASE_DISORDER","start":2882,"end":2898},{"text":"spontaneous","label":"DETAILED_DESCRIPTION","start":2913,"end":2924},{"text":"ECF","label":"DISEASE_DISORDER","start":2925,"end":2928},{"text":"discharged","label":"CLINICAL_EVENT","start":2958,"end":2968},{"text":"2 weeks after","label":"DATE","start":2969,"end":2982},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":2983,"end":2990},{"text":"complications","label":"DISEASE_DISORDER","start":3007,"end":3020},{"text":"hernia","label":"DISEASE_DISORDER","start":3025,"end":3031},{"text":"10 months","label":"DURATION","start":3063,"end":3072},{"text":"follow-up","label":"CLINICAL_EVENT","start":3076,"end":3085}],"tokens":["A ","62-year-old"," ","female"," ","presented"," to the ","outpatient department"," of ","Wuhan Central Hospital of Tongji Medical College"," in ","September 2015","with a complaint of ","recurrent"," ","infections"," in the ","umbilical region",".\nShe reported ","abdominal"," ","pain"," similar to a ","burning sensation"," that accompanied the ","discharge of faecal matter",".\nThese ","symptoms and signs"," ","waxed and waned"," but ","lasted for 5years",".\nOur attention was piqued by the fact that the patient\u2019s family described the patient as an individual who ","cried easily",".\nThe patient had ","no history of diarrhoea, constipation or other abdominal disturbances",".\n","No surgical treatment"," was mentioned in her prior medical history.\nAcoordinated ","physical examination"," revealed ","normal"," ","vital signs",".\nAn ","external"," ","fistula"," was located in the ","umbilical region"," with ","redness"," of the surrounding ","skin",".\n","Morphological examination"," indicated that ","fistula secretions"," mainly consisted of ","small intestinal juice",".\nThe ","abdominal wall"," was ","soft",", with no ","tenderness",".\n","Bowel sounds"," were ","regular",".\n","Escherichia coli"," and ","Enterococcus faecalis"," were detected in the ","fistula secretion"," ","culture",".\nOther findings from ","laboratory examinations"," were ","normal",".\nA ","CT"," scan of the ","abdomen"," revealed that part of the ","intestinal wall"," was ","adhered"," to the ","abdominal wall"," in the ","navel region",", although no ","bowel"," ","obstruction"," was detected (Fig.1).\nA presumptive diagnosis of ","ECF"," was reached; this diagnosis was mainly based on ","digital"," ","radiography"," of the fistulous tract conducted using ","iopamidol-370 as a contrast agent",".\nThis procedure was performed under ","local"," ","anaesthesia"," and revealed that the ","distal ileum"," approximately ","40 cm"," from the ","ileocaecal junction"," was ","entrapped"," (Fig.2).\nThe patient agreed to ","surgery"," after a clear ","preoperative conversation",".\nShe understood the operative risk factors and signed an informed consent.\nAfter ","bowel preparation",", the patient received an exploratory ","laparotomy",".\nThe ","abdominal cavity"," was completely ","exposed",", and a loop of the ","terminal ileum"," (approximately ","40 cm"," ","proximal to the ileocaecal junction",") was found ","entrapped"," in the ","internal hernia ring","; this finding was consistent with the preoperative contrast image.\nThe ","defect"," in the ","abdominal wall"," was ","less than 1.0 cm",", and an extremely small portion of the ","bowel wall"," was ","stuck"," and could not be retrieved back into the cavity (Fig.3).\nNonetheless, this ","defect"," resulted in ","perforation"," over the loop (Fig.4).\n","Side-to-side"," ","ileo-ileal"," ","anastomosis"," was completed by utilizing a ","75 mm"," ","linear stapler"," to ","remove"," the affected ","ileum segment",".\nThe ","internal hernia ring"," was ","closed"," with ","plication"," ","sutures"," instead of via mesh repair due to the patient\u2019s small defect and infection risk.\nThe abdominal cavity was thoroughly ","cleaned"," with ","saline solution",", and a ","rubber"," ","drainage tube"," was placed in the ","pelvis",".\nThe ","scar tissue"," was ","removed"," to improve wound healing; subsequently, ","relaxation"," ","sutures"," were available to close the abdomen in layers.\nA final diagnosis of ","Richter\u2019s hernia"," presenting as ","spontaneous"," ","ECF"," was reached.\nThe patient was ","discharged"," ","2 weeks after"," ","surgery"," without serious ","complications",".\nNo ","hernia"," recurrence was observed during ","10 months"," of 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-{"full_text":"A 3-month-old infant from the UAE with a genetically-confirmed diagnosis of Jarcho-Levin syndrome and dependent on mechanical ventilation since birth was admitted to our centre for the implantation of VEPTRs.\nWe received an intubated patient, mechanically ventilated in a volume-controlled mode, with a 0.30\u20130.45 fraction of inspired oxygen (FiO2) (peak inspiratory pressures (PIP) of 23\u201345\u2005cm\u2005H2O, positive end-expiratory pressure (PEEP) of 7\u2005cm\u2005H2O, backup respiratory rate (RR) of 34).\nA chest X-ray of the thorax was performed on admission (figure 1A), and a month after the first surgery (figure 1B), showing improvement of the bilateral posterior atelectasis in the base of the lungs.\nOwing to the difficulty of progressing in the weaning process from mechanical ventilation after the VEPTRs were implanted to expand the thorax, a bronchoscopy was performed, showing bronchomalacia predominantly in both upper lobar bronchi.\nAs prolonged mechanical ventilation was expected, a tracheostomy was previously performed.\nAfter an initial CT scan (figure 2A), a follow-up CT scan (figure 2B) a month after the surgery showed a resolution of the posterior-basal atelectasis, coinciding with a decrease of FiO2 to 0.21.\nPostoperatively, the patient was on the Servo-i ventilator in a volume-controlled mode and needed variable PIPs between 25 and 45\u2005cm\u2005H2O and PEEP values of 7\u201311\u2005cm\u2005H2O.\nDuring the attempts to wean the patient off the ventilator in the following months, he was unable to activate the inspiratory flow trigger and required significant sedoanalgesia to adapt to the ventilator due to repeated episodes of desaturation, on some occasions with bradycardia, associated to bronchial collapse.\nHe continued to have asynchrony which required boluses of sedation in addition to existing medications.\nHe initially received fentanyl and midazolam through a continuous infusion pump with progressive increase in the doses as well as continuous cisatracurium as a muscular relaxant to adapt to mechanical ventilation (figure 3).\nAs clinical stabilisation was achieved, the muscular relaxant was withdrawn and a progressive decrease of sedation was initiated along with a change in the drug regimen.\nDuring this period, the patient developed an ocular flutter which was attributed to a pharmacological cause after neurological alterations were ruled out with normal EEG, ophthalmoscopy, metabolic workup and cranial MRI.\nAt 5\u2005months of age, the NAVA mode started to improve the patient's adaptation to the ventilator through the use of a neural trigger.\nThe NAVA catheter additionally costs around \u20ac200 per catheter; according to the manufacturer it should be changed every 5\u2005days.\nIt was required for 7\u2005months; nevertheless the catheters were changed every 15\u2005days without observing a deterioration of the Edi signal.\nAccording to the literature, Jarcho-Levin syndrome does not appear with mental retardation and life expectancy is pretty long, so ethically, we considered that this patient should have an opportunity to overcome his thoracic insufficiency if it were technically possible.\nTachypnoea was initially observed with a RR of 55 without other signs of increase in his work of breathing and his RR eventually returned to normal for his age (40) over the next few days.\nThe synchrony achieved with the ventilator allowed a progressive decrease of the sedoanalgesia he received until it was completely withdrawn in 10\u2005days; and the need for extra boluses of sedation was reduced to zero.\nConcurrently to the reduction of sedation, his ocular flutter disappeared and he showed significant progress in his psychomotor development.\nThe settings used were: NAVA level of 1\u2005cm\u2005H2O\/\u00b5V, PEEP 11\u2005cm\u2005H2O, Edi trigger 0.5\u2005\u00b5V.\nThe patient had tidal volumes (Vt) of 6\u20137\u2005mL\/kg (figure 3).\nAfter 10\u2005days on the NAVA mode, he did not require any type of sedation and the sporadic episodes of bronchial collapse were resolved with a quick increase of PEEP to 20\u2005cm\u2005H2O or manual ventilation with the self-inflating bag.\nOnce he was stabilised on the NAVA mode, his PIPs oscillated between 15 and 45\u2005cm\u2005H2O with a NAVA level of 0.4 and Edi peaks between 15 and 100\u2005\u00b5V.\nA posterior pulmonary CT scan performed 2\u2005months after the first surgery, 1\u2005month after starting NAVA and prior to the first thoracic expansion, showed a significant reduction in the posterobasal atelectases previously observed (figure 2B).\nWhen he turned 1\u2005year old, after several attempts with different devices Trilogy 100 (Philips), Astral 150 (ResMed), the patient finally tolerated mechanical ventilation with a home ventilator (Monnal T-50, Air Liquide) in a volume assisted\/controlled mode with the following settings: Vt 80\u2005mL (9\u2005mL\/kg), PEEP 10\u2005cm\u2005H2O, flow trigger 0.5\u2005L\/min.\nHis PIPs were around 30\u2005cm\u2005H2O.\nHe did not tolerate a decrease of PEEP below 9\u2005cm\u2005H2O or short disconnections from the ventilator.\nCurrently, the patient is 19\u2005months old, is able to walk and his neurodevelopment seems to be normal.\n","ner_info":[{"text":"3-month-old","label":"AGE","start":2,"end":13},{"text":"from the UAE","label":"PERSONAL_BACKGROUND","start":21,"end":33},{"text":"genetically-confirmed diagnosis of Jarcho-Levin syndrome","label":"HISTORY","start":41,"end":97},{"text":"dependent on mechanical ventilation since birth","label":"HISTORY","start":102,"end":149},{"text":"admitted","label":"CLINICAL_EVENT","start":154,"end":162},{"text":"centre","label":"NONBIOLOGICAL_LOCATION","start":170,"end":176},{"text":"implantation of VEPTRs","label":"THERAPEUTIC_PROCEDURE","start":185,"end":207},{"text":"intubated","label":"THERAPEUTIC_PROCEDURE","start":224,"end":233},{"text":"mechanically","label":"DETAILED_DESCRIPTION","start":243,"end":255},{"text":"ventilated","label":"THERAPEUTIC_PROCEDURE","start":256,"end":266},{"text":"volume-controlled mode","label":"DETAILED_DESCRIPTION","start":272,"end":294},{"text":"0.30\u20130.45 fraction of inspired oxygen","label":"LAB_VALUE","start":303,"end":340},{"text":"peak inspiratory pressures (PIP) of 23\u201345\u2005cm\u2005H2O","label":"LAB_VALUE","start":349,"end":397},{"text":"positive end-expiratory pressure (PEEP) of 7\u2005cm\u2005H2O","label":"LAB_VALUE","start":399,"end":450},{"text":"backup respiratory rate (RR) of 34","label":"LAB_VALUE","start":452,"end":486},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":491,"end":496},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":497,"end":502},{"text":"thorax","label":"BIOLOGICAL_STRUCTURE","start":510,"end":516},{"text":"admission","label":"CLINICAL_EVENT","start":534,"end":543},{"text":"a month after","label":"DATE","start":561,"end":574},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":585,"end":592},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":633,"end":642},{"text":"posterior","label":"DETAILED_DESCRIPTION","start":643,"end":652},{"text":"atelectasis","label":"DISEASE_DISORDER","start":653,"end":664},{"text":"base of the lungs","label":"BIOLOGICAL_STRUCTURE","start":672,"end":689},{"text":"bronchoscopy","label":"THERAPEUTIC_PROCEDURE","start":837,"end":849},{"text":"bronchomalacia","label":"DISEASE_DISORDER","start":873,"end":887},{"text":"both upper lobar bronchi","label":"BIOLOGICAL_STRUCTURE","start":905,"end":929},{"text":"prolonged","label":"DETAILED_DESCRIPTION","start":934,"end":943},{"text":"mechanical","label":"DETAILED_DESCRIPTION","start":944,"end":954},{"text":"ventilation","label":"THERAPEUTIC_PROCEDURE","start":955,"end":966},{"text":"tracheostomy","label":"THERAPEUTIC_PROCEDURE","start":983,"end":995},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1039,"end":1041},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1072,"end":1074},{"text":"a month after","label":"DATE","start":1092,"end":1105},{"text":"posterior-basal","label":"DETAILED_DESCRIPTION","start":1145,"end":1160},{"text":"atelectasis","label":"DISEASE_DISORDER","start":1161,"end":1172},{"text":"decrease","label":"LAB_VALUE","start":1192,"end":1200},{"text":"FiO2","label":"DIAGNOSTIC_PROCEDURE","start":1204,"end":1208},{"text":"0.21","label":"LAB_VALUE","start":1212,"end":1216},{"text":"Servo-i","label":"DETAILED_DESCRIPTION","start":1258,"end":1265},{"text":"ventilator","label":"THERAPEUTIC_PROCEDURE","start":1266,"end":1276},{"text":"volume-controlled mode","label":"DETAILED_DESCRIPTION","start":1282,"end":1304},{"text":"variable","label":"DETAILED_DESCRIPTION","start":1316,"end":1324},{"text":"PIPs","label":"DIAGNOSTIC_PROCEDURE","start":1325,"end":1329},{"text":"between 25 and 45\u2005cm\u2005H2O","label":"LAB_VALUE","start":1330,"end":1354},{"text":"PEEP","label":"DIAGNOSTIC_PROCEDURE","start":1359,"end":1363},{"text":"7\u201311\u2005cm\u2005H2O","label":"LAB_VALUE","start":1374,"end":1385},{"text":"sedoanalgesia","label":"MEDICATION","start":1551,"end":1564},{"text":"desaturation","label":"SIGN_SYMPTOM","start":1620,"end":1632},{"text":"bradycardia","label":"SIGN_SYMPTOM","start":1657,"end":1668},{"text":"bronchial collapse","label":"DISEASE_DISORDER","start":1684,"end":1702},{"text":"asynchrony","label":"SIGN_SYMPTOM","start":1725,"end":1735},{"text":"sedation","label":"MEDICATION","start":1762,"end":1770},{"text":"fentanyl","label":"MEDICATION","start":1830,"end":1838},{"text":"midazolam","label":"MEDICATION","start":1843,"end":1852},{"text":"continuous infusion pump","label":"ADMINISTRATION","start":1863,"end":1887},{"text":"progressive increase in the doses","label":"DOSAGE","start":1893,"end":1926},{"text":"continuous","label":"DOSAGE","start":1938,"end":1948},{"text":"cisatracurium","label":"MEDICATION","start":1949,"end":1962},{"text":"muscular relaxant","label":"MEDICATION","start":1968,"end":1985},{"text":"clinical stabilisation","label":"SIGN_SYMPTOM","start":2036,"end":2058},{"text":"muscular relaxant","label":"MEDICATION","start":2077,"end":2094},{"text":"progressive decrease","label":"DOSAGE","start":2115,"end":2135},{"text":"sedation","label":"MEDICATION","start":2139,"end":2147},{"text":"ocular flutter","label":"SIGN_SYMPTOM","start":2248,"end":2262},{"text":"normal","label":"LAB_VALUE","start":2362,"end":2368},{"text":"EEG","label":"DIAGNOSTIC_PROCEDURE","start":2369,"end":2372},{"text":"ophthalmoscopy","label":"DIAGNOSTIC_PROCEDURE","start":2374,"end":2388},{"text":"metabolic 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were changed","label":"THERAPEUTIC_PROCEDURE","start":2732,"end":2754},{"text":"every 15\u2005days","label":"FREQUENCY","start":2755,"end":2768},{"text":"deterioration of the Edi signal","label":"SIGN_SYMPTOM","start":2789,"end":2820},{"text":"According to the literature, Jarcho-Levin syndrome does not appear with mental retardation and life expectancy is pretty long, so ethically, we considered that this patient should have an opportunity to overcome his thoracic insufficiency if it were technically possible","label":"OTHER_ENTITY","start":2822,"end":3092},{"text":"Tachypnoea","label":"SIGN_SYMPTOM","start":3094,"end":3104},{"text":"RR","label":"DIAGNOSTIC_PROCEDURE","start":3135,"end":3137},{"text":"55","label":"LAB_VALUE","start":3141,"end":3143},{"text":"work of 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11\u2005cm\u2005H2O","label":"LAB_VALUE","start":3692,"end":3706},{"text":"Edi trigger 0.5\u2005\u00b5V","label":"LAB_VALUE","start":3708,"end":3726},{"text":"tidal volumes","label":"DIAGNOSTIC_PROCEDURE","start":3744,"end":3757},{"text":"Vt","label":"DIAGNOSTIC_PROCEDURE","start":3759,"end":3761},{"text":"6\u20137\u2005mL\/kg","label":"LAB_VALUE","start":3766,"end":3775},{"text":"After 10\u2005days","label":"DATE","start":3788,"end":3801},{"text":"NAVA mode","label":"THERAPEUTIC_PROCEDURE","start":3809,"end":3818},{"text":"sedation","label":"MEDICATION","start":3851,"end":3859},{"text":"bronchial collapse","label":"DISEASE_DISORDER","start":3889,"end":3907},{"text":"PEEP","label":"DIAGNOSTIC_PROCEDURE","start":3947,"end":3951},{"text":"20\u2005cm\u2005H2O","label":"LAB_VALUE","start":3955,"end":3964},{"text":"manual","label":"DETAILED_DESCRIPTION","start":3968,"end":3974},{"text":"ventilation","label":"THERAPEUTIC_PROCEDURE","start":3975,"end":3986},{"text":"self-inflating 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0.5\u2005L\/min","label":"LAB_VALUE","start":4727,"end":4749},{"text":"PIPs","label":"DIAGNOSTIC_PROCEDURE","start":4755,"end":4759},{"text":"around 30\u2005cm\u2005H2O","label":"LAB_VALUE","start":4765,"end":4781},{"text":"tolerate","label":"SIGN_SYMPTOM","start":4794,"end":4802},{"text":"decrease","label":"LAB_VALUE","start":4805,"end":4813},{"text":"PEEP","label":"DIAGNOSTIC_PROCEDURE","start":4817,"end":4821},{"text":"below 9\u2005cm\u2005H2O","label":"LAB_VALUE","start":4822,"end":4836},{"text":"short disconnections","label":"DETAILED_DESCRIPTION","start":4840,"end":4860},{"text":"ventilator","label":"THERAPEUTIC_PROCEDURE","start":4870,"end":4880},{"text":"19\u2005months old","label":"DATE","start":4908,"end":4921},{"text":"able to walk","label":"SIGN_SYMPTOM","start":4926,"end":4938},{"text":"neurodevelopment","label":"DIAGNOSTIC_PROCEDURE","start":4947,"end":4963},{"text":"normal","label":"LAB_VALUE","start":4976,"end":4982}],"tokens":["A ","3-month-old"," infant ","from the UAE"," with a ","genetically-confirmed diagnosis of Jarcho-Levin syndrome"," and ","dependent on mechanical ventilation since birth"," was ","admitted"," to our ","centre"," for the ","implantation of VEPTRs",".\nWe received an ","intubated"," patient, ","mechanically"," ","ventilated"," in a ","volume-controlled mode",", with a ","0.30\u20130.45 fraction of inspired oxygen"," (FiO2) (","peak inspiratory pressures (PIP) of 23\u201345\u2005cm\u2005H2O",", ","positive end-expiratory pressure (PEEP) of 7\u2005cm\u2005H2O",", ","backup respiratory rate (RR) of 34",").\nA ","chest"," ","X-ray"," of the ","thorax"," was performed on ","admission"," (figure 1A), and ","a month after"," the first ","surgery"," (figure 1B), showing improvement of the ","bilateral"," ","posterior"," ","atelectasis"," in the ","base of the lungs",".\nOwing to the difficulty of progressing in the weaning process from mechanical ventilation after the VEPTRs were implanted to expand the thorax, a ","bronchoscopy"," was performed, showing ","bronchomalacia"," predominantly in ","both upper lobar bronchi",".\nAs ","prolonged"," ","mechanical"," ","ventilation"," was expected, a ","tracheostomy"," was previously performed.\nAfter an initial ","CT"," scan (figure 2A), a follow-up ","CT"," scan (figure 2B) ","a month after"," the surgery showed a resolution of the ","posterior-basal"," ","atelectasis",", coinciding with a ","decrease"," of ","FiO2"," to ","0.21",".\nPostoperatively, the patient was on the ","Servo-i"," ","ventilator"," in a ","volume-controlled mode"," and needed ","variable"," ","PIPs"," ","between 25 and 45\u2005cm\u2005H2O"," and ","PEEP"," values of ","7\u201311\u2005cm\u2005H2O",".\nDuring the attempts to wean the patient off the ventilator in the following months, he was unable to activate the inspiratory flow trigger and required significant ","sedoanalgesia"," to adapt to the ventilator due to repeated episodes of ","desaturation",", on some occasions with ","bradycardia",", associated to ","bronchial collapse",".\nHe continued to have ","asynchrony"," which required boluses of ","sedation"," in addition to existing medications.\nHe initially received ","fentanyl"," and ","midazolam"," through a ","continuous infusion pump"," with ","progressive increase in the doses"," as well as ","continuous"," ","cisatracurium"," as a ","muscular relaxant"," to adapt to mechanical ventilation (figure 3).\nAs ","clinical stabilisation"," was achieved, the ","muscular relaxant"," was withdrawn and a ","progressive decrease"," of ","sedation"," was initiated along with a change in the drug regimen.\nDuring this period, the patient developed an ","ocular flutter"," which was attributed to a pharmacological cause after neurological alterations were ruled out with ","normal"," ","EEG",", ","ophthalmoscopy",", ","metabolic workup"," and ","cranial"," ","MRI",".\nAt ","5\u2005months of age",", the ","NAVA mode"," started to ","improve"," the patient's ","adaptation to the ventilator"," through the use of a ","neural trigger",".\nThe ","NAVA catheter"," additionally ","costs around \u20ac200 per catheter","; ","according to the manufacturer it should be changed every 5\u2005days",".\nIt was required ","for 7\u2005months","; nevertheless the ","catheters were changed"," ","every 15\u2005days"," without observing a ","deterioration of the Edi signal",".\n","According to the literature, Jarcho-Levin syndrome does not appear with mental retardation and life expectancy is pretty long, so ethically, we considered that this patient should have an opportunity to overcome his thoracic insufficiency if it were technically possible",".\n","Tachypnoea"," was initially observed with a ","RR"," of ","55"," without other signs of increase in his ","work of breathing"," and his ","RR"," eventually returned to ","normal"," for his age (","40",") over the next few days.\nThe ","synchrony"," achieved with the ","ventilator"," allowed a progressive decrease of the ","sedoanalgesia"," he received until ","it"," was completely withdrawn in ","10\u2005days","; and the need for extra boluses of ","sedation"," was reduced to zero.\nConcurrently to the reduction of sedation, his ","ocular flutter"," disappeared and he showed significant ","progress"," in his ","psychomotor development",".\nThe settings used were: ","NAVA level of 1\u2005cm\u2005H2O\/\u00b5V",", ","PEEP 11\u2005cm\u2005H2O",", ","Edi trigger 0.5\u2005\u00b5V",".\nThe patient had ","tidal volumes"," (","Vt",") of ","6\u20137\u2005mL\/kg"," (figure 3).\n","After 10\u2005days"," on the ","NAVA mode",", he did not require any type of ","sedation"," and the sporadic episodes of ","bronchial collapse"," were resolved with a quick increase of ","PEEP"," to ","20\u2005cm\u2005H2O"," or ","manual"," ","ventilation"," with the ","self-inflating bag",".\nOnce he was stabilised on the ","NAVA mode",", his ","PIP","s oscillated ","between 15 and 45\u2005cm\u2005H2O"," with a ","NAVA level of 0.4"," and ","Edi peaks"," ","between 15 and 100\u2005\u00b5V",".\nA ","posterior"," ","pulmonary"," ","CT"," scan performed ","2\u2005months after"," the first surgery, 1\u2005month after starting NAVA and prior to the first thoracic expansion, showed a significant reduction in the ","posterobasal"," ","atelectases"," previously observed (figure 2B).\nWhen he turned ","1\u2005year old",", after several attempts with ","different devices"," ","Trilogy 100 (Philips)",", ","Astral 150 (ResMed)",", the patient finally tolerated ","mechanical"," ","ventilation"," with a ","home ventilator"," (","Monnal T-50, Air Liquide",") in a ","volume assisted\/controlled mode with the following settings",": ","Vt 80\u2005mL (9\u2005mL\/kg)",", ","PEEP 10\u2005cm\u2005H2O",", ","flow trigger 0.5\u2005L\/min",".\nHis ","PIPs"," were ","around 30\u2005cm\u2005H2O",".\nHe did not ","tolerate"," a ","decrease"," of ","PEEP"," ","below 9\u2005cm\u2005H2O"," or ","short disconnections"," from the ","ventilator",".\nCurrently, the patient is ","19\u2005months old",", is ","able to walk"," and his ","neurodevelopment"," seems to be ","normal",".\n"],"ner_labels":[0,5,0,58,0,39,0,39,0,13,0,48,0,75,0,75,0,22,0,75,0,22,0,42,0,42,0,42,0,42,0,12,0,24,0,12,0,13,0,19,0,75,0,22,0,22,0,26,0,12,0,75,0,26,0,12,0,22,0,22,0,75,0,75,0,24,0,24,0,19,0,22,0,26,0,42,0,24,0,42,0,22,0,75,0,22,0,22,0,24,0,42,0,24,0,42,0,46,0,69,0,69,0,26,0,69,0,46,0,46,0,46,0,4,0,29,0,29,0,46,0,46,0,69,0,46,0,29,0,46,0,69,0,42,0,24,0,24,0,24,0,12,0,24,0,19,0,75,0,42,0,24,0,75,0,75,0,22,0,51,0,32,0,75,0,35,0,69,0,51,0,69,0,24,0,42,0,69,0,24,0,42,0,42,0,69,0,75,0,46,0,18,0,19,0,46,0,69,0,42,0,24,0,42,0,42,0,42,0,24,0,24,0,42,0,19,0,75,0,46,0,26,0,24,0,42,0,22,0,75,0,22,0,75,0,24,0,42,0,42,0,24,0,42,0,22,0,12,0,24,0,19,0,22,0,26,0,19,0,75,0,22,0,22,0,22,0,75,0,22,0,22,0,22,0,42,0,42,0,42,0,24,0,42,0,69,0,42,0,24,0,42,0,22,0,75,0,19,0,69,0,24,0,42,0]}
-{"full_text":"A 40-year-old woman visited the Department of Obstetrics and Gynecology in our hospital because of a complaint of sudden dyspnea on effort.\nShe was previously diagnosed with endometriosis and prescribed a combination oral contraceptive pill (drospirenone\/ethinylestradiol betadex, trade name; Yaz\u2122, Bayer, Leverkusen, Germany).\nFollowing the Kumamoto Earthquakes and subsequent aftershocks in April 2016, she spent 7 nights in a vehicle.\nShe noticed sudden dyspnea on effort when she walked outside the car on the 8th morning after the first earthquake.\nAlthough she walked around for personal reasons during the daytime, she spent nights in her small car with her legs in a hanging position.\nShe noticed swelling and pain in her left lower extremity, and her serum D-dimer levels were 13.2 \u03bcg\/mL.\nDeep vein thrombosis (DVT) was suspected by her home doctor.\nA contrast-enhanced computed tomography (CT)-scan revealed a contrast deficit in the bilateral pulmonary artery (Fig.2A) and in the left lower extremity (posterior tibial, soleus and gastrocnemius vein) (Fig.2B).\nHer right ventricular function was intact (estimated pulmonary artery pressure=29\/8 mmHg in cardiac ultrasound).\nHer plasma brain natriuretic peptide and high-sense troponin T concentration levels were 97.2 pg\/mL and 0.0061 ng\/mL, respectively.\nShe was diagnosed with PTE and admitted to our department.\nOn admission, her blood pressure was 129\/80 mmHg and her heart rate was 72 beats per minute.\nHer degree of oxygen saturation (SaO2) in arterial blood gas was 97.7%.\nHer body mass index was 24.4 kg\/m2.\nElectrocardiography and cardiac ultrasound did not indicate heart failure.\nAn investigation of most factors related to thrombus formation (including protein C, protein S, antithrombin, and antiphospholipid antibodies) revealed that all such factors were normal.\nThe discontinuation of the oral contraceptive and the administration of rivaroxaban (30 mg, daily), a direct oral anticoagulant (trade name: Xarelto\u2122, Bayer) was initiated according to the results of the EINSTEIN-PE trial (3).\nAfter 7 days, a follow-up contrast-enhanced CT scan revealed a reduction in the thrombosis (Fig.3).\nThe patient was followed up with rivaroxaban.\nThe patient gave her consent for the publication of this study.\n","ner_info":[{"text":"40-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"visited","label":"CLINICAL_EVENT","start":20,"end":27},{"text":"Department of Obstetrics and Gynecology","label":"NONBIOLOGICAL_LOCATION","start":32,"end":71},{"text":"our hospital","label":"NONBIOLOGICAL_LOCATION","start":75,"end":87},{"text":"sudden","label":"DETAILED_DESCRIPTION","start":114,"end":120},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":121,"end":128},{"text":"on effort","label":"DETAILED_DESCRIPTION","start":129,"end":138},{"text":"endometriosis","label":"HISTORY","start":174,"end":187},{"text":"combination","label":"DETAILED_DESCRIPTION","start":205,"end":216},{"text":"oral","label":"ADMINISTRATION","start":217,"end":221},{"text":"contraceptive","label":"MEDICATION","start":222,"end":235},{"text":"pill","label":"ADMINISTRATION","start":236,"end":240},{"text":"drospirenone","label":"MEDICATION","start":242,"end":254},{"text":"ethinylestradiol betadex","label":"MEDICATION","start":255,"end":279},{"text":"trade name; Yaz\u2122","label":"DETAILED_DESCRIPTION","start":281,"end":297},{"text":"Bayer, Leverkusen, Germany","label":"DETAILED_DESCRIPTION","start":299,"end":325},{"text":"Kumamoto Earthquakes","label":"OTHER_EVENT","start":342,"end":362},{"text":"aftershocks","label":"OTHER_EVENT","start":378,"end":389},{"text":"April 2016","label":"DATE","start":393,"end":403},{"text":"spent","label":"ACTIVITY","start":409,"end":414},{"text":"7 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position","label":"DETAILED_DESCRIPTION","start":675,"end":691},{"text":"swelling","label":"SIGN_SYMPTOM","start":705,"end":713},{"text":"pain","label":"SIGN_SYMPTOM","start":718,"end":722},{"text":"left lower extremity","label":"BIOLOGICAL_STRUCTURE","start":730,"end":750},{"text":"serum D-dimer","label":"DIAGNOSTIC_PROCEDURE","start":760,"end":773},{"text":"13.2 \u03bcg\/mL","label":"LAB_VALUE","start":786,"end":796},{"text":"Deep vein thrombosis","label":"DISEASE_DISORDER","start":798,"end":818},{"text":"DVT","label":"DISEASE_DISORDER","start":820,"end":823},{"text":"home doctor","label":"NONBIOLOGICAL_LOCATION","start":846,"end":857},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":861,"end":878},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":879,"end":898},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":900,"end":902},{"text":"contrast deficit","label":"SIGN_SYMPTOM","start":920,"end":936},{"text":"bilateral pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":944,"end":970},{"text":"left lower extremity","label":"BIOLOGICAL_STRUCTURE","start":991,"end":1011},{"text":"posterior tibial, soleus and gastrocnemius vein","label":"DETAILED_DESCRIPTION","start":1013,"end":1060},{"text":"right ventricular function","label":"DIAGNOSTIC_PROCEDURE","start":1076,"end":1102},{"text":"intact","label":"LAB_VALUE","start":1107,"end":1113},{"text":"pulmonary artery pressure","label":"DIAGNOSTIC_PROCEDURE","start":1125,"end":1150},{"text":"29\/8 mmHg","label":"LAB_VALUE","start":1151,"end":1160},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":1164,"end":1171},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1172,"end":1182},{"text":"plasma","label":"DETAILED_DESCRIPTION","start":1189,"end":1195},{"text":"brain natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":1196,"end":1221},{"text":"high-sense","label":"DETAILED_DESCRIPTION","start":1226,"end":1236},{"text":"troponin T concentration","label":"DIAGNOSTIC_PROCEDURE","start":1237,"end":1261},{"text":"97.2 pg\/mL","label":"LAB_VALUE","start":1274,"end":1284},{"text":"0.0061 ng\/mL","label":"LAB_VALUE","start":1289,"end":1301},{"text":"PTE","label":"DISEASE_DISORDER","start":1340,"end":1343},{"text":"admitted","label":"CLINICAL_EVENT","start":1348,"end":1356},{"text":"department","label":"NONBIOLOGICAL_LOCATION","start":1364,"end":1374},{"text":"admission","label":"CLINICAL_EVENT","start":1379,"end":1388},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1394,"end":1408},{"text":"129\/80 mmHg","label":"LAB_VALUE","start":1413,"end":1424},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":1433,"end":1443},{"text":"72 beats per minute","label":"LAB_VALUE","start":1448,"end":1467},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":1483,"end":1500},{"text":"SaO2","label":"DIAGNOSTIC_PROCEDURE","start":1502,"end":1506},{"text":"arterial blood gas","label":"DETAILED_DESCRIPTION","start":1511,"end":1529},{"text":"97.7%","label":"LAB_VALUE","start":1534,"end":1539},{"text":"body mass index","label":"DIAGNOSTIC_PROCEDURE","start":1545,"end":1560},{"text":"24.4 kg\/m2","label":"LAB_VALUE","start":1565,"end":1575},{"text":"Electrocardiography","label":"DIAGNOSTIC_PROCEDURE","start":1577,"end":1596},{"text":"cardiac","label":"BIOLOGICAL_STRUCTURE","start":1601,"end":1608},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1609,"end":1619},{"text":"heart failure","label":"DISEASE_DISORDER","start":1637,"end":1650},{"text":"factors related to thrombus formation","label":"DIAGNOSTIC_PROCEDURE","start":1677,"end":1714},{"text":"protein C","label":"DIAGNOSTIC_PROCEDURE","start":1726,"end":1735},{"text":"protein S","label":"DIAGNOSTIC_PROCEDURE","start":1737,"end":1746},{"text":"antithrombin","label":"DIAGNOSTIC_PROCEDURE","start":1748,"end":1760},{"text":"antiphospholipid antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1766,"end":1793},{"text":"normal","label":"LAB_VALUE","start":1831,"end":1837},{"text":"oral","label":"ADMINISTRATION","start":1866,"end":1870},{"text":"contraceptive","label":"MEDICATION","start":1871,"end":1884},{"text":"rivaroxaban","label":"MEDICATION","start":1911,"end":1922},{"text":"30 mg, daily","label":"DOSAGE","start":1924,"end":1936},{"text":"direct","label":"DETAILED_DESCRIPTION","start":1941,"end":1947},{"text":"oral","label":"ADMINISTRATION","start":1948,"end":1952},{"text":"anticoagulant","label":"MEDICATION","start":1953,"end":1966},{"text":"trade name: Xarelto\u2122","label":"DETAILED_DESCRIPTION","start":1968,"end":1988},{"text":"Bayer","label":"DETAILED_DESCRIPTION","start":1990,"end":1995},{"text":"according to the results of the EINSTEIN-PE trial","label":"DETAILED_DESCRIPTION","start":2011,"end":2060},{"text":"After 7 days","label":"DATE","start":2066,"end":2078},{"text":"follow-up","label":"CLINICAL_EVENT","start":2082,"end":2091},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":2092,"end":2109},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2110,"end":2112},{"text":"thrombosis","label":"DISEASE_DISORDER","start":2146,"end":2156},{"text":"followed up","label":"CLINICAL_EVENT","start":2182,"end":2193},{"text":"rivaroxaban","label":"MEDICATION","start":2199,"end":2210}],"tokens":["A ","40-year-old"," ","woman"," ","visited"," the ","Department of Obstetrics and Gynecology"," in ","our hospital"," because of a complaint of ","sudden"," ","dyspnea"," ","on effort",".\nShe was previously diagnosed with ","endometriosis"," and prescribed a ","combination"," ","oral"," ","contraceptive"," ","pill"," (","drospirenone","\/","ethinylestradiol betadex",", ","trade name; Yaz\u2122",", ","Bayer, Leverkusen, Germany",").\nFollowing the ","Kumamoto Earthquakes"," and subsequent ","aftershocks"," in ","April 2016",", she ","spent"," ","7 nights"," in a ","vehicle",".\nShe noticed ","sudden"," ","dyspnea"," ","on effort"," when she ","walked"," ","outside"," the car on the ","8th morning after"," the ","first earthquake",".\nAlthough she ","walked around"," for personal reasons during the daytime, she ","spent nights"," in her ","small car"," with her ","legs"," in a ","hanging position",".\nShe noticed ","swelling"," and ","pain"," in her ","left lower extremity",", and her ","serum D-dimer"," levels were ","13.2 \u03bcg\/mL",".\n","Deep vein thrombosis"," (","DVT",") was suspected by her ","home doctor",".\nA ","contrast-enhanced"," ","computed tomography"," (","CT",")-scan revealed a ","contrast deficit"," in the ","bilateral pulmonary artery"," (Fig.2A) and in the ","left lower extremity"," (","posterior tibial, soleus and gastrocnemius vein",") (Fig.2B).\nHer ","right ventricular function"," was ","intact"," (estimated ","pulmonary artery pressure","=","29\/8 mmHg"," in ","cardiac"," ","ultrasound",").\nHer ","plasma"," ","brain natriuretic peptide"," and ","high-sense"," ","troponin T concentration"," levels were ","97.2 pg\/mL"," and ","0.0061 ng\/mL",", respectively.\nShe was diagnosed with ","PTE"," and ","admitted"," to our ","department",".\nOn ","admission",", her ","blood pressure"," was ","129\/80 mmHg"," and her ","heart rate"," was ","72 beats per minute",".\nHer degree of ","oxygen saturation"," (","SaO2",") in ","arterial blood gas"," was ","97.7%",".\nHer ","body mass index"," was ","24.4 kg\/m2",".\n","Electrocardiography"," and ","cardiac"," ","ultrasound"," did not indicate ","heart failure",".\nAn investigation of most ","factors related to thrombus formation"," (including ","protein C",", ","protein S",", ","antithrombin",", and ","antiphospholipid antibodies",") revealed that all such factors were ","normal",".\nThe discontinuation of the ","oral"," ","contraceptive"," and the administration of ","rivaroxaban"," (","30 mg, daily","), a ","direct"," ","oral"," ","anticoagulant"," (","trade name: Xarelto\u2122",", ","Bayer",") was initiated ","according to the results of the EINSTEIN-PE trial"," (3).\n","After 7 days",", a ","follow-up"," ","contrast-enhanced"," ","CT"," scan revealed a reduction in the ","thrombosis"," (Fig.3).\nThe patient was ","followed up"," with ","rivaroxaban",".\nThe patient gave her consent for the publication of this study.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,48,0,22,0,69,0,22,0,39,0,22,0,4,0,46,0,4,0,46,0,46,0,22,0,22,0,53,0,53,0,19,0,1,0,32,0,48,0,22,0,69,0,22,0,13,0,48,0,19,0,53,0,1,0,1,0,48,0,12,0,22,0,69,0,69,0,12,0,24,0,42,0,26,0,26,0,48,0,22,0,24,0,24,0,69,0,12,0,12,0,22,0,24,0,42,0,24,0,42,0,12,0,24,0,22,0,24,0,22,0,24,0,42,0,42,0,26,0,13,0,48,0,13,0,24,0,42,0,24,0,42,0,24,0,24,0,22,0,42,0,24,0,42,0,24,0,12,0,24,0,26,0,24,0,24,0,24,0,24,0,24,0,42,0,4,0,46,0,46,0,29,0,22,0,4,0,46,0,22,0,22,0,22,0,19,0,13,0,22,0,24,0,26,0,13,0,46,0]}
-{"full_text":"The patient was a 48-year-old man who had previously been hospitalized due to hemoptysis at 42 years of age.\nAt that time, a chest radiograph and chest computed tomography (CT) revealed diffuse ground-glass opacity (GGO) in the bilateral lung fields (Fig.1,2), and a bronchoscopic examination revealed the accumulation of large amounts of blood in the trachea and bronchi (Fig.3).\nThe patient's bronchoalveolar lavage fluid (BALF) was bloody and contained numerous hemosiderin-laden macrophages.\nA culture test of the BALF revealed no findings.\nAn electrocardiogram and transthoracic echocardiogram revealed no abnormalities.\nA questionnaire that was completed at that time did not reveal the patient's hemorrhagic episode or a family history of bleeding disease, with the exception of his younger brother who had been diagnosed with hepatitis C.\nFurthermore, he had not received any drugs that had the potential to cause DAH.\nFollowing the above-mentioned examinations, DAH due to some sort of vasculitis was suspected.\nThus, treatment with high-dose intravenous methylprednisolone (1,000 mg daily) for 3 days followed by prednisolone (25 mg daily) was initiated.\nThis relieved his symptoms.\nChest CT showed the resolution of the GGO.\nThe patient's prednisolone dose was tapered and eventually discontinued at two-and-a-half years after his discharge from our hospital.\nThe patient was readmitted to our hospital with a recurrence of hemoptysis at 46 years of age.\nThe above-described therapy was initiated and led to the improvement of his condition.\nThe prednisolone dose was tapered from 60 mg daily to a maintenance dose of 5 mg daily.\nAt 48 years of age, he was readmitted to our hospital with a further recurrence of hemoptysis.\nAt this point, he had steroid-induced diabetes mellitus, which was treated with glimepiride (3 mg daily).\nAt admission, his weight was 75 kg and height 167 cm; his vital signs were as follows: blood pressure, 178\/102 mmHg; pulse rate, 109 beats\/min, pulse oximetry, 97% in room air; and body temperature, 36.8\u00b0C.\nChest auscultation revealed fine crackles in the right lung field.\nNo skin rash, subcutaneous bleeding or joint swelling were present.\nA chest radiograph and CT showed the presence of diffuse GGO in the bilateral lung fields.\nMild anemia was observed (hemoglobin, 11.3 g\/dL), although hemoglobin levels had been 14.6 g\/dL prior to the hemoptysis episode.\nThe activated partial thromboplastin time (APTT) was prolonged to 53.5 seconds (normal range, 25.1-40.7 seconds).\nLaboratory tests showed that the patient's blood glucose and hemoglobin A1c levels were 299 mg\/dL and 8.2%, respectively, due to the steroid-induced diabetes mellitus.\nAutoantibodies for various collagen diseases were negative (Table).\nWe diagnosed the condition as a recurrence of DAH and again administered high-dose intravenous methylprednisolone for 3 days, followed by prednisolone (60 mg daily).\nHis condition improved, as had been observed during the previous episodes.\nA further detailed inquiry regarding the patient's medical history revealed that, as an elementary school student, he had been hospitalized and had received blood transfusions twice following abnormally heavy bleeding after tooth extraction; however, a specific congenital bleeding disorder had not been diagnosed at that time.\nIt was also revealed that his younger brother had been diagnosed with hemophilia B during adolescence.\nConsidering the possibility of hemophilia, his blood coagulation factors were examined, revealing that his factor IX activity was 3%.\nThe patient was subsequently diagnosed with moderate hemophilia B.\nBy the time of this diagnosis, the patient's DAH had already resolved with the corticosteroid therapy.\nWe decided to continue treating the patient using prednisolone alone, without coagulation factor IX replacement therapy.\nNo recurrence of DAH or hemorrhagic symptoms have been observed during 3 years since the tapering and discontinuation of prednisolone.\n","ner_info":[{"text":"48-year-old","label":"AGE","start":18,"end":29},{"text":"man","label":"SEX","start":30,"end":33},{"text":"hospitalized","label":"CLINICAL_EVENT","start":58,"end":70},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":78,"end":88},{"text":"at 42 years of age","label":"DATE","start":89,"end":107},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":125,"end":130},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":131,"end":141},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":146,"end":151},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":152,"end":171},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":173,"end":175},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":186,"end":193},{"text":"ground-glass opacity","label":"SIGN_SYMPTOM","start":194,"end":214},{"text":"GGO","label":"SIGN_SYMPTOM","start":216,"end":219},{"text":"bilateral lung","label":"BIOLOGICAL_STRUCTURE","start":228,"end":242},{"text":"bronchoscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":267,"end":292},{"text":"accumulation","label":"SIGN_SYMPTOM","start":306,"end":318},{"text":"large amounts","label":"SEVERITY","start":322,"end":335},{"text":"blood","label":"DETAILED_DESCRIPTION","start":339,"end":344},{"text":"trachea","label":"BIOLOGICAL_STRUCTURE","start":352,"end":359},{"text":"bronchi","label":"BIOLOGICAL_STRUCTURE","start":364,"end":371},{"text":"bronchoalveolar lavage fluid","label":"DIAGNOSTIC_PROCEDURE","start":395,"end":423},{"text":"BALF","label":"DIAGNOSTIC_PROCEDURE","start":425,"end":429},{"text":"bloody","label":"LAB_VALUE","start":435,"end":441},{"text":"hemosiderin-laden macrophages","label":"LAB_VALUE","start":465,"end":494},{"text":"culture test","label":"DIAGNOSTIC_PROCEDURE","start":498,"end":510},{"text":"BALF","label":"DIAGNOSTIC_PROCEDURE","start":518,"end":522},{"text":"no findings","label":"LAB_VALUE","start":532,"end":543},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":548,"end":565},{"text":"transthoracic","label":"BIOLOGICAL_STRUCTURE","start":570,"end":583},{"text":"echocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":584,"end":598},{"text":"no abnormalities","label":"LAB_VALUE","start":608,"end":624},{"text":"questionnaire","label":"OTHER_EVENT","start":628,"end":641},{"text":"at that time","label":"DATE","start":661,"end":673},{"text":"hemorrhagic episode","label":"SIGN_SYMPTOM","start":703,"end":722},{"text":"younger brother who had been diagnosed with hepatitis C","label":"FAMILY_HISTORY","start":790,"end":845},{"text":"drugs","label":"MEDICATION","start":884,"end":889},{"text":"potential to cause DAH","label":"DETAILED_DESCRIPTION","start":903,"end":925},{"text":"DAH","label":"DISEASE_DISORDER","start":971,"end":974},{"text":"vasculitis","label":"DISEASE_DISORDER","start":995,"end":1005},{"text":"intravenous","label":"ADMINISTRATION","start":1052,"end":1063},{"text":"methylprednisolone","label":"MEDICATION","start":1064,"end":1082},{"text":"1,000 mg daily","label":"DOSAGE","start":1084,"end":1098},{"text":"3 days","label":"DURATION","start":1104,"end":1110},{"text":"prednisolone","label":"MEDICATION","start":1123,"end":1135},{"text":"25 mg daily","label":"DOSAGE","start":1137,"end":1148},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1183,"end":1191},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1193,"end":1198},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1199,"end":1201},{"text":"GGO","label":"SIGN_SYMPTOM","start":1231,"end":1234},{"text":"prednisolone","label":"MEDICATION","start":1250,"end":1262},{"text":"tapered","label":"DOSAGE","start":1272,"end":1279},{"text":"discontinued","label":"DOSAGE","start":1295,"end":1307},{"text":"two-and-a-half years","label":"DATE","start":1311,"end":1331},{"text":"discharge","label":"CLINICAL_EVENT","start":1342,"end":1351},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1361,"end":1369},{"text":"readmitted","label":"CLINICAL_EVENT","start":1387,"end":1397},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1405,"end":1413},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":1435,"end":1445},{"text":"at 46 years of age","label":"DATE","start":1446,"end":1464},{"text":"improvement","label":"LAB_VALUE","start":1523,"end":1534},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":1542,"end":1551},{"text":"prednisolone","label":"MEDICATION","start":1557,"end":1569},{"text":"tapered","label":"DOSAGE","start":1579,"end":1586},{"text":"60 mg daily","label":"DOSAGE","start":1592,"end":1603},{"text":"5 mg daily","label":"DOSAGE","start":1629,"end":1639},{"text":"At 48 years of age","label":"DATE","start":1641,"end":1659},{"text":"readmitted","label":"CLINICAL_EVENT","start":1668,"end":1678},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1686,"end":1694},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":1724,"end":1734},{"text":"steroid","label":"MEDICATION","start":1758,"end":1765},{"text":"diabetes mellitus","label":"DISEASE_DISORDER","start":1774,"end":1791},{"text":"glimepiride","label":"MEDICATION","start":1816,"end":1827},{"text":"3 mg daily","label":"DOSAGE","start":1829,"end":1839},{"text":"admission","label":"CLINICAL_EVENT","start":1845,"end":1854},{"text":"weight","label":"DIAGNOSTIC_PROCEDURE","start":1860,"end":1866},{"text":"75 kg","label":"LAB_VALUE","start":1871,"end":1876},{"text":"height","label":"DIAGNOSTIC_PROCEDURE","start":1881,"end":1887},{"text":"167 cm","label":"LAB_VALUE","start":1888,"end":1894},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":1900,"end":1911},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1929,"end":1943},{"text":"178\/102 mmHg","label":"LAB_VALUE","start":1945,"end":1957},{"text":"pulse rate","label":"DIAGNOSTIC_PROCEDURE","start":1959,"end":1969},{"text":"109 beats\/min","label":"LAB_VALUE","start":1971,"end":1984},{"text":"pulse oximetry","label":"DIAGNOSTIC_PROCEDURE","start":1986,"end":2000},{"text":"97%","label":"LAB_VALUE","start":2002,"end":2005},{"text":"room air","label":"DETAILED_DESCRIPTION","start":2009,"end":2017},{"text":"body temperature","label":"DIAGNOSTIC_PROCEDURE","start":2023,"end":2039},{"text":"36.8\u00b0C","label":"LAB_VALUE","start":2041,"end":2047},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":2049,"end":2054},{"text":"auscultation","label":"DIAGNOSTIC_PROCEDURE","start":2055,"end":2067},{"text":"fine","label":"DETAILED_DESCRIPTION","start":2077,"end":2081},{"text":"crackles","label":"SIGN_SYMPTOM","start":2082,"end":2090},{"text":"right lung","label":"BIOLOGICAL_STRUCTURE","start":2098,"end":2108},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":2119,"end":2123},{"text":"rash","label":"SIGN_SYMPTOM","start":2124,"end":2128},{"text":"subcutaneous","label":"BIOLOGICAL_STRUCTURE","start":2130,"end":2142},{"text":"bleeding","label":"SIGN_SYMPTOM","start":2143,"end":2151},{"text":"joint","label":"BIOLOGICAL_STRUCTURE","start":2155,"end":2160},{"text":"swelling","label":"SIGN_SYMPTOM","start":2161,"end":2169},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2186,"end":2191},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":2192,"end":2202},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2207,"end":2209},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2233,"end":2240},{"text":"GGO","label":"SIGN_SYMPTOM","start":2241,"end":2244},{"text":"bilateral lung","label":"BIOLOGICAL_STRUCTURE","start":2252,"end":2266},{"text":"Mild","label":"SEVERITY","start":2275,"end":2279},{"text":"anemia","label":"SIGN_SYMPTOM","start":2280,"end":2286},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":2301,"end":2311},{"text":"11.3 g\/dL","label":"LAB_VALUE","start":2313,"end":2322},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":2334,"end":2344},{"text":"14.6 g\/dL","label":"LAB_VALUE","start":2361,"end":2370},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":2384,"end":2394},{"text":"activated partial thromboplastin time","label":"DIAGNOSTIC_PROCEDURE","start":2408,"end":2445},{"text":"APTT","label":"DIAGNOSTIC_PROCEDURE","start":2447,"end":2451},{"text":"prolonged","label":"LAB_VALUE","start":2457,"end":2466},{"text":"53.5 seconds","label":"LAB_VALUE","start":2470,"end":2482},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":2518,"end":2534},{"text":"blood glucose","label":"DIAGNOSTIC_PROCEDURE","start":2561,"end":2574},{"text":"hemoglobin A1c","label":"DIAGNOSTIC_PROCEDURE","start":2579,"end":2593},{"text":"299 mg\/dL","label":"LAB_VALUE","start":2606,"end":2615},{"text":"8.2%","label":"LAB_VALUE","start":2620,"end":2624},{"text":"steroid","label":"MEDICATION","start":2651,"end":2658},{"text":"diabetes mellitus","label":"DISEASE_DISORDER","start":2667,"end":2684},{"text":"Autoantibodies for various collagen diseases","label":"DIAGNOSTIC_PROCEDURE","start":2686,"end":2730},{"text":"negative","label":"LAB_VALUE","start":2736,"end":2744},{"text":"DAH","label":"DISEASE_DISORDER","start":2800,"end":2803},{"text":"high-dose","label":"DOSAGE","start":2827,"end":2836},{"text":"intravenous","label":"ADMINISTRATION","start":2837,"end":2848},{"text":"methylprednisolone","label":"MEDICATION","start":2849,"end":2867},{"text":"3 days","label":"DURATION","start":2872,"end":2878},{"text":"prednisolone","label":"MEDICATION","start":2892,"end":2904},{"text":"60 mg daily","label":"DOSAGE","start":2906,"end":2917},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":2924,"end":2933},{"text":"improved","label":"LAB_VALUE","start":2934,"end":2942},{"text":"as an elementary school student","label":"DATE","start":3077,"end":3108},{"text":"hospitalized","label":"CLINICAL_EVENT","start":3122,"end":3134},{"text":"had received blood transfusions twice following abnormally heavy bleeding after tooth extraction","label":"HISTORY","start":3139,"end":3235},{"text":"congenital","label":"DETAILED_DESCRIPTION","start":3257,"end":3267},{"text":"bleeding disorder","label":"DISEASE_DISORDER","start":3268,"end":3285},{"text":"at that time","label":"DATE","start":3309,"end":3321},{"text":"younger brother had been diagnosed with hemophilia B during adolescence","label":"FAMILY_HISTORY","start":3353,"end":3424},{"text":"hemophilia","label":"DISEASE_DISORDER","start":3457,"end":3467},{"text":"blood coagulation factors","label":"DIAGNOSTIC_PROCEDURE","start":3473,"end":3498},{"text":"factor IX activity","label":"DIAGNOSTIC_PROCEDURE","start":3533,"end":3551},{"text":"3%","label":"LAB_VALUE","start":3556,"end":3558},{"text":"moderate","label":"SEVERITY","start":3604,"end":3612},{"text":"hemophilia B","label":"DISEASE_DISORDER","start":3613,"end":3625},{"text":"DAH","label":"DISEASE_DISORDER","start":3672,"end":3675},{"text":"corticosteroid therapy","label":"MEDICATION","start":3706,"end":3728},{"text":"prednisolone","label":"MEDICATION","start":3780,"end":3792},{"text":"coagulation factor IX replacement therapy","label":"MEDICATION","start":3808,"end":3849},{"text":"DAH","label":"DISEASE_DISORDER","start":3868,"end":3871},{"text":"hemorrhagic symptoms","label":"SIGN_SYMPTOM","start":3875,"end":3895},{"text":"during 3 years","label":"DURATION","start":3915,"end":3929},{"text":"prednisolone","label":"MEDICATION","start":3972,"end":3984}],"tokens":["The patient was a ","48-year-old"," ","man"," who had previously been ","hospitalized"," due to ","hemoptysis"," ","at 42 years of age",".\nAt that time, a ","chest"," ","radiograph"," and ","chest"," ","computed tomography"," (","CT",") revealed ","diffuse"," ","ground-glass opacity"," (","GGO",") in the ","bilateral lung"," fields (Fig.1,2), and a ","bronchoscopic examination"," revealed the ","accumulation"," of ","large amounts"," of ","blood"," in the ","trachea"," and ","bronchi"," (Fig.3).\nThe patient's ","bronchoalveolar lavage fluid"," (","BALF",") was ","bloody"," and contained numerous ","hemosiderin-laden macrophages",".\nA ","culture test"," of the ","BALF"," revealed ","no findings",".\nAn ","electrocardiogram"," and ","transthoracic"," ","echocardiogram"," revealed ","no abnormalities",".\nA ","questionnaire"," that was completed ","at that time"," did not reveal the patient's ","hemorrhagic episode"," or a family history of bleeding disease, with the exception of his ","younger brother who had been diagnosed with hepatitis C",".\nFurthermore, he had not received any ","drugs"," that had the ","potential to cause DAH",".\nFollowing the above-mentioned examinations, ","DAH"," due to some sort of ","vasculitis"," was suspected.\nThus, treatment with high-dose ","intravenous"," ","methylprednisolone"," (","1,000 mg daily",") for ","3 days"," followed by ","prednisolone"," (","25 mg daily",") was initiated.\nThis relieved his ","symptoms",".\n","Chest"," ","CT"," showed the resolution of the ","GGO",".\nThe patient's ","prednisolone"," dose was ","tapered"," and eventually ","discontinued"," at ","two-and-a-half years"," after his ","discharge"," from our ","hospital",".\nThe patient was ","readmitted"," to our ","hospital"," with a recurrence of ","hemoptysis"," ","at 46 years of age",".\nThe above-described therapy was initiated and led to the ","improvement"," of his ","condition",".\nThe ","prednisolone"," dose was ","tapered"," from ","60 mg daily"," to a maintenance dose of ","5 mg daily",".\n","At 48 years of age",", he was ","readmitted"," to our ","hospital"," with a further recurrence of ","hemoptysis",".\nAt this point, he had ","steroid","-induced ","diabetes mellitus",", which was treated with ","glimepiride"," (","3 mg daily",").\nAt ","admission",", his ","weight"," was ","75 kg"," and ","height"," ","167 cm","; his ","vital signs"," were as follows: ","blood pressure",", ","178\/102 mmHg","; ","pulse rate",", ","109 beats\/min",", ","pulse oximetry",", ","97%"," in ","room air","; and ","body temperature",", ","36.8\u00b0C",".\n","Chest"," ","auscultation"," revealed ","fine"," ","crackles"," in the ","right lung"," field.\nNo ","skin"," ","rash",", ","subcutaneous"," ","bleeding"," or ","joint"," ","swelling"," were present.\nA ","chest"," ","radiograph"," and ","CT"," showed the presence of ","diffuse"," ","GGO"," in the ","bilateral lung"," fields.\n","Mild"," ","anemia"," was observed (","hemoglobin",", ","11.3 g\/dL","), although ","hemoglobin"," levels had been ","14.6 g\/dL"," prior to the ","hemoptysis"," episode.\nThe ","activated partial thromboplastin time"," (","APTT",") was ","prolonged"," to ","53.5 seconds"," (normal range, 25.1-40.7 seconds).\n","Laboratory tests"," showed that the patient's ","blood glucose"," and ","hemoglobin A1c"," levels were ","299 mg\/dL"," and ","8.2%",", respectively, due to the ","steroid","-induced ","diabetes mellitus",".\n","Autoantibodies for various collagen diseases"," were ","negative"," (Table).\nWe diagnosed the condition as a recurrence of ","DAH"," and again administered ","high-dose"," ","intravenous"," ","methylprednisolone"," for ","3 days",", followed by ","prednisolone"," (","60 mg daily",").\nHis ","condition"," ","improved",", as had been observed during the previous episodes.\nA further detailed inquiry regarding the patient's medical history revealed that, ","as an elementary school student",", he had been ","hospitalized"," and ","had received blood transfusions twice following abnormally heavy bleeding after tooth extraction","; however, a specific ","congenital"," ","bleeding disorder"," had not been diagnosed ","at that time",".\nIt was also revealed that his ","younger brother had been diagnosed with hemophilia B during adolescence",".\nConsidering the possibility of ","hemophilia",", his ","blood coagulation factors"," were examined, revealing that his ","factor IX activity"," was ","3%",".\nThe patient was subsequently diagnosed with ","moderate"," ","hemophilia B",".\nBy the time of this diagnosis, the patient's ","DAH"," had already resolved with the ","corticosteroid therapy",".\nWe decided to continue treating the patient using ","prednisolone"," alone, without ","coagulation factor IX replacement therapy",".\nNo recurrence of ","DAH"," or ","hemorrhagic symptoms"," have been observed ","during 3 years"," since the tapering and discontinuation of ","prednisolone",".\n"],"ner_labels":[0,5,0,65,0,13,0,69,0,19,0,12,0,24,0,12,0,24,0,24,0,22,0,69,0,69,0,12,0,24,0,69,0,63,0,22,0,12,0,12,0,24,0,24,0,42,0,42,0,24,0,24,0,42,0,24,0,12,0,24,0,42,0,53,0,19,0,69,0,34,0,46,0,22,0,26,0,26,0,4,0,46,0,29,0,32,0,46,0,29,0,69,0,12,0,24,0,69,0,46,0,29,0,29,0,19,0,13,0,48,0,13,0,48,0,69,0,19,0,42,0,24,0,46,0,29,0,29,0,29,0,19,0,13,0,48,0,69,0,46,0,26,0,46,0,29,0,13,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,12,0,24,0,22,0,69,0,12,0,12,0,69,0,12,0,69,0,12,0,69,0,12,0,24,0,24,0,22,0,69,0,12,0,63,0,69,0,24,0,42,0,24,0,42,0,69,0,24,0,24,0,42,0,42,0,24,0,24,0,24,0,42,0,42,0,46,0,26,0,24,0,42,0,26,0,29,0,4,0,46,0,32,0,46,0,29,0,24,0,42,0,19,0,13,0,39,0,22,0,26,0,19,0,34,0,26,0,24,0,24,0,42,0,63,0,26,0,26,0,46,0,46,0,46,0,26,0,69,0,32,0,46,0]}
-{"full_text":"A 34-year-old Japanese woman had a diagnosis of MCTD with the presence of Raynaud's phenomenon, pancytopenia, elevated plasma creatinine kinase, and antibodies against U1-ribonucleoprotein in 2005 and received 10 mg of prednisolone daily.\nPulmonary arterial systolic pressure estimated by echocardiography was slightly elevated (48 mmHg) in 2006.\nShe felt progressive shortness of breath on physical effort in 2011.\nPulmonary arterial hypertension was diagnosed with 74 mmHg of mean pulmonary arterial pressure (mPAP) evaluated by right heart catheterization (RHC) in 2012.\nCyclophosphamide-based immunosuppressive therapy was proposed but refused because of possible early menopausal symptoms.\nTreatment with 250 mg\/day of bosentan and 120 \u03bcg\/day of beraprost was initiated.\nHowever, in January 2014, her dyspnea deteriorated (WHO functional class IV), and she was admitted to our hospital.\nA physical examination showed low systemic blood pressure (89\/61 mmHg), tachycardia (104\/min), low blood oxygen level (percutaneous oxygen saturation (SpO2) 95%), jugular venous distension, and severe systemic edema.\nCoarse crackles and loud pulmonic valve closure sounds were detected.\nShe was unable to undergo the 6-minute walk test due to severe dyspnea.\nLaboratory examinations showed elevated plasma brain natriuretic peptide (BNP) level (929.4 pg\/mL), hypoxemia (PaO2 62.5 mmHg, PaCO2 27.1 mmHg), and the presence of antibodies against U1-ribonucleoprotein (97.9 U\/mL) as well as antinuclear antibodies (1:640, speckled pattern).\nA chest X-ray showed enlarged pulmonary arteries and cardiomegaly (Figure).\nElectrocardiogram showed P wave elevation in the V1-V2 leads.\nRHC demonstrated elevated mPAP (65 mmHg) with normal pulmonary arterial wedge pressure (12 mmHg), high pulmonary vascular resistance (1,547 dyne\u30fbsec\u30fbcm-5), and decreased cardiac output (cardiac index 1.69 L\/min\/m2).\nA ventilation\/perfusion scan showed no signs of pulmonary thromboembolism.\nNo signs of chronic obstructive pulmonary disease or interstitial lung diseases were found with computed tomography.\nHer dyspnea was therefore considered to be due to MCTD-associated PAH which was refractory to bosentan and beraprost therapy.\nIn addition to supportive therapy with oxygen supplementation and diuretics (40 mg\/day of furosemide), initiation of 60 mg\/day of sildenafil as well as gradual increment in the dose of beraprost was chosen as an additional treatment.\nHowever, her dyspnea remained unchanged, and her plasma BNP level increased.\nIVCY (750 mg\/m2, every 4 weeks) was initiated, and the dose of prednisolone was increased to 60 mg daily.\nHer dyspnea then ameliorated, and she became able to undergo the 6-minute walk test (260 m, minimum SpO2 95 %).\nHer plasma BNP level also decreased after the initiation of IVCY (Figure).\nSix months after the admission, a follow-up RHC revealed improved mPAP (65 to 53 mmHg), pulmonary vascular resistance (1,547 to 1,116 dyne\u30fbsec\u30fbcm-5), and cardiac index (1.69 to 1.83 L\/min\/m2) (Table).\nSince she remained stable but did not obtain further improvements 18 months after the admission (Table), we consider parenteral prostanoids or lung transplantation as a subsequent treatment.\n","ner_info":[{"text":"34-year-old","label":"AGE","start":2,"end":13},{"text":"Japanese","label":"PERSONAL_BACKGROUND","start":14,"end":22},{"text":"woman","label":"SEX","start":23,"end":28},{"text":"MCTD","label":"DISEASE_DISORDER","start":48,"end":52},{"text":"Raynaud's phenomenon","label":"DISEASE_DISORDER","start":74,"end":94},{"text":"pancytopenia","label":"SIGN_SYMPTOM","start":96,"end":108},{"text":"elevated","label":"LAB_VALUE","start":110,"end":118},{"text":"plasma","label":"DETAILED_DESCRIPTION","start":119,"end":125},{"text":"creatinine kinase","label":"DIAGNOSTIC_PROCEDURE","start":126,"end":143},{"text":"antibodies against","label":"LAB_VALUE","start":149,"end":167},{"text":"U1-ribonucleoprotein","label":"DIAGNOSTIC_PROCEDURE","start":168,"end":188},{"text":"2005","label":"DATE","start":192,"end":196},{"text":"10 mg","label":"DOSAGE","start":210,"end":215},{"text":"prednisolone","label":"MEDICATION","start":219,"end":231},{"text":"daily","label":"DOSAGE","start":232,"end":237},{"text":"Pulmonary arterial systolic pressure","label":"DIAGNOSTIC_PROCEDURE","start":239,"end":275},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":289,"end":305},{"text":"slightly elevated","label":"LAB_VALUE","start":310,"end":327},{"text":"48 mmHg","label":"LAB_VALUE","start":329,"end":336},{"text":"2006","label":"DATE","start":341,"end":345},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":356,"end":367},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":368,"end":387},{"text":"physical effort","label":"ACTIVITY","start":391,"end":406},{"text":"2011","label":"DATE","start":410,"end":414},{"text":"Pulmonary arterial hypertension","label":"DISEASE_DISORDER","start":416,"end":447},{"text":"74 mmHg","label":"LAB_VALUE","start":467,"end":474},{"text":"mean pulmonary arterial pressure","label":"DIAGNOSTIC_PROCEDURE","start":478,"end":510},{"text":"mPAP","label":"DIAGNOSTIC_PROCEDURE","start":512,"end":516},{"text":"right heart catheterization","label":"DIAGNOSTIC_PROCEDURE","start":531,"end":558},{"text":"RHC","label":"DIAGNOSTIC_PROCEDURE","start":560,"end":563},{"text":"2012","label":"DATE","start":568,"end":572},{"text":"Cyclophosphamide","label":"MEDICATION","start":574,"end":590},{"text":"immunosuppressive therapy","label":"MEDICATION","start":597,"end":622},{"text":"early","label":"DETAILED_DESCRIPTION","start":668,"end":673},{"text":"menopausal symptoms","label":"SIGN_SYMPTOM","start":674,"end":693},{"text":"250 mg\/day","label":"DOSAGE","start":710,"end":720},{"text":"bosentan","label":"MEDICATION","start":724,"end":732},{"text":"120 \u03bcg\/day","label":"DOSAGE","start":737,"end":747},{"text":"beraprost","label":"MEDICATION","start":751,"end":760},{"text":"January 2014","label":"DATE","start":788,"end":800},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":806,"end":813},{"text":"WHO functional class","label":"DIAGNOSTIC_PROCEDURE","start":828,"end":848},{"text":"IV","label":"LAB_VALUE","start":849,"end":851},{"text":"admitted","label":"CLINICAL_EVENT","start":866,"end":874},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":882,"end":890},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":894,"end":914},{"text":"low","label":"LAB_VALUE","start":922,"end":925},{"text":"systemic blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":926,"end":949},{"text":"89\/61 mmHg","label":"LAB_VALUE","start":951,"end":961},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":964,"end":975},{"text":"104\/min","label":"LAB_VALUE","start":977,"end":984},{"text":"low","label":"LAB_VALUE","start":987,"end":990},{"text":"blood oxygen level","label":"DIAGNOSTIC_PROCEDURE","start":991,"end":1009},{"text":"percutaneous oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":1011,"end":1041},{"text":"SpO2","label":"DIAGNOSTIC_PROCEDURE","start":1043,"end":1047},{"text":"95%","label":"LAB_VALUE","start":1049,"end":1052},{"text":"jugular venous","label":"BIOLOGICAL_STRUCTURE","start":1055,"end":1069},{"text":"distension","label":"SIGN_SYMPTOM","start":1070,"end":1080},{"text":"severe","label":"SEVERITY","start":1086,"end":1092},{"text":"systemic","label":"DETAILED_DESCRIPTION","start":1093,"end":1101},{"text":"edema","label":"SIGN_SYMPTOM","start":1102,"end":1107},{"text":"Coarse","label":"DETAILED_DESCRIPTION","start":1109,"end":1115},{"text":"crackles","label":"SIGN_SYMPTOM","start":1116,"end":1124},{"text":"loud","label":"DETAILED_DESCRIPTION","start":1129,"end":1133},{"text":"pulmonic valve closure sounds","label":"SIGN_SYMPTOM","start":1134,"end":1163},{"text":"6-minute walk test","label":"DIAGNOSTIC_PROCEDURE","start":1209,"end":1227},{"text":"severe","label":"SEVERITY","start":1235,"end":1241},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1242,"end":1249},{"text":"Laboratory examinations","label":"DIAGNOSTIC_PROCEDURE","start":1251,"end":1274},{"text":"elevated","label":"LAB_VALUE","start":1282,"end":1290},{"text":"plasma","label":"DETAILED_DESCRIPTION","start":1291,"end":1297},{"text":"brain natriuretic peptide","label":"DIAGNOSTIC_PROCEDURE","start":1298,"end":1323},{"text":"BNP","label":"DIAGNOSTIC_PROCEDURE","start":1325,"end":1328},{"text":"929.4 pg\/mL","label":"LAB_VALUE","start":1337,"end":1348},{"text":"hypoxemia","label":"SIGN_SYMPTOM","start":1351,"end":1360},{"text":"PaO2","label":"DIAGNOSTIC_PROCEDURE","start":1362,"end":1366},{"text":"62.5 mmHg","label":"LAB_VALUE","start":1367,"end":1376},{"text":"PaCO2","label":"DIAGNOSTIC_PROCEDURE","start":1378,"end":1383},{"text":"27.1 mmHg","label":"LAB_VALUE","start":1384,"end":1393},{"text":"presence of antibodies against","label":"LAB_VALUE","start":1404,"end":1434},{"text":"U1-ribonucleoprotein","label":"DIAGNOSTIC_PROCEDURE","start":1435,"end":1455},{"text":"97.9 U\/mL","label":"LAB_VALUE","start":1457,"end":1466},{"text":"antinuclear antibodies","label":"DIAGNOSTIC_PROCEDURE","start":1479,"end":1501},{"text":"1:640","label":"LAB_VALUE","start":1503,"end":1508},{"text":"speckled pattern","label":"LAB_VALUE","start":1510,"end":1526},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1531,"end":1536},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":1537,"end":1542},{"text":"enlarged","label":"SIGN_SYMPTOM","start":1550,"end":1558},{"text":"pulmonary arteries","label":"BIOLOGICAL_STRUCTURE","start":1559,"end":1577},{"text":"cardiomegaly","label":"SIGN_SYMPTOM","start":1582,"end":1594},{"text":"Electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1605,"end":1622},{"text":"P wave elevation","label":"SIGN_SYMPTOM","start":1630,"end":1646},{"text":"V1-V2 leads","label":"DETAILED_DESCRIPTION","start":1654,"end":1665},{"text":"RHC","label":"DIAGNOSTIC_PROCEDURE","start":1667,"end":1670},{"text":"elevated","label":"LAB_VALUE","start":1684,"end":1692},{"text":"mPAP","label":"DIAGNOSTIC_PROCEDURE","start":1693,"end":1697},{"text":"65 mmHg","label":"LAB_VALUE","start":1699,"end":1706},{"text":"normal","label":"LAB_VALUE","start":1713,"end":1719},{"text":"pulmonary arterial wedge pressure","label":"DIAGNOSTIC_PROCEDURE","start":1720,"end":1753},{"text":"12 mmHg","label":"LAB_VALUE","start":1755,"end":1762},{"text":"high","label":"LAB_VALUE","start":1765,"end":1769},{"text":"pulmonary vascular resistance","label":"DIAGNOSTIC_PROCEDURE","start":1770,"end":1799},{"text":"1,547 dyne\u30fbsec\u30fbcm-5","label":"LAB_VALUE","start":1801,"end":1820},{"text":"decreased","label":"LAB_VALUE","start":1827,"end":1836},{"text":"cardiac output","label":"DIAGNOSTIC_PROCEDURE","start":1837,"end":1851},{"text":"cardiac index 1.69 L\/min\/m2","label":"LAB_VALUE","start":1853,"end":1880},{"text":"ventilation\/perfusion scan","label":"DIAGNOSTIC_PROCEDURE","start":1885,"end":1911},{"text":"pulmonary thromboembolism","label":"DISEASE_DISORDER","start":1931,"end":1956},{"text":"chronic obstructive pulmonary disease","label":"DISEASE_DISORDER","start":1970,"end":2007},{"text":"interstitial lung diseases","label":"DISEASE_DISORDER","start":2011,"end":2037},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":2054,"end":2073},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2079,"end":2086},{"text":"MCTD","label":"DISEASE_DISORDER","start":2125,"end":2129},{"text":"PAH","label":"DISEASE_DISORDER","start":2141,"end":2144},{"text":"bosentan","label":"MEDICATION","start":2169,"end":2177},{"text":"beraprost","label":"MEDICATION","start":2182,"end":2191},{"text":"supportive therapy","label":"THERAPEUTIC_PROCEDURE","start":2216,"end":2234},{"text":"oxygen supplementation","label":"THERAPEUTIC_PROCEDURE","start":2240,"end":2262},{"text":"diuretics","label":"MEDICATION","start":2267,"end":2276},{"text":"40 mg\/day","label":"DOSAGE","start":2278,"end":2287},{"text":"furosemide","label":"MEDICATION","start":2291,"end":2301},{"text":"60 mg\/day","label":"DOSAGE","start":2318,"end":2327},{"text":"sildenafil","label":"MEDICATION","start":2331,"end":2341},{"text":"gradual increment in the dose","label":"DOSAGE","start":2353,"end":2382},{"text":"beraprost","label":"MEDICATION","start":2386,"end":2395},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2448,"end":2455},{"text":"plasma","label":"DETAILED_DESCRIPTION","start":2484,"end":2490},{"text":"BNP","label":"DIAGNOSTIC_PROCEDURE","start":2491,"end":2494},{"text":"increased","label":"LAB_VALUE","start":2501,"end":2510},{"text":"IVCY","label":"MEDICATION","start":2512,"end":2516},{"text":"750 mg\/m2, every 4 weeks","label":"DOSAGE","start":2518,"end":2542},{"text":"prednisolone","label":"MEDICATION","start":2575,"end":2587},{"text":"60 mg daily","label":"DOSAGE","start":2605,"end":2616},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2622,"end":2629},{"text":"6-minute walk test","label":"DIAGNOSTIC_PROCEDURE","start":2683,"end":2701},{"text":"260 m","label":"LAB_VALUE","start":2703,"end":2708},{"text":"minimum SpO2","label":"DIAGNOSTIC_PROCEDURE","start":2710,"end":2722},{"text":"95 %","label":"LAB_VALUE","start":2723,"end":2727},{"text":"plasma","label":"DETAILED_DESCRIPTION","start":2734,"end":2740},{"text":"BNP","label":"DIAGNOSTIC_PROCEDURE","start":2741,"end":2744},{"text":"decreased","label":"LAB_VALUE","start":2756,"end":2765},{"text":"IVCY","label":"MEDICATION","start":2790,"end":2794},{"text":"Six months after","label":"DATE","start":2805,"end":2821},{"text":"admission","label":"CLINICAL_EVENT","start":2826,"end":2835},{"text":"RHC","label":"DIAGNOSTIC_PROCEDURE","start":2849,"end":2852},{"text":"improved","label":"LAB_VALUE","start":2862,"end":2870},{"text":"mPAP","label":"DIAGNOSTIC_PROCEDURE","start":2871,"end":2875},{"text":"53 mmHg","label":"LAB_VALUE","start":2883,"end":2890},{"text":"pulmonary vascular resistance","label":"DIAGNOSTIC_PROCEDURE","start":2893,"end":2922},{"text":"1,116 dyne\u30fbsec\u30fbcm-5","label":"LAB_VALUE","start":2933,"end":2952},{"text":"cardiac index","label":"DIAGNOSTIC_PROCEDURE","start":2959,"end":2972},{"text":"1.83 L\/min\/m2","label":"LAB_VALUE","start":2982,"end":2995},{"text":"stable","label":"SIGN_SYMPTOM","start":3025,"end":3031},{"text":"18 months after","label":"DATE","start":3072,"end":3087},{"text":"admission","label":"CLINICAL_EVENT","start":3092,"end":3101},{"text":"parenteral","label":"ADMINISTRATION","start":3123,"end":3133},{"text":"prostanoids","label":"MEDICATION","start":3134,"end":3145},{"text":"lung transplantation","label":"THERAPEUTIC_PROCEDURE","start":3149,"end":3169}],"tokens":["A ","34-year-old"," ","Japanese"," ","woman"," had a diagnosis of ","MCTD"," with the presence of ","Raynaud's phenomenon",", ","pancytopenia",", ","elevated"," ","plasma"," ","creatinine kinase",", and ","antibodies against"," ","U1-ribonucleoprotein"," in ","2005"," and received ","10 mg"," of ","prednisolone"," ","daily",".\n","Pulmonary arterial systolic pressure"," estimated by ","echocardiography"," was ","slightly elevated"," (","48 mmHg",") in ","2006",".\nShe felt ","progressive"," ","shortness of breath"," on ","physical effort"," in ","2011",".\n","Pulmonary arterial hypertension"," was diagnosed with ","74 mmHg"," of ","mean pulmonary arterial pressure"," (","mPAP",") evaluated by ","right heart catheterization"," (","RHC",") in ","2012",".\n","Cyclophosphamide","-based ","immunosuppressive therapy"," was proposed but refused because of possible ","early"," ","menopausal symptoms",".\nTreatment with ","250 mg\/day"," of ","bosentan"," and ","120 \u03bcg\/day"," of ","beraprost"," was initiated.\nHowever, in ","January 2014",", her ","dyspnea"," deteriorated (","WHO functional class"," ","IV","), and she was ","admitted"," to our ","hospital",".\nA ","physical examination"," showed ","low"," ","systemic blood pressure"," (","89\/61 mmHg","), ","tachycardia"," (","104\/min","), ","low"," ","blood oxygen level"," (","percutaneous oxygen saturation"," (","SpO2",") ","95%","), ","jugular venous"," ","distension",", and ","severe"," ","systemic"," ","edema",".\n","Coarse"," ","crackles"," and ","loud"," ","pulmonic valve closure sounds"," were detected.\nShe was unable to undergo the ","6-minute walk test"," due to ","severe"," ","dyspnea",".\n","Laboratory examinations"," showed ","elevated"," ","plasma"," ","brain natriuretic peptide"," (","BNP",") level (","929.4 pg\/mL","), ","hypoxemia"," (","PaO2"," ","62.5 mmHg",", ","PaCO2"," ","27.1 mmHg","), and the ","presence of antibodies against"," ","U1-ribonucleoprotein"," (","97.9 U\/mL",") as well as ","antinuclear antibodies"," (","1:640",", ","speckled pattern",").\nA ","chest"," ","X-ray"," showed ","enlarged"," ","pulmonary arteries"," and ","cardiomegaly"," (Figure).\n","Electrocardiogram"," showed ","P wave elevation"," in the ","V1-V2 leads",".\n","RHC"," demonstrated ","elevated"," ","mPAP"," (","65 mmHg",") with ","normal"," ","pulmonary arterial wedge pressure"," (","12 mmHg","), ","high"," ","pulmonary vascular resistance"," (","1,547 dyne\u30fbsec\u30fbcm-5","), and ","decreased"," ","cardiac output"," (","cardiac index 1.69 L\/min\/m2",").\nA ","ventilation\/perfusion scan"," showed no signs of ","pulmonary thromboembolism",".\nNo signs of ","chronic obstructive pulmonary disease"," or ","interstitial lung diseases"," were found with ","computed tomography",".\nHer ","dyspnea"," was therefore considered to be due to ","MCTD","-associated ","PAH"," which was refractory to ","bosentan"," and ","beraprost"," therapy.\nIn addition to ","supportive therapy"," with ","oxygen supplementation"," and ","diuretics"," (","40 mg\/day"," of ","furosemide","), initiation of ","60 mg\/day"," of ","sildenafil"," as well as ","gradual increment in the dose"," of ","beraprost"," was chosen as an additional treatment.\nHowever, her ","dyspnea"," remained unchanged, and her ","plasma"," ","BNP"," level ","increased",".\n","IVCY"," (","750 mg\/m2, every 4 weeks",") was initiated, and the dose of ","prednisolone"," was increased to ","60 mg daily",".\nHer ","dyspnea"," then ameliorated, and she became able to undergo the ","6-minute walk test"," (","260 m",", ","minimum SpO2"," ","95 %",").\nHer ","plasma"," ","BNP"," level also ","decreased"," after the initiation of ","IVCY"," (Figure).\n","Six months after"," the ","admission",", a follow-up ","RHC"," revealed ","improved"," ","mPAP"," (65 to ","53 mmHg","), ","pulmonary vascular resistance"," (1,547 to ","1,116 dyne\u30fbsec\u30fbcm-5","), and ","cardiac index"," (1.69 to ","1.83 L\/min\/m2",") (Table).\nSince she remained ","stable"," but did not obtain further improvements ","18 months after"," the ","admission"," (Table), we consider ","parenteral"," ","prostanoids"," or ","lung transplantation"," as a subsequent treatment.\n"],"ner_labels":[0,5,0,58,0,65,0,26,0,26,0,69,0,42,0,22,0,24,0,42,0,24,0,19,0,29,0,46,0,29,0,24,0,24,0,42,0,42,0,19,0,22,0,69,0,1,0,19,0,26,0,42,0,24,0,24,0,24,0,24,0,19,0,46,0,46,0,22,0,69,0,29,0,46,0,29,0,46,0,19,0,69,0,24,0,42,0,13,0,48,0,24,0,42,0,24,0,42,0,69,0,42,0,42,0,24,0,24,0,24,0,42,0,12,0,69,0,63,0,22,0,69,0,22,0,69,0,22,0,69,0,24,0,63,0,69,0,24,0,42,0,22,0,24,0,24,0,42,0,69,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,42,0,12,0,24,0,69,0,12,0,69,0,24,0,69,0,22,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,26,0,26,0,26,0,24,0,69,0,26,0,26,0,46,0,46,0,75,0,75,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,69,0,22,0,24,0,42,0,46,0,29,0,46,0,29,0,69,0,24,0,42,0,24,0,42,0,22,0,24,0,42,0,46,0,19,0,13,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,69,0,19,0,13,0,4,0,46,0,75,0]}
-{"full_text":"A 22-year-old Tibetan man without significant past medical history was diagnosed with pulmonary tuberculosis (PTB) in a routine medical examination and received anti-TB therapy that included isoniazid (INH, 300\u200amg\/d), RMP (450\u200amg\/d), ethambutol (EMB, 750\u200amg\/d), and pyrazinamide (PZA, 1500\u200amg\/d).\nAfter 1 week of continuous therapy, he was admitted to the Tibet People's Hospital with nasal hemorrhage and the platelet (PLT) count was 0.4\u200a\u00d7\u200a109\/L (normal range, 100\u2013300\u200a\u00d7\u200a109\/L).\nEpistaxis was cured after symptomatic treatment.\nTwo days later, he developed hematochezia, hematuria, and purpura, and required transfusion of fresh-frozen plasma and platelets in another local hospital.\nFour days later (November 18, 2015), he was transferred to the West China Hospital due to the ineffective treatment.\nOn physical examination, he presented with pallor, mild jaundice on the sclera, purpura, tachycardia (heart rate 132\/min) and weak breath sounds at the base of the left lung.\nLaboratory results on admission indicated DIC: prothrombin time (17.8\u200aseconds; normal range, 9.6\u201312.8\u200aseconds), international normalized ratio (1.53; normal range, 0.88\u20131.15), fibrinogen (1.13\u200ag\/L; normal range, 2.0\u20134.0\u200ag\/L), D-dimers (23.45\u200amg\/L; normal range, <0.55\u200amg\/L), fibrin degradation product (60.4\u200amg\/L; normal range,<5\u200amg\/L), and PLT (2\u200a\u00d7\u200a109\/L; normal range, 100\u2013300\u200a\u00d7\u200a109\/L).\nOther abnormal data were as follows: white blood cell (WBC, 48.38\u200a\u00d7\u200a109\/L; normal range, 3.5\u20139.5), hemoglobin (65\u200ag\/L; normal range, 130\u2013175\u200ag\/L), total bilirubin (30.8 umol\/L; normal range, 5.0\u201328.0\u200aumol\/L), direct bilirubin (16.6 umol\/L; normal range, < 8.8 umol\/L), aspartate aminotransferase (75 U\/L; normal range, <40 U\/L), alanine aminotransferase (293 U\/L; normal range, <50 U\/L), lactate dehydrogenase (380 U\/L; normal range, 110\u2013220\u200aU\/L), serum urea nitrogen (13.01 mmol\/L; normal range, 3.2\u20137.79 mmol\/L), C-reactive protein (16.70\u200amg\/L; normal range, <5\u200amg\/L), complement 3 (0.41\u200ag\/L; normal range, 0.785\u20131.520\u200ag\/L), and complement 4 (0.0797\u200ag\/L; normal range, 0.145\u20130.360\u200ag\/L).\nRoutine urine test showed blood cell >330\u200aCell\/uL, leukocyte 250 Cell\/uL, protein 2\u200ag\/L, and urobilinogen 70 umol\/L.\nRoutine stool test showed red blood cell 4+\/HP, white blood cell 1+\/HP, occult blood test (+).\nT-SPOT result was positive.\nReal-time polymerase chain reaction analysis for mycobacterium TB on sputum was positive.\nAcid fast stain test of a sputum smear was negative.\nChest computed tomography (CT) on admission (November 18, 2015) (Fig.1) showed infiltrates on the upper lobe of the left lung, left pleural effusion, and pericardial effusion, accompanied by enlargement of mediastinal lymph nodes.\nAbdominal ultrasound showed a small amount of fluid adjacent to the liver and spleen.\nSerologic markers were negative for acute or chronic viral hepatitis, HIV, direct Coomb test, and autoimmune hepatitis.\nPeripheral blood film and culture were negative.\nBone marrow smear and medulloculture were also negative.\nThe antituberculosis drugs were discontinued immediately after admission.\nBesides fasting, he was initiated with infusion of fresh-frozen plasma, platelet, packed red blood cells, intravenous immune globulin, recombinant human thrombopoietin, omeprazole, and polyene phosphatidylcholine as well as nutrition supportive treatment.\nFive days after fasting (November 23, 2015), the patient started a therapy consisting of EMB, moxifloxacin, and amikacin, while he had no further active hemorrhage.\nEight days after admission (November 26, 2015), the platelet counts had risen gradually.\nINH (200\u200amg\/d, intravenously guttae) was administered on 24 days after admission (December 11, 2015), while his liver function tests and platelet counts returned to normal.\nThe main laboratory features are summarized in Table 1.\nOne month later (December 17, 2015), reviewed chest CT (Fig.1) indicated the infiltration, hydrothorax, and pericardial effusion were absorbed well.\nAlmost about 4 weeks after admission, the patient recovered and left hospital with INH (300\u200amg\/d), EMB (750\u200amg\/d), levofloxacin (500\u200amg\/d), and streptomycin (750,000 U\/d, intramuscular injection).\nThere was no recurrence of DIC or hemorrhage during 8 months of follow-up.\nUnfortunately, the patient refused a follow-up chest CT after his discharge.\nTable \u200b2 shows the timeline of this case.\n","ner_info":[{"text":"22-year-old","label":"AGE","start":2,"end":13},{"text":"Tibetan","label":"PERSONAL_BACKGROUND","start":14,"end":21},{"text":"man","label":"SEX","start":22,"end":25},{"text":"without significant past medical history","label":"HISTORY","start":26,"end":66},{"text":"pulmonary tuberculosis","label":"DISEASE_DISORDER","start":86,"end":108},{"text":"PTB","label":"DISEASE_DISORDER","start":110,"end":113},{"text":"routine","label":"DETAILED_DESCRIPTION","start":120,"end":127},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":136,"end":147},{"text":"anti-TB therapy","label":"MEDICATION","start":161,"end":176},{"text":"isoniazid","label":"MEDICATION","start":191,"end":200},{"text":"INH","label":"MEDICATION","start":202,"end":205},{"text":"300\u200amg\/d","label":"DOSAGE","start":207,"end":215},{"text":"RMP","label":"MEDICATION","start":218,"end":221},{"text":"450\u200amg\/d","label":"DOSAGE","start":223,"end":231},{"text":"ethambutol","label":"MEDICATION","start":234,"end":244},{"text":"EMB","label":"MEDICATION","start":246,"end":249},{"text":"750\u200amg\/d","label":"DOSAGE","start":251,"end":259},{"text":"pyrazinamide","label":"MEDICATION","start":266,"end":278},{"text":"PZA","label":"MEDICATION","start":280,"end":283},{"text":"1500\u200amg\/d","label":"DOSAGE","start":285,"end":294},{"text":"1 week","label":"DURATION","start":303,"end":309},{"text":"therapy","label":"COREFERENCE","start":324,"end":331},{"text":"admitted","label":"CLINICAL_EVENT","start":340,"end":348},{"text":"Tibet People's Hospital","label":"NONBIOLOGICAL_LOCATION","start":356,"end":379},{"text":"nasal","label":"BIOLOGICAL_STRUCTURE","start":385,"end":390},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":391,"end":401},{"text":"platelet","label":"DIAGNOSTIC_PROCEDURE","start":410,"end":418},{"text":"PLT","label":"DIAGNOSTIC_PROCEDURE","start":420,"end":423},{"text":"0.4\u200a\u00d7\u200a109\/L","label":"LAB_VALUE","start":435,"end":446},{"text":"Epistaxis","label":"SIGN_SYMPTOM","start":480,"end":489},{"text":"symptomatic treatment","label":"THERAPEUTIC_PROCEDURE","start":506,"end":527},{"text":"Two days later","label":"DATE","start":529,"end":543},{"text":"hematochezia","label":"SIGN_SYMPTOM","start":558,"end":570},{"text":"hematuria","label":"SIGN_SYMPTOM","start":572,"end":581},{"text":"purpura","label":"SIGN_SYMPTOM","start":587,"end":594},{"text":"transfusion","label":"THERAPEUTIC_PROCEDURE","start":609,"end":620},{"text":"fresh-frozen plasma","label":"MEDICATION","start":624,"end":643},{"text":"platelets","label":"MEDICATION","start":648,"end":657},{"text":"another local hospital","label":"NONBIOLOGICAL_LOCATION","start":661,"end":683},{"text":"Four days later","label":"DATE","start":685,"end":700},{"text":"November 18, 2015","label":"DATE","start":702,"end":719},{"text":"transferred","label":"CLINICAL_EVENT","start":729,"end":740},{"text":"West China Hospital","label":"NONBIOLOGICAL_LOCATION","start":748,"end":767},{"text":"ineffective","label":"QUALITATIVE_CONCEPT","start":779,"end":790},{"text":"treatment","label":"THERAPEUTIC_PROCEDURE","start":791,"end":800},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":805,"end":825},{"text":"pallor","label":"SIGN_SYMPTOM","start":845,"end":851},{"text":"mild","label":"SEVERITY","start":853,"end":857},{"text":"jaundice","label":"SIGN_SYMPTOM","start":858,"end":866},{"text":"sclera","label":"BIOLOGICAL_STRUCTURE","start":874,"end":880},{"text":"purpura","label":"SIGN_SYMPTOM","start":882,"end":889},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":891,"end":902},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":904,"end":914},{"text":"132\/min","label":"LAB_VALUE","start":915,"end":922},{"text":"weak breath sounds","label":"SIGN_SYMPTOM","start":928,"end":946},{"text":"base of the left lung","label":"BIOLOGICAL_STRUCTURE","start":954,"end":975},{"text":"Laboratory results","label":"DIAGNOSTIC_PROCEDURE","start":977,"end":995},{"text":"admission","label":"CLINICAL_EVENT","start":999,"end":1008},{"text":"DIC","label":"DISEASE_DISORDER","start":1019,"end":1022},{"text":"prothrombin time","label":"DIAGNOSTIC_PROCEDURE","start":1024,"end":1040},{"text":"17.8\u200aseconds","label":"LAB_VALUE","start":1042,"end":1054},{"text":"international normalized ratio","label":"DIAGNOSTIC_PROCEDURE","start":1089,"end":1119},{"text":"1.53","label":"LAB_VALUE","start":1121,"end":1125},{"text":"fibrinogen","label":"DIAGNOSTIC_PROCEDURE","start":1153,"end":1163},{"text":"1.13\u200ag\/L","label":"LAB_VALUE","start":1165,"end":1173},{"text":"D-dimers","label":"DIAGNOSTIC_PROCEDURE","start":1203,"end":1211},{"text":"23.45\u200amg\/L","label":"LAB_VALUE","start":1213,"end":1223},{"text":"fibrin degradation product","label":"DIAGNOSTIC_PROCEDURE","start":1252,"end":1278},{"text":"60.4\u200amg\/L","label":"LAB_VALUE","start":1280,"end":1289},{"text":"PLT","label":"DIAGNOSTIC_PROCEDURE","start":1318,"end":1321},{"text":"2\u200a\u00d7\u200a109\/L","label":"LAB_VALUE","start":1323,"end":1332},{"text":"white blood cell","label":"DIAGNOSTIC_PROCEDURE","start":1403,"end":1419},{"text":"WBC","label":"DIAGNOSTIC_PROCEDURE","start":1421,"end":1424},{"text":"48.38\u200a\u00d7\u200a109\/L","label":"LAB_VALUE","start":1426,"end":1439},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1465,"end":1475},{"text":"65\u200ag\/L","label":"LAB_VALUE","start":1477,"end":1483},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1513,"end":1528},{"text":"30.8 umol\/L","label":"LAB_VALUE","start":1530,"end":1541},{"text":"direct bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1575,"end":1591},{"text":"16.6 umol\/L","label":"LAB_VALUE","start":1593,"end":1604},{"text":"aspartate aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1635,"end":1661},{"text":"75 U\/L","label":"LAB_VALUE","start":1663,"end":1669},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1695,"end":1719},{"text":"293 U\/L","label":"LAB_VALUE","start":1721,"end":1728},{"text":"lactate dehydrogenase","label":"DIAGNOSTIC_PROCEDURE","start":1754,"end":1775},{"text":"380 U\/L","label":"LAB_VALUE","start":1777,"end":1784},{"text":"serum urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":1814,"end":1833},{"text":"13.01 mmol\/L","label":"LAB_VALUE","start":1835,"end":1847},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1881,"end":1899},{"text":"16.70\u200amg\/L","label":"LAB_VALUE","start":1901,"end":1911},{"text":"complement 3","label":"DIAGNOSTIC_PROCEDURE","start":1937,"end":1949},{"text":"0.41\u200ag\/L","label":"LAB_VALUE","start":1951,"end":1959},{"text":"complement 4","label":"DIAGNOSTIC_PROCEDURE","start":1997,"end":2009},{"text":"0.0797\u200ag\/L","label":"LAB_VALUE","start":2011,"end":2021},{"text":"urine test","label":"DIAGNOSTIC_PROCEDURE","start":2063,"end":2073},{"text":"blood cell","label":"DIAGNOSTIC_PROCEDURE","start":2081,"end":2091},{"text":">330\u200aCell\/uL","label":"LAB_VALUE","start":2092,"end":2104},{"text":"leukocyte","label":"DIAGNOSTIC_PROCEDURE","start":2106,"end":2115},{"text":"250 Cell\/uL","label":"LAB_VALUE","start":2116,"end":2127},{"text":"protein","label":"DIAGNOSTIC_PROCEDURE","start":2129,"end":2136},{"text":"2\u200ag\/L","label":"LAB_VALUE","start":2137,"end":2142},{"text":"urobilinogen","label":"DIAGNOSTIC_PROCEDURE","start":2148,"end":2160},{"text":"70 umol\/L","label":"LAB_VALUE","start":2161,"end":2170},{"text":"stool test","label":"DIAGNOSTIC_PROCEDURE","start":2180,"end":2190},{"text":"red blood cell","label":"DIAGNOSTIC_PROCEDURE","start":2198,"end":2212},{"text":"4+\/HP","label":"LAB_VALUE","start":2213,"end":2218},{"text":"white blood cell","label":"DIAGNOSTIC_PROCEDURE","start":2220,"end":2236},{"text":"1+\/HP","label":"LAB_VALUE","start":2237,"end":2242},{"text":"occult blood test","label":"DIAGNOSTIC_PROCEDURE","start":2244,"end":2261},{"text":"+","label":"LAB_VALUE","start":2263,"end":2264},{"text":"T-SPOT","label":"DIAGNOSTIC_PROCEDURE","start":2267,"end":2273},{"text":"positive","label":"LAB_VALUE","start":2285,"end":2293},{"text":"Real-time polymerase chain reaction","label":"DETAILED_DESCRIPTION","start":2295,"end":2330},{"text":"analysis for mycobacterium TB","label":"DIAGNOSTIC_PROCEDURE","start":2331,"end":2360},{"text":"sputum","label":"DETAILED_DESCRIPTION","start":2364,"end":2370},{"text":"positive","label":"LAB_VALUE","start":2375,"end":2383},{"text":"Acid fast stain test","label":"DIAGNOSTIC_PROCEDURE","start":2385,"end":2405},{"text":"sputum smear","label":"DETAILED_DESCRIPTION","start":2411,"end":2423},{"text":"negative","label":"LAB_VALUE","start":2428,"end":2436},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":2438,"end":2443},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":2444,"end":2463},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2465,"end":2467},{"text":"admission","label":"CLINICAL_EVENT","start":2472,"end":2481},{"text":"November 18, 2015","label":"DATE","start":2483,"end":2500},{"text":"infiltrates","label":"SIGN_SYMPTOM","start":2517,"end":2528},{"text":"upper lobe of the left lung","label":"BIOLOGICAL_STRUCTURE","start":2536,"end":2563},{"text":"left","label":"DETAILED_DESCRIPTION","start":2565,"end":2569},{"text":"pleural effusion","label":"DISEASE_DISORDER","start":2570,"end":2586},{"text":"pericardial effusion","label":"DISEASE_DISORDER","start":2592,"end":2612},{"text":"enlargement","label":"SIGN_SYMPTOM","start":2629,"end":2640},{"text":"mediastinal lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":2644,"end":2667},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":2669,"end":2678},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2679,"end":2689},{"text":"small amount","label":"QUALITATIVE_CONCEPT","start":2699,"end":2711},{"text":"fluid","label":"SIGN_SYMPTOM","start":2715,"end":2720},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2737,"end":2742},{"text":"spleen","label":"BIOLOGICAL_STRUCTURE","start":2747,"end":2753},{"text":"Serologic markers","label":"DIAGNOSTIC_PROCEDURE","start":2755,"end":2772},{"text":"negative","label":"LAB_VALUE","start":2778,"end":2786},{"text":"acute","label":"DETAILED_DESCRIPTION","start":2791,"end":2796},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":2800,"end":2807},{"text":"viral hepatitis","label":"DISEASE_DISORDER","start":2808,"end":2823},{"text":"HIV","label":"DISEASE_DISORDER","start":2825,"end":2828},{"text":"direct Coomb test","label":"DIAGNOSTIC_PROCEDURE","start":2830,"end":2847},{"text":"autoimmune hepatitis","label":"DISEASE_DISORDER","start":2853,"end":2873},{"text":"Peripheral blood","label":"DETAILED_DESCRIPTION","start":2875,"end":2891},{"text":"film and culture","label":"DIAGNOSTIC_PROCEDURE","start":2892,"end":2908},{"text":"negative","label":"LAB_VALUE","start":2914,"end":2922},{"text":"Bone marrow","label":"DETAILED_DESCRIPTION","start":2924,"end":2935},{"text":"smear and medulloculture","label":"DIAGNOSTIC_PROCEDURE","start":2936,"end":2960},{"text":"negative","label":"LAB_VALUE","start":2971,"end":2979},{"text":"antituberculosis drugs","label":"MEDICATION","start":2985,"end":3007},{"text":"admission","label":"CLINICAL_EVENT","start":3044,"end":3053},{"text":"fasting","label":"THERAPEUTIC_PROCEDURE","start":3063,"end":3070},{"text":"infusion","label":"ADMINISTRATION","start":3094,"end":3102},{"text":"fresh-frozen","label":"DETAILED_DESCRIPTION","start":3106,"end":3118},{"text":"plasma","label":"MEDICATION","start":3119,"end":3125},{"text":"platelet","label":"MEDICATION","start":3127,"end":3135},{"text":"packed red blood cells","label":"MEDICATION","start":3137,"end":3159},{"text":"intravenous","label":"ADMINISTRATION","start":3161,"end":3172},{"text":"immune globulin","label":"MEDICATION","start":3173,"end":3188},{"text":"recombinant","label":"DETAILED_DESCRIPTION","start":3190,"end":3201},{"text":"human thrombopoietin","label":"MEDICATION","start":3202,"end":3222},{"text":"omeprazole","label":"MEDICATION","start":3224,"end":3234},{"text":"polyene phosphatidylcholine","label":"MEDICATION","start":3240,"end":3267},{"text":"nutrition supportive treatment","label":"THERAPEUTIC_PROCEDURE","start":3279,"end":3309},{"text":"Five days after","label":"DATE","start":3311,"end":3326},{"text":"fasting","label":"THERAPEUTIC_PROCEDURE","start":3327,"end":3334},{"text":"November 23, 2015","label":"DATE","start":3336,"end":3353},{"text":"EMB","label":"MEDICATION","start":3400,"end":3403},{"text":"moxifloxacin","label":"MEDICATION","start":3405,"end":3417},{"text":"amikacin","label":"MEDICATION","start":3423,"end":3431},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":3464,"end":3474},{"text":"Eight days after","label":"DATE","start":3476,"end":3492},{"text":"admission","label":"CLINICAL_EVENT","start":3493,"end":3502},{"text":"November 26, 2015","label":"DATE","start":3504,"end":3521},{"text":"platelet","label":"DIAGNOSTIC_PROCEDURE","start":3528,"end":3536},{"text":"risen","label":"LAB_VALUE","start":3548,"end":3553},{"text":"INH","label":"MEDICATION","start":3565,"end":3568},{"text":"200\u200amg\/d","label":"DOSAGE","start":3570,"end":3578},{"text":"intravenously guttae","label":"ADMINISTRATION","start":3580,"end":3600},{"text":"24 days 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effusion","label":"DISEASE_DISORDER","start":3902,"end":3922},{"text":"about 4 weeks after","label":"DATE","start":3950,"end":3969},{"text":"admission","label":"CLINICAL_EVENT","start":3970,"end":3979},{"text":"recovered","label":"OUTCOME","start":3993,"end":4002},{"text":"left hospital","label":"CLINICAL_EVENT","start":4007,"end":4020},{"text":"INH","label":"MEDICATION","start":4026,"end":4029},{"text":"300\u200amg\/d","label":"DOSAGE","start":4031,"end":4039},{"text":"EMB","label":"MEDICATION","start":4042,"end":4045},{"text":"750\u200amg\/d","label":"DOSAGE","start":4047,"end":4055},{"text":"levofloxacin","label":"MEDICATION","start":4058,"end":4070},{"text":"500\u200amg\/d","label":"DOSAGE","start":4072,"end":4080},{"text":"streptomycin","label":"MEDICATION","start":4087,"end":4099},{"text":"750,000 U\/d","label":"DOSAGE","start":4101,"end":4112},{"text":"intramuscular injection","label":"ADMINISTRATION","start":4114,"end":4137},{"text":"DIC","label":"DISEASE_DISORDER","start":4167,"end":4170},{"text":"hemorrhage","label":"SIGN_SYMPTOM","start":4174,"end":4184},{"text":"8 months","label":"DURATION","start":4192,"end":4200},{"text":"follow-up","label":"CLINICAL_EVENT","start":4204,"end":4213},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":4262,"end":4267},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":4268,"end":4270},{"text":"discharge","label":"CLINICAL_EVENT","start":4281,"end":4290}],"tokens":["A ","22-year-old"," ","Tibetan"," ","man"," ","without significant past medical history"," was diagnosed with ","pulmonary tuberculosis"," (","PTB",") in a ","routine"," medical ","examination"," and received ","anti-TB therapy"," that included ","isoniazid"," (","INH",", ","300\u200amg\/d","), ","RMP"," (","450\u200amg\/d","), ","ethambutol"," (","EMB",", ","750\u200amg\/d","), and ","pyrazinamide"," (","PZA",", ","1500\u200amg\/d",").\nAfter ","1 week"," of continuous ","therapy",", he was ","admitted"," to the ","Tibet People's Hospital"," with ","nasal"," ","hemorrhage"," and the ","platelet"," (","PLT",") count was ","0.4\u200a\u00d7\u200a109\/L"," (normal range, 100\u2013300\u200a\u00d7\u200a109\/L).\n","Epistaxis"," was cured after ","symptomatic treatment",".\n","Two days later",", he developed ","hematochezia",", ","hematuria",", and ","purpura",", and required ","transfusion"," of ","fresh-frozen plasma"," and ","platelets"," in ","another local hospital",".\n","Four days later"," (","November 18, 2015","), he was ","transferred"," to the ","West China Hospital"," due to the ","ineffective"," ","treatment",".\nOn ","physical examination",", he presented with ","pallor",", ","mild"," ","jaundice"," on the ","sclera",", ","purpura",", ","tachycardia"," (","heart rate"," ","132\/min",") and ","weak breath sounds"," at the ","base of the left lung",".\n","Laboratory results"," on ","admission"," indicated ","DIC",": ","prothrombin time"," (","17.8\u200aseconds","; normal range, 9.6\u201312.8\u200aseconds), ","international normalized ratio"," (","1.53","; normal range, 0.88\u20131.15), ","fibrinogen"," (","1.13\u200ag\/L","; normal range, 2.0\u20134.0\u200ag\/L), ","D-dimers"," (","23.45\u200amg\/L","; normal range, <0.55\u200amg\/L), ","fibrin degradation product"," (","60.4\u200amg\/L","; normal range,<5\u200amg\/L), and ","PLT"," (","2\u200a\u00d7\u200a109\/L","; normal range, 100\u2013300\u200a\u00d7\u200a109\/L).\nOther abnormal data were as follows: ","white blood cell"," (","WBC",", ","48.38\u200a\u00d7\u200a109\/L","; normal range, 3.5\u20139.5), ","hemoglobin"," (","65\u200ag\/L","; normal range, 130\u2013175\u200ag\/L), ","total bilirubin"," (","30.8 umol\/L","; normal range, 5.0\u201328.0\u200aumol\/L), ","direct bilirubin"," (","16.6 umol\/L","; normal range, < 8.8 umol\/L), ","aspartate aminotransferase"," (","75 U\/L","; normal range, <40 U\/L), ","alanine aminotransferase"," (","293 U\/L","; normal range, <50 U\/L), ","lactate dehydrogenase"," (","380 U\/L","; normal range, 110\u2013220\u200aU\/L), ","serum urea nitrogen"," (","13.01 mmol\/L","; normal range, 3.2\u20137.79 mmol\/L), ","C-reactive protein"," (","16.70\u200amg\/L","; normal range, <5\u200amg\/L), ","complement 3"," (","0.41\u200ag\/L","; normal range, 0.785\u20131.520\u200ag\/L), and ","complement 4"," (","0.0797\u200ag\/L","; normal range, 0.145\u20130.360\u200ag\/L).\nRoutine ","urine test"," showed ","blood cell"," ",">330\u200aCell\/uL",", ","leukocyte"," ","250 Cell\/uL",", ","protein"," ","2\u200ag\/L",", and ","urobilinogen"," ","70 umol\/L",".\nRoutine ","stool test"," showed ","red blood cell"," ","4+\/HP",", ","white blood cell"," ","1+\/HP",", ","occult blood test"," (","+",").\n","T-SPOT"," result was ","positive",".\n","Real-time polymerase chain reaction"," ","analysis for mycobacterium TB"," on ","sputum"," was ","positive",".\n","Acid fast stain test"," of a ","sputum smear"," was ","negative",".\n","Chest"," ","computed tomography"," (","CT",") on ","admission"," (","November 18, 2015",") (Fig.1) showed ","infiltrates"," on the ","upper lobe of the left lung",", ","left"," ","pleural effusion",", and ","pericardial effusion",", accompanied by ","enlargement"," of ","mediastinal lymph nodes",".\n","Abdominal"," ","ultrasound"," showed a ","small amount"," of ","fluid"," adjacent to the ","liver"," and ","spleen",".\n","Serologic markers"," were ","negative"," for ","acute"," or ","chronic"," ","viral hepatitis",", ","HIV",", ","direct Coomb test",", and ","autoimmune hepatitis",".\n","Peripheral blood"," ","film and culture"," were ","negative",".\n","Bone marrow"," ","smear and medulloculture"," were also ","negative",".\nThe ","antituberculosis drugs"," were discontinued immediately after ","admission",".\nBesides ","fasting",", he was initiated with ","infusion"," of ","fresh-frozen"," ","plasma",", ","platelet",", ","packed red blood cells",", ","intravenous"," ","immune globulin",", ","recombinant"," ","human thrombopoietin",", ","omeprazole",", and ","polyene phosphatidylcholine"," as well as ","nutrition supportive treatment",".\n","Five days after"," ","fasting"," (","November 23, 2015","), the patient started a therapy consisting of ","EMB",", ","moxifloxacin",", and ","amikacin",", while he had no further active ","hemorrhage",".\n","Eight days after"," ","admission"," (","November 26, 2015","), the ","platelet"," counts had ","risen"," gradually.\n","INH"," (","200\u200amg\/d",", ","intravenously guttae",") was administered on ","24 days after"," ","admission"," (","December 11, 2015","), while his ","liver function tests"," and ","platelet"," counts returned to ","normal",".\nThe main ","laboratory features"," are summarized in Table 1.\n","One month later"," (","December 17, 2015","), reviewed ","chest"," ","CT"," (Fig.1) indicated the ","infiltration",", ","hydrothorax",", and ","pericardial effusion"," were absorbed well.\nAlmost ","about 4 weeks after"," ","admission",", the patient ","recovered"," and ","left hospital"," with ","INH"," (","300\u200amg\/d","), ","EMB"," (","750\u200amg\/d","), ","levofloxacin"," (","500\u200amg\/d","), and ","streptomycin"," (","750,000 U\/d",", ","intramuscular injection",").\nThere was no recurrence of ","DIC"," or ","hemorrhage"," during ","8 months"," of ","follow-up",".\nUnfortunately, the patient refused a follow-up ","chest"," ","CT"," after his ","discharge",".\nTable \u200b2 shows the timeline of this case.\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,26,0,26,0,22,0,24,0,46,0,46,0,46,0,29,0,46,0,29,0,46,0,46,0,29,0,46,0,46,0,29,0,32,0,18,0,13,0,48,0,12,0,69,0,24,0,24,0,42,0,69,0,75,0,19,0,69,0,69,0,69,0,75,0,46,0,46,0,48,0,19,0,19,0,13,0,48,0,59,0,75,0,24,0,69,0,63,0,69,0,12,0,69,0,69,0,24,0,42,0,69,0,12,0,24,0,13,0,26,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,22,0,42,0,24,0,22,0,42,0,12,0,24,0,24,0,13,0,19,0,69,0,12,0,22,0,26,0,26,0,69,0,12,0,12,0,24,0,59,0,69,0,12,0,12,0,24,0,42,0,22,0,22,0,26,0,26,0,24,0,26,0,22,0,24,0,42,0,22,0,24,0,42,0,46,0,13,0,75,0,4,0,22,0,46,0,46,0,46,0,4,0,46,0,22,0,46,0,46,0,46,0,75,0,19,0,75,0,19,0,46,0,46,0,46,0,69,0,19,0,13,0,19,0,24,0,42,0,46,0,29,0,4,0,19,0,13,0,19,0,24,0,24,0,42,0,24,0,19,0,19,0,12,0,24,0,69,0,69,0,26,0,19,0,13,0,56,0,13,0,46,0,29,0,46,0,29,0,46,0,29,0,46,0,29,0,4,0,26,0,69,0,32,0,13,0,12,0,24,0,13,0]}
-{"full_text":"A 34-year-old Hispanic male without significant past medical history presented to our hospital with a one month history of cough; productive of whitish sputum.\nAt presentation, he denied fever, chills, night sweats, chest pain, hemoptysis, back pain, recent travel or sick contacts.\nHe reported that he had approximately a 15\u201320 pound weight loss during the last six months.\nHe denied smoking, socially drank alcohol, and had unprotected sexual intercourse with multiple partners in the past.\nOn admission, his temperature was 97.9\u00b0F; heart rate was 85 beats per minute, respiratory rate was 16 breaths per minute, blood pressure was 107\/66 mm Hg, and oxygen saturation was 100% on room air.\nExamination showed oral thrush, decreased breath sounds and crackles on the right lower lung base.\nNo cutaneous lesions were reported and the rest of clinical examination was unremarkable.\nHis complete blood count (CBC) showed hemoglobin of 9.7 g\/dL, WBCs 2.3\u00d7109\/L, and platelets of 164\u00d7109\/L.\nHis creatinine was 0.62 mg\/dL, and blood urea nitrogen was 10 mg\/dL.\nRadiograph of the chest showed extensive right and left perihilar opacity more on the right side, and computed tomography (CT) scan of the chest showed a right sided large perihilar mass (Figure 1) with multiple thoracic and lumbar vertebrae, ribs, and sternal tiny lytic lesions consistent with bony metastasis (Figure 2).\nBlood and sputum cultures were negative.\nTuberculosis was ruled out by three consecutive negative sputum smears for acid fast bacilli and a negative QUANTIferon gold test.\nHe tested positive for human immunodeficiency virus (HIV) and his CD4 counts came back at 7 cells\/uL.\nHe was started on prophylaxis with bactrim 80\u2013160 mg daily and azithromycin 1200 mg weekly for opportunistic infections.\nBronchoscopy with biopsy was performed but was unrevealing and he underwent a video assisted mediastinoscopy with biopsies of the right hilar mass.\nPathology showed spindle cells positive for CD34, BCL2, vimentin, and HHV-8 with diffuse positivity for CD31 diagnostic of KS.\nHe started treatment with HAART in the form of emtricitabine and tenofovir disoproxil fumarate 200\/300 mg and dolutegravir 50 mg.\nThe patient was actively involved in decisions regarding management options.\nHe favored HAART isolated regimen without additional chemotherapy.\nHis condition showed continuing clinical improvement; a repeat CT scan of the chest at three months showed profound regression of the disease with disappearance of most of the lesions (Figure 3).\n","ner_info":[{"text":"34-year-old","label":"AGE","start":2,"end":13},{"text":"Hispanic","label":"PERSONAL_BACKGROUND","start":14,"end":22},{"text":"male","label":"SEX","start":23,"end":27},{"text":"without significant past medical history","label":"HISTORY","start":28,"end":68},{"text":"presented","label":"CLINICAL_EVENT","start":69,"end":78},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":86,"end":94},{"text":"one month","label":"DURATION","start":102,"end":111},{"text":"cough","label":"SIGN_SYMPTOM","start":123,"end":128},{"text":"whitish","label":"COLOR","start":144,"end":151},{"text":"sputum","label":"SIGN_SYMPTOM","start":152,"end":158},{"text":"fever","label":"SIGN_SYMPTOM","start":187,"end":192},{"text":"chills","label":"SIGN_SYMPTOM","start":194,"end":200},{"text":"night sweats","label":"SIGN_SYMPTOM","start":202,"end":214},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":216,"end":221},{"text":"pain","label":"SIGN_SYMPTOM","start":222,"end":226},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":228,"end":238},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":240,"end":244},{"text":"pain","label":"SIGN_SYMPTOM","start":245,"end":249},{"text":"recent","label":"DETAILED_DESCRIPTION","start":251,"end":257},{"text":"travel","label":"CLINICAL_EVENT","start":258,"end":264},{"text":"sick","label":"DETAILED_DESCRIPTION","start":268,"end":272},{"text":"contacts","label":"CLINICAL_EVENT","start":273,"end":281},{"text":"15\u201320 pound","label":"LAB_VALUE","start":323,"end":334},{"text":"weight loss","label":"SIGN_SYMPTOM","start":335,"end":346},{"text":"last six months","label":"DURATION","start":358,"end":373},{"text":"denied smoking","label":"HISTORY","start":378,"end":392},{"text":"drank alcohol","label":"HISTORY","start":403,"end":416},{"text":"had unprotected sexual intercourse with multiple partners","label":"HISTORY","start":422,"end":479},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":511,"end":522},{"text":"97.9\u00b0F","label":"LAB_VALUE","start":527,"end":533},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":535,"end":545},{"text":"85 beats per minute","label":"LAB_VALUE","start":550,"end":569},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":571,"end":587},{"text":"16 breaths per minute","label":"LAB_VALUE","start":592,"end":613},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":615,"end":629},{"text":"107\/66 mm Hg","label":"LAB_VALUE","start":634,"end":646},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":652,"end":669},{"text":"100%","label":"LAB_VALUE","start":674,"end":678},{"text":"room air","label":"DETAILED_DESCRIPTION","start":682,"end":690},{"text":"Examination","label":"DIAGNOSTIC_PROCEDURE","start":692,"end":703},{"text":"oral","label":"BIOLOGICAL_STRUCTURE","start":711,"end":715},{"text":"thrush","label":"SIGN_SYMPTOM","start":716,"end":722},{"text":"decreased","label":"LAB_VALUE","start":724,"end":733},{"text":"breath sounds","label":"DIAGNOSTIC_PROCEDURE","start":734,"end":747},{"text":"crackles","label":"SIGN_SYMPTOM","start":752,"end":760},{"text":"right lower lung base","label":"BIOLOGICAL_STRUCTURE","start":768,"end":789},{"text":"cutaneous","label":"BIOLOGICAL_STRUCTURE","start":794,"end":803},{"text":"lesions","label":"SIGN_SYMPTOM","start":804,"end":811},{"text":"clinical examination","label":"DIAGNOSTIC_PROCEDURE","start":842,"end":862},{"text":"unremarkable","label":"LAB_VALUE","start":867,"end":879},{"text":"complete blood count","label":"DIAGNOSTIC_PROCEDURE","start":885,"end":905},{"text":"CBC","label":"DIAGNOSTIC_PROCEDURE","start":907,"end":910},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":919,"end":929},{"text":"9.7 g\/dL","label":"LAB_VALUE","start":933,"end":941},{"text":"WBCs","label":"DIAGNOSTIC_PROCEDURE","start":943,"end":947},{"text":"2.3\u00d7109\/L","label":"LAB_VALUE","start":948,"end":957},{"text":"platelets","label":"DIAGNOSTIC_PROCEDURE","start":963,"end":972},{"text":"164\u00d7109\/L","label":"LAB_VALUE","start":976,"end":985},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":991,"end":1001},{"text":"0.62 mg\/dL","label":"LAB_VALUE","start":1006,"end":1016},{"text":"blood urea nitrogen","label":"DIAGNOSTIC_PROCEDURE","start":1022,"end":1041},{"text":"10 mg\/dL","label":"LAB_VALUE","start":1046,"end":1054},{"text":"Radiograph","label":"DIAGNOSTIC_PROCEDURE","start":1056,"end":1066},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1074,"end":1079},{"text":"extensive","label":"SEVERITY","start":1087,"end":1096},{"text":"right","label":"BIOLOGICAL_STRUCTURE","start":1097,"end":1102},{"text":"left","label":"BIOLOGICAL_STRUCTURE","start":1107,"end":1111},{"text":"perihilar","label":"BIOLOGICAL_STRUCTURE","start":1112,"end":1121},{"text":"opacity","label":"SIGN_SYMPTOM","start":1122,"end":1129},{"text":"more on the right side","label":"BIOLOGICAL_STRUCTURE","start":1130,"end":1152},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1158,"end":1177},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1179,"end":1181},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1195,"end":1200},{"text":"right sided","label":"BIOLOGICAL_STRUCTURE","start":1210,"end":1221},{"text":"large","label":"SEVERITY","start":1222,"end":1227},{"text":"perihilar","label":"BIOLOGICAL_STRUCTURE","start":1228,"end":1237},{"text":"mass","label":"SIGN_SYMPTOM","start":1238,"end":1242},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1259,"end":1267},{"text":"thoracic","label":"BIOLOGICAL_STRUCTURE","start":1268,"end":1276},{"text":"lumbar","label":"BIOLOGICAL_STRUCTURE","start":1281,"end":1287},{"text":"vertebrae","label":"BIOLOGICAL_STRUCTURE","start":1288,"end":1297},{"text":"ribs","label":"BIOLOGICAL_STRUCTURE","start":1299,"end":1303},{"text":"sternal","label":"BIOLOGICAL_STRUCTURE","start":1309,"end":1316},{"text":"tiny","label":"SEVERITY","start":1317,"end":1321},{"text":"lytic","label":"DETAILED_DESCRIPTION","start":1322,"end":1327},{"text":"lesions","label":"SIGN_SYMPTOM","start":1328,"end":1335},{"text":"bony","label":"BIOLOGICAL_STRUCTURE","start":1352,"end":1356},{"text":"metastasis","label":"DISEASE_DISORDER","start":1357,"end":1367},{"text":"Blood","label":"BIOLOGICAL_STRUCTURE","start":1380,"end":1385},{"text":"sputum","label":"BIOLOGICAL_STRUCTURE","start":1390,"end":1396},{"text":"cultures","label":"DIAGNOSTIC_PROCEDURE","start":1397,"end":1405},{"text":"negative","label":"LAB_VALUE","start":1411,"end":1419},{"text":"Tuberculosis","label":"DISEASE_DISORDER","start":1421,"end":1433},{"text":"three consecutive","label":"DETAILED_DESCRIPTION","start":1451,"end":1468},{"text":"negative","label":"LAB_VALUE","start":1469,"end":1477},{"text":"sputum smears","label":"DIAGNOSTIC_PROCEDURE","start":1478,"end":1491},{"text":"acid fast bacilli","label":"DETAILED_DESCRIPTION","start":1496,"end":1513},{"text":"negative","label":"LAB_VALUE","start":1520,"end":1528},{"text":"QUANTIferon gold test","label":"DIAGNOSTIC_PROCEDURE","start":1529,"end":1550},{"text":"positive","label":"LAB_VALUE","start":1562,"end":1570},{"text":"human immunodeficiency virus","label":"DIAGNOSTIC_PROCEDURE","start":1575,"end":1603},{"text":"HIV","label":"DIAGNOSTIC_PROCEDURE","start":1605,"end":1608},{"text":"CD4 counts","label":"DIAGNOSTIC_PROCEDURE","start":1618,"end":1628},{"text":"7 cells\/uL","label":"LAB_VALUE","start":1642,"end":1652},{"text":"prophylaxis","label":"THERAPEUTIC_PROCEDURE","start":1672,"end":1683},{"text":"bactrim","label":"MEDICATION","start":1689,"end":1696},{"text":"80\u2013160 mg daily","label":"DOSAGE","start":1697,"end":1712},{"text":"azithromycin","label":"MEDICATION","start":1717,"end":1729},{"text":"1200 mg weekly","label":"DOSAGE","start":1730,"end":1744},{"text":"Bronchoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1775,"end":1787},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1793,"end":1799},{"text":"unrevealing","label":"LAB_VALUE","start":1822,"end":1833},{"text":"video assisted","label":"DETAILED_DESCRIPTION","start":1853,"end":1867},{"text":"mediastinoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1868,"end":1883},{"text":"biopsies","label":"DIAGNOSTIC_PROCEDURE","start":1889,"end":1897},{"text":"right hilar","label":"BIOLOGICAL_STRUCTURE","start":1905,"end":1916},{"text":"mass","label":"SIGN_SYMPTOM","start":1917,"end":1921},{"text":"Pathology","label":"DIAGNOSTIC_PROCEDURE","start":1923,"end":1932},{"text":"spindle cells","label":"SIGN_SYMPTOM","start":1940,"end":1953},{"text":"positive","label":"LAB_VALUE","start":1954,"end":1962},{"text":"CD34","label":"DIAGNOSTIC_PROCEDURE","start":1967,"end":1971},{"text":"BCL2","label":"DIAGNOSTIC_PROCEDURE","start":1973,"end":1977},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":1979,"end":1987},{"text":"HHV-8","label":"DIAGNOSTIC_PROCEDURE","start":1993,"end":1998},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2004,"end":2011},{"text":"positivity","label":"LAB_VALUE","start":2012,"end":2022},{"text":"CD31","label":"DIAGNOSTIC_PROCEDURE","start":2027,"end":2031},{"text":"KS","label":"DISEASE_DISORDER","start":2046,"end":2048},{"text":"HAART","label":"MEDICATION","start":2076,"end":2081},{"text":"emtricitabine and tenofovir disoproxil fumarate","label":"MEDICATION","start":2097,"end":2144},{"text":"200\/300 mg","label":"LAB_VALUE","start":2145,"end":2155},{"text":"dolutegravir","label":"MEDICATION","start":2160,"end":2172},{"text":"50 mg","label":"LAB_VALUE","start":2173,"end":2178},{"text":"actively involved","label":"DETAILED_DESCRIPTION","start":2196,"end":2213},{"text":"decisions","label":"CLINICAL_EVENT","start":2217,"end":2226},{"text":"management options","label":"DETAILED_DESCRIPTION","start":2237,"end":2255},{"text":"HAART","label":"MEDICATION","start":2268,"end":2273},{"text":"additional chemotherapy","label":"MEDICATION","start":2299,"end":2322},{"text":"clinical improvement","label":"SIGN_SYMPTOM","start":2356,"end":2376},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2387,"end":2389},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2402,"end":2407},{"text":"three months","label":"DATE","start":2411,"end":2423},{"text":"regression","label":"SIGN_SYMPTOM","start":2440,"end":2450},{"text":"lesions","label":"SIGN_SYMPTOM","start":2500,"end":2507}],"tokens":["A ","34-year-old"," ","Hispanic"," ","male"," ","without significant past medical history"," ","presented"," to our ","hospital"," with a ","one month"," history of ","cough","; productive of ","whitish"," ","sputum",".\nAt presentation, he denied ","fever",", ","chills",", ","night sweats",", ","chest"," ","pain",", ","hemoptysis",", ","back"," ","pain",", ","recent"," ","travel"," or ","sick"," ","contacts",".\nHe reported that he had approximately a ","15\u201320 pound"," ","weight loss"," during the ","last six months",".\nHe ","denied smoking",", socially ","drank alcohol",", and ","had unprotected sexual intercourse with multiple partners"," in the past.\nOn admission, his ","temperature"," was ","97.9\u00b0F","; ","heart rate"," was ","85 beats per minute",", ","respiratory rate"," was ","16 breaths per minute",", ","blood pressure"," was ","107\/66 mm Hg",", and ","oxygen saturation"," was ","100%"," on ","room air",".\n","Examination"," showed ","oral"," ","thrush",", ","decreased"," ","breath sounds"," and ","crackles"," on the ","right lower lung base",".\nNo ","cutaneous"," ","lesions"," were reported and the rest of ","clinical examination"," was ","unremarkable",".\nHis ","complete blood count"," (","CBC",") showed ","hemoglobin"," of ","9.7 g\/dL",", ","WBCs"," ","2.3\u00d7109\/L",", and ","platelets"," of ","164\u00d7109\/L",".\nHis ","creatinine"," was ","0.62 mg\/dL",", and ","blood urea nitrogen"," was ","10 mg\/dL",".\n","Radiograph"," of the ","chest"," showed ","extensive"," ","right"," and ","left"," ","perihilar"," ","opacity"," ","more on the right side",", and ","computed tomography"," (","CT",") scan of the ","chest"," showed a ","right sided"," ","large"," ","perihilar"," ","mass"," (Figure 1) with ","multiple"," ","thoracic"," and ","lumbar"," ","vertebrae",", ","ribs",", and ","sternal"," ","tiny"," ","lytic"," ","lesions"," consistent with ","bony"," ","metastasis"," (Figure 2).\n","Blood"," and ","sputum"," ","cultures"," were ","negative",".\n","Tuberculosis"," was ruled out by ","three consecutive"," ","negative"," ","sputum smears"," for ","acid fast bacilli"," and a ","negative"," ","QUANTIferon gold test",".\nHe tested ","positive"," for ","human immunodeficiency virus"," (","HIV",") and his ","CD4 counts"," came back at ","7 cells\/uL",".\nHe was started on ","prophylaxis"," with ","bactrim"," ","80\u2013160 mg daily"," and ","azithromycin"," ","1200 mg weekly"," for opportunistic infections.\n","Bronchoscopy"," with ","biopsy"," was performed but was ","unrevealing"," and he underwent a ","video assisted"," ","mediastinoscopy"," with ","biopsies"," of the ","right hilar"," ","mass",".\n","Pathology"," showed ","spindle cells"," ","positive"," for ","CD34",", ","BCL2",", ","vimentin",", and ","HHV-8"," with ","diffuse"," ","positivity"," for ","CD31"," diagnostic of ","KS",".\nHe started treatment with ","HAART"," in the form of ","emtricitabine and tenofovir disoproxil fumarate"," ","200\/300 mg"," and ","dolutegravir"," ","50 mg",".\nThe patient was ","actively involved"," in ","decisions"," regarding ","management options",".\nHe favored ","HAART"," isolated regimen without ","additional chemotherapy",".\nHis condition showed continuing ","clinical improvement","; a repeat ","CT"," scan of the ","chest"," at ","three months"," showed profound ","regression"," of the disease with disappearance of most of the ","lesions"," (Figure 3).\n"],"ner_labels":[0,5,0,58,0,65,0,39,0,13,0,48,0,32,0,69,0,15,0,69,0,69,0,69,0,69,0,12,0,69,0,69,0,12,0,69,0,22,0,13,0,22,0,13,0,42,0,69,0,32,0,39,0,39,0,39,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,12,0,69,0,42,0,24,0,69,0,12,0,12,0,69,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,12,0,63,0,12,0,12,0,12,0,69,0,12,0,24,0,24,0,12,0,12,0,63,0,12,0,69,0,22,0,12,0,12,0,12,0,12,0,12,0,63,0,22,0,69,0,12,0,26,0,12,0,12,0,24,0,42,0,26,0,22,0,42,0,24,0,22,0,42,0,24,0,42,0,24,0,24,0,24,0,42,0,75,0,46,0,29,0,46,0,29,0,24,0,24,0,42,0,22,0,24,0,24,0,12,0,69,0,24,0,69,0,42,0,24,0,24,0,24,0,24,0,22,0,42,0,24,0,26,0,46,0,46,0,42,0,46,0,42,0,22,0,13,0,22,0,46,0,46,0,69,0,24,0,12,0,19,0,69,0,69,0]}
-{"full_text":"A 58-year-old white American male presented to the emergency department (ED) with acute onset of confusion, disorientation, inability to walk steadily, and dehydration with associated generalized weakness, polyuria, and polydipsia over the previous week.\nHe had been diagnosed with CML six years earlier, with no hematological response to multiple chemotherapy regimens; he was at that time on treatment with allopurinol and awaiting allogenic bone marrow transplant.\nVital signs on admission to the ED included heart rate of 104 bpm, blood pressure of 122\/68 mm Hg and temperature of 99.7\u00b0F (37.6\u00b0C).\nThere were no remarkable findings on physical examination except for altered mental status and dehydration.\nLaboratory evaluations were: hemoglobin 13.3 g\/dL, white blood cell count 18.3\u00d7109\/L (neutrophils 79.6%, lymphocytes 7.2%, and monocytes 8.3%), and platelet count 910\u00d7109\/L.\nSerum levels were: calcium 18.6 mg\/dL, phosphate 4.6 mg\/dL, sodium 135 mEq\/L, potassium 2.7 mg\/dL, albumin 4.0 g\/dL, creatinine 2.2 mg\/dL, total bilirubin 0.9 mg\/dL, alkaline phosphatase 125 IU\/L, aspartate aminotransferase 41 IU\/L, and alanine aminotransferase 71 IU\/L.\nSPEP was negative for an M spike.\nHormones and vitamins levels were: PTH 8.5 pg\/L (15\u201365 pg\/L), PHTrP 1.4 pg\/L (<2 pg\/L), 25-OH vitamin D 30.4 ng\/mL (20\u201350 ng\/mL) and 1,25 OH vitamin D3 33.7 ng\/mL (18\u201364) ng\/mL.\nChest CT scan showed diffuse lytic lesions and bone destruction throughout the visualized thoracic skeleton, concerning for diffuse bone marrow involvement.\nThe clinical history and biochemical findings led to a diagnosis of CML-associated hypercalcemia in the context of a blast phase.\nTreatment with aggressive hydration with 0.9% saline and calcitonin 400 units subcutaneous was administered.\nAdditionally, zoledronic acid 3.3 mg intravenous, adjusted for renal insufficiency, was given.\nAfter five days of treatment, normalization of symptoms and serum calcium levels were achieved.\nAfter discharge from the hospital, the patient continued with palliative treatment with ponatinib and radiotherapy.\nAcceptable serum calcium levels were maintained with zoledronic acid 4 mg every eight weeks.\nDespite these therapies, his cancer progressed and he passed away approximately eight months after the initial admission for hypercalcemia.\n","ner_info":[{"text":"58-year-old","label":"AGE","start":2,"end":13},{"text":"white","label":"PERSONAL_BACKGROUND","start":14,"end":19},{"text":"American","label":"PERSONAL_BACKGROUND","start":20,"end":28},{"text":"male","label":"SEX","start":29,"end":33},{"text":"presented","label":"CLINICAL_EVENT","start":34,"end":43},{"text":"emergency department","label":"NONBIOLOGICAL_LOCATION","start":51,"end":71},{"text":"ED","label":"NONBIOLOGICAL_LOCATION","start":73,"end":75},{"text":"acute onset","label":"DETAILED_DESCRIPTION","start":82,"end":93},{"text":"confusion","label":"SIGN_SYMPTOM","start":97,"end":106},{"text":"disorientation","label":"SIGN_SYMPTOM","start":108,"end":122},{"text":"inability to walk steadily","label":"SIGN_SYMPTOM","start":124,"end":150},{"text":"dehydration","label":"SIGN_SYMPTOM","start":156,"end":167},{"text":"weakness","label":"SIGN_SYMPTOM","start":196,"end":204},{"text":"polyuria","label":"SIGN_SYMPTOM","start":206,"end":214},{"text":"polydipsia","label":"SIGN_SYMPTOM","start":220,"end":230},{"text":"over the previous week","label":"DURATION","start":231,"end":253},{"text":"diagnosed","label":"CLINICAL_EVENT","start":267,"end":276},{"text":"CML","label":"DISEASE_DISORDER","start":282,"end":285},{"text":"six years earlier","label":"DATE","start":286,"end":303},{"text":"hematological response","label":"SIGN_SYMPTOM","start":313,"end":335},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":339,"end":347},{"text":"chemotherapy","label":"MEDICATION","start":348,"end":360},{"text":"regimens","label":"DETAILED_DESCRIPTION","start":361,"end":369},{"text":"allopurinol","label":"MEDICATION","start":409,"end":420},{"text":"awaiting","label":"CLINICAL_EVENT","start":425,"end":433},{"text":"allogenic","label":"DETAILED_DESCRIPTION","start":434,"end":443},{"text":"bone marrow transplant","label":"THERAPEUTIC_PROCEDURE","start":444,"end":466},{"text":"Vital signs","label":"DIAGNOSTIC_PROCEDURE","start":468,"end":479},{"text":"admission","label":"CLINICAL_EVENT","start":483,"end":492},{"text":"ED","label":"NONBIOLOGICAL_LOCATION","start":500,"end":502},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":512,"end":522},{"text":"104 bpm","label":"LAB_VALUE","start":526,"end":533},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":535,"end":549},{"text":"122\/68 mm Hg","label":"LAB_VALUE","start":553,"end":565},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":570,"end":581},{"text":"99.7\u00b0F","label":"LAB_VALUE","start":585,"end":591},{"text":"37.6\u00b0C","label":"LAB_VALUE","start":593,"end":599},{"text":"no remarkable findings","label":"LAB_VALUE","start":613,"end":635},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":639,"end":659},{"text":"altered mental status","label":"SIGN_SYMPTOM","start":671,"end":692},{"text":"dehydration","label":"SIGN_SYMPTOM","start":697,"end":708},{"text":"Laboratory evaluations","label":"DIAGNOSTIC_PROCEDURE","start":710,"end":732},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":739,"end":749},{"text":"13.3 g\/dL","label":"LAB_VALUE","start":750,"end":759},{"text":"white blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":761,"end":783},{"text":"18.3\u00d7109\/L","label":"LAB_VALUE","start":784,"end":794},{"text":"neutrophils 79.6%","label":"LAB_VALUE","start":796,"end":813},{"text":"lymphocytes 7.2%","label":"LAB_VALUE","start":815,"end":831},{"text":"monocytes 8.3%","label":"LAB_VALUE","start":837,"end":851},{"text":"platelet count","label":"DIAGNOSTIC_PROCEDURE","start":858,"end":872},{"text":"910\u00d7109\/L","label":"LAB_VALUE","start":873,"end":882},{"text":"Serum levels","label":"DIAGNOSTIC_PROCEDURE","start":884,"end":896},{"text":"calcium","label":"DIAGNOSTIC_PROCEDURE","start":903,"end":910},{"text":"18.6 mg\/dL","label":"LAB_VALUE","start":911,"end":921},{"text":"phosphate","label":"DIAGNOSTIC_PROCEDURE","start":923,"end":932},{"text":"4.6 mg\/dL","label":"LAB_VALUE","start":933,"end":942},{"text":"sodium","label":"DIAGNOSTIC_PROCEDURE","start":944,"end":950},{"text":"135 mEq\/L","label":"LAB_VALUE","start":951,"end":960},{"text":"potassium","label":"DIAGNOSTIC_PROCEDURE","start":962,"end":971},{"text":"2.7 mg\/dL","label":"LAB_VALUE","start":972,"end":981},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":983,"end":990},{"text":"4.0 g\/dL","label":"LAB_VALUE","start":991,"end":999},{"text":"creatinine","label":"DIAGNOSTIC_PROCEDURE","start":1001,"end":1011},{"text":"2.2 mg\/dL","label":"LAB_VALUE","start":1012,"end":1021},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1023,"end":1038},{"text":"0.9 mg\/dL","label":"LAB_VALUE","start":1039,"end":1048},{"text":"alkaline phosphatase","label":"DIAGNOSTIC_PROCEDURE","start":1050,"end":1070},{"text":"125 IU\/L","label":"LAB_VALUE","start":1071,"end":1079},{"text":"aspartate aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1081,"end":1107},{"text":"41 IU\/L","label":"LAB_VALUE","start":1108,"end":1115},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":1121,"end":1145},{"text":"71 IU\/L","label":"LAB_VALUE","start":1146,"end":1153},{"text":"SPEP","label":"DIAGNOSTIC_PROCEDURE","start":1155,"end":1159},{"text":"negative for an M spike","label":"LAB_VALUE","start":1164,"end":1187},{"text":"Hormones and vitamins levels","label":"DIAGNOSTIC_PROCEDURE","start":1189,"end":1217},{"text":"PTH","label":"DIAGNOSTIC_PROCEDURE","start":1224,"end":1227},{"text":"8.5 pg\/L","label":"LAB_VALUE","start":1228,"end":1236},{"text":"PHTrP","label":"DIAGNOSTIC_PROCEDURE","start":1251,"end":1256},{"text":"1.4 pg\/L","label":"LAB_VALUE","start":1257,"end":1265},{"text":"25-OH vitamin D","label":"DIAGNOSTIC_PROCEDURE","start":1277,"end":1292},{"text":"30.4 ng\/mL","label":"LAB_VALUE","start":1293,"end":1303},{"text":"1,25 OH vitamin D3","label":"DIAGNOSTIC_PROCEDURE","start":1322,"end":1340},{"text":"33.7 ng\/mL","label":"LAB_VALUE","start":1341,"end":1351},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1367,"end":1372},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":1373,"end":1380},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":1388,"end":1395},{"text":"lytic","label":"DETAILED_DESCRIPTION","start":1396,"end":1401},{"text":"lesions","label":"SIGN_SYMPTOM","start":1402,"end":1409},{"text":"bone destruction","label":"SIGN_SYMPTOM","start":1414,"end":1430},{"text":"thoracic skeleton","label":"BIOLOGICAL_STRUCTURE","start":1457,"end":1474},{"text":"bone marrow involvement","label":"SIGN_SYMPTOM","start":1499,"end":1522},{"text":"diagnosis","label":"CLINICAL_EVENT","start":1579,"end":1588},{"text":"CML","label":"DISEASE_DISORDER","start":1592,"end":1595},{"text":"hypercalcemia","label":"SIGN_SYMPTOM","start":1607,"end":1620},{"text":"blast phase","label":"SIGN_SYMPTOM","start":1641,"end":1652},{"text":"aggressive","label":"DETAILED_DESCRIPTION","start":1669,"end":1679},{"text":"hydration","label":"THERAPEUTIC_PROCEDURE","start":1680,"end":1689},{"text":"0.9%","label":"LAB_VALUE","start":1695,"end":1699},{"text":"saline","label":"MEDICATION","start":1700,"end":1706},{"text":"calcitonin","label":"MEDICATION","start":1711,"end":1721},{"text":"400 units","label":"DOSAGE","start":1722,"end":1731},{"text":"subcutaneous","label":"ADMINISTRATION","start":1732,"end":1744},{"text":"zoledronic acid","label":"MEDICATION","start":1777,"end":1792},{"text":"3.3 mg","label":"DOSAGE","start":1793,"end":1799},{"text":"intravenous","label":"ADMINISTRATION","start":1800,"end":1811},{"text":"adjusted for renal insufficiency","label":"DETAILED_DESCRIPTION","start":1813,"end":1845},{"text":"After five days","label":"DURATION","start":1858,"end":1873},{"text":"normalization","label":"LAB_VALUE","start":1888,"end":1901},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1905,"end":1913},{"text":"serum calcium levels","label":"DIAGNOSTIC_PROCEDURE","start":1918,"end":1938},{"text":"discharge","label":"CLINICAL_EVENT","start":1960,"end":1969},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1979,"end":1987},{"text":"palliative treatment","label":"THERAPEUTIC_PROCEDURE","start":2016,"end":2036},{"text":"ponatinib","label":"MEDICATION","start":2042,"end":2051},{"text":"radiotherapy","label":"THERAPEUTIC_PROCEDURE","start":2056,"end":2068},{"text":"serum calcium levels","label":"DIAGNOSTIC_PROCEDURE","start":2081,"end":2101},{"text":"maintained","label":"LAB_VALUE","start":2107,"end":2117},{"text":"zoledronic acid","label":"MEDICATION","start":2123,"end":2138},{"text":"4 mg every eight weeks","label":"DOSAGE","start":2139,"end":2161},{"text":"cancer","label":"DISEASE_DISORDER","start":2192,"end":2198},{"text":"passed away","label":"OUTCOME","start":2217,"end":2228},{"text":"eight months after","label":"DATE","start":2243,"end":2261}],"tokens":["A ","58-year-old"," ","white"," ","American"," ","male"," ","presented"," to the ","emergency department"," (","ED",") with ","acute onset"," of ","confusion",", ","disorientation",", ","inability to walk steadily",", and ","dehydration"," with associated generalized ","weakness",", ","polyuria",", and ","polydipsia"," ","over the previous week",".\nHe had been ","diagnosed"," with ","CML"," ","six years earlier",", with no ","hematological response"," to ","multiple"," ","chemotherapy"," ","regimens","; he was at that time on treatment with ","allopurinol"," and ","awaiting"," ","allogenic"," ","bone marrow transplant",".\n","Vital signs"," on ","admission"," to the ","ED"," included ","heart rate"," of ","104 bpm",", ","blood pressure"," of ","122\/68 mm Hg"," and ","temperature"," of ","99.7\u00b0F"," (","37.6\u00b0C",").\nThere were ","no remarkable findings"," on ","physical examination"," except for ","altered mental status"," and ","dehydration",".\n","Laboratory evaluations"," were: ","hemoglobin"," ","13.3 g\/dL",", ","white blood cell count"," ","18.3\u00d7109\/L"," (","neutrophils 79.6%",", ","lymphocytes 7.2%",", and ","monocytes 8.3%","), and ","platelet count"," ","910\u00d7109\/L",".\n","Serum levels"," were: ","calcium"," ","18.6 mg\/dL",", ","phosphate"," ","4.6 mg\/dL",", ","sodium"," ","135 mEq\/L",", ","potassium"," ","2.7 mg\/dL",", ","albumin"," ","4.0 g\/dL",", ","creatinine"," ","2.2 mg\/dL",", ","total bilirubin"," ","0.9 mg\/dL",", ","alkaline phosphatase"," ","125 IU\/L",", ","aspartate aminotransferase"," ","41 IU\/L",", and ","alanine aminotransferase"," ","71 IU\/L",".\n","SPEP"," was ","negative for an M spike",".\n","Hormones and vitamins levels"," were: ","PTH"," ","8.5 pg\/L"," (15\u201365 pg\/L), ","PHTrP"," ","1.4 pg\/L"," (<2 pg\/L), ","25-OH vitamin D"," ","30.4 ng\/mL"," (20\u201350 ng\/mL) and ","1,25 OH vitamin D3"," ","33.7 ng\/mL"," (18\u201364) ng\/mL.\n","Chest"," ","CT scan"," showed ","diffuse"," ","lytic"," ","lesions"," and ","bone destruction"," throughout the visualized ","thoracic skeleton",", concerning for diffuse ","bone marrow involvement",".\nThe clinical history and biochemical findings led to a ","diagnosis"," of ","CML","-associated ","hypercalcemia"," in the context of a ","blast phase",".\nTreatment with ","aggressive"," ","hydration"," with ","0.9%"," ","saline"," and ","calcitonin"," ","400 units"," ","subcutaneous"," was administered.\nAdditionally, ","zoledronic acid"," ","3.3 mg"," ","intravenous",", ","adjusted for renal insufficiency",", was given.\n","After five days"," of treatment, ","normalization"," of ","symptoms"," and ","serum calcium levels"," were achieved.\nAfter ","discharge"," from the ","hospital",", the patient continued with ","palliative treatment"," with ","ponatinib"," and ","radiotherapy",".\nAcceptable ","serum calcium levels"," were ","maintained"," with ","zoledronic acid"," ","4 mg every eight weeks",".\nDespite these therapies, his ","cancer"," progressed and he ","passed away"," approximately ","eight months after"," the initial admission for hypercalcemia.\n"],"ner_labels":[0,5,0,58,0,58,0,65,0,13,0,48,0,48,0,22,0,69,0,69,0,69,0,69,0,69,0,69,0,69,0,32,0,13,0,26,0,19,0,69,0,22,0,46,0,22,0,46,0,13,0,22,0,75,0,24,0,13,0,48,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,42,0,24,0,69,0,69,0,24,0,24,0,42,0,24,0,42,0,42,0,42,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,22,0,22,0,69,0,69,0,12,0,69,0,13,0,26,0,69,0,69,0,22,0,75,0,42,0,46,0,46,0,29,0,4,0,46,0,29,0,4,0,22,0,32,0,42,0,69,0,24,0,13,0,48,0,75,0,46,0,75,0,24,0,42,0,46,0,29,0,26,0,56,0,19,0]}
-{"full_text":"A 31-year-old man developed diabetes insipidus with urine volume up to 10 to 20\u200aL every 24\u200ahours in 2003.\nFour years later, he complained of fatigue, anorexia, jaundice and pruritus, and a symptomatic occipital mass.\nLaboratory tests showed an abnormal liver enzyme (Table \u200b1), the patient was negative for hepatitis viruses.\nAs shown in Fig.1, abdominal MRI showed multiple low-density lesions in the liver on the T1-weighted image and obvious expansion of the intrahepatic bile duct on the T2-weighted image.\nMagnetic resonance cholangiopancreatography revealed multifocal intrahepatic bile duct strictures and dilatation, but the common hepatic duct was normal, it was highly suggestive of SC.\nThe neurohypophyseal area MRI showed the thickened hypothalamic nuclei and a low-density signal of 4.9\u200a\u00d7\u200a5.6\u200amm in size in the hypothalamic-pituitary area.\nA multisystem, high-risk organ LCH was confirmed after occipital mass was biopsied in the local hospital, the patient was given ursodeoxycholic acid 150\u200amg 3 times a day.\nThen, he began to receive a course of COEP chemotherapy (cyclophosphamide, 1000\u200amg; vincristine, 2\u200amg; epirubicin, 90\u200amg; and prednisone, 90\u200amg) in 2009.\nHowever, on the 5th day of the 1st COEP chemotherapy, the patient appeared to severe liver function injury with an obvious increase of serum bilirubin (Table 1).\nHe refused further chemotherapy.\nOne year later, the patient developed liver decompensation with bleeding esophageal varices, ascites, and splenomegaly, and he was referred to LT (Model for End Stage Liver Disease score 17).\nHe underwent successful orthotopic LT in November 2011 in our center, and the donor came from voluntary deceased citizen organ donation in China.\nLiver histopathology after LT revealed micronodular cirrhosis with SC and positive immunostaining (CD1a and S100), suggestive of LCH involving in the liver (Fig.2).\nPostoperatively, the man continued to be immunosuppressed with tacrolimus and mycofenolate mofetil.\nThe patient is currently well with normal liver function and no evidence of recurrence of LCH for 4 and a half years follow-up.\n","ner_info":[{"text":"31-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"diabetes insipidus","label":"DISEASE_DISORDER","start":28,"end":46},{"text":"urine volume","label":"DIAGNOSTIC_PROCEDURE","start":52,"end":64},{"text":"10 to 20\u200aL","label":"VOLUME","start":71,"end":81},{"text":"every 24\u200ahours","label":"FREQUENCY","start":82,"end":96},{"text":"2003","label":"DATE","start":100,"end":104},{"text":"Four years later","label":"DATE","start":106,"end":122},{"text":"fatigue","label":"SIGN_SYMPTOM","start":141,"end":148},{"text":"anorexia","label":"SIGN_SYMPTOM","start":150,"end":158},{"text":"jaundice","label":"SIGN_SYMPTOM","start":160,"end":168},{"text":"pruritus","label":"SIGN_SYMPTOM","start":173,"end":181},{"text":"symptomatic","label":"DETAILED_DESCRIPTION","start":189,"end":200},{"text":"occipital","label":"BIOLOGICAL_STRUCTURE","start":201,"end":210},{"text":"mass","label":"SIGN_SYMPTOM","start":211,"end":215},{"text":"Laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":217,"end":233},{"text":"abnormal","label":"LAB_VALUE","start":244,"end":252},{"text":"liver enzyme","label":"DIAGNOSTIC_PROCEDURE","start":253,"end":265},{"text":"negative","label":"LAB_VALUE","start":294,"end":302},{"text":"hepatitis 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cholangiopancreatography","label":"DIAGNOSTIC_PROCEDURE","start":511,"end":554},{"text":"multifocal","label":"DETAILED_DESCRIPTION","start":564,"end":574},{"text":"intrahepatic bile duct","label":"BIOLOGICAL_STRUCTURE","start":575,"end":597},{"text":"strictures","label":"SIGN_SYMPTOM","start":598,"end":608},{"text":"dilatation","label":"SIGN_SYMPTOM","start":613,"end":623},{"text":"common hepatic duct","label":"DIAGNOSTIC_PROCEDURE","start":633,"end":652},{"text":"normal","label":"LAB_VALUE","start":657,"end":663},{"text":"SC","label":"DISEASE_DISORDER","start":693,"end":695},{"text":"neurohypophyseal area","label":"BIOLOGICAL_STRUCTURE","start":701,"end":722},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":723,"end":726},{"text":"thickened","label":"SIGN_SYMPTOM","start":738,"end":747},{"text":"hypothalamic 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viruses",".\nAs shown in Fig.1, ","abdominal"," ","MRI"," showed ","multiple"," ","low-density"," ","lesions"," in the ","liver"," on the ","T1-weighted image"," and ","obvious"," ","expansion"," of the ","intrahepatic bile duct"," on the ","T2-weighted image",".\n","Magnetic resonance cholangiopancreatography"," revealed ","multifocal"," ","intrahepatic bile duct"," ","strictures"," and ","dilatation",", but the ","common hepatic duct"," was ","normal",", it was highly suggestive of ","SC",".\nThe ","neurohypophyseal area"," ","MRI"," showed the ","thickened"," ","hypothalamic nuclei"," and a ","low-density"," ","signal"," of ","4.9\u200a\u00d7\u200a5.6\u200amm"," in size in the ","hypothalamic-pituitary area",".\nA ","multisystem",", ","high-risk"," ","organ"," ","LCH"," was confirmed after ","occipital"," ","mass"," was ","biopsied"," in the ","local hospital",", the patient was given ","ursodeoxycholic acid"," ","150\u200amg 3 times a day",".\nThen, he began to receive a course of ","COEP chemotherapy"," (","cyclophosphamide",", ","1000\u200amg","; ","vincristine",", ","2\u200amg","; ","epirubicin",", ","90\u200amg","; and ","prednisone",", ","90\u200amg",") in ","2009",".\nHowever, on the ","5th day"," of the 1st ","COEP chemotherapy",", the patient appeared to ","severe"," ","liver"," ","function injury"," with an ","obvious"," ","increase"," of ","serum bilirubin"," (Table 1).\nHe refused further ","chemotherapy",".\n","One year later",", the patient developed ","liver"," ","decompensation"," with ","bleeding"," ","esophageal"," ","varices",", ","ascites",", and ","splenomegaly",", and he was ","referred"," to ","LT"," (","Model for End Stage Liver Disease"," score ","17",").\nHe underwent successful ","orthotopic"," ","LT"," in ","November 2011"," in our ","center",", and the ","donor"," came from ","voluntary deceased citizen"," organ donation in ","China",".\n","Liver histopathology"," after ","LT"," revealed ","micronodular"," ","cirrhosis"," with ","SC"," and ","positive"," ","immunostaining"," (","CD1a"," and ","S100","), suggestive of ","LCH"," involving in the ","liver"," (Fig.2).\nPostoperatively, the man continued to be ","immunosuppressed"," with ","tacrolimus"," and ","mycofenolate mofetil",".\nThe patient is currently ","well"," with ","normal"," ","liver function"," and no evidence of ","recurrence"," of ","LCH"," for ","4 and a half years"," 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-{"full_text":"On December 28, 2014, a 70-year-old man complaining of abdominal pain, dizziness, and nausea was referred to the Hebei General Hospital, Hebei, China.\nGastroscopy showed irregular hemorrhagic ulcerative lesions extending from the gastric body to the lesser curvature and pyloric stenosis of the stomach.\nGastric biopsy revealed adenocarcinoma.\nOn January 7, 2015, palliative gastrectomy plus Roux-en-Y near esophagojejunostomy were performed.\nDiffuse enlarged para-aortic and anterior superior pancreatic lymph nodes, as well as lymph nodes around the common hepatic artery, could not be resected.\nPostoperative pathology demonstrated moderately differentiated gastric adenocarcinoma (Fig.1A).\nImmunohistochemistry showed the following: human epidermal growth factor receptor 2 (HER-2) (+), vascular endothelial growth factor (VEGF) (+), CD31 (+), CD105 (+) (Fig.1B\u2013E), triple positive (TP) (+), glutathione S-transferase \u03c0 (GST-\u03c0) (+++), topoisomerase enzyme II \u03b1 (TOPOII \u03b1), P53 (\u2013), and Ki-67 (70%).\nThe diagnosis was stage IV gastric adenocarcinoma with multiple lymphnodes metastases (T4N2M1).\nThe patient was administered 1 cycle of chemotherapy with oxaliplatin and S-1; however, the treatment was terminated, as the patient could not tolerate the associated gastrointestinal disturbances.\nOn February 2, 2015, adjuvant radiotherapy was administered.\nBefore radiotherapy, positron-emission tomography computed tomography (PET-CT) showed extensive distant metastasis (left supraclavicular and mediastinal lymph nodes, and lymph nodes throughout the abdominal cavity).\nThe patient's Eastern Cooperative Oncology Group (ECOG) performance status was 2, and his body mass index (BMI) was 19; therefore, he was considered to be at risk of malnutrition.\nOral apatinib 850\u200amg once a day combined with and following radiotherapy was prescribed.\nInformed consent was obtained from the patient prior to treatment.\nIn an attempt to improve tolerance to treatment, palliative intensity modulated radiation therapy (IMRT) was used.\nThe patient received a dose of 64 Gy in 30 fractions to the mediastinum and doses of 52 Gy in 26 fractions to the other abdominal metastatic lesions (n\u200a=\u200a5).\nThe left supraclavicular lymph node was treated with apatinib alone (Figs.2 and 3A\u2013C).\nA PET-CT scan performed 2 weeks after radiotherapy showed an 80% reduction in the maximum standardized uptake value (SUVmax) of 2-deoxy-2-[[18]F]fluoro-d-glucose (FDG).\nFDG uptake was higher in the left supraclavicular lymph node compared to the metastatic regions treated with concurrent apatinib and radiation therapy.\nAccording to Response Evaluation Criteria in Solid Tumors (RECIST), the clinical effect was partial response (Fig.2).\nThe patient received further radiotherapy (66 Gy in 28 fractions) to the left supraclavicular lymph node due to residual metastasis.\nTumor markers and biochemical analyses were evaluated every 2 months.\nTwo months after therapy, chest, and abdominal CT scans indicated stable disease; anemia and gastrointestinal symptoms had improved, ECOG performance status was 0, and BMI was 22.\nHematologic toxicity, hypertension, renal dysfunction, proteinuria, and hand\u2013foot syndrome were not observed during apatinib therapy.\nIn September 2015, a follow-up examination showed increased carbohydrate antigen (CA) 125 and ferritin; however, gastroscopy and abdominal CT revealed no abnormalities.\nIn November 2015, the patient had difficulty swallowing and experienced intermittent hematochezia.\nApatinib was terminated due to gastrointestinal bleeding.\nGastroscopy revealed anastomotic stenosis due to gastric cancer and intragastric hemorrhage (Fig.3D\u2013F).\nThe patient and his family refused chemoradiotherapy.\nSymptomatic treatment with a hemostatic drug and best supportive care were prescribed.\nAfter 1 week of therapy, hemorrhaging was resolved.\nOne month later, the patient again experienced intermittent hematochezia.\nOn December 20, 2015, PET-CT demonstrated extensive metastasis.\nThe patient and his family requested best supportive care.\nOn April 16, 2016, the patient died due to pulmonary infection.\n","ner_info":[{"text":"December 28, 2014","label":"DATE","start":3,"end":20},{"text":"70-year-old","label":"AGE","start":24,"end":35},{"text":"man","label":"SEX","start":36,"end":39},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":55,"end":64},{"text":"pain","label":"SIGN_SYMPTOM","start":65,"end":69},{"text":"dizziness","label":"SIGN_SYMPTOM","start":71,"end":80},{"text":"nausea","label":"SIGN_SYMPTOM","start":86,"end":92},{"text":"referred","label":"CLINICAL_EVENT","start":97,"end":105},{"text":"Hebei General Hospital, Hebei, 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later,","label":"DATE","start":3849,"end":3865},{"text":"intermittent","label":"DETAILED_DESCRIPTION","start":3896,"end":3908},{"text":"hematochezia","label":"SIGN_SYMPTOM","start":3909,"end":3921},{"text":"December 20, 2015","label":"DATE","start":3926,"end":3943},{"text":"PET-CT","label":"DIAGNOSTIC_PROCEDURE","start":3945,"end":3951},{"text":"extensive","label":"SEVERITY","start":3965,"end":3974},{"text":"metastasis","label":"DISEASE_DISORDER","start":3975,"end":3985},{"text":"supportive care","label":"THERAPEUTIC_PROCEDURE","start":4029,"end":4044},{"text":"April 16, 2016","label":"DATE","start":4049,"end":4063},{"text":"died","label":"OUTCOME","start":4077,"end":4081},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":4089,"end":4098},{"text":"infection","label":"DISEASE_DISORDER","start":4099,"end":4108}],"tokens":["On ","December 28, 2014",", a ","70-year-old"," ","man"," complaining of ","abdominal"," ","pain",", ","dizziness",", and ","nausea"," was ","referred"," to the ","Hebei General Hospital, Hebei, China",".\n","Gastroscopy"," showed ","irregular"," ","hemorrhagic"," ","ulcerative lesions"," extending from the ","gastric body"," to the ","lesser curvature"," and ","pyloric stenosis"," of the ","stomach",".\n","Gastric"," ","biopsy"," revealed ","adenocarcinoma",".\nOn ","January 7, 2015",", ","palliative"," ","gastrectomy"," plus ","Roux-en-Y"," near ","esophagojejunostomy"," were performed.\n","Diffuse"," ","enlarged"," ","para-aortic"," and ","anterior"," ","superior"," ","pancreatic lymph nodes",", as well as ","lymph nodes"," around the ","common hepatic artery",", could not be ","resected",".\nPostoperative ","pathology"," demonstrated ","moderately differentiated"," ","gastric adenocarcinoma"," (Fig.1A).\n","Immunohistochemistry"," showed the following: ","human epidermal growth factor receptor 2"," (","HER-2",") (","+","), ","vascular endothelial growth factor"," (","VEGF",") (","+","), ","CD31"," (","+","), ","CD105"," (","+",") (Fig.1B\u2013E), ","triple positive"," (","TP",") (","+","), ","glutathione S-transferase \u03c0"," (","GST-\u03c0",") (","+++","), ","topoisomerase enzyme II \u03b1"," (","TOPOII \u03b1","), ","P53"," (","\u2013","), and ","Ki-67"," (","70%",").\nThe diagnosis was ","stage IV"," ","gastric adenocarcinoma"," with ","multiple"," ","lymphnodes"," ","metastases"," (","T4N2M1",").\nThe patient was administered ","1"," ","cycle of chemotherapy"," with ","oxaliplatin"," and ","S-1","; however, the treatment was ","terminated",", as the patient could not tolerate the associated ","gastrointestinal disturbances",".\nOn ","February 2, 2015",", ","adjuvant radiotherapy"," was administered.\nBefore radiotherapy, ","positron-emission tomography computed tomography"," (","PET-CT",") showed ","extensive"," ","distant"," ","metastasis"," (","left supraclavicular"," and ","mediastinal"," ","lymph nodes",", and ","lymph nodes"," throughout the ","abdominal cavity",").\nThe patient's ","Eastern Cooperative Oncology Group"," (","ECOG",") performance status was ","2",", and his ","body mass index"," (","BMI",") was ","19","; therefore, he was considered to be at risk of ","malnutrition",".\n","Oral"," ","apatinib"," ","850\u200amg"," ","once a day"," combined with and following ","radiotherapy"," was ","prescribed",".\nInformed consent was obtained from the patient prior to treatment.\nIn an attempt to improve tolerance to treatment, ","palliative"," ","intensity modulated radiation therapy"," (","IMRT",") was used.\nThe patient received a dose of ","64 Gy in 30 fractions"," to the ","mediastinum"," and doses of ","52 Gy in 26 fractions"," to the other ","abdominal"," ","metastatic lesions"," (n\u200a=\u200a5).\nThe ","left supraclavicular"," ","lymph node"," was treated with ","apatinib"," alone (Figs.2 and 3A\u2013C).\nA ","PET-CT"," scan performed ","2 weeks after radiotherapy"," showed an ","80% reduction"," in the ","maximum standardized uptake value"," (","SUVmax",") of ","2-deoxy-2-[[18]F]fluoro-d-glucose"," (","FDG",").\n","FDG uptake"," was ","higher"," in the ","left supraclavicular"," ","lymph node"," compared to the ","metastatic regions"," treated with concurrent ","apatinib"," and ","radiation therapy",".\nAccording to ","Response Evaluation Criteria in Solid Tumors"," (","RECIST","), the clinical effect was ","partial response"," (Fig.2).\nThe patient received further ","radiotherapy"," (","66 Gy in 28 fractions",") to the ","left supraclavicular"," ","lymph node"," due to ","residual metastasis",".\n","Tumor markers"," and ","biochemical analyses"," were evaluated ","every 2 months",".\n","Two months after therapy",", ","chest",", and ","abdominal"," ","CT scans"," indicated ","stable"," ","disease","; ","anemia"," and ","gastrointestinal symptoms"," had ","improved",", ","ECOG"," performance status was ","0",", and ","BMI"," was ","22",".\n","Hematologic toxicity",", ","hypertension",", ","renal dysfunction",", ","proteinuria",", and ","hand\u2013foot syndrome"," were not observed during ","apatinib"," therapy.\nIn ","September 2015",", a ","follow-up examination"," showed ","increased"," ","carbohydrate antigen (CA) 125"," and ","ferritin","; however, ","gastroscopy"," and ","abdominal"," ","CT"," revealed no ","abnormalities",".\nIn ","November 2015",", the patient had ","difficulty swallowing"," and experienced ","intermittent"," ","hematochezia",".\n","Apatinib"," was ","terminated"," due to ","gastrointestinal bleeding",".\n","Gastroscopy"," revealed ","anastomotic stenosis"," due to ","gastric cancer"," and ","intragastric hemorrhag","e (Fig.3D\u2013F).\nThe patient and his family refused ","chemoradiotherapy",".\nSymptomatic treatment with a ","hemostatic drug"," and best ","supportive care"," were ","prescribed",".\n","After 1 week"," of therapy, ","hemorrhaging"," was resolved.\n","One month later,"," the patient again experienced ","intermittent"," ","hematochezia",".\nOn ","December 20, 2015",", ","PET-CT"," demonstrated ","extensive"," ","metastasis",".\nThe patient and his family requested best ","supportive care",".\nOn ","April 16, 2016",", the patient ","died"," due to ","pulmonary"," 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-{"full_text":"A 44-year-old man had been diagnosed with LCNEC of the thymus with bone metastasis at a different hospital 3 years previously.\nThe serum levels of ACTH and cortisol were elevated, but brain magnetic resonance imaging revealed that his pituitary gland was normal.\nHowever, immunohistochemical staining of the thymic tumor tissue revealed partial anti-ACTH antibody positivity.\nThe tumor was therefore determined to be ectopically producing ACTH.\nThe patient underwent chemotherapy with cisplatin and irinotecan, but the continuation of chemotherapy was problematic due to a lack of tolerance.\nTreatment for hypertension and diabetes caused by the ectopic ACTH syndrome was initiated, as was treatment with zoledronic acid for bone metastasis.\nThe patient was referred to the Endocrine Center at our hospital after 3 months due to a sensation of weakness and the worsening of his hyperglycemia.\nA physical examination revealed hypertension, a subcutaneous mass that was palpable in the anterior chest, and redness and swelling of the left lower leg without fever, respiratory symptoms, hypoxemia, or abnormal chest sounds.\nThe oxygen saturation by pulse oximeter in room air and was 97% and his respiratory rate was 13 breaths per minute.\nAmong the laboratory findings, the white blood cell and neutrophil counts, and blood sugar, triglyceride, and low-density lipoprotein cholesterol levels were found to be elevated, and the patient's potassium level was decreased to 2.8 mEq\/L.\nThe patient's lactate dehydrogenase (468 IU\/L), beta-D glucan (370.8 pg\/mL), ACTH (354.1 pg\/mL), and cortisol (49.1 \u03bcg\/dL) levels were also elevated.\nThe patient's serum was negative for aspergillus, candida, and cryptococcus antigens; a cytomegalovirus pp65 antigenemia test also yielded a negative result.\nThese data suggested that the increased production of ACTH by the tumor, along with the progression of the disease, had promoted the elevation of the patient's serum levels of ACTH and cortisol.\nComputed tomography (CT) revealed the progression of the disease in the both thymic and metastatic bone lesions, along with the multiple ground-glass opacities in both lungs (Fig.1, \u200b2).\nThe patient underwent bronchoalveolar lavage (BAL) in the right B5 segment with 150 mL saline, and 62.7% of the BAL fluid was recovered.\nThe cell count in the BAL fluid was 0.61\u00d7105 per mL, and the cell differentiation in the BAL fluid was 17.0% macrophages, 81.0% lymphocytes, and 2.0% neutrophils, with a CD 4\/8 ratio of 0.57.\nGram, Ziehl-Neelsen, and Grocott staining were all negative.\nA polymerase chain reaction revealed that the patient's BAL fluid was positive for Pneumocystis jirovecii.\nPCP was diagnosed based on the above results.\nThe patient was treated with sulfamethoxazole\/trimethoprim (12 g\/day) for 3 weeks.\nAnti-cortisol therapy with metyrapone was also initiated at the same time with a small dose to slowly correct the hypercortisolemia.\nIntensive insulin therapy, potassium supplementation were initiated, while cefazolin was administered to treat cellulitis of the left lower leg.\nThe patient's PCP fully improved without the exacerbation of his respiratory status.\nThereafter, we continued to administer sulfamethoxazole\/trimethoprim at a prophylactic dose.\nThe metyrapone dosage was gradually increased from 250 mg\/day, and the blood cortisol value was observed to decline slowly (Fig.3).\nIn order to prevent hypocortisolemia, the patient was temporarily treated with hydrocortisone.\nAfter an improvement of his left lower leg cellulitis, PCP, and hyperglycemia, the patient underwent laminectomy and radiation therapy for spinal cord compression, which had been caused by a metastatic spinal tumor.\nOctreotide therapy was initiated, and he was discharged on the 68th day of hospitalization.\n","ner_info":[{"text":"44-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"diagnosed","label":"CLINICAL_EVENT","start":27,"end":36},{"text":"LCNEC","label":"DISEASE_DISORDER","start":42,"end":47},{"text":"thymus","label":"BIOLOGICAL_STRUCTURE","start":55,"end":61},{"text":"bone","label":"BIOLOGICAL_STRUCTURE","start":67,"end":71},{"text":"metastasis","label":"SIGN_SYMPTOM","start":72,"end":82},{"text":"different hospital","label":"NONBIOLOGICAL_LOCATION","start":88,"end":106},{"text":"3 years previously","label":"DATE","start":107,"end":125},{"text":"ACTH","label":"DIAGNOSTIC_PROCEDURE","start":147,"end":151},{"text":"cortisol","label":"DIAGNOSTIC_PROCEDURE","start":156,"end":164},{"text":"elevated","label":"LAB_VALUE","start":170,"end":178},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":184,"end":189},{"text":"magnetic resonance 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recovered","label":"LAB_VALUE","start":2268,"end":2304},{"text":"cell count","label":"DIAGNOSTIC_PROCEDURE","start":2310,"end":2320},{"text":"BAL fluid","label":"DETAILED_DESCRIPTION","start":2328,"end":2337},{"text":"0.61\u00d7105 per mL","label":"LAB_VALUE","start":2342,"end":2357},{"text":"cell differentiation","label":"DIAGNOSTIC_PROCEDURE","start":2367,"end":2387},{"text":"BAL fluid","label":"DETAILED_DESCRIPTION","start":2395,"end":2404},{"text":"17.0% macrophages","label":"LAB_VALUE","start":2409,"end":2426},{"text":"81.0% lymphocytes","label":"LAB_VALUE","start":2428,"end":2445},{"text":"2.0% neutrophils","label":"LAB_VALUE","start":2451,"end":2467},{"text":"CD 4\/8 ratio of 0.57","label":"LAB_VALUE","start":2476,"end":2496},{"text":"Gram","label":"DIAGNOSTIC_PROCEDURE","start":2498,"end":2502},{"text":"Ziehl-Neelsen","label":"DIAGNOSTIC_PROCEDURE","start":2504,"end":2517},{"text":"Grocott staining","label":"DIAGNOSTIC_PROCEDURE","start":2523,"end":2539},{"text":"negative","label":"LAB_VALUE","start":2549,"end":2557},{"text":"polymerase chain reaction","label":"DIAGNOSTIC_PROCEDURE","start":2561,"end":2586},{"text":"BAL fluid","label":"DETAILED_DESCRIPTION","start":2615,"end":2624},{"text":"positive","label":"LAB_VALUE","start":2629,"end":2637},{"text":"Pneumocystis jirovecii","label":"DIAGNOSTIC_PROCEDURE","start":2642,"end":2664},{"text":"PCP","label":"DISEASE_DISORDER","start":2666,"end":2669},{"text":"sulfamethoxazole\/trimethoprim","label":"MEDICATION","start":2741,"end":2770},{"text":"12 g\/day","label":"DOSAGE","start":2772,"end":2780},{"text":"3 weeks","label":"DURATION","start":2786,"end":2793},{"text":"Anti-cortisol therapy","label":"THERAPEUTIC_PROCEDURE","start":2795,"end":2816},{"text":"metyrapone","label":"MEDICATION","start":2822,"end":2832},{"text":"small dose","label":"DOSAGE","start":2876,"end":2886},{"text":"hypercortisolemia","label":"DISEASE_DISORDER","start":2909,"end":2926},{"text":"insulin","label":"MEDICATION","start":2938,"end":2945},{"text":"potassium","label":"MEDICATION","start":2955,"end":2964},{"text":"cefazolin","label":"MEDICATION","start":3003,"end":3012},{"text":"cellulitis","label":"DISEASE_DISORDER","start":3039,"end":3049},{"text":"left lower leg","label":"BIOLOGICAL_STRUCTURE","start":3057,"end":3071},{"text":"PCP","label":"DISEASE_DISORDER","start":3087,"end":3090},{"text":"exacerbation","label":"SIGN_SYMPTOM","start":3118,"end":3130},{"text":"respiratory status","label":"DIAGNOSTIC_PROCEDURE","start":3138,"end":3156},{"text":"sulfamethoxazole\/trimethoprim","label":"MEDICATION","start":3197,"end":3226},{"text":"prophylactic dose","label":"DOSAGE","start":3232,"end":3249},{"text":"metyrapone","label":"MEDICATION","start":3255,"end":3265},{"text":"250 mg\/day","label":"DOSAGE","start":3302,"end":3312},{"text":"blood cortisol","label":"DIAGNOSTIC_PROCEDURE","start":3322,"end":3336},{"text":"decline slowly","label":"LAB_VALUE","start":3359,"end":3373},{"text":"temporarily","label":"DETAILED_DESCRIPTION","start":3437,"end":3448},{"text":"hydrocortisone","label":"MEDICATION","start":3462,"end":3476},{"text":"left lower leg","label":"BIOLOGICAL_STRUCTURE","start":3506,"end":3520},{"text":"cellulitis","label":"DISEASE_DISORDER","start":3521,"end":3531},{"text":"PCP","label":"DISEASE_DISORDER","start":3533,"end":3536},{"text":"hyperglycemia","label":"DISEASE_DISORDER","start":3542,"end":3555},{"text":"laminectomy","label":"THERAPEUTIC_PROCEDURE","start":3579,"end":3590},{"text":"radiation therapy","label":"THERAPEUTIC_PROCEDURE","start":3595,"end":3612},{"text":"spinal cord compression","label":"DISEASE_DISORDER","start":3617,"end":3640},{"text":"metastatic","label":"DETAILED_DESCRIPTION","start":3669,"end":3679},{"text":"spinal","label":"BIOLOGICAL_STRUCTURE","start":3680,"end":3686},{"text":"tumor","label":"SIGN_SYMPTOM","start":3687,"end":3692},{"text":"Octreotide","label":"MEDICATION","start":3694,"end":3704},{"text":"discharged","label":"CLINICAL_EVENT","start":3739,"end":3749},{"text":"68th day","label":"DATE","start":3757,"end":3765}],"tokens":["A ","44-year-old"," ","man"," had been ","diagnosed"," with ","LCNEC"," of the ","thymus"," with ","bone"," ","metastasis"," at a ","different hospital"," ","3 years previously",".\nThe serum levels of ","ACTH"," and ","cortisol"," were ","elevated",", but ","brain"," ","magnetic resonance imaging"," revealed that his ","pituitary gland"," was ","normal",".\nHowever, ","immunohistochemical staining"," of the ","thymic tumor tissue"," revealed ","partial"," ","anti-ACTH antibody"," ","positivity",".\nThe ","tumor"," was therefore determined to be ","ectopically producing ACTH",".\nThe patient underwent ","chemotherapy"," with ","cisplatin"," and ","irinotecan",", but the continuation of chemotherapy was ","problematic due to a lack of tolerance",".\nTreatment for ","hypertension"," and ","diabetes"," caused by the ","ectopic ACTH syndrome"," was initiated, as was treatment with ","zoledronic acid"," for ","bone"," ","metastasis",".\nThe patient was ","referred"," to the ","Endocrine Center at our hospital"," ","after 3 months"," due to a ","sensation of weakness"," and the worsening of his ","hyperglycemia",".\nA ","physical examination"," revealed ","hypertension",", a ","subcutaneous"," ","mass"," that was ","palpable"," in the ","anterior chest",", and ","redness"," and ","swelling"," of the ","left lower leg"," without ","fever",", ","respiratory symptoms",", ","hypoxemia",", or ","abnormal chest sounds",".\nThe ","oxygen saturation"," by ","pulse oximeter"," in ","room air"," and was ","97%"," and his ","respiratory rate"," was ","13 breaths per minute",".\nAmong the ","laboratory findings",", the ","white blood cell"," and ","neutrophil"," counts, and ","blood sugar",", ","triglyceride",", and ","low-density lipoprotein cholesterol"," levels were found to be ","elevated",", and the patient's ","potassium"," level was ","decreased"," to ","2.8 mEq\/L",".\nThe patient's ","lactate dehydrogenase"," (","468 IU\/L","), ","beta-D glucan"," (","370.8 pg\/mL","), ","ACTH"," (","354.1 pg\/mL","), and ","cortisol"," (","49.1 \u03bcg\/dL",") levels were also ","elevated",".\nThe patient's ","serum"," was ","negative"," for ","aspergillus",", ","candida",", and ","cryptococcus antigens","; a ","cytomegalovirus pp65 antigenemia test"," also yielded a ","negative"," result.\nThese data suggested that the increased production of ACTH by the tumor, along with the progression of the disease, had promoted the elevation of the patient's serum levels of ACTH and cortisol.\n","Computed tomography"," (","CT",") revealed the ","progression of the disease"," in the both ","thymic"," and ","metastatic"," ","bone"," ","lesions",", along with the ","multiple"," ","ground-glass"," ","opacities"," in ","both lungs"," (Fig.1, \u200b2).\nThe patient underwent ","bronchoalveolar lavage"," (","BAL",") in the ","right B5 segment"," with ","150 mL saline",", and ","62.7% of the BAL fluid was recovered",".\nThe ","cell count"," in the ","BAL fluid"," was ","0.61\u00d7105 per mL",", and the ","cell differentiation"," in the ","BAL fluid"," was ","17.0% macrophages",", ","81.0% lymphocytes",", and ","2.0% neutrophils",", with a ","CD 4\/8 ratio of 0.57",".\n","Gram",", ","Ziehl-Neelsen",", and ","Grocott staining"," were all ","negative",".\nA ","polymerase chain reaction"," revealed that the patient's ","BAL fluid"," was ","positive"," for ","Pneumocystis jirovecii",".\n","PCP"," was diagnosed based on the above results.\nThe patient was treated with ","sulfamethoxazole\/trimethoprim"," (","12 g\/day",") for ","3 weeks",".\n","Anti-cortisol therapy"," with ","metyrapone"," was also initiated at the same time with a ","small dose"," to slowly correct the ","hypercortisolemia",".\nIntensive ","insulin"," therapy, ","potassium"," supplementation were initiated, while ","cefazolin"," was administered to treat ","cellulitis"," of the ","left lower leg",".\nThe patient's ","PCP"," fully improved without the ","exacerbation"," of his ","respiratory status",".\nThereafter, we continued to administer ","sulfamethoxazole\/trimethoprim"," at a ","prophylactic dose",".\nThe ","metyrapone"," dosage was gradually increased from ","250 mg\/day",", and the ","blood cortisol"," value was observed to ","decline slowly"," (Fig.3).\nIn order to prevent hypocortisolemia, the patient was ","temporarily"," treated with ","hydrocortisone",".\nAfter an improvement of his ","left lower leg"," ","cellulitis",", ","PCP",", and ","hyperglycemia",", the patient underwent ","laminectomy"," and ","radiation therapy"," for ","spinal cord compression",", which had been caused by a ","metastatic"," ","spinal"," ","tumor",".\n","Octreotide"," therapy was initiated, and he was ","discharged"," on the ","68th day"," of hospitalization.\n"],"ner_labels":[0,5,0,65,0,13,0,26,0,12,0,12,0,69,0,48,0,19,0,24,0,24,0,42,0,12,0,24,0,22,0,42,0,24,0,12,0,42,0,24,0,42,0,18,0,22,0,46,0,46,0,46,0,22,0,69,0,26,0,26,0,46,0,12,0,69,0,13,0,48,0,19,0,69,0,69,0,24,0,69,0,22,0,69,0,22,0,12,0,69,0,69,0,12,0,69,0,69,0,69,0,69,0,24,0,22,0,22,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,69,0,12,0,22,0,12,0,69,0,22,0,73,0,69,0,12,0,24,0,24,0,12,0,22,0,42,0,24,0,22,0,42,0,24,0,22,0,42,0,42,0,42,0,42,0,24,0,24,0,24,0,42,0,24,0,22,0,42,0,24,0,26,0,46,0,29,0,32,0,75,0,46,0,29,0,26,0,46,0,46,0,46,0,26,0,12,0,26,0,69,0,24,0,46,0,29,0,46,0,29,0,24,0,42,0,22,0,46,0,12,0,26,0,26,0,26,0,75,0,75,0,26,0,22,0,12,0,69,0,46,0,13,0,19,0]}
-{"full_text":"A 68-year-old man referred to the Internal Medicine Department of Razi Hospital in Rasht (a city in the north of Iran) with a hypogastric region discomfort, especially in the right lower quadrant for one month.\nThe pain was a colicky form which had a few episodes each day, each episode lasting for 4\u20135 minutes.\nThe pain radiated to the back and was alleviated by resting to one side.\nNo association between the pain, defecation, and eating were reported.\nFurthermore, the patient complained of a 2\u20133 kg weight loss over the last one month followed by anorexia.\nHowever, no symptoms of nausea, vomiting, fever, or shaking chills were demonstrated.\nHe was first admitted to another center for a week, then was referred to our hospital for further evaluation.\nThe patient had undergone a surgery for prostatectomy seven years before his presentation to our center.\nAlso, he had a history of endoscopy five years earlier due to dyspepsia, which was found to be Helicobacter pylori positive at that time and which was eradicated after a treatment course.\nNo history of HIV, diabetes, smoking, or alcohol consumption was recorded.\nHis vital signs were normal at the time of admission.\nOn physical examination, the abdomen was soft, there was no distention, and bowel sounds were normoactive.\nHowever, tenderness in the right lower quadrant of the abdomen with no rebound state was noted.\nThe peripheral blood analysis is shown in Table 1.\nStool examination, urine analysis, and evaluation of electrolytes were all normal.\nAn abdominal CT scan showed a well-demarcated and homogenous solitary mass in the cecum with no distention in the ileum.\nThe ileum wall was thickened (Figure 1).\nA colonoscopy revealed a large mass like lesion in the cecum (Figure 2); during the procedure a biopsy was taken from the cecum.\nThe lamina propria was infiltrated by a number of PMNCs admixed by some eosinophils (Figure 3).\nImmunohistochemical evaluation was positive for vimentin and CD68.\nC-Kit (CD117) was negative while CD34, smooth muscle actin (SMA), and ALK were focally positive.\nThere were no reports of cyclin D1, desmin, or pancytokeratin (Figure 4).When the colonoscopy was performed, the evidences of invasive obstruction lead us to the suspicion of a malignant tumor.\nAfter pathological confirmation of IMT, the patient was referred for surgery in order to remove the mass.\nOn surgery, approximately 40 mL ascites were found in the abdomen.\nA mass was seen in the cecum with ileocolic intussusception.\nAfterwards, the patient underwent right hemicolectomy with an end-to-end anastomosis of ileocolic.\nNo enlarge lymph nodes were observed.\nThe patient was discharged seven days after surgery and had no complications during follow-up.\n","ner_info":[{"text":"68-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":18,"end":26},{"text":"Internal Medicine Department","label":"NONBIOLOGICAL_LOCATION","start":34,"end":62},{"text":"Razi Hospital","label":"NONBIOLOGICAL_LOCATION","start":66,"end":79},{"text":"Rasht","label":"NONBIOLOGICAL_LOCATION","start":83,"end":88},{"text":"a city in the north of Iran","label":"NONBIOLOGICAL_LOCATION","start":90,"end":117},{"text":"hypogastric region","label":"BIOLOGICAL_STRUCTURE","start":126,"end":144},{"text":"discomfort","label":"SIGN_SYMPTOM","start":145,"end":155},{"text":"right lower quadrant","label":"BIOLOGICAL_STRUCTURE","start":175,"end":195},{"text":"one month","label":"DURATION","start":200,"end":209},{"text":"pain","label":"COREFERENCE","start":215,"end":219},{"text":"colicky form","label":"DETAILED_DESCRIPTION","start":226,"end":238},{"text":"a few episodes each day","label":"FREQUENCY","start":249,"end":272},{"text":"each episode lasting for 4\u20135 minutes","label":"DETAILED_DESCRIPTION","start":274,"end":310},{"text":"pain","label":"COREFERENCE","start":316,"end":320},{"text":"back","label":"NONBIOLOGICAL_LOCATION","start":337,"end":341},{"text":"alleviated","label":"SIGN_SYMPTOM","start":350,"end":360},{"text":"resting to one side","label":"ACTIVITY","start":364,"end":383},{"text":"No association between the pain, defecation, and eating","label":"HISTORY","start":385,"end":440},{"text":"2\u20133 kg","label":"LAB_VALUE","start":497,"end":503},{"text":"weight loss","label":"SIGN_SYMPTOM","start":504,"end":515},{"text":"last one month","label":"DURATION","start":525,"end":539},{"text":"anorexia","label":"SIGN_SYMPTOM","start":552,"end":560},{"text":"nausea","label":"SIGN_SYMPTOM","start":586,"end":592},{"text":"vomiting","label":"SIGN_SYMPTOM","start":594,"end":602},{"text":"fever","label":"SIGN_SYMPTOM","start":604,"end":609},{"text":"shaking chills","label":"SIGN_SYMPTOM","start":614,"end":628},{"text":"admitted","label":"CLINICAL_EVENT","start":661,"end":669},{"text":"another center","label":"NONBIOLOGICAL_LOCATION","start":673,"end":687},{"text":"a week","label":"DURATION","start":692,"end":698},{"text":"referred","label":"CLINICAL_EVENT","start":709,"end":717},{"text":"our hospital","label":"NONBIOLOGICAL_LOCATION","start":721,"end":733},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":786,"end":793},{"text":"prostatectomy","label":"THERAPEUTIC_PROCEDURE","start":798,"end":811},{"text":"seven years before","label":"DATE","start":812,"end":830},{"text":"presentation","label":"CLINICAL_EVENT","start":835,"end":847},{"text":"our center","label":"NONBIOLOGICAL_LOCATION","start":851,"end":861},{"text":"endoscopy","label":"HISTORY","start":889,"end":898},{"text":"five years earlier","label":"DATE","start":899,"end":917},{"text":"dyspepsia","label":"DISEASE_DISORDER","start":925,"end":934},{"text":"Helicobacter pylori","label":"DIAGNOSTIC_PROCEDURE","start":958,"end":977},{"text":"positive","label":"LAB_VALUE","start":978,"end":986},{"text":"eradicated","label":"SIGN_SYMPTOM","start":1014,"end":1024},{"text":"treatment course","label":"THERAPEUTIC_PROCEDURE","start":1033,"end":1049},{"text":"No history of HIV, diabetes, smoking, or alcohol consumption","label":"HISTORY","start":1051,"end":1111},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":1130,"end":1141},{"text":"normal","label":"LAB_VALUE","start":1147,"end":1153},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1183,"end":1203},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":1209,"end":1216},{"text":"soft","label":"SIGN_SYMPTOM","start":1221,"end":1225},{"text":"distention","label":"SIGN_SYMPTOM","start":1240,"end":1250},{"text":"bowel sounds","label":"DIAGNOSTIC_PROCEDURE","start":1256,"end":1268},{"text":"normoactive","label":"LAB_VALUE","start":1274,"end":1285},{"text":"tenderness","label":"SIGN_SYMPTOM","start":1296,"end":1306},{"text":"right lower quadrant of the abdomen","label":"BIOLOGICAL_STRUCTURE","start":1314,"end":1349},{"text":"no","label":"LAB_VALUE","start":1355,"end":1357},{"text":"rebound state","label":"DIAGNOSTIC_PROCEDURE","start":1358,"end":1371},{"text":"peripheral blood analysis","label":"DIAGNOSTIC_PROCEDURE","start":1387,"end":1412},{"text":"Stool examination","label":"DIAGNOSTIC_PROCEDURE","start":1434,"end":1451},{"text":"urine analysis","label":"DIAGNOSTIC_PROCEDURE","start":1453,"end":1467},{"text":"evaluation of electrolytes","label":"DIAGNOSTIC_PROCEDURE","start":1473,"end":1499},{"text":"normal","label":"LAB_VALUE","start":1509,"end":1515},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":1520,"end":1529},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1530,"end":1532},{"text":"well-demarcated","label":"DETAILED_DESCRIPTION","start":1547,"end":1562},{"text":"homogenous","label":"DETAILED_DESCRIPTION","start":1567,"end":1577},{"text":"solitary","label":"DETAILED_DESCRIPTION","start":1578,"end":1586},{"text":"mass","label":"SIGN_SYMPTOM","start":1587,"end":1591},{"text":"cecum","label":"BIOLOGICAL_STRUCTURE","start":1599,"end":1604},{"text":"distention","label":"SIGN_SYMPTOM","start":1613,"end":1623},{"text":"ileum","label":"BIOLOGICAL_STRUCTURE","start":1631,"end":1636},{"text":"ileum wall","label":"BIOLOGICAL_STRUCTURE","start":1642,"end":1652},{"text":"thickened","label":"SIGN_SYMPTOM","start":1657,"end":1666},{"text":"colonoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1681,"end":1692},{"text":"large","label":"LAB_VALUE","start":1704,"end":1709},{"text":"mass like","label":"DETAILED_DESCRIPTION","start":1710,"end":1719},{"text":"lesion","label":"SIGN_SYMPTOM","start":1720,"end":1726},{"text":"cecum","label":"BIOLOGICAL_STRUCTURE","start":1734,"end":1739},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1775,"end":1781},{"text":"cecum","label":"BIOLOGICAL_STRUCTURE","start":1801,"end":1806},{"text":"lamina propria","label":"BIOLOGICAL_STRUCTURE","start":1812,"end":1826},{"text":"infiltrated","label":"SIGN_SYMPTOM","start":1831,"end":1842},{"text":"PMNCs","label":"BIOLOGICAL_STRUCTURE","start":1858,"end":1863},{"text":"eosinophils","label":"BIOLOGICAL_STRUCTURE","start":1880,"end":1891},{"text":"Immunohistochemical evaluation","label":"DIAGNOSTIC_PROCEDURE","start":1904,"end":1934},{"text":"positive","label":"LAB_VALUE","start":1939,"end":1947},{"text":"vimentin","label":"DIAGNOSTIC_PROCEDURE","start":1952,"end":1960},{"text":"CD68","label":"DIAGNOSTIC_PROCEDURE","start":1965,"end":1969},{"text":"C-Kit","label":"DIAGNOSTIC_PROCEDURE","start":1971,"end":1976},{"text":"CD117","label":"DIAGNOSTIC_PROCEDURE","start":1978,"end":1983},{"text":"negative","label":"LAB_VALUE","start":1989,"end":1997},{"text":"CD34","label":"DIAGNOSTIC_PROCEDURE","start":2004,"end":2008},{"text":"smooth muscle actin","label":"DIAGNOSTIC_PROCEDURE","start":2010,"end":2029},{"text":"SMA","label":"DIAGNOSTIC_PROCEDURE","start":2031,"end":2034},{"text":"ALK","label":"DIAGNOSTIC_PROCEDURE","start":2041,"end":2044},{"text":"focally positive","label":"LAB_VALUE","start":2050,"end":2066},{"text":"no reports","label":"LAB_VALUE","start":2079,"end":2089},{"text":"cyclin D1","label":"DIAGNOSTIC_PROCEDURE","start":2093,"end":2102},{"text":"desmin","label":"DIAGNOSTIC_PROCEDURE","start":2104,"end":2110},{"text":"pancytokeratin","label":"DIAGNOSTIC_PROCEDURE","start":2115,"end":2129},{"text":"malignant tumor","label":"DISEASE_DISORDER","start":2245,"end":2260},{"text":"IMT","label":"DISEASE_DISORDER","start":2297,"end":2300},{"text":"referred","label":"CLINICAL_EVENT","start":2318,"end":2326},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":2331,"end":2338},{"text":"surgery","label":"COREFERENCE","start":2371,"end":2378},{"text":"40 mL","label":"VOLUME","start":2394,"end":2399},{"text":"ascites","label":"SIGN_SYMPTOM","start":2400,"end":2407},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":2426,"end":2433},{"text":"mass","label":"SIGN_SYMPTOM","start":2437,"end":2441},{"text":"cecum","label":"BIOLOGICAL_STRUCTURE","start":2458,"end":2463},{"text":"ileocolic","label":"BIOLOGICAL_STRUCTURE","start":2469,"end":2478},{"text":"intussusception","label":"SIGN_SYMPTOM","start":2479,"end":2494},{"text":"right","label":"DETAILED_DESCRIPTION","start":2530,"end":2535},{"text":"hemicolectomy","label":"THERAPEUTIC_PROCEDURE","start":2536,"end":2549},{"text":"end-to-end","label":"DETAILED_DESCRIPTION","start":2558,"end":2568},{"text":"anastomosis of ileocolic","label":"THERAPEUTIC_PROCEDURE","start":2569,"end":2593},{"text":"enlarge","label":"SIGN_SYMPTOM","start":2598,"end":2605},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":2606,"end":2617},{"text":"discharged","label":"CLINICAL_EVENT","start":2649,"end":2659},{"text":"seven days after","label":"DATE","start":2660,"end":2676},{"text":"complications","label":"SIGN_SYMPTOM","start":2696,"end":2709},{"text":"follow-up","label":"CLINICAL_EVENT","start":2717,"end":2726}],"tokens":["A ","68-year-old"," ","man"," ","referred"," to the ","Internal Medicine Department"," of ","Razi Hospital"," in ","Rasht"," (","a city in the north of Iran",") with a ","hypogastric region"," ","discomfort",", especially in the ","right lower quadrant"," for ","one month",".\nThe ","pain"," was a ","colicky form"," which had ","a few episodes each day",", ","each episode lasting for 4\u20135 minutes",".\nThe ","pain"," radiated to the ","back"," and was ","alleviated"," by ","resting to one side",".\n","No association between the pain, defecation, and eating"," were reported.\nFurthermore, the patient complained of a ","2\u20133 kg"," ","weight loss"," over the ","last one month"," followed by ","anorexia",".\nHowever, no symptoms of ","nausea",", ","vomiting",", ","fever",", or ","shaking chills"," were demonstrated.\nHe was first ","admitted"," to ","another center"," for ","a week",", then was ","referred"," to ","our hospital"," for further evaluation.\nThe patient had undergone a ","surgery"," for ","prostatectomy"," ","seven years before"," his ","presentation"," to ","our center",".\nAlso, he had a history of ","endoscopy"," ","five years earlier"," due to ","dyspepsia",", which was found to be ","Helicobacter pylori"," ","positive"," at that time and which was ","eradicated"," after a ","treatment course",".\n","No history of HIV, diabetes, smoking, or alcohol consumption"," was recorded.\nHis ","vital signs"," were ","normal"," at the time of admission.\nOn ","physical examination",", the ","abdomen"," was ","soft",", there was no ","distention",", and ","bowel sounds"," were ","normoactive",".\nHowever, ","tenderness"," in the ","right lower quadrant of the abdomen"," with ","no"," ","rebound state"," was noted.\nThe ","peripheral blood analysis"," is shown in Table 1.\n","Stool examination",", ","urine analysis",", and ","evaluation of electrolytes"," were all ","normal",".\nAn ","abdominal"," ","CT"," scan showed a ","well-demarcated"," and ","homogenous"," ","solitary"," ","mass"," in the ","cecum"," with no ","distention"," in the ","ileum",".\nThe ","ileum wall"," was ","thickened"," (Figure 1).\nA ","colonoscopy"," revealed a ","large"," ","mass like"," ","lesion"," in the ","cecum"," (Figure 2); during the procedure a ","biopsy"," was taken from the ","cecum",".\nThe ","lamina propria"," was ","infiltrated"," by a number of ","PMNCs"," admixed by some ","eosinophils"," (Figure 3).\n","Immunohistochemical evaluation"," was ","positive"," for ","vimentin"," and ","CD68",".\n","C-Kit"," (","CD117",") was ","negative"," while ","CD34",", ","smooth muscle actin"," (","SMA","), and ","ALK"," were ","focally positive",".\nThere were ","no reports"," of ","cyclin D1",", ","desmin",", or ","pancytokeratin"," (Figure 4).When the colonoscopy was performed, the evidences of invasive obstruction lead us to the suspicion of a ","malignant tumor",".\nAfter pathological confirmation of ","IMT",", the patient was ","referred"," for ","surgery"," in order to remove the mass.\nOn ","surgery",", approximately ","40 mL"," ","ascites"," were found in the ","abdomen",".\nA ","mass"," was seen in the ","cecum"," with ","ileocolic"," ","intussusception",".\nAfterwards, the patient underwent ","right"," ","hemicolectomy"," with an ","end-to-end"," ","anastomosis of ileocolic",".\nNo ","enlarge"," ","lymph nodes"," were observed.\nThe patient was ","discharged"," ","seven days after"," surgery and had no ","complications"," during ","follow-up",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,48,0,48,0,48,0,12,0,69,0,12,0,32,0,18,0,22,0,35,0,22,0,18,0,48,0,69,0,1,0,39,0,42,0,69,0,32,0,69,0,69,0,69,0,69,0,69,0,13,0,48,0,32,0,13,0,48,0,75,0,75,0,19,0,13,0,48,0,39,0,19,0,26,0,24,0,42,0,69,0,75,0,39,0,24,0,42,0,24,0,12,0,69,0,69,0,24,0,42,0,69,0,12,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,12,0,24,0,22,0,22,0,22,0,69,0,12,0,69,0,12,0,12,0,69,0,24,0,42,0,22,0,69,0,12,0,24,0,12,0,12,0,69,0,12,0,12,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,42,0,24,0,24,0,24,0,26,0,26,0,13,0,75,0,18,0,79,0,69,0,12,0,69,0,12,0,12,0,69,0,22,0,75,0,22,0,75,0,69,0,12,0,13,0,19,0,69,0,13,0]}
-{"full_text":"A 51-year-old G1P1 Caucasian female with lifelong neurogenic bladder secondary to spina bifida occulta was referred for symptoms of constipation and (FI).\nShe averaged one Bristol Type 1\u20132 stool every 5 days requiring frequent manual disimpaction.\nAdditionally, she reported twice weekly episodes of urgent fecal seepage, which required the use of daily continence pads.\nHer symptoms did not improve with the addition of psyllium and bisacodyl suppositories.\nA defecography suggested atrophy of the puborectalis and poor squeeze with EAS muscle atrophy.\nAnorectal manometry (ARM) showed a normal resting pressure with no augmentation of squeeze pressure, consistent with weak EAS (Figure 1).\nDuring bearing down, fixed perineal descent was noted with the inability to widen the posterior anorectal angle and poor evacuation of contrast with straining, consistent with DD.\nWith pushing, ARM similarly demonstrated type IV DD, which is classified as inability to generate adequate propulsive forces along with absent or incomplete relaxation of the anal sphincter [8] (Figure 2).\nReflex and sensory testing indicated an intact rectoanal inhibitory reflex and rectal hypersensitivity.\nThe patient failed management with home and conventional biofeedback therapy.\nFollowing a successful trial of temporary SNS with improvement in FI symptoms by 75%, the patient had a permanent SNS placed.\nOne year later, the patient reports sustained improvement in constipation and FI symptoms.\n","ner_info":[{"text":"51-year-old","label":"AGE","start":2,"end":13},{"text":"G1P1","label":"HISTORY","start":14,"end":18},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":19,"end":28},{"text":"female","label":"SEX","start":29,"end":35},{"text":"neurogenic bladder","label":"HISTORY","start":50,"end":68},{"text":"spina bifida occulta","label":"HISTORY","start":82,"end":102},{"text":"referred","label":"CLINICAL_EVENT","start":107,"end":115},{"text":"constipation","label":"SIGN_SYMPTOM","start":132,"end":144},{"text":"FI","label":"SIGN_SYMPTOM","start":150,"end":152},{"text":"Bristol Type","label":"DIAGNOSTIC_PROCEDURE","start":172,"end":184},{"text":"1\u20132","label":"LAB_VALUE","start":185,"end":188},{"text":"stool","label":"ACTIVITY","start":189,"end":194},{"text":"every 5 days","label":"FREQUENCY","start":195,"end":207},{"text":"frequent","label":"DETAILED_DESCRIPTION","start":218,"end":226},{"text":"manual disimpaction","label":"THERAPEUTIC_PROCEDURE","start":227,"end":246},{"text":"twice weekly","label":"FREQUENCY","start":275,"end":287},{"text":"urgent","label":"SEVERITY","start":300,"end":306},{"text":"fecal seepage","label":"SIGN_SYMPTOM","start":307,"end":320},{"text":"daily","label":"FREQUENCY","start":348,"end":353},{"text":"continence pads","label":"THERAPEUTIC_PROCEDURE","start":354,"end":369},{"text":"psyllium","label":"MEDICATION","start":421,"end":429},{"text":"bisacodyl","label":"MEDICATION","start":434,"end":443},{"text":"suppositories","label":"ADMINISTRATION","start":444,"end":457},{"text":"defecography","label":"DIAGNOSTIC_PROCEDURE","start":461,"end":473},{"text":"atrophy","label":"SIGN_SYMPTOM","start":484,"end":491},{"text":"puborectalis","label":"BIOLOGICAL_STRUCTURE","start":499,"end":511},{"text":"poor squeeze","label":"SIGN_SYMPTOM","start":516,"end":528},{"text":"EAS muscle","label":"BIOLOGICAL_STRUCTURE","start":534,"end":544},{"text":"atrophy","label":"SIGN_SYMPTOM","start":545,"end":552},{"text":"Anorectal manometry","label":"DIAGNOSTIC_PROCEDURE","start":554,"end":573},{"text":"ARM","label":"DIAGNOSTIC_PROCEDURE","start":575,"end":578},{"text":"normal","label":"LAB_VALUE","start":589,"end":595},{"text":"resting pressure","label":"DIAGNOSTIC_PROCEDURE","start":596,"end":612},{"text":"augmentation of squeeze pressure","label":"SIGN_SYMPTOM","start":621,"end":653},{"text":"weak EAS","label":"DISEASE_DISORDER","start":671,"end":679},{"text":"bearing down","label":"ACTIVITY","start":699,"end":711},{"text":"fixed perineal descent","label":"SIGN_SYMPTOM","start":713,"end":735},{"text":"inability to widen","label":"LAB_VALUE","start":755,"end":773},{"text":"posterior anorectal angle","label":"DIAGNOSTIC_PROCEDURE","start":778,"end":803},{"text":"poor","label":"LAB_VALUE","start":808,"end":812},{"text":"evacuation of contrast","label":"DIAGNOSTIC_PROCEDURE","start":813,"end":835},{"text":"straining","label":"SIGN_SYMPTOM","start":841,"end":850},{"text":"DD","label":"DISEASE_DISORDER","start":868,"end":870},{"text":"pushing","label":"ACTIVITY","start":877,"end":884},{"text":"ARM","label":"DIAGNOSTIC_PROCEDURE","start":886,"end":889},{"text":"type IV","label":"LAB_VALUE","start":913,"end":920},{"text":"DD","label":"DISEASE_DISORDER","start":921,"end":923},{"text":"Reflex and sensory testing","label":"DIAGNOSTIC_PROCEDURE","start":1078,"end":1104},{"text":"intact","label":"LAB_VALUE","start":1118,"end":1124},{"text":"rectoanal inhibitory reflex","label":"DIAGNOSTIC_PROCEDURE","start":1125,"end":1152},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":1157,"end":1163},{"text":"hypersensitivity","label":"SIGN_SYMPTOM","start":1164,"end":1180},{"text":"management","label":"SIGN_SYMPTOM","start":1201,"end":1211},{"text":"home","label":"DETAILED_DESCRIPTION","start":1217,"end":1221},{"text":"conventional","label":"DETAILED_DESCRIPTION","start":1226,"end":1238},{"text":"biofeedback therapy","label":"THERAPEUTIC_PROCEDURE","start":1239,"end":1258},{"text":"temporary","label":"DETAILED_DESCRIPTION","start":1292,"end":1301},{"text":"SNS","label":"THERAPEUTIC_PROCEDURE","start":1302,"end":1305},{"text":"FI","label":"SIGN_SYMPTOM","start":1326,"end":1328},{"text":"75%","label":"LAB_VALUE","start":1341,"end":1344},{"text":"permanent","label":"DETAILED_DESCRIPTION","start":1364,"end":1373},{"text":"SNS","label":"THERAPEUTIC_PROCEDURE","start":1374,"end":1377},{"text":"One year later","label":"DATE","start":1386,"end":1400},{"text":"constipation","label":"SIGN_SYMPTOM","start":1447,"end":1459},{"text":"FI","label":"SIGN_SYMPTOM","start":1464,"end":1466}],"tokens":["A ","51-year-old"," ","G1P1"," ","Caucasian"," ","female"," with lifelong ","neurogenic bladder"," secondary to ","spina bifida occulta"," was ","referred"," for symptoms of ","constipation"," and (","FI",").\nShe averaged one ","Bristol Type"," ","1\u20132"," ","stool"," ","every 5 days"," requiring ","frequent"," ","manual disimpaction",".\nAdditionally, she reported ","twice weekly"," episodes of ","urgent"," ","fecal seepage",", which required the use of ","daily"," ","continence pads",".\nHer symptoms did not improve with the addition of ","psyllium"," and ","bisacodyl"," ","suppositories",".\nA ","defecography"," suggested ","atrophy"," of the ","puborectalis"," and ","poor squeeze"," with ","EAS muscle"," ","atrophy",".\n","Anorectal manometry"," (","ARM",") showed a ","normal"," ","resting pressure"," with no ","augmentation of squeeze pressure",", consistent with ","weak EAS"," (Figure 1).\nDuring ","bearing down",", ","fixed perineal descent"," was noted with the ","inability to widen"," the ","posterior anorectal angle"," and ","poor"," ","evacuation of contrast"," with ","straining",", consistent with ","DD",".\nWith ","pushing",", ","ARM"," similarly demonstrated ","type IV"," ","DD",", which is classified as inability to generate adequate propulsive forces along with absent or incomplete relaxation of the anal sphincter [8] (Figure 2).\n","Reflex and sensory testing"," indicated an ","intact"," ","rectoanal inhibitory reflex"," and ","rectal"," ","hypersensitivity",".\nThe patient failed ","management"," with ","home"," and ","conventional"," ","biofeedback therapy",".\nFollowing a successful trial of ","temporary"," ","SNS"," with improvement in ","FI"," symptoms by ","75%",", the patient had a ","permanent"," ","SNS"," placed.\n","One year later",", the patient reports sustained improvement in ","constipation"," and ","FI"," symptoms.\n"],"ner_labels":[0,5,0,39,0,58,0,65,0,39,0,39,0,13,0,69,0,69,0,24,0,42,0,1,0,35,0,22,0,75,0,35,0,63,0,69,0,35,0,75,0,46,0,46,0,4,0,24,0,69,0,12,0,69,0,12,0,69,0,24,0,24,0,42,0,24,0,69,0,26,0,1,0,69,0,42,0,24,0,42,0,24,0,69,0,26,0,1,0,24,0,42,0,26,0,24,0,42,0,24,0,12,0,69,0,69,0,22,0,22,0,75,0,22,0,75,0,69,0,42,0,22,0,75,0,19,0,69,0,69,0]}
-{"full_text":"A 52-year-old man with a 30-year history of smoking presented with an abnormal nodule measuring 0.8\u200a\u00d7\u200a1.5\u200acm in the left upper lung lobe imaged through chest computed tomography (CT) scanning in March 2012 in a community hospital.\nHe had previously been well without any additional relevant or abnormal symptoms.\nPhysical examination suggested no significant abnormalities.\nLaboratory findings were within normal range, except for a carcinoembryonic antigen (CEA) level of 30.25\u200ang\/mL (normal range, 0\u20135\u200ang\/mL) found in the serum.\nSubsequently, a positron emission tomography (PET)\/CT scan showed a lung lesion with a standardized uptake value of 7.94, which was highly suspected to be a malignant tumor (Fig.1).\nSubsequently, he underwent left upper lung lobectomy and lymph node dissection.\nPostoperative pathological examination revealed an adenocarcinoma (ADC) (Fig.2A).\nImmunohistochemistry (IHC) staining results were positive for CK7, TTF-1, p63, and NapsinA and negative for CK 5\/6, Syn, cgA, and Ki-67 (20%\u201330%).\nThe clinical stage was classified as IA2 (pT1bN0M0).\nBecause the tumor was still in an early stage, the patient did not receive adjuvant treatment but continued to be monitored through regular hospital visits every 3 months.\nThe patient's condition had been stable until the onset of left chest pain in April 2015.\nThe patient was transferred to our hospital (a tertiary care hospital) for further treatment.\nPhysical examination suggested a significant tender point in the left chest wall.\nLaboratory findings showed only a single parameter outside the normal range: the cytokeratin19 fragment antigen 21\u20131 (CYFRA21\u20131) level was 17.45\u200ang\/mL in the serum (normal range\u200a=\u200a0\u20133.3\u200ang\/mL).\nCT and PET\/CT scans highlighted the serious involvement of left pleura, showing bilateral lung lesions (Fig.3A and E).\nAt that point, the clinical stage was upgraded to IVB.\nAfter the CT-guided left pleura puncture, pathological IHC analysis showed positive staining for p63, p40, CK 7, and CK 5\/6, while TTF-1 and NapsinA staining were absent, supporting a diagnosis of squamous cell carcinoma (SCC) (Fig.2B).\nMeanwhile, molecular evaluation confirmed an L858R mutation in exon 21 and a T790M mutation in exon 20 (Fig.4B and C).\nConsidering the pathology of the SCC was quite distinct compared with that of the originally resected NSCLC specimen, we retrospectively reassessed the surgery specimen to verify our primary diagnosis.\nThe morphologic and IHC results were in complete agreement with the initial diagnoses, but an L858R mutation was identified using the newly added molecular evaluation (Fig.4A).\nTo relieve the acute pain in the left pleura as quickly as possible, palliative three-dimensional conformal radiotherapy (3D-CRT) for the chest lesion was delivered at a total dose of 42\u200aGy\/14 fractions (f), once daily and 5f\/week (Fig.5).\nThe volume over radiation dose 5\u200aGy (V5) values of the left, right, and total lungs were 20%, 0%, and 7.8%, respectively; the volume over radiation dose 20\u200aGy (V20) values were 10%, 0%, and 5%, respectively; the mean lung dose (MLD) was 5\u200aGy.\nMeanwhile, considering the MST pathology was that of SCC, the patient received GP chemotherapy (cisplatin 75\u200amg\/m2 d1, gemcitabine 1250\u200amg\/m2 d1, d8, for 21 days as a cycle) for 4 cycles, and the patient achieved partial remission (PR) after 2 cycles, followed by stable disease (SD) after 4 cycles (Fig.3[B3[B and F] and [C and G]) according to response evaluation criteria in solid tumors (RECIST) 1.1.\nThen, gefitinib (150\u200amg qd) was used as maintenance treatment from November 2015 onward.\nDuring the treatment, Ibandronate sodium was given monthly for skeletal-related events.\nThe patient is currently under surveillance with SD (Fig.3D and H) and with PS scores of 0.\n","ner_info":[{"text":"52-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"30-year history of smoking","label":"HISTORY","start":25,"end":51},{"text":"presented","label":"CLINICAL_EVENT","start":52,"end":61},{"text":"abnormal","label":"DETAILED_DESCRIPTION","start":70,"end":78},{"text":"nodule","label":"SIGN_SYMPTOM","start":79,"end":85},{"text":"0.8\u200a\u00d7\u200a1.5\u200acm","label":"AREA","start":96,"end":108},{"text":"left upper lung lobe","label":"BIOLOGICAL_STRUCTURE","start":116,"end":136},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":152,"end":157},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":158,"end":177},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":179,"end":181},{"text":"March 2012","label":"DATE","start":195,"end":205},{"text":"community hospital","label":"NONBIOLOGICAL_LOCATION","start":211,"end":229},{"text":"previously been well without any additional relevant or abnormal symptoms","label":"HISTORY","start":238,"end":311},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":313,"end":333},{"text":"abnormalities","label":"SIGN_SYMPTOM","start":359,"end":372},{"text":"Laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":374,"end":393},{"text":"within normal range","label":"LAB_VALUE","start":399,"end":418},{"text":"carcinoembryonic antigen","label":"DIAGNOSTIC_PROCEDURE","start":433,"end":457},{"text":"CEA","label":"DIAGNOSTIC_PROCEDURE","start":459,"end":462},{"text":"30.25\u200ang\/mL","label":"LAB_VALUE","start":473,"end":484},{"text":"serum","label":"BIOLOGICAL_STRUCTURE","start":524,"end":529},{"text":"positron emission tomography","label":"DIAGNOSTIC_PROCEDURE","start":547,"end":575},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":577,"end":580},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":582,"end":584},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":599,"end":603},{"text":"lesion","label":"SIGN_SYMPTOM","start":604,"end":610},{"text":"standardized uptake value","label":"DIAGNOSTIC_PROCEDURE","start":618,"end":643},{"text":"7.94","label":"LAB_VALUE","start":647,"end":651},{"text":"malignant tumor","label":"DISEASE_DISORDER","start":688,"end":703},{"text":"left upper lung","label":"BIOLOGICAL_STRUCTURE","start":740,"end":755},{"text":"lobectomy","label":"THERAPEUTIC_PROCEDURE","start":756,"end":765},{"text":"lymph node dissection","label":"THERAPEUTIC_PROCEDURE","start":770,"end":791},{"text":"pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":807,"end":831},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":844,"end":858},{"text":"ADC","label":"DISEASE_DISORDER","start":860,"end":863},{"text":"Immunohistochemistry","label":"DIAGNOSTIC_PROCEDURE","start":875,"end":895},{"text":"IHC","label":"DIAGNOSTIC_PROCEDURE","start":897,"end":900},{"text":"positive","label":"LAB_VALUE","start":924,"end":932},{"text":"CK7","label":"DIAGNOSTIC_PROCEDURE","start":937,"end":940},{"text":"TTF-1","label":"DIAGNOSTIC_PROCEDURE","start":942,"end":947},{"text":"p63","label":"DIAGNOSTIC_PROCEDURE","start":949,"end":952},{"text":"NapsinA","label":"DIAGNOSTIC_PROCEDURE","start":958,"end":965},{"text":"negative","label":"LAB_VALUE","start":970,"end":978},{"text":"CK 5\/6","label":"DIAGNOSTIC_PROCEDURE","start":983,"end":989},{"text":"Syn","label":"DIAGNOSTIC_PROCEDURE","start":991,"end":994},{"text":"cgA","label":"DIAGNOSTIC_PROCEDURE","start":996,"end":999},{"text":"Ki-67","label":"DIAGNOSTIC_PROCEDURE","start":1005,"end":1010},{"text":"clinical stage","label":"DIAGNOSTIC_PROCEDURE","start":1026,"end":1040},{"text":"IA2","label":"LAB_VALUE","start":1059,"end":1062},{"text":"pT1bN0M0","label":"LAB_VALUE","start":1064,"end":1072},{"text":"tumor","label":"COREFERENCE","start":1087,"end":1092},{"text":"early stage","label":"DETAILED_DESCRIPTION","start":1109,"end":1120},{"text":"adjuvant treatment","label":"MEDICATION","start":1150,"end":1168},{"text":"monitored","label":"THERAPEUTIC_PROCEDURE","start":1189,"end":1198},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1215,"end":1223},{"text":"visits","label":"CLINICAL_EVENT","start":1224,"end":1230},{"text":"every 3 months","label":"FREQUENCY","start":1231,"end":1245},{"text":"condition","label":"DIAGNOSTIC_PROCEDURE","start":1261,"end":1270},{"text":"stable","label":"LAB_VALUE","start":1280,"end":1286},{"text":"left chest","label":"BIOLOGICAL_STRUCTURE","start":1306,"end":1316},{"text":"pain","label":"SIGN_SYMPTOM","start":1317,"end":1321},{"text":"April 2015","label":"DATE","start":1325,"end":1335},{"text":"transferred","label":"CLINICAL_EVENT","start":1353,"end":1364},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1372,"end":1380},{"text":"tertiary care hospital","label":"NONBIOLOGICAL_LOCATION","start":1384,"end":1406},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":1431,"end":1451},{"text":"significant","label":"SEVERITY","start":1464,"end":1475},{"text":"tender point","label":"SIGN_SYMPTOM","start":1476,"end":1488},{"text":"left chest wall","label":"BIOLOGICAL_STRUCTURE","start":1496,"end":1511},{"text":"Laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":1513,"end":1532},{"text":"cytokeratin19 fragment antigen 21\u20131","label":"DIAGNOSTIC_PROCEDURE","start":1594,"end":1629},{"text":"CYFRA21\u20131","label":"DIAGNOSTIC_PROCEDURE","start":1631,"end":1640},{"text":"17.45\u200ang\/mL","label":"LAB_VALUE","start":1652,"end":1663},{"text":"serum","label":"BIOLOGICAL_STRUCTURE","start":1671,"end":1676},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1707,"end":1709},{"text":"PET","label":"DIAGNOSTIC_PROCEDURE","start":1714,"end":1717},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1718,"end":1720},{"text":"serious","label":"SEVERITY","start":1743,"end":1750},{"text":"involvement","label":"SIGN_SYMPTOM","start":1751,"end":1762},{"text":"left pleura","label":"BIOLOGICAL_STRUCTURE","start":1766,"end":1777},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1787,"end":1796},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":1797,"end":1801},{"text":"lesions","label":"SIGN_SYMPTOM","start":1802,"end":1809},{"text":"clinical stage","label":"DIAGNOSTIC_PROCEDURE","start":1845,"end":1859},{"text":"upgraded","label":"LAB_VALUE","start":1864,"end":1872},{"text":"IVB","label":"LAB_VALUE","start":1876,"end":1879},{"text":"CT-guided","label":"DETAILED_DESCRIPTION","start":1891,"end":1900},{"text":"left pleura","label":"BIOLOGICAL_STRUCTURE","start":1901,"end":1912},{"text":"puncture","label":"THERAPEUTIC_PROCEDURE","start":1913,"end":1921},{"text":"IHC analysis","label":"DIAGNOSTIC_PROCEDURE","start":1936,"end":1948},{"text":"positive","label":"LAB_VALUE","start":1956,"end":1964},{"text":"p63","label":"DIAGNOSTIC_PROCEDURE","start":1978,"end":1981},{"text":"p40","label":"DIAGNOSTIC_PROCEDURE","start":1983,"end":1986},{"text":"CK 7","label":"DIAGNOSTIC_PROCEDURE","start":1988,"end":1992},{"text":"CK 5\/6","label":"DIAGNOSTIC_PROCEDURE","start":1998,"end":2004},{"text":"TTF-1","label":"DIAGNOSTIC_PROCEDURE","start":2012,"end":2017},{"text":"NapsinA","label":"DIAGNOSTIC_PROCEDURE","start":2022,"end":2029},{"text":"absent","label":"LAB_VALUE","start":2044,"end":2050},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":2078,"end":2101},{"text":"SCC","label":"DISEASE_DISORDER","start":2103,"end":2106},{"text":"molecular evaluation","label":"DIAGNOSTIC_PROCEDURE","start":2129,"end":2149},{"text":"L858R mutation","label":"SIGN_SYMPTOM","start":2163,"end":2177},{"text":"exon 21","label":"DETAILED_DESCRIPTION","start":2181,"end":2188},{"text":"T790M mutation","label":"SIGN_SYMPTOM","start":2195,"end":2209},{"text":"exon 20","label":"DETAILED_DESCRIPTION","start":2213,"end":2220},{"text":"Considering the pathology of the SCC was quite distinct compared with that of the originally resected NSCLC specimen, we retrospectively reassessed the surgery specimen to verify our primary diagnosis","label":"OTHER_ENTITY","start":2237,"end":2437},{"text":"The morphologic and IHC results were in complete agreement with the initial diagnoses, but an L858R mutation was identified using the newly added molecular evaluation","label":"OTHER_ENTITY","start":2439,"end":2605},{"text":"palliative","label":"DETAILED_DESCRIPTION","start":2685,"end":2695},{"text":"three-dimensional conformal radiotherapy","label":"THERAPEUTIC_PROCEDURE","start":2696,"end":2736},{"text":"3D-CRT","label":"THERAPEUTIC_PROCEDURE","start":2738,"end":2744},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":2754,"end":2759},{"text":"lesion","label":"SIGN_SYMPTOM","start":2760,"end":2766},{"text":"42\u200aGy\/14 fractions","label":"DOSAGE","start":2800,"end":2818},{"text":"once daily","label":"FREQUENCY","start":2824,"end":2834},{"text":"5f\/week","label":"DOSAGE","start":2839,"end":2846},{"text":"volume over radiation dose 5\u200aGy","label":"DIAGNOSTIC_PROCEDURE","start":2860,"end":2891},{"text":"left","label":"BIOLOGICAL_STRUCTURE","start":2911,"end":2915},{"text":"right","label":"BIOLOGICAL_STRUCTURE","start":2917,"end":2922},{"text":"total lungs","label":"BIOLOGICAL_STRUCTURE","start":2928,"end":2939},{"text":"20%","label":"LAB_VALUE","start":2945,"end":2948},{"text":"0%","label":"LAB_VALUE","start":2950,"end":2952},{"text":"7.8%","label":"LAB_VALUE","start":2958,"end":2962},{"text":"volume over radiation dose 20\u200aGy","label":"DIAGNOSTIC_PROCEDURE","start":2982,"end":3014},{"text":"10%","label":"LAB_VALUE","start":3033,"end":3036},{"text":"0%","label":"LAB_VALUE","start":3038,"end":3040},{"text":"5%","label":"LAB_VALUE","start":3046,"end":3048},{"text":"mean lung dose","label":"DIAGNOSTIC_PROCEDURE","start":3068,"end":3082},{"text":"MLD","label":"DIAGNOSTIC_PROCEDURE","start":3084,"end":3087},{"text":"5\u200aGy","label":"LAB_VALUE","start":3093,"end":3097},{"text":"GP chemotherapy","label":"MEDICATION","start":3178,"end":3193},{"text":"cisplatin","label":"MEDICATION","start":3195,"end":3204},{"text":"75\u200amg\/m2 d1","label":"DOSAGE","start":3205,"end":3216},{"text":"gemcitabine","label":"MEDICATION","start":3218,"end":3229},{"text":"1250\u200amg\/m2 d1, d8","label":"DOSAGE","start":3230,"end":3247},{"text":"21 days as a cycle","label":"DETAILED_DESCRIPTION","start":3253,"end":3271},{"text":"4 cycles","label":"LAB_VALUE","start":3277,"end":3285},{"text":"partial","label":"DETAILED_DESCRIPTION","start":3312,"end":3319},{"text":"remission","label":"SIGN_SYMPTOM","start":3320,"end":3329},{"text":"after 2 cycles","label":"DATE","start":3335,"end":3349},{"text":"stable disease","label":"DISEASE_DISORDER","start":3363,"end":3377},{"text":"SD","label":"DISEASE_DISORDER","start":3379,"end":3381},{"text":"after 4 cycles","label":"DATE","start":3383,"end":3397},{"text":"response evaluation criteria in solid tumors","label":"DIAGNOSTIC_PROCEDURE","start":3445,"end":3489},{"text":"RECIST","label":"DIAGNOSTIC_PROCEDURE","start":3491,"end":3497},{"text":"1.1","label":"DETAILED_DESCRIPTION","start":3499,"end":3502},{"text":"gefitinib","label":"MEDICATION","start":3510,"end":3519},{"text":"150\u200amg qd","label":"DOSAGE","start":3521,"end":3530},{"text":"from November 2015","label":"DATE","start":3566,"end":3584},{"text":"Ibandronate sodium","label":"MEDICATION","start":3615,"end":3633},{"text":"monthly","label":"FREQUENCY","start":3644,"end":3651},{"text":"skeletal-related events","label":"SIGN_SYMPTOM","start":3656,"end":3679},{"text":"under surveillance","label":"CLINICAL_EVENT","start":3706,"end":3724},{"text":"SD","label":"DIAGNOSTIC_PROCEDURE","start":3730,"end":3732},{"text":"PS","label":"DIAGNOSTIC_PROCEDURE","start":3757,"end":3759},{"text":"0","label":"LAB_VALUE","start":3770,"end":3771}],"tokens":["A ","52-year-old"," ","man"," with a ","30-year history of smoking"," ","presented"," with an ","abnormal"," ","nodule"," measuring ","0.8\u200a\u00d7\u200a1.5\u200acm"," in the ","left upper lung lobe"," imaged through ","chest"," ","computed tomography"," (","CT",") scanning in ","March 2012"," in a ","community hospital",".\nHe had ","previously been well without any additional relevant or abnormal symptoms",".\n","Physical examination"," suggested no significant ","abnormalities",".\n","Laboratory findings"," were ","within normal range",", except for a ","carcinoembryonic antigen"," (","CEA",") level of ","30.25\u200ang\/mL"," (normal range, 0\u20135\u200ang\/mL) found in the ","serum",".\nSubsequently, a ","positron emission tomography"," (","PET",")\/","CT"," scan showed a ","lung"," ","lesion"," with a ","standardized uptake value"," of ","7.94",", which was highly suspected to be a ","malignant tumor"," (Fig.1).\nSubsequently, he underwent ","left upper lung"," ","lobectomy"," and ","lymph node dissection",".\nPostoperative ","pathological examination"," revealed an ","adenocarcinoma"," (","ADC",") (Fig.2A).\n","Immunohistochemistry"," (","IHC",") staining results were ","positive"," for ","CK7",", ","TTF-1",", ","p63",", and ","NapsinA"," and ","negative"," for ","CK 5\/6",", ","Syn",", ","cgA",", and ","Ki-67"," (20%\u201330%).\nThe ","clinical stage"," was classified as ","IA2"," (","pT1bN0M0",").\nBecause the ","tumor"," was still in an ","early stage",", the patient did not receive ","adjuvant treatment"," but continued to be ","monitored"," through regular ","hospital"," ","visits"," ","every 3 months",".\nThe patient's ","condition"," had been ","stable"," until the onset of ","left chest"," ","pain"," in ","April 2015",".\nThe patient was ","transferred"," to our ","hospital"," (a ","tertiary care hospital",") for further treatment.\n","Physical examination"," suggested a ","significant"," ","tender point"," in the ","left chest wall",".\n","Laboratory findings"," showed only a single parameter outside the normal range: the ","cytokeratin19 fragment antigen 21\u20131"," (","CYFRA21\u20131",") level was ","17.45\u200ang\/mL"," in the ","serum"," (normal range\u200a=\u200a0\u20133.3\u200ang\/mL).\n","CT"," and ","PET","\/","CT"," scans highlighted the ","serious"," ","involvement"," of ","left pleura",", showing ","bilateral"," ","lung"," ","lesions"," (Fig.3A and E).\nAt that point, the ","clinical stage"," was ","upgraded"," to ","IVB",".\nAfter the ","CT-guided"," ","left pleura"," ","puncture",", pathological ","IHC analysis"," showed ","positive"," staining for ","p63",", ","p40",", ","CK 7",", and ","CK 5\/6",", while ","TTF-1"," and ","NapsinA"," staining were ","absent",", supporting a diagnosis of ","squamous cell carcinoma"," (","SCC",") (Fig.2B).\nMeanwhile, ","molecular evaluation"," confirmed an ","L858R mutation"," in ","exon 21"," and a ","T790M mutation"," in ","exon 20"," (Fig.4B and C).\n","Considering the pathology of the SCC was quite distinct compared with that of the originally resected NSCLC specimen, we retrospectively reassessed the surgery specimen to verify our primary diagnosis",".\n","The morphologic and IHC results were in complete agreement with the initial diagnoses, but an L858R mutation was identified using the newly added molecular evaluation"," (Fig.4A).\nTo relieve the acute pain in the left pleura as quickly as possible, ","palliative"," ","three-dimensional conformal radiotherapy"," (","3D-CRT",") for the ","chest"," ","lesion"," was delivered at a total dose of ","42\u200aGy\/14 fractions"," (f), ","once daily"," and ","5f\/week"," (Fig.5).\nThe ","volume over radiation dose 5\u200aGy"," (V5) values of the ","left",", ","right",", and ","total lungs"," were ","20%",", ","0%",", and ","7.8%",", respectively; the ","volume over radiation dose 20\u200aGy"," (V20) values were ","10%",", ","0%",", and ","5%",", respectively; the ","mean lung dose"," (","MLD",") was ","5\u200aGy",".\nMeanwhile, considering the MST pathology was that of SCC, the patient received ","GP chemotherapy"," (","cisplatin"," ","75\u200amg\/m2 d1",", ","gemcitabine"," ","1250\u200amg\/m2 d1, d8",", for ","21 days as a cycle",") for ","4 cycles",", and the patient achieved ","partial"," ","remission"," (PR) ","after 2 cycles",", followed by ","stable disease"," (","SD",") ","after 4 cycles"," (Fig.3[B3[B and F] and [C and G]) according to ","response evaluation criteria in solid tumors"," (","RECIST",") ","1.1",".\nThen, ","gefitinib"," (","150\u200amg qd",") was used as maintenance treatment ","from November 2015"," onward.\nDuring the treatment, ","Ibandronate sodium"," was given ","monthly"," for ","skeletal-related events",".\nThe patient is currently ","under surveillance"," with ","SD"," (Fig.3D and H) and with ","PS"," scores of 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-{"full_text":"A 57-year-old male was admitted to our hospital with 5 months\u2019 history of massive rectal bleeding (rectorrhagia).\nHe had past history of passage of fresh blood mixed stool since last 55 years.\nHe first complained of rectal bleeding at the age of 2.\nHe went hospital numerous times for this symptom; multiple interventions were done but disease was not cured completely.\nDuring one of his hospital visit in the past (patient forgot the date), he was diagnosed and treated as hemorrhoids.\nThe symptom was relieved for a while and then recurred again.\nThirty years ago, he was diagnosed as rectal hemangioma and managed with cryotherapy in our hospital.\nThat could also just relieve the symptom for few years and it recurred again.\nThen, he consulted many other hospitals, but could only get short-term symptomatic relief without proper treatment of the cause.\nSince 5 months, the severity of rectal bleeding increased.\nHe then went to local hospital where intervention was done to control bleeding and symptomatic treatment was done with intravenous fluid and blood transfusion.\nHe finally referred to our hospital for further evaluation.\nIntermediate rectal bleeding of fresh blood was presented on admission.\nPatient complained of dizziness on standing, shortness of breath, and palpitation on walking a short distance.\nThere was no history of similar illness in family.\nOn general examination, patient appeared pale, but his heart rate and blood pressure were within normal limit during rest.\nHe lost 5\u200akg of his body weight during last 5 months.\nOn rectal examination, fresh blood was seen around anal region and soft mass was felt on digital rectal examination.\nOn proctoscopy, anal cavity and rectum were seen filled with fresh blood, but active site of bleeding, polyp, or ulcer was not detected.\nOn laboratory examination, red blood cell count was 3.09\u200a\u00d7\u200a1012\/L (Normal: 4.32\u20135.72\u200a\u00d7\u200a1012\/L) and hemoglobin was 86\u200ag\/L (Normal: 135\u2013175\u200ag\/L).\nAll other parameters were within normal limit.\nNone enhanced CT showed isodense (35\u200aHU) homogenous bowel wall thickening that on contrast-enhanced CT venous phase enhances heterogeneously.\nMultiple calcifications were seen in the thickened bowel wall and around the peri-rectal area.\nLesion was seen extending from distal sigmoid to whole of the rectum (Fig.1).\nMultiple hypodense lesions were also seen in spleen (Fig.2).\nAfter initial management of anemia, the patient underwent abdominal laparotomy followed by surgical excision.\nDuring surgery, 25\u200acm long lesion was found extending from distal sigmoid to whole of the rectum.\nWhole of the rectum and part of the sigmoid colon were excised and sigmoid-anus anastomosis was done.\nPostsurgical histopathological examination of excised specimen showed submucosal multiple thin-walled vessel of varying size with interposed stroma.\nSome vessels lumen consisted of blood cells (consistent with blood vessel), whereas other consisted of clear fluid (consistent with lymph vessel).\nImmunohistochemistry of specimen showed endothelial cells positive for CD 31 and CD 34.\nSome cells were positive for D2\u201340, while others were negative for D2\u201340 (Fig.3).\nOn the basis of histopathological report and immunohistochemistry, hemolymphangioma was diagnosed.\nThe surgery, which followed by complication (intestinal infection), was well managed and the patient was discharged from hospital on the 23rd day of surgery.\nThen after, no further complication or recurrence was noticed during 6 months\u2019 follow-up.\nThis study was approved by the First Affiliated Hospital of Sun Yat-Sen University Institutional Review Board.\nWritten consent for this case report was obtained from the patient.\n","ner_info":[{"text":"57-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"admitted","label":"CLINICAL_EVENT","start":23,"end":31},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":39,"end":47},{"text":"5 months","label":"DURATION","start":53,"end":61},{"text":"massive","label":"SEVERITY","start":74,"end":81},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":82,"end":88},{"text":"bleeding","label":"SIGN_SYMPTOM","start":89,"end":97},{"text":"past history of passage of fresh blood mixed stool since last 55 years.","label":"HISTORY","start":121,"end":192},{"text":"rectal bleeding at the age of 2","label":"HISTORY","start":216,"end":247},{"text":"went","label":"CLINICAL_EVENT","start":252,"end":256},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":257,"end":265},{"text":"symptom","label":"COREFERENCE","start":290,"end":297},{"text":"interventions","label":"THERAPEUTIC_PROCEDURE","start":308,"end":321},{"text":"diagnosed and treated as hemorrhoids","label":"HISTORY","start":449,"end":485},{"text":"symptom","label":"SIGN_SYMPTOM","start":491,"end":498},{"text":"a while","label":"DURATION","start":516,"end":523},{"text":"recurred","label":"SIGN_SYMPTOM","start":533,"end":541},{"text":"Thirty years ago","label":"DATE","start":549,"end":565},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":587,"end":593},{"text":"hemangioma","label":"DISEASE_DISORDER","start":594,"end":604},{"text":"cryotherapy","label":"THERAPEUTIC_PROCEDURE","start":622,"end":633},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":641,"end":649},{"text":"symptom","label":"SIGN_SYMPTOM","start":684,"end":691},{"text":"few years","label":"DURATION","start":696,"end":705},{"text":"recurred","label":"SIGN_SYMPTOM","start":713,"end":721},{"text":"consulted","label":"CLINICAL_EVENT","start":738,"end":747},{"text":"many other hospitals","label":"NONBIOLOGICAL_LOCATION","start":748,"end":768},{"text":"short-term","label":"DETAILED_DESCRIPTION","start":789,"end":799},{"text":"symptomatic relief","label":"SIGN_SYMPTOM","start":800,"end":818},{"text":"Since 5 months","label":"DURATION","start":858,"end":872},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":890,"end":896},{"text":"bleeding","label":"SIGN_SYMPTOM","start":897,"end":905},{"text":"went","label":"CLINICAL_EVENT","start":925,"end":929},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":933,"end":947},{"text":"intervention","label":"THERAPEUTIC_PROCEDURE","start":954,"end":966},{"text":"bleeding","label":"SIGN_SYMPTOM","start":987,"end":995},{"text":"symptomatic treatment","label":"THERAPEUTIC_PROCEDURE","start":1000,"end":1021},{"text":"intravenous","label":"ADMINISTRATION","start":1036,"end":1047},{"text":"fluid","label":"MEDICATION","start":1048,"end":1053},{"text":"blood transfusion","label":"THERAPEUTIC_PROCEDURE","start":1058,"end":1075},{"text":"referred","label":"CLINICAL_EVENT","start":1088,"end":1096},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1104,"end":1112},{"text":"Intermediate","label":"SEVERITY","start":1137,"end":1149},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":1150,"end":1156},{"text":"bleeding","label":"SIGN_SYMPTOM","start":1157,"end":1165},{"text":"fresh blood","label":"DETAILED_DESCRIPTION","start":1169,"end":1180},{"text":"admission","label":"CLINICAL_EVENT","start":1198,"end":1207},{"text":"dizziness","label":"SIGN_SYMPTOM","start":1231,"end":1240},{"text":"standing","label":"DETAILED_DESCRIPTION","start":1244,"end":1252},{"text":"shortness of breath","label":"SIGN_SYMPTOM","start":1254,"end":1273},{"text":"palpitation","label":"SIGN_SYMPTOM","start":1279,"end":1290},{"text":"walking a short distance","label":"DETAILED_DESCRIPTION","start":1294,"end":1318},{"text":"no history of similar illness in family","label":"FAMILY_HISTORY","start":1330,"end":1369},{"text":"general examination","label":"DIAGNOSTIC_PROCEDURE","start":1374,"end":1393},{"text":"pale","label":"SIGN_SYMPTOM","start":1412,"end":1416},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":1426,"end":1436},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":1441,"end":1455},{"text":"within normal limit","label":"LAB_VALUE","start":1461,"end":1480},{"text":"lost 5\u200akg","label":"LAB_VALUE","start":1497,"end":1506},{"text":"body weight","label":"DIAGNOSTIC_PROCEDURE","start":1514,"end":1525},{"text":"during last 5 months","label":"DURATION","start":1526,"end":1546},{"text":"rectal examination","label":"DIAGNOSTIC_PROCEDURE","start":1551,"end":1569},{"text":"fresh blood","label":"SIGN_SYMPTOM","start":1571,"end":1582},{"text":"around anal region","label":"BIOLOGICAL_STRUCTURE","start":1592,"end":1610},{"text":"soft","label":"TEXTURE","start":1615,"end":1619},{"text":"mass","label":"SIGN_SYMPTOM","start":1620,"end":1624},{"text":"digital rectal examination","label":"DIAGNOSTIC_PROCEDURE","start":1637,"end":1663},{"text":"proctoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1668,"end":1679},{"text":"anal cavity","label":"BIOLOGICAL_STRUCTURE","start":1681,"end":1692},{"text":"rectum","label":"BIOLOGICAL_STRUCTURE","start":1697,"end":1703},{"text":"fresh blood","label":"SIGN_SYMPTOM","start":1726,"end":1737},{"text":"active site of bleeding","label":"SIGN_SYMPTOM","start":1743,"end":1766},{"text":"polyp","label":"SIGN_SYMPTOM","start":1768,"end":1773},{"text":"ulcer","label":"SIGN_SYMPTOM","start":1778,"end":1783},{"text":"laboratory examination","label":"DIAGNOSTIC_PROCEDURE","start":1805,"end":1827},{"text":"red blood cell count","label":"DIAGNOSTIC_PROCEDURE","start":1829,"end":1849},{"text":"3.09\u200a\u00d7\u200a1012\/L","label":"LAB_VALUE","start":1854,"end":1867},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":1901,"end":1911},{"text":"86\u200ag\/L","label":"LAB_VALUE","start":1916,"end":1922},{"text":"All other parameters","label":"DIAGNOSTIC_PROCEDURE","start":1946,"end":1966},{"text":"within normal limit","label":"LAB_VALUE","start":1972,"end":1991},{"text":"None enhanced","label":"DETAILED_DESCRIPTION","start":1993,"end":2006},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2007,"end":2009},{"text":"isodense","label":"DETAILED_DESCRIPTION","start":2017,"end":2025},{"text":"35\u200aHU","label":"LAB_VALUE","start":2027,"end":2032},{"text":"homogenous","label":"DETAILED_DESCRIPTION","start":2034,"end":2044},{"text":"bowel wall","label":"BIOLOGICAL_STRUCTURE","start":2045,"end":2055},{"text":"thickening","label":"SIGN_SYMPTOM","start":2056,"end":2066},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":2075,"end":2092},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":2093,"end":2095},{"text":"venous phase","label":"DETAILED_DESCRIPTION","start":2096,"end":2108},{"text":"enhances","label":"SIGN_SYMPTOM","start":2109,"end":2117},{"text":"heterogeneously","label":"DETAILED_DESCRIPTION","start":2118,"end":2133},{"text":"Multiple","label":"DETAILED_DESCRIPTION","start":2135,"end":2143},{"text":"calcifications","label":"SIGN_SYMPTOM","start":2144,"end":2158},{"text":"thickened bowel wall","label":"BIOLOGICAL_STRUCTURE","start":2176,"end":2196},{"text":"peri-rectal area","label":"BIOLOGICAL_STRUCTURE","start":2212,"end":2228},{"text":"Lesion","label":"SIGN_SYMPTOM","start":2230,"end":2236},{"text":"distal sigmoid","label":"BIOLOGICAL_STRUCTURE","start":2261,"end":2275},{"text":"whole of the rectum","label":"BIOLOGICAL_STRUCTURE","start":2279,"end":2298},{"text":"Multiple","label":"DETAILED_DESCRIPTION","start":2308,"end":2316},{"text":"hypodense","label":"DETAILED_DESCRIPTION","start":2317,"end":2326},{"text":"lesions","label":"SIGN_SYMPTOM","start":2327,"end":2334},{"text":"spleen","label":"BIOLOGICAL_STRUCTURE","start":2353,"end":2359},{"text":"management","label":"THERAPEUTIC_PROCEDURE","start":2383,"end":2393},{"text":"anemia","label":"SIGN_SYMPTOM","start":2397,"end":2403},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":2427,"end":2436},{"text":"laparotomy","label":"THERAPEUTIC_PROCEDURE","start":2437,"end":2447},{"text":"surgical excision","label":"THERAPEUTIC_PROCEDURE","start":2460,"end":2477},{"text":"25\u200acm","label":"DISTANCE","start":2495,"end":2500},{"text":"lesion","label":"SIGN_SYMPTOM","start":2506,"end":2512},{"text":"distal sigmoid","label":"BIOLOGICAL_STRUCTURE","start":2538,"end":2552},{"text":"whole of the rectum","label":"BIOLOGICAL_STRUCTURE","start":2556,"end":2575},{"text":"Whole of the rectum","label":"BIOLOGICAL_STRUCTURE","start":2577,"end":2596},{"text":"part of the sigmoid colon","label":"BIOLOGICAL_STRUCTURE","start":2601,"end":2626},{"text":"excised","label":"THERAPEUTIC_PROCEDURE","start":2632,"end":2639},{"text":"sigmoid-anus","label":"DETAILED_DESCRIPTION","start":2644,"end":2656},{"text":"anastomosis","label":"THERAPEUTIC_PROCEDURE","start":2657,"end":2668},{"text":"histopathological examination","label":"DIAGNOSTIC_PROCEDURE","start":2692,"end":2721},{"text":"excised specimen","label":"DETAILED_DESCRIPTION","start":2725,"end":2741},{"text":"submucosal multiple thin-walled vessel","label":"DETAILED_DESCRIPTION","start":2749,"end":2787},{"text":"varying size","label":"LAB_VALUE","start":2791,"end":2803},{"text":"interposed stroma","label":"LAB_VALUE","start":2809,"end":2826},{"text":"Some vessels lumen consisted of blood cells","label":"LAB_VALUE","start":2828,"end":2871},{"text":"other consisted of clear fluid","label":"LAB_VALUE","start":2912,"end":2942},{"text":"Immunohistochemistry","label":"DIAGNOSTIC_PROCEDURE","start":2975,"end":2995},{"text":"endothelial cells","label":"BIOLOGICAL_STRUCTURE","start":3015,"end":3032},{"text":"positive","label":"LAB_VALUE","start":3033,"end":3041},{"text":"CD 31","label":"DIAGNOSTIC_PROCEDURE","start":3046,"end":3051},{"text":"CD 34","label":"DIAGNOSTIC_PROCEDURE","start":3056,"end":3061},{"text":"Some cells","label":"BIOLOGICAL_STRUCTURE","start":3063,"end":3073},{"text":"positive","label":"LAB_VALUE","start":3079,"end":3087},{"text":"D2\u201340","label":"DIAGNOSTIC_PROCEDURE","start":3092,"end":3097},{"text":"others","label":"BIOLOGICAL_STRUCTURE","start":3105,"end":3111},{"text":"negative","label":"LAB_VALUE","start":3117,"end":3125},{"text":"D2\u201340","label":"DIAGNOSTIC_PROCEDURE","start":3130,"end":3135},{"text":"hemolymphangioma","label":"DISEASE_DISORDER","start":3212,"end":3228},{"text":"intestinal","label":"BIOLOGICAL_STRUCTURE","start":3289,"end":3299},{"text":"infection","label":"DISEASE_DISORDER","start":3300,"end":3309},{"text":"managed","label":"THERAPEUTIC_PROCEDURE","start":3321,"end":3328},{"text":"discharged","label":"CLINICAL_EVENT","start":3349,"end":3359},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":3365,"end":3373},{"text":"23rd day","label":"DATE","start":3381,"end":3389},{"text":"complication","label":"SIGN_SYMPTOM","start":3425,"end":3437},{"text":"recurrence","label":"SIGN_SYMPTOM","start":3441,"end":3451},{"text":"6 months\u2019","label":"DURATION","start":3471,"end":3480},{"text":"follow-up","label":"CLINICAL_EVENT","start":3481,"end":3490}],"tokens":["A ","57-year-old"," ","male"," was ","admitted"," to our ","hospital"," with ","5 months","\u2019 history of ","massive"," ","rectal"," ","bleeding"," (rectorrhagia).\nHe had ","past history of passage of fresh blood mixed stool since last 55 years.","\nHe first complained of ","rectal bleeding at the age of 2",".\nHe ","went"," ","hospital"," numerous times for this ","symptom","; multiple ","interventions"," were done but disease was not cured completely.\nDuring one of his hospital visit in the past (patient forgot the date), he was ","diagnosed and treated as hemorrhoids",".\nThe ","symptom"," was relieved for ","a while"," and then ","recurred"," again.\n","Thirty years ago",", he was diagnosed as ","rectal"," ","hemangioma"," and managed with ","cryotherapy"," in our ","hospital",".\nThat could also just relieve the ","symptom"," for ","few years"," and it ","recurred"," again.\nThen, he ","consulted"," ","many other hospitals",", but could only get ","short-term"," ","symptomatic relief"," without proper treatment of the cause.\n","Since 5 months",", the severity of ","rectal"," ","bleeding"," increased.\nHe then ","went"," to ","local hospital"," where ","intervention"," was done to control ","bleeding"," and ","symptomatic treatment"," was done with ","intravenous"," ","fluid"," and ","blood transfusion",".\nHe finally ","referred"," to our ","hospital"," for further evaluation.\n","Intermediate"," ","rectal"," ","bleeding"," of ","fresh blood"," was presented on ","admission",".\nPatient complained of ","dizziness"," on ","standing",", ","shortness of breath",", and ","palpitation"," on ","walking a short distance",".\nThere was ","no history of similar illness in family",".\nOn ","general examination",", patient appeared ","pale",", but his ","heart rate"," and ","blood pressure"," were ","within normal limit"," during rest.\nHe ","lost 5\u200akg"," of his ","body weight"," ","during last 5 months",".\nOn ","rectal examination",", ","fresh blood"," was seen ","around anal region"," and ","soft"," ","mass"," was felt on ","digital rectal examination",".\nOn ","proctoscopy",", ","anal cavity"," and ","rectum"," were seen filled with ","fresh blood",", but ","active site of bleeding",", ","polyp",", or ","ulcer"," was not detected.\nOn ","laboratory examination",", ","red blood cell count"," was ","3.09\u200a\u00d7\u200a1012\/L"," (Normal: 4.32\u20135.72\u200a\u00d7\u200a1012\/L) and ","hemoglobin"," was ","86\u200ag\/L"," (Normal: 135\u2013175\u200ag\/L).\n","All other parameters"," were ","within normal limit",".\n","None enhanced"," ","CT"," showed ","isodense"," (","35\u200aHU",") ","homogenous"," ","bowel wall"," ","thickening"," that on ","contrast-enhanced"," ","CT"," ","venous phase"," ","enhances"," ","heterogeneously",".\n","Multiple"," ","calcifications"," were seen in the ","thickened bowel wall"," and around the ","peri-rectal area",".\n","Lesion"," was seen extending from ","distal sigmoid"," to ","whole of the rectum"," (Fig.1).\n","Multiple"," ","hypodense"," ","lesions"," were also seen in ","spleen"," (Fig.2).\nAfter initial ","management"," of ","anemia",", the patient underwent ","abdominal"," ","laparotomy"," followed by ","surgical excision",".\nDuring surgery, ","25\u200acm"," long ","lesion"," was found extending from ","distal sigmoid"," to ","whole of the rectum",".\n","Whole of the rectum"," and ","part of the sigmoid colon"," were ","excised"," and ","sigmoid-anus"," ","anastomosis"," was done.\nPostsurgical ","histopathological examination"," of ","excised specimen"," showed ","submucosal multiple thin-walled vessel"," of ","varying size"," with ","interposed stroma",".\n","Some vessels lumen consisted of blood cells"," (consistent with blood vessel), whereas ","other consisted of clear fluid"," (consistent with lymph vessel).\n","Immunohistochemistry"," of specimen showed ","endothelial cells"," ","positive"," for ","CD 31"," and ","CD 34",".\n","Some cells"," were ","positive"," for ","D2\u201340",", while ","others"," were ","negative"," for ","D2\u201340"," (Fig.3).\nOn the basis of histopathological report and immunohistochemistry, ","hemolymphangioma"," was diagnosed.\nThe surgery, which followed by complication (","intestinal"," ","infection","), was well ","managed"," and the patient was ","discharged"," from ","hospital"," on the ","23rd day"," of surgery.\nThen after, no further ","complication"," or ","recurrence"," was noticed during ","6 months\u2019"," ","follow-up",".\nThis study was approved by the First Affiliated Hospital of Sun Yat-Sen University Institutional Review Board.\nWritten consent for this case report was obtained from the patient.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,32,0,63,0,12,0,69,0,39,0,39,0,13,0,48,0,18,0,75,0,39,0,69,0,32,0,69,0,19,0,12,0,26,0,75,0,48,0,69,0,32,0,69,0,13,0,48,0,22,0,69,0,32,0,12,0,69,0,13,0,48,0,75,0,69,0,75,0,4,0,46,0,75,0,13,0,48,0,63,0,12,0,69,0,22,0,13,0,69,0,22,0,69,0,69,0,22,0,34,0,24,0,69,0,24,0,24,0,42,0,42,0,24,0,32,0,24,0,69,0,12,0,73,0,69,0,24,0,24,0,12,0,12,0,69,0,69,0,69,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,22,0,42,0,22,0,12,0,69,0,22,0,24,0,22,0,69,0,22,0,22,0,69,0,12,0,12,0,69,0,12,0,12,0,22,0,22,0,69,0,12,0,75,0,69,0,12,0,75,0,75,0,27,0,69,0,12,0,12,0,12,0,12,0,75,0,22,0,75,0,24,0,22,0,22,0,42,0,42,0,42,0,42,0,24,0,12,0,42,0,24,0,24,0,12,0,42,0,24,0,12,0,42,0,24,0,26,0,12,0,26,0,75,0,13,0,48,0,19,0,69,0,69,0,32,0,13,0]}
-{"full_text":"We report the case of a 68-year-old female with no past medical history, presented with an upper gastrointestinal bleeding and pain in left upper abdomen.\nPhysical examination found a splenomegaly and signs of portosystemic collateral formation including abdominal wall dilated veins and rectal haemorrhoids.\nNo biological abnormalities were noted besides those due to hypersplenism (anaemia and thrombocytopenia).\nThe patient underwent upper gastrointestinal endoscopy that showed stage III oesophageal varices with portal hypertensive gastropathy and red signs.\nUltrasonography revealed a fusiform dilatation of the portal bifurcation measuring 40 mm in diameter with dilated branches; no signs of portal thrombosis were detected (Figure 1).\nThe portal Doppler study showed a normal hepatopetal flow.\nOther signs of portal hypertension were found, including splenomegaly, repermeation of the umbilical vein and a splenorenal collateral circulation.\nA complementary angio-CT allowed a better assessment of the portal system that contained some thin calcifications in the aneurysmal wall and the main portal trunk (Figure 2, Figure 3, Figure 4).\nOther signs of portal hypertension were noted such as oesophageal and gastric varices, parietal collateral circulation associated to ultrasonography findings.\nLiver cirrhosis was confirmed by transcient elastometry and biopsy.\n","ner_info":[{"text":"68-year-old","label":"AGE","start":24,"end":35},{"text":"female","label":"SEX","start":36,"end":42},{"text":"no past medical history","label":"HISTORY","start":48,"end":71},{"text":"presented","label":"CLINICAL_EVENT","start":73,"end":82},{"text":"upper gastrointestinal","label":"BIOLOGICAL_STRUCTURE","start":91,"end":113},{"text":"bleeding","label":"SIGN_SYMPTOM","start":114,"end":122},{"text":"pain","label":"SIGN_SYMPTOM","start":127,"end":131},{"text":"left upper abdomen","label":"BIOLOGICAL_STRUCTURE","start":135,"end":153},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":155,"end":175},{"text":"splenomegaly","label":"SIGN_SYMPTOM","start":184,"end":196},{"text":"portosystemic collateral formation","label":"DISEASE_DISORDER","start":210,"end":244},{"text":"abdominal wall","label":"BIOLOGICAL_STRUCTURE","start":255,"end":269},{"text":"dilated veins","label":"SIGN_SYMPTOM","start":270,"end":283},{"text":"rectal","label":"BIOLOGICAL_STRUCTURE","start":288,"end":294},{"text":"haemorrhoids","label":"SIGN_SYMPTOM","start":295,"end":307},{"text":"biological abnormalities","label":"SIGN_SYMPTOM","start":312,"end":336},{"text":"hypersplenism","label":"DISEASE_DISORDER","start":369,"end":382},{"text":"anaemia","label":"SIGN_SYMPTOM","start":384,"end":391},{"text":"thrombocytopenia","label":"SIGN_SYMPTOM","start":396,"end":412},{"text":"upper gastrointestinal","label":"BIOLOGICAL_STRUCTURE","start":437,"end":459},{"text":"endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":460,"end":469},{"text":"stage III","label":"DETAILED_DESCRIPTION","start":482,"end":491},{"text":"oesophageal","label":"BIOLOGICAL_STRUCTURE","start":492,"end":503},{"text":"varices","label":"SIGN_SYMPTOM","start":504,"end":511},{"text":"portal hypertensive gastropathy","label":"DISEASE_DISORDER","start":517,"end":548},{"text":"red signs","label":"SIGN_SYMPTOM","start":553,"end":562},{"text":"Ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":564,"end":579},{"text":"fusiform dilatation","label":"SIGN_SYMPTOM","start":591,"end":610},{"text":"portal bifurcation","label":"BIOLOGICAL_STRUCTURE","start":618,"end":636},{"text":"40 mm","label":"DISTANCE","start":647,"end":652},{"text":"dilated branches","label":"DETAILED_DESCRIPTION","start":670,"end":686},{"text":"signs of portal thrombosis","label":"SIGN_SYMPTOM","start":691,"end":717},{"text":"portal","label":"BIOLOGICAL_STRUCTURE","start":748,"end":754},{"text":"Doppler study","label":"DIAGNOSTIC_PROCEDURE","start":755,"end":768},{"text":"normal hepatopetal flow","label":"LAB_VALUE","start":778,"end":801},{"text":"Other signs of portal hypertension","label":"SIGN_SYMPTOM","start":803,"end":837},{"text":"splenomegaly","label":"SIGN_SYMPTOM","start":860,"end":872},{"text":"repermeation","label":"SIGN_SYMPTOM","start":874,"end":886},{"text":"umbilical vein","label":"BIOLOGICAL_STRUCTURE","start":894,"end":908},{"text":"splenorenal","label":"BIOLOGICAL_STRUCTURE","start":915,"end":926},{"text":"collateral circulation","label":"SIGN_SYMPTOM","start":927,"end":949},{"text":"angio","label":"BIOLOGICAL_STRUCTURE","start":967,"end":972},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":973,"end":975},{"text":"thin calcifications","label":"SIGN_SYMPTOM","start":1045,"end":1064},{"text":"aneurysmal wall","label":"BIOLOGICAL_STRUCTURE","start":1072,"end":1087},{"text":"main portal trunk","label":"BIOLOGICAL_STRUCTURE","start":1096,"end":1113},{"text":"Other signs of portal hypertension","label":"SIGN_SYMPTOM","start":1146,"end":1180},{"text":"oesophageal","label":"BIOLOGICAL_STRUCTURE","start":1200,"end":1211},{"text":"gastric","label":"BIOLOGICAL_STRUCTURE","start":1216,"end":1223},{"text":"varices","label":"SIGN_SYMPTOM","start":1224,"end":1231},{"text":"parietal","label":"BIOLOGICAL_STRUCTURE","start":1233,"end":1241},{"text":"collateral circulation","label":"SIGN_SYMPTOM","start":1242,"end":1264},{"text":"ultrasonography","label":"COREFERENCE","start":1279,"end":1294},{"text":"Liver cirrhosis","label":"DISEASE_DISORDER","start":1305,"end":1320},{"text":"transcient elastometry","label":"DIAGNOSTIC_PROCEDURE","start":1338,"end":1360},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1365,"end":1371}],"tokens":["We report the case of a ","68-year-old"," ","female"," with ","no past medical history",", ","presented"," with an ","upper gastrointestinal"," ","bleeding"," and ","pain"," in ","left upper abdomen",".\n","Physical examination"," found a ","splenomegaly"," and signs of ","portosystemic collateral formation"," including ","abdominal wall"," ","dilated veins"," and ","rectal"," ","haemorrhoids",".\nNo ","biological abnormalities"," were noted besides those due to ","hypersplenism"," (","anaemia"," and ","thrombocytopenia",").\nThe patient underwent ","upper gastrointestinal"," ","endoscopy"," that showed ","stage III"," ","oesophageal"," ","varices"," with ","portal hypertensive gastropathy"," and ","red signs",".\n","Ultrasonography"," revealed a ","fusiform dilatation"," of the ","portal bifurcation"," measuring ","40 mm"," in diameter with ","dilated branches","; no ","signs of portal thrombosis"," were detected (Figure 1).\nThe ","portal"," ","Doppler study"," showed a ","normal hepatopetal flow",".\n","Other signs of portal hypertension"," were found, including ","splenomegaly",", ","repermeation"," of the ","umbilical vein"," and a ","splenorenal"," ","collateral circulation",".\nA complementary ","angio","-","CT"," allowed a better assessment of the portal system that contained some ","thin calcifications"," in the ","aneurysmal wall"," and the ","main portal trunk"," (Figure 2, Figure 3, Figure 4).\n","Other signs of portal hypertension"," were noted such as ","oesophageal"," and ","gastric"," ","varices",", ","parietal"," ","collateral circulation"," associated to ","ultrasonography"," findings.\n","Liver cirrhosis"," was confirmed by ","transcient elastometry"," and ","biopsy",".\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,12,0,69,0,69,0,12,0,24,0,69,0,26,0,12,0,69,0,12,0,69,0,69,0,26,0,69,0,69,0,12,0,24,0,22,0,12,0,69,0,26,0,69,0,24,0,69,0,12,0,27,0,22,0,69,0,12,0,24,0,42,0,69,0,69,0,69,0,12,0,12,0,69,0,12,0,24,0,69,0,12,0,12,0,69,0,12,0,12,0,69,0,12,0,69,0,18,0,26,0,24,0,24,0]}
-{"full_text":"A 64-year-old man was admitted to the Department of Gastroenterology of the Affiliated Hospital of Qingdao University Medical College (Qingdao, China) due to epigastric pains.\nPhysical examination revealed no palpable mass, lymphadenopathy, or organomegaly.\nOn endoscopy, several submucosal lesions were identified in the gastric antrum and the duodenal bulb (Fig.1).\nEndoscopic ultrasonography (EUS) (OLYMPUS EUS EU-ME2, Miniprobe sonography) demonstrated that the lesions were almost 0.5-cm homogeneously hypoechoic neoplasms originating from the submucous layer (Fig.2) and the initial diagnosis was digestive neuroendocrine tumors.\nComputed tomography revealed enlarged lymph nodes in multiple regions (mediastinal, retroperitoneal, mesenteric, and inguinal) and intracavitary nodules in the duodenum.\nTo reach a definitive diagnosis, the patient underwent repeat EUS and biopsy was performed.\nOn endoscopy, a 2 \u00d7 1-cm columnar uplift in the terminal ileum and multiple submucosal lesions in the rectum were identified (Fig.3).\nEUS revealed that the lesions in the terminal ileum were sized 1.6 \u00d7 1.2\u200acm and the lesions in the rectum were sized almost 0.6 \u00d7 1.0\u200acm, they were all homogeneously hypoechoic and originated from the muscularis mucosa layer.\nPathological examination of the biopsied specimens from the lesions of the rectum showed diffuse lymphomatous proliferation and dense infiltration by monomorphic, small cleaved cells with irregularly shaped nuclei (Fig.4).\nOn immunohistochemical analysis, the cells were positive for cyclin D1, CD20, CD21, SOX-11, and Bcl-2, but negative for CD3 and CD10, which was compatible with the diagnosis of MCL.\nKi-67 staining revealed a proliferative index of 30%.\nBased on these findings, the diagnosis of Ann Arbor stage IV MCL was confirmed.\nThe patient was referred for combination chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP regimen).\nThe patient has been in remission clinically.\n","ner_info":[{"text":"64-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"admitted","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"Department of Gastroenterology","label":"NONBIOLOGICAL_LOCATION","start":38,"end":68},{"text":"Affiliated Hospital of Qingdao University Medical College (Qingdao, China)","label":"NONBIOLOGICAL_LOCATION","start":76,"end":150},{"text":"epigastric","label":"BIOLOGICAL_STRUCTURE","start":158,"end":168},{"text":"pains","label":"SIGN_SYMPTOM","start":169,"end":174},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":176,"end":196},{"text":"mass","label":"SIGN_SYMPTOM","start":218,"end":222},{"text":"lymphadenopathy","label":"SIGN_SYMPTOM","start":224,"end":239},{"text":"organomegaly","label":"SIGN_SYMPTOM","start":244,"end":256},{"text":"endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":261,"end":270},{"text":"several","label":"DETAILED_DESCRIPTION","start":272,"end":279},{"text":"submucosal","label":"BIOLOGICAL_STRUCTURE","start":280,"end":290},{"text":"lesions","label":"SIGN_SYMPTOM","start":291,"end":298},{"text":"gastric antrum","label":"BIOLOGICAL_STRUCTURE","start":322,"end":336},{"text":"duodenal bulb","label":"BIOLOGICAL_STRUCTURE","start":345,"end":358},{"text":"Endoscopic ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":368,"end":394},{"text":"EUS","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":399},{"text":"OLYMPUS EUS EU-ME2","label":"DETAILED_DESCRIPTION","start":402,"end":420},{"text":"Miniprobe sonography","label":"DETAILED_DESCRIPTION","start":422,"end":442},{"text":"lesions","label":"SIGN_SYMPTOM","start":466,"end":473},{"text":"almost 0.5-cm","label":"DISTANCE","start":479,"end":492},{"text":"hypoechoic","label":"DETAILED_DESCRIPTION","start":507,"end":517},{"text":"neoplasms","label":"SIGN_SYMPTOM","start":518,"end":527},{"text":"submucous layer","label":"BIOLOGICAL_STRUCTURE","start":549,"end":564},{"text":"digestive","label":"BIOLOGICAL_STRUCTURE","start":603,"end":612},{"text":"neuroendocrine tumors","label":"DISEASE_DISORDER","start":613,"end":634},{"text":"Computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":636,"end":655},{"text":"enlarged lymph nodes","label":"SIGN_SYMPTOM","start":665,"end":685},{"text":"mediastinal","label":"BIOLOGICAL_STRUCTURE","start":707,"end":718},{"text":"retroperitoneal","label":"BIOLOGICAL_STRUCTURE","start":720,"end":735},{"text":"mesenteric","label":"BIOLOGICAL_STRUCTURE","start":737,"end":747},{"text":"inguinal","label":"BIOLOGICAL_STRUCTURE","start":753,"end":761},{"text":"intracavitary","label":"DETAILED_DESCRIPTION","start":767,"end":780},{"text":"nodules","label":"SIGN_SYMPTOM","start":781,"end":788},{"text":"duodenum","label":"BIOLOGICAL_STRUCTURE","start":796,"end":804},{"text":"repeat","label":"DETAILED_DESCRIPTION","start":861,"end":867},{"text":"EUS","label":"DIAGNOSTIC_PROCEDURE","start":868,"end":871},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":876,"end":882},{"text":"endoscopy","label":"DIAGNOSTIC_PROCEDURE","start":901,"end":910},{"text":"2 \u00d7 1-cm","label":"AREA","start":914,"end":922},{"text":"columnar uplift","label":"SIGN_SYMPTOM","start":923,"end":938},{"text":"terminal ileum","label":"BIOLOGICAL_STRUCTURE","start":946,"end":960},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":965,"end":973},{"text":"submucosal","label":"BIOLOGICAL_STRUCTURE","start":974,"end":984},{"text":"lesions","label":"SIGN_SYMPTOM","start":985,"end":992},{"text":"rectum","label":"BIOLOGICAL_STRUCTURE","start":1000,"end":1006},{"text":"EUS","label":"DIAGNOSTIC_PROCEDURE","start":1032,"end":1035},{"text":"lesions","label":"SIGN_SYMPTOM","start":1054,"end":1061},{"text":"terminal ileum","label":"BIOLOGICAL_STRUCTURE","start":1069,"end":1083},{"text":"1.6 \u00d7 1.2\u200acm","label":"AREA","start":1095,"end":1107},{"text":"lesions","label":"SIGN_SYMPTOM","start":1116,"end":1123},{"text":"rectum","label":"BIOLOGICAL_STRUCTURE","start":1131,"end":1137},{"text":"0.6 \u00d7 1.0\u200acm","label":"AREA","start":1156,"end":1168},{"text":"homogeneously hypoechoic","label":"DETAILED_DESCRIPTION","start":1184,"end":1208},{"text":"originated from the muscularis mucosa layer","label":"DETAILED_DESCRIPTION","start":1213,"end":1256},{"text":"Pathological examination","label":"DIAGNOSTIC_PROCEDURE","start":1258,"end":1282},{"text":"lesions","label":"SIGN_SYMPTOM","start":1318,"end":1325},{"text":"rectum","label":"BIOLOGICAL_STRUCTURE","start":1333,"end":1339},{"text":"lymphomatous proliferation","label":"DETAILED_DESCRIPTION","start":1355,"end":1381},{"text":"dense infiltration","label":"DETAILED_DESCRIPTION","start":1386,"end":1404},{"text":"monomorphic, small cleaved cells with irregularly shaped nuclei","label":"BIOLOGICAL_STRUCTURE","start":1408,"end":1471},{"text":"immunohistochemical analysis","label":"DIAGNOSTIC_PROCEDURE","start":1484,"end":1512},{"text":"positive","label":"LAB_VALUE","start":1529,"end":1537},{"text":"cyclin D1","label":"DIAGNOSTIC_PROCEDURE","start":1542,"end":1551},{"text":"CD20","label":"DIAGNOSTIC_PROCEDURE","start":1553,"end":1557},{"text":"CD21","label":"DIAGNOSTIC_PROCEDURE","start":1559,"end":1563},{"text":"SOX-11","label":"DIAGNOSTIC_PROCEDURE","start":1565,"end":1571},{"text":"Bcl-2","label":"DIAGNOSTIC_PROCEDURE","start":1577,"end":1582},{"text":"negative","label":"LAB_VALUE","start":1588,"end":1596},{"text":"CD3","label":"DIAGNOSTIC_PROCEDURE","start":1601,"end":1604},{"text":"CD10","label":"DIAGNOSTIC_PROCEDURE","start":1609,"end":1613},{"text":"MCL","label":"DISEASE_DISORDER","start":1658,"end":1661},{"text":"Ki-67 staining","label":"DIAGNOSTIC_PROCEDURE","start":1663,"end":1677},{"text":"proliferative index of 30%","label":"LAB_VALUE","start":1689,"end":1715},{"text":"Ann Arbor stage IV","label":"LAB_VALUE","start":1759,"end":1777},{"text":"MCL","label":"DISEASE_DISORDER","start":1778,"end":1781},{"text":"chemotherapy","label":"MEDICATION","start":1838,"end":1850},{"text":"rituximab","label":"MEDICATION","start":1856,"end":1865},{"text":"cyclophosphamide","label":"MEDICATION","start":1867,"end":1883},{"text":"doxorubicin","label":"MEDICATION","start":1885,"end":1896},{"text":"vincristine","label":"MEDICATION","start":1898,"end":1909},{"text":"prednisone","label":"MEDICATION","start":1915,"end":1925},{"text":"R-CHOP regimen","label":"MEDICATION","start":1927,"end":1941},{"text":"remission","label":"SIGN_SYMPTOM","start":1968,"end":1977}],"tokens":["A ","64-year-old"," ","man"," was ","admitted"," to the ","Department of Gastroenterology"," of the ","Affiliated Hospital of Qingdao University Medical College (Qingdao, China)"," due to ","epigastric"," ","pains",".\n","Physical examination"," revealed no palpable ","mass",", ","lymphadenopathy",", or ","organomegaly",".\nOn ","endoscopy",", ","several"," ","submucosal"," ","lesions"," were identified in the ","gastric antrum"," and the ","duodenal bulb"," (Fig.1).\n","Endoscopic ultrasonography"," (","EUS",") (","OLYMPUS EUS EU-ME2",", ","Miniprobe sonography",") demonstrated that the ","lesions"," were ","almost 0.5-cm"," homogeneously ","hypoechoic"," ","neoplasms"," originating from the ","submucous layer"," (Fig.2) and the initial diagnosis was ","digestive"," ","neuroendocrine tumors",".\n","Computed tomography"," revealed ","enlarged lymph nodes"," in multiple regions (","mediastinal",", ","retroperitoneal",", ","mesenteric",", and ","inguinal",") and ","intracavitary"," ","nodules"," in the ","duodenum",".\nTo reach a definitive diagnosis, the patient underwent ","repeat"," ","EUS"," and ","biopsy"," was performed.\nOn ","endoscopy",", a ","2 \u00d7 1-cm"," ","columnar uplift"," in the ","terminal ileum"," and ","multiple"," ","submucosal"," ","lesions"," in the ","rectum"," were identified (Fig.3).\n","EUS"," revealed that the ","lesions"," in the ","terminal ileum"," were sized ","1.6 \u00d7 1.2\u200acm"," and the ","lesions"," in the ","rectum"," were sized almost ","0.6 \u00d7 1.0\u200acm",", they were all ","homogeneously hypoechoic"," and ","originated from the muscularis mucosa layer",".\n","Pathological examination"," of the biopsied specimens from the ","lesions"," of the ","rectum"," showed diffuse ","lymphomatous proliferation"," and ","dense infiltration"," by ","monomorphic, small cleaved cells with irregularly shaped nuclei"," (Fig.4).\nOn ","immunohistochemical analysis",", the cells were ","positive"," for ","cyclin D1",", ","CD20",", ","CD21",", ","SOX-11",", and ","Bcl-2",", but ","negative"," for ","CD3"," and ","CD10",", which was compatible with the diagnosis of ","MCL",".\n","Ki-67 staining"," revealed a ","proliferative index of 30%",".\nBased on these findings, the diagnosis of ","Ann Arbor stage IV"," ","MCL"," was confirmed.\nThe patient was referred for combination ","chemotherapy"," with ","rituximab",", ","cyclophosphamide",", ","doxorubicin",", ","vincristine",", and ","prednisone"," (","R-CHOP regimen",").\nThe patient has been in ","remission"," clinically.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,48,0,12,0,69,0,24,0,69,0,69,0,69,0,24,0,22,0,12,0,69,0,12,0,12,0,24,0,24,0,22,0,22,0,69,0,27,0,22,0,69,0,12,0,12,0,26,0,24,0,69,0,12,0,12,0,12,0,12,0,22,0,69,0,12,0,22,0,24,0,24,0,24,0,8,0,69,0,12,0,22,0,12,0,69,0,12,0,24,0,69,0,12,0,8,0,69,0,12,0,8,0,22,0,22,0,24,0,69,0,12,0,22,0,22,0,12,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,26,0,24,0,42,0,42,0,26,0,46,0,46,0,46,0,46,0,46,0,46,0,46,0,69,0]}
-{"full_text":"A 78-year-old previously healthy male heavy smoker presented at the Emergency Department with generalized jaundice (sclera and skin), ascites, and hepatic coma.\nThe relatives declared that he was known to have a urinary bladder carcinoma that was diagnosed at a routine control performed 3 months before but no medical papers to prove this diagnosis were shown.\nThey also mentioned a 2-month history of progressive jaundice, somnolence, and temporary loss of consciousness.\nNo weight loss or other clinical signs were mentioned.\nNo previously viral hepatitis or drug excess was reported.\nNo family history of cancer was declared.\nAt the present admission, the abdominal CT scan showed marked hepatomegaly with multiple small nodules (2\u201310\u200amm in diameter) that was supposed to be hepatic metastases from the bladder carcinoma.\nThe thoracic x-ray showed a bilateral bronchopneumonia without abnormal opacities.\nThe patient died with hepatic encephalopathy at 7\u200ahours after admission.\nPrior to the autopsy, signed informed consent of the relatives was obtained for the case publication.\nBeing about a case report, no Ethical Committee approval was necessary.\nAt autopsy, the macroscopic examination showed a huge liver (6.5 kg) with widely distributed white nodules of varying sizes (Fig.1).\nThe urinary bladder was not modified, but a 30 \u00d7 30 \u00d7 50\u200amm prostate nodule with infiltrative aspect was observed (Fig.2).\nThe bilateral bronchopneumonia was confirmed, without any central tumor mass.\nA 10-mm white nodule was identified encasing a small bronchus from the middle lobe of the right lung, without peripheral nodules (Fig.3).\nExcept for moderate edema, no other brain lesions were identified.\nThe other organs did not show modifications.\nThe tissues were fixed in 10% neutral formalin and embedded in paraffin together with iliac crest bone grafting.\nMicroscopic examination of the prostate showed a 3+3 Gleason's grade 2 occult adenocarcinoma (Fig.2).\nClusters and sheets of small round cells were seen in the liver parenchyma (Fig.1) and the lymph nodes from the hepatic hilum.\nExamination of the lung parenchyma showed a peribronchial SCLC with multiple tumor emboli in both veins and lymphatic vessels and multiple \u201ccoin-shaped\u201d tumor nodules of 1 to 2\u200amm in diameter below the pleura (Fig.3).\nThe small round tumor cells were also seen in bone marrow from the iliac crest bone (Fig.3).\nNo brain metastases have been detected.\nBased on the macro- and microscopic features and clinical picture, the final diagnosis was \u201cperibronchial and coin-like peripheral SCLC with massive angiolymphatic invasion and metastases in the lymph nodes, liver and bone, associated with encephalopathy and synchronous occult adenocarcinoma of the prostate.\u201d\n","ner_info":[{"text":"78-year-old","label":"AGE","start":2,"end":13},{"text":"previously healthy","label":"HISTORY","start":14,"end":32},{"text":"male","label":"SEX","start":33,"end":37},{"text":"heavy smoker","label":"HISTORY","start":38,"end":50},{"text":"presented","label":"CLINICAL_EVENT","start":51,"end":60},{"text":"Emergency Department","label":"NONBIOLOGICAL_LOCATION","start":68,"end":88},{"text":"generalized","label":"DETAILED_DESCRIPTION","start":94,"end":105},{"text":"jaundice","label":"SIGN_SYMPTOM","start":106,"end":114},{"text":"sclera","label":"BIOLOGICAL_STRUCTURE","start":116,"end":122},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":127,"end":131},{"text":"ascites","label":"SIGN_SYMPTOM","start":134,"end":141},{"text":"hepatic coma","label":"DISEASE_DISORDER","start":147,"end":159},{"text":"urinary bladder carcinoma","label":"DISEASE_DISORDER","start":212,"end":237},{"text":"3 months before","label":"DATE","start":288,"end":303},{"text":"2-month","label":"DURATION","start":384,"end":391},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":403,"end":414},{"text":"jaundice","label":"SIGN_SYMPTOM","start":415,"end":423},{"text":"somnolence","label":"SIGN_SYMPTOM","start":425,"end":435},{"text":"temporary","label":"DETAILED_DESCRIPTION","start":441,"end":450},{"text":"loss of consciousness","label":"SIGN_SYMPTOM","start":451,"end":472},{"text":"weight loss","label":"SIGN_SYMPTOM","start":477,"end":488},{"text":"viral hepatitis","label":"DISEASE_DISORDER","start":543,"end":558},{"text":"drug excess","label":"CLINICAL_EVENT","start":562,"end":573},{"text":"No family history of cancer","label":"FAMILY_HISTORY","start":588,"end":615},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":660,"end":669},{"text":"CT scan","label":"DIAGNOSTIC_PROCEDURE","start":670,"end":677},{"text":"hepatomegaly","label":"SIGN_SYMPTOM","start":692,"end":704},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":710,"end":718},{"text":"small","label":"DETAILED_DESCRIPTION","start":719,"end":724},{"text":"nodules","label":"SIGN_SYMPTOM","start":725,"end":732},{"text":"2\u201310\u200amm","label":"DISTANCE","start":734,"end":741},{"text":"hepatic","label":"BIOLOGICAL_STRUCTURE","start":779,"end":786},{"text":"metastases","label":"SIGN_SYMPTOM","start":787,"end":797},{"text":"bladder carcinoma","label":"DISEASE_DISORDER","start":807,"end":824},{"text":"thoracic","label":"BIOLOGICAL_STRUCTURE","start":830,"end":838},{"text":"x-ray","label":"DIAGNOSTIC_PROCEDURE","start":839,"end":844},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":854,"end":863},{"text":"bronchopneumonia","label":"SIGN_SYMPTOM","start":864,"end":880},{"text":"abnormal","label":"LAB_VALUE","start":889,"end":897},{"text":"opacities","label":"SIGN_SYMPTOM","start":898,"end":907},{"text":"died","label":"CLINICAL_EVENT","start":921,"end":925},{"text":"hepatic encephalopathy","label":"DISEASE_DISORDER","start":931,"end":953},{"text":"7\u200ahours after","label":"TIME","start":957,"end":970},{"text":"autopsy","label":"DIAGNOSTIC_PROCEDURE","start":995,"end":1002},{"text":"macroscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1172,"end":1195},{"text":"huge","label":"LAB_VALUE","start":1205,"end":1209},{"text":"liver","label":"DIAGNOSTIC_PROCEDURE","start":1210,"end":1215},{"text":"6.5 kg","label":"MASS","start":1217,"end":1223},{"text":"widely distributed","label":"DETAILED_DESCRIPTION","start":1230,"end":1248},{"text":"white","label":"COLOR","start":1249,"end":1254},{"text":"nodules","label":"SIGN_SYMPTOM","start":1255,"end":1262},{"text":"varying sizes","label":"DETAILED_DESCRIPTION","start":1266,"end":1279},{"text":"urinary bladder","label":"DIAGNOSTIC_PROCEDURE","start":1293,"end":1308},{"text":"not modified","label":"LAB_VALUE","start":1313,"end":1325},{"text":"30 \u00d7 30 \u00d7 50\u200amm","label":"VOLUME","start":1333,"end":1348},{"text":"prostate","label":"BIOLOGICAL_STRUCTURE","start":1349,"end":1357},{"text":"nodule","label":"SIGN_SYMPTOM","start":1358,"end":1364},{"text":"infiltrative aspect","label":"DETAILED_DESCRIPTION","start":1370,"end":1389},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1416,"end":1425},{"text":"bronchopneumonia","label":"SIGN_SYMPTOM","start":1426,"end":1442},{"text":"central","label":"DETAILED_DESCRIPTION","start":1470,"end":1477},{"text":"tumor mass","label":"SIGN_SYMPTOM","start":1478,"end":1488},{"text":"10-mm","label":"DISTANCE","start":1492,"end":1497},{"text":"white","label":"COLOR","start":1498,"end":1503},{"text":"nodule","label":"SIGN_SYMPTOM","start":1504,"end":1510},{"text":"small bronchus","label":"BIOLOGICAL_STRUCTURE","start":1537,"end":1551},{"text":"middle lobe of the right lung","label":"BIOLOGICAL_STRUCTURE","start":1561,"end":1590},{"text":"peripheral nodules","label":"SIGN_SYMPTOM","start":1600,"end":1618},{"text":"moderate","label":"SEVERITY","start":1639,"end":1647},{"text":"edema","label":"SIGN_SYMPTOM","start":1648,"end":1653},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":1664,"end":1669},{"text":"lesions","label":"SIGN_SYMPTOM","start":1670,"end":1677},{"text":"other organs","label":"BIOLOGICAL_STRUCTURE","start":1699,"end":1711},{"text":"modifications","label":"SIGN_SYMPTOM","start":1725,"end":1738},{"text":"Microscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":1853,"end":1876},{"text":"prostate","label":"BIOLOGICAL_STRUCTURE","start":1884,"end":1892},{"text":"3+3 Gleason's grade","label":"DIAGNOSTIC_PROCEDURE","start":1902,"end":1921},{"text":"2","label":"LAB_VALUE","start":1922,"end":1923},{"text":"occult","label":"DETAILED_DESCRIPTION","start":1924,"end":1930},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":1931,"end":1945},{"text":"peribronchial","label":"BIOLOGICAL_STRUCTURE","start":2126,"end":2139},{"text":"SCLC","label":"DISEASE_DISORDER","start":2140,"end":2144},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":2150,"end":2158},{"text":"tumor emboli","label":"SIGN_SYMPTOM","start":2159,"end":2171},{"text":"veins","label":"BIOLOGICAL_STRUCTURE","start":2180,"end":2185},{"text":"lymphatic vessels","label":"BIOLOGICAL_STRUCTURE","start":2190,"end":2207},{"text":"coin-shaped","label":"SHAPE","start":2222,"end":2233},{"text":"tumor","label":"SIGN_SYMPTOM","start":2235,"end":2240},{"text":"1 to 2\u200amm","label":"DISTANCE","start":2252,"end":2261},{"text":"below the pleura","label":"BIOLOGICAL_STRUCTURE","start":2274,"end":2290},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":2396,"end":2401},{"text":"metastases","label":"SIGN_SYMPTOM","start":2402,"end":2412},{"text":"peribronchial","label":"BIOLOGICAL_STRUCTURE","start":2525,"end":2538},{"text":"coin-like","label":"SHAPE","start":2543,"end":2552},{"text":"peripheral","label":"DETAILED_DESCRIPTION","start":2553,"end":2563},{"text":"SCLC","label":"DISEASE_DISORDER","start":2564,"end":2568},{"text":"massive","label":"SEVERITY","start":2574,"end":2581},{"text":"angiolymphatic","label":"BIOLOGICAL_STRUCTURE","start":2582,"end":2596},{"text":"invasion","label":"DISEASE_DISORDER","start":2597,"end":2605},{"text":"metastases","label":"SIGN_SYMPTOM","start":2610,"end":2620},{"text":"lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":2628,"end":2639},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":2641,"end":2646},{"text":"bone","label":"BIOLOGICAL_STRUCTURE","start":2651,"end":2655},{"text":"encephalopathy","label":"DISEASE_DISORDER","start":2673,"end":2687},{"text":"synchronous","label":"DETAILED_DESCRIPTION","start":2692,"end":2703},{"text":"occult","label":"DETAILED_DESCRIPTION","start":2704,"end":2710},{"text":"adenocarcinoma","label":"DISEASE_DISORDER","start":2711,"end":2725},{"text":"prostate","label":"BIOLOGICAL_STRUCTURE","start":2733,"end":2741}],"tokens":["A ","78-year-old"," ","previously healthy"," ","male"," ","heavy smoker"," ","presented"," at the ","Emergency Department"," with ","generalized"," ","jaundice"," (","sclera"," and ","skin","), ","ascites",", and ","hepatic coma",".\nThe relatives declared that he was known to have a ","urinary bladder carcinoma"," that was diagnosed at a routine control performed ","3 months before"," but no medical papers to prove this diagnosis were shown.\nThey also mentioned a ","2-month"," history of ","progressive"," ","jaundice",", ","somnolence",", and ","temporary"," ","loss of consciousness",".\nNo ","weight loss"," or other clinical signs were mentioned.\nNo previously ","viral hepatitis"," or ","drug excess"," was reported.\n","No family history of cancer"," was declared.\nAt the present admission, the ","abdominal"," ","CT scan"," showed marked ","hepatomegaly"," with ","multiple"," ","small"," ","nodules"," (","2\u201310\u200amm"," in diameter) that was supposed to be ","hepatic"," ","metastases"," from the ","bladder carcinoma",".\nThe ","thoracic"," ","x-ray"," showed a ","bilateral"," ","bronchopneumonia"," without ","abnormal"," ","opacities",".\nThe patient ","died"," with ","hepatic encephalopathy"," at ","7\u200ahours after"," admission.\nPrior to the ","autopsy",", signed informed consent of the relatives was obtained for the case publication.\nBeing about a case report, no Ethical Committee approval was necessary.\nAt autopsy, the ","macroscopic examination"," showed a ","huge"," ","liver"," (","6.5 kg",") with ","widely distributed"," ","white"," ","nodules"," of ","varying sizes"," (Fig.1).\nThe ","urinary bladder"," was ","not modified",", but a ","30 \u00d7 30 \u00d7 50\u200amm"," ","prostate"," ","nodule"," with ","infiltrative aspect"," was observed (Fig.2).\nThe ","bilateral"," ","bronchopneumonia"," was confirmed, without any ","central"," ","tumor mass",".\nA ","10-mm"," ","white"," ","nodule"," was identified encasing a ","small bronchus"," from the ","middle lobe of the right lung",", without ","peripheral nodules"," (Fig.3).\nExcept for ","moderate"," ","edema",", no other ","brain"," ","lesions"," were identified.\nThe ","other organs"," did not show ","modifications",".\nThe tissues were fixed in 10% neutral formalin and embedded in paraffin together with iliac crest bone grafting.\n","Microscopic examination"," of the ","prostate"," showed a ","3+3 Gleason's grade"," ","2"," ","occult"," ","adenocarcinoma"," (Fig.2).\nClusters and sheets of small round cells were seen in the liver parenchyma (Fig.1) and the lymph nodes from the hepatic hilum.\nExamination of the lung parenchyma showed a ","peribronchial"," ","SCLC"," with ","multiple"," ","tumor emboli"," in both ","veins"," and ","lymphatic vessels"," and multiple \u201c","coin-shaped","\u201d ","tumor"," nodules of ","1 to 2\u200amm"," in diameter ","below the pleura"," (Fig.3).\nThe small round tumor cells were also seen in bone marrow from the iliac crest bone (Fig.3).\nNo ","brain"," ","metastases"," have been detected.\nBased on the macro- and microscopic features and clinical picture, the final diagnosis was \u201c","peribronchial"," and ","coin-like"," ","peripheral"," ","SCLC"," with ","massive"," ","angiolymphatic"," ","invasion"," and ","metastases"," in the ","lymph nodes",", ","liver"," and ","bone",", associated with ","encephalopathy"," and ","synchronous"," ","occult"," ","adenocarcinoma"," of the ","prostate",".\u201d\n"],"ner_labels":[0,5,0,39,0,65,0,39,0,13,0,48,0,22,0,69,0,12,0,12,0,69,0,26,0,26,0,19,0,32,0,22,0,69,0,69,0,22,0,69,0,69,0,26,0,13,0,34,0,12,0,24,0,69,0,22,0,22,0,69,0,27,0,12,0,69,0,26,0,12,0,24,0,22,0,69,0,42,0,69,0,13,0,26,0,78,0,24,0,24,0,42,0,24,0,44,0,22,0,15,0,69,0,22,0,24,0,42,0,79,0,12,0,69,0,22,0,22,0,69,0,22,0,69,0,27,0,15,0,69,0,12,0,12,0,69,0,63,0,69,0,12,0,69,0,12,0,69,0,24,0,12,0,24,0,42,0,22,0,26,0,12,0,26,0,22,0,69,0,12,0,12,0,67,0,69,0,27,0,12,0,12,0,69,0,12,0,67,0,22,0,26,0,63,0,12,0,26,0,69,0,12,0,12,0,12,0,26,0,22,0,22,0,26,0,12,0]}
-{"full_text":"An 18-year-old college student was referred from the University Clinic for having low hemoglobin (Hg 4.7 g\/dl).\nHe was completely well till one month back when he presented with easy fatigability, postural dizziness, palpitation and dyspnea.\nHe gave history of 30 kg weight loss over the past 6 months.\nOn physical examination, he looked pale, not jaundiced or cyanosed.\nHis vital signs were all within normal limits, except for an elevated heart rate (98\/min).\nCardiovascular, respiratory and abdominal examinations were unremarkable.\nPrimary investigations in our hospital revealed low hemoglobin level (5.1 g\/dl), low iron (<10 ug\/dl), and a positive occult blood test.\nA provisional diagnosis of microcytic hypochromic anemia for further workup was made.\nBone marrow aspirate and trephine biopsy revealed normocellular marrow, depicting normal trilineage hematopoiesis.\nUpper GI endoscopy showed erosive antral gastritis with patchy ulcerative inflammation.\nAbdominal ultrasound showed a slightly enlarged liver with a rounded echogenic lesion in the anterior wall of the right lobe suggestive of hemangioma.\nThe spleen was slightly enlarged and normal in echogenicity with no focal lesions.\nComputed Tomography (CT) scan of the abdomen and pelvis showed a fairly large well defined soft tissue mass located in the anterior upper pelvis and engulfing jejunal loops causing bowel wall thickening.\nThe patient underwent an exploratory laparotomy and excision of the jejunal mass.\nMacroscopic examination revealed an 11 \u00d7 8 \u00d7 2 cm annular mass located within the jejunal wall ulcerating through the mucosa and extending to the serosal surface.\nMicroscopic examination revealed a tumor situated in the muscularis propria and extending to the mucosa and the serosa.\nThe neoplastic cells were arranged in predominantly pseudoalveolar pattern (Fig.1a,b).\nThey were polygonal in shape with variable amount of eosinophilic to clear cytoplasm (Fig.1c).\nThe nuclei were oval with vesicular chromatin and inconspicuous nucleoli.\nScattered osteoclast-like multinucleated giant cells were also identified (Fig.1b,c).\nFrequent mitotic figures and necrosis were noted.\nAll lymph nodes were not involved by tumor.\nImmunohistochemically, the neoplastic cells were strongly and diffusely positive for S-100 protein (Fig.1d).\nThey were also positive for vimentin.\nMelanocytic markers (HMB45 and Melan A), neuroendocrine markers (chromogranin A, synaptophysin and CD56), smooth muscle actin, desmin, CD34, CD117, cytokeratin and LCA were all negative in the neoplastic cells.\nFluorescein in situ hybridization (FISH) analysis for EWSR1 break apart probe on paraffin-embedded tumor showed evidence of a 22q12 rearrangement in 197 out of 205 (96%) of interphase nuclei scored.\nThe native state of EWSR1 break apart probe will be seen as two adjacent or fused (overlapping) red\/green (yellow) signals.\nHowever, EWSR1 gene rearrangement presented as one red and one green separated signal (Fig.1e).\nThe patient did not receive chemotherapy or radiotherapy.\nDuring the clinical follow up, the patient remained disease free for 3 years until he presented with local recurrence.\nThe treatment plan was surgical resection but the patient sought medical advice in a different institution where he died of the disease a year later.\n","ner_info":[{"text":"18-year-old","label":"AGE","start":3,"end":14},{"text":"college student","label":"OCCUPATION","start":15,"end":30},{"text":"referred","label":"CLINICAL_EVENT","start":35,"end":43},{"text":"from the University Clinic","label":"NONBIOLOGICAL_LOCATION","start":44,"end":70},{"text":"low","label":"LAB_VALUE","start":82,"end":85},{"text":"hemoglobin","label":"DIAGNOSTIC_PROCEDURE","start":86,"end":96},{"text":"4.7 g\/dl","label":"LAB_VALUE","start":101,"end":109},{"text":"He was completely well","label":"HISTORY","start":112,"end":134},{"text":"one month back","label":"DATE","start":140,"end":154},{"text":"presented","label":"CLINICAL_EVENT","start":163,"end":172},{"text":"easy","label":"DETAILED_DESCRIPTION","start":178,"end":182},{"text":"fatigability","label":"SIGN_SYMPTOM","start":183,"end":195},{"text":"postural","label":"DETAILED_DESCRIPTION","start":197,"end":205},{"text":"dizziness","label":"SIGN_SYMPTOM","start":206,"end":215},{"text":"palpitation","label":"SIGN_SYMPTOM","start":217,"end":228},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":233,"end":240},{"text":"30 kg","label":"LAB_VALUE","start":261,"end":266},{"text":"weight loss","label":"SIGN_SYMPTOM","start":267,"end":278},{"text":"over the past 6 months","label":"DURATION","start":279,"end":301},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":306,"end":326},{"text":"pale","label":"SIGN_SYMPTOM","start":338,"end":342},{"text":"jaundiced","label":"SIGN_SYMPTOM","start":348,"end":357},{"text":"cyanosed","label":"SIGN_SYMPTOM","start":361,"end":369},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":375,"end":386},{"text":"within normal limits","label":"LAB_VALUE","start":396,"end":416},{"text":"elevated","label":"LAB_VALUE","start":432,"end":440},{"text":"heart 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ug\/dl","label":"LAB_VALUE","start":627,"end":636},{"text":"positive","label":"LAB_VALUE","start":645,"end":653},{"text":"occult blood test","label":"DIAGNOSTIC_PROCEDURE","start":654,"end":671},{"text":"microcytic hypochromic anemia","label":"DISEASE_DISORDER","start":700,"end":729},{"text":"Bone marrow aspirate","label":"DIAGNOSTIC_PROCEDURE","start":759,"end":779},{"text":"trephine biopsy","label":"DIAGNOSTIC_PROCEDURE","start":784,"end":799},{"text":"normocellular marrow","label":"LAB_VALUE","start":809,"end":829},{"text":"normal trilineage hematopoiesis","label":"LAB_VALUE","start":841,"end":872},{"text":"Upper 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were ","unremarkable",".\nPrimary ","investigations"," in our ","hospital"," revealed ","low"," ","hemoglobin"," level (","5.1 g\/dl","), ","low"," ","iron"," (","<10 ug\/dl","), and a ","positive"," ","occult blood test",".\nA provisional diagnosis of ","microcytic hypochromic anemia"," for further workup was made.\n","Bone marrow aspirate"," and ","trephine biopsy"," revealed ","normocellular marrow",", depicting ","normal trilineage hematopoiesis",".\n","Upper GI"," ","endoscopy"," showed ","erosive"," ","antral"," ","gastritis"," with ","patchy"," ","ulcerative"," ","inflammation",".\n","Abdominal"," ","ultrasound"," showed a ","slightly"," ","enlarged"," ","liver"," with a ","rounded"," ","echogenic"," ","lesion"," in the ","anterior wall of the right lobe"," suggestive of ","hemangioma",".\nThe ","spleen"," was ","slightly"," ","enlarged"," and ","normal in echogenicity"," with no ","focal"," ","lesions",".\n","Computed Tomography"," (","CT",") scan of the ","abdomen"," and ","pelvis"," showed a ","fairly large"," ","well defined"," ","soft tissue"," ","mass"," located in the ","anterior upper pelvis"," and engulfing ","jejunal loops"," causing ","bowel wall"," ","thickening",".\nThe patient underwent an exploratory ","laparotomy"," and ","excision"," of the ","jejunal"," ","mass",".\n","Macroscopic examination"," revealed an ","11 \u00d7 8 \u00d7 2 cm"," ","annular"," ","mass"," located ","within the jejunal wall"," ","ulcerating through the mucosa"," and ","extending to the serosal surface",".\n","Microscopic examination"," revealed a ","tumor"," situated in the ","muscularis propria"," and ","extending to the mucosa"," and the ","serosa",".\nThe ","neoplastic cells"," were arranged in ","predominantly pseudoalveolar pattern"," (Fig.1a,b).\n","They"," were ","polygonal"," in shape with ","variable amount of eosinophilic to clear cytoplasm"," (Fig.1c).\nThe ","nuclei were oval with vesicular chromatin and inconspicuous nucleoli",".\n","Scattered"," ","osteoclast-like"," ","multinucleated"," ","giant cells"," were also identified (Fig.1b,c).\n","Frequent"," ","mitotic figures"," and ","necrosis"," were noted.\n","All lymph nodes"," were not ","involved by tumor",".\n","Immunohistochemically",", the ","neoplastic cells"," were strongly and diffusely ","positive"," for ","S-100 protein"," (Fig.1d).\nThey were also ","positive"," for ","vimentin",".\n","Melanocytic markers"," (","HMB45"," and ","Melan A","), ","neuroendocrine markers"," (","chromogranin A",", ","synaptophysin"," and ","CD56","), ","smooth muscle actin",", ","desmin",", ","CD34",", ","CD117",", ","cytokeratin"," and ","LCA"," were all ","negative"," in the ","neoplastic cells",".\n","Fluorescein in situ hybridization"," (","FISH",") analysis for ","EWSR1 break apart probe"," on ","paraffin-embedded tumor"," showed evidence of a ","22q12 rearrangement"," in ","197 out of 205 (96%) of interphase nuclei"," scored.\nThe native state of EWSR1 break apart probe will be seen as two adjacent or fused (overlapping) red\/green (yellow) signals.\nHowever, EWSR1 gene rearrangement presented as one red and one green separated signal (Fig.1e).\nThe patient did not receive ","chemotherapy"," or ","radiotherapy",".\nDuring the clinical ","follow up",", the patient remained ","disease free"," for ","3 years"," until he ","presented"," with ","local"," ","recurrence",".\nThe treatment plan was surgical ","resection"," but the patient ","sought medical advice"," in a ","different institution"," where he ","died"," of the disease ","a year 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-{"full_text":"An 84-year-old woman presented to a local clinic with dyspnea on exertion and left back pain persisting for a month.\nShe was admitted to our hospital because of left pleural effusion on a chest X-ray.\nShe suffered hypertension and dyslipidemia but had no history of pleural tuberculosis or chronic pyothorax, nor a smoking history or dust exposure.\nOn examination, her vital signs and oxygen saturation were normal (SpO2: 96% ambient air).\nA chest examination revealed a mass on the left side of her back with pain and decreased breathing sounds in the left lower-lung field.\nThe rest of the examination findings were normal.\nLaboratory tests revealed elevated levels of C reactive protein, lactate dehydrogenase (LDH), and soluble interleukin-2 receptor (sIL-2R) (Table 1).\nA chest X-ray (Fig.1) showed left pleural effusion with mediastinal shift.\nOn the first hospital day, an intercostal drainage tube was inserted, and after drainage, chest computed tomography (CT) (Fig.2) revealed an irregular pleural mass invading her left chest wall with rib destruction and pleural effusion.\nThe mass was adjacent to the posterior mediastinum, but the lateral side of the mass was thick and invading the chest wall, so we diagnosed this mass as a chest wall tumor.\nThe pleural fluid was serous and not purulent.\nA fluid analysis showed it to be exudative, and 81% of the white blood cells were lymphocytes.\nThe fluid culture was negative, and cytology did not show any evidence of malignancy (Table 1).\nCT-guided needle biopsy was performed.\nThe histopathology results supported a diagnosis of diffuse large B-cell lymphoma (DLBCL) that was positive for CD10 and CD20 but negative for CD3 and CD5 (Fig.3).\n18-fluorodeoxyglucose positron emission tomography\/computed tomography (FDG-PET\/CT) revealed high FDG uptake in the left chest wall mass without any other uptake (Fig.4A and B), so we diagnosed her with primary malignant lymphoma originating from the chest wall.\nWe reconfirmed her medical history, and she never had either tuberculous pleurisy or pyothorax.\nHer performance status (PS) was 3 because of her back pain and fatigue.\nOwing to her bad PS and age, it was difficult to perform an operation or administer combination chemotherapy with Rituximab, so low-dose oral etoposide (50 mg\/day d1-14, q28) was administered.\nHer pleural effusion disappeared within two weeks, her back pain disappeared, and her PS improved to 1 within a month.\nChest CT performed four months later showed complete response (Fig.4C and D).\nShe continued oral chemotherapy and maintained a good PS for one year after the diagnosis.\n","ner_info":[{"text":"84-year-old","label":"AGE","start":3,"end":14},{"text":"woman","label":"SEX","start":15,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":21,"end":30},{"text":"local clinic","label":"NONBIOLOGICAL_LOCATION","start":36,"end":48},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":54,"end":61},{"text":"on 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culture","label":"DIAGNOSTIC_PROCEDURE","start":1405,"end":1418},{"text":"negative","label":"LAB_VALUE","start":1423,"end":1431},{"text":"cytology","label":"DIAGNOSTIC_PROCEDURE","start":1437,"end":1445},{"text":"malignancy","label":"SIGN_SYMPTOM","start":1475,"end":1485},{"text":"CT-guided","label":"DETAILED_DESCRIPTION","start":1497,"end":1506},{"text":"needle","label":"DETAILED_DESCRIPTION","start":1507,"end":1513},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1514,"end":1520},{"text":"histopathology","label":"DIAGNOSTIC_PROCEDURE","start":1540,"end":1554},{"text":"diffuse large B-cell lymphoma","label":"DISEASE_DISORDER","start":1588,"end":1617},{"text":"DLBCL","label":"DISEASE_DISORDER","start":1619,"end":1624},{"text":"positive","label":"LAB_VALUE","start":1635,"end":1643},{"text":"CD10","label":"DIAGNOSTIC_PROCEDURE","start":1648,"end":1652},{"text":"CD20","label":"DIAGNOSTIC_PROCEDURE","start":1657,"end":1661},{"text":"negative","label":"LAB_VALUE","start":1666,"end":1674},{"text":"CD3","label":"DIAGNOSTIC_PROCEDURE","start":1679,"end":1682},{"text":"CD5","label":"DIAGNOSTIC_PROCEDURE","start":1687,"end":1690},{"text":"18-fluorodeoxyglucose positron emission tomography\/computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1700,"end":1770},{"text":"FDG-PET\/CT","label":"DIAGNOSTIC_PROCEDURE","start":1772,"end":1782},{"text":"high FDG uptake","label":"SIGN_SYMPTOM","start":1793,"end":1808},{"text":"left chest wall","label":"BIOLOGICAL_STRUCTURE","start":1816,"end":1831},{"text":"mass","label":"SIGN_SYMPTOM","start":1832,"end":1836},{"text":"primary malignant lymphoma","label":"DISEASE_DISORDER","start":1903,"end":1929},{"text":"originating from the chest wall","label":"BIOLOGICAL_STRUCTURE","start":1930,"end":1961},{"text":"never had either tuberculous pleurisy or pyothorax","label":"HISTORY","start":2007,"end":2057},{"text":"performance status","label":"DIAGNOSTIC_PROCEDURE","start":2063,"end":2081},{"text":"PS","label":"DIAGNOSTIC_PROCEDURE","start":2083,"end":2085},{"text":"3","label":"LAB_VALUE","start":2091,"end":2092},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":2108,"end":2112},{"text":"pain","label":"SIGN_SYMPTOM","start":2113,"end":2117},{"text":"fatigue","label":"SIGN_SYMPTOM","start":2122,"end":2129},{"text":"Rituximab","label":"MEDICATION","start":2245,"end":2254},{"text":"low-dose","label":"DETAILED_DESCRIPTION","start":2259,"end":2267},{"text":"oral","label":"ADMINISTRATION","start":2268,"end":2272},{"text":"etoposide","label":"MEDICATION","start":2273,"end":2282},{"text":"50 mg\/day d1-14, q28","label":"DOSAGE","start":2284,"end":2304},{"text":"pleural effusion","label":"SIGN_SYMPTOM","start":2328,"end":2344},{"text":"within two weeks","label":"DATE","start":2357,"end":2373},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":2379,"end":2383},{"text":"pain","label":"SIGN_SYMPTOM","start":2384,"end":2388},{"text":"PS","label":"DIAGNOSTIC_PROCEDURE","start":2410,"end":2412},{"text":"1","label":"LAB_VALUE","start":2425,"end":2426},{"text":"within a month","label":"DATE","start":2427,"end":2441},{"text":"Chest CT","label":"DIAGNOSTIC_PROCEDURE","start":2443,"end":2451},{"text":"four months later","label":"DATE","start":2462,"end":2479},{"text":"complete response","label":"LAB_VALUE","start":2487,"end":2504},{"text":"oral","label":"ADMINISTRATION","start":2535,"end":2539},{"text":"chemotherapy","label":"MEDICATION","start":2540,"end":2552},{"text":"good","label":"LAB_VALUE","start":2570,"end":2574},{"text":"PS","label":"DIAGNOSTIC_PROCEDURE","start":2575,"end":2577},{"text":"one year after the diagnosis","label":"DATE","start":2582,"end":2610}],"tokens":["An ","84-year-old"," ","woman"," ","presented"," to a ","local clinic"," with ","dyspnea"," ","on exertion"," and ","left back"," ","pain"," ","persisting for a mont","h.\nShe was ","admitted"," to our ","hospital"," because of ","left"," ","pleural effusion"," on a ","chest"," ","X-ray",".\nShe suffered ","hypertension"," and ","dyslipidemia"," but had ","no history of pleural tuberculosis or chronic pyothorax",", ","nor a smoking history or dust exposure",".\nOn ","examination",", her ","vital signs"," and ","oxygen saturation"," were ","normal"," (","SpO2",": ","96%"," ","ambient air",").\nA ","chest examination"," revealed a ","mass"," on the ","left side of her back"," with ","pain"," and ","decreased breathing sounds"," in the ","left lower-lung field",".\n","The rest"," of the ","examination findings"," were ","normal",".\n","Laboratory tests"," revealed ","elevated levels"," of ","C reactive protein",", ","lactate dehydrogenase"," (","LDH","), and ","soluble interleukin-2 receptor"," (","sIL-2R",") (Table 1).\nA ","chest"," ","X-ray"," (Fig.1) showed ","left"," ","pleural effusion"," with ","mediastinal shift",".\n","On the first hospital day",", an ","intercostal"," ","drainage tube"," was inserted, and after drainage, ","chest"," ","computed tomography"," (","CT",") (Fig.2) revealed an ","irregular"," ","pleural"," ","mass"," invading her ","left chest wall"," with ","rib"," ","destruction"," and ","pleural effusion",".\nThe ","mass"," was ","adjacent to the posterior mediastinum",", but the ","lateral side"," of the ","mass"," was ","thick"," and invading the ","chest wall",", so we diagnosed this ","mass"," as a ","chest wall tumor",".\nThe ","pleural fluid"," was ","serous"," and not ","purulent",".\nA ","fluid analysis"," showed it to be ","exudative",", and ","81% of the white blood cells were lymphocytes",".\nThe ","fluid culture"," was ","negative",", and ","cytology"," did not show any evidence of ","malignancy"," (Table 1).\n","CT-guided"," ","needle"," ","biopsy"," was performed.\nThe ","histopathology"," results supported a diagnosis of ","diffuse large B-cell lymphoma"," (","DLBCL",") that was ","positive"," for ","CD10"," and ","CD20"," but ","negative"," for ","CD3"," and ","CD5"," (Fig.3).\n","18-fluorodeoxyglucose positron emission tomography\/computed tomography"," (","FDG-PET\/CT",") revealed ","high FDG uptake"," in the ","left chest wall"," ","mass"," without any other uptake (Fig.4A and B), so we diagnosed her with ","primary malignant lymphoma"," ","originating from the chest wall",".\nWe reconfirmed her medical history, and she ","never had either tuberculous pleurisy or pyothorax",".\nHer ","performance status"," (","PS",") was ","3"," because of her ","back"," ","pain"," and ","fatigue",".\nOwing to her bad PS and age, it was difficult to perform an operation or administer combination chemotherapy with ","Rituximab",", so ","low-dose"," ","oral"," ","etoposide"," (","50 mg\/day d1-14, q28",") was administered.\nHer ","pleural effusion"," disappeared ","within two weeks",", her ","back"," ","pain"," disappeared, and her ","PS"," improved to ","1"," ","within a month",".\n","Chest CT"," performed ","four months later"," showed ","complete response"," (Fig.4C and D).\nShe continued ","oral"," ","chemotherapy"," and maintained a ","good"," ","PS"," for ","one year after the diagnosis",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,22,0,12,0,69,0,32,0,13,0,48,0,22,0,69,0,12,0,24,0,39,0,39,0,39,0,39,0,24,0,24,0,24,0,42,0,24,0,42,0,22,0,24,0,69,0,12,0,69,0,69,0,12,0,22,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,12,0,24,0,22,0,69,0,22,0,19,0,12,0,75,0,12,0,24,0,24,0,22,0,12,0,69,0,12,0,12,0,69,0,69,0,69,0,12,0,22,0,69,0,22,0,12,0,69,0,26,0,12,0,69,0,69,0,24,0,42,0,42,0,24,0,42,0,24,0,69,0,22,0,22,0,24,0,24,0,26,0,26,0,42,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,69,0,12,0,69,0,26,0,12,0,39,0,24,0,24,0,42,0,12,0,69,0,69,0,46,0,22,0,4,0,46,0,29,0,69,0,19,0,12,0,69,0,24,0,42,0,19,0,24,0,19,0,42,0,4,0,46,0,42,0,24,0,19,0]}
-{"full_text":"An 82-year-old woman was transferred to our hospital because of dyspnea and massive hemoptysis.\nThe patient had a history of bronchial asthma that was well-controlled with bronchodilator medications.\nShe had no history of tuberculosis, nontuberculous mycobacterial infection, or smoking.\nThe physical examination revealed diffuse bilateral crackles.\nShe suffered from severe hypoxemia (pH 7.362, PCO2 35.1 mmHg, PO2 61.0 mmHg, HCO3- 20.1 mmHg, BE -5.5 mmHg, SpO2 90.5%, under 10 L O2\/min, reservoir mask).\nAfter the tracheal intubation, 100 mL of bright-red blood was aspirated.\nA chest radiograph showed bilateral infiltrates (Fig.1).\nA chest CT further demonstrated multiple consolidations and ground glass opacity and focal bronchiectasis in right segment 4 (S4) (Fig.2).\nThere were no space-occupying lesions.\nFour days after admission, her respiratory condition was improved.\nSince there was no active hemorrhaging from the tracheal tube, she was then extubated.\nAfter that, only a small amount of bloody sputum was coughed up.\nTo determine the origin of bleeding, she underwent contrast-enhanced CT, which showed bronchiectasis in right S4 and regression of the infiltration.\nCTA revealed an abnormal vascular anastomosis between the right inferior phrenic artery and right pulmonary artery beside the focal bronchiectasis at the right middle lobe (Fig.3), which led us to suspect it as the possible source of the massive hemoptysis.\nWe therefore performed embolization by superselecting the right inferior phrenic artery with a 2.2-Fr. microcatheter (Fig.4).\nAn angiogram of the right bronchial artery showed no obvious active bleeding.\nThree weeks after the embolization, she was successfully discharged and has been free from recurrent hemoptysis for three years.\n","ner_info":[{"text":"82-year-old","label":"AGE","start":3,"end":14},{"text":"woman","label":"SEX","start":15,"end":20},{"text":"transferred","label":"CLINICAL_EVENT","start":25,"end":36},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":44,"end":52},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":64,"end":71},{"text":"massive","label":"SEVERITY","start":76,"end":83},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":84,"end":94},{"text":"bronchial asthma","label":"HISTORY","start":125,"end":141},{"text":"bronchodilator medications","label":"HISTORY","start":172,"end":198},{"text":"no history of tuberculosis, nontuberculous mycobacterial infection, or smoking","label":"HISTORY","start":208,"end":286},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":292,"end":312},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":322,"end":329},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":330,"end":339},{"text":"crackles","label":"SIGN_SYMPTOM","start":340,"end":348},{"text":"severe","label":"SEVERITY","start":368,"end":374},{"text":"hypoxemia","label":"SIGN_SYMPTOM","start":375,"end":384},{"text":"pH","label":"DIAGNOSTIC_PROCEDURE","start":386,"end":388},{"text":"7.362","label":"LAB_VALUE","start":389,"end":394},{"text":"PCO2","label":"DIAGNOSTIC_PROCEDURE","start":396,"end":400},{"text":"35.1 mmHg","label":"LAB_VALUE","start":401,"end":410},{"text":"PO2","label":"DIAGNOSTIC_PROCEDURE","start":412,"end":415},{"text":"61.0 mmHg","label":"LAB_VALUE","start":416,"end":425},{"text":"HCO3-","label":"DIAGNOSTIC_PROCEDURE","start":427,"end":432},{"text":"20.1 mmHg","label":"LAB_VALUE","start":433,"end":442},{"text":"BE","label":"DIAGNOSTIC_PROCEDURE","start":444,"end":446},{"text":"-5.5 mmHg","label":"LAB_VALUE","start":447,"end":456},{"text":"SpO2","label":"DIAGNOSTIC_PROCEDURE","start":458,"end":462},{"text":"90.5%","label":"LAB_VALUE","start":463,"end":468},{"text":"under 10 L O2\/min","label":"LAB_VALUE","start":470,"end":487},{"text":"reservoir mask","label":"DETAILED_DESCRIPTION","start":489,"end":503},{"text":"tracheal","label":"BIOLOGICAL_STRUCTURE","start":516,"end":524},{"text":"intubation","label":"THERAPEUTIC_PROCEDURE","start":525,"end":535},{"text":"100 mL","label":"VOLUME","start":537,"end":543},{"text":"bright-red","label":"COLOR","start":547,"end":557},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":558,"end":563},{"text":"aspirated","label":"SIGN_SYMPTOM","start":568,"end":577},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":581,"end":586},{"text":"radiograph","label":"DIAGNOSTIC_PROCEDURE","start":587,"end":597},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":605,"end":614},{"text":"infiltrates","label":"SIGN_SYMPTOM","start":615,"end":626},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":638,"end":643},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":644,"end":646},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":668,"end":676},{"text":"consolidations","label":"SIGN_SYMPTOM","start":677,"end":691},{"text":"ground glass","label":"TEXTURE","start":696,"end":708},{"text":"opacity","label":"SIGN_SYMPTOM","start":709,"end":716},{"text":"focal","label":"DETAILED_DESCRIPTION","start":721,"end":726},{"text":"bronchiectasis","label":"DISEASE_DISORDER","start":727,"end":741},{"text":"right segment 4","label":"BIOLOGICAL_STRUCTURE","start":745,"end":760},{"text":"S4","label":"BIOLOGICAL_STRUCTURE","start":762,"end":764},{"text":"space-occupying","label":"DETAILED_DESCRIPTION","start":789,"end":804},{"text":"lesions","label":"SIGN_SYMPTOM","start":805,"end":812},{"text":"Four days after","label":"DATE","start":814,"end":829},{"text":"respiratory condition","label":"DIAGNOSTIC_PROCEDURE","start":845,"end":866},{"text":"improved","label":"LAB_VALUE","start":871,"end":879},{"text":"active","label":"DETAILED_DESCRIPTION","start":900,"end":906},{"text":"hemorrhaging","label":"SIGN_SYMPTOM","start":907,"end":919},{"text":"tracheal tube","label":"THERAPEUTIC_PROCEDURE","start":929,"end":942},{"text":"extubated","label":"THERAPEUTIC_PROCEDURE","start":957,"end":966},{"text":"small amount","label":"SEVERITY","start":987,"end":999},{"text":"bloody","label":"DETAILED_DESCRIPTION","start":1003,"end":1009},{"text":"sputum","label":"SIGN_SYMPTOM","start":1010,"end":1016},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":1084,"end":1101},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1102,"end":1104},{"text":"bronchiectasis","label":"DISEASE_DISORDER","start":1119,"end":1133},{"text":"right S4","label":"BIOLOGICAL_STRUCTURE","start":1137,"end":1145},{"text":"infiltration","label":"SIGN_SYMPTOM","start":1168,"end":1180},{"text":"CTA","label":"DIAGNOSTIC_PROCEDURE","start":1182,"end":1185},{"text":"abnormal","label":"DETAILED_DESCRIPTION","start":1198,"end":1206},{"text":"vascular","label":"BIOLOGICAL_STRUCTURE","start":1207,"end":1215},{"text":"anastomosis","label":"DISEASE_DISORDER","start":1216,"end":1227},{"text":"right inferior phrenic artery","label":"BIOLOGICAL_STRUCTURE","start":1240,"end":1269},{"text":"right pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":1274,"end":1296},{"text":"focal","label":"DETAILED_DESCRIPTION","start":1308,"end":1313},{"text":"bronchiectasis","label":"DISEASE_DISORDER","start":1314,"end":1328},{"text":"right middle lobe","label":"BIOLOGICAL_STRUCTURE","start":1336,"end":1353},{"text":"massive","label":"SEVERITY","start":1420,"end":1427},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":1428,"end":1438},{"text":"embolization","label":"THERAPEUTIC_PROCEDURE","start":1463,"end":1475},{"text":"superselecting","label":"THERAPEUTIC_PROCEDURE","start":1479,"end":1493},{"text":"right inferior phrenic artery","label":"BIOLOGICAL_STRUCTURE","start":1498,"end":1527},{"text":"2.2-Fr. microcatheter","label":"DETAILED_DESCRIPTION","start":1535,"end":1556},{"text":"angiogram","label":"DIAGNOSTIC_PROCEDURE","start":1569,"end":1578},{"text":"right bronchial artery","label":"BIOLOGICAL_STRUCTURE","start":1586,"end":1608},{"text":"active","label":"DETAILED_DESCRIPTION","start":1627,"end":1633},{"text":"bleeding","label":"SIGN_SYMPTOM","start":1634,"end":1642},{"text":"Three weeks after","label":"DATE","start":1644,"end":1661},{"text":"discharged","label":"CLINICAL_EVENT","start":1701,"end":1711},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":1735,"end":1744},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":1745,"end":1755},{"text":"three years","label":"DURATION","start":1760,"end":1771}],"tokens":["An ","82-year-old"," ","woman"," was ","transferred"," to our ","hospital"," because of ","dyspnea"," and ","massive"," ","hemoptysis",".\nThe patient had a history of ","bronchial asthma"," that was well-controlled with ","bronchodilator medications",".\nShe had ","no history of tuberculosis, nontuberculous mycobacterial infection, or smoking",".\nThe ","physical examination"," revealed ","diffuse"," ","bilateral"," ","crackles",".\nShe suffered from ","severe"," ","hypoxemia"," (","pH"," ","7.362",", ","PCO2"," ","35.1 mmHg",", ","PO2"," ","61.0 mmHg",", ","HCO3-"," ","20.1 mmHg",", ","BE"," ","-5.5 mmHg",", ","SpO2"," ","90.5%",", ","under 10 L O2\/min",", ","reservoir mask",").\nAfter the ","tracheal"," ","intubation",", ","100 mL"," of ","bright-red"," ","blood"," was ","aspirated",".\nA ","chest"," ","radiograph"," showed ","bilateral"," ","infiltrates"," (Fig.1).\nA ","chest"," ","CT"," further demonstrated ","multiple"," ","consolidations"," and ","ground glass"," ","opacity"," and ","focal"," ","bronchiectasis"," in ","right segment 4"," (","S4",") (Fig.2).\nThere were no ","space-occupying"," ","lesions",".\n","Four days after"," admission, her ","respiratory condition"," was ","improved",".\nSince there was no ","active"," ","hemorrhaging"," from the ","tracheal tube",", she was then ","extubated",".\nAfter that, only a ","small amount"," of ","bloody"," ","sputum"," was coughed up.\nTo determine the origin of bleeding, she underwent ","contrast-enhanced"," ","CT",", which showed ","bronchiectasis"," in ","right S4"," and regression of the ","infiltration",".\n","CTA"," revealed an ","abnormal"," ","vascular"," ","anastomosis"," between the ","right inferior phrenic artery"," and ","right pulmonary artery"," beside the ","focal"," ","bronchiectasis"," at the ","right middle lobe"," (Fig.3), which led us to suspect it as the possible source of the ","massive"," ","hemoptysis",".\nWe therefore performed ","embolization"," by ","superselecting"," the ","right inferior phrenic artery"," with a ","2.2-Fr. microcatheter"," (Fig.4).\nAn ","angiogram"," of the ","right bronchial artery"," showed no obvious ","active"," ","bleeding",".\n","Three weeks after"," the embolization, she was successfully ","discharged"," and has been free from ","recurrent"," ","hemoptysis"," for ","three years",".\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,63,0,69,0,39,0,39,0,39,0,24,0,22,0,22,0,69,0,63,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,22,0,12,0,75,0,79,0,15,0,12,0,69,0,12,0,24,0,22,0,69,0,12,0,24,0,22,0,69,0,73,0,69,0,22,0,26,0,12,0,12,0,22,0,69,0,19,0,24,0,42,0,22,0,69,0,75,0,75,0,63,0,22,0,69,0,22,0,24,0,26,0,12,0,69,0,24,0,22,0,12,0,26,0,12,0,12,0,22,0,26,0,12,0,63,0,69,0,75,0,75,0,12,0,22,0,24,0,12,0,22,0,69,0,19,0,13,0,22,0,69,0,32,0]}
-{"full_text":"A 65-year-old man with a 45-year history of cigarette smoking visited our hospital for the diagnosis of an abnormal chest shadow on X-ray.\nHe did not have any remarkable medical history and had not been prescribed anticoagulants or antiplatelet agents.\nA computed tomography (CT) scan revealed a huge mass in the left upper lobe (maximum size: 11.0 cm in diameter) that subsequently expanded to the left hilum and mediastinum, as well as an intrapulmonary metastasis located in the left lower lobe, pleural effusion on the left side, and multiple liver tumors ranging from 0.5 to 4.7 cm in diameter (Fig.1).\nOf note, some of the liver metastases were located subcapsularly, and the liver surface was irregularly distorted.\nThe laboratory findings were as follows: white blood cell count 11,900\/mm3, hemoglobin 14.8 g\/dL, platelet count 214,000\/mm3, aspartate transaminase 31 IU\/L, alanine transaminase 19 IU\/L, and lactate dehydrogenase (LDH) 749 IU\/L.\nNo coagulation abnormalities were found.\nA subsequent histological examination of a tumor specimen obtained by bronchoscopy confirmed the diagnosis of small cell carcinoma.\nOn considering the clinical diagnosis, performance status, and age of the patient, we decided on a regimen of antitumor chemotherapy consisting of cisplatin (60 mg\/m2 body surface area on Day 1) and etoposide (100 mg\/m2 body surface area on Days 1-3).\nOn a day after 2 weeks from the initial CT scan, he started his first chemotherapy session.\nOn Day 3 after initiating chemotherapy, he complained of abdominal discomfort, and his vital signs showed tachycardia (120 beats per minute) and hypotension (85\/55 mmHg).\nA hematological examination showed severe anemia (hemoglobin 6.7 g\/dL) that had dramatically dropped from 14.8 g\/dL over 10 days.\nWe attempted to identify the bleeding site on gastrointestinal endoscopy, to no avail, but a CT scan revealed the rapid enlargement of a liver tumor in the left lobe, which contained partial high-density areas on the plain scan, and also a novel finding of ascites showing higher density than usual, all suggesting a ruptured liver metastasis and associated hemorrhagic ascites (Fig.2).\nA subsequent contrast-enhanced CT image was negative for extravasation.\nHe underwent angiography for the left and right hepatic arteries, but we only observed obscure tumor vessels in the left hepatic lobe without extravasation (Fig.3A).\nWe suspected this might be due to the hypovascularity of the metastatic tumors and inactive bleeding at the time.\nAlthough the benefit of therapeutic embolization of the hepatic artery was uncertain based on the findings on angiography, we performed transcatheter arterial embolization (TAE) of the left main hepatic artery using gelform particles to prevent future re-bleeding.\nPost-embolization angiography revealed a slowed blood flow in the left hepatic artery, and the peripheral vessels were weakly visualized (Fig.3B).\nAfter the embolization concomitant with supportive therapies, including RBC transfusions of 6 U in total, the clinical course of the patient stabilized.\nHis blood pressure remained around 120\/70 mmHg, tachycardia disappeared, and the anemia was improved after transfusion and did not progress again.\nLiver dysfunction did not appear.\nA month after the embolization, he was in relatively good health and re-started his antitumor chemotherapy, which he continued (first-line regimen) for six courses.\nA good partial response was gained after chemotherapy for both the lung and liver lesions.\n","ner_info":[{"text":"65-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"45-year history of cigarette smoking","label":"HISTORY","start":25,"end":61},{"text":"visited","label":"CLINICAL_EVENT","start":62,"end":69},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":74,"end":82},{"text":"abnormal","label":"DETAILED_DESCRIPTION","start":107,"end":115},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":116,"end":121},{"text":"shadow","label":"SIGN_SYMPTOM","start":122,"end":128},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":132,"end":137},{"text":"did not have any remarkable medical history","label":"HISTORY","start":142,"end":185},{"text":"anticoagulants","label":"MEDICATION","start":214,"end":228},{"text":"antiplatelet agents","label":"MEDICATION","start":232,"end":251},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":255,"end":274},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":276,"end":278},{"text":"huge","label":"DETAILED_DESCRIPTION","start":296,"end":300},{"text":"mass","label":"SIGN_SYMPTOM","start":301,"end":305},{"text":"left upper 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arteries","label":"BIOLOGICAL_STRUCTURE","start":2263,"end":2294},{"text":"obscure","label":"DETAILED_DESCRIPTION","start":2317,"end":2324},{"text":"tumor vessels","label":"SIGN_SYMPTOM","start":2325,"end":2338},{"text":"left hepatic lobe","label":"BIOLOGICAL_STRUCTURE","start":2346,"end":2363},{"text":"extravasation","label":"SIGN_SYMPTOM","start":2372,"end":2385},{"text":"transcatheter arterial embolization","label":"THERAPEUTIC_PROCEDURE","start":2646,"end":2681},{"text":"TAE","label":"THERAPEUTIC_PROCEDURE","start":2683,"end":2686},{"text":"left main hepatic artery","label":"BIOLOGICAL_STRUCTURE","start":2695,"end":2719},{"text":"gelform particles","label":"THERAPEUTIC_PROCEDURE","start":2726,"end":2743},{"text":"angiography","label":"DIAGNOSTIC_PROCEDURE","start":2793,"end":2804},{"text":"slowed","label":"LAB_VALUE","start":2816,"end":2822},{"text":"blood flow","label":"DIAGNOSTIC_PROCEDURE","start":2823,"end":2833},{"text":"left hepatic 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","X-ray",".\nHe ","did not have any remarkable medical history"," and had not been prescribed ","anticoagulants"," or ","antiplatelet agents",".\nA ","computed tomography"," (","CT",") scan revealed a ","huge"," ","mass"," in the ","left upper lobe"," (maximum size: ","11.0 cm"," in diameter) that subsequently expanded to the ","left hilum"," and ","mediastinum",", as well as an ","intrapulmonary"," ","metastasis"," located in the ","left lower lobe",", ","pleural effusion"," on the ","left side",", and ","multiple"," ","liver"," ","tumors"," ranging from ","0.5 to 4.7 cm"," in diameter (Fig.1).\nOf note, ","some"," of the ","liver"," ","metastases"," were ","located subcapsularly",", and the ","liver surface"," was ","irregularly"," ","distorted",".\nThe ","laboratory findings"," were as follows: ","white blood cell count"," ","11,900\/mm3",", ","hemoglobin"," ","14.8 g\/dL",", ","platelet count"," ","214,000\/mm3",", ","aspartate transaminase"," ","31 IU\/L",", ","alanine transaminase"," ","19 IU\/L",", and ","lactate dehydrogenase"," (","LDH",") ","749 IU\/L",".\nNo ","coagulation abnormalities"," were found.\nA subsequent ","histological examination"," of a ","tumor"," specimen obtained by ","bronchoscopy"," confirmed the diagnosis of ","small cell carcinoma",".\nOn considering the clinical diagnosis, performance status, and age of the patient, we decided on a regimen of ","antitumor"," ","chemotherapy"," consisting of ","cisplatin"," (","60 mg\/m2 body surface area"," on ","Day 1",") and ","etoposide"," (","100 mg\/m2 body surface area"," on ","Days 1-3",").\nOn ","a day after 2 weeks"," from the initial ","CT"," scan, he started his first ","chemotherapy"," session.\nOn ","Day 3"," after initiating chemotherapy, he complained of ","abdominal"," ","discomfort",", and his ","vital signs"," showed ","tachycardia"," (","120 beats per minute",") and ","hypotension"," (","85\/55 mmHg",").\nA ","hematological examination"," showed ","severe"," ","anemia"," (","hemoglobin"," ","6.7 g\/dL",") that had dramatically ","dropped"," from ","14.8 g\/dL"," ","over 10 days",".\nWe attempted to identify the bleeding site on ","gastrointestinal"," ","endoscopy",", to no avail, but a ","CT"," scan revealed the ","rapid"," ","enlargement"," of a ","liver"," ","tumor"," in the ","left lobe",", which contained ","partial"," ","high-density areas"," on the ","plain scan",", and also a novel finding of ","ascites"," showing ","higher density than usual",", all suggesting a ","ruptured"," ","liver"," ","metastasis"," and associated ","hemorrhagic"," ","ascites"," (Fig.2).\nA subsequent ","contrast-enhanced"," ","CT"," image was negative for ","extravasation",".\nHe underwent ","angiography"," for the ","left and right hepatic arteries",", but we only observed ","obscure"," ","tumor vessels"," in the ","left hepatic lobe"," without ","extravasation"," (Fig.3A).\nWe suspected this might be due to the hypovascularity of the metastatic tumors and inactive bleeding at the time.\nAlthough the benefit of therapeutic embolization of the hepatic artery was uncertain based on the findings on angiography, we performed ","transcatheter arterial embolization"," (","TAE",") of the ","left main hepatic artery"," using ","gelform particles"," to prevent future re-bleeding.\nPost-embolization ","angiography"," revealed a ","slowed"," ","blood flow"," in the ","left hepatic artery",", and the peripheral vessels were weakly visualized (Fig.3B).\nAfter the embolization concomitant with ","supportive therapies",", including ","RBC"," ","transfusions"," of ","6 U"," in total, the ","clinical course"," of the patient ","stabilized",".\nHis ","blood pressure"," remained around ","120\/70 mmHg",", ","tachycardia"," disappeared, and the ","anemia"," was improved after transfusion and did not progress again.\n","Liver"," ","dysfunction"," did not appear.\n","A month after"," the embolization, he was in ","relatively good"," ","health"," and re-started his ","antitumor"," ","chemotherapy",", which he continued (first-line regimen) for ","six courses",".\nA ","good"," ","partial"," ","response"," was gained after ","chemotherapy"," for both the ","lung"," and ","liver"," ","lesions",".\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,48,0,22,0,12,0,69,0,24,0,39,0,46,0,46,0,24,0,24,0,22,0,69,0,12,0,27,0,12,0,12,0,12,0,69,0,12,0,26,0,22,0,22,0,12,0,69,0,27,0,22,0,12,0,18,0,22,0,12,0,22,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,69,0,24,0,69,0,24,0,26,0,22,0,46,0,46,0,29,0,19,0,46,0,29,0,19,0,19,0,24,0,46,0,19,0,12,0,69,0,24,0,69,0,42,0,69,0,42,0,24,0,63,0,69,0,24,0,42,0,42,0,42,0,32,0,12,0,24,0,24,0,22,0,69,0,12,0,69,0,12,0,22,0,69,0,24,0,69,0,22,0,22,0,12,0,69,0,22,0,69,0,22,0,24,0,69,0,24,0,12,0,22,0,69,0,12,0,69,0,75,0,75,0,12,0,75,0,24,0,42,0,24,0,12,0,75,0,46,0,4,0,29,0,24,0,42,0,24,0,42,0,69,0,69,0,12,0,69,0,19,0,42,0,24,0,22,0,46,0,29,0,42,0,42,0,24,0,46,0,12,0,12,0,69,0]}
-{"full_text":"A 33-year-old Moroccan man with a 5-month history of recurring sinusitis presented with temperature, myalgia, cough, and hemoptysis.\nThoracic physical examination revealed reduced vesicular murmur, and chest X-ray showed bilateral diffuse alveolar infiltrates.\nLaboratory analyses showed elevation of acute-phase proteins (CRP 26\u200amg\/dL) and creatinine (1.2\u200amg\/dL) with nonnephrotic proteinuria and microscopic glomerular hematuria.\nAn antibiotic therapy for community acquired and atypical pneumoniae with levofloxacin 500\u200amg daily iv was established, but on the 3rd day from admission the patient developed respiratory failure unresponsive to noninvasive ventilation and had to be intubated.\nWhite lung with consolidations and ground glass areas at computed tomography scan (Fig.1), diffuse airways bleeding at fiberoptic bronchoscopy, mild normocytic anemia (9\u200ag\/dL), and ANCA-PR3 positivity (18.9\u200aU\/mL) were consistent with the diagnosis of GPA.\nDespite maximal ventilatory support, gas exchange did not improve (pH 7.33, PaO2 71\u200amm\u200aHg, PaCO2 51\u200amm\u200aHg, HCO3\u2013 25\u200ammol\/L, SaO2 94%) requiring extracorporeal membrane oxygenation (ECMO).\nTreatment with high-dose methylprednisolone (1\u200ag daily for 3 days and 1\u200amg\/kg daily thereafter), cyclophosphamide (1.2\u200ag\/pulse every 2 weeks for the 1st 3 pulses, followed by infusions every 3 weeks for the next 2 pulses), and plasma exchange (PE), according to European vasculitis study group recommendations,[4] was immediately started with respiratory improvement that allowed ECMO and orotracheal tube withdrawal and subsequent discharge from intensive care unit.\nAfter 9 days from the beginning of treatment ANCA-PR3 levels normalized (3\u200aU\/mL).\nTwo months later, after the 5th bolus of cyclophosphamide and with prednisone 0.3\u200amg\/kg\/day, the patient complained arthromyalgia and testicular pain with edema, cough, and shortness of breath: laboratory data showed worsening of renal function, mild anemia, and hypoxemia (PaO2 61\u200amm\u200aHg).\nEpididymitis was confirmed by ultrasound.\nBecause of rapidly progressive renal failure (estimated glomerular filtration rate 35\u200amL\/min) renal biopsy was performed and showed prominent intracapillary and extracapillary proliferation, with the formation of some fibrocellular crescents and focal capillary necrosis (Fig.2).\nLung computed tomography-scan and fiberoptic bronchoscopy also confirmed alveolar hemorrhage relapse.\nTreatment with high-dose methylprednisolone (1\u200ag daily for 3 consecutive days) and rituximab (375\u200amg\/m2 weekly for 4 weeks) was started with rapid resolution of urologic and pulmonary involvement but delayed and partial improvement of renal function.\nAt a 1-year follow-up, the patient is alive and under treatment with azathioprine (150\u200amg daily) and prednisone (15\u200amg daily).\nRenal function has markedly improved (estimated glomerular filtration rate 94\u200amL\/min) same as gas-exchange (pH 7.42, PaO2 86\u200amm\u200aHg, PaCO2 36\u200amm\u200aHg, HCO3\u2013 23\u200ammol\/L, SaO2 95%).\nThe patient signed institutional informed consent form at the time of admission to hospitalization.\nAn approval by ethics committee was not necessary because of the routine health care.\n","ner_info":[{"text":"33-year-old","label":"AGE","start":2,"end":13},{"text":"Moroccan","label":"PERSONAL_BACKGROUND","start":14,"end":22},{"text":"man","label":"SEX","start":23,"end":26},{"text":"5-month","label":"DURATION","start":34,"end":41},{"text":"recurring","label":"DETAILED_DESCRIPTION","start":53,"end":62},{"text":"sinusitis","label":"DISEASE_DISORDER","start":63,"end":72},{"text":"temperature","label":"SIGN_SYMPTOM","start":88,"end":99},{"text":"myalgia","label":"SIGN_SYMPTOM","start":101,"end":108},{"text":"cough","label":"SIGN_SYMPTOM","start":110,"end":115},{"text":"hemoptysis","label":"SIGN_SYMPTOM","start":121,"end":131},{"text":"Thoracic","label":"BIOLOGICAL_STRUCTURE","start":133,"end":141},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":142,"end":162},{"text":"reduced","label":"LAB_VALUE","start":172,"end":179},{"text":"vesicular 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areas","label":"SIGN_SYMPTOM","start":728,"end":746},{"text":"computed 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-{"full_text":"A 41-year-old Caucasian woman underwent a primary double lung transplantation for cystic fibrosis in 2006.\nHer medical history was otherwise unremarkable and the patient had no known history of pulmonary tuberculosis or tuberculosis contact.\nOn December 2015, she underwent retransplantation for chronic lung allograft dysfunction.\nDuring the month preceding retransplantation, 4 sputum specimens remained negative for acid-fast bacilli and specific M. tuberculosis culture and real-time polymerase chain reaction (PCR) testing.\nOn postoperative day 42, deterioration of her respiratory status prompted a chest-computerized tomography (CT) scan revealing sub-centimeter bilateral nodules primarily located in the apical posterior lobes and a bilateral pleural effusion (Fig.1).\nThe same day, a bronchoalveolar lavage (BAL) yielded a positive real-time PCR for rifampicin-susceptible M. tuberculosis, confirmed by culture on postoperative day 62.\nTuberculin skin test (TST) or interferon-\u03b3 release assay (IGRA) test were not performed.\nAll the BALs performed on postoperative period yielded no other pathogen except for the one performed on day 60 that cultured Pseudomonas aeruginosa; the adjunctive antibiotic therapy was imipenem-cilastatin, 3\u200ag\/d.\nHistological examination of a lung biopsy performed 6 weeks after retransplantation revealed a caseating granuloma and necrosis.\nAcid-fast bacilli were identified as rifampicin-susceptible M. tuberculosis by real-time PCR.\nOn postoperative day 65, the patient's status worsened with severe hypoxemia, shock unresponsive to high dose cathecolamines, and multiorgan failure.\nThe patient died on postoperative day 70, despite treatment combining isoniazid, rifampicin, ethambutol, and pyrazinamide.\nRetrospective real-time PCR testing of the explanted lung and BALs performed on postoperative days 1, 7, and 21 remained negative.\nThe organ donor died of posttraumatic intracerebral hemorrhage.\nHe was a 47-year-old man with no history of lung disease or risk factors for tuberculosis other than chronic alcohol use and smoking.\nTST results were not available.\nDuring hospitalization, a lung CT-scan showed no signs of active or previous tuberculosis and no TST or IGRA test results were available.\nRoutine cultures of per-transplantation right lung biopsy yielded Candida albicans.\nRetrospective M. tuberculosis real-time PCR yielded negative results on the left and right donor-lung biopsies.\nBoth kidneys from the same donor were transplanted into 2 other recipients.\nSix months after transplantation, neither of the kidney recipients had developed any signs or symptoms suggestive of active tuberculosis.\n","ner_info":[{"text":"41-year-old","label":"AGE","start":2,"end":13},{"text":"Caucasian","label":"PERSONAL_BACKGROUND","start":14,"end":23},{"text":"woman","label":"SEX","start":24,"end":29},{"text":"primary","label":"DETAILED_DESCRIPTION","start":42,"end":49},{"text":"double","label":"DETAILED_DESCRIPTION","start":50,"end":56},{"text":"lung transplantation","label":"THERAPEUTIC_PROCEDURE","start":57,"end":77},{"text":"cystic fibrosis","label":"HISTORY","start":82,"end":97},{"text":"2006","label":"DATE","start":101,"end":105},{"text":"medical history was otherwise unremarkable","label":"HISTORY","start":111,"end":153},{"text":"no known history of pulmonary tuberculosis or tuberculosis contact","label":"HISTORY","start":174,"end":240},{"text":"December 2015","label":"DATE","start":245,"end":258},{"text":"retransplantation","label":"THERAPEUTIC_PROCEDURE","start":274,"end":291},{"text":"chronic","label":"DETAILED_DESCRIPTION","start":296,"end":303},{"text":"lung allograft 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65","label":"DATE","start":1491,"end":1497},{"text":"status","label":"DIAGNOSTIC_PROCEDURE","start":1513,"end":1519},{"text":"worsened","label":"LAB_VALUE","start":1520,"end":1528},{"text":"severe","label":"SEVERITY","start":1534,"end":1540},{"text":"hypoxemia","label":"SIGN_SYMPTOM","start":1541,"end":1550},{"text":"shock","label":"DISEASE_DISORDER","start":1552,"end":1557},{"text":"high dose","label":"DOSAGE","start":1574,"end":1583},{"text":"cathecolamines","label":"MEDICATION","start":1584,"end":1598},{"text":"multiorgan failure","label":"DISEASE_DISORDER","start":1604,"end":1622},{"text":"died","label":"OUTCOME","start":1636,"end":1640},{"text":"day 70","label":"DATE","start":1658,"end":1664},{"text":"isoniazid","label":"MEDICATION","start":1694,"end":1703},{"text":"rifampicin","label":"MEDICATION","start":1705,"end":1715},{"text":"ethambutol","label":"MEDICATION","start":1717,"end":1727},{"text":"pyrazinamide","label":"MEDICATION","start":1733,"end":1745},{"text":"real-time","label":"DETAILED_DESCRIPTION","start":1761,"end":1770},{"text":"PCR","label":"DIAGNOSTIC_PROCEDURE","start":1771,"end":1774},{"text":"explanted lung","label":"DETAILED_DESCRIPTION","start":1790,"end":1804},{"text":"BALs performed on postoperative days 1, 7, and 21","label":"DETAILED_DESCRIPTION","start":1809,"end":1858},{"text":"negative","label":"LAB_VALUE","start":1868,"end":1876},{"text":"organ donor","label":"SUBJECT","start":1882,"end":1893},{"text":"died of posttraumatic intracerebral hemorrhage","label":"DETAILED_DESCRIPTION","start":1894,"end":1940},{"text":"He","label":"COREFERENCE","start":1942,"end":1944},{"text":"a 47-year-old man","label":"DETAILED_DESCRIPTION","start":1949,"end":1966},{"text":"no history of lung disease or risk factors for tuberculosis","label":"DETAILED_DESCRIPTION","start":1972,"end":2031},{"text":"chronic alcohol use and smoking","label":"DETAILED_DESCRIPTION","start":2043,"end":2074},{"text":"TST results were not available","label":"DETAILED_DESCRIPTION","start":2076,"end":2106},{"text":"lung CT-scan showed no signs of active or previous tuberculosis","label":"DETAILED_DESCRIPTION","start":2134,"end":2197},{"text":"no TST or IGRA test results were available","label":"DETAILED_DESCRIPTION","start":2202,"end":2244},{"text":"cultures of per-transplantation right lung biopsy yielded Candida albicans","label":"DETAILED_DESCRIPTION","start":2254,"end":2328},{"text":"M. tuberculosis real-time PCR yielded negative results on the left and right donor-lung biopsies","label":"DETAILED_DESCRIPTION","start":2344,"end":2440},{"text":"Both kidneys","label":"DETAILED_DESCRIPTION","start":2442,"end":2454},{"text":"donor","label":"COREFERENCE","start":2469,"end":2474},{"text":"transplanted into 2 other recipients","label":"DETAILED_DESCRIPTION","start":2480,"end":2516},{"text":"Six months after transplantation","label":"DETAILED_DESCRIPTION","start":2518,"end":2550},{"text":"kidney recipients","label":"SUBJECT","start":2567,"end":2584}],"tokens":["A ","41-year-old"," ","Caucasian"," ","woman"," underwent a ","primary"," ","double"," ","lung transplantation"," for ","cystic fibrosis"," in ","2006",".\nHer ","medical history was otherwise unremarkable"," and the patient had ","no known history of pulmonary tuberculosis or tuberculosis contact",".\nOn ","December 2015",", she underwent ","retransplantation"," for ","chronic"," ","lung allograft dysfunction",".\nDuring the ","month preceding"," retransplantation, ","4"," ","sputum specimens"," remained ","negative"," for ","acid-fast bacilli"," and ","specific M. tuberculosis culture"," and ","real-time"," ","polymerase chain reaction"," (","PCR",") testing.\nOn postoperative ","day 42",", ","deterioration"," of her ","respiratory status"," prompted a ","chest","-","computerized tomography"," (","CT",") scan revealing ","sub-centimeter"," ","bilateral"," ","nodules"," primarily located in the ","apical posterior lobes"," and a ","bilateral"," ","pleural effusion"," (Fig.1).\nThe same day, a ","bronchoalveolar lavage"," (","BAL",") yielded a ","positive"," ","real-time"," ","PCR"," for ","rifampicin-susceptible M. tuberculosis",", ","confirmed"," by ","culture"," on postoperative ","day 62",".\n","Tuberculin skin test"," (","TST",") or ","interferon-\u03b3 release assay"," (","IGRA",") test were not performed.\nAll the ","BAL","s performed on postoperative period yielded ","no other pathogen"," except for the ","one"," performed on ","day 60"," that cultured ","Pseudomonas aeruginosa","; the ","adjunctive"," ","antibiotic therapy"," was ","imipenem-cilastatin",", ","3\u200ag\/d",".\n","Histological examination"," of a ","lung"," ","biopsy"," performed ","6 weeks after"," retransplantation revealed a ","caseating granuloma"," and ","necrosis",".\n","Acid-fast bacilli"," were identified as ","rifampicin-susceptible M. tuberculosis"," by ","real-time"," ","PCR",".\nOn postoperative ","day 65",", the patient's ","status"," ","worsened"," with ","severe"," ","hypoxemia",", ","shock"," unresponsive to ","high dose"," ","cathecolamines",", and ","multiorgan failure",".\nThe patient ","died"," on postoperative ","day 70",", despite treatment combining ","isoniazid",", ","rifampicin",", ","ethambutol",", and ","pyrazinamide",".\nRetrospective ","real-time"," ","PCR"," testing of the ","explanted lung"," and ","BALs performed on postoperative days 1, 7, and 21"," remained ","negative",".\nThe ","organ donor"," ","died of posttraumatic intracerebral hemorrhage",".\n","He"," was ","a 47-year-old man"," with ","no history of lung disease or risk factors for tuberculosis"," other than ","chronic alcohol use and smoking",".\n","TST results were not available",".\nDuring hospitalization, a ","lung CT-scan showed no signs of active or previous tuberculosis"," and ","no TST or IGRA test results were available",".\nRoutine ","cultures of per-transplantation right lung biopsy yielded Candida albicans",".\nRetrospective ","M. tuberculosis real-time PCR yielded negative results on the left and right donor-lung biopsies",".\n","Both kidneys"," from the same ","donor"," were ","transplanted into 2 other recipients",".\n","Six months after transplantation",", neither of the ","kidney recipients"," had developed any signs or symptoms suggestive of active tuberculosis.\n"],"ner_labels":[0,5,0,58,0,65,0,22,0,22,0,75,0,39,0,19,0,39,0,39,0,19,0,75,0,22,0,26,0,19,0,42,0,24,0,42,0,22,0,22,0,22,0,24,0,24,0,19,0,42,0,24,0,12,0,24,0,24,0,22,0,22,0,69,0,12,0,22,0,26,0,24,0,24,0,42,0,22,0,24,0,22,0,42,0,24,0,19,0,24,0,24,0,24,0,24,0,24,0,42,0,18,0,19,0,42,0,22,0,46,0,46,0,29,0,24,0,12,0,24,0,19,0,42,0,42,0,42,0,22,0,22,0,24,0,19,0,24,0,42,0,63,0,69,0,26,0,29,0,46,0,26,0,56,0,19,0,46,0,46,0,46,0,46,0,22,0,24,0,22,0,22,0,42,0,71,0,22,0,18,0,22,0,22,0,22,0,22,0,22,0,22,0,22,0,22,0,22,0,18,0,22,0,22,0,71,0]}
-{"full_text":"A 16-year-old female suffered from an abdominal pain at right upper quadrant, lasting for more than 10 days.\nShortly ahead of her medical consultation, 4 ascaris-like worms were vomited out, individually with a length of about 10\u200acm.\nShe had a previous onset of ascariasis, during which low-grade fever (38.4\u00b0C) occurred without apparent jaundice, diarrhea, or anemia.\nPhysical examination revealed tenderness at right upper quadrant.\nHer total leukocyte count was 11.2\u200aG\/L consisting of 5.2% eosinophils.\nSerum and urine amylase were 386 and 928\u200aU\/L, respectively.\nIn terms of liver functionality, the level of total bilirubin rose up to 23.2\u200a\u03bcm\/L, meanwhile the hepatic enzymes were similarly elevated (alanine aminotransferase 163\u200aU\/L; aspartate aminotransferase 96\u200aU\/L).\nAbdominal ultrasound described the enlargement of the gallbladder, upper segment of common bile duct (1.5\u200acm in diameter) and intrahepatic bile duct (1.3\u200acm in diameter).\nFurthermore, the intrahepatic bile duct was also discovered to be filled with echogenic and banded substances.\nBased on such evidences, she was clinically diagnosed as biliary ascariasis with a concomitant manifestation of biliary duct infection.\nThrough a laparoscopic exploration, the enlarged gallbladder and common bile duct were visually confirmed, as well as the massive storage of worms within the biliary tract.\nSubsequently, a 1\u200acm incision was made on the common bile duct in order to facilitate the extraction of the pathogenic worms, which were then placed into a specimen bag laparoscopically (Fig.1).\nOnce the contained worms were virtually cleared out under laparoscope, chodedochoscopy was employed to seek for more hidden worms inside the biliary system (Fig.2).\nAfter finishing the removal of ascarides, the biliary duct incision was well sutured, with a T-tube placed in situ (Fig.3).\nEventually, a standard laparoscopic cholecystectomy was performed, followed by the removal of specimen bags and drainage tube placement (Fig.4).\nThe total amount of worms inside the common bile duct summed up to more than 100 (Fig.5).\nPostoperatively, she was treated with oral antihelminthic drugs for 3 days.\nThe T-tube was rinsed with saline every day, and during the first 3 days, 6 more worms were additionally washed out.\nThe patient experienced a smooth postoperative recovery and was finally discharged from hospital without any complications.\n","ner_info":[{"text":"16-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":38,"end":47},{"text":"pain","label":"SIGN_SYMPTOM","start":48,"end":52},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":56,"end":76},{"text":"more than 10 days","label":"DURATION","start":90,"end":107},{"text":"consultation","label":"CLINICAL_EVENT","start":138,"end":150},{"text":"4","label":"LAB_VALUE","start":152,"end":153},{"text":"ascaris-like worms","label":"DETAILED_DESCRIPTION","start":154,"end":172},{"text":"vomited","label":"SIGN_SYMPTOM","start":178,"end":185},{"text":"10\u200acm","label":"DISTANCE","start":227,"end":232},{"text":"previous onset","label":"DETAILED_DESCRIPTION","start":244,"end":258},{"text":"ascariasis","label":"DISEASE_DISORDER","start":262,"end":272},{"text":"low-grade","label":"LAB_VALUE","start":287,"end":296},{"text":"fever","label":"SIGN_SYMPTOM","start":297,"end":302},{"text":"38.4\u00b0C","label":"LAB_VALUE","start":304,"end":310},{"text":"jaundice","label":"SIGN_SYMPTOM","start":338,"end":346},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":348,"end":356},{"text":"anemia","label":"SIGN_SYMPTOM","start":361,"end":367},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":369,"end":389},{"text":"tenderness","label":"SIGN_SYMPTOM","start":399,"end":409},{"text":"right upper quadrant","label":"BIOLOGICAL_STRUCTURE","start":413,"end":433},{"text":"total leukocyte count","label":"DIAGNOSTIC_PROCEDURE","start":439,"end":460},{"text":"11.2\u200aG\/L","label":"LAB_VALUE","start":465,"end":473},{"text":"5.2% eosinophils","label":"LAB_VALUE","start":488,"end":504},{"text":"Serum","label":"BIOLOGICAL_STRUCTURE","start":506,"end":511},{"text":"urine","label":"BIOLOGICAL_STRUCTURE","start":516,"end":521},{"text":"amylase","label":"DIAGNOSTIC_PROCEDURE","start":522,"end":529},{"text":"928\u200aU\/L","label":"LAB_VALUE","start":543,"end":550},{"text":"liver functionality","label":"DIAGNOSTIC_PROCEDURE","start":578,"end":597},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":612,"end":627},{"text":"rose up","label":"LAB_VALUE","start":628,"end":635},{"text":"23.2\u200a\u03bcm\/L","label":"LAB_VALUE","start":639,"end":648},{"text":"hepatic enzymes","label":"DIAGNOSTIC_PROCEDURE","start":664,"end":679},{"text":"elevated","label":"LAB_VALUE","start":695,"end":703},{"text":"alanine aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":705,"end":729},{"text":"163\u200aU\/L","label":"LAB_VALUE","start":730,"end":737},{"text":"aspartate aminotransferase","label":"DIAGNOSTIC_PROCEDURE","start":739,"end":765},{"text":"96\u200aU\/L","label":"LAB_VALUE","start":766,"end":772},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":775,"end":784},{"text":"ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":785,"end":795},{"text":"enlargement","label":"SIGN_SYMPTOM","start":810,"end":821},{"text":"gallbladder","label":"BIOLOGICAL_STRUCTURE","start":829,"end":840},{"text":"upper segment of common bile duct","label":"BIOLOGICAL_STRUCTURE","start":842,"end":875},{"text":"1.5\u200acm in diameter","label":"DISTANCE","start":877,"end":895},{"text":"intrahepatic bile duct","label":"BIOLOGICAL_STRUCTURE","start":901,"end":923},{"text":"1.3\u200acm in diameter","label":"DISTANCE","start":925,"end":943},{"text":"intrahepatic bile duct","label":"BIOLOGICAL_STRUCTURE","start":963,"end":985},{"text":"echogenic","label":"SIGN_SYMPTOM","start":1024,"end":1033},{"text":"banded substances","label":"SIGN_SYMPTOM","start":1038,"end":1055},{"text":"biliary","label":"BIOLOGICAL_STRUCTURE","start":1114,"end":1121},{"text":"ascariasis","label":"DISEASE_DISORDER","start":1122,"end":1132},{"text":"biliary duct","label":"BIOLOGICAL_STRUCTURE","start":1169,"end":1181},{"text":"infection","label":"DISEASE_DISORDER","start":1182,"end":1191},{"text":"laparoscopic exploration","label":"DIAGNOSTIC_PROCEDURE","start":1203,"end":1227},{"text":"enlarged","label":"SIGN_SYMPTOM","start":1233,"end":1241},{"text":"gallbladder","label":"BIOLOGICAL_STRUCTURE","start":1242,"end":1253},{"text":"common bile duct","label":"BIOLOGICAL_STRUCTURE","start":1258,"end":1274},{"text":"massive storage","label":"SEVERITY","start":1315,"end":1330},{"text":"worms","label":"SIGN_SYMPTOM","start":1334,"end":1339},{"text":"biliary tract","label":"BIOLOGICAL_STRUCTURE","start":1351,"end":1364},{"text":"1\u200acm","label":"DISTANCE","start":1382,"end":1386},{"text":"incision","label":"THERAPEUTIC_PROCEDURE","start":1387,"end":1395},{"text":"common bile duct","label":"BIOLOGICAL_STRUCTURE","start":1412,"end":1428},{"text":"extraction","label":"THERAPEUTIC_PROCEDURE","start":1456,"end":1466},{"text":"worms","label":"SIGN_SYMPTOM","start":1485,"end":1490},{"text":"placed into a specimen bag","label":"THERAPEUTIC_PROCEDURE","start":1508,"end":1534},{"text":"laparoscopically","label":"DETAILED_DESCRIPTION","start":1535,"end":1551},{"text":"worms","label":"SIGN_SYMPTOM","start":1580,"end":1585},{"text":"laparoscope","label":"DIAGNOSTIC_PROCEDURE","start":1619,"end":1630},{"text":"chodedochoscopy","label":"DIAGNOSTIC_PROCEDURE","start":1632,"end":1647},{"text":"hidden","label":"DETAILED_DESCRIPTION","start":1678,"end":1684},{"text":"worms","label":"SIGN_SYMPTOM","start":1685,"end":1690},{"text":"biliary system","label":"BIOLOGICAL_STRUCTURE","start":1702,"end":1716},{"text":"removal","label":"THERAPEUTIC_PROCEDURE","start":1746,"end":1753},{"text":"ascarides","label":"COREFERENCE","start":1757,"end":1766},{"text":"biliary duct","label":"BIOLOGICAL_STRUCTURE","start":1772,"end":1784},{"text":"incision was well sutured","label":"THERAPEUTIC_PROCEDURE","start":1785,"end":1810},{"text":"T-tube placed","label":"THERAPEUTIC_PROCEDURE","start":1819,"end":1832},{"text":"laparoscopic","label":"DETAILED_DESCRIPTION","start":1873,"end":1885},{"text":"cholecystectomy","label":"THERAPEUTIC_PROCEDURE","start":1886,"end":1901},{"text":"removal of specimen bags","label":"THERAPEUTIC_PROCEDURE","start":1933,"end":1957},{"text":"drainage tube placement","label":"THERAPEUTIC_PROCEDURE","start":1962,"end":1985},{"text":"worms","label":"SIGN_SYMPTOM","start":2015,"end":2020},{"text":"common bile duct","label":"BIOLOGICAL_STRUCTURE","start":2032,"end":2048},{"text":"more than 100","label":"LAB_VALUE","start":2062,"end":2075},{"text":"oral","label":"ADMINISTRATION","start":2123,"end":2127},{"text":"antihelminthic drugs","label":"MEDICATION","start":2128,"end":2148},{"text":"3 days","label":"DURATION","start":2153,"end":2159},{"text":"T-tube was rinsed with saline","label":"THERAPEUTIC_PROCEDURE","start":2165,"end":2194},{"text":"during the first 3 days","label":"DURATION","start":2210,"end":2233},{"text":"6","label":"LAB_VALUE","start":2235,"end":2236},{"text":"worms","label":"SIGN_SYMPTOM","start":2242,"end":2247},{"text":"smooth","label":"LAB_VALUE","start":2304,"end":2310},{"text":"postoperative recovery","label":"THERAPEUTIC_PROCEDURE","start":2311,"end":2333},{"text":"discharged","label":"CLINICAL_EVENT","start":2350,"end":2360},{"text":"from hospital","label":"NONBIOLOGICAL_LOCATION","start":2361,"end":2374},{"text":"complications","label":"SIGN_SYMPTOM","start":2387,"end":2400}],"tokens":["A ","16-year-old"," ","female"," suffered from an ","abdominal"," ","pain"," at ","right upper quadrant",", lasting for ","more than 10 days",".\nShortly ahead of her medical ","consultation",", ","4"," ","ascaris-like worms"," were ","vomited"," out, individually with a length of about ","10\u200acm",".\nShe had a ","previous onset"," of ","ascariasis",", during which ","low-grade"," ","fever"," (","38.4\u00b0C",") occurred without apparent ","jaundice",", ","diarrhea",", or ","anemia",".\n","Physical examination"," revealed ","tenderness"," at ","right upper quadrant",".\nHer ","total leukocyte count"," was ","11.2\u200aG\/L"," consisting of ","5.2% eosinophils",".\n","Serum"," and ","urine"," ","amylase"," were 386 and ","928\u200aU\/L",", respectively.\nIn terms of ","liver functionality",", the level of ","total bilirubin"," ","rose up"," to ","23.2\u200a\u03bcm\/L",", meanwhile the ","hepatic enzymes"," were similarly ","elevated"," (","alanine aminotransferase"," ","163\u200aU\/L","; ","aspartate aminotransferase"," ","96\u200aU\/L",").\n","Abdominal"," ","ultrasound"," described the ","enlargement"," of the ","gallbladder",", ","upper segment of common bile duct"," (","1.5\u200acm in diameter",") and ","intrahepatic bile duct"," (","1.3\u200acm in diameter",").\nFurthermore, the ","intrahepatic bile duct"," was also discovered to be filled with ","echogenic"," and ","banded substances",".\nBased on such evidences, she was clinically diagnosed as ","biliary"," ","ascariasis"," with a concomitant manifestation of ","biliary duct"," ","infection",".\nThrough a ","laparoscopic exploration",", the ","enlarged"," ","gallbladder"," and ","common bile duct"," were visually confirmed, as well as the ","massive storage"," of ","worms"," within the ","biliary tract",".\nSubsequently, a ","1\u200acm"," ","incision"," was made on the ","common bile duct"," in order to facilitate the ","extraction"," of the pathogenic ","worms",", which were then ","placed into a specimen bag"," ","laparoscopically"," (Fig.1).\nOnce the contained ","worms"," were virtually cleared out under ","laparoscope",", ","chodedochoscopy"," was employed to seek for more ","hidden"," ","worms"," inside the ","biliary system"," (Fig.2).\nAfter finishing the ","removal"," of ","ascarides",", the ","biliary duct"," ","incision was well sutured",", with a ","T-tube placed"," in situ (Fig.3).\nEventually, a standard ","laparoscopic"," ","cholecystectomy"," was performed, followed by the ","removal of specimen bags"," and ","drainage tube placement"," (Fig.4).\nThe total amount of ","worms"," inside the ","common bile duct"," summed up to ","more than 100"," (Fig.5).\nPostoperatively, she was treated with ","oral"," ","antihelminthic drugs"," for ","3 days",".\nThe ","T-tube was rinsed with saline"," every day, and ","during the first 3 days",", ","6"," more ","worms"," were additionally washed out.\nThe patient experienced a ","smooth"," ","postoperative recovery"," and was finally ","discharged"," ","from hospital"," without any ","complications",".\n"],"ner_labels":[0,5,0,65,0,12,0,69,0,12,0,32,0,13,0,42,0,22,0,69,0,27,0,22,0,26,0,42,0,69,0,42,0,69,0,69,0,69,0,24,0,69,0,12,0,24,0,42,0,42,0,12,0,12,0,24,0,42,0,24,0,24,0,42,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,69,0,12,0,12,0,27,0,12,0,27,0,12,0,69,0,69,0,12,0,26,0,12,0,26,0,24,0,69,0,12,0,12,0,63,0,69,0,12,0,27,0,75,0,12,0,75,0,69,0,75,0,22,0,69,0,24,0,24,0,22,0,69,0,12,0,75,0,18,0,12,0,75,0,75,0,22,0,75,0,75,0,75,0,69,0,12,0,42,0,4,0,46,0,32,0,75,0,32,0,42,0,69,0,42,0,75,0,13,0,48,0,69,0]}
-{"full_text":"A 41-year-old man with a history of alcoholism for 10 years and sober for the last 3 years, recurrent alcoholic pancreatitis, and no known liver disease, presented with several episodes of hematemesis and abdominal pain for 2 days.\nEsophagogastroduodenoscopy (EGD), performed 3 years earlier for abdominal pain, had revealed no esophageal varices, gastric varices, portal hypertensive gastropathy, or other GI lesions.\nPhysical examination revealed a blood pressure\u200a=\u200a100\/60\u200amm\u200aHg, pulse\u200a=\u200a60\u200abeats\/min, no jaundice, no stigmata of chronic liver disease, a soft abdomen with mild epigastric tenderness but no rebound tenderness, no abdominal bruit, and no pulsatile abdominal mass.\nRectal examination revealed gross melena.\nLaboratory tests revealed hemoglobin\u200a=\u200a12.5\u200ag\/dL, platelets\u200a=\u200a301,000\/mL, INR (international normalized ratio)\u200a=\u200a1.0, blood urea nitrogen\u200a=\u200a20\u200amg\/dL, and creatinine\u200a=\u200a1.1\u200amg\/dL.\nSerum aspartate aminotransferase\u200a=\u200a21\u200aIU\/L, alanine aminotransferase\u200a=\u200a16\u200aIU\/L, total bilirubin\u200a=\u200a0.6\u200amg\/dL, alkaline phosphatase\u200a=\u200a64\u200aIU\/L, albumin\u200a=\u200a4.4\u200agm\/dL, and lipase\u200a=\u200a32\u200aU\/dL.\nThe hemoglobin declined acutely to 9.3\u200ag\/dL.\nAbdomino-pelvic computerized tomography (CT), with intravenous contrast, revealed a 5-cm wide, irregular, pancreatic\/peripancreatic mass, compressing both the lesser curvature of the stomach and the SV (Fig.1A, B), a normal portal vein, and normal liver parenchyma.\nThe SV compression was pathophysiologically significant as indicated by proximal SV dilatation.\nEGD revealed in the proximal stomach a fine, reticular, pale-white, polygonal, mucosal, network in a snakeskin pattern, and characteristic of portal hypertensive gastropathy that was actively oozing; extensive coffee-ground, blood clots in the stomach; small gastric cardial and fundal varices without stigmata of recent hemorrhage (SRH); and no esophageal varices (Fig.\u200b2).\nThe extrinsic mass produced a large, round bulge extending into the lumen of the proximal gastric body along the lesser curvature (Fig.2).\nMagnetic resonance cholangio-pancreatography (MRCP) revealed a 5-cm wide, enhancing, vascular mass likely arising from the LGA and located between the gastric lesser curvature and distal pancreatic body; compressing the stomach; compressing the middle SV; and resulting in large collateral veins draining the SV into the superior mesenteric vein (Fig.3A, B).\nAbdominal ultrasound with Doppler studies demonstrated large, turbulent arterial flow into this vascular mass, suggesting a large PA (Fig.4).\nVisceral arteriogram showed a 5.3\u200a\u00d7\u200a2.2-cm-wide PA supplied by an LGA branch (Fig.5A), which was embolized and occluded with microcoils (Fig.5B).\nEight weeks later, the patient had a stable hemoglobin level with no further GI bleeding.\nAbdomino-pelvic CT angiography demonstrated the PA had markedly decreased in diameter, contained numerous microcoils, and had no blood flow \u200b(Fig.1C).\n","ner_info":[{"text":"41-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"alcoholism","label":"HISTORY","start":36,"end":46},{"text":"10 years","label":"DURATION","start":51,"end":59},{"text":"sober","label":"HISTORY","start":64,"end":69},{"text":"last 3 years","label":"DURATION","start":78,"end":90},{"text":"recurrent alcoholic pancreatitis","label":"HISTORY","start":92,"end":124},{"text":"no known liver disease","label":"HISTORY","start":130,"end":152},{"text":"presented","label":"CLINICAL_EVENT","start":154,"end":163},{"text":"several 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hemorrhage"," (","SRH","); and no ","esophageal"," ","varices"," (Fig.\u200b2).\nThe extrinsic ","mass"," produced a ","large",", ","round"," ","bulge"," ","extending into the lumen of the proximal gastric body"," along the ","lesser curvature"," (Fig.2).\n","Magnetic resonance cholangio-pancreatography"," (","MRCP",") revealed a ","5-cm"," wide, ","enhancing",", ","vascular"," ","mass"," likely ","arising from the LGA"," and located ","between the gastric lesser curvature and distal pancreatic body","; ","compressing"," the ","stomach","; ","compressing"," the ","middle SV","; and resulting in ","large"," ","collateral veins"," draining the ","SV"," into the ","superior mesenteric vein"," (Fig.3A, B).\n","Abdominal"," ","ultrasound"," with ","Doppler studies"," demonstrated ","large",", ","turbulent"," ","arterial"," ","flow"," into this ","vascular"," ","mass",", suggesting a ","large"," ","PA"," (Fig.4).\n","Visceral"," ","arteriogram"," showed a 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\u200b(Fig.1C).\n"],"ner_labels":[0,5,0,65,0,39,0,32,0,39,0,32,0,39,0,39,0,13,0,22,0,69,0,12,0,69,0,32,0,24,0,24,0,19,0,12,0,69,0,12,0,69,0,12,0,69,0,12,0,22,0,26,0,12,0,69,0,24,0,24,0,42,0,24,0,42,0,69,0,69,0,69,0,12,0,63,0,12,0,69,0,22,0,69,0,12,0,69,0,22,0,12,0,69,0,24,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,12,0,24,0,24,0,22,0,27,0,22,0,12,0,12,0,69,0,69,0,12,0,12,0,42,0,24,0,42,0,24,0,12,0,69,0,42,0,12,0,69,0,24,0,12,0,22,0,22,0,15,0,67,0,12,0,69,0,73,0,26,0,69,0,63,0,73,0,69,0,12,0,12,0,12,0,12,0,69,0,69,0,69,0,12,0,69,0,18,0,22,0,67,0,69,0,12,0,12,0,24,0,24,0,27,0,22,0,12,0,69,0,12,0,12,0,69,0,12,0,69,0,12,0,22,0,69,0,12,0,12,0,12,0,24,0,22,0,22,0,22,0,12,0,69,0,12,0,18,0,22,0,26,0,22,0,24,0,79,0,26,0,12,0,75,0,75,0,22,0,19,0,42,0,24,0,12,0,69,0,12,0,22,0,24,0,26,0,42,0,22,0,22,0]}
-{"full_text":"A 75-year-old man was referred to our hospital for the evaluation of dysphagia for 9 months.\nHe had associated symptoms of nausea and vomiting but denied hematemesis, hematochezia, lethargy, and dyspnea.\nHe was an active smoker and consumed alcohol for 30 years.\nPhysical examination revealed no peripheral lymphadenopathy, thyromegaly, ascites, or mass in the abdomen.\nLaboratory data were normal: HBs-Ag negative, HIV negative, and syphilis negative.\nTest for serum antibody against Helicobacter pylori was negative.\nChest computed tomography (CT) was notable for a huge well-circumscribed and homogeneous cylindrical mesenchymal neoplasm measuring 15.5\u00d75.9\u00d74.0\u200acm in lower and middle esophagus with mild contrast enhancement (Fig.1A).\nCT revealed no abnormalities in the lungs, heart, ribs, or mediastinum.\nEndoscopic examination showed a submucosal lesion in the esophagus starting at 20\u200acm from the incisor teeth extending up to the cardia (Fig.1B).\nEndoscopic ultrasonography (EUS) revealed hypoechoic lesion with a clear boundary located in the 4th layer.\nThe mass appeared as a benign tumor and was preoperatively diagnosed as esophageal leiomyoma based on chest CT, endoscopic examination, and EUS findings.\nEndoscopic mucosal resection or endoscopic submucosal resection was not possible because of large size.\nHence, surgical resection was planned and informed written consent was taken.\nThe patient underwent thoracoscopic-assisted resection of the mass with gastroesophageal anastomosis, thoracic duct ligation, and jejunostomy.\nPostoperative course was uneventful.\nGrossly, a spindle shaped lump measuring 14\u200a\u00d7\u200a3.5\u200a\u00d7\u200a2.5\u200acm, was observed in the resected esophagus, which grew into the esophageal lumen and blocked most of lumen.\nThis lump located in the submucosa was covered with intact mucosa, without erosion, ulcer, and hemorrhage.\nIts cut surface was homogenously white to grayish-white in color.\nHistological examination using hematoxylin and eosin staining revealed that tumor was covered with intact squamous epithelium, arising from the submucosal layer and expanding in to the muscular layer.\nThe tumor was composed of many nodules of varying sizes separated by collagen fibers.\nNumerous cytoplasm-rich cells were observed in the collagenous septations with invasive growth pattern (Fig.2A\u2013C).\nThe nodules were mainly composed of small to mid-sized centrocyte-like or monocyte-like cells arranged in diffuse pattern.\nThese atypical lymphocytes possessed clear boundary, pale cytoplasm, irregular nucleus, and occasional nucleolus (Fig.2D).\nMitosis was rare.\nNo lymphoepithelial lesion was recognized in the lesion.\nOn immunohistochemical staining, epithelium was diffusely positive for cytokeratin (Fig.3A), and the tumor cells were diffusely positive for cluster of differentiation (CD)20, paired box 5 (Fig.3B), and B-cell lymphoma (Bcl)-2 (Fig.3D).\nSmall deposits of tumor cells, which were distributed mainly in the collagen fibers, were positive for multiple myeloma oncogene 1, CD138, and CD43.\nSeveral tumor cells were also positive for CD30.\nSmall lymphocytes were positive for CD3 and CD5.\nFollicular dendritic cells were positive for CD21 and CD23 (Fig.3C).\nAll cells were negative for CyclinD1, CD10, Bcl-6, and B lymphocyte specific activation of OCT binding protein 1.\nThese follicular dendritic cells were arranged in nodules in which the tumor cells were relatively evenly distributed.\nThis pattern was suggestive of follicular colonizations seen in MALT lymphoma.\nIn this case, gene rearragements and clonality analysis of immunoglobulin heavy chain gene, kappa light chain gene, and lambda light chain gene was performed using the IdentiCloneTM IGH\/IGK\/IGL Gene Clonality Assay (InVivoScribe Technologies, CA).\nOn monoclonal gene rearrangement, 1 band appeared within 150 to 175 base pairs (bp) in heavy chain gene, 2 discrete bands within 225 to 250\u200abp in kappa light chain gene, and 1 band within 125 to 150\u200abp in lambda light chain gene (Fig.4).\nIn addition, no Epstein\u2013Barr virus was observed in this lymphoma on in situ hybridization using the EB virus-encoded small RNA (Fig.3E, F).\nBased on the clinical data, pathological, immunohistochemical, and gene rearragements analysis, final diagnosis of primary esophageal MALT lymphoma was made.\nAfter the surgical resection, no additional therapy in the form of chemotherapy or radiotherapy was administered.\nOver the 8 months of follow-up, no evidence of recurrence or metastases was found on CT and the patient has been asymptomatic.\nEthical approval for this study was obtained from Medical Ethics Committee of the Third Affiliated Hospital, the Third Military Medical University.\nWritten informed consent was obtained from the patient for the publication of this case report and the accompanying images.\n","ner_info":[{"text":"75-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"referred","label":"CLINICAL_EVENT","start":22,"end":30},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":38,"end":46},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":69,"end":78},{"text":"9 months","label":"DURATION","start":83,"end":91},{"text":"nausea","label":"SIGN_SYMPTOM","start":123,"end":129},{"text":"vomiting","label":"SIGN_SYMPTOM","start":134,"end":142},{"text":"hematemesis","label":"SIGN_SYMPTOM","start":154,"end":165},{"text":"hematochezia","label":"SIGN_SYMPTOM","start":167,"end":179},{"text":"lethargy","label":"SIGN_SYMPTOM","start":181,"end":189},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":195,"end":202},{"text":"active smoker","label":"HISTORY","start":214,"end":227},{"text":"consumed alcohol for 30 years","label":"HISTORY","start":232,"end":261},{"text":"Physical 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tomography","label":"DIAGNOSTIC_PROCEDURE","start":525,"end":544},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":546,"end":548},{"text":"huge","label":"DETAILED_DESCRIPTION","start":568,"end":572},{"text":"well-circumscribed","label":"DETAILED_DESCRIPTION","start":573,"end":591},{"text":"homogeneous","label":"DETAILED_DESCRIPTION","start":596,"end":607},{"text":"cylindrical","label":"SHAPE","start":608,"end":619},{"text":"mesenchymal","label":"DETAILED_DESCRIPTION","start":620,"end":631},{"text":"neoplasm","label":"SIGN_SYMPTOM","start":632,"end":640},{"text":"15.5\u00d75.9\u00d74.0\u200acm","label":"VOLUME","start":651,"end":666},{"text":"lower and middle esophagus","label":"BIOLOGICAL_STRUCTURE","start":670,"end":696},{"text":"mild contrast enhancement","label":"DETAILED_DESCRIPTION","start":702,"end":727},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":738,"end":740},{"text":"abnormalities","label":"SIGN_SYMPTOM","start":753,"end":766},{"text":"lungs","label":"BIOLOGICAL_STRUCTURE","start":774,"end":779},{"text":"heart","label":"BIOLOGICAL_STRUCTURE","start":781,"end":786},{"text":"ribs","label":"BIOLOGICAL_STRUCTURE","start":788,"end":792},{"text":"mediastinum","label":"BIOLOGICAL_STRUCTURE","start":797,"end":808},{"text":"Endoscopic examination","label":"DIAGNOSTIC_PROCEDURE","start":810,"end":832},{"text":"submucosal","label":"DETAILED_DESCRIPTION","start":842,"end":852},{"text":"lesion","label":"SIGN_SYMPTOM","start":853,"end":859},{"text":"esophagus","label":"BIOLOGICAL_STRUCTURE","start":867,"end":876},{"text":"20\u200acm from the incisor teeth","label":"DISTANCE","start":889,"end":917},{"text":"up to the cardia","label":"BIOLOGICAL_STRUCTURE","start":928,"end":944},{"text":"Endoscopic ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":955,"end":981},{"text":"EUS","label":"DIAGNOSTIC_PROCEDURE","start":983,"end":986},{"text":"hypoechoic","label":"DETAILED_DESCRIPTION","start":997,"end":1007},{"text":"lesion","label":"SIGN_SYMPTOM","start":1008,"end":1014},{"text":"lear boundary","label":"DETAILED_DESCRIPTION","start":1023,"end":1036},{"text":"4th layer","label":"DETAILED_DESCRIPTION","start":1052,"end":1061},{"text":"mass","label":"COREFERENCE","start":1067,"end":1071},{"text":"benign tumor","label":"SIGN_SYMPTOM","start":1086,"end":1098},{"text":"esophageal leiomyoma","label":"DISEASE_DISORDER","start":1135,"end":1155},{"text":"Endoscopic","label":"DETAILED_DESCRIPTION","start":1217,"end":1227},{"text":"mucosal","label":"DETAILED_DESCRIPTION","start":1228,"end":1235},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1236,"end":1245},{"text":"endoscopic","label":"DETAILED_DESCRIPTION","start":1249,"end":1259},{"text":"submucosal","label":"DETAILED_DESCRIPTION","start":1260,"end":1270},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1271,"end":1280},{"text":"surgical","label":"DETAILED_DESCRIPTION","start":1328,"end":1336},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1337,"end":1346},{"text":"thoracoscopic-assisted","label":"DETAILED_DESCRIPTION","start":1421,"end":1443},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1444,"end":1453},{"text":"mass","label":"COREFERENCE","start":1461,"end":1465},{"text":"gastroesophageal","label":"DETAILED_DESCRIPTION","start":1471,"end":1487},{"text":"anastomosis","label":"THERAPEUTIC_PROCEDURE","start":1488,"end":1499},{"text":"thoracic duct","label":"BIOLOGICAL_STRUCTURE","start":1501,"end":1514},{"text":"ligation","label":"THERAPEUTIC_PROCEDURE","start":1515,"end":1523},{"text":"jejunostomy","label":"THERAPEUTIC_PROCEDURE","start":1529,"end":1540},{"text":"Postoperative course","label":"THERAPEUTIC_PROCEDURE","start":1542,"end":1562},{"text":"uneventful","label":"LAB_VALUE","start":1567,"end":1577},{"text":"spindle shaped","label":"SHAPE","start":1590,"end":1604},{"text":"lump","label":"SIGN_SYMPTOM","start":1605,"end":1609},{"text":"14\u200a\u00d7\u200a3.5\u200a\u00d7\u200a2.5\u200acm","label":"VOLUME","start":1620,"end":1637},{"text":"esophagus","label":"BIOLOGICAL_STRUCTURE","start":1668,"end":1677},{"text":"esophageal lumen","label":"BIOLOGICAL_STRUCTURE","start":1699,"end":1715},{"text":"blocked","label":"SIGN_SYMPTOM","start":1720,"end":1727},{"text":"lumen","label":"BIOLOGICAL_STRUCTURE","start":1736,"end":1741},{"text":"lump","label":"COREFERENCE","start":1748,"end":1752},{"text":"submucosa","label":"BIOLOGICAL_STRUCTURE","start":1768,"end":1777},{"text":"covered with intact mucosa","label":"DETAILED_DESCRIPTION","start":1782,"end":1808},{"text":"erosion","label":"SIGN_SYMPTOM","start":1818,"end":1825},{"text":"ulcer","label":"DISEASE_DISORDER","start":1827,"end":1832},{"text":"hemorrhage","label":"DISEASE_DISORDER","start":1838,"end":1848},{"text":"homogenously white","label":"COLOR","start":1870,"end":1888},{"text":"grayish-white","label":"COLOR","start":1892,"end":1905},{"text":"Histological examination","label":"DIAGNOSTIC_PROCEDURE","start":1916,"end":1940},{"text":"hematoxylin","label":"DIAGNOSTIC_PROCEDURE","start":1947,"end":1958},{"text":"eosin staining","label":"DIAGNOSTIC_PROCEDURE","start":1963,"end":1977},{"text":"tumor","label":"COREFERENCE","start":1992,"end":1997},{"text":"covered with intact squamous epithelium","label":"DETAILED_DESCRIPTION","start":2002,"end":2041},{"text":"from the submucosal layer","label":"BIOLOGICAL_STRUCTURE","start":2051,"end":2076},{"text":"muscular layer","label":"BIOLOGICAL_STRUCTURE","start":2101,"end":2115},{"text":"tumor","label":"COREFERENCE","start":2121,"end":2126},{"text":"composed of many nodules of varying sizes separated by collagen fibers","label":"DETAILED_DESCRIPTION","start":2131,"end":2201},{"text":"Numerous cytoplasm-rich cells were observed in the collagenous septations with invasive growth pattern","label":"DETAILED_DESCRIPTION","start":2203,"end":2305},{"text":"nodules were mainly composed of small to mid-sized centrocyte-like or monocyte-like cells arranged in diffuse pattern","label":"DETAILED_DESCRIPTION","start":2322,"end":2439},{"text":"atypical lymphocytes","label":"DETAILED_DESCRIPTION","start":2447,"end":2467},{"text":"clear boundary","label":"DETAILED_DESCRIPTION","start":2478,"end":2492},{"text":"pale cytoplasm","label":"DETAILED_DESCRIPTION","start":2494,"end":2508},{"text":"irregular nucleus","label":"DETAILED_DESCRIPTION","start":2510,"end":2527},{"text":"occasional nucleolus","label":"DETAILED_DESCRIPTION","start":2533,"end":2553},{"text":"Mitosis","label":"DIAGNOSTIC_PROCEDURE","start":2564,"end":2571},{"text":"rare","label":"LAB_VALUE","start":2576,"end":2580},{"text":"lymphoepithelial","label":"DETAILED_DESCRIPTION","start":2585,"end":2601},{"text":"lesion","label":"SIGN_SYMPTOM","start":2602,"end":2608},{"text":"lesion","label":"COREFERENCE","start":2631,"end":2637},{"text":"immunohistochemical staining","label":"DIAGNOSTIC_PROCEDURE","start":2642,"end":2670},{"text":"epithelium","label":"BIOLOGICAL_STRUCTURE","start":2672,"end":2682},{"text":"diffusely positive","label":"LAB_VALUE","start":2687,"end":2705},{"text":"cytokeratin","label":"DIAGNOSTIC_PROCEDURE","start":2710,"end":2721},{"text":"tumor cells","label":"COREFERENCE","start":2740,"end":2751},{"text":"diffusely positive","label":"LAB_VALUE","start":2757,"end":2775},{"text":"cluster of differentiation (CD)20","label":"DIAGNOSTIC_PROCEDURE","start":2780,"end":2813},{"text":"paired box 5","label":"DIAGNOSTIC_PROCEDURE","start":2815,"end":2827},{"text":"B-cell lymphoma (Bcl)-2","label":"DIAGNOSTIC_PROCEDURE","start":2842,"end":2865},{"text":"Small deposits of tumor cells","label":"BIOLOGICAL_STRUCTURE","start":2876,"end":2905},{"text":"mainly in the collagen fibers","label":"DETAILED_DESCRIPTION","start":2930,"end":2959},{"text":"positive","label":"LAB_VALUE","start":2966,"end":2974},{"text":"multiple myeloma oncogene 1","label":"DIAGNOSTIC_PROCEDURE","start":2979,"end":3006},{"text":"CD138","label":"DIAGNOSTIC_PROCEDURE","start":3008,"end":3013},{"text":"CD43","label":"DIAGNOSTIC_PROCEDURE","start":3019,"end":3023},{"text":"Several tumor cells","label":"BIOLOGICAL_STRUCTURE","start":3025,"end":3044},{"text":"positive","label":"LAB_VALUE","start":3055,"end":3063},{"text":"CD30","label":"DIAGNOSTIC_PROCEDURE","start":3068,"end":3072},{"text":"Small lymphocytes","label":"BIOLOGICAL_STRUCTURE","start":3074,"end":3091},{"text":"positive","label":"LAB_VALUE","start":3097,"end":3105},{"text":"CD3","label":"DIAGNOSTIC_PROCEDURE","start":3110,"end":3113},{"text":"CD5","label":"DIAGNOSTIC_PROCEDURE","start":3118,"end":3121},{"text":"Follicular dendritic cells","label":"BIOLOGICAL_STRUCTURE","start":3123,"end":3149},{"text":"positive","label":"LAB_VALUE","start":3155,"end":3163},{"text":"CD21","label":"DIAGNOSTIC_PROCEDURE","start":3168,"end":3172},{"text":"CD23","label":"DIAGNOSTIC_PROCEDURE","start":3177,"end":3181},{"text":"All cells","label":"BIOLOGICAL_STRUCTURE","start":3192,"end":3201},{"text":"negative","label":"LAB_VALUE","start":3207,"end":3215},{"text":"CyclinD1","label":"DIAGNOSTIC_PROCEDURE","start":3220,"end":3228},{"text":"CD10","label":"DIAGNOSTIC_PROCEDURE","start":3230,"end":3234},{"text":"Bcl-6","label":"DIAGNOSTIC_PROCEDURE","start":3236,"end":3241},{"text":"B lymphocyte specific activation of OCT binding protein 1","label":"DIAGNOSTIC_PROCEDURE","start":3247,"end":3304},{"text":"MALT lymphoma","label":"DISEASE_DISORDER","start":3489,"end":3502},{"text":"gene rearragements and clonality analysis","label":"DIAGNOSTIC_PROCEDURE","start":3518,"end":3559},{"text":"immunoglobulin heavy chain gene","label":"DIAGNOSTIC_PROCEDURE","start":3563,"end":3594},{"text":"kappa light chain gene","label":"DIAGNOSTIC_PROCEDURE","start":3596,"end":3618},{"text":"lambda light chain gene","label":"DIAGNOSTIC_PROCEDURE","start":3624,"end":3647},{"text":"IdentiCloneTM IGH\/IGK\/IGL Gene Clonality Assay","label":"DETAILED_DESCRIPTION","start":3672,"end":3718},{"text":"InVivoScribe Technologies, CA","label":"DETAILED_DESCRIPTION","start":3720,"end":3749},{"text":"1 band appeared within 150 to 175 base pairs","label":"LAB_VALUE","start":3786,"end":3830},{"text":"heavy chain gene","label":"COREFERENCE","start":3839,"end":3855},{"text":"2 discrete bands within 225 to 250\u200abp","label":"LAB_VALUE","start":3857,"end":3894},{"text":"kappa light chain gene","label":"COREFERENCE","start":3898,"end":3920},{"text":"1 band within 125 to 150\u200abp","label":"LAB_VALUE","start":3926,"end":3953},{"text":"lambda light chain gene","label":"COREFERENCE","start":3957,"end":3980},{"text":"Epstein\u2013Barr virus","label":"DISEASE_DISORDER","start":4006,"end":4024},{"text":"in situ hybridization","label":"DIAGNOSTIC_PROCEDURE","start":4058,"end":4079},{"text":"EB virus-encoded small RNA","label":"DETAILED_DESCRIPTION","start":4090,"end":4116},{"text":"primary","label":"DETAILED_DESCRIPTION","start":4245,"end":4252},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":4253,"end":4263},{"text":"MALT lymphoma","label":"DISEASE_DISORDER","start":4264,"end":4277},{"text":"surgical","label":"DETAILED_DESCRIPTION","start":4298,"end":4306},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":4307,"end":4316},{"text":"therapy","label":"THERAPEUTIC_PROCEDURE","start":4332,"end":4339},{"text":"chemotherapy","label":"MEDICATION","start":4355,"end":4367},{"text":"radiotherapy","label":"THERAPEUTIC_PROCEDURE","start":4371,"end":4383},{"text":"8 months","label":"DURATION","start":4411,"end":4419},{"text":"follow-up","label":"CLINICAL_EVENT","start":4423,"end":4432},{"text":"recurrence","label":"SIGN_SYMPTOM","start":4449,"end":4459},{"text":"metastases","label":"SIGN_SYMPTOM","start":4463,"end":4473},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":4487,"end":4489},{"text":"asymptomatic","label":"SIGN_SYMPTOM","start":4515,"end":4527}],"tokens":["A ","75-year-old"," ","man"," was ","referred"," to our ","hospital"," for the evaluation of ","dysphagia"," for ","9 months",".\nHe had associated symptoms of ","nausea"," and ","vomiting"," but denied ","hematemesis",", ","hematochezia",", ","lethargy",", and ","dyspnea",".\nHe was an ","active smoker"," and ","consumed alcohol for 30 years",".\n","Physical examination"," revealed no ","peripheral"," ","lymphadenopathy",", ","thyromegaly",", ","ascites",", or ","mass"," in the ","abdomen",".\n","Laboratory data"," were ","normal",": ","HBs-Ag"," ","negative",", ","HIV"," ","negative",", and ","syphilis"," ","negative",".\nTest for ","serum antibody against Helicobacter pylori"," was ","negative",".\n","Chest"," ","computed tomography"," (","CT",") was notable for a ","huge"," ","well-circumscribed"," and ","homogeneous"," ","cylindrical"," ","mesenchymal"," ","neoplasm"," measuring ","15.5\u00d75.9\u00d74.0\u200acm"," in ","lower and middle esophagus"," with ","mild contrast enhancement"," (Fig.1A).\n","CT"," revealed no ","abnormalities"," in the ","lungs",", ","heart",", ","ribs",", or ","mediastinum",".\n","Endoscopic examination"," showed a ","submucosal"," ","lesion"," in the ","esophagus"," starting at ","20\u200acm from the incisor teeth"," extending ","up to the cardia"," (Fig.1B).\n","Endoscopic ultrasonography"," (","EUS",") revealed ","hypoechoic"," ","lesion"," with a c","lear boundary"," located in the ","4th layer",".\nThe ","mass"," appeared as a ","benign tumor"," and was preoperatively diagnosed as ","esophageal leiomyoma"," based on chest CT, endoscopic examination, and EUS findings.\n","Endoscopic"," ","mucosal"," ","resection"," or ","endoscopic"," ","submucosal"," ","resection"," was not possible because of large size.\nHence, ","surgical"," ","resection"," was planned and informed written consent was taken.\nThe patient underwent ","thoracoscopic-assisted"," ","resection"," of the ","mass"," with ","gastroesophageal"," ","anastomosis",", ","thoracic duct"," ","ligation",", and ","jejunostomy",".\n","Postoperative course"," was ","uneventful",".\nGrossly, a ","spindle shaped"," ","lump"," measuring ","14\u200a\u00d7\u200a3.5\u200a\u00d7\u200a2.5\u200acm",", was observed in the resected ","esophagus",", which grew into the ","esophageal lumen"," and ","blocked"," most of ","lumen",".\nThis ","lump"," located in the ","submucosa"," was ","covered with intact mucosa",", without ","erosion",", ","ulcer",", and ","hemorrhage",".\nIts cut surface was ","homogenously white"," to ","grayish-white"," in color.\n","Histological examination"," using ","hematoxylin"," and ","eosin staining"," revealed that ","tumor"," was ","covered with intact squamous epithelium",", arising ","from the submucosal layer"," and expanding in to the ","muscular layer",".\nThe ","tumor"," was ","composed of many nodules of varying sizes separated by collagen fibers",".\n","Numerous cytoplasm-rich cells were observed in the collagenous septations with invasive growth pattern"," (Fig.2A\u2013C).\nThe ","nodules were mainly composed of small to mid-sized centrocyte-like or monocyte-like cells arranged in diffuse pattern",".\nThese ","atypical lymphocytes"," possessed ","clear boundary",", ","pale cytoplasm",", ","irregular nucleus",", and ","occasional nucleolus"," (Fig.2D).\n","Mitosis"," was ","rare",".\nNo ","lymphoepithelial"," ","lesion"," was recognized in the ","lesion",".\nOn ","immunohistochemical staining",", ","epithelium"," was ","diffusely positive"," for ","cytokeratin"," (Fig.3A), and the ","tumor cells"," were ","diffusely positive"," for ","cluster of differentiation (CD)20",", ","paired box 5"," (Fig.3B), and ","B-cell lymphoma (Bcl)-2"," (Fig.3D).\n","Small deposits of tumor cells",", which were distributed ","mainly in the collagen fibers",", were ","positive"," for ","multiple myeloma oncogene 1",", ","CD138",", and ","CD43",".\n","Several tumor cells"," were also ","positive"," for ","CD30",".\n","Small lymphocytes"," were ","positive"," for ","CD3"," and ","CD5",".\n","Follicular dendritic cells"," were ","positive"," for ","CD21"," and ","CD23"," (Fig.3C).\n","All cells"," were ","negative"," for ","CyclinD1",", ","CD10",", ","Bcl-6",", and ","B lymphocyte specific activation of OCT binding protein 1",".\nThese follicular dendritic cells were arranged in nodules in which the tumor cells were relatively evenly distributed.\nThis pattern was suggestive of follicular colonizations seen in ","MALT lymphoma",".\nIn this case, ","gene rearragements and clonality analysis"," of ","immunoglobulin heavy chain gene",", ","kappa light chain gene",", and ","lambda light chain gene"," was performed using the ","IdentiCloneTM IGH\/IGK\/IGL Gene Clonality Assay"," (","InVivoScribe Technologies, CA",").\nOn monoclonal gene rearrangement, ","1 band appeared within 150 to 175 base pairs"," (bp) in ","heavy chain gene",", ","2 discrete bands within 225 to 250\u200abp"," in ","kappa light chain gene",", and ","1 band within 125 to 150\u200abp"," in ","lambda light chain gene"," (Fig.4).\nIn addition, no ","Epstein\u2013Barr virus"," was observed in this lymphoma on ","in situ hybridization"," using the ","EB virus-encoded small RNA"," (Fig.3E, F).\nBased on the clinical data, pathological, immunohistochemical, and gene rearragements analysis, final diagnosis of ","primary"," ","esophageal"," ","MALT lymphoma"," was made.\nAfter the ","surgical"," ","resection",", no additional ","therapy"," in the form of ","chemotherapy"," or ","radiotherapy"," was administered.\nOver the ","8 months"," of ","follow-up",", no evidence of ","recurrence"," or ","metastases"," was found on ","CT"," and the patient has been ","asymptomatic",".\nEthical approval for this study was obtained from Medical Ethics Committee of the Third Affiliated Hospital, the Third Military Medical University.\nWritten informed consent was obtained from the patient for the publication of this case report and the accompanying images.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,69,0,32,0,69,0,69,0,69,0,69,0,69,0,69,0,39,0,39,0,24,0,22,0,69,0,69,0,69,0,69,0,12,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,24,0,24,0,22,0,22,0,22,0,67,0,22,0,69,0,79,0,12,0,22,0,24,0,69,0,12,0,12,0,12,0,12,0,24,0,22,0,69,0,12,0,27,0,12,0,24,0,24,0,22,0,69,0,22,0,22,0,18,0,69,0,26,0,22,0,22,0,75,0,22,0,22,0,75,0,22,0,75,0,22,0,75,0,18,0,22,0,75,0,12,0,75,0,75,0,75,0,42,0,67,0,69,0,79,0,12,0,12,0,69,0,12,0,18,0,12,0,22,0,69,0,26,0,26,0,15,0,15,0,24,0,24,0,24,0,18,0,22,0,12,0,12,0,18,0,22,0,22,0,22,0,22,0,22,0,22,0,22,0,22,0,24,0,42,0,22,0,69,0,18,0,24,0,12,0,42,0,24,0,18,0,42,0,24,0,24,0,24,0,12,0,22,0,42,0,24,0,24,0,24,0,12,0,42,0,24,0,12,0,42,0,24,0,24,0,12,0,42,0,24,0,24,0,12,0,42,0,24,0,24,0,24,0,24,0,26,0,24,0,24,0,24,0,24,0,22,0,22,0,42,0,18,0,42,0,18,0,42,0,18,0,26,0,24,0,22,0,22,0,12,0,26,0,22,0,75,0,75,0,46,0,75,0,32,0,13,0,69,0,69,0,24,0,69,0]}
-{"full_text":"A 47-year-old female patient presented progressively worsening pain in the chest wall, back, and bilateral lower extremities as well as muscle weakness.\nShe did not have a family history of bone disease or fractures.\nPhysical examination was unremarkable excluding bone and muscular abnormalities.\nBone scintigraphy using technetium-99m methylenediphosphate showed increased uptake in the shoulder, multiple ribs, thoracic and lumbar spines, bilateral sacroiliac joints, left ilium, and left foot (Fig.1).\nPlain radiographs revealed osteoporosis change of thoracic and lumbar spine as well as compression change of several spines, consistent with findings of magnetic resonance imaging and computed tomography (CT) (Fig.1).\nDecreased bone mass was presented in the lumbar spine (T-score: \u22123.4), femoral neck (T-score: \u22123.1), and hip (T-score: \u22123.5).\nMain laboratory data are shown in Table \u200b1.\nShe demonstrated hypophosphatemia, hypokalemia, hypouricemia, elevated level of ALP, C-telopeptides and chloride, and decreased carbon dioxide combining power.\nThe urinalysis revealed a high pH value, increased level of potassium, and decreased level of specific gravity, chlorine, and phosphate.\nPersistent glycosuria and proteinuria were repeatedly found, despite normal HbA1c and plasma glucose level.\nOther laboratory test results including thyroid function test, serum parathyroid hormone, 25-hydroxyvitamin D, and protein electrophoresis were within normal range.\nIn addition, all of serum tumor markers were negative.\nDue to limited technique, we cannot determine the level of serum fibroblast growth factor 23.\nWith the clinical diagnosis of HO, fluorodeoxyglucose positron emission tomography\/computed tomography (18F-FDG PET\/CT) and technetium-99m octreotide (99mTc-OCT) scintigraphy were performed to confirm whether the occult causative tumor exist.\nHowever, the results of these 2 tests were negative except that mild uptake in the seventh rib was found on PET\/CT, which identified no evidence of a neoplastic lesion potentially responsible for HO (Fig.2).\nThe immunological examination showed elevated level of serum IgG, IgM, and IgA, as well as positive antinuclear antibody, anti-SSA antibody, and rheumatic factor.\nSubsequently, Schirmer test was abnormal and lip biopsy supported the diagnosis of SS (Fig.3).\nEventually, this patient was diagnosed with HO secondary to SS, and she was then treated with alkalinization (citrate 4\u200ag\/day and potassium citrate 3\u200ag\/day for 2 weeks), steroids (prednisone 20\u200amg\/day for 1 month, 10\u200amg\/day for 4 months), neutral phosphate (1.0\u200ag\/day for 5 months), calcium supplements (600\u200amg\/day for 5 months), and together with activated vitamin D (0.5\u200ag\/day for 5 months).\nSo far, she recovered uneventfully with relieved pain and increased serum phosphorus level.\nThis case report was approved by the ethics committee of West China Hospital of Sichuan University, Chengdu, China, and the written informed consent was obtained.\n","ner_info":[{"text":"47-year-old","label":"AGE","start":2,"end":13},{"text":"female","label":"SEX","start":14,"end":20},{"text":"presented","label":"CLINICAL_EVENT","start":29,"end":38},{"text":"progressively worsening","label":"DETAILED_DESCRIPTION","start":39,"end":62},{"text":"pain","label":"SIGN_SYMPTOM","start":63,"end":67},{"text":"chest wall","label":"BIOLOGICAL_STRUCTURE","start":75,"end":85},{"text":"back","label":"BIOLOGICAL_STRUCTURE","start":87,"end":91},{"text":"bilateral lower extremities","label":"BIOLOGICAL_STRUCTURE","start":97,"end":124},{"text":"muscle weakness","label":"SIGN_SYMPTOM","start":136,"end":151},{"text":"did not have a family history of bone disease or fractures","label":"FAMILY_HISTORY","start":157,"end":215},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":217,"end":237},{"text":"unremarkable","label":"LAB_VALUE","start":242,"end":254},{"text":"excluding bone and muscular abnormalities","label":"DETAILED_DESCRIPTION","start":255,"end":296},{"text":"Bone","label":"BIOLOGICAL_STRUCTURE","start":298,"end":302},{"text":"scintigraphy","label":"DIAGNOSTIC_PROCEDURE","start":303,"end":315},{"text":"using technetium-99m methylenediphosphate","label":"DETAILED_DESCRIPTION","start":316,"end":357},{"text":"uptake","label":"SIGN_SYMPTOM","start":375,"end":381},{"text":"shoulder","label":"BIOLOGICAL_STRUCTURE","start":389,"end":397},{"text":"multiple ribs","label":"BIOLOGICAL_STRUCTURE","start":399,"end":412},{"text":"thoracic and lumbar spines","label":"BIOLOGICAL_STRUCTURE","start":414,"end":440},{"text":"bilateral sacroiliac joints","label":"BIOLOGICAL_STRUCTURE","start":442,"end":469},{"text":"left ilium","label":"BIOLOGICAL_STRUCTURE","start":471,"end":481},{"text":"left 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ribs",", ","thoracic and lumbar spines",", ","bilateral sacroiliac joints",", ","left ilium",", and ","left foot"," (Fig.1).\n","Plain"," ","radiographs"," revealed ","osteoporosis"," change of ","thoracic and lumbar spine"," as well as ","compression"," change of ","several spines",", consistent with findings of ","magnetic resonance imaging"," and ","computed tomography"," (","CT",") (Fig.1).\n","Decreased"," ","bone mass"," was presented in the ","lumbar spine"," (","T-score: \u22123.4","), ","femoral neck"," (","T-score: \u22123.1","), and ","hip"," (","T-score: \u22123.5",").\nMain laboratory data are shown in Table \u200b1.\nShe demonstrated ","hypophosphatemia",", ","hypokalemia",", ","hypouricemia",", ","elevated"," level of ","ALP",", ","C-telopeptides"," and ","chloride",", and ","decreased"," ","carbon dioxide combining power",".\nThe ","urinalysis"," revealed a ","high"," ","pH"," value, ","increased"," level of ","potassium",", and ","decreased"," level of ","specific gravity",", ","chlorine",", and ","phosphate",".\n","Persistent"," ","glycosuria"," and ","proteinuria"," were repeatedly found, despite ","normal"," ","HbA1c"," and ","plasma glucose"," level.\nOther ","laboratory test"," results including ","thyroid function"," test, ","serum parathyroid hormone",", ","25-hydroxyvitamin D",", and ","protein electrophoresis"," were ","within normal range",".\nIn addition, all of ","serum tumor markers"," were ","negative",".\nDue to limited technique, we cannot determine the level of ","serum fibroblast growth factor 23",".\nWith the clinical diagnosis of ","HO",", ","fluorodeoxyglucose positron emission tomography","\/","computed tomography"," (","18F-FDG PET","\/","CT",") and ","technetium-99m octreotide"," (","99mTc-OCT",") ","scintigraphy"," were performed to confirm whether the ","occult"," ","causative"," ","tumor"," exist.\nHowever, the results of ","these 2 tests"," were ","negative"," except that ","mild"," ","uptake"," in the ","seventh rib"," was found on ","PET","\/","CT",", which identified no evidence of a ","neoplastic"," ","lesion"," potentially responsible for HO (Fig.2).\nThe ","immunological examination"," showed ","elevated"," level of ","serum IgG",", ","IgM",", and ","IgA",", as well as ","positive"," ","antinuclear antibody",", ","anti-SSA antibody",", and ","rheumatic factor",".\nSubsequently, ","Schirmer test"," was ","abnormal"," and ","lip"," ","biopsy"," supported the diagnosis of ","SS"," (Fig.3).\nEventually, this patient was diagnosed with ","HO"," secondary to ","SS",", and she was then treated with ","alkalinization"," (","citrate"," ","4\u200ag\/day"," and ","potassium citrate"," ","3\u200ag\/day"," for ","2 weeks","), ","steroids"," (","prednisone"," ","20\u200amg\/day"," for ","1 month",", ","10\u200amg\/day"," for ","4 months","), ","neutral phosphate"," (","1.0\u200ag\/day"," for ","5 months","), ","calcium supplements"," (","600\u200amg\/day"," for ","5 months","), and together with ","activated vitamin D"," (","0.5\u200ag\/day"," for ","5 months",").\nSo far, she ","recovered"," uneventfully with relieved ","pain"," and ","increased"," ","serum phosphorus"," level.\nThis case report was approved by the ethics committee of West China Hospital of Sichuan University, Chengdu, China, and the written informed consent was obtained.\n"],"ner_labels":[0,5,0,65,0,13,0,22,0,69,0,12,0,12,0,12,0,69,0,34,0,24,0,42,0,22,0,12,0,24,0,22,0,69,0,12,0,12,0,12,0,12,0,12,0,12,0,22,0,24,0,26,0,12,0,69,0,12,0,24,0,24,0,24,0,42,0,24,0,12,0,42,0,12,0,42,0,12,0,42,0,69,0,69,0,69,0,42,0,24,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,24,0,22,0,69,0,69,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,42,0,24,0,26,0,24,0,24,0,24,0,24,0,22,0,22,0,24,0,22,0,22,0,69,0,18,0,42,0,63,0,69,0,12,0,24,0,24,0,22,0,69,0,24,0,42,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,12,0,24,0,26,0,26,0,26,0,75,0,46,0,29,0,46,0,29,0,32,0,46,0,46,0,29,0,32,0,29,0,32,0,46,0,29,0,32,0,46,0,29,0,32,0,46,0,29,0,32,0,69,0,69,0,42,0,24,0]}
-{"full_text":"A 69-year-old man became aware of the onset of exertional dyspnea in July 2010.\nHe had a history of smoking for more than 40 years, 20 cigarettes per day.\nHis parents and 1 brother had lung cancer.\nHis past medical history was unremarkable.\nHe had no occupational exposure.\nDue to the exertional dyspnea, he was admitted to the People's Hospital of Shunde District for echocardiography and computed tomography pulmonary angiography (CTPA).\nEchocardiography indicated that he had severe PAH, because his pulmonary arterial pressure (PAP) was 104\u200ammHg, and his right heart was enlarged (the right ventricle diameter: 57\u200amm).\nCTPA showed that he had not only PAH, but also a thrombus in the upper lobe artery of the right lung.\nHowever, the region in the lung affected by this PE was considered too small to induce such a severe PAH.\nIn addition, he did not have connective tissue disease, drug use, history of chemotherapy, or HIV test (+), so he was diagnosed as IPAH combined with PE.\nHe was treated with warfarin (2.5\u200amg per day with a target of the international normalized ratio [INR] between 1.5 and 2.5) and slidenafil targeted PAH therapy (20\u200amg twice per day).\nThe patient's dyspnea was relieved slightly after the use of these medications for 1 month and the retested PAP by echocardiography was decreased to 72\u200ammHg, but all the other symptoms and signs failed to further improve after taking these medications for 6 months.\nIn March 2011, he went to the Kyorin University affiliated hospital in Japan for further treatment.\nRight heart catheterization revealed PAP 72\/34\/47\u200ammHg, pulmonary capillary wedge pressure (PCWP) 17\/5\/10\u200ammHg, cardiac output 4.3\u200aL\/min, cardiac ejection index 2.36\u200aL\/min\/m2, and pulmonary vascular resistance 7.3 Wood units.\nHe was retested for CTPA that showed that the thrombus in the upper lobe artery of the right lung disappeared.\nHe was still diagnosed as having IPAH, so treated with sildenafil (20\u200amg 3 times a day) and sorafenib (400\u200amg once a day) targeted PAH therapy and oral warfarin anticoagulation therapy (2.5\u20133.75\u200amg per day, but the daily dose was adjusted by INR that was between 2 and 3).\nDisappointingly, his dyspnea was not relieved and the PAP tested by the echocardiography was around 95\u200ammHg.\nIn September 2011, he visited the Shanghai Pulmonary hospital in China because of no relief of dyspnea.\nArterial blood gas analysis showed that PaO2 was 63\u200ammHg with oxygen saturation 93%; lung function test revealed a mild obstructive dysfunction of the pulmonary ventilation (FEV1\/FVC 62.06%, FEV1% Prediction 80.9%) and a severe reduction in the diffusing capacity of the lungs for carbon monoxide (DLCO 42%); 6-minute walk test was 385\u200am.\nChest high-resolution computed tomography (HRCT) (Fig.1A and B) showed smooth thickening of interlobular septa, diffuse centrilobular nodules, and the enlargement of mediastinal lymph nodes.\nThe right heart catheterization revealed that PAP was 83\/34\/53\u200ammHg and PCWP was 14\/6\/11\u200ammHg.\nAcute vasodilator testing was negative.\nCoronary angiography and CTPA were both normal; pulmonary ventilation\/perfusion (V\u2019\/Q\u2019) lung scan showed a matched ventilation and perfusion defects.\nBronchoalveolar lavage showed an elevated percentage (65%) of hemosiderin-laden macrophages with the Golde score 80 (the normal range: 0\u201320).\nHe was still diagnosed as having IPAH, but he was suspected as actually having PVOD.\nHe was continuously treated with the targeted PAH therapy, and he was asked to continue his anticoagulation treatment, but he stopped warfarin anticoagulation treatment by himself sometime in 2014 (he failed to recall the exact date.) because he felt that it was too cumbersome to frequently test the INR for blood coagulation monitoring.\nFurthermore, after he discontinued his warfarin therapy, he also failed to monitor D-Dimer to prevent PE recurrence.\nHis dyspnea was relatively stable, but he developed many, but not fatal, episodes of pulmonary edema during the therapy.\nIn January 2015, he was rushed to hospital because his dyspnea was suddenly exacerbated.\nCTPA showed a thrombus in the right main pulmonary artery (Fig.1C).\nRivaroxaban was administered for anticoagulation treatment, but this medication did not relieve his dyspnea, therefore, he was too ill to walk.\nInstead, he was bound to his wheelchair for half a year.\nThe severe PAH (suspected as PVOD) combined with a life-threatening PE mandates a lung transplantation for his survival.\nSix months later, he was undergone a bilateral sequential allogenic lung transplantation assisted by veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) after he signed the written consent on July 29, 2015.\nHistology of the explanted lung specimen showed pulmonary vein occlusion (Fig.1D\u2013F) and the pulmonary embolism in the right pulmonary artery.\nUntil then, he was confirmed as having PVOD combined with PE, instead of IPAH.\nHe has been living well without dyspnea for more than 1 year after the lung transplantation and the echocardiography showed the normalizations of PAP and the once enlarged right ventricle of his heart.\nThis study was approved by the Ethics Committee of The People's Hospital of Zhongshan City.\nThe written informed consent was obtained from the patient.\n","ner_info":[{"text":"69-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"exertional","label":"DETAILED_DESCRIPTION","start":47,"end":57},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":58,"end":65},{"text":"July 2010","label":"DATE","start":69,"end":78},{"text":"smoking for more than 40 years, 20 cigarettes per day","label":"HISTORY","start":100,"end":153},{"text":"parents and 1 brother had lung cancer","label":"FAMILY_HISTORY","start":159,"end":196},{"text":"past medical history was unremarkable","label":"HISTORY","start":202,"end":239},{"text":"no occupational exposure","label":"HISTORY","start":248,"end":272},{"text":"exertional","label":"DETAILED_DESCRIPTION","start":285,"end":295},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":296,"end":303},{"text":"admitted","label":"CLINICAL_EVENT","start":312,"end":320},{"text":"People's Hospital of Shunde District","label":"NONBIOLOGICAL_LOCATION","start":328,"end":364},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":369,"end":385},{"text":"computed tomography pulmonary angiography","label":"DIAGNOSTIC_PROCEDURE","start":390,"end":431},{"text":"CTPA","label":"DIAGNOSTIC_PROCEDURE","start":433,"end":437},{"text":"Echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":440,"end":456},{"text":"severe","label":"SEVERITY","start":479,"end":485},{"text":"PAH","label":"DISEASE_DISORDER","start":486,"end":489},{"text":"pulmonary arterial pressure","label":"DIAGNOSTIC_PROCEDURE","start":503,"end":530},{"text":"PAP","label":"DIAGNOSTIC_PROCEDURE","start":532,"end":535},{"text":"104\u200ammHg","label":"LAB_VALUE","start":541,"end":549},{"text":"right heart","label":"BIOLOGICAL_STRUCTURE","start":559,"end":570},{"text":"enlarged","label":"SIGN_SYMPTOM","start":575,"end":583},{"text":"right ventricle diameter","label":"DIAGNOSTIC_PROCEDURE","start":589,"end":613},{"text":"57\u200amm","label":"LAB_VALUE","start":615,"end":620},{"text":"CTPA","label":"DIAGNOSTIC_PROCEDURE","start":623,"end":627},{"text":"PAH","label":"DISEASE_DISORDER","start":656,"end":659},{"text":"thrombus","label":"DISEASE_DISORDER","start":672,"end":680},{"text":"upper lobe artery of the right lung","label":"BIOLOGICAL_STRUCTURE","start":688,"end":723},{"text":"region in the lung","label":"BIOLOGICAL_STRUCTURE","start":738,"end":756},{"text":"PE","label":"COREFERENCE","start":774,"end":776},{"text":"did not have connective tissue disease, drug use, history of chemotherapy, or HIV test (+)","label":"HISTORY","start":847,"end":937},{"text":"IPAH","label":"DISEASE_DISORDER","start":962,"end":966},{"text":"PE","label":"DISEASE_DISORDER","start":981,"end":983},{"text":"warfarin","label":"MEDICATION","start":1005,"end":1013},{"text":"2.5\u200amg per day","label":"DOSAGE","start":1015,"end":1029},{"text":"international normalized ratio","label":"DIAGNOSTIC_PROCEDURE","start":1051,"end":1081},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":1083,"end":1086},{"text":"1.5 and 2.5","label":"LAB_VALUE","start":1096,"end":1107},{"text":"slidenafil","label":"MEDICATION","start":1113,"end":1123},{"text":"20\u200amg twice per day","label":"DOSAGE","start":1146,"end":1165},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":1182,"end":1189},{"text":"medications","label":"MEDICATION","start":1235,"end":1246},{"text":"1 month","label":"DURATION","start":1251,"end":1258},{"text":"PAP","label":"DIAGNOSTIC_PROCEDURE","start":1276,"end":1279},{"text":"echocardiography","label":"DETAILED_DESCRIPTION","start":1283,"end":1299},{"text":"decreased","label":"LAB_VALUE","start":1304,"end":1313},{"text":"72\u200ammHg","label":"LAB_VALUE","start":1317,"end":1324},{"text":"other symptoms and signs","label":"SIGN_SYMPTOM","start":1338,"end":1362},{"text":"failed to further improve","label":"LAB_VALUE","start":1363,"end":1388},{"text":"medications","label":"MEDICATION","start":1408,"end":1419},{"text":"6 months","label":"DURATION","start":1424,"end":1432},{"text":"March 2011","label":"DATE","start":1437,"end":1447},{"text":"went","label":"CLINICAL_EVENT","start":1452,"end":1456},{"text":"Kyorin University affiliated hospital","label":"NONBIOLOGICAL_LOCATION","start":1464,"end":1501},{"text":"Japan","label":"NONBIOLOGICAL_LOCATION","start":1505,"end":1510},{"text":"Right heart","label":"BIOLOGICAL_STRUCTURE","start":1534,"end":1545},{"text":"catheterization","label":"DIAGNOSTIC_PROCEDURE","start":1546,"end":1561},{"text":"PAP","label":"DIAGNOSTIC_PROCEDURE","start":1571,"end":1574},{"text":"72\/34\/47\u200ammHg","label":"LAB_VALUE","start":1575,"end":1588},{"text":"pulmonary capillary wedge pressure","label":"DIAGNOSTIC_PROCEDURE","start":1590,"end":1624},{"text":"PCWP","label":"DIAGNOSTIC_PROCEDURE","start":1626,"end":1630},{"text":"17\/5\/10\u200ammHg","label":"LAB_VALUE","start":1632,"end":1644},{"text":"cardiac output","label":"DIAGNOSTIC_PROCEDURE","start":1646,"end":1660},{"text":"4.3\u200aL\/min","label":"LAB_VALUE","start":1661,"end":1670},{"text":"cardiac ejection index","label":"DIAGNOSTIC_PROCEDURE","start":1672,"end":1694},{"text":"2.36\u200aL\/min\/m2","label":"LAB_VALUE","start":1695,"end":1708},{"text":"pulmonary vascular resistance","label":"DIAGNOSTIC_PROCEDURE","start":1714,"end":1743},{"text":"7.3 Wood units","label":"LAB_VALUE","start":1744,"end":1758},{"text":"CTPA","label":"DIAGNOSTIC_PROCEDURE","start":1780,"end":1784},{"text":"thrombus","label":"DISEASE_DISORDER","start":1806,"end":1814},{"text":"upper lobe artery of the right lung","label":"BIOLOGICAL_STRUCTURE","start":1822,"end":1857},{"text":"IPAH","label":"DISEASE_DISORDER","start":1904,"end":1908},{"text":"sildenafil","label":"MEDICATION","start":1926,"end":1936},{"text":"20\u200amg 3 times a day","label":"DOSAGE","start":1938,"end":1957},{"text":"sorafenib","label":"MEDICATION","start":1963,"end":1972},{"text":"400\u200amg once a day","label":"DOSAGE","start":1974,"end":1991},{"text":"PAH therapy","label":"THERAPEUTIC_PROCEDURE","start":2002,"end":2013},{"text":"oral","label":"ADMINISTRATION","start":2018,"end":2022},{"text":"warfarin","label":"MEDICATION","start":2023,"end":2031},{"text":"anticoagulation therapy","label":"THERAPEUTIC_PROCEDURE","start":2032,"end":2055},{"text":"2.5\u20133.75\u200amg per day","label":"DOSAGE","start":2057,"end":2076},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":2113,"end":2116},{"text":"2 and 3","label":"LAB_VALUE","start":2134,"end":2141},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2165,"end":2172},{"text":"PAP","label":"DIAGNOSTIC_PROCEDURE","start":2198,"end":2201},{"text":"echocardiography","label":"DETAILED_DESCRIPTION","start":2216,"end":2232},{"text":"around 95\u200ammHg","label":"LAB_VALUE","start":2237,"end":2251},{"text":"September 2011","label":"DATE","start":2256,"end":2270},{"text":"visited","label":"CLINICAL_EVENT","start":2275,"end":2282},{"text":"Shanghai Pulmonary hospital","label":"NONBIOLOGICAL_LOCATION","start":2287,"end":2314},{"text":"China","label":"NONBIOLOGICAL_LOCATION","start":2318,"end":2323},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":2348,"end":2355},{"text":"Arterial blood gas analysis","label":"DIAGNOSTIC_PROCEDURE","start":2357,"end":2384},{"text":"PaO2","label":"DIAGNOSTIC_PROCEDURE","start":2397,"end":2401},{"text":"63\u200ammHg","label":"LAB_VALUE","start":2406,"end":2413},{"text":"oxygen saturation","label":"DIAGNOSTIC_PROCEDURE","start":2419,"end":2436},{"text":"93%","label":"LAB_VALUE","start":2437,"end":2440},{"text":"lung function test","label":"DIAGNOSTIC_PROCEDURE","start":2442,"end":2460},{"text":"mild","label":"SEVERITY","start":2472,"end":2476},{"text":"obstructive dysfunction","label":"DISEASE_DISORDER","start":2477,"end":2500},{"text":"pulmonary ventilation","label":"DETAILED_DESCRIPTION","start":2508,"end":2529},{"text":"FEV1\/FVC","label":"DIAGNOSTIC_PROCEDURE","start":2531,"end":2539},{"text":"62.06%","label":"LAB_VALUE","start":2540,"end":2546},{"text":"FEV1%","label":"DIAGNOSTIC_PROCEDURE","start":2548,"end":2553},{"text":"Prediction","label":"DETAILED_DESCRIPTION","start":2554,"end":2564},{"text":"80.9%","label":"LAB_VALUE","start":2565,"end":2570},{"text":"reduction","label":"LAB_VALUE","start":2585,"end":2594},{"text":"diffusing capacity of the lungs for carbon monoxide","label":"DIAGNOSTIC_PROCEDURE","start":2602,"end":2653},{"text":"DLCO","label":"DIAGNOSTIC_PROCEDURE","start":2655,"end":2659},{"text":"42%","label":"LAB_VALUE","start":2660,"end":2663},{"text":"6-minute","label":"DETAILED_DESCRIPTION","start":2666,"end":2674},{"text":"walk test","label":"DIAGNOSTIC_PROCEDURE","start":2675,"end":2684},{"text":"385\u200am","label":"LAB_VALUE","start":2689,"end":2694},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":2696,"end":2701},{"text":"high-resolution computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":2702,"end":2737},{"text":"HRCT","label":"DIAGNOSTIC_PROCEDURE","start":2739,"end":2743},{"text":"smooth","label":"TEXTURE","start":2767,"end":2773},{"text":"thickening","label":"SIGN_SYMPTOM","start":2774,"end":2784},{"text":"interlobular septa","label":"BIOLOGICAL_STRUCTURE","start":2788,"end":2806},{"text":"diffuse","label":"DETAILED_DESCRIPTION","start":2808,"end":2815},{"text":"centrilobular","label":"BIOLOGICAL_STRUCTURE","start":2816,"end":2829},{"text":"nodules","label":"SIGN_SYMPTOM","start":2830,"end":2837},{"text":"enlargement","label":"SIGN_SYMPTOM","start":2847,"end":2858},{"text":"mediastinal lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":2862,"end":2885},{"text":"right heart","label":"BIOLOGICAL_STRUCTURE","start":2891,"end":2902},{"text":"catheterization","label":"DIAGNOSTIC_PROCEDURE","start":2903,"end":2918},{"text":"PAP","label":"DIAGNOSTIC_PROCEDURE","start":2933,"end":2936},{"text":"83\/34\/53\u200ammHg","label":"LAB_VALUE","start":2941,"end":2954},{"text":"PCWP","label":"DIAGNOSTIC_PROCEDURE","start":2959,"end":2963},{"text":"14\/6\/11\u200ammHg","label":"LAB_VALUE","start":2968,"end":2980},{"text":"Acute vasodilator testing","label":"DIAGNOSTIC_PROCEDURE","start":2982,"end":3007},{"text":"negative","label":"LAB_VALUE","start":3012,"end":3020},{"text":"Coronary angiography","label":"DIAGNOSTIC_PROCEDURE","start":3022,"end":3042},{"text":"CTPA","label":"DIAGNOSTIC_PROCEDURE","start":3047,"end":3051},{"text":"normal","label":"LAB_VALUE","start":3062,"end":3068},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":3070,"end":3079},{"text":"ventilation\/perfusion","label":"DIAGNOSTIC_PROCEDURE","start":3080,"end":3101},{"text":"V\u2019\/Q\u2019","label":"DIAGNOSTIC_PROCEDURE","start":3103,"end":3108},{"text":"lung","label":"BIOLOGICAL_STRUCTURE","start":3110,"end":3114},{"text":"matched ventilation and perfusion defects","label":"SIGN_SYMPTOM","start":3129,"end":3170},{"text":"Bronchoalveolar lavage","label":"DIAGNOSTIC_PROCEDURE","start":3172,"end":3194},{"text":"elevated","label":"LAB_VALUE","start":3205,"end":3213},{"text":"65%","label":"LAB_VALUE","start":3226,"end":3229},{"text":"hemosiderin-laden macrophages","label":"BIOLOGICAL_STRUCTURE","start":3234,"end":3263},{"text":"Golde score","label":"DIAGNOSTIC_PROCEDURE","start":3273,"end":3284},{"text":"80","label":"LAB_VALUE","start":3285,"end":3287},{"text":"IPAH","label":"DISEASE_DISORDER","start":3347,"end":3351},{"text":"PVOD","label":"DISEASE_DISORDER","start":3393,"end":3397},{"text":"PAH therapy","label":"THERAPEUTIC_PROCEDURE","start":3445,"end":3456},{"text":"anticoagulation treatment","label":"THERAPEUTIC_PROCEDURE","start":3491,"end":3516},{"text":"warfarin","label":"MEDICATION","start":3533,"end":3541},{"text":"by himself","label":"DETAILED_DESCRIPTION","start":3568,"end":3578},{"text":"sometime in 2014","label":"DATE","start":3579,"end":3595},{"text":"monitor D-Dimer","label":"DIAGNOSTIC_PROCEDURE","start":3813,"end":3828},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":3859,"end":3866},{"text":"stable","label":"LAB_VALUE","start":3882,"end":3888},{"text":"many","label":"DETAILED_DESCRIPTION","start":3907,"end":3911},{"text":"not fatal","label":"SEVERITY","start":3917,"end":3926},{"text":"pulmonary edema","label":"DISEASE_DISORDER","start":3940,"end":3955},{"text":"January 2015","label":"DATE","start":3979,"end":3991},{"text":"rushed","label":"CLINICAL_EVENT","start":4000,"end":4006},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":4010,"end":4018},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":4031,"end":4038},{"text":"exacerbated","label":"DETAILED_DESCRIPTION","start":4052,"end":4063},{"text":"CTPA","label":"DIAGNOSTIC_PROCEDURE","start":4065,"end":4069},{"text":"thrombus","label":"DISEASE_DISORDER","start":4079,"end":4087},{"text":"right main pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":4095,"end":4122},{"text":"Rivaroxaban","label":"MEDICATION","start":4133,"end":4144},{"text":"anticoagulation treatment","label":"THERAPEUTIC_PROCEDURE","start":4166,"end":4191},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":4233,"end":4240},{"text":"too ill to walk","label":"SIGN_SYMPTOM","start":4260,"end":4275},{"text":"bound to his wheelchair","label":"ACTIVITY","start":4293,"end":4316},{"text":"half a year","label":"DURATION","start":4321,"end":4332},{"text":"PAH","label":"DISEASE_DISORDER","start":4345,"end":4348},{"text":"PVOD","label":"DISEASE_DISORDER","start":4363,"end":4367},{"text":"life-threatening","label":"SEVERITY","start":4385,"end":4401},{"text":"PE","label":"DISEASE_DISORDER","start":4402,"end":4404},{"text":"lung transplantation","label":"THERAPEUTIC_PROCEDURE","start":4416,"end":4436},{"text":"Six months later","label":"DATE","start":4455,"end":4471},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":4492,"end":4501},{"text":"sequential","label":"DETAILED_DESCRIPTION","start":4502,"end":4512},{"text":"allogenic","label":"DETAILED_DESCRIPTION","start":4513,"end":4522},{"text":"lung transplantation","label":"THERAPEUTIC_PROCEDURE","start":4523,"end":4543},{"text":"veno-arterial extra-corporeal membrane oxygenation","label":"THERAPEUTIC_PROCEDURE","start":4556,"end":4606},{"text":"VA-ECMO","label":"THERAPEUTIC_PROCEDURE","start":4608,"end":4615},{"text":"July 29, 2015","label":"DATE","start":4656,"end":4669},{"text":"Histology","label":"DIAGNOSTIC_PROCEDURE","start":4671,"end":4680},{"text":"explanted lung specimen","label":"BIOLOGICAL_STRUCTURE","start":4688,"end":4711},{"text":"pulmonary vein","label":"BIOLOGICAL_STRUCTURE","start":4719,"end":4733},{"text":"occlusion","label":"LAB_VALUE","start":4734,"end":4743},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":4763,"end":4772},{"text":"embolism","label":"LAB_VALUE","start":4773,"end":4781},{"text":"right pulmonary artery","label":"BIOLOGICAL_STRUCTURE","start":4789,"end":4811},{"text":"PVOD","label":"DISEASE_DISORDER","start":4852,"end":4856},{"text":"PE","label":"DISEASE_DISORDER","start":4871,"end":4873},{"text":"IPAH","label":"DISEASE_DISORDER","start":4886,"end":4890},{"text":"well","label":"SIGN_SYMPTOM","start":4911,"end":4915},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":4924,"end":4931},{"text":"more than 1 year","label":"DURATION","start":4936,"end":4952},{"text":"echocardiography","label":"DIAGNOSTIC_PROCEDURE","start":4992,"end":5008},{"text":"normalizations","label":"LAB_VALUE","start":5020,"end":5034},{"text":"PAP","label":"DIAGNOSTIC_PROCEDURE","start":5038,"end":5041},{"text":"enlarged","label":"SIGN_SYMPTOM","start":5055,"end":5063},{"text":"right ventricle of his heart","label":"BIOLOGICAL_STRUCTURE","start":5064,"end":5092}],"tokens":["A ","69-year-old"," ","man"," became aware of the onset of ","exertional"," ","dyspnea"," in ","July 2010",".\nHe had a history of ","smoking for more than 40 years, 20 cigarettes per day",".\nHis ","parents and 1 brother had lung cancer",".\nHis ","past medical history was unremarkable",".\nHe had ","no occupational exposure",".\nDue to the ","exertional"," ","dyspnea",", he was ","admitted"," to the ","People's Hospital of Shunde District"," for ","echocardiography"," and ","computed tomography pulmonary angiography"," (","CTPA",").\n","Echocardiography"," indicated that he had ","severe"," ","PAH",", because his ","pulmonary arterial pressure"," (","PAP",") was ","104\u200ammHg",", and his ","right heart"," was ","enlarged"," (the ","right ventricle diameter",": ","57\u200amm",").\n","CTPA"," showed that he had not only ","PAH",", but also a ","thrombus"," in the ","upper lobe artery of the right lung",".\nHowever, the ","region in the lung"," affected by this ","PE"," was considered too small to induce such a severe PAH.\nIn addition, he ","did not have connective tissue disease, drug use, history of chemotherapy, or HIV test (+)",", so he was diagnosed as ","IPAH"," combined with ","PE",".\nHe was treated with ","warfarin"," (","2.5\u200amg per day"," with a target of the ","international normalized ratio"," [","INR","] between ","1.5 and 2.5",") and ","slidenafil"," targeted PAH therapy (","20\u200amg twice per day",").\nThe patient's ","dyspnea"," was relieved slightly after the use of these ","medications"," for ","1 month"," and the retested ","PAP"," by ","echocardiography"," was ","decreased"," to ","72\u200ammHg",", but all the ","other symptoms and signs"," ","failed to further improve"," after taking these ","medications"," for ","6 months",".\nIn ","March 2011",", he ","went"," to the ","Kyorin University affiliated hospital"," in ","Japan"," for further treatment.\n","Right heart"," ","catheterization"," revealed ","PAP"," ","72\/34\/47\u200ammHg",", ","pulmonary capillary wedge pressure"," (","PCWP",") ","17\/5\/10\u200ammHg",", ","cardiac output"," ","4.3\u200aL\/min",", ","cardiac ejection index"," ","2.36\u200aL\/min\/m2",", and ","pulmonary vascular resistance"," ","7.3 Wood units",".\nHe was retested for ","CTPA"," that showed that the ","thrombus"," in the ","upper lobe artery of the right lung"," disappeared.\nHe was still diagnosed as having ","IPAH",", so treated with ","sildenafil"," (","20\u200amg 3 times a day",") and ","sorafenib"," (","400\u200amg once a day",") targeted ","PAH therapy"," and ","oral"," ","warfarin"," ","anticoagulation therapy"," (","2.5\u20133.75\u200amg per day",", but the daily dose was adjusted by ","INR"," that was between ","2 and 3",").\nDisappointingly, his ","dyspnea"," was not relieved and the ","PAP"," tested by the ","echocardiography"," was ","around 95\u200ammHg",".\nIn ","September 2011",", he ","visited"," the ","Shanghai Pulmonary hospital"," in ","China"," because of no relief of ","dyspnea",".\n","Arterial blood gas analysis"," showed that ","PaO2"," was ","63\u200ammHg"," with ","oxygen saturation"," ","93%","; ","lung function test"," revealed a ","mild"," ","obstructive dysfunction"," of the ","pulmonary ventilation"," (","FEV1\/FVC"," ","62.06%",", ","FEV1%"," ","Prediction"," ","80.9%",") and a severe ","reduction"," in the ","diffusing capacity of the lungs for carbon monoxide"," (","DLCO"," ","42%","); ","6-minute"," ","walk test"," was ","385\u200am",".\n","Chest"," ","high-resolution computed tomography"," (","HRCT",") (Fig.1A and B) showed ","smooth"," ","thickening"," of ","interlobular septa",", ","diffuse"," ","centrilobular"," ","nodules",", and the ","enlargement"," of ","mediastinal lymph nodes",".\nThe ","right heart"," ","catheterization"," revealed that ","PAP"," was ","83\/34\/53\u200ammHg"," and ","PCWP"," was ","14\/6\/11\u200ammHg",".\n","Acute vasodilator testing"," was ","negative",".\n","Coronary angiography"," and ","CTPA"," were both ","normal","; ","pulmonary"," ","ventilation\/perfusion"," (","V\u2019\/Q\u2019",") ","lung"," scan showed a ","matched ventilation and perfusion defects",".\n","Bronchoalveolar lavage"," showed an ","elevated"," percentage (","65%",") of ","hemosiderin-laden macrophages"," with the ","Golde score"," ","80"," (the normal range: 0\u201320).\nHe was still diagnosed as having ","IPAH",", but he was suspected as actually having ","PVOD",".\nHe was continuously treated with the targeted ","PAH therapy",", and he was asked to continue his ","anticoagulation treatment",", but he stopped ","warfarin"," anticoagulation treatment ","by himself"," ","sometime in 2014"," (he failed to recall the exact date.) because he felt that it was too cumbersome to frequently test the INR for blood coagulation monitoring.\nFurthermore, after he discontinued his warfarin therapy, he also failed to ","monitor D-Dimer"," to prevent PE recurrence.\nHis ","dyspnea"," was relatively ","stable",", but he developed ","many",", but ","not fatal",", episodes of ","pulmonary edema"," during the therapy.\nIn ","January 2015",", he was ","rushed"," to ","hospital"," because his ","dyspnea"," was suddenly ","exacerbated",".\n","CTPA"," showed a ","thrombus"," in the ","right main pulmonary artery"," (Fig.1C).\n","Rivaroxaban"," was administered for ","anticoagulation treatment",", but this medication did not relieve his ","dyspnea",", therefore, he was ","too ill to walk",".\nInstead, he was ","bound to his wheelchair"," for ","half a year",".\nThe severe ","PAH"," (suspected as ","PVOD",") combined with a ","life-threatening"," ","PE"," mandates a ","lung transplantation"," for his survival.\n","Six months later",", he was undergone a ","bilateral"," ","sequential"," ","allogenic"," ","lung transplantation"," assisted by ","veno-arterial extra-corporeal membrane oxygenation"," (","VA-ECMO",") after he signed the written consent on ","July 29, 2015",".\n","Histology"," of the ","explanted lung specimen"," showed ","pulmonary vein"," ","occlusion"," (Fig.1D\u2013F) and the ","pulmonary"," ","embolism"," in the ","right pulmonary artery",".\nUntil then, he was confirmed as having ","PVOD"," combined with ","PE",", instead of ","IPAH",".\nHe has been living ","well"," without ","dyspnea"," for ","more than 1 year"," after the lung transplantation and the ","echocardiography"," showed the ","normalizations"," of ","PAP"," and the once ","enlarged"," ","right ventricle of his heart",".\nThis study was approved by the Ethics Committee of The People's Hospital of Zhongshan City.\nThe written informed consent was obtained from the patient.\n"],"ner_labels":[0,5,0,65,0,22,0,69,0,19,0,39,0,34,0,39,0,39,0,22,0,69,0,13,0,48,0,24,0,24,0,24,0,24,0,63,0,26,0,24,0,24,0,42,0,12,0,69,0,24,0,42,0,24,0,26,0,26,0,12,0,12,0,18,0,39,0,26,0,26,0,46,0,29,0,24,0,24,0,42,0,46,0,29,0,69,0,46,0,32,0,24,0,22,0,42,0,42,0,69,0,42,0,46,0,32,0,19,0,13,0,48,0,48,0,12,0,24,0,24,0,42,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,26,0,12,0,26,0,46,0,29,0,46,0,29,0,75,0,4,0,46,0,75,0,29,0,24,0,42,0,69,0,24,0,22,0,42,0,19,0,13,0,48,0,48,0,69,0,24,0,24,0,42,0,24,0,42,0,24,0,63,0,26,0,22,0,24,0,42,0,24,0,22,0,42,0,42,0,24,0,24,0,42,0,22,0,24,0,42,0,12,0,24,0,24,0,73,0,69,0,12,0,22,0,12,0,69,0,69,0,12,0,12,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,24,0,42,0,12,0,24,0,24,0,12,0,69,0,24,0,42,0,42,0,12,0,24,0,42,0,26,0,26,0,75,0,75,0,46,0,22,0,19,0,24,0,69,0,42,0,22,0,63,0,26,0,19,0,13,0,48,0,69,0,22,0,24,0,26,0,12,0,46,0,75,0,69,0,69,0,1,0,32,0,26,0,26,0,63,0,26,0,75,0,19,0,22,0,22,0,22,0,75,0,75,0,75,0,19,0,24,0,12,0,12,0,42,0,12,0,42,0,12,0,26,0,26,0,26,0,69,0,69,0,32,0,24,0,42,0,24,0,69,0,12,0]}
-{"full_text":"A 58-year-old cotton farmer was presented to the West China Hospital of Sichuan University because of an over 1-month history of recurrent fever (between 38 and 40\u200a\u00b0C), productive cough, and dyspnea.\nPrior to admission, he was diagnosed of pneumonia and treated with latamoxef, ofloxacin, vancomycin, and voriconazole at local hospital.\nHowever, no remission of symptoms was observed.\nMoreover, he was a hepatitis B virus carrier with a 10 pack-years smoking history.\nHowever, no history of diabetes mellitus, tuberculosis, and use of glucocorticoids in the past were informed.\nOn admission, blood pressure, 145\/95\u200amm\u200aHg; heart rate, 120 per minute; respiratory rate, 30 per minute; and temperature, 39.3\u200a\u00b0C.\nPhysical examination revealed diminished breath sounds, but no rales were heard, and evaluation of other systems was unremarkable except moderate edema of lower limbs.\nArterial blood gases analysis showed pH 7.361, PCO2 53.5\u200amm\u200aHg, and PO2 62.8\u200amm\u200aHg.\nLaboratory data (Table \u200b(Table1)1) revealed leukocytosis of 49,500\/mm3 with 97.4% neutrophils, and elevated procalcitonin of 5.16\u200ang\/mL.\nChest computed tomography, presence of nodules, masses, patchy consolidations, and bilateral pleural effusion, is noted (Fig.1A).\nMeanwhile, it was soon alerted in sputum smear with presence of filamentous, gram-positive, weakly acid-fast, and beaded bacilli with possible diagnosis of Nocardia infection (Fig.1B, C).\nTrimethoprim-sulfamethoxazole (3 pills per 6\u200ahours) with noninvasive ventilation was promptly administered.\nSputum culture showed growth of numerous bacteria that were precisely determined to be N otitidiscaviarum by the method of mass spectroscopy on day 6 after admission (Fig.1D).\nAntibiotics were thus modified to amikacin and imipenem in addition to trimethoprim-sulfamethoxazole in accordance with the sensitivity test.\nHowever, the patient was not improved as expected and eventually died from severe respiratory insufficiency on the 13th hospital day.\n","ner_info":[{"text":"58-year-old","label":"AGE","start":2,"end":13},{"text":"cotton farmer","label":"OCCUPATION","start":14,"end":27},{"text":"presented","label":"CLINICAL_EVENT","start":32,"end":41},{"text":"West China Hospital of Sichuan University","label":"NONBIOLOGICAL_LOCATION","start":49,"end":90},{"text":"over 1-month","label":"DURATION","start":105,"end":117},{"text":"recurrent","label":"DETAILED_DESCRIPTION","start":129,"end":138},{"text":"fever","label":"SIGN_SYMPTOM","start":139,"end":144},{"text":"between 38 and 40\u200a\u00b0C","label":"LAB_VALUE","start":146,"end":166},{"text":"productive","label":"DETAILED_DESCRIPTION","start":169,"end":179},{"text":"cough","label":"SIGN_SYMPTOM","start":180,"end":185},{"text":"dyspnea","label":"SIGN_SYMPTOM","start":191,"end":198},{"text":"pneumonia","label":"DISEASE_DISORDER","start":240,"end":249},{"text":"latamoxef","label":"MEDICATION","start":267,"end":276},{"text":"ofloxacin","label":"MEDICATION","start":278,"end":287},{"text":"vancomycin","label":"MEDICATION","start":289,"end":299},{"text":"voriconazole","label":"MEDICATION","start":305,"end":317},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":321,"end":335},{"text":"remission of symptoms","label":"SIGN_SYMPTOM","start":349,"end":370},{"text":"hepatitis B virus carrier","label":"HISTORY","start":404,"end":429},{"text":"10 pack-years smoking history","label":"HISTORY","start":437,"end":466},{"text":"no history of diabetes mellitus, tuberculosis, and use of glucocorticoids in the past","label":"HISTORY","start":477,"end":562},{"text":"admission","label":"CLINICAL_EVENT","start":581,"end":590},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":592,"end":606},{"text":"145\/95\u200amm\u200aHg","label":"LAB_VALUE","start":608,"end":620},{"text":"heart rate","label":"DIAGNOSTIC_PROCEDURE","start":622,"end":632},{"text":"120 per minute","label":"LAB_VALUE","start":634,"end":648},{"text":"respiratory rate","label":"DIAGNOSTIC_PROCEDURE","start":650,"end":666},{"text":"30 per minute","label":"LAB_VALUE","start":668,"end":681},{"text":"temperature","label":"DIAGNOSTIC_PROCEDURE","start":687,"end":698},{"text":"39.3\u200a\u00b0C","label":"LAB_VALUE","start":700,"end":707},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":709,"end":729},{"text":"diminished breath sounds","label":"SIGN_SYMPTOM","start":739,"end":763},{"text":"rales","label":"SIGN_SYMPTOM","start":772,"end":777},{"text":"evaluation of other systems","label":"DIAGNOSTIC_PROCEDURE","start":794,"end":821},{"text":"unremarkable","label":"LAB_VALUE","start":826,"end":838},{"text":"moderate","label":"SEVERITY","start":846,"end":854},{"text":"edema","label":"SIGN_SYMPTOM","start":855,"end":860},{"text":"lower limbs","label":"BIOLOGICAL_STRUCTURE","start":864,"end":875},{"text":"Arterial blood gases analysis","label":"DIAGNOSTIC_PROCEDURE","start":877,"end":906},{"text":"pH","label":"DIAGNOSTIC_PROCEDURE","start":914,"end":916},{"text":"7.361","label":"LAB_VALUE","start":917,"end":922},{"text":"PCO2","label":"DIAGNOSTIC_PROCEDURE","start":924,"end":928},{"text":"53.5\u200amm\u200aHg","label":"LAB_VALUE","start":929,"end":939},{"text":"PO2","label":"DIAGNOSTIC_PROCEDURE","start":945,"end":948},{"text":"62.8\u200amm\u200aHg","label":"LAB_VALUE","start":949,"end":959},{"text":"leukocytosis","label":"SIGN_SYMPTOM","start":1005,"end":1017},{"text":"49,500\/mm3","label":"LAB_VALUE","start":1021,"end":1031},{"text":"97.4% neutrophils","label":"LAB_VALUE","start":1037,"end":1054},{"text":"procalcitonin","label":"DIAGNOSTIC_PROCEDURE","start":1069,"end":1082},{"text":"5.16\u200ang\/mL","label":"LAB_VALUE","start":1086,"end":1096},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1098,"end":1103},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1104,"end":1123},{"text":"nodules","label":"SIGN_SYMPTOM","start":1137,"end":1144},{"text":"masses","label":"SIGN_SYMPTOM","start":1146,"end":1152},{"text":"patchy consolidations","label":"SIGN_SYMPTOM","start":1154,"end":1175},{"text":"bilateral pleural effusion","label":"SIGN_SYMPTOM","start":1181,"end":1207},{"text":"sputum smear","label":"DIAGNOSTIC_PROCEDURE","start":1262,"end":1274},{"text":"filamentous","label":"DETAILED_DESCRIPTION","start":1292,"end":1303},{"text":"gram-positive","label":"DETAILED_DESCRIPTION","start":1305,"end":1318},{"text":"weakly acid-fast","label":"DETAILED_DESCRIPTION","start":1320,"end":1336},{"text":"beaded","label":"DETAILED_DESCRIPTION","start":1342,"end":1348},{"text":"bacilli","label":"SIGN_SYMPTOM","start":1349,"end":1356},{"text":"Nocardia infection","label":"DISEASE_DISORDER","start":1384,"end":1402},{"text":"Trimethoprim-sulfamethoxazole","label":"MEDICATION","start":1416,"end":1445},{"text":"3 pills per 6\u200ahours","label":"DOSAGE","start":1447,"end":1466},{"text":"noninvasive","label":"DETAILED_DESCRIPTION","start":1473,"end":1484},{"text":"ventilation","label":"THERAPEUTIC_PROCEDURE","start":1485,"end":1496},{"text":"Sputum culture","label":"DIAGNOSTIC_PROCEDURE","start":1524,"end":1538},{"text":"growth of numerous bacteria","label":"LAB_VALUE","start":1546,"end":1573},{"text":"N otitidiscaviarum","label":"SIGN_SYMPTOM","start":1611,"end":1629},{"text":"mass spectroscopy","label":"DIAGNOSTIC_PROCEDURE","start":1647,"end":1664},{"text":"day 6 after admission","label":"DATE","start":1668,"end":1689},{"text":"Antibiotics","label":"MEDICATION","start":1700,"end":1711},{"text":"amikacin","label":"MEDICATION","start":1734,"end":1742},{"text":"imipenem","label":"MEDICATION","start":1747,"end":1755},{"text":"trimethoprim-sulfamethoxazole","label":"MEDICATION","start":1771,"end":1800},{"text":"improved","label":"SIGN_SYMPTOM","start":1871,"end":1879},{"text":"died","label":"OUTCOME","start":1907,"end":1911},{"text":"severe","label":"SEVERITY","start":1917,"end":1923},{"text":"respiratory insufficiency","label":"SIGN_SYMPTOM","start":1924,"end":1949},{"text":"13th hospital day","label":"DATE","start":1957,"end":1974}],"tokens":["A ","58-year-old"," ","cotton farmer"," was ","presented"," to the ","West China Hospital of Sichuan University"," because of an ","over 1-month"," history of ","recurrent"," ","fever"," (","between 38 and 40\u200a\u00b0C","), ","productive"," ","cough",", and ","dyspnea",".\nPrior to admission, he was diagnosed of ","pneumonia"," and treated with ","latamoxef",", ","ofloxacin",", ","vancomycin",", and ","voriconazole"," at ","local hospital",".\nHowever, no ","remission of symptoms"," was observed.\nMoreover, he was a ","hepatitis B virus carrier"," with a ","10 pack-years smoking history",".\nHowever, ","no history of diabetes mellitus, tuberculosis, and use of glucocorticoids in the past"," were informed.\nOn ","admission",", ","blood pressure",", ","145\/95\u200amm\u200aHg","; ","heart rate",", ","120 per minute","; ","respiratory rate",", ","30 per minute","; and ","temperature",", ","39.3\u200a\u00b0C",".\n","Physical examination"," revealed ","diminished breath sounds",", but no ","rales"," were heard, and ","evaluation of other systems"," was ","unremarkable"," except ","moderate"," ","edema"," of ","lower limbs",".\n","Arterial blood gases analysis"," showed ","pH"," ","7.361",", ","PCO2"," ","53.5\u200amm\u200aHg",", and ","PO2"," ","62.8\u200amm\u200aHg",".\nLaboratory data (Table \u200b(Table1)1) revealed ","leukocytosis"," of ","49,500\/mm3"," with ","97.4% neutrophils",", and elevated ","procalcitonin"," of ","5.16\u200ang\/mL",".\n","Chest"," ","computed tomography",", presence of ","nodules",", ","masses",", ","patchy consolidations",", and ","bilateral pleural effusion",", is noted (Fig.1A).\nMeanwhile, it was soon alerted in ","sputum smear"," with presence of ","filamentous",", ","gram-positive",", ","weakly acid-fast",", and ","beaded"," ","bacilli"," with possible diagnosis of ","Nocardia infection"," (Fig.1B, C).\n","Trimethoprim-sulfamethoxazole"," (","3 pills per 6\u200ahours",") with ","noninvasive"," ","ventilation"," was promptly administered.\n","Sputum culture"," showed ","growth of numerous bacteria"," that were precisely determined to be ","N otitidiscaviarum"," by the method of ","mass spectroscopy"," on ","day 6 after admission"," (Fig.1D).\n","Antibiotics"," were thus modified to ","amikacin"," and ","imipenem"," in addition to ","trimethoprim-sulfamethoxazole"," in accordance with the sensitivity test.\nHowever, the patient was not ","improved"," as expected and eventually ","died"," from ","severe"," ","respiratory insufficiency"," on the ","13th hospital day",".\n"],"ner_labels":[0,5,0,50,0,13,0,48,0,32,0,22,0,69,0,42,0,22,0,69,0,69,0,26,0,46,0,46,0,46,0,46,0,48,0,69,0,39,0,39,0,39,0,13,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,69,0,69,0,24,0,42,0,63,0,69,0,12,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,69,0,42,0,42,0,24,0,42,0,12,0,24,0,69,0,69,0,69,0,69,0,24,0,22,0,22,0,22,0,22,0,69,0,26,0,46,0,29,0,22,0,75,0,24,0,42,0,69,0,24,0,19,0,46,0,46,0,46,0,46,0,69,0,56,0,63,0,69,0,19,0]}
-{"full_text":"n March 2015, a 62-year-old woman was admitted to our hospital.\nShe complained of progressive visual disturbance, which began about 4 years ago and was treated as cataract in local hospital, but no relief was seen.\nOn the contrary, the symptoms aggravated half a year ago, together with headache, left eye pain, tearing and increased secretions, and the computed tomography (CT) scan of the brain in local hospital showed a sellar region lesion.\nBesides, 2 years earlier, the patient underwent resection of melanoma in the left heel (T2N0M0, ki67 3\u20135%, Stage II), followed by resection of the recurred melanoma nearby the primary site 15 months later (T3N3M0, Stage III), without lymphadenectomy.\nShe had no family history of melanoma.\nOn physical examination, the patient had bilateral temporal hemianopsia, the right finger counting was 1\u200am, and the left finger counting was no more than 0.5\u200am.\nEnlarged lymph nodes were palpable in the right groin.\nOn ophthalmologic examination, the patient had right vision of 0.4 and left vision of 0.08, with the same intraocular pressure 15\u200amm Hg bilaterally.\nThe optometry found the right eye of +6.00DS\/+0.25DC\u221765\u00b0 and the left eye of +6.25DS\/+0.50DC\u221720\u00b0.\nThe patient had maculopathy of both eyes and optic atrophy of the left eye.\nLight reflex and eye movement of both eyes were normal.\nCT scans of the brain parenchyma, orbital, and chest were unremarkable.\nCT scan and ultrasound examination of the abdomen showed hepatic portal and retroperitoneal lymphadenectasis and enlarged left lobe of the liver with substantial placeholder lesions.\nUltrasound examination of bilateral inguinal lymph nodes discovered multiple low echo light groups, the largest of which was 31\u200amm in diameter, with hilus of the echo and asymmetrical thickening of the skin.\nCT scan of sellar region revealed a crumby mass, protruding out of the sphenoid sinus, with obscure boundary and bone destruction.\nAnd the average CT value of the mass was 46\u200aHU.\nSellar region magnetic resonance imaging (MRI) revealed a round mass of 30\u200amm in diameter in the enlarged sellae (Fig.1A, B).\nThe mass showed isointense in T1-weighted images (T1-WI) and T2-weighted images (T2-WI), with homogeneous enhancement after Gadolinium-DTPA injection, and dural tail sign was seen.\nSmall foci inside the tumor showed hyperintense signals in T1-WI and hypointense signals in T2-WI, without enhancement.\nAnd it was seen that the mass penetrated meninges, surrounded the left internal carotid artery, and was blurred with the left optic nerve.\nPituitary stalk became shorter with a right displacement.\nLaboratory findings revealed increased levels of prolactin (119.08\u200a\u03bcg\/L, normal range 5.99\u201330.04\u200a\u03bcg\/L) and cortisol (677.10\u200anmol\/L, normal range 118.60\u2013618.00\u200anmol\/L) and decreased levels of free thyroxine (FT4) (6.04\u200apmol\/L, normal range 12.00\u201322.00\u200apmol\/L) and free triiodothyronine (FT3) (2.09\u200apmol\/L, normal range 3.50\u20136.50\u200apmol\/L).\nThe patient was diagnosed with a giant prolactinoma.\nThe patient underwent transnasal transsphenoidal surgery to remove the tumor and relieve the compression of the optic nerve.\nIntraoperatively, it was seen that the tumor invaded and filled the left interval of the sphenoid sinus, and part of bone in sellar floor and left side parasellar was destroyed and absorbed.\nA little normal pituitary tissue was seen in the top right of tumor in the sellar turcica.\nThe tumor was reddish black with extremely rich blood supply and had close adhesion to the surrounding structure.\nThe texture in the center of the tumor was soft and much tougher over the rim.\nIntraoperative frozen-section examination found melanin granules, and it was considered to be malignant melanoma or meningioma.\nThe tumor cells were composed of eosinophilic staining epithelial cells.\nMost of cell nuclei were round, a few were reniform and hippocrepiform with evident nucleoli, and nuclear fission was seen.\nThe tumor showed no evidence of necrosis (Fig.2).\nThe tumor was immunopositive focally for melanoma-specific markers such as S-100, HMB45, and Vimentin, and immunopositive for neuroendocrine tumor markers such as CgA and Syn (Fig.3).\nThe Ki67 index was 3% to 5%; it was higher in metastatic melanoma than in the adenomatous component.\nTaken the melanoma history and suspected lymph node and hepatic metastasis into consideration, the patient was diagnosised with MMPA.\nAfter surgery, significant relief was seen in visual field and headache, and the level of prolactin, cortisol, and FT4 returned to normal with hormone replacement therapy.\nBecause the focal liver lesions and lymphadenectasis did not cause much discomfort, the patient refused any further surgical intervention or other treatment.\nShe was discharged from the hospital immediately and was disease free until 2 months after the third surgery.\nThe patient successively found new melanoma metastatic sites in the skin of lower left leg, knees, the upper left leg, the left groin and the right groin, and the right leg.\nAt the follow-up in late January 2016, the patient could not walk and live by herself and was depressed.\nAt the latest follow-up, in late January, 2017, the patient was alive with worse symptoms, she had sensory deficits of both legs, which could not move, hyperalgesia of hands and mouth, impaired intelligence, but she lived well with the disease by careful nursing of her daughter.\n","ner_info":[{"text":"March 2015","label":"DATE","start":2,"end":12},{"text":"62-year-old","label":"AGE","start":16,"end":27},{"text":"woman","label":"SEX","start":28,"end":33},{"text":"admitted","label":"CLINICAL_EVENT","start":38,"end":46},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":54,"end":62},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":82,"end":93},{"text":"visual 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tomography","label":"DIAGNOSTIC_PROCEDURE","start":354,"end":373},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":375,"end":377},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":391,"end":396},{"text":"local hospital","label":"NONBIOLOGICAL_LOCATION","start":400,"end":414},{"text":"sellar region","label":"BIOLOGICAL_STRUCTURE","start":424,"end":437},{"text":"lesion","label":"SIGN_SYMPTOM","start":438,"end":444},{"text":"2 years earlier","label":"DATE","start":455,"end":470},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":494,"end":503},{"text":"melanoma","label":"DISEASE_DISORDER","start":507,"end":515},{"text":"left heel","label":"BIOLOGICAL_STRUCTURE","start":523,"end":532},{"text":"T2N0M0","label":"LAB_VALUE","start":534,"end":540},{"text":"ki67 3\u20135%","label":"LAB_VALUE","start":542,"end":551},{"text":"Stage 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eyes","label":"BIOLOGICAL_STRUCTURE","start":1230,"end":1239},{"text":"optic atrophy","label":"DISEASE_DISORDER","start":1244,"end":1257},{"text":"left eye","label":"BIOLOGICAL_STRUCTURE","start":1265,"end":1273},{"text":"Light reflex","label":"DIAGNOSTIC_PROCEDURE","start":1275,"end":1287},{"text":"eye movement","label":"DIAGNOSTIC_PROCEDURE","start":1292,"end":1304},{"text":"both eyes","label":"BIOLOGICAL_STRUCTURE","start":1308,"end":1317},{"text":"normal","label":"LAB_VALUE","start":1323,"end":1329},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1331,"end":1333},{"text":"brain 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liver","label":"BIOLOGICAL_STRUCTURE","start":1525,"end":1547},{"text":"substantial","label":"SEVERITY","start":1553,"end":1564},{"text":"placeholder","label":"DETAILED_DESCRIPTION","start":1565,"end":1576},{"text":"lesions","label":"SIGN_SYMPTOM","start":1577,"end":1584},{"text":"Ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":1586,"end":1596},{"text":"bilateral","label":"DETAILED_DESCRIPTION","start":1612,"end":1621},{"text":"inguinal lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":1622,"end":1642},{"text":"multiple","label":"DETAILED_DESCRIPTION","start":1654,"end":1662},{"text":"low echo light groups","label":"SIGN_SYMPTOM","start":1663,"end":1684},{"text":"largest of which was 31\u200amm","label":"DISTANCE","start":1690,"end":1716},{"text":"hilus of the echo","label":"DETAILED_DESCRIPTION","start":1735,"end":1752},{"text":"asymmetrical","label":"DETAILED_DESCRIPTION","start":1757,"end":1769},{"text":"thickening","label":"SIGN_SYMPTOM","start":1770,"end":1780},{"text":"skin","label":"BIOLOGICAL_STRUCTURE","start":1788,"end":1792},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1794,"end":1796},{"text":"sellar region","label":"BIOLOGICAL_STRUCTURE","start":1805,"end":1818},{"text":"crumby","label":"TEXTURE","start":1830,"end":1836},{"text":"mass","label":"SIGN_SYMPTOM","start":1837,"end":1841},{"text":"sphenoid sinus","label":"BIOLOGICAL_STRUCTURE","start":1865,"end":1879},{"text":"obscure boundary","label":"DETAILED_DESCRIPTION","start":1886,"end":1902},{"text":"bone destruction","label":"DETAILED_DESCRIPTION","start":1907,"end":1923},{"text":"average","label":"DETAILED_DESCRIPTION","start":1933,"end":1940},{"text":"CT value","label":"DIAGNOSTIC_PROCEDURE","start":1941,"end":1949},{"text":"mass","label":"SIGN_SYMPTOM","start":1957,"end":1961},{"text":"46\u200aHU","label":"LAB_VALUE","start":1966,"end":1971},{"text":"Sellar region","label":"BIOLOGICAL_STRUCTURE","start":1973,"end":1986},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":1987,"end":2013},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":2015,"end":2018},{"text":"round","label":"SHAPE","start":2031,"end":2036},{"text":"mass","label":"SIGN_SYMPTOM","start":2037,"end":2041},{"text":"30\u200amm","label":"DISTANCE","start":2045,"end":2050},{"text":"enlarged sellae","label":"BIOLOGICAL_STRUCTURE","start":2070,"end":2085},{"text":"mass","label":"COREFERENCE","start":2103,"end":2107},{"text":"isointense","label":"SIGN_SYMPTOM","start":2115,"end":2125},{"text":"T1-weighted images","label":"DIAGNOSTIC_PROCEDURE","start":2129,"end":2147},{"text":"T1-WI","label":"DIAGNOSTIC_PROCEDURE","start":2149,"end":2154},{"text":"T2-weighted images","label":"DIAGNOSTIC_PROCEDURE","start":2160,"end":2178},{"text":"T2-WI","label":"DIAGNOSTIC_PROCEDURE","start":2180,"end":2185},{"text":"homogeneous","label":"DETAILED_DESCRIPTION","start":2193,"end":2204},{"text":"enhancement","label":"SIGN_SYMPTOM","start":2205,"end":2216},{"text":"Gadolinium-DTPA injection","label":"DETAILED_DESCRIPTION","start":2223,"end":2248},{"text":"dural tail sign","label":"DETAILED_DESCRIPTION","start":2254,"end":2269},{"text":"tumor","label":"COREFERENCE","start":2302,"end":2307},{"text":"hyperintense signals","label":"SIGN_SYMPTOM","start":2315,"end":2335},{"text":"T1-WI","label":"DIAGNOSTIC_PROCEDURE","start":2339,"end":2344},{"text":"hypointense signals","label":"SIGN_SYMPTOM","start":2349,"end":2368},{"text":"T2-WI","label":"DIAGNOSTIC_PROCEDURE","start":2372,"end":2377},{"text":"without enhancement","label":"DETAILED_DESCRIPTION","start":2379,"end":2398},{"text":"mass","label":"COREFERENCE","start":2425,"end":2429},{"text":"meninges","label":"BIOLOGICAL_STRUCTURE","start":2441,"end":2449},{"text":"left internal carotid artery","label":"BIOLOGICAL_STRUCTURE","start":2466,"end":2494},{"text":"left optic nerve","label":"BIOLOGICAL_STRUCTURE","start":2521,"end":2537},{"text":"Pituitary stalk","label":"BIOLOGICAL_STRUCTURE","start":2539,"end":2554},{"text":"shorter","label":"SIGN_SYMPTOM","start":2562,"end":2569},{"text":"right displacement","label":"DETAILED_DESCRIPTION","start":2577,"end":2595},{"text":"Laboratory findings","label":"DIAGNOSTIC_PROCEDURE","start":2597,"end":2616},{"text":"increased","label":"LAB_VALUE","start":2626,"end":2635},{"text":"prolactin","label":"DIAGNOSTIC_PROCEDURE","start":2646,"end":2655},{"text":"119.08\u200a\u03bcg\/L","label":"LAB_VALUE","start":2657,"end":2668},{"text":"cortisol","label":"DIAGNOSTIC_PROCEDURE","start":2704,"end":2712},{"text":"677.10\u200anmol\/L","label":"LAB_VALUE","start":2714,"end":2727},{"text":"decreased","label":"LAB_VALUE","start":2768,"end":2777},{"text":"free thyroxine","label":"DIAGNOSTIC_PROCEDURE","start":2788,"end":2802},{"text":"FT4","label":"DIAGNOSTIC_PROCEDURE","start":2804,"end":2807},{"text":"6.04\u200apmol\/L","label":"LAB_VALUE","start":2810,"end":2821},{"text":"free triiodothyronine","label":"DIAGNOSTIC_PROCEDURE","start":2860,"end":2881},{"text":"FT3","label":"DIAGNOSTIC_PROCEDURE","start":2883,"end":2886},{"text":"2.09\u200apmol\/L","label":"LAB_VALUE","start":2889,"end":2900},{"text":"giant","label":"DETAILED_DESCRIPTION","start":2967,"end":2972},{"text":"prolactinoma","label":"DISEASE_DISORDER","start":2973,"end":2985},{"text":"transnasal","label":"DETAILED_DESCRIPTION","start":3009,"end":3019},{"text":"transsphenoidal","label":"DETAILED_DESCRIPTION","start":3020,"end":3035},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":3036,"end":3043},{"text":"tumor","label":"SIGN_SYMPTOM","start":3151,"end":3156},{"text":"left interval of the sphenoid sinus","label":"BIOLOGICAL_STRUCTURE","start":3180,"end":3215},{"text":"bone in sellar floor","label":"BIOLOGICAL_STRUCTURE","start":3229,"end":3249},{"text":"left side parasellar","label":"BIOLOGICAL_STRUCTURE","start":3254,"end":3274},{"text":"destroyed","label":"SIGN_SYMPTOM","start":3279,"end":3288},{"text":"absorbed","label":"SIGN_SYMPTOM","start":3293,"end":3301},{"text":"little normal pituitary tissue was seen in the top right","label":"DETAILED_DESCRIPTION","start":3305,"end":3361},{"text":"tumor","label":"COREFERENCE","start":3365,"end":3370},{"text":"sellar turcica","label":"BIOLOGICAL_STRUCTURE","start":3378,"end":3392},{"text":"tumor","label":"COREFERENCE","start":3398,"end":3403},{"text":"reddish black","label":"COLOR","start":3408,"end":3421},{"text":"extremely rich blood supply","label":"DETAILED_DESCRIPTION","start":3427,"end":3454},{"text":"close adhesion to the surrounding structure","label":"DETAILED_DESCRIPTION","start":3463,"end":3506},{"text":"tumor","label":"COREFERENCE","start":3541,"end":3546},{"text":"soft","label":"TEXTURE","start":3551,"end":3555},{"text":"much tougher over the rim","label":"TEXTURE","start":3560,"end":3585},{"text":"Intraoperative","label":"DETAILED_DESCRIPTION","start":3587,"end":3601},{"text":"frozen-section examination","label":"DIAGNOSTIC_PROCEDURE","start":3602,"end":3628},{"text":"melanin granules","label":"SIGN_SYMPTOM","start":3635,"end":3651},{"text":"malignant melanoma","label":"DISEASE_DISORDER","start":3681,"end":3699},{"text":"meningioma","label":"DISEASE_DISORDER","start":3703,"end":3713},{"text":"tumor cells","label":"COREFERENCE","start":3719,"end":3730},{"text":"eosinophilic staining epithelial cells","label":"DETAILED_DESCRIPTION","start":3748,"end":3786},{"text":"cell nuclei","label":"DIAGNOSTIC_PROCEDURE","start":3796,"end":3807},{"text":"round","label":"SHAPE","start":3813,"end":3818},{"text":"reniform","label":"LAB_VALUE","start":3831,"end":3839},{"text":"hippocrepiform","label":"LAB_VALUE","start":3844,"end":3858},{"text":"evident","label":"LAB_VALUE","start":3864,"end":3871},{"text":"nucleoli","label":"DIAGNOSTIC_PROCEDURE","start":3872,"end":3880},{"text":"nuclear fission","label":"DIAGNOSTIC_PROCEDURE","start":3886,"end":3901},{"text":"seen","label":"LAB_VALUE","start":3906,"end":3910},{"text":"tumor","label":"COREFERENCE","start":3916,"end":3921},{"text":"necrosis","label":"SIGN_SYMPTOM","start":3944,"end":3952},{"text":"immunopositive","label":"LAB_VALUE","start":3976,"end":3990},{"text":"focally","label":"DETAILED_DESCRIPTION","start":3991,"end":3998},{"text":"melanoma-specific markers","label":"DIAGNOSTIC_PROCEDURE","start":4003,"end":4028},{"text":"S-100","label":"DIAGNOSTIC_PROCEDURE","start":4037,"end":4042},{"text":"HMB45","label":"DIAGNOSTIC_PROCEDURE","start":4044,"end":4049},{"text":"Vimentin","label":"DIAGNOSTIC_PROCEDURE","start":4055,"end":4063},{"text":"immunopositive","label":"LAB_VALUE","start":4069,"end":4083},{"text":"neuroendocrine tumor markers","label":"DIAGNOSTIC_PROCEDURE","start":4088,"end":4116},{"text":"CgA","label":"DIAGNOSTIC_PROCEDURE","start":4125,"end":4128},{"text":"Syn","label":"DIAGNOSTIC_PROCEDURE","start":4133,"end":4136},{"text":"Ki67 index","label":"DIAGNOSTIC_PROCEDURE","start":4150,"end":4160},{"text":"3% to 5%","label":"LAB_VALUE","start":4165,"end":4173},{"text":"higher","label":"LAB_VALUE","start":4182,"end":4188},{"text":"metastatic melanoma than in the adenomatous component","label":"DETAILED_DESCRIPTION","start":4192,"end":4245},{"text":"MMPA","label":"DISEASE_DISORDER","start":4375,"end":4379},{"text":"relief","label":"LAB_VALUE","start":4408,"end":4414},{"text":"visual field","label":"DIAGNOSTIC_PROCEDURE","start":4427,"end":4439},{"text":"headache","label":"SIGN_SYMPTOM","start":4444,"end":4452},{"text":"prolactin","label":"DIAGNOSTIC_PROCEDURE","start":4471,"end":4480},{"text":"cortisol","label":"DIAGNOSTIC_PROCEDURE","start":4482,"end":4490},{"text":"FT4","label":"DIAGNOSTIC_PROCEDURE","start":4496,"end":4499},{"text":"normal","label":"LAB_VALUE","start":4512,"end":4518},{"text":"hormone replacement therapy","label":"MEDICATION","start":4524,"end":4551},{"text":"discomfort","label":"SIGN_SYMPTOM","start":4625,"end":4635},{"text":"surgical intervention","label":"THERAPEUTIC_PROCEDURE","start":4669,"end":4690},{"text":"discharged","label":"CLINICAL_EVENT","start":4719,"end":4729},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":4739,"end":4747},{"text":"disease","label":"DISEASE_DISORDER","start":4768,"end":4775},{"text":"2 months after","label":"DATE","start":4787,"end":4801},{"text":"melanoma","label":"DISEASE_DISORDER","start":4856,"end":4864},{"text":"metastatic sites","label":"SIGN_SYMPTOM","start":4865,"end":4881},{"text":"skin of lower left leg","label":"BIOLOGICAL_STRUCTURE","start":4889,"end":4911},{"text":"upper left leg","label":"BIOLOGICAL_STRUCTURE","start":4924,"end":4938},{"text":"left groin","label":"BIOLOGICAL_STRUCTURE","start":4944,"end":4954},{"text":"right groin","label":"BIOLOGICAL_STRUCTURE","start":4963,"end":4974},{"text":"right leg","label":"BIOLOGICAL_STRUCTURE","start":4984,"end":4993},{"text":"follow-up","label":"CLINICAL_EVENT","start":5002,"end":5011},{"text":"late January 2016","label":"DATE","start":5015,"end":5032},{"text":"walk","label":"ACTIVITY","start":5056,"end":5060},{"text":"live by herself","label":"ACTIVITY","start":5065,"end":5080},{"text":"depressed","label":"DISEASE_DISORDER","start":5089,"end":5098},{"text":"follow-up","label":"CLINICAL_EVENT","start":5114,"end":5123},{"text":"late January, 2017","label":"DATE","start":5128,"end":5146},{"text":"alive","label":"SIGN_SYMPTOM","start":5164,"end":5169},{"text":"symptoms","label":"SIGN_SYMPTOM","start":5181,"end":5189},{"text":"sensory deficits","label":"SIGN_SYMPTOM","start":5199,"end":5215},{"text":"both legs","label":"BIOLOGICAL_STRUCTURE","start":5219,"end":5228},{"text":"could not move","label":"SIGN_SYMPTOM","start":5236,"end":5250},{"text":"hyperalgesia","label":"SIGN_SYMPTOM","start":5252,"end":5264},{"text":"hands","label":"BIOLOGICAL_STRUCTURE","start":5268,"end":5273},{"text":"mouth","label":"BIOLOGICAL_STRUCTURE","start":5278,"end":5283},{"text":"impaired intelligence","label":"SIGN_SYMPTOM","start":5285,"end":5306},{"text":"nursing","label":"CLINICAL_EVENT","start":5355,"end":5362},{"text":"daughter","label":"SUBJECT","start":5370,"end":5378}],"tokens":["n ","March 2015",", a ","62-year-old"," ","woman"," was ","admitted"," to our ","hospital",".\nShe complained of ","progressive"," ","visual disturbance",", which began about ","4 years ago"," and was treated as ","cataract"," in ","local hospital",", but no ","relief"," was seen.\nOn the contrary, the ","symptoms"," aggravated ","half a year ago",", together with ","headache",", ","left eye"," ","pain",", ","tearing"," and increased ","secretions",", and the ","computed tomography"," (","CT",") scan of the ","brain"," in ","local hospital"," showed a ","sellar region"," ","lesion",".\nBesides, ","2 years earlier",", the patient underwent ","resection"," of ","melanoma"," in the ","left heel"," (","T2N0M0",", ","ki67 3\u20135%",", ","Stage II","), followed by ","resection"," of the ","recurred"," ","melanoma"," ","nearby the primary site"," ","15 months later"," (","T3N3M0",", ","Stage III","), without ","lymphadenectomy",".\nShe had ","no family history of melanoma",".\nOn ","physical examination",", the patient had ","bilateral"," ","temporal"," ","hemianopsia",", the ","right finger counting"," was ","1\u200am",", and the ","left finger counting"," was ","no more than 0.5\u200am",".\n","Enlarged"," ","lymph nodes"," were palpable in the ","right groin",".\nOn ","ophthalmologic examination",", the patient had ","right vision"," of ","0.4"," and ","left vision"," of ","0.08",", with the same ","intraocular pressure"," ","15\u200amm Hg"," ","bilaterally",".\nThe ","optometry"," found the ","right eye"," of ","+6.00DS\/+0.25DC\u221765\u00b0"," and the ","left eye"," of ","+6.25DS\/+0.50DC\u221720\u00b0",".\nThe patient had ","maculopathy"," of ","both eyes"," and ","optic atrophy"," of the ","left eye",".\n","Light reflex"," and ","eye movement"," of ","both eyes"," were ","normal",".\n","CT"," scans of the ","brain parenchyma",", ","orbital",", and ","chest"," were ","unremarkable",".\n","CT"," scan and ","ultrasound"," examination of the ","abdomen"," showed ","hepatic portal"," and ","retroperitoneal"," ","lymphadenectasis"," and ","enlarged"," ","left lobe of the liver"," with ","substantial"," ","placeholder"," ","lesions",".\n","Ultrasound"," examination of ","bilateral"," ","inguinal lymph nodes"," discovered ","multiple"," ","low echo light groups",", the ","largest of which was 31\u200amm"," in diameter, with ","hilus of the echo"," and ","asymmetrical"," ","thickening"," of the ","skin",".\n","CT"," scan of ","sellar region"," revealed a ","crumby"," ","mass",", protruding out of the ","sphenoid sinus",", with ","obscure boundary"," and ","bone destruction",".\nAnd the ","average"," ","CT value"," of the ","mass"," was ","46\u200aHU",".\n","Sellar region"," ","magnetic resonance imaging"," (","MRI",") revealed a ","round"," ","mass"," of ","30\u200amm"," in diameter in the ","enlarged sellae"," (Fig.1A, B).\nThe ","mass"," showed ","isointense"," in ","T1-weighted images"," (","T1-WI",") and ","T2-weighted images"," (","T2-WI","), with ","homogeneous"," ","enhancement"," after ","Gadolinium-DTPA injection",", and ","dural tail sign"," was seen.\nSmall foci inside the ","tumor"," showed ","hyperintense signals"," in ","T1-WI"," and ","hypointense signals"," in ","T2-WI",", ","without enhancement",".\nAnd it was seen that the ","mass"," penetrated ","meninges",", surrounded the ","left internal carotid artery",", and was blurred with the ","left optic nerve",".\n","Pituitary stalk"," became ","shorter"," with a ","right displacement",".\n","Laboratory findings"," revealed ","increased"," levels of ","prolactin"," (","119.08\u200a\u03bcg\/L",", normal range 5.99\u201330.04\u200a\u03bcg\/L) and ","cortisol"," (","677.10\u200anmol\/L",", normal range 118.60\u2013618.00\u200anmol\/L) and ","decreased"," levels of ","free thyroxine"," (","FT4",") (","6.04\u200apmol\/L",", normal range 12.00\u201322.00\u200apmol\/L) and ","free triiodothyronine"," (","FT3",") (","2.09\u200apmol\/L",", normal range 3.50\u20136.50\u200apmol\/L).\nThe patient was diagnosed with a ","giant"," ","prolactinoma",".\nThe patient underwent ","transnasal"," ","transsphenoidal"," ","surgery"," to remove the tumor and relieve the compression of the optic nerve.\nIntraoperatively, it was seen that the ","tumor"," invaded and filled the ","left interval of the sphenoid sinus",", and part of ","bone in sellar floor"," and ","left side parasellar"," was ","destroyed"," and ","absorbed",".\nA ","little normal pituitary tissue was seen in the top right"," of ","tumor"," in the ","sellar turcica",".\nThe ","tumor"," was ","reddish black"," with ","extremely rich blood supply"," and had ","close adhesion to the surrounding structure",".\nThe texture in the center of the ","tumor"," was ","soft"," and ","much tougher over the rim",".\n","Intraoperative"," ","frozen-section examination"," found ","melanin granules",", and it was considered to be ","malignant melanoma"," or ","meningioma",".\nThe ","tumor cells"," were composed of ","eosinophilic staining epithelial cells",".\nMost of ","cell nuclei"," were ","round",", a few were ","reniform"," and ","hippocrepiform"," with ","evident"," ","nucleoli",", and ","nuclear fission"," was ","seen",".\nThe ","tumor"," showed no evidence of ","necrosis"," (Fig.2).\nThe tumor was ","immunopositive"," ","focally"," for ","melanoma-specific markers"," such as ","S-100",", ","HMB45",", and ","Vimentin",", and ","immunopositive"," for ","neuroendocrine tumor markers"," such as ","CgA"," and ","Syn"," (Fig.3).\nThe ","Ki67 index"," was ","3% to 5%","; it was ","higher"," in ","metastatic melanoma than in the adenomatous component",".\nTaken the melanoma history and suspected lymph node and hepatic metastasis into consideration, the patient was diagnosised with ","MMPA",".\nAfter surgery, significant ","relief"," was seen in ","visual field"," and ","headache",", and the level of ","prolactin",", ","cortisol",", and ","FT4"," returned to ","normal"," with ","hormone replacement therapy",".\nBecause the focal liver lesions and lymphadenectasis did not cause much ","discomfort",", the patient refused any further ","surgical intervention"," or other treatment.\nShe was ","discharged"," from the ","hospital"," immediately and was ","disease"," free until ","2 months after"," the third surgery.\nThe patient successively found new ","melanoma"," ","metastatic sites"," in the ","skin of lower left leg",", knees, the ","upper left leg",", the ","left groin"," and the ","right groin",", and the ","right leg",".\nAt the ","follow-up"," in ","late January 2016",", the patient could not ","walk"," and ","live by herself"," and was ","depressed",".\nAt the latest ","follow-up",", in ","late January, 2017",", the patient was ","alive"," with worse ","symptoms",", she had ","sensory deficits"," of ","both legs",", which ","could not move",", ","hyperalgesia"," of ","hands"," and ","mouth",", ","impaired intelligence",", but she lived well with the disease by careful ","nursing"," of her ","daughter",".\n"],"ner_labels":[0,19,0,5,0,65,0,13,0,48,0,22,0,69,0,19,0,26,0,48,0,69,0,69,0,19,0,69,0,12,0,69,0,69,0,69,0,24,0,24,0,12,0,48,0,12,0,69,0,19,0,75,0,26,0,12,0,42,0,42,0,42,0,75,0,22,0,26,0,12,0,19,0,42,0,42,0,75,0,34,0,24,0,22,0,22,0,69,0,24,0,42,0,24,0,42,0,69,0,12,0,12,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,24,0,12,0,42,0,12,0,42,0,26,0,12,0,26,0,12,0,24,0,24,0,12,0,42,0,24,0,12,0,12,0,12,0,42,0,24,0,24,0,12,0,12,0,12,0,69,0,69,0,12,0,63,0,22,0,69,0,24,0,22,0,12,0,22,0,69,0,27,0,22,0,22,0,69,0,12,0,24,0,12,0,73,0,69,0,12,0,22,0,22,0,22,0,24,0,69,0,42,0,12,0,24,0,24,0,67,0,69,0,27,0,12,0,18,0,69,0,24,0,24,0,24,0,24,0,22,0,69,0,22,0,22,0,18,0,69,0,24,0,69,0,24,0,22,0,18,0,12,0,12,0,12,0,12,0,69,0,22,0,24,0,42,0,24,0,42,0,24,0,42,0,42,0,24,0,24,0,42,0,24,0,24,0,42,0,22,0,26,0,22,0,22,0,75,0,69,0,12,0,12,0,12,0,69,0,69,0,22,0,18,0,12,0,18,0,15,0,22,0,22,0,18,0,73,0,73,0,22,0,24,0,69,0,26,0,26,0,18,0,22,0,24,0,67,0,42,0,42,0,42,0,24,0,24,0,42,0,18,0,69,0,42,0,22,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,42,0,42,0,22,0,26,0,42,0,24,0,69,0,24,0,24,0,24,0,42,0,46,0,69,0,75,0,13,0,48,0,26,0,19,0,26,0,69,0,12,0,12,0,12,0,12,0,12,0,13,0,19,0,1,0,1,0,26,0,13,0,19,0,69,0,69,0,69,0,12,0,69,0,69,0,12,0,12,0,69,0,13,0,71,0]}
-{"full_text":"In 2013, a 50-year-old man patient visited hospital complaining of local bone pain in the left leg.\nOn August 14, 2013, the patient underwent a left distal femoral tumor en bloc resection and reconstruction with a modular femoral prosthetic system.\nPathology diagnosis confirmed osteoblastic osteosarcoma (Fig.2).\nOne cycle of neoadjuvant chemotherapy and 4 cycles of adjuvant chemotherapy with MAP regimen (high-dose methotrexate, cisplatin, and doxorubicin) were administered.\nIn January 2015, a mass was found on the left upper crus area.\nTumor recurrence was confirmed by biopsy on January 23, 2015.\nHowever, only an upper femur amputation was carried out, as the patient refused hip joint replacement.\nAfter wound healing, the patient went back to his normal life in the help of artificial limb, but refused to receive further chemotherapy due to concerns regarding the chemotherapy toxicities such as nausea, vomiting, leucopenia, deadlimb, and headache.\nAbout half a year after the amputation, the patient got occasional cough and chest tightness.\nThen a thin chest computed tomography (CT) was performed on July 15, 2015.\nThe CT results revealed multiple pulmonary nodules (Table \u200b1), considering the possibility of metastases.\nThe patient still rejected further chemotherapy.\nImmunophenotype was suggestive of CD31+ and CD34+ tumor cells (Fig.3).\nFurthermore, most cells showed strong positive staining for VEGFR-2 (Fig.3).\nApatinib was administered at a dose of 500\u200amg daily.\nHalf a month later, the symptoms disappeared, but a progressive wound necrosis appeared.\nA debridement surgery was finally conducted and an enlarged lymph node near iliac vessels was resected on February 24, 2016 (Fig.(Fig.4).4).\nThe result of pathological examination revealed an inflammatory hyperplasia lymph node.\nApatinib administration was stopped during the 3 weeks of wound healing period.\nThe thin chest CT was performed 7 and 11 months following apatinib administration.\nAt the 7-month follow-up time point, 2 out of 5 measurable and 9 out of 17 non-measurable lesions disappeared, but 1 new measurable nodule and 6 new non-measurable lesions were observed (Table \u200b1, Fig.5), which considered PD according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 standard.\nHowever, at the 11-month follow-up time point, a total of 9 lesions disappeared, including 1 measurable nodule and 2 non-measurable lesions presented before apatinib treatment as well as 6 non-measureable lesions presented 7 months after apatinib treatment.\nNo new lesion was raised.\nAfter target lesion measurement according to the RECIST 1.1 standard, it was narrowly considered PR.\nThe toxicities the patient experienced included mild hand-foot syndrome and slight high blood pressure.\nBoth were well controlled after appropriate treatment.\nNo severe toxicities and other treatment-related adverse events were observed.\nThe patient continued to use apatinib as maintenance therapy without major toxic effects, and went back to normal life, even driving an automatic car.\n","ner_info":[{"text":"In 2013","label":"DATE","start":0,"end":7},{"text":"50-year-old","label":"AGE","start":11,"end":22},{"text":"man","label":"SEX","start":23,"end":26},{"text":"visited","label":"CLINICAL_EVENT","start":35,"end":42},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":43,"end":51},{"text":"local","label":"DETAILED_DESCRIPTION","start":67,"end":72},{"text":"bone","label":"BIOLOGICAL_STRUCTURE","start":73,"end":77},{"text":"pain","label":"SIGN_SYMPTOM","start":78,"end":82},{"text":"left leg","label":"BIOLOGICAL_STRUCTURE","start":90,"end":98},{"text":"August 14, 2013","label":"DATE","start":103,"end":118},{"text":"left distal femoral","label":"BIOLOGICAL_STRUCTURE","start":144,"end":163},{"text":"tumor","label":"SIGN_SYMPTOM","start":164,"end":169},{"text":"en bloc","label":"DETAILED_DESCRIPTION","start":170,"end":177},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":178,"end":187},{"text":"reconstruction","label":"THERAPEUTIC_PROCEDURE","start":192,"end":206},{"text":"modular femoral prosthetic system","label":"DETAILED_DESCRIPTION","start":214,"end":247},{"text":"Pathology diagnosis","label":"DIAGNOSTIC_PROCEDURE","start":249,"end":268},{"text":"osteoblastic","label":"DETAILED_DESCRIPTION","start":279,"end":291},{"text":"osteosarcoma","label":"DISEASE_DISORDER","start":292,"end":304},{"text":"One cycle","label":"DOSAGE","start":314,"end":323},{"text":"neoadjuvant","label":"DETAILED_DESCRIPTION","start":327,"end":338},{"text":"chemotherapy","label":"MEDICATION","start":339,"end":351},{"text":"4 cycles","label":"DOSAGE","start":356,"end":364},{"text":"adjuvant","label":"DETAILED_DESCRIPTION","start":368,"end":376},{"text":"chemotherapy","label":"MEDICATION","start":377,"end":389},{"text":"MAP 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for VEGFR-2","label":"DIAGNOSTIC_PROCEDURE","start":1403,"end":1423},{"text":"Apatinib","label":"MEDICATION","start":1433,"end":1441},{"text":"500\u200amg daily","label":"DOSAGE","start":1472,"end":1484},{"text":"Half a month later","label":"DATE","start":1486,"end":1504},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1510,"end":1518},{"text":"progressive","label":"DETAILED_DESCRIPTION","start":1538,"end":1549},{"text":"wound necrosis","label":"SIGN_SYMPTOM","start":1550,"end":1564},{"text":"debridement surgery","label":"THERAPEUTIC_PROCEDURE","start":1577,"end":1596},{"text":"enlarged","label":"SIGN_SYMPTOM","start":1626,"end":1634},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":1635,"end":1645},{"text":"near iliac vessels","label":"BIOLOGICAL_STRUCTURE","start":1646,"end":1664},{"text":"resected","label":"THERAPEUTIC_PROCEDURE","start":1669,"end":1677},{"text":"February 24, 2016","label":"DATE","start":1681,"end":1698},{"text":"pathological 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of 17 non-measurable","label":"LAB_VALUE","start":2030,"end":2056},{"text":"lesions","label":"SIGN_SYMPTOM","start":2057,"end":2064},{"text":"1 new measurable","label":"LAB_VALUE","start":2082,"end":2098},{"text":"nodule","label":"SIGN_SYMPTOM","start":2099,"end":2105},{"text":"6 new non-measurable","label":"LAB_VALUE","start":2110,"end":2130},{"text":"lesions","label":"SIGN_SYMPTOM","start":2131,"end":2138},{"text":"PD","label":"LAB_VALUE","start":2189,"end":2191},{"text":"Response Evaluation Criteria in Solid Tumors","label":"DIAGNOSTIC_PROCEDURE","start":2209,"end":2253},{"text":"RECIST","label":"DIAGNOSTIC_PROCEDURE","start":2255,"end":2261},{"text":"1.1","label":"DETAILED_DESCRIPTION","start":2263,"end":2266},{"text":"11-month","label":"DATE","start":2293,"end":2301},{"text":"follow-up","label":"CLINICAL_EVENT","start":2302,"end":2311},{"text":"9","label":"LAB_VALUE","start":2335,"end":2336},{"text":"lesions","label":"SIGN_SYMPTOM","start":2337,"end":2344},{"text":"1 measurable nodule","label":"LAB_VALUE","start":2368,"end":2387},{"text":"2 non-measurable lesions","label":"LAB_VALUE","start":2392,"end":2416},{"text":"6 non-measureable lesions","label":"LAB_VALUE","start":2464,"end":2489},{"text":"lesion","label":"DETAILED_DESCRIPTION","start":2574,"end":2580},{"text":"measurement","label":"DIAGNOSTIC_PROCEDURE","start":2581,"end":2592},{"text":"RECIST 1.1 standard","label":"DIAGNOSTIC_PROCEDURE","start":2610,"end":2629},{"text":"PR","label":"LAB_VALUE","start":2658,"end":2660},{"text":"mild","label":"SEVERITY","start":2710,"end":2714},{"text":"hand-foot syndrome","label":"DISEASE_DISORDER","start":2715,"end":2733},{"text":"slight","label":"SEVERITY","start":2738,"end":2744},{"text":"high blood pressure","label":"SIGN_SYMPTOM","start":2745,"end":2764},{"text":"well controlled after appropriate 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","reconstruction"," with a ","modular femoral prosthetic system",".\n","Pathology diagnosis"," confirmed ","osteoblastic"," ","osteosarcoma"," (Fig.2).\n","One cycle"," of ","neoadjuvant"," ","chemotherapy"," and ","4 cycles"," of ","adjuvant"," ","chemotherapy"," with ","MAP regimen"," (","high-dose"," ","methotrexate",", ","cisplatin",", and ","doxorubicin",") were administered.\nIn ","January 2015",", a ","mass"," was found on the ","left upper crus area",".\nTumor ","recurrence"," was confirmed by ","biopsy"," on ","January 23, 2015",".\nHowever, only an ","upper femur"," ","amputation"," was carried out, as the patient refused ","hip"," ","joint replacement",".\nAfter ","wound healing",", the patient ","went back to his normal life"," in the help of ","artificial limb",", but refused to receive further ","chemotherapy"," due to concerns regarding the chemotherapy toxicities such as nausea, vomiting, leucopenia, deadlimb, and headache.\nAbout ","half a year after"," the amputation, the patient got ","occasional"," ","cough"," and ","chest"," ","tightness",".\nThen a ","thin"," ","chest"," ","computed tomography"," (","CT",") was performed on ","July 15, 2015",".\nThe CT results revealed ","multiple"," ","pulmonary"," ","nodules"," (Table \u200b1), considering the possibility of ","metastases",".\nThe patient still rejected further ","chemotherapy",".\n","Immunophenotype"," was suggestive of ","CD31+"," and ","CD34+"," ","tumor"," cells (Fig.3).\nFurthermore, most ","cells"," showed ","strong positive"," ","staining for VEGFR-2"," (Fig.3).\n","Apatinib"," was administered at a dose of ","500\u200amg daily",".\n","Half a month later",", the ","symptoms"," disappeared, but a ","progressive"," ","wound necrosis"," appeared.\nA ","debridement surgery"," was finally conducted and an ","enlarged"," ","lymph node"," ","near iliac vessels"," was ","resected"," on ","February 24, 2016"," (Fig.(Fig.4).4).\nThe result of ","pathological examination"," revealed an ","inflammatory"," ","hyperplasia"," ","lymph node",".\n","Apatinib"," administration was stopped during the ","3 weeks"," of ","wound healing"," period.\nThe ","thin"," ","chest"," ","CT"," was performed ","7 and 11 months"," following apatinib administration.\nAt the ","7-month"," ","follow-up"," time point, ","2 out of 5 measurable"," and ","9 out of 17 non-measurable"," ","lesions"," disappeared, but ","1 new measurable"," ","nodule"," and ","6 new non-measurable"," ","lesions"," were observed (Table \u200b1, Fig.5), which considered ","PD"," according to the ","Response Evaluation Criteria in Solid Tumors"," (","RECIST",") ","1.1"," standard.\nHowever, at the ","11-month"," ","follow-up"," time point, a total of ","9"," ","lesions"," disappeared, including ","1 measurable nodule"," and ","2 non-measurable lesions"," presented before apatinib treatment as well as ","6 non-measureable lesions"," presented 7 months after apatinib treatment.\nNo new lesion was raised.\nAfter target ","lesion"," ","measurement"," according to the ","RECIST 1.1 standard",", it was narrowly considered ","PR",".\nThe toxicities the patient experienced included ","mild"," ","hand-foot syndrome"," and ","slight"," ","high blood pressure",".\nBoth were ","well controlled after appropriate treatment",".\nNo ","severe"," ","toxicities"," and other ","treatment-related"," ","adverse events"," were observed.\nThe patient continued to use ","apatinib"," as maintenance therapy without major ","toxic effects",", and ","went back to normal life",", even ","driving"," an ","automatic car",".\n"],"ner_labels":[0,19,0,5,0,65,0,13,0,48,0,22,0,12,0,69,0,12,0,19,0,12,0,69,0,22,0,75,0,75,0,22,0,24,0,22,0,26,0,29,0,22,0,46,0,29,0,22,0,46,0,46,0,29,0,46,0,46,0,46,0,19,0,69,0,12,0,69,0,24,0,19,0,12,0,75,0,12,0,75,0,75,0,13,0,75,0,46,0,19,0,22,0,69,0,12,0,69,0,22,0,12,0,24,0,24,0,19,0,22,0,12,0,69,0,69,0,46,0,24,0,22,0,22,0,69,0,18,0,42,0,24,0,46,0,29,0,19,0,69,0,22,0,69,0,75,0,69,0,12,0,12,0,75,0,19,0,24,0,22,0,69,0,12,0,46,0,32,0,75,0,22,0,12,0,24,0,19,0,19,0,13,0,42,0,42,0,69,0,42,0,69,0,42,0,69,0,42,0,24,0,24,0,22,0,19,0,13,0,42,0,69,0,42,0,42,0,42,0,22,0,24,0,24,0,42,0,63,0,26,0,63,0,69,0,42,0,63,0,69,0,22,0,69,0,46,0,69,0,13,0,1,0,22,0]}
-{"full_text":"A 61-year-old Chinese woman complained of dizziness for 3 weeks and was admitted to our hospital after a bifrontal mass was found radiologically.\nOther than dizziness, the patient presented no signs or symptoms that are commonly associated with neurological disease, such as headache, vomiting, sensory disturbances, altered consciousness, or seizures.\nExcept for a 20-year history of hypertension, which was properly controlled with angiotensin-converting enzyme inhibitors, the patient was otherwise healthy.\nNo special circumstances were identified regarding her personal or family history, and the patient was found to be normal upon neurological examination.\nPlain and contrast-enhanced magnetic resonance imaging (MRI) of the head showed a space-occupying lesion in the bifrontal lobe, mainly on the right side, clinging to the sagittal sinus and the cerebral falx.\nThe 5.7\u200a\u00d7\u200a5.0\u200a\u00d7\u200a5.0\u200acm dural-based mass growing across the sagittal midline revealed isointensity on the T1-weighted image and a slight hyperintensity on the T2-weighted image and was homogenously enhanced with a characteristic \u201cdural-tail\u201d sign (Fig.1).\nDiagnosis of a parasagittal-parafalcine meningioma was made, and a craniotomic meningioma resection was chosen as treatment.\nThe blood cell examination; coagulation function, liver and renal function tests; urinalysis; chest x-rays and electrocardiogram were normal.\nThe albumin was 36\u200ag\/L, the total bilirubin (TBil) was 12.2\u200a\u03bcmol\/L, and the direct bilirubin (DBil) was 4.1\u200a\u03bcmol\/L.\nAlanine transaminase (ALT) was 17\u200aU\/L, and the international normalized ratio (INR) for coagulation values was 1.02.\nBecause of the patient's advanced age and history of hypertension, we performed an echocardiograph and a blood gas analysis and tested her creatine kinase levels and pulmonary functions.\nThe results revealed no surgical contraindications.\nWritten consent was obtained from the patient.\nFive hundred milligrams of VPA twice per day was initiated 3 days before the operation.\nThe patient tolerated the administration well.\nA craniotomy was then performed with a radical tumor resection (Simpson II).\nThe tumor was pink and solid and had a moderate blood supply, and its texture was medium.\nThirty minutes before the end of surgery, 800\u200amg of VPA was administered by intravenous infusion.\nAfter the operation, the patient regained consciousness within 30 minutes and scored 15 on the Glasgow coma scale (GCS).\nTwo hours later as she was being transported back to her ward, the patient underwent UGH.\nThe vomitus (approximately 50\u200amL) was composed of coffee-colored blood.\nExcluding the possible etiology of endotracheal intubation damage, we diagnosed the patient as experiencing acute erosive-hemorrhagic gastritis, a reaction to the craniotomy injury.\nThe patient was given omeprazole to inhibit gastric acid secretion, and the hematemesis ceased.\nThe patient was administered VPA (1200\u200amg, intravenously) during the first 2 postoperative days.\nBecause of her stomach and intestine functional recovery, the VPA dosage was changed to 500\u200amg via oral administration twice a day.\nA brain MRI was performed on postoperative day 3, and it revealed that the tumor was radically removed and the operative field was clean (Fig.2A and B).\nA subsequent paraffin histological examination confirmed the diagnosis of meningioma.\nAt 3 am on postoperative day 4, the patient was suddenly found in a deep coma.\nHer pupils were dilated to 3.0\u200amm and round, and the light reflex was sensitive.\nThe neurological examination was unremarkable, and her vital signs were stable; however, her mental state gradually changed to a deep coma (GCS\u200a=\u200a8), which we believed was caused by intracranial lesions.\nA computerized tomography (CT) scan of the brain was immediately performed; however, it failed to reveal any abnormalities, such as severe brain swelling, intracranial hemorrhage, or cerebral infarction (Fig.2C).\nBecause a possible cerebral infarction could not be excluded within 24\u200ahours, glucocorticoid, mannitol, and a vasodilator were used.\nThe patient's routine laboratory results for blood cell, liver, and renal functions were in relatively normal ranges.\nThe albumin was 33\u200ag\/L, the TBil was 13.3\u200a\u03bcmol\/L, and the DBil was 4.5\u200a\u03bcmol\/L.\nALT was 12\u200aU\/L, and the INR for coagulation values was 1.01.\nBecause of her history of UGH, we checked her blood ammonia levels and performed a fecal occult blood test and blood gas analysis.\nHer blood ammonia was elevated (181.6\u200a\u03bcmol\/L; normal range is 11\u201332\u200a\u03bcmol\/L), whereas the fecal occult blood test was positive.\nThus, considering her history and elevated blood ammonia, she was diagnosed with UGH-induced hepatic encephalopathy, and the oral administration of VPA was changed to intravenous administration to prevent seizures.\nLactulose, vitamin B, and L-arginine were administered, clysis with vinegar was performed, and the patient was fasted.\nThe patient's blood ammonia level fluctuated (144.8\u2013207.7\u200a\u03bcmol\/L), and she remained unconscious during the following 3 days.\nBecause of the unremarkable progress in the patient's mental state and blood ammonia level, we held a multidisciplinary conference to discuss diagnosis and treatment, initially considering hemodialysis or peritoneal dialysis.\nAfter the multidisciplinary discussion, a suspected diagnosis of VHE was finally made, even though the blood VPA level was within the normal range.\nWe decided to stop VPA administration before performing any dialysis and administered levetiracetam instead of VPA.\nThe patient's blood VPA and ammonia levels were then routinely monitored.\nThe patient's mental state began to improve from the first 24\u200ahours of VPA discontinuation, and she achieved complete consciousness within 48\u200ahours (GCS\u200a=\u200a15).\nThe ammonia levels in her blood decreased dramatically and returned to normal within 4 days (Fig.3).\nOn postoperative day 15 (8 days after the discontinuation of VPA), the patient was discharged with no complications.\nThe follow-up interviews in postoperative month 5 witnessed her full consciousness and non-recurrence of the primary tumor (Fig.2D).\nThe patient's GCS score was 15, and she reported enjoying a satisfying quality of postoperative life.\n","ner_info":[{"text":"61-year-old","label":"AGE","start":2,"end":13},{"text":"Chinese","label":"PERSONAL_BACKGROUND","start":14,"end":21},{"text":"woman","label":"SEX","start":22,"end":27},{"text":"dizziness","label":"SIGN_SYMPTOM","start":42,"end":51},{"text":"3 weeks","label":"DURATION","start":56,"end":63},{"text":"admitted","label":"CLINICAL_EVENT","start":72,"end":80},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":88,"end":96},{"text":"bifrontal","label":"BIOLOGICAL_STRUCTURE","start":105,"end":114},{"text":"mass","label":"SIGN_SYMPTOM","start":115,"end":119},{"text":"radiologically","label":"DIAGNOSTIC_PROCEDURE","start":130,"end":144},{"text":"dizziness","label":"SIGN_SYMPTOM","start":157,"end":166},{"text":"signs or symptoms that are commonly associated with neurological disease","label":"SIGN_SYMPTOM","start":193,"end":265},{"text":"headache","label":"SIGN_SYMPTOM","start":275,"end":283},{"text":"vomiting","label":"SIGN_SYMPTOM","start":285,"end":293},{"text":"sensory disturbances","label":"SIGN_SYMPTOM","start":295,"end":315},{"text":"altered consciousness","label":"SIGN_SYMPTOM","start":317,"end":338},{"text":"seizures","label":"SIGN_SYMPTOM","start":343,"end":351},{"text":"20-year history of hypertension","label":"HISTORY","start":366,"end":397},{"text":"angiotensin-converting enzyme inhibitors","label":"MEDICATION","start":434,"end":474},{"text":"healthy","label":"SIGN_SYMPTOM","start":502,"end":509},{"text":"No special circumstances were identified regarding her personal or family history","label":"FAMILY_HISTORY","start":511,"end":592},{"text":"normal","label":"LAB_VALUE","start":626,"end":632},{"text":"neurological examination","label":"DIAGNOSTIC_PROCEDURE","start":638,"end":662},{"text":"Plain","label":"DETAILED_DESCRIPTION","start":664,"end":669},{"text":"contrast-enhanced","label":"DETAILED_DESCRIPTION","start":674,"end":691},{"text":"magnetic resonance imaging","label":"DIAGNOSTIC_PROCEDURE","start":692,"end":718},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":720,"end":723},{"text":"head","label":"BIOLOGICAL_STRUCTURE","start":732,"end":736},{"text":"space-occupying","label":"DETAILED_DESCRIPTION","start":746,"end":761},{"text":"lesion","label":"SIGN_SYMPTOM","start":762,"end":768},{"text":"bifrontal lobe","label":"BIOLOGICAL_STRUCTURE","start":776,"end":790},{"text":"mainly on the right side","label":"BIOLOGICAL_STRUCTURE","start":792,"end":816},{"text":"clinging to the sagittal sinus","label":"BIOLOGICAL_STRUCTURE","start":818,"end":848},{"text":"cerebral falx","label":"BIOLOGICAL_STRUCTURE","start":857,"end":870},{"text":"5.7\u200a\u00d7\u200a5.0\u200a\u00d7\u200a5.0\u200acm","label":"VOLUME","start":876,"end":894},{"text":"mass","label":"COREFERENCE","start":907,"end":911},{"text":"across the sagittal midline","label":"BIOLOGICAL_STRUCTURE","start":920,"end":947},{"text":"isointensity","label":"SIGN_SYMPTOM","start":957,"end":969},{"text":"T1-weighted image","label":"DIAGNOSTIC_PROCEDURE","start":977,"end":994},{"text":"hyperintensity","label":"SIGN_SYMPTOM","start":1008,"end":1022},{"text":"T2-weighted image","label":"DIAGNOSTIC_PROCEDURE","start":1030,"end":1047},{"text":"characteristic \u201cdural-tail\u201d sign","label":"DETAILED_DESCRIPTION","start":1085,"end":1117},{"text":"parasagittal-parafalcine","label":"DETAILED_DESCRIPTION","start":1142,"end":1166},{"text":"meningioma","label":"DISEASE_DISORDER","start":1167,"end":1177},{"text":"craniotomic","label":"DETAILED_DESCRIPTION","start":1194,"end":1205},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1217,"end":1226},{"text":"blood cell examination","label":"DIAGNOSTIC_PROCEDURE","start":1256,"end":1278},{"text":"coagulation function","label":"DIAGNOSTIC_PROCEDURE","start":1280,"end":1300},{"text":"liver and renal function","label":"DIAGNOSTIC_PROCEDURE","start":1302,"end":1326},{"text":"urinalysis","label":"DIAGNOSTIC_PROCEDURE","start":1334,"end":1344},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1346,"end":1351},{"text":"x-rays","label":"DIAGNOSTIC_PROCEDURE","start":1352,"end":1358},{"text":"electrocardiogram","label":"DIAGNOSTIC_PROCEDURE","start":1363,"end":1380},{"text":"normal","label":"LAB_VALUE","start":1386,"end":1392},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":1398,"end":1405},{"text":"36\u200ag\/L","label":"LAB_VALUE","start":1410,"end":1416},{"text":"total bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1422,"end":1437},{"text":"TBil","label":"DIAGNOSTIC_PROCEDURE","start":1439,"end":1443},{"text":"12.2\u200a\u03bcmol\/L","label":"LAB_VALUE","start":1449,"end":1460},{"text":"direct bilirubin","label":"DIAGNOSTIC_PROCEDURE","start":1470,"end":1486},{"text":"DBil","label":"DIAGNOSTIC_PROCEDURE","start":1488,"end":1492},{"text":"4.1\u200a\u03bcmol\/L","label":"LAB_VALUE","start":1498,"end":1508},{"text":"Alanine transaminase","label":"DIAGNOSTIC_PROCEDURE","start":1510,"end":1530},{"text":"ALT","label":"DIAGNOSTIC_PROCEDURE","start":1532,"end":1535},{"text":"17\u200aU\/L","label":"LAB_VALUE","start":1541,"end":1547},{"text":"international normalized ratio","label":"DIAGNOSTIC_PROCEDURE","start":1557,"end":1587},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":1589,"end":1592},{"text":"1.02","label":"LAB_VALUE","start":1621,"end":1625},{"text":"echocardiograph","label":"DIAGNOSTIC_PROCEDURE","start":1710,"end":1725},{"text":"blood gas analysis","label":"DIAGNOSTIC_PROCEDURE","start":1732,"end":1750},{"text":"creatine kinase","label":"DIAGNOSTIC_PROCEDURE","start":1766,"end":1781},{"text":"pulmonary functions","label":"DIAGNOSTIC_PROCEDURE","start":1793,"end":1812},{"text":"no surgical contraindications","label":"LAB_VALUE","start":1835,"end":1864},{"text":"Five hundred milligrams","label":"DOSAGE","start":1913,"end":1936},{"text":"VPA","label":"MEDICATION","start":1940,"end":1943},{"text":"twice per day","label":"DOSAGE","start":1944,"end":1957},{"text":"3 days before the operation","label":"DATE","start":1972,"end":1999},{"text":"craniotomy","label":"THERAPEUTIC_PROCEDURE","start":2050,"end":2060},{"text":"tumor resection","label":"THERAPEUTIC_PROCEDURE","start":2095,"end":2110},{"text":"tumor","label":"COREFERENCE","start":2129,"end":2134},{"text":"pink","label":"COLOR","start":2139,"end":2143},{"text":"solid","label":"DETAILED_DESCRIPTION","start":2148,"end":2153},{"text":"moderate blood supply","label":"DETAILED_DESCRIPTION","start":2164,"end":2185},{"text":"medium","label":"TEXTURE","start":2207,"end":2213},{"text":"Thirty minutes before the end of surgery","label":"TIME","start":2215,"end":2255},{"text":"800\u200amg","label":"DOSAGE","start":2257,"end":2263},{"text":"VPA","label":"MEDICATION","start":2267,"end":2270},{"text":"intravenous infusion","label":"ADMINISTRATION","start":2291,"end":2311},{"text":"consciousness","label":"SIGN_SYMPTOM","start":2355,"end":2368},{"text":"within 30 minutes","label":"TIME","start":2369,"end":2386},{"text":"15","label":"LAB_VALUE","start":2398,"end":2400},{"text":"Glasgow coma scale","label":"DIAGNOSTIC_PROCEDURE","start":2408,"end":2426},{"text":"GCS","label":"DIAGNOSTIC_PROCEDURE","start":2428,"end":2431},{"text":"Two hours later","label":"DATE","start":2434,"end":2449},{"text":"transported","label":"CLINICAL_EVENT","start":2467,"end":2478},{"text":"ward","label":"NONBIOLOGICAL_LOCATION","start":2491,"end":2495},{"text":"UGH","label":"DISEASE_DISORDER","start":2519,"end":2522},{"text":"vomitus","label":"SIGN_SYMPTOM","start":2528,"end":2535},{"text":"approximately 50\u200amL","label":"VOLUME","start":2537,"end":2556},{"text":"coffee-colored","label":"COLOR","start":2574,"end":2588},{"text":"blood","label":"DETAILED_DESCRIPTION","start":2589,"end":2594},{"text":"endotracheal","label":"BIOLOGICAL_STRUCTURE","start":2631,"end":2643},{"text":"intubation","label":"DETAILED_DESCRIPTION","start":2644,"end":2654},{"text":"damage","label":"SIGN_SYMPTOM","start":2655,"end":2661},{"text":"acute","label":"DETAILED_DESCRIPTION","start":2704,"end":2709},{"text":"erosive-hemorrhagic","label":"DETAILED_DESCRIPTION","start":2710,"end":2729},{"text":"gastritis","label":"DISEASE_DISORDER","start":2730,"end":2739},{"text":"craniotomy","label":"DETAILED_DESCRIPTION","start":2759,"end":2769},{"text":"injury","label":"SIGN_SYMPTOM","start":2770,"end":2776},{"text":"omeprazole","label":"MEDICATION","start":2800,"end":2810},{"text":"hematemesis","label":"SIGN_SYMPTOM","start":2854,"end":2865},{"text":"VPA","label":"MEDICATION","start":2903,"end":2906},{"text":"1200\u200amg","label":"DOSAGE","start":2908,"end":2915},{"text":"intravenously","label":"ADMINISTRATION","start":2917,"end":2930},{"text":"during the first 2 postoperative days","label":"DATE","start":2932,"end":2969},{"text":"VPA","label":"MEDICATION","start":3033,"end":3036},{"text":"500\u200amg","label":"DOSAGE","start":3059,"end":3065},{"text":"oral","label":"ADMINISTRATION","start":3070,"end":3074},{"text":"twice a day","label":"DOSAGE","start":3090,"end":3101},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":3105,"end":3110},{"text":"MRI","label":"DIAGNOSTIC_PROCEDURE","start":3111,"end":3114},{"text":"day 3","label":"DATE","start":3146,"end":3151},{"text":"tumor","label":"SIGN_SYMPTOM","start":3178,"end":3183},{"text":"operative field","label":"DIAGNOSTIC_PROCEDURE","start":3214,"end":3229},{"text":"clean","label":"LAB_VALUE","start":3234,"end":3239},{"text":"paraffin","label":"DETAILED_DESCRIPTION","start":3269,"end":3277},{"text":"histological examination","label":"DIAGNOSTIC_PROCEDURE","start":3278,"end":3302},{"text":"meningioma","label":"DISEASE_DISORDER","start":3330,"end":3340},{"text":"3 am","label":"TIME","start":3345,"end":3349},{"text":"day 4","label":"TIME","start":3367,"end":3372},{"text":"deep","label":"SEVERITY","start":3410,"end":3414},{"text":"coma","label":"DISEASE_DISORDER","start":3415,"end":3419},{"text":"pupils were dilated","label":"SIGN_SYMPTOM","start":3425,"end":3444},{"text":"3.0\u200amm","label":"DISTANCE","start":3448,"end":3454},{"text":"round","label":"SHAPE","start":3459,"end":3464},{"text":"light reflex","label":"DIAGNOSTIC_PROCEDURE","start":3474,"end":3486},{"text":"sensitive","label":"LAB_VALUE","start":3491,"end":3500},{"text":"neurological examination","label":"DIAGNOSTIC_PROCEDURE","start":3506,"end":3530},{"text":"unremarkable","label":"LAB_VALUE","start":3535,"end":3547},{"text":"vital signs","label":"DIAGNOSTIC_PROCEDURE","start":3557,"end":3568},{"text":"stable","label":"LAB_VALUE","start":3574,"end":3580},{"text":"mental state","label":"DIAGNOSTIC_PROCEDURE","start":3595,"end":3607},{"text":"gradually changed","label":"LAB_VALUE","start":3608,"end":3625},{"text":"deep","label":"LAB_VALUE","start":3631,"end":3635},{"text":"coma","label":"DISEASE_DISORDER","start":3636,"end":3640},{"text":"GCS","label":"DIAGNOSTIC_PROCEDURE","start":3642,"end":3645},{"text":"8","label":"LAB_VALUE","start":3648,"end":3649},{"text":"intracranial","label":"BIOLOGICAL_STRUCTURE","start":3684,"end":3696},{"text":"lesions","label":"SIGN_SYMPTOM","start":3697,"end":3704},{"text":"computerized tomography","label":"DIAGNOSTIC_PROCEDURE","start":3708,"end":3731},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":3733,"end":3735},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":3749,"end":3754},{"text":"failed to reveal any abnormalities","label":"LAB_VALUE","start":3794,"end":3828},{"text":"severe","label":"SEVERITY","start":3838,"end":3844},{"text":"brain","label":"BIOLOGICAL_STRUCTURE","start":3845,"end":3850},{"text":"swelling","label":"SIGN_SYMPTOM","start":3851,"end":3859},{"text":"intracranial hemorrhage","label":"DISEASE_DISORDER","start":3861,"end":3884},{"text":"cerebral infarction","label":"DISEASE_DISORDER","start":3889,"end":3908},{"text":"cerebral infarction","label":"DISEASE_DISORDER","start":3938,"end":3957},{"text":"within 24\u200ahours","label":"TIME","start":3980,"end":3995},{"text":"glucocorticoid","label":"MEDICATION","start":3997,"end":4011},{"text":"mannitol","label":"MEDICATION","start":4013,"end":4021},{"text":"vasodilator","label":"MEDICATION","start":4029,"end":4040},{"text":"laboratory results","label":"DIAGNOSTIC_PROCEDURE","start":4074,"end":4092},{"text":"blood cell","label":"BIOLOGICAL_STRUCTURE","start":4097,"end":4107},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":4109,"end":4114},{"text":"renal","label":"BIOLOGICAL_STRUCTURE","start":4120,"end":4125},{"text":"functions","label":"DIAGNOSTIC_PROCEDURE","start":4126,"end":4135},{"text":"relatively normal ranges","label":"LAB_VALUE","start":4144,"end":4168},{"text":"albumin","label":"DIAGNOSTIC_PROCEDURE","start":4174,"end":4181},{"text":"33\u200ag\/L","label":"LAB_VALUE","start":4186,"end":4192},{"text":"TBil","label":"DIAGNOSTIC_PROCEDURE","start":4198,"end":4202},{"text":"13.3\u200a\u03bcmol\/L","label":"LAB_VALUE","start":4207,"end":4218},{"text":"DBil","label":"DIAGNOSTIC_PROCEDURE","start":4228,"end":4232},{"text":"4.5\u200a\u03bcmol\/L","label":"LAB_VALUE","start":4237,"end":4247},{"text":"ALT","label":"DIAGNOSTIC_PROCEDURE","start":4249,"end":4252},{"text":"12\u200aU\/L","label":"LAB_VALUE","start":4257,"end":4263},{"text":"INR","label":"DIAGNOSTIC_PROCEDURE","start":4273,"end":4276},{"text":"1.01","label":"LAB_VALUE","start":4304,"end":4308},{"text":"history of UGH","label":"HISTORY","start":4325,"end":4339},{"text":"blood ammonia","label":"DIAGNOSTIC_PROCEDURE","start":4356,"end":4369},{"text":"fecal occult blood test","label":"DIAGNOSTIC_PROCEDURE","start":4393,"end":4416},{"text":"blood gas analysis","label":"DIAGNOSTIC_PROCEDURE","start":4421,"end":4439},{"text":"blood ammonia","label":"COREFERENCE","start":4445,"end":4458},{"text":"elevated","label":"LAB_VALUE","start":4463,"end":4471},{"text":"181.6\u200a\u03bcmol\/L","label":"LAB_VALUE","start":4473,"end":4485},{"text":"fecal occult blood test","label":"COREFERENCE","start":4530,"end":4553},{"text":"positive","label":"LAB_VALUE","start":4558,"end":4566},{"text":"UGH","label":"DISEASE_DISORDER","start":4649,"end":4652},{"text":"hepatic encephalopathy","label":"DISEASE_DISORDER","start":4661,"end":4683},{"text":"VPA","label":"MEDICATION","start":4716,"end":4719},{"text":"intravenous","label":"ADMINISTRATION","start":4735,"end":4746},{"text":"Lactulose","label":"MEDICATION","start":4783,"end":4792},{"text":"vitamin B","label":"MEDICATION","start":4794,"end":4803},{"text":"L-arginine","label":"MEDICATION","start":4809,"end":4819},{"text":"clysis","label":"THERAPEUTIC_PROCEDURE","start":4839,"end":4845},{"text":"vinegar","label":"DETAILED_DESCRIPTION","start":4851,"end":4858},{"text":"fasted","label":"THERAPEUTIC_PROCEDURE","start":4894,"end":4900},{"text":"blood ammonia","label":"DIAGNOSTIC_PROCEDURE","start":4916,"end":4929},{"text":"fluctuated","label":"LAB_VALUE","start":4936,"end":4946},{"text":"144.8\u2013207.7\u200a\u03bcmol\/L","label":"LAB_VALUE","start":4948,"end":4966},{"text":"unconscious","label":"SIGN_SYMPTOM","start":4986,"end":4997},{"text":"following 3 days","label":"DURATION","start":5009,"end":5025},{"text":"progress","label":"LAB_VALUE","start":5055,"end":5063},{"text":"mental state","label":"DIAGNOSTIC_PROCEDURE","start":5081,"end":5093},{"text":"blood ammonia","label":"DIAGNOSTIC_PROCEDURE","start":5098,"end":5111},{"text":"held a multidisciplinary conference","label":"CLINICAL_EVENT","start":5122,"end":5157},{"text":"VHE","label":"DISEASE_DISORDER","start":5318,"end":5321},{"text":"blood VPA","label":"DIAGNOSTIC_PROCEDURE","start":5356,"end":5365},{"text":"normal range","label":"LAB_VALUE","start":5387,"end":5399},{"text":"VPA","label":"MEDICATION","start":5420,"end":5423},{"text":"mental state","label":"DIAGNOSTIC_PROCEDURE","start":5605,"end":5617},{"text":"improve","label":"LAB_VALUE","start":5627,"end":5634},{"text":"first 24\u200ahours","label":"TIME","start":5644,"end":5658},{"text":"complete","label":"DETAILED_DESCRIPTION","start":5700,"end":5708},{"text":"consciousness","label":"SIGN_SYMPTOM","start":5709,"end":5722},{"text":"within 48\u200ahours","label":"DATE","start":5723,"end":5738},{"text":"GCS","label":"DIAGNOSTIC_PROCEDURE","start":5740,"end":5743},{"text":"15","label":"LAB_VALUE","start":5746,"end":5748},{"text":"ammonia levels","label":"DIAGNOSTIC_PROCEDURE","start":5755,"end":5769},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":5777,"end":5782},{"text":"decreased","label":"LAB_VALUE","start":5783,"end":5792},{"text":"normal","label":"LAB_VALUE","start":5822,"end":5828},{"text":"within 4 days","label":"DATE","start":5829,"end":5842},{"text":"day 15","label":"DATE","start":5869,"end":5875},{"text":"discharged","label":"CLINICAL_EVENT","start":5935,"end":5945},{"text":"complications","label":"SIGN_SYMPTOM","start":5954,"end":5967},{"text":"follow-up","label":"CLINICAL_EVENT","start":5973,"end":5982},{"text":"month 5","label":"DATE","start":6011,"end":6018},{"text":"full","label":"DETAILED_DESCRIPTION","start":6033,"end":6037},{"text":"consciousness","label":"SIGN_SYMPTOM","start":6038,"end":6051},{"text":"recurrence","label":"SIGN_SYMPTOM","start":6060,"end":6070},{"text":"primary tumor","label":"DETAILED_DESCRIPTION","start":6078,"end":6091},{"text":"GCS","label":"DIAGNOSTIC_PROCEDURE","start":6116,"end":6119},{"text":"15","label":"LAB_VALUE","start":6130,"end":6132},{"text":"satisfying","label":"LAB_VALUE","start":6162,"end":6172},{"text":"quality of postoperative life","label":"DIAGNOSTIC_PROCEDURE","start":6173,"end":6202}],"tokens":["A ","61-year-old"," ","Chinese"," ","woman"," complained of ","dizziness"," for ","3 weeks"," and was ","admitted"," to our ","hospital"," after a ","bifrontal"," ","mass"," was found ","radiologically",".\nOther than ","dizziness",", the patient presented no ","signs or symptoms that are commonly associated with neurological disease",", such as ","headache",", ","vomiting",", ","sensory disturbances",", ","altered consciousness",", or ","seizures",".\nExcept for a ","20-year history of hypertension",", which was properly controlled with ","angiotensin-converting enzyme inhibitors",", the patient was otherwise ","healthy",".\n","No special circumstances were identified regarding her personal or family history",", and the patient was found to be ","normal"," upon ","neurological examination",".\n","Plain"," and ","contrast-enhanced"," ","magnetic resonance imaging"," (","MRI",") of the ","head"," showed a ","space-occupying"," ","lesion"," in the ","bifrontal lobe",", ","mainly on the right side",", ","clinging to the sagittal sinus"," and the ","cerebral falx",".\nThe ","5.7\u200a\u00d7\u200a5.0\u200a\u00d7\u200a5.0\u200acm"," dural-based ","mass"," growing ","across the sagittal midline"," revealed ","isointensity"," on the ","T1-weighted image"," and a slight ","hyperintensity"," on the ","T2-weighted image"," and was homogenously enhanced with a ","characteristic \u201cdural-tail\u201d sign"," (Fig.1).\nDiagnosis of a ","parasagittal-parafalcine"," ","meningioma"," was made, and a ","craniotomic"," meningioma ","resection"," was chosen as treatment.\nThe ","blood cell examination","; ","coagulation function",", ","liver and renal function"," tests; ","urinalysis","; ","chest"," ","x-rays"," and ","electrocardiogram"," were ","normal",".\nThe ","albumin"," was ","36\u200ag\/L",", the ","total bilirubin"," (","TBil",") was ","12.2\u200a\u03bcmol\/L",", and the ","direct bilirubin"," (","DBil",") was ","4.1\u200a\u03bcmol\/L",".\n","Alanine transaminase"," (","ALT",") was ","17\u200aU\/L",", and the ","international normalized ratio"," (","INR",") for coagulation values was ","1.02",".\nBecause of the patient's advanced age and history of hypertension, we performed an ","echocardiograph"," and a ","blood gas analysis"," and tested her ","creatine kinase"," levels and ","pulmonary functions",".\nThe results revealed ","no surgical contraindications",".\nWritten consent was obtained from the patient.\n","Five hundred milligrams"," of ","VPA"," ","twice per day"," was initiated ","3 days before the operation",".\nThe patient tolerated the administration well.\nA ","craniotomy"," was then performed with a radical ","tumor resection"," (Simpson II).\nThe ","tumor"," was ","pink"," and ","solid"," and had a ","moderate blood supply",", and its texture was ","medium",".\n","Thirty minutes before the end of surgery",", ","800\u200amg"," of ","VPA"," was administered by ","intravenous infusion",".\nAfter the operation, the patient regained ","consciousness"," ","within 30 minutes"," and scored ","15"," on the ","Glasgow coma scale"," (","GCS",").\n","Two hours later"," as she was being ","transported"," back to her ","ward",", the patient underwent ","UGH",".\nThe ","vomitus"," (","approximately 50\u200amL",") was composed of ","coffee-colored"," ","blood",".\nExcluding the possible etiology of ","endotracheal"," ","intubation"," ","damage",", we diagnosed the patient as experiencing ","acute"," ","erosive-hemorrhagic"," ","gastritis",", a reaction to the ","craniotomy"," ","injury",".\nThe patient was given ","omeprazole"," to inhibit gastric acid secretion, and the ","hematemesis"," ceased.\nThe patient was administered ","VPA"," (","1200\u200amg",", ","intravenously",") ","during the first 2 postoperative days",".\nBecause of her stomach and intestine functional recovery, the ","VPA"," dosage was changed to ","500\u200amg"," via ","oral"," administration ","twice a day",".\nA ","brain"," ","MRI"," was performed on postoperative ","day 3",", and it revealed that the ","tumor"," was radically removed and the ","operative field"," was ","clean"," (Fig.2A and B).\nA subsequent ","paraffin"," ","histological examination"," confirmed the diagnosis of ","meningioma",".\nAt ","3 am"," on postoperative ","day 4",", the patient was suddenly found in a ","deep"," ","coma",".\nHer ","pupils were dilated"," to ","3.0\u200amm"," and ","round",", and the ","light reflex"," was ","sensitive",".\nThe ","neurological examination"," was ","unremarkable",", and her ","vital signs"," were ","stable","; however, her ","mental state"," ","gradually changed"," to a ","deep"," ","coma"," (","GCS","\u200a=\u200a","8","), which we believed was caused by ","intracranial"," ","lesions",".\nA ","computerized tomography"," (","CT",") scan of the ","brain"," was immediately performed; however, it ","failed to reveal any abnormalities",", such as ","severe"," ","brain"," ","swelling",", ","intracranial hemorrhage",", or ","cerebral infarction"," (Fig.2C).\nBecause a possible ","cerebral infarction"," could not be excluded ","within 24\u200ahours",", ","glucocorticoid",", ","mannitol",", and a ","vasodilator"," were used.\nThe patient's routine ","laboratory results"," for ","blood cell",", ","liver",", and ","renal"," ","functions"," were in ","relatively normal ranges",".\nThe ","albumin"," was ","33\u200ag\/L",", the ","TBil"," was ","13.3\u200a\u03bcmol\/L",", and the ","DBil"," was ","4.5\u200a\u03bcmol\/L",".\n","ALT"," was ","12\u200aU\/L",", and the ","INR"," for coagulation values was ","1.01",".\nBecause of her ","history of UGH",", we checked her ","blood ammonia"," levels and performed a ","fecal occult blood test"," and ","blood gas analysis",".\nHer ","blood ammonia"," was ","elevated"," (","181.6\u200a\u03bcmol\/L","; normal range is 11\u201332\u200a\u03bcmol\/L), whereas the ","fecal occult blood test"," was ","positive",".\nThus, considering her history and elevated blood ammonia, she was diagnosed with ","UGH","-induced ","hepatic encephalopathy",", and the oral administration of ","VPA"," was changed to ","intravenous"," administration to prevent seizures.\n","Lactulose",", ","vitamin B",", and ","L-arginine"," were administered, ","clysis"," with ","vinegar"," was performed, and the patient was ","fasted",".\nThe patient's ","blood ammonia"," level ","fluctuated"," (","144.8\u2013207.7\u200a\u03bcmol\/L","), and she remained ","unconscious"," during the ","following 3 days",".\nBecause of the unremarkable ","progress"," in the patient's ","mental state"," and ","blood ammonia"," level, we ","held a multidisciplinary conference"," to discuss diagnosis and treatment, initially considering hemodialysis or peritoneal dialysis.\nAfter the multidisciplinary discussion, a suspected diagnosis of ","VHE"," was finally made, even though the ","blood VPA"," level was within the ","normal range",".\nWe decided to stop ","VPA"," administration before performing any dialysis and administered levetiracetam instead of VPA.\nThe patient's blood VPA and ammonia levels were then routinely monitored.\nThe patient's ","mental state"," began to ","improve"," from the ","first 24\u200ahours"," of VPA discontinuation, and she achieved ","complete"," ","consciousness"," ","within 48\u200ahours"," (","GCS","\u200a=\u200a","15",").\nThe ","ammonia levels"," in her ","blood"," ","decreased"," dramatically and returned to ","normal"," ","within 4 days"," (Fig.3).\nOn postoperative ","day 15"," (8 days after the discontinuation of VPA), the patient was ","discharged"," with no ","complications",".\nThe ","follow-up"," interviews in postoperative ","month 5"," witnessed her ","full"," ","consciousness"," and non-","recurrence"," of the ","primary tumor"," (Fig.2D).\nThe patient's ","GCS"," score was ","15",", and she reported enjoying a ","satisfying"," ","quality of postoperative 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-{"full_text":"A 60-year-old man presented with a retroperitoneal metastatic lymph node in magnetic resonance (MR) imaging with a history of right liver resection in 2010, pulmonary wedge resection in 2012, and transarterial chemoembolization twice in 2014, in which the postoperative pathology suggested the mixed liver cancer, and poorly differentiated lung cancer from liver metastasis.\nAt examination, the tumor was very close to the duodenum, pancreas, stomach, and hepatic portal vein.\nThe patient with unresectable masses had hypertension over 10 years and chronic HBV-related cirrhosis for 30 years when he was treated with lamivudine 100\u200amg qd, and adefovir dipivoxil 10\u200amg qd for 6 years.\nHe kept a constant body temperature of 37\u200a\u00b0C, the blood pressure of 148\/96\u200amm\u200aHg, and the pulse of 77 beats every minute.\nThe patient had no obvious sense of abdominal pain, abdominal distention, nausea, and vomiting.\nOn a test of tumor markers levels, the results were normal, which showed carcinoembryonic antigen 3.7\u200ang\/mL, alpha fetoprotein 17.3\u200ang\/mL, and carbohydrate antigen 19\u20139 levels 6.1\u200aU\/mL.\nIn this study, the procedure was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University.\nThe efficacy of local ablation was estimated with Choi criteria, which appraised the variations both in tumor size and lesion density on computed tomography (CT) imaging: complete response, disappearance of all lesions and no new lesions; partial response (PR), a decrease in size of 10% or a decrease in tumor density over 15% on CT and no new lesions; stable disease, not fit for complete response, PR, or progressive disease; and progressive disease, an increase in tumor size over 10% and not fit for PR by tumor density on CT or new lesions.[19]\nPreoperative MR imaging scan showed a mass of 2.8\u200a\u00d7\u200a3.5\u200acm in size close to the duodenum, pancreas, and blood vessels (Fig.1A).\nDuring substance phase, MR images indicated mildly high signal intensity around the tumor and intermediate low signal intensity in the solid component and in the walls (Fig.1B).\nBefore the initial ablation, there was a retroperitoneal mild hyperechoic area on axial US image (Fig.1C).\nIn this study, the inpatient underwent percutaneous transhepatic biopsies and ablations to avoid the nearby blood vessels, the procedure of which was performed about 40 minutes under local anesthesia and mild sedation.\nWe used ultrasonography to real-timely guide the inserting of 2 Nd:YAG laser fibers (Echolaser X4, ESAOTE, Italy) in 0.3\u200amm diameter through a 21-gauge Chiba needle into the lesions (Fig.1D).\nAlthough part of the heat ran off by blood flow,[20] ablation could keep valid area from 12 to 15\u200amm with the power of 5\u200aW in 5 to 6 minutes.\nSubsequently, immediate ultrasonography showed that the whole lesion was covered with hyperechoic zone (Fig.\u200b(Fig.1E and F).\nHowever, the next day contrast-enhanced ultrasound (CEUS) revealed an abnormal residual of proximal part of the pancreatic head (Fig.2A).\nAt 5-day follow-up contrast-enhanced CT images, the lower mass had low signal intensity and upper tumor revealed intermediate high signal intensity of residual in substance phase (Fig.2B and C).\nSurprizingly, 1-week follow-up CEUS image showed an enlarged retroperitoneal lymph node located near the pancreatic head, which could be fusion of these residuary small nodules (Fig.2D).\nThen the patient undergoing the 2nd ablation with 2 laser fibers showed the lesions well-defined hyperechoic zone (Fig.2E and F).\nOn the 2nd day, postoperative CEUS images showed they were still remanent (Fig.2G and I).\nAt the corresponding MR imaging, it also showed this in left of tumor (Fig.2H).\nThus, the 3rd laser ablation was performed (Fig.2J)2J) and 3 days later CEUS found that there was still a minor lesion located in the separation gap of last 2 needles (Fig.3A).\nSubsequently the patient had the 4th ablation along this separation gap until hyperechoic overlay (Fig.3B\u2013D), then 3 days later, based on these 4 treatments, enhanced CT image of the retroperitoneal mass suggested complete necrosis (Fig.3E\u2013G).3E\u2013G).\nAfter the following 1 month, substance phase MR revealed low-intensity signal of tumor necrosis with resolution of his problems (Fig.3H).\nUntil 5 months after 4 ablations, CT showed the tumor PR with little enhanced recurrence (yellow arrows), which located in the left lower edge of original lesions (Fig.4A and B).\nOn laboratory test of tumor markers, the levels of carcinoembryonic antigen, alpha fetoprotein, and carbohydrate antigen 19\u20139 indicated 3.6\u200ang\/mL, 26.7\u200ang\/mL, and 8.1\u200aU\/mL, respectively.\nNo obvious side effects were discovered in this case during these procedures.\n","ner_info":[{"text":"60-year-old","label":"AGE","start":2,"end":13},{"text":"man","label":"SEX","start":14,"end":17},{"text":"presented","label":"CLINICAL_EVENT","start":18,"end":27},{"text":"retroperitoneal","label":"BIOLOGICAL_STRUCTURE","start":35,"end":50},{"text":"metastatic","label":"SIGN_SYMPTOM","start":51,"end":61},{"text":"lymph node","label":"BIOLOGICAL_STRUCTURE","start":62,"end":72},{"text":"magnetic resonance","label":"DIAGNOSTIC_PROCEDURE","start":76,"end":94},{"text":"MR","label":"DIAGNOSTIC_PROCEDURE","start":96,"end":98},{"text":"right liver","label":"BIOLOGICAL_STRUCTURE","start":126,"end":137},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":138,"end":147},{"text":"2010","label":"DATE","start":151,"end":155},{"text":"pulmonary wedge","label":"BIOLOGICAL_STRUCTURE","start":157,"end":172},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":173,"end":182},{"text":"2012","label":"DATE","start":186,"end":190},{"text":"transarterial chemoembolization","label":"THERAPEUTIC_PROCEDURE","start":196,"end":227},{"text":"twice","label":"DETAILED_DESCRIPTION","start":228,"end":233},{"text":"2014","label":"DATE","start":237,"end":241},{"text":"pathology","label":"DIAGNOSTIC_PROCEDURE","start":270,"end":279},{"text":"mixed","label":"DETAILED_DESCRIPTION","start":294,"end":299},{"text":"liver cancer","label":"DISEASE_DISORDER","start":300,"end":312},{"text":"poorly differentiated","label":"DETAILED_DESCRIPTION","start":318,"end":339},{"text":"lung cancer","label":"DISEASE_DISORDER","start":340,"end":351},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":357,"end":362},{"text":"metastasis","label":"SIGN_SYMPTOM","start":363,"end":373},{"text":"examination","label":"DIAGNOSTIC_PROCEDURE","start":378,"end":389},{"text":"tumor","label":"COREFERENCE","start":395,"end":400},{"text":"duodenum","label":"BIOLOGICAL_STRUCTURE","start":423,"end":431},{"text":"pancreas","label":"BIOLOGICAL_STRUCTURE","start":433,"end":441},{"text":"stomach","label":"BIOLOGICAL_STRUCTURE","start":443,"end":450},{"text":"hepatic portal vein","label":"BIOLOGICAL_STRUCTURE","start":456,"end":475},{"text":"unresectable","label":"DETAILED_DESCRIPTION","start":494,"end":506},{"text":"masses","label":"SIGN_SYMPTOM","start":507,"end":513},{"text":"hypertension over 10 years","label":"HISTORY","start":518,"end":544},{"text":"chronic HBV-related cirrhosis for 30 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minute","label":"LAB_VALUE","start":783,"end":804},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":842,"end":851},{"text":"pain","label":"SIGN_SYMPTOM","start":852,"end":856},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":858,"end":867},{"text":"distention","label":"SIGN_SYMPTOM","start":868,"end":878},{"text":"nausea","label":"SIGN_SYMPTOM","start":880,"end":886},{"text":"vomiting","label":"SIGN_SYMPTOM","start":892,"end":900},{"text":"tumor markers","label":"DIAGNOSTIC_PROCEDURE","start":915,"end":928},{"text":"normal","label":"LAB_VALUE","start":954,"end":960},{"text":"carcinoembryonic antigen","label":"DIAGNOSTIC_PROCEDURE","start":975,"end":999},{"text":"3.7\u200ang\/mL","label":"LAB_VALUE","start":1000,"end":1009},{"text":"alpha fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":1011,"end":1028},{"text":"17.3\u200ang\/mL","label":"LAB_VALUE","start":1029,"end":1039},{"text":"carbohydrate antigen 19\u20139","label":"DIAGNOSTIC_PROCEDURE","start":1045,"end":1070},{"text":"6.1\u200aU\/mL","label":"LAB_VALUE","start":1078,"end":1086},{"text":"local","label":"DETAILED_DESCRIPTION","start":1227,"end":1232},{"text":"ablation","label":"THERAPEUTIC_PROCEDURE","start":1233,"end":1241},{"text":"Choi criteria","label":"DIAGNOSTIC_PROCEDURE","start":1261,"end":1274},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1348,"end":1367},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":1369,"end":1371},{"text":"complete response, disappearance of all lesions and no new lesions; partial response (PR), a decrease in size of 10% or a decrease in tumor density over 15% on CT and no new lesions; stable disease, not fit for complete response, PR, or progressive disease; and progressive disease, an increase in tumor size over 10% and not fit for PR by tumor density on CT or new lesions","label":"OTHER_ENTITY","start":1382,"end":1756},{"text":"MR","label":"DIAGNOSTIC_PROCEDURE","start":1775,"end":1777},{"text":"mass","label":"SIGN_SYMPTOM","start":1800,"end":1804},{"text":"2.8\u200a\u00d7\u200a3.5\u200acm","label":"AREA","start":1808,"end":1820},{"text":"duodenum","label":"BIOLOGICAL_STRUCTURE","start":1842,"end":1850},{"text":"pancreas","label":"BIOLOGICAL_STRUCTURE","start":1852,"end":1860},{"text":"blood vessels","label":"BIOLOGICAL_STRUCTURE","start":1866,"end":1879},{"text":"substance phase","label":"DETAILED_DESCRIPTION","start":1897,"end":1912},{"text":"MR","label":"DIAGNOSTIC_PROCEDURE","start":1914,"end":1916},{"text":"mildly high","label":"SEVERITY","start":1934,"end":1945},{"text":"signal intensity","label":"SIGN_SYMPTOM","start":1946,"end":1962},{"text":"tumor","label":"COREFERENCE","start":1974,"end":1979},{"text":"intermediate low","label":"SEVERITY","start":1984,"end":2000},{"text":"signal 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minutes","label":"DURATION","start":2335,"end":2351},{"text":"local anesthesia","label":"MEDICATION","start":2358,"end":2374},{"text":"sedation","label":"MEDICATION","start":2384,"end":2392},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":2402,"end":2417},{"text":"real-timely","label":"DETAILED_DESCRIPTION","start":2421,"end":2432},{"text":"2 Nd:YAG","label":"DETAILED_DESCRIPTION","start":2456,"end":2464},{"text":"laser fibers","label":"THERAPEUTIC_PROCEDURE","start":2465,"end":2477},{"text":"Echolaser X4, ESAOTE, Italy","label":"DETAILED_DESCRIPTION","start":2479,"end":2506},{"text":"0.3\u200amm diameter","label":"DETAILED_DESCRIPTION","start":2511,"end":2526},{"text":"through a 21-gauge Chiba needl","label":"DETAILED_DESCRIPTION","start":2527,"end":2557},{"text":"lesions","label":"SIGN_SYMPTOM","start":2568,"end":2575},{"text":"ablation","label":"THERAPEUTIC_PROCEDURE","start":2639,"end":2647},{"text":"area from 12 to 15\u200amm","label":"DETAILED_DESCRIPTION","start":2665,"end":2686},{"text":"power of 5\u200aW","label":"DETAILED_DESCRIPTION","start":2696,"end":2708},{"text":"5 to 6 minutes","label":"DETAILED_DESCRIPTION","start":2712,"end":2726},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":2752,"end":2767},{"text":"lesion","label":"SIGN_SYMPTOM","start":2790,"end":2796},{"text":"hyperechoic zone","label":"SIGN_SYMPTOM","start":2814,"end":2830},{"text":"next day","label":"DATE","start":2866,"end":2874},{"text":"contrast-enhanced ultrasound","label":"DIAGNOSTIC_PROCEDURE","start":2875,"end":2903},{"text":"CEUS","label":"DIAGNOSTIC_PROCEDURE","start":2905,"end":2909},{"text":"abnormal residual","label":"SIGN_SYMPTOM","start":2923,"end":2940},{"text":"proximal part of the pancreatic 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necrosis","label":"SIGN_SYMPTOM","start":4171,"end":4195},{"text":"problems","label":"SIGN_SYMPTOM","start":4219,"end":4227},{"text":"Until 5 months","label":"DATE","start":4238,"end":4252},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":4272,"end":4274},{"text":"tumor","label":"SIGN_SYMPTOM","start":4286,"end":4291},{"text":"recurrence","label":"SIGN_SYMPTOM","start":4316,"end":4326},{"text":"tumor markers","label":"DIAGNOSTIC_PROCEDURE","start":4439,"end":4452},{"text":"carcinoembryonic antigen","label":"DIAGNOSTIC_PROCEDURE","start":4468,"end":4492},{"text":"alpha fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":4494,"end":4511},{"text":"carbohydrate antigen 19\u20139","label":"DIAGNOSTIC_PROCEDURE","start":4517,"end":4542},{"text":"3.6\u200ang\/mL","label":"LAB_VALUE","start":4553,"end":4562},{"text":"26.7\u200ang\/mL","label":"LAB_VALUE","start":4564,"end":4574},{"text":"8.1\u200aU\/mL","label":"LAB_VALUE","start":4580,"end":4588},{"text":"side effects","label":"SIGN_SYMPTOM","start":4615,"end":4627}],"tokens":["A ","60-year-old"," ","man"," ","presented"," with a ","retroperitoneal"," ","metastatic"," ","lymph node"," in ","magnetic resonance"," (","MR",") imaging with a history of ","right liver"," ","resection"," in ","2010",", ","pulmonary wedge"," ","resection"," in ","2012",", and ","transarterial chemoembolization"," ","twice"," in ","2014",", in which the postoperative ","pathology"," suggested the ","mixed"," ","liver cancer",", and ","poorly differentiated"," ","lung cancer"," from ","liver"," ","metastasis",".\nAt ","examination",", the ","tumor"," was very close to the ","duodenum",", ","pancreas",", ","stomach",", and ","hepatic portal vein",".\nThe patient with ","unresectable"," ","masses"," had ","hypertension over 10 years"," and ","chronic HBV-related cirrhosis for 30 years"," when he was treated with ","lamivudine"," ","100\u200amg qd",", and ","adefovir dipivoxil"," ","10\u200amg qd"," for ","6 years",".\nHe kept a ","constant"," ","body temperature"," of ","37\u200a\u00b0C",", the ","blood pressure"," of ","148\/96\u200amm\u200aHg",", and the ","pulse"," of ","77 beats every minute",".\nThe patient had no obvious sense of ","abdominal"," ","pain",", ","abdominal"," ","distention",", ","nausea",", and ","vomiting",".\nOn a test of ","tumor markers"," levels, the results were ","normal",", which showed ","carcinoembryonic antigen"," ","3.7\u200ang\/mL",", ","alpha fetoprotein"," ","17.3\u200ang\/mL",", and ","carbohydrate antigen 19\u20139"," levels ","6.1\u200aU\/mL",".\nIn this study, the procedure was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University.\nThe efficacy of ","local"," ","ablation"," was estimated with ","Choi criteria",", which appraised the variations both in tumor size and lesion density on ","computed tomography"," (","CT",") imaging: ","complete response, disappearance of all lesions and no new lesions; partial response (PR), a decrease in size of 10% or a decrease in tumor density over 15% on CT and no new lesions; stable disease, not fit for complete response, PR, or progressive disease; and progressive disease, an increase in tumor size over 10% and not fit for PR by tumor density on CT or new lesions",".[19]\nPreoperative ","MR"," imaging scan showed a ","mass"," of ","2.8\u200a\u00d7\u200a3.5\u200acm"," in size close to the ","duodenum",", ","pancreas",", and ","blood vessels"," (Fig.1A).\nDuring ","substance phase",", ","MR"," images indicated ","mildly high"," ","signal intensity"," around the ","tumor"," and ","intermediate low"," ","signal intensity"," in the ","solid component"," and in the ","walls"," (Fig.1B).\nBefore the initial ","ablation",", there was a ","retroperitoneal"," ","mild"," ","hyperechoic area"," on ","axial"," ","US"," image (Fig.1C).\nIn this study, the inpatient underwent ","percutaneous"," ","transhepatic"," ","biopsies"," and ","ablations"," to avoid the nearby blood vessels, the procedure of which was performed ","about 40 minutes"," under ","local anesthesia"," and mild ","sedation",".\nWe used ","ultrasonography"," to ","real-timely"," guide the inserting of ","2 Nd:YAG"," ","laser fibers"," (","Echolaser X4, ESAOTE, Italy",") in ","0.3\u200amm diameter"," ","through a 21-gauge Chiba needl","e into the ","lesions"," (Fig.1D).\nAlthough part of the heat ran off by blood flow,[20] ","ablation"," could keep valid ","area from 12 to 15\u200amm"," with the ","power of 5\u200aW"," in ","5 to 6 minutes",".\nSubsequently, immediate ","ultrasonography"," showed that the whole ","lesion"," was covered with ","hyperechoic zone"," (Fig.\u200b(Fig.1E and F).\nHowever, the ","next day"," ","contrast-enhanced ultrasound"," (","CEUS",") revealed an ","abnormal residual"," of ","proximal part of the pancreatic head"," (Fig.2A).\nAt ","5-day"," ","follow-up"," ","contrast-enhanced"," ","CT images",", the ","lower"," ","mass"," had ","low"," ","signal intensity"," and ","upper"," ","tumor"," revealed ","intermediate high"," ","signal intensity"," of ","residual in substance phase"," (Fig.2B and C).\nSurprizingly, ","1-week"," ","follow-up"," ","CEUS"," image showed an ","enlarged"," ","retroperitoneal"," ","lymph node"," located ","near the pancreatic head",", which could be fusion of these residuary small nodules (Fig.2D).\nThen the patient undergoing the ","2nd"," ","ablation"," with ","2"," ","laser fibers"," showed the ","lesions"," well-defined ","hyperechoic zone"," (Fig.2E and F).\nOn the ","2nd day",", postoperative ","CEUS"," images showed ","they"," were still remanent (Fig.2G and I).\nAt the corresponding ","MR"," imaging, it also showed this in left of ","tumor"," (Fig.2H).\nThus, the ","3rd"," ","laser"," ","ablation"," was performed (Fig.2J)2J) and ","3 days later"," ","CEUS"," found that there was still a ","minor"," ","lesion"," located in the separation gap of last 2 needles (Fig.3A).\nSubsequently the patient had the ","4th"," ","ablation"," along this separation gap until hyperechoic overlay (Fig.3B\u2013D), then ","3 days later",", based on these 4 treatments, enhanced ","CT"," image of the ","retroperitoneal"," ","mass"," suggested complete ","necrosis"," (Fig.3E\u2013G).3E\u2013G).\n","After the following 1 month",", substance phase ","MR"," revealed low-intensity ","signal of tumor necrosis"," with resolution of his ","problems"," (Fig.3H).\n","Until 5 months"," after 4 ablations, ","CT"," showed the ","tumor"," PR with little enhanced ","recurrence"," (yellow arrows), which located in the left lower edge of original lesions (Fig.4A and B).\nOn laboratory test of ","tumor markers",", the levels of ","carcinoembryonic antigen",", ","alpha fetoprotein",", and ","carbohydrate antigen 19\u20139"," indicated ","3.6\u200ang\/mL",", ","26.7\u200ang\/mL",", and ","8.1\u200aU\/mL",", respectively.\nNo obvious ","side effects"," were discovered in this case during these procedures.\n"],"ner_labels":[0,5,0,65,0,13,0,12,0,69,0,12,0,24,0,24,0,12,0,75,0,19,0,12,0,75,0,19,0,75,0,22,0,19,0,24,0,22,0,26,0,22,0,26,0,12,0,69,0,24,0,18,0,12,0,12,0,12,0,12,0,22,0,69,0,39,0,39,0,46,0,29,0,46,0,29,0,32,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,12,0,69,0,12,0,69,0,69,0,69,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,22,0,75,0,24,0,24,0,24,0,51,0,24,0,69,0,8,0,12,0,12,0,12,0,22,0,24,0,63,0,69,0,18,0,63,0,69,0,12,0,12,0,75,0,12,0,63,0,69,0,22,0,24,0,22,0,12,0,24,0,75,0,32,0,46,0,46,0,24,0,22,0,22,0,75,0,22,0,22,0,22,0,69,0,75,0,22,0,22,0,22,0,24,0,69,0,69,0,19,0,24,0,24,0,69,0,12,0,19,0,13,0,22,0,24,0,22,0,69,0,63,0,69,0,22,0,69,0,63,0,69,0,22,0,19,0,13,0,24,0,69,0,12,0,12,0,12,0,22,0,75,0,22,0,75,0,69,0,69,0,19,0,24,0,18,0,24,0,69,0,22,0,22,0,75,0,19,0,24,0,63,0,69,0,22,0,75,0,19,0,24,0,12,0,69,0,69,0,19,0,24,0,69,0,69,0,19,0,24,0,69,0,69,0,24,0,24,0,24,0,24,0,42,0,42,0,42,0,69,0]}
-{"full_text":"A 61-year-old male patient had a history of chronic obstructive pulmonary disease under regular bronchodilator treatment.\nIn 2014, he suffered from severe productive cough with mucus sputum for several months and unintentional body weight loss 6\u200akg within 6 months.\nAfter sputum analysis and chest imaging examinations in May 2014, he was diagnosed of squamous cell carcinoma in right upper lobe lung (cT3N2M0, stage IIIa).\nThen he received neoadjuvant chemoradiotherapy (etoposide 70\u200amg [45\u200amg\/m2]\u200a+\u200acisplatin 79\u200amg [50\u200amg\/m2]; 4500\u200acGY in 25 fractions) from June to July 2014.\nIn October 2014, surgical intervention was arranged.\nBecause the tumor was located at right hilum and invaded main bronchus and major vessels, video-assisted thoracoscopic surgery with right side intrapericardial pneumonectomy was performed.\nPostoperatively, pathological exams revealed squamous cell carcinoma, T3N0M0, stage IIB.\nThe postoperative course was smooth but he suffered from severe cough and right chest pain one month later.\nLaboratory exams revealed leukocytosis (white blood cells\u200a=\u200a21,860\u200a\u03bcL) and elevated C-reactive protein to 23.94\u200amg\/dL.\nChest X-ray showed cavitary lesion and computed tomography showed pleural effusion and fluid collection with mottled gas appearance in the dependent portion of right hemithorax (Fig.1A).\nAccording to the patient's history, results of laboratory exams, and imaging findings, postpneumonectomy empyema was diagnosed and bronchopleural fistula was highly suspected.\nAfter admission, chest tube drainage was inserted and bronchoscopic tissue glue sealing was performed.\nHowever, persistent air leakage was presented and we decided to repair the bronchial stump with flap coverage.\nBecause the patient just received neoadjuvant chemoradiotherapy a few months ago, the flaps harvested from chest area were not appropriate because the pedicle arteries might have been injured by irradiation.\nAfter discussing with the plastic surgeon, we decided to repair the bronchial stump by a TRAM flap.\nIntraoperatively, the patient was placed in supine.\nRight side exploratory thoracotomy was performed and the bronchial stump was located.\nThe superior epigastric vascular artery and right rectus abdominis muscle was identified and the location of the TRAM flap was marked on the skin (Fig.2A).\nThen the TRAM flap was harvested from right rectus abdominis (Fig.2B) and was deepithelialized (Fig.2C).\nThrough a subcutaneous tunnel, the TRAM flap was moved toward the right thoracic space with no tension or kinking on the pedicle (Fig.2D).\nThen the TRAM flap was fixed to posterior chest wall to cover the bronchial stump (Fig.2E) and the tissue glue was also applied to the bronchial stump under bronchoscope.\nThe donor site of flap was closed with mesh repair.\nThe postoperative course was smooth and the air leak was diminished gradually.\nThen the patient was discharge under stable condition and was free from air leak after following for 12 months (Fig.1B).\nThe patient provided written informed consent for publication of this report and all accompanying images.\n","ner_info":[{"text":"61-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"chronic obstructive pulmonary disease","label":"HISTORY","start":44,"end":81},{"text":"regular bronchodilator treatment","label":"HISTORY","start":88,"end":120},{"text":"2014","label":"DATE","start":125,"end":129},{"text":"severe","label":"SEVERITY","start":148,"end":154},{"text":"productive","label":"DETAILED_DESCRIPTION","start":155,"end":165},{"text":"cough","label":"SIGN_SYMPTOM","start":166,"end":171},{"text":"mucus sputum","label":"DETAILED_DESCRIPTION","start":177,"end":189},{"text":"for several months","label":"DURATION","start":190,"end":208},{"text":"unintentional","label":"DETAILED_DESCRIPTION","start":213,"end":226},{"text":"weight loss","label":"SIGN_SYMPTOM","start":232,"end":243},{"text":"6\u200akg","label":"LAB_VALUE","start":244,"end":248},{"text":"within 6 months","label":"DURATION","start":249,"end":264},{"text":"sputum analysis","label":"DIAGNOSTIC_PROCEDURE","start":272,"end":287},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":292,"end":297},{"text":"imaging examinations","label":"DIAGNOSTIC_PROCEDURE","start":298,"end":318},{"text":"May 2014","label":"DATE","start":322,"end":330},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":352,"end":375},{"text":"right upper lobe lung","label":"BIOLOGICAL_STRUCTURE","start":379,"end":400},{"text":"cT3N2M0","label":"LAB_VALUE","start":402,"end":409},{"text":"stage IIIa","label":"LAB_VALUE","start":411,"end":421},{"text":"neoadjuvant","label":"DETAILED_DESCRIPTION","start":441,"end":452},{"text":"chemoradiotherapy","label":"THERAPEUTIC_PROCEDURE","start":453,"end":470},{"text":"etoposide","label":"MEDICATION","start":472,"end":481},{"text":"70\u200amg [45\u200amg\/m2]","label":"DOSAGE","start":482,"end":499},{"text":"cisplatin","label":"MEDICATION","start":501,"end":510},{"text":"79\u200amg [50\u200amg\/m2]","label":"DOSAGE","start":511,"end":527},{"text":"4500\u200acGY in 25 fractions","label":"DOSAGE","start":529,"end":553},{"text":"from June to July 2014","label":"DURATION","start":555,"end":577},{"text":"October 2014","label":"DATE","start":582,"end":594},{"text":"surgical intervention","label":"THERAPEUTIC_PROCEDURE","start":596,"end":617},{"text":"tumor","label":"SIGN_SYMPTOM","start":644,"end":649},{"text":"right hilum","label":"BIOLOGICAL_STRUCTURE","start":665,"end":676},{"text":"main bronchus","label":"BIOLOGICAL_STRUCTURE","start":689,"end":702},{"text":"major vessels","label":"BIOLOGICAL_STRUCTURE","start":707,"end":720},{"text":"video-assisted","label":"DETAILED_DESCRIPTION","start":722,"end":736},{"text":"thoracoscopic","label":"DETAILED_DESCRIPTION","start":737,"end":750},{"text":"surgery","label":"THERAPEUTIC_PROCEDURE","start":751,"end":758},{"text":"right side","label":"DETAILED_DESCRIPTION","start":764,"end":774},{"text":"intrapericardial","label":"BIOLOGICAL_STRUCTURE","start":775,"end":791},{"text":"pneumonectomy","label":"THERAPEUTIC_PROCEDURE","start":792,"end":805},{"text":"pathological exams","label":"DIAGNOSTIC_PROCEDURE","start":838,"end":856},{"text":"squamous cell carcinoma","label":"DISEASE_DISORDER","start":866,"end":889},{"text":"T3N0M0","label":"LAB_VALUE","start":891,"end":897},{"text":"stage IIB","label":"LAB_VALUE","start":899,"end":908},{"text":"postoperative course","label":"THERAPEUTIC_PROCEDURE","start":914,"end":934},{"text":"smooth","label":"LAB_VALUE","start":939,"end":945},{"text":"severe","label":"SEVERITY","start":967,"end":973},{"text":"cough","label":"SIGN_SYMPTOM","start":974,"end":979},{"text":"right chest","label":"BIOLOGICAL_STRUCTURE","start":984,"end":995},{"text":"pain","label":"SIGN_SYMPTOM","start":996,"end":1000},{"text":"one month later","label":"DATE","start":1001,"end":1016},{"text":"Laboratory exams","label":"DIAGNOSTIC_PROCEDURE","start":1018,"end":1034},{"text":"leukocytosis","label":"SIGN_SYMPTOM","start":1044,"end":1056},{"text":"white blood cells","label":"DIAGNOSTIC_PROCEDURE","start":1058,"end":1075},{"text":"21,860\u200a\u03bcL","label":"LAB_VALUE","start":1078,"end":1087},{"text":"elevated","label":"LAB_VALUE","start":1093,"end":1101},{"text":"C-reactive protein","label":"DIAGNOSTIC_PROCEDURE","start":1102,"end":1120},{"text":"23.94\u200amg\/dL","label":"LAB_VALUE","start":1124,"end":1135},{"text":"Chest","label":"BIOLOGICAL_STRUCTURE","start":1137,"end":1142},{"text":"X-ray","label":"DIAGNOSTIC_PROCEDURE","start":1143,"end":1148},{"text":"cavitary","label":"DETAILED_DESCRIPTION","start":1156,"end":1164},{"text":"lesion","label":"SIGN_SYMPTOM","start":1165,"end":1171},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":1176,"end":1195},{"text":"pleural effusion","label":"SIGN_SYMPTOM","start":1203,"end":1219},{"text":"fluid collection","label":"SIGN_SYMPTOM","start":1224,"end":1240},{"text":"mottled gas appearance","label":"DETAILED_DESCRIPTION","start":1246,"end":1268},{"text":"dependent portion of right hemithorax","label":"BIOLOGICAL_STRUCTURE","start":1276,"end":1313},{"text":"postpneumonectomy","label":"DETAILED_DESCRIPTION","start":1411,"end":1428},{"text":"empyema","label":"SIGN_SYMPTOM","start":1429,"end":1436},{"text":"bronchopleural fistula","label":"DISEASE_DISORDER","start":1455,"end":1477},{"text":"admission","label":"CLINICAL_EVENT","start":1506,"end":1515},{"text":"chest","label":"BIOLOGICAL_STRUCTURE","start":1517,"end":1522},{"text":"tube drainage","label":"THERAPEUTIC_PROCEDURE","start":1523,"end":1536},{"text":"bronchoscopic","label":"DETAILED_DESCRIPTION","start":1554,"end":1567},{"text":"tissue glue sealing","label":"THERAPEUTIC_PROCEDURE","start":1568,"end":1587},{"text":"persistent","label":"DETAILED_DESCRIPTION","start":1612,"end":1622},{"text":"air leakage","label":"SIGN_SYMPTOM","start":1623,"end":1634},{"text":"repair","label":"THERAPEUTIC_PROCEDURE","start":1667,"end":1673},{"text":"bronchial stump","label":"BIOLOGICAL_STRUCTURE","start":1678,"end":1693},{"text":"flap coverage","label":"THERAPEUTIC_PROCEDURE","start":1699,"end":1712},{"text":"neoadjuvant","label":"DETAILED_DESCRIPTION","start":1748,"end":1759},{"text":"chemoradiotherapy","label":"THERAPEUTIC_PROCEDURE","start":1760,"end":1777},{"text":"repair","label":"THERAPEUTIC_PROCEDURE","start":1979,"end":1985},{"text":"bronchial stump","label":"BIOLOGICAL_STRUCTURE","start":1990,"end":2005},{"text":"TRAM flap","label":"THERAPEUTIC_PROCEDURE","start":2011,"end":2020},{"text":"placed in supine","label":"THERAPEUTIC_PROCEDURE","start":2056,"end":2072},{"text":"Right side","label":"DETAILED_DESCRIPTION","start":2074,"end":2084},{"text":"exploratory","label":"DETAILED_DESCRIPTION","start":2085,"end":2096},{"text":"thoracotomy","label":"DIAGNOSTIC_PROCEDURE","start":2097,"end":2108},{"text":"bronchial stump","label":"BIOLOGICAL_STRUCTURE","start":2131,"end":2146},{"text":"superior epigastric vascular artery","label":"BIOLOGICAL_STRUCTURE","start":2164,"end":2199},{"text":"right rectus abdominis muscle","label":"BIOLOGICAL_STRUCTURE","start":2204,"end":2233},{"text":"TRAM flap","label":"THERAPEUTIC_PROCEDURE","start":2273,"end":2282},{"text":"marked on the skin","label":"DETAILED_DESCRIPTION","start":2287,"end":2305},{"text":"TRAM flap","label":"THERAPEUTIC_PROCEDURE","start":2325,"end":2334},{"text":"harvested","label":"THERAPEUTIC_PROCEDURE","start":2339,"end":2348},{"text":"right rectus abdominis","label":"BIOLOGICAL_STRUCTURE","start":2354,"end":2376},{"text":"deepithelialized","label":"THERAPEUTIC_PROCEDURE","start":2394,"end":2410},{"text":"subcutaneous tunnel","label":"THERAPEUTIC_PROCEDURE","start":2431,"end":2450},{"text":"TRAM flap","label":"THERAPEUTIC_PROCEDURE","start":2456,"end":2465},{"text":"right thoracic space","label":"BIOLOGICAL_STRUCTURE","start":2487,"end":2507},{"text":"tension","label":"SIGN_SYMPTOM","start":2516,"end":2523},{"text":"kinking","label":"SIGN_SYMPTOM","start":2527,"end":2534},{"text":"pedicle","label":"BIOLOGICAL_STRUCTURE","start":2542,"end":2549},{"text":"TRAM flap","label":"THERAPEUTIC_PROCEDURE","start":2569,"end":2578},{"text":"posterior chest wall","label":"BIOLOGICAL_STRUCTURE","start":2592,"end":2612},{"text":"bronchial stump","label":"BIOLOGICAL_STRUCTURE","start":2626,"end":2641},{"text":"tissue glue","label":"THERAPEUTIC_PROCEDURE","start":2659,"end":2670},{"text":"bronchial stump","label":"BIOLOGICAL_STRUCTURE","start":2695,"end":2710},{"text":"bronchoscope","label":"DIAGNOSTIC_PROCEDURE","start":2717,"end":2729},{"text":"donor site of flap","label":"BIOLOGICAL_STRUCTURE","start":2735,"end":2753},{"text":"mesh repair","label":"THERAPEUTIC_PROCEDURE","start":2770,"end":2781},{"text":"postoperative course","label":"THERAPEUTIC_PROCEDURE","start":2787,"end":2807},{"text":"smooth","label":"LAB_VALUE","start":2812,"end":2818},{"text":"air leak","label":"SIGN_SYMPTOM","start":2827,"end":2835},{"text":"diminished","label":"LAB_VALUE","start":2840,"end":2850},{"text":"discharge","label":"CLINICAL_EVENT","start":2883,"end":2892},{"text":"stable condition","label":"SIGN_SYMPTOM","start":2899,"end":2915},{"text":"air leak","label":"SIGN_SYMPTOM","start":2934,"end":2942},{"text":"after following for 12 months","label":"DATE","start":2943,"end":2972}],"tokens":["A ","61-year-old"," ","male"," patient had a history of ","chronic obstructive pulmonary disease"," under ","regular bronchodilator treatment",".\nIn ","2014",", he suffered from ","severe"," ","productive"," ","cough"," with ","mucus sputum"," ","for several months"," and ","unintentional"," body ","weight loss"," ","6\u200akg"," ","within 6 months",".\nAfter ","sputum analysis"," and ","chest"," ","imaging examinations"," in ","May 2014",", he was diagnosed of ","squamous cell carcinoma"," in ","right upper lobe lung"," (","cT3N2M0",", ","stage IIIa",").\nThen he received ","neoadjuvant"," ","chemoradiotherapy"," (","etoposide"," ","70\u200amg [45\u200amg\/m2]\u200a","+\u200a","cisplatin"," ","79\u200amg [50\u200amg\/m2]","; ","4500\u200acGY in 25 fractions",") ","from June to July 2014",".\nIn ","October 2014",", ","surgical intervention"," was arranged.\nBecause the ","tumor"," was located at ","right hilum"," and invaded ","main bronchus"," and ","major vessels",", ","video-assisted"," ","thoracoscopic"," ","surgery"," with ","right side"," ","intrapericardial"," ","pneumonectomy"," was performed.\nPostoperatively, ","pathological exams"," revealed ","squamous cell carcinoma",", ","T3N0M0",", ","stage IIB",".\nThe ","postoperative course"," was ","smooth"," but he suffered from ","severe"," ","cough"," and ","right chest"," ","pain"," ","one month later",".\n","Laboratory exams"," revealed ","leukocytosis"," (","white blood cells","\u200a=\u200a","21,860\u200a\u03bcL",") and ","elevated"," ","C-reactive protein"," to ","23.94\u200amg\/dL",".\n","Chest"," ","X-ray"," showed ","cavitary"," ","lesion"," and ","computed tomography"," showed ","pleural effusion"," and ","fluid collection"," with ","mottled gas appearance"," in the ","dependent portion of right hemithorax"," (Fig.1A).\nAccording to the patient's history, results of laboratory exams, and imaging findings, ","postpneumonectomy"," ","empyema"," was diagnosed and ","bronchopleural fistula"," was highly suspected.\nAfter ","admission",", ","chest"," ","tube drainage"," was inserted and ","bronchoscopic"," ","tissue glue sealing"," was performed.\nHowever, ","persistent"," ","air leakage"," was presented and we decided to ","repair"," the ","bronchial stump"," with ","flap coverage",".\nBecause the patient just received ","neoadjuvant"," ","chemoradiotherapy"," a few months ago, the flaps harvested from chest area were not appropriate because the pedicle arteries might have been injured by irradiation.\nAfter discussing with the plastic surgeon, we decided to ","repair"," the ","bronchial stump"," by a ","TRAM flap",".\nIntraoperatively, the patient was ","placed in supine",".\n","Right side"," ","exploratory"," ","thoracotomy"," was performed and the ","bronchial stump"," was located.\nThe ","superior epigastric vascular artery"," and ","right rectus abdominis muscle"," was identified and the location of the ","TRAM flap"," was ","marked on the skin"," (Fig.2A).\nThen the ","TRAM flap"," was ","harvested"," from ","right rectus abdominis"," (Fig.2B) and was ","deepithelialized"," (Fig.2C).\nThrough a ","subcutaneous tunnel",", the ","TRAM flap"," was moved toward the ","right thoracic space"," with no ","tension"," or ","kinking"," on the ","pedicle"," (Fig.2D).\nThen the ","TRAM flap"," was fixed to ","posterior chest wall"," to cover the ","bronchial stump"," (Fig.2E) and the ","tissue glue"," was also applied to the ","bronchial stump"," under ","bronchoscope",".\nThe ","donor site of flap"," was closed with ","mesh repair",".\nThe ","postoperative course"," was ","smooth"," and the ","air leak"," was ","diminished"," gradually.\nThen the patient was ","discharge"," under ","stable condition"," and was free from ","air leak"," ","after following for 12 months"," (Fig.1B).\nThe patient provided written informed consent for publication of this report and all accompanying images.\n"],"ner_labels":[0,5,0,65,0,39,0,39,0,19,0,63,0,22,0,69,0,22,0,32,0,22,0,69,0,42,0,32,0,24,0,12,0,24,0,19,0,26,0,12,0,42,0,42,0,22,0,75,0,46,0,29,0,46,0,29,0,29,0,32,0,19,0,75,0,69,0,12,0,12,0,12,0,22,0,22,0,75,0,22,0,12,0,75,0,24,0,26,0,42,0,42,0,75,0,42,0,63,0,69,0,12,0,69,0,19,0,24,0,69,0,24,0,42,0,42,0,24,0,42,0,12,0,24,0,22,0,69,0,24,0,69,0,69,0,22,0,12,0,22,0,69,0,26,0,13,0,12,0,75,0,22,0,75,0,22,0,69,0,75,0,12,0,75,0,22,0,75,0,75,0,12,0,75,0,75,0,22,0,22,0,24,0,12,0,12,0,12,0,75,0,22,0,75,0,75,0,12,0,75,0,75,0,75,0,12,0,69,0,69,0,12,0,75,0,12,0,12,0,75,0,12,0,24,0,12,0,75,0,75,0,42,0,69,0,42,0,13,0,69,0,69,0,19,0]}
-{"full_text":"A 63-year-old male patient without smoking or drinking history was admitted on June 11, 2014.\nHis major complaints were gradually aggravated dysphagia and fatigue, on suspicion of obstructive disease in upper digestive tract.\nHe had been an athlete before, and then retired in good physical status before admission.\nHis family and social history indicated nothing abnormal.\nThorough physical examination of his skin, oral mucosa, eyes, and genital areas failed to identify any superficial lesions.\nAdditionally, laboratory tests including hepatic function, renal function, and serum tumor markers such as carcinoembryonic antigen, cytokeratin 19 fragment, squamous cell carcinoma, neuron-specific enolase, and carbohydrate antigen 125 were all in normal range.\nTherefore, further endoscopic and radiological examinations were carried out for accurate diagnosis.\nEndoscopic examination revealed a slightly pigmented, irregular mass, which was located in lower esophagus, measuring 5.0\u200acm\u200a\u00d7\u200a3.0\u200acm in size.\nFine needle biopsy of the lesion revealed esophageal melanoma, which was confirmed by histopathology.\nBesides chest and abdomen computed tomography (CT), enhanced cranial magnetic resonance image (MRI) and bone emission computed tomography (ECT) showed enlarged mediastinal, nd also celiac lymph nodes (Fig.1A), without obvious involvement of supraclavicular lymph nodes.\nConcurrently, the CT showed an isolated, irregular pulmonary tumor (Fig.1B).\nPositron emission tomography was not carried out, because it was not covered by health insurance of this patient.\nTherefore, this patient was clinically staged as cT3NxM1 according to the 7th edition of American Joint Committee on Cancer TNM staging system for esophageal cancer.\nCT-guided percutaneous pulmonary biopsy was avoided, with the aim to diminish the risk of tumor dissemination.\nSingle-stage resection of the esophageal and pulmonary lesions was assumed to be reasonable after multidisciplinary consultation, which was approved by Ethical Committee of Xuzhou Central Hospital.\nBecause the prognosis of this patient probably was extremely poor without targeted antibodies, which he could not afford for financial reasons.\nAfter his informed consent, simultaneous Ivor-Lewis esophagectomy and right upper lobectomy were performed successfully, under general anesthesia, after double-lumen endotracheal intubation, followed by systemic dissection of lymph nodes located in mediastinum and abdomen, in accordance with the principles of oncological surgery.\nThe operation time was 290 minutes, without obvious bleeding during the surgery.\nPostoperative pathological staining of the specimen revealed pleomorphic cells and abundant melanin granules (Fig.1C), whereas immunohistochemical tests demonstrated positive expression of human melanoma black 45 (HMB45), microtubule-associated protein tau 1 (MAPT1), melan A and S100, and negative expression of desmin, synaptophysin, and epithelial membrane antigen (EMA), which was consistent with melanoma.\nThe resection margin and dissected lymph nodes were pathologically tumor-negative.\nIn addition, molecular study of the patient indicated mutation of V-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E.\nBased on these findings, a diagnosis of advanced PMME was tentatively established as stage IV (pT3N0M1), because there was insufficient evidence to distinguish synchronous primary pulmonary melanoma from metastasis for this patient.\nThe postoperative recovery was mainly uneventful, and the patient was discharged 14 days after surgery.\nSubsequently, 4 cycles of adjuvant conventional chemotherapy with an interval of 3 weeks were completed, with controlled moderate toxic effects including thrombocytopenia, leukopenia, nausea, vomiting, and diarrhea.\nThe detailed chemotherapy regimen is as follows: paclitaxel liposome for injection on day 1 and day 8 (135\u200amg per square meter of body surface area; Nanjing Luye Sike Pharmaceutical Co., Ltd., Jiangsu, China.), tegafur injection on day 2 to 4 (1000\u200amg per square meter of body-surface area; Shandong Qilu Pharmaceutical Co., Ltd., Jinan, China.) plus cis-platinum on day 2 to 3 (75\u200amg per square meter of body-surface area; Shandong Qilu Pharmaceutical Co., Ltd., Jinan, China).\nThis patient suffered from moderate leukopenia\/ myelosuppression after the second cycle of TPF chemotherapy, and he recovered quickly after the administration of granulocyte colony-stimulating factor (G-CSF).\nConcurrently, recombinant human interferon alpha-2b (Harbin pharmaceutical group biological engineering Co., Ltd, Harbin, China) was administrated via hypodermic injection thereafter (6000 units every 3 days; Fig.2), lasting for 1 year.\nThe patient was followed up continuously after the surgery.\nChest and abdomen CT, cranial MRI, bone ECT, and thorough physical examination were carried out every 3 months.\nEncouragingly, the patient survived without loco-regional recurrence or remote metastasis during the follow-up of two and a half years up to now (Fig.3).\n","ner_info":[{"text":"63-year-old","label":"AGE","start":2,"end":13},{"text":"male","label":"SEX","start":14,"end":18},{"text":"without smoking or drinking history","label":"HISTORY","start":27,"end":62},{"text":"admitted","label":"CLINICAL_EVENT","start":67,"end":75},{"text":"on June 11, 2014","label":"DATE","start":76,"end":92},{"text":"dysphagia","label":"SIGN_SYMPTOM","start":141,"end":150},{"text":"fatigue","label":"SIGN_SYMPTOM","start":155,"end":162},{"text":"obstructive disease","label":"DISEASE_DISORDER","start":180,"end":199},{"text":"upper digestive tract","label":"BIOLOGICAL_STRUCTURE","start":203,"end":224},{"text":"had been an athlete","label":"OCCUPATION","start":229,"end":248},{"text":"retired in good physical status","label":"HISTORY","start":266,"end":297},{"text":"His family and social history indicated nothing 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system","label":"DETAILED_DESCRIPTION","start":1642,"end":1710},{"text":"esophageal cancer","label":"DISEASE_DISORDER","start":1715,"end":1732},{"text":"CT-guided","label":"DETAILED_DESCRIPTION","start":1734,"end":1743},{"text":"percutaneous","label":"DETAILED_DESCRIPTION","start":1744,"end":1756},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1757,"end":1766},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1767,"end":1773},{"text":"Single-stage","label":"DETAILED_DESCRIPTION","start":1845,"end":1857},{"text":"resection","label":"THERAPEUTIC_PROCEDURE","start":1858,"end":1867},{"text":"esophageal","label":"BIOLOGICAL_STRUCTURE","start":1875,"end":1885},{"text":"pulmonary","label":"BIOLOGICAL_STRUCTURE","start":1890,"end":1899},{"text":"lesions","label":"SIGN_SYMPTOM","start":1900,"end":1907},{"text":"consultation","label":"CLINICAL_EVENT","start":1961,"end":1973},{"text":"targeted 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1","label":"DIAGNOSTIC_PROCEDURE","start":2822,"end":2858},{"text":"MAPT1","label":"DIAGNOSTIC_PROCEDURE","start":2860,"end":2865},{"text":"melan A","label":"DIAGNOSTIC_PROCEDURE","start":2868,"end":2875},{"text":"S100","label":"DIAGNOSTIC_PROCEDURE","start":2880,"end":2884},{"text":"negative expression","label":"LAB_VALUE","start":2890,"end":2909},{"text":"desmin","label":"DIAGNOSTIC_PROCEDURE","start":2913,"end":2919},{"text":"synaptophysin","label":"DIAGNOSTIC_PROCEDURE","start":2921,"end":2934},{"text":"epithelial membrane antigen","label":"DIAGNOSTIC_PROCEDURE","start":2940,"end":2967},{"text":"EMA","label":"DIAGNOSTIC_PROCEDURE","start":2969,"end":2972},{"text":"melanoma","label":"DISEASE_DISORDER","start":3001,"end":3009},{"text":"resection margin","label":"BIOLOGICAL_STRUCTURE","start":3015,"end":3031},{"text":"dissected lymph nodes","label":"BIOLOGICAL_STRUCTURE","start":3036,"end":3057},{"text":"tumor","label":"SIGN_SYMPTOM","start":3078,"end":3083},{"text":"molecular study","label":"DIAGNOSTIC_PROCEDURE","start":3107,"end":3122},{"text":"mutation of V-raf murine sarcoma viral oncogene homolog B1","label":"SIGN_SYMPTOM","start":3148,"end":3206},{"text":"advanced","label":"SEVERITY","start":3261,"end":3269},{"text":"PMME","label":"DISEASE_DISORDER","start":3270,"end":3274},{"text":"stage IV","label":"LAB_VALUE","start":3306,"end":3314},{"text":"pT3N0M1","label":"LAB_VALUE","start":3316,"end":3323},{"text":"postoperative recovery","label":"THERAPEUTIC_PROCEDURE","start":3458,"end":3480},{"text":"mainly uneventful","label":"LAB_VALUE","start":3485,"end":3502},{"text":"discharged","label":"CLINICAL_EVENT","start":3524,"end":3534},{"text":"14 days after surgery","label":"DATE","start":3535,"end":3556},{"text":"4 cycles","label":"DOSAGE","start":3572,"end":3580},{"text":"adjuvant","label":"DETAILED_DESCRIPTION","start":3584,"end":3592},{"text":"conventional","label":"DETAILED_DESCRIPTION","start":3593,"end":3605},{"text":"chemotherapy","label":"MEDICATION","start":3606,"end":3618},{"text":"an interval of 3 weeks","label":"DOSAGE","start":3624,"end":3646},{"text":"thrombocytopenia","label":"SIGN_SYMPTOM","start":3712,"end":3728},{"text":"leukopenia","label":"SIGN_SYMPTOM","start":3730,"end":3740},{"text":"nausea","label":"SIGN_SYMPTOM","start":3742,"end":3748},{"text":"vomiting","label":"SIGN_SYMPTOM","start":3750,"end":3758},{"text":"diarrhea","label":"SIGN_SYMPTOM","start":3764,"end":3772},{"text":"paclitaxel 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months","label":"FREQUENCY","start":4855,"end":4869},{"text":"survived","label":"OUTCOME","start":4898,"end":4906},{"text":"loco-regional","label":"DETAILED_DESCRIPTION","start":4915,"end":4928},{"text":"recurrence","label":"SIGN_SYMPTOM","start":4929,"end":4939},{"text":"remote","label":"DETAILED_DESCRIPTION","start":4943,"end":4949},{"text":"metastasis","label":"SIGN_SYMPTOM","start":4950,"end":4960},{"text":"follow-up","label":"CLINICAL_EVENT","start":4972,"end":4981},{"text":"two and a half years","label":"DURATION","start":4985,"end":5005}],"tokens":["A ","63-year-old"," ","male"," patient ","without smoking or drinking history"," was ","admitted"," ","on June 11, 2014",".\nHis major complaints were gradually aggravated ","dysphagia"," and ","fatigue",", on suspicion of ","obstructive disease"," in ","upper digestive tract",".\nHe ","had been an athlete"," before, and then ","retired in good physical status"," before admission.\n","His family and social history indicated nothing abnormal",".\nThorough ","physical examination"," of his ","skin",", ","oral mucosa",", ","eyes",", and ","genital areas"," failed to identify any superficial ","lesions",".\nAdditionally, ","laboratory tests"," including ","hepatic function",", ","renal function",", and ","serum tumor markers"," such as ","carcinoembryonic antigen",", ","cytokeratin 19 fragment",", ","squamous cell carcinoma",", ","neuron-specific enolase",", and ","carbohydrate antigen 125"," were all ","in normal range",".\nTherefore, further ","endoscopic"," and ","radiological"," ","examinations"," were carried out for accurate diagnosis.\n","Endoscopic examination"," revealed a ","slightly pigmented",", ","irregular"," ","mass",", which was located in ","lower esophagus",", measuring ","5.0\u200acm\u200a\u00d7\u200a3.0\u200acm"," in size.\n","Fine needle"," ","biopsy"," of the ","lesion"," revealed ","esophageal"," ","melanoma",", which was confirmed by ","histopathology",".\nBesides ","chest"," and ","abdomen"," ","computed tomography"," (","CT","), ","enhanced"," ","cranial"," ","magnetic resonance image"," (","MRI",") and ","bone"," ","emission computed tomography"," (","ECT",") showed ","enlarged"," ","mediastinal",", nd also ","celiac"," ","lymph nodes"," (Fig.1A), without obvious ","involvement"," of ","supraclavicular"," ","lymph nodes",".\nConcurrently, the ","CT"," showed an ","isolated",", ","irregular"," ","pulmonary"," ","tumor"," (Fig.1B).\n","Positron emission tomography"," was not carried out, because it was not covered by health insurance of this patient.\nTherefore, this patient was ","clinically staged"," as ","cT3NxM1"," according to the ","7th edition of American Joint Committee on Cancer TNM staging system"," for ","esophageal cancer",".\n","CT-guided"," ","percutaneous"," ","pulmonary"," ","biopsy"," was avoided, with the aim to diminish the risk of tumor dissemination.\n","Single-stage"," ","resection"," of the ","esophageal"," and ","pulmonary"," ","lesions"," was assumed to be reasonable after multidisciplinary ","consultation",", which was approved by Ethical Committee of Xuzhou Central Hospital.\nBecause the prognosis of this patient probably was extremely poor without ","targeted antibodies",", which he could not afford for financial reasons.\nAfter his informed consent, ","simultaneous"," ","Ivor-Lewis"," ","esophagectomy"," and ","right upper"," ","lobectomy"," were performed successfully, under ","general anesthesia",", after ","double-lumen"," ","endotracheal"," ","intubation",", followed by ","systemic"," ","dissection"," of ","lymph nodes"," located in ","mediastinum"," and ","abdomen",", in accordance with the principles of oncological surgery.\nThe operation time was ","290 minutes",", without obvious ","bleeding"," during the surgery.\nPostoperative ","pathological staining"," of the specimen revealed ","pleomorphic cells"," and abundant ","melanin granules"," (Fig.1C), whereas ","immunohistochemical tests"," demonstrated ","positive expression"," of ","human melanoma black 45"," (","HMB45","), ","microtubule-associated protein tau 1"," (","MAPT1","), ","melan A"," and ","S100",", and ","negative expression"," of ","desmin",", ","synaptophysin",", and ","epithelial membrane antigen"," (","EMA","), which was consistent with ","melanoma",".\nThe ","resection margin"," and ","dissected lymph nodes"," were pathologically ","tumor","-negative.\nIn addition, ","molecular study"," of the patient indicated ","mutation of V-raf murine sarcoma viral oncogene homolog B1"," (BRAF) V600E.\nBased on these findings, a diagnosis of ","advanced"," ","PMME"," was tentatively established as ","stage IV"," (","pT3N0M1","), because there was insufficient evidence to distinguish synchronous primary pulmonary melanoma from metastasis for this patient.\nThe ","postoperative recovery"," was ","mainly uneventful",", and the patient was ","discharged"," ","14 days after surgery",".\nSubsequently, ","4 cycles"," of ","adjuvant"," ","conventional"," ","chemotherapy"," with ","an interval of 3 weeks"," were completed, with controlled moderate toxic effects including ","thrombocytopenia",", ","leukopenia",", ","nausea",", ","vomiting",", and ","diarrhea",".\nThe detailed chemotherapy regimen is as follows: ","paclitaxel liposome"," for ","injection"," on day 1 and day 8 (135\u200amg per square meter of body surface area; Nanjing Luye Sike Pharmaceutical Co., Ltd., Jiangsu, China.), ","tegafur"," ","injection"," on day 2 to 4 (1000\u200amg per square meter of body-surface area; Shandong Qilu Pharmaceutical Co., Ltd., Jinan, China.) plus ","cis-platinum"," on day 2 to 3 (75\u200amg per square meter of body-surface area; Shandong Qilu Pharmaceutical Co., Ltd., Jinan, China).\nThis patient suffered from ","moderate"," ","leukopenia","\/ ","myelosuppression"," after the second cycle of TPF ","chemotherapy",", and he ","recovered"," quickly after the administration of ","granulocyte colony-stimulating factor"," (","G-CSF",").\nConcurrently, recombinant ","human interferon alpha-2b"," (Harbin pharmaceutical group biological engineering Co., Ltd, Harbin, China) was administrated via ","hypodermic injection"," thereafter (","6000 units every 3 days","; Fig.2), lasting ","for 1 year",".\nThe patient was ","followed up"," continuously after the surgery.\n","Chest"," and ","abdomen"," ","CT",", ","cranial"," ","MRI",", ","bone"," ","ECT",", and thorough ","physical examination"," were carried out ","every 3 months",".\nEncouragingly, the patient ","survived"," without ","loco-regional"," ","recurrence"," or ","remote"," ","metastasis"," during the ","follow-up"," of ","two and a half years"," up to now (Fig.3).\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,19,0,69,0,69,0,26,0,12,0,50,0,39,0,39,0,24,0,12,0,12,0,12,0,12,0,69,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,22,0,22,0,24,0,24,0,15,0,22,0,69,0,12,0,8,0,22,0,24,0,18,0,12,0,26,0,24,0,12,0,12,0,24,0,24,0,22,0,12,0,24,0,24,0,12,0,24,0,24,0,69,0,12,0,12,0,12,0,69,0,12,0,12,0,24,0,22,0,22,0,12,0,69,0,24,0,24,0,42,0,22,0,26,0,22,0,22,0,12,0,24,0,22,0,75,0,12,0,12,0,69,0,13,0,75,0,22,0,22,0,75,0,22,0,75,0,46,0,22,0,22,0,75,0,22,0,75,0,12,0,12,0,12,0,32,0,69,0,24,0,69,0,69,0,24,0,42,0,24,0,24,0,24,0,24,0,24,0,24,0,42,0,24,0,24,0,24,0,24,0,26,0,12,0,12,0,69,0,24,0,69,0,63,0,26,0,42,0,42,0,75,0,42,0,13,0,19,0,29,0,22,0,22,0,46,0,29,0,69,0,69,0,69,0,69,0,69,0,46,0,4,0,46,0,4,0,46,0,63,0,69,0,69,0,46,0,69,0,46,0,46,0,46,0,4,0,29,0,32,0,13,0,12,0,12,0,24,0,12,0,24,0,12,0,24,0,24,0,35,0,56,0,22,0,69,0,22,0,69,0,13,0,32,0]}
-{"full_text":"A 34-year-old woman, 1 week postpartum, presented to our dermatology clinic with an intensely pruritic generalized rash.\nTwo days after delivery of her child, the patient developed an itchy rash on the abdomen.\nOn discharge, she was instructed to follow up with the dermatology department if the rash did not resolve.\nAfter leaving the hospital, she reported that the eruption had progressively spread to the buttocks and legs and the itching seemed to be worse.\nThe patient's prenatal course was uneventful.\nShe gained 13 kg during pregnancy, with a prepregnancy weight of 72 kg.\nA healthy male neonate was delivered by caesarean section at 38 weeks' gestation without complication.\nThe patient's medical history was unremarkable.\nShe was currently not taking any medications, and she reported no known drug allergies.\nOn physical examination, the patient was afebrile and her blood pressure was normal.\nExamination of the skin revealed erythematous papules and urticarial plaques involving the abdominal striae with periumbilical sparing.\nSimilar lesions were noted on the legs and buttocks (Fig.1a).\nThe face, palms, and soles were uninvolved.\nNo vesicles or pustules were noted.\nBased on the characteristic clinical presentation and disease course, she was diagnosed with PUPPP.\nShe was informed of the safety profile and potential benefits of medications but remained reluctant to use medications during lactation, despite her severe symptoms.\nAWB injection was then considered for her treatment.\nVenous blood of 10 mL was drawn from the patient, followed by intramuscular injection of 5 mL of the blood on each side of her buttock.\nSeven days later, both subjective and objective improvements of symptoms were noticed and she received 1 more session of AWB injection (Fig.1b).\nOn follow-up after 12 days, all subjective symptoms had improved, leaving only postinflammatory hyperpigmentation (Fig.1c).\nNo complications such as infection, abscess formation, or hematoma were observed at the injection site.\n","ner_info":[{"text":"34-year-old","label":"AGE","start":2,"end":13},{"text":"woman","label":"SEX","start":14,"end":19},{"text":"1 week postpartum","label":"HISTORY","start":21,"end":38},{"text":"presented","label":"CLINICAL_EVENT","start":40,"end":49},{"text":"dermatology clinic","label":"NONBIOLOGICAL_LOCATION","start":57,"end":75},{"text":"intensely","label":"SEVERITY","start":84,"end":93},{"text":"pruritic","label":"DETAILED_DESCRIPTION","start":94,"end":102},{"text":"generalized","label":"DETAILED_DESCRIPTION","start":103,"end":114},{"text":"rash","label":"SIGN_SYMPTOM","start":115,"end":119},{"text":"Two days after","label":"DATE","start":121,"end":135},{"text":"delivery of her child","label":"CLINICAL_EVENT","start":136,"end":157},{"text":"itchy","label":"DETAILED_DESCRIPTION","start":184,"end":189},{"text":"rash","label":"SIGN_SYMPTOM","start":190,"end":194},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":202,"end":209},{"text":"discharge","label":"CLINICAL_EVENT","start":214,"end":223},{"text":"eruption","label":"SIGN_SYMPTOM","start":368,"end":376},{"text":"progressively spread","label":"DETAILED_DESCRIPTION","start":381,"end":401},{"text":"buttocks","label":"BIOLOGICAL_STRUCTURE","start":409,"end":417},{"text":"legs","label":"BIOLOGICAL_STRUCTURE","start":422,"end":426},{"text":"itching","label":"SIGN_SYMPTOM","start":435,"end":442},{"text":"prenatal course","label":"SIGN_SYMPTOM","start":477,"end":492},{"text":"uneventful","label":"LAB_VALUE","start":497,"end":507},{"text":"gained","label":"SIGN_SYMPTOM","start":513,"end":519},{"text":"13 kg","label":"LAB_VALUE","start":520,"end":525},{"text":"during pregnancy","label":"DETAILED_DESCRIPTION","start":526,"end":542},{"text":"prepregnancy","label":"DETAILED_DESCRIPTION","start":551,"end":563},{"text":"72 kg","label":"WEIGHT","start":574,"end":579},{"text":"healthy","label":"DETAILED_DESCRIPTION","start":583,"end":590},{"text":"male","label":"DETAILED_DESCRIPTION","start":591,"end":595},{"text":"neonate","label":"SUBJECT","start":596,"end":603},{"text":"caesarean section","label":"THERAPEUTIC_PROCEDURE","start":621,"end":638},{"text":"at 38 weeks' gestation","label":"LAB_VALUE","start":639,"end":661},{"text":"complication","label":"SIGN_SYMPTOM","start":670,"end":682},{"text":"medical history was unremarkable","label":"HISTORY","start":698,"end":730},{"text":"medications","label":"MEDICATION","start":765,"end":776},{"text":"drug allergies","label":"SIGN_SYMPTOM","start":804,"end":818},{"text":"physical examination","label":"DIAGNOSTIC_PROCEDURE","start":823,"end":843},{"text":"b","label":"SIGN_SYMPTOM","start":864,"end":865},{"text":"blood pressure","label":"DIAGNOSTIC_PROCEDURE","start":878,"end":892},{"text":"normal","label":"LAB_VALUE","start":897,"end":903},{"text":"Examination of the skin","label":"DIAGNOSTIC_PROCEDURE","start":905,"end":928},{"text":"erythematous","label":"DETAILED_DESCRIPTION","start":938,"end":950},{"text":"papules","label":"SIGN_SYMPTOM","start":951,"end":958},{"text":"urticarial","label":"DETAILED_DESCRIPTION","start":963,"end":973},{"text":"plaques","label":"SIGN_SYMPTOM","start":974,"end":981},{"text":"abdominal striae","label":"BIOLOGICAL_STRUCTURE","start":996,"end":1012},{"text":"periumbilical sparing","label":"BIOLOGICAL_STRUCTURE","start":1018,"end":1039},{"text":"lesions","label":"SIGN_SYMPTOM","start":1049,"end":1056},{"text":"legs","label":"BIOLOGICAL_STRUCTURE","start":1075,"end":1079},{"text":"buttocks","label":"BIOLOGICAL_STRUCTURE","start":1084,"end":1092},{"text":"face","label":"BIOLOGICAL_STRUCTURE","start":1107,"end":1111},{"text":"palms","label":"BIOLOGICAL_STRUCTURE","start":1113,"end":1118},{"text":"soles","label":"BIOLOGICAL_STRUCTURE","start":1124,"end":1129},{"text":"uninvolved","label":"SIGN_SYMPTOM","start":1135,"end":1145},{"text":"vesicles","label":"SIGN_SYMPTOM","start":1150,"end":1158},{"text":"pustules","label":"SIGN_SYMPTOM","start":1162,"end":1170},{"text":"PUPPP","label":"DISEASE_DISORDER","start":1276,"end":1281},{"text":"medications","label":"MEDICATION","start":1390,"end":1401},{"text":"AWB injection","label":"THERAPEUTIC_PROCEDURE","start":1449,"end":1462},{"text":"Venous blood","label":"BIOLOGICAL_STRUCTURE","start":1502,"end":1514},{"text":"10 mL","label":"VOLUME","start":1518,"end":1523},{"text":"drawn","label":"THERAPEUTIC_PROCEDURE","start":1528,"end":1533},{"text":"intramuscular","label":"ADMINISTRATION","start":1564,"end":1577},{"text":"injection","label":"THERAPEUTIC_PROCEDURE","start":1578,"end":1587},{"text":"5 mL","label":"VOLUME","start":1591,"end":1595},{"text":"blood","label":"BIOLOGICAL_STRUCTURE","start":1603,"end":1608},{"text":"each side of her buttock","label":"BIOLOGICAL_STRUCTURE","start":1612,"end":1636},{"text":"Seven days later","label":"DATE","start":1638,"end":1654},{"text":"improvements","label":"LAB_VALUE","start":1686,"end":1698},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1702,"end":1710},{"text":"1 more session","label":"LAB_VALUE","start":1741,"end":1755},{"text":"AWB injection","label":"THERAPEUTIC_PROCEDURE","start":1759,"end":1772},{"text":"after 12 days","label":"DATE","start":1796,"end":1809},{"text":"symptoms","label":"SIGN_SYMPTOM","start":1826,"end":1834},{"text":"improved","label":"LAB_VALUE","start":1839,"end":1847},{"text":"postinflammatory","label":"DETAILED_DESCRIPTION","start":1862,"end":1878},{"text":"hyperpigmentation","label":"SIGN_SYMPTOM","start":1879,"end":1896},{"text":"infection","label":"SIGN_SYMPTOM","start":1932,"end":1941},{"text":"abscess","label":"SIGN_SYMPTOM","start":1943,"end":1950},{"text":"hematoma","label":"SIGN_SYMPTOM","start":1965,"end":1973},{"text":"the injection site","label":"BIOLOGICAL_STRUCTURE","start":1991,"end":2009}],"tokens":["A ","34-year-old"," ","woman",", ","1 week postpartum",", ","presented"," to our ","dermatology clinic"," with an ","intensely"," ","pruritic"," ","generalized"," ","rash",".\n","Two days after"," ","delivery of her child",", the patient developed an ","itchy"," ","rash"," on the ","abdomen",".\nOn ","discharge",", she was instructed to follow up with the dermatology department if the rash did not resolve.\nAfter leaving the hospital, she reported that the ","eruption"," had ","progressively spread"," to the ","buttocks"," and ","legs"," and the ","itching"," seemed to be worse.\nThe patient's ","prenatal course"," was ","uneventful",".\nShe ","gained"," ","13 kg"," ","during pregnancy",", with a ","prepregnancy"," weight of ","72 kg",".\nA ","healthy"," ","male"," ","neonate"," was delivered by ","caesarean section"," ","at 38 weeks' gestation"," without ","complication",".\nThe patient's ","medical history was unremarkable",".\nShe was currently not taking any ","medications",", and she reported no known ","drug allergies",".\nOn ","physical examination",", the patient was afe","b","rile and her ","blood pressure"," was ","normal",".\n","Examination of the skin"," revealed ","erythematous"," ","papules"," and ","urticarial"," ","plaques"," involving the ","abdominal striae"," with ","periumbilical sparing",".\nSimilar ","lesions"," were noted on the ","legs"," and ","buttocks"," (Fig.1a).\nThe ","face",", ","palms",", and ","soles"," were ","uninvolved",".\nNo ","vesicles"," or ","pustules"," were noted.\nBased on the characteristic clinical presentation and disease course, she was diagnosed with ","PUPPP",".\nShe was informed of the safety profile and potential benefits of medications but remained reluctant to use ","medications"," during lactation, despite her severe symptoms.\n","AWB injection"," was then considered for her treatment.\n","Venous blood"," of ","10 mL"," was ","drawn"," from the patient, followed by ","intramuscular"," ","injection"," of ","5 mL"," of the ","blood"," on ","each side of her buttock",".\n","Seven days later",", both subjective and objective ","improvements"," of ","symptoms"," were noticed and she received ","1 more session"," of ","AWB injection"," (Fig.1b).\nOn follow-up ","after 12 days",", all subjective ","symptoms"," had ","improved",", leaving only ","postinflammatory"," ","hyperpigmentation"," (Fig.1c).\nNo complications such as ","infection",", ","abscess"," formation, or ","hematoma"," were observed at ","the injection site",".\n"],"ner_labels":[0,5,0,65,0,39,0,13,0,48,0,63,0,22,0,22,0,69,0,19,0,13,0,22,0,69,0,12,0,13,0,69,0,22,0,12,0,12,0,69,0,69,0,42,0,69,0,42,0,22,0,22,0,82,0,22,0,22,0,71,0,75,0,42,0,69,0,39,0,46,0,69,0,24,0,69,0,24,0,42,0,24,0,22,0,69,0,22,0,69,0,12,0,12,0,69,0,12,0,12,0,12,0,12,0,12,0,69,0,69,0,69,0,26,0,46,0,75,0,12,0,79,0,75,0,4,0,75,0,79,0,12,0,12,0,19,0,42,0,69,0,42,0,75,0,19,0,69,0,42,0,22,0,69,0,69,0,69,0,69,0,12,0]}
-{"full_text":"The proband (II-2 in Fig.2) is a 45-year old woman, who first presented to our university hospital at the age of 35 and was referred to us because of her pregnancy.\nShe has congenital deafness, first experienced syncope at the age of 3, and was diagnosed with epilepsy.\nShe was treated with anti-epilepsy medications; however, she subsequently experienced several instances of syncope.\nAt the age of 13, she had a syncope event, and was suspected of having JLNS because of her congenital deafness and prolonged QT interval.\nHer syncope was diagnosed as an arrhythmic episode when she was aware of tachycardia and as epilepsy when she was not.\nShe also had a subarachnoid hemorrhage at the age of 29.\nWhen she first presented at our hospital, she was not taking beta-blockers, because of a history of asthma, but was taking mexiletine in addition to phenytoin.\nHer QTc was found to be prolonged (584 ms) at presentation and administration of atenolol was initiated.\nShe delivered her baby (III-1 in Fig.2) through Caesarean operation at our hospital at the age of 35.\nAt 37, she delivered her second baby (III-2 in Fig.2) through Caesarean operation at our hospital.\nDespite administration of beta-blockers, her QTc remained prolonged (600 msec at the age of 37, 780 msec at 44) (Figs.2 and \u200b3a), which is not unexpected because treatment with beta-blockers in LQTS1 is not expected to overtly reduce QTc [18].\nHowever, she continued to experience occasional syncope and finally underwent an implantable cardioverter defibrillator (ICD) operation at 38 years of age.\nSubsequently, she is in a stable clinical condition.\nBecause the proband was suspected of JLNS and both infants had a measured QTc of 500 ms or greater within 1 month after birth, beta blockers were initiated and both children remain in stable condition at ages 10 and 8 (Figs.2 and 3b, c).\nQTc of the son (III-1 in Fig.2) was measured as 500 ms one month after birth, while the QTc of his sister (III-2) was 530 ms at birth.\nThe father (I-1) and mother (I-2) of the proband were first cousins.\nThere is no history of sudden unexplained syncope or death of children or adults in the immediate family members, despite the prolonged QTc of the children.\nClinical evaluation and consultation of the proband and her family members were performed at Chiba University Hospital.\nClinical phenotypes were deduced from the clinical history, physical examinations, and ECG.\nBlood samples were collected from the proband and her family members following genetic counseling, and written informed consent was obtained prior to sample collection.\nGenomic DNA was isolated from peripheral blood lymphocytes according to established protocols at our laboratory [19].\nEntire coding exons, including the intronic boundaries of the genes, of KCNQ1 (NCBI ref: NM_000218) and other LQT causative genes (KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5) were amplified by polymerase chain reaction (PCR), according to established protocols in our laboratory.\nBriefly, 30\u2013100 ng of genomic DNA was subjected to PCR amplification with DNA polymerase (PrimeSTAR GXL DNA Polymerase; Takara Bio Inc., Kusatsu, Japan) and primer sets.\nThe amplicons were subjected to conventional sequencing with Sanger sequencers (Applied Biosystems 3730\/3130 DNA analyzers; Thermo Fisher Scientific, Waltham, MA, USA).\nThe sequence data were processed with Gene Codes Sequencher Software (Takara Bio Inc.) and mapped to the human genome sequence (build GRCh37\/hg19).\nGenetic analysis was performed to screen all coding exons and the exon\u2013intron boundaries of the KCNQ1 gene (NCBI ref: NM_000218.2, NP_000209.2) with concurrent screening of other LQT causative genes (KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5).\nWe detected a novel homozygous nonsense variant, NM_000218.2:c.115G\u2009>\u2009T (p.Glu39X, in exon 1a), in the KCNQ1 gene of the proband, as well as a homozygous common variant (NM_000218.2:c.1343C\u2009>\u2009G, p.Pro448Arg) (Additional file 1: Table S1).\nGenetic screening of her mother (I-2) and children (III-1 and III-2) revealed that they were heterozygous for the nonsense variant (Fig.2).\nHer husband (II-3) was also screened and found to be heterozygous for the common variant (NM_000218.2:c.1343C\u2009>\u2009G, p.Pro448Arg).\nThe proband is a child from a first-cousin marriage, and we have concluded the homozygous nonsense variant in the proband is the cause of her JLNS1.\nThe proband was negative for pathogenic variants in other LQT causative genes, including the KCNE1 gene (Additional file 1: Table S1).\n","ner_info":[{"text":"45-year old","label":"AGE","start":33,"end":44},{"text":"woman","label":"SEX","start":45,"end":50},{"text":"presented","label":"CLINICAL_EVENT","start":62,"end":71},{"text":"university hospital","label":"BIOLOGICAL_STRUCTURE","start":79,"end":98},{"text":"at the age of 35","label":"DATE","start":99,"end":115},{"text":"pregnancy","label":"HISTORY","start":154,"end":163},{"text":"congenital deafness","label":"HISTORY","start":173,"end":192},{"text":"syncope","label":"SIGN_SYMPTOM","start":212,"end":219},{"text":"age of 3","label":"DATE","start":227,"end":235},{"text":"epilepsy","label":"HISTORY","start":260,"end":268},{"text":"anti-epilepsy medications","label":"MEDICATION","start":291,"end":316},{"text":"several instances","label":"DETAILED_DESCRIPTION","start":356,"end":373},{"text":"syncope","label":"SIGN_SYMPTOM","start":377,"end":384},{"text":"age of 13","label":"DATE","start":393,"end":402},{"text":"syncope","label":"SIGN_SYMPTOM","start":414,"end":421},{"text":"JLNS","label":"DISEASE_DISORDER","start":457,"end":461},{"text":"prolonged QT interval","label":"SIGN_SYMPTOM","start":501,"end":522},{"text":"syncope","label":"SIGN_SYMPTOM","start":528,"end":535},{"text":"arrhythmic episode","label":"SIGN_SYMPTOM","start":556,"end":574},{"text":"tachycardia","label":"SIGN_SYMPTOM","start":597,"end":608},{"text":"epilepsy","label":"DISEASE_DISORDER","start":616,"end":624},{"text":"subarachnoid hemorrhage","label":"SIGN_SYMPTOM","start":658,"end":681},{"text":"age of 29","label":"DATE","start":689,"end":698},{"text":"presented","label":"CLINICAL_EVENT","start":715,"end":724},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":732,"end":740},{"text":"beta-blockers","label":"MEDICATION","start":761,"end":774},{"text":"asthma","label":"HISTORY","start":800,"end":806},{"text":"mexiletine","label":"MEDICATION","start":823,"end":833},{"text":"phenytoin","label":"MEDICATION","start":849,"end":858},{"text":"QTc","label":"DIAGNOSTIC_PROCEDURE","start":864,"end":867},{"text":"prolonged","label":"LAB_VALUE","start":884,"end":893},{"text":"584 ms","label":"LAB_VALUE","start":895,"end":901},{"text":"presentation","label":"CLINICAL_EVENT","start":906,"end":918},{"text":"atenolol","label":"MEDICATION","start":941,"end":949},{"text":"delivered","label":"CLINICAL_EVENT","start":969,"end":978},{"text":"baby","label":"SUBJECT","start":983,"end":987},{"text":"Caesarean operation","label":"THERAPEUTIC_PROCEDURE","start":1013,"end":1032},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1040,"end":1048},{"text":"age of 35","label":"DATE","start":1056,"end":1065},{"text":"At 37","label":"DATE","start":1067,"end":1072},{"text":"delivered","label":"CLINICAL_EVENT","start":1078,"end":1087},{"text":"second baby","label":"SUBJECT","start":1092,"end":1103},{"text":"Caesarean operation","label":"THERAPEUTIC_PROCEDURE","start":1129,"end":1148},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":1156,"end":1164},{"text":"beta-blockers","label":"MEDICATION","start":1192,"end":1205},{"text":"QTc","label":"DIAGNOSTIC_PROCEDURE","start":1211,"end":1214},{"text":"prolonged","label":"LAB_VALUE","start":1224,"end":1233},{"text":"600 msec","label":"LAB_VALUE","start":1235,"end":1243},{"text":"age of 37","label":"DATE","start":1251,"end":1260},{"text":"780 msec","label":"LAB_VALUE","start":1262,"end":1270},{"text":"occasional","label":"DETAILED_DESCRIPTION","start":1447,"end":1457},{"text":"syncope","label":"SIGN_SYMPTOM","start":1458,"end":1465},{"text":"implantable cardioverter defibrillator","label":"THERAPEUTIC_PROCEDURE","start":1491,"end":1529},{"text":"ICD","label":"THERAPEUTIC_PROCEDURE","start":1531,"end":1534},{"text":"38 years of age","label":"DATE","start":1549,"end":1564},{"text":"stable clinical condition","label":"SIGN_SYMPTOM","start":1592,"end":1617},{"text":"JLNS","label":"DISEASE_DISORDER","start":1656,"end":1660},{"text":"both infants","label":"SUBJECT","start":1665,"end":1677},{"text":"measured QTc of 500 ms or greater within 1 month after birth","label":"FAMILY_HISTORY","start":1684,"end":1744},{"text":"beta blockers","label":"FAMILY_HISTORY","start":1746,"end":1759},{"text":"stable condition at ages 10 and 8","label":"FAMILY_HISTORY","start":1803,"end":1836},{"text":"QTc","label":"FAMILY_HISTORY","start":1857,"end":1860},{"text":"son","label":"SUBJECT","start":1868,"end":1871},{"text":"500 ms one month after birth","label":"FAMILY_HISTORY","start":1905,"end":1933},{"text":"QTc","label":"FAMILY_HISTORY","start":1945,"end":1948},{"text":"sister","label":"SUBJECT","start":1956,"end":1962},{"text":"530 ms at birth","label":"FAMILY_HISTORY","start":1975,"end":1990},{"text":"The father (I-1) and mother (I-2) of the proband were first cousins","label":"HISTORY","start":1992,"end":2059},{"text":"no history of sudden unexplained syncope or death of children or adults","label":"FAMILY_HISTORY","start":2070,"end":2141},{"text":"immediate family members","label":"SUBJECT","start":2149,"end":2173},{"text":"Clinical evaluation","label":"DIAGNOSTIC_PROCEDURE","start":2218,"end":2237},{"text":"consultation","label":"CLINICAL_EVENT","start":2242,"end":2254},{"text":"Chiba University Hospital","label":"NONBIOLOGICAL_LOCATION","start":2311,"end":2336},{"text":"physical examinations","label":"DIAGNOSTIC_PROCEDURE","start":2398,"end":2419},{"text":"ECG","label":"DIAGNOSTIC_PROCEDURE","start":2425,"end":2428},{"text":"Blood samples","label":"DIAGNOSTIC_PROCEDURE","start":2430,"end":2443},{"text":"genetic counseling","label":"CLINICAL_EVENT","start":2509,"end":2527},{"text":"Genomic DNA","label":"DIAGNOSTIC_PROCEDURE","start":2599,"end":2610},{"text":"peripheral blood lymphocytes","label":"BIOLOGICAL_STRUCTURE","start":2629,"end":2657},{"text":"KCNQ1","label":"DETAILED_DESCRIPTION","start":2789,"end":2794},{"text":"LQT causative genes","label":"DETAILED_DESCRIPTION","start":2827,"end":2846},{"text":"KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5","label":"DETAILED_DESCRIPTION","start":2848,"end":2895},{"text":"polymerase chain reaction","label":"DIAGNOSTIC_PROCEDURE","start":2915,"end":2940},{"text":"PCR","label":"DIAGNOSTIC_PROCEDURE","start":2942,"end":2945},{"text":"30\u2013100 ng of genomic DNA","label":"DETAILED_DESCRIPTION","start":3011,"end":3035},{"text":"PCR amplification","label":"COREFERENCE","start":3053,"end":3070},{"text":"DNA polymerase","label":"DETAILED_DESCRIPTION","start":3076,"end":3090},{"text":"PrimeSTAR GXL DNA Polymerase; Takara Bio Inc., Kusatsu, Japan","label":"DETAILED_DESCRIPTION","start":3092,"end":3153},{"text":"primer sets","label":"DETAILED_DESCRIPTION","start":3159,"end":3170},{"text":"amplicons","label":"DETAILED_DESCRIPTION","start":3176,"end":3185},{"text":"conventional","label":"DETAILED_DESCRIPTION","start":3204,"end":3216},{"text":"sequencing","label":"DIAGNOSTIC_PROCEDURE","start":3217,"end":3227},{"text":"Sanger sequencers","label":"DETAILED_DESCRIPTION","start":3233,"end":3250},{"text":"Applied Biosystems 3730\/3130 DNA analyzers; Thermo Fisher Scientific, Waltham, MA, USA","label":"DETAILED_DESCRIPTION","start":3252,"end":3338},{"text":"processed with Gene Codes Sequencher Software","label":"DETAILED_DESCRIPTION","start":3364,"end":3409},{"text":"Takara Bio Inc.","label":"DETAILED_DESCRIPTION","start":3411,"end":3426},{"text":"mapped to the human genome sequence","label":"DETAILED_DESCRIPTION","start":3432,"end":3467},{"text":"build GRCh37\/hg19","label":"DETAILED_DESCRIPTION","start":3469,"end":3486},{"text":"Genetic analysis","label":"DIAGNOSTIC_PROCEDURE","start":3489,"end":3505},{"text":"KCNQ1 gene","label":"DETAILED_DESCRIPTION","start":3585,"end":3595},{"text":"LQT causative genes","label":"DETAILED_DESCRIPTION","start":3668,"end":3687},{"text":"KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5","label":"DETAILED_DESCRIPTION","start":3689,"end":3736},{"text":"homozygous nonsense variant","label":"SIGN_SYMPTOM","start":3759,"end":3786},{"text":"NM_000218.2:c.115G\u2009>\u2009T","label":"DETAILED_DESCRIPTION","start":3788,"end":3810},{"text":"homozygous common variant","label":"SIGN_SYMPTOM","start":3882,"end":3907},{"text":"NM_000218.2:c.1343C\u2009>\u2009G","label":"DETAILED_DESCRIPTION","start":3909,"end":3932},{"text":"Genetic screening","label":"DIAGNOSTIC_PROCEDURE","start":3978,"end":3995},{"text":"mother","label":"SUBJECT","start":4003,"end":4009},{"text":"children","label":"SUBJECT","start":4020,"end":4028},{"text":"heterozygous for the nonsense variant","label":"FAMILY_HISTORY","start":4071,"end":4108},{"text":"husband","label":"SUBJECT","start":4122,"end":4129},{"text":"heterozygous for the common variant","label":"FAMILY_HISTORY","start":4171,"end":4206},{"text":"The proband is a child from a first-cousin marriage","label":"HISTORY","start":4247,"end":4298},{"text":"homozygous nonsense variant","label":"SIGN_SYMPTOM","start":4326,"end":4353},{"text":"JLNS1","label":"DISEASE_DISORDER","start":4389,"end":4394},{"text":"pathogenic variants in other LQT causative genes","label":"SIGN_SYMPTOM","start":4425,"end":4473}],"tokens":["The proband (II-2 in Fig.2) is a ","45-year old"," ","woman",", who first ","presented"," to our ","university hospital"," ","at the age of 35"," and was referred to us because of her ","pregnancy",".\nShe has ","congenital deafness",", first experienced ","syncope"," at the ","age of 3",", and was diagnosed with ","epilepsy",".\nShe was treated with ","anti-epilepsy medications","; however, she subsequently experienced ","several instances"," of ","syncope",".\nAt the ","age of 13",", she had a ","syncope"," event, and was suspected of having ","JLNS"," because of her congenital deafness and ","prolonged QT interval",".\nHer ","syncope"," was diagnosed as an ","arrhythmic episode"," when she was aware of ","tachycardia"," and as ","epilepsy"," when she was not.\nShe also had a ","subarachnoid hemorrhage"," at the ","age of 29",".\nWhen she first ","presented"," at our ","hospital",", she was not taking ","beta-blockers",", because of a history of ","asthma",", but was taking ","mexiletine"," in addition to ","phenytoin",".\nHer ","QTc"," was found to be ","prolonged"," (","584 ms",") at ","presentation"," and administration of ","atenolol"," was initiated.\nShe ","delivered"," her ","baby"," (III-1 in Fig.2) through ","Caesarean operation"," at our ","hospital"," at the ","age of 35",".\n","At 37",", she ","delivered"," her ","second baby"," (III-2 in Fig.2) through ","Caesarean operation"," at our ","hospital",".\nDespite administration of ","beta-blockers",", her ","QTc"," remained ","prolonged"," (","600 msec"," at the ","age of 37",", ","780 msec"," at 44) (Figs.2 and \u200b3a), which is not unexpected because treatment with beta-blockers in LQTS1 is not expected to overtly reduce QTc [18].\nHowever, she continued to experience ","occasional"," ","syncope"," and finally underwent an ","implantable cardioverter defibrillator"," (","ICD",") operation at ","38 years of age",".\nSubsequently, she is in a ","stable clinical condition",".\nBecause the proband was suspected of ","JLNS"," and ","both infants"," had a ","measured QTc of 500 ms or greater within 1 month after birth",", ","beta blockers"," were initiated and both children remain in ","stable condition at ages 10 and 8"," (Figs.2 and 3b, c).\n","QTc"," of the ","son"," (III-1 in Fig.2) was measured as ","500 ms one month after birth",", while the ","QTc"," of his ","sister"," (III-2) was ","530 ms at birth",".\n","The father (I-1) and mother (I-2) of the proband were first cousins",".\nThere is ","no history of sudden unexplained syncope or death of children or adults"," in the ","immediate family members",", despite the prolonged QTc of the children.\n","Clinical evaluation"," and ","consultation"," of the proband and her family members were performed at ","Chiba University Hospital",".\nClinical phenotypes were deduced from the clinical history, ","physical examinations",", and ","ECG",".\n","Blood samples"," were collected from the proband and her family members following ","genetic counseling",", and written informed consent was obtained prior to sample collection.\n","Genomic DNA"," was isolated from ","peripheral blood lymphocytes"," according to established protocols at our laboratory [19].\nEntire coding exons, including the intronic boundaries of the genes, of ","KCNQ1"," (NCBI ref: NM_000218) and other ","LQT causative genes"," (","KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5",") were amplified by ","polymerase chain reaction"," (","PCR","), according to established protocols in our laboratory.\nBriefly, ","30\u2013100 ng of genomic DNA"," was subjected to ","PCR amplification"," with ","DNA polymerase"," (","PrimeSTAR GXL DNA Polymerase; Takara Bio Inc., Kusatsu, Japan",") and ","primer sets",".\nThe ","amplicons"," were subjected to ","conventional"," ","sequencing"," with ","Sanger sequencers"," (","Applied Biosystems 3730\/3130 DNA analyzers; Thermo Fisher Scientific, Waltham, MA, USA",").\nThe sequence data were ","processed with Gene Codes Sequencher Software"," (","Takara Bio Inc.",") and ","mapped to the human genome sequence"," (","build GRCh37\/hg19",").\n","Genetic analysis"," was performed to screen all coding exons and the exon\u2013intron boundaries of the ","KCNQ1 gene"," (NCBI ref: NM_000218.2, NP_000209.2) with concurrent screening of other ","LQT causative genes"," (","KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5",").\nWe detected a novel ","homozygous nonsense variant",", ","NM_000218.2:c.115G\u2009>\u2009T"," (p.Glu39X, in exon 1a), in the KCNQ1 gene of the proband, as well as a ","homozygous common variant"," (","NM_000218.2:c.1343C\u2009>\u2009G",", p.Pro448Arg) (Additional file 1: Table S1).\n","Genetic screening"," of her ","mother"," (I-2) and ","children"," (III-1 and III-2) revealed that they were ","heterozygous for the nonsense variant"," (Fig.2).\nHer ","husband"," (II-3) was also screened and found to be ","heterozygous for the common variant"," (NM_000218.2:c.1343C\u2009>\u2009G, p.Pro448Arg).\n","The proband is a child from a first-cousin marriage",", and we have concluded the ","homozygous nonsense variant"," in the proband is the cause of her ","JLNS1",".\nThe proband was negative for ","pathogenic variants in other LQT causative genes",", including the KCNE1 gene (Additional file 1: Table S1).\n"],"ner_labels":[0,5,0,65,0,13,0,12,0,19,0,39,0,39,0,69,0,19,0,39,0,46,0,22,0,69,0,19,0,69,0,26,0,69,0,69,0,69,0,69,0,26,0,69,0,19,0,13,0,48,0,46,0,39,0,46,0,46,0,24,0,42,0,42,0,13,0,46,0,13,0,71,0,75,0,48,0,19,0,19,0,13,0,71,0,75,0,48,0,46,0,24,0,42,0,42,0,19,0,42,0,22,0,69,0,75,0,75,0,19,0,69,0,26,0,71,0,34,0,34,0,34,0,34,0,71,0,34,0,34,0,71,0,34,0,39,0,34,0,71,0,24,0,13,0,48,0,24,0,24,0,24,0,13,0,24,0,12,0,22,0,22,0,22,0,24,0,24,0,22,0,18,0,22,0,22,0,22,0,22,0,22,0,24,0,22,0,22,0,22,0,22,0,22,0,22,0,24,0,22,0,22,0,22,0,69,0,22,0,69,0,22,0,24,0,71,0,71,0,34,0,71,0,34,0,39,0,69,0,26,0,69,0]}
-{"full_text":"A 4 and a half years old male child presented to our hospital for abdominal swelling.\nThe child occasionally felt stomach ache that was relieved for no reason.\nThe child showed no obvious tenderness and rebound.\nHe was born as a premature baby in the 32nd week of his mother's pregnancy.\nHis medical history included inguinal hernia on 2 sides, but he had only received an operation for the left inguinal hernia.\nNo family or genetic history was found.\nPhysical examination of this child showed that the abdomen was obviously bulging.\nThe mass could be touched below umbilicus about 3 fingers.\nThere were no other positive signs.\nThe results of laboratory tests were almost normal, including alpha-fetoprotein (AFP) level.\nThe Child\u2013Pugh score was less than 5.\nAbdominal ultrasonography showed an uneven lesion in the liver and a diagnosis of HB was considered.\nEnhancement computed tomography (CT) scanning showed a large mass in the left upper abdomen and left lobe of the liver with an irregular edge.\nThe size of the mass was 12.3\u200a\u00d7\u200a10.2\u200a\u00d7\u200a7.2\u200acm (Fig.1).\nThere was an uneven nodular shadow and the edge was obvious when the mass was enhanced.\nCalcification and an expanded bile duct were not observed.\nThe left branch of the portal was pressed and the distant part was shown to be unclear.\nAbnormal was not observed in the right branch.\nAccording to the medical history, the diagnosis of HB was considered.\nWe did not recommend a biopsy to the patient because it might cause bleeding and tumor diffusion.\nAn operation was necessary.\nThe patient underwent DVSS surgery with sufficient preparation.\nExploration showed an extrahepatic 12\u200a\u00d7\u200a10\u200acm mass in the left lobe of the liver (Fig.2).\nAfter the operation, the sample was split.\nThe edge of the tumor was clear but no envelope.\nTremelloid mesenchyme was seen on the section (Fig.2C).\nThe pathological examination showed that the sample was grey red and 14\u200a\u00d7\u200a13\u200a\u00d7\u200a7\u200acm in size.\nThe color of the section was grey red and grey white.\nMHL was diagnosed (Fig.3).\nImmunohistochemistry results (Fig.4) were the following: mesenchymal CD34 (+), D2\u201340 (+), S-100 (-), SMA (+), CD7 (-), epithelium CK19 (+), AFP (-), HCG (-).\nAfter 9 days of recovery, the patient returned home without complications.\nA follow-up examination, which included blood routine, liver renal function, coagulation routine, and ultrasound scan at 30 days, did not show any abnormality.\nNo adverse or unanticipated event was presented.\n","ner_info":[{"text":"4 and a half years old","label":"AGE","start":2,"end":24},{"text":"male","label":"SEX","start":25,"end":29},{"text":"presented","label":"CLINICAL_EVENT","start":36,"end":45},{"text":"hospital","label":"NONBIOLOGICAL_LOCATION","start":53,"end":61},{"text":"abdominal","label":"BIOLOGICAL_STRUCTURE","start":66,"end":75},{"text":"swelling","label":"SIGN_SYMPTOM","start":76,"end":84},{"text":"occasionally","label":"DETAILED_DESCRIPTION","start":96,"end":108},{"text":"stomach ache","label":"SIGN_SYMPTOM","start":114,"end":126},{"text":"relieved for no reason","label":"DETAILED_DESCRIPTION","start":136,"end":158},{"text":"tenderness","label":"SIGN_SYMPTOM","start":188,"end":198},{"text":"rebound","label":"SIGN_SYMPTOM","start":203,"end":210},{"text":"born as a premature baby in the 32nd week of his mother's pregnancy","label":"HISTORY","start":219,"end":286},{"text":"inguinal hernia on 2 sides","label":"HISTORY","start":317,"end":343},{"text":"operation for the left inguinal hernia","label":"HISTORY","start":373,"end":411},{"text":"No family or genetic history was found","label":"FAMILY_HISTORY","start":413,"end":451},{"text":"Physical examination","label":"DIAGNOSTIC_PROCEDURE","start":453,"end":473},{"text":"abdomen","label":"BIOLOGICAL_STRUCTURE","start":504,"end":511},{"text":"obviously","label":"DETAILED_DESCRIPTION","start":516,"end":525},{"text":"bulging","label":"SIGN_SYMPTOM","start":526,"end":533},{"text":"mass","label":"SIGN_SYMPTOM","start":539,"end":543},{"text":"below umbilicus","label":"BIOLOGICAL_STRUCTURE","start":561,"end":576},{"text":"about 3 fingers","label":"DISTANCE","start":577,"end":592},{"text":"laboratory tests","label":"DIAGNOSTIC_PROCEDURE","start":645,"end":661},{"text":"almost normal","label":"LAB_VALUE","start":667,"end":680},{"text":"alpha-fetoprotein","label":"DIAGNOSTIC_PROCEDURE","start":692,"end":709},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":711,"end":714},{"text":"Child\u2013Pugh score","label":"DIAGNOSTIC_PROCEDURE","start":727,"end":743},{"text":"less than 5","label":"LAB_VALUE","start":748,"end":759},{"text":"Abdominal","label":"BIOLOGICAL_STRUCTURE","start":761,"end":770},{"text":"ultrasonography","label":"DIAGNOSTIC_PROCEDURE","start":771,"end":786},{"text":"uneven","label":"DETAILED_DESCRIPTION","start":797,"end":803},{"text":"lesion","label":"SIGN_SYMPTOM","start":804,"end":810},{"text":"liver","label":"BIOLOGICAL_STRUCTURE","start":818,"end":823},{"text":"HB","label":"DISEASE_DISORDER","start":843,"end":845},{"text":"Enhancement","label":"DETAILED_DESCRIPTION","start":862,"end":873},{"text":"computed tomography","label":"DIAGNOSTIC_PROCEDURE","start":874,"end":893},{"text":"CT","label":"DIAGNOSTIC_PROCEDURE","start":895,"end":897},{"text":"large","label":"DETAILED_DESCRIPTION","start":917,"end":922},{"text":"mass","label":"SIGN_SYMPTOM","start":923,"end":927},{"text":"left upper abdomen","label":"BIOLOGICAL_STRUCTURE","start":935,"end":953},{"text":"left lobe of the liver","label":"BIOLOGICAL_STRUCTURE","start":958,"end":980},{"text":"irregular edge","label":"SHAPE","start":989,"end":1003},{"text":"mass","label":"COREFERENCE","start":1021,"end":1025},{"text":"12.3\u200a\u00d7\u200a10.2\u200a\u00d7\u200a7.2\u200acm","label":"VOLUME","start":1030,"end":1050},{"text":"uneven nodular shadow","label":"DETAILED_DESCRIPTION","start":1073,"end":1094},{"text":"edge was obvious","label":"DETAILED_DESCRIPTION","start":1103,"end":1119},{"text":"mass","label":"COREFERENCE","start":1129,"end":1133},{"text":"Calcification","label":"SIGN_SYMPTOM","start":1148,"end":1161},{"text":"expanded bile duct","label":"SIGN_SYMPTOM","start":1169,"end":1187},{"text":"left branch of the portal","label":"BIOLOGICAL_STRUCTURE","start":1211,"end":1236},{"text":"pressed","label":"DETAILED_DESCRIPTION","start":1241,"end":1248},{"text":"distant part was shown to be unclear","label":"DETAILED_DESCRIPTION","start":1257,"end":1293},{"text":"Abnormal","label":"SIGN_SYMPTOM","start":1295,"end":1303},{"text":"right branch","label":"BIOLOGICAL_STRUCTURE","start":1328,"end":1340},{"text":"HB","label":"DISEASE_DISORDER","start":1393,"end":1395},{"text":"biopsy","label":"DIAGNOSTIC_PROCEDURE","start":1435,"end":1441},{"text":"operation","label":"THERAPEUTIC_PROCEDURE","start":1513,"end":1522},{"text":"DVSS surgery","label":"THERAPEUTIC_PROCEDURE","start":1560,"end":1572},{"text":"with sufficient preparation","label":"DETAILED_DESCRIPTION","start":1573,"end":1600},{"text":"Exploration","label":"DIAGNOSTIC_PROCEDURE","start":1602,"end":1613},{"text":"extrahepatic","label":"DETAILED_DESCRIPTION","start":1624,"end":1636},{"text":"12\u200a\u00d7\u200a10\u200acm","label":"AREA","start":1637,"end":1647},{"text":"mass","label":"SIGN_SYMPTOM","start":1648,"end":1652},{"text":"left lobe of the liver","label":"BIOLOGICAL_STRUCTURE","start":1660,"end":1682},{"text":"sample","label":"COREFERENCE","start":1717,"end":1723},{"text":"split","label":"DETAILED_DESCRIPTION","start":1728,"end":1733},{"text":"tumor","label":"COREFERENCE","start":1751,"end":1756},{"text":"no envelope","label":"DETAILED_DESCRIPTION","start":1771,"end":1782},{"text":"Tremelloid","label":"DETAILED_DESCRIPTION","start":1784,"end":1794},{"text":"mesenchyme","label":"BIOLOGICAL_STRUCTURE","start":1795,"end":1805},{"text":"sample","label":"COREFERENCE","start":1885,"end":1891},{"text":"grey red","label":"COLOR","start":1896,"end":1904},{"text":"14\u200a\u00d7\u200a13\u200a\u00d7\u200a7\u200acm","label":"VOLUME","start":1909,"end":1923},{"text":"section","label":"COREFERENCE","start":1950,"end":1957},{"text":"grey red","label":"COLOR","start":1962,"end":1970},{"text":"grey white","label":"COLOR","start":1975,"end":1985},{"text":"MHL","label":"DISEASE_DISORDER","start":1987,"end":1990},{"text":"Immunohistochemistry results","label":"DIAGNOSTIC_PROCEDURE","start":2014,"end":2042},{"text":"mesenchymal CD34","label":"DIAGNOSTIC_PROCEDURE","start":2071,"end":2087},{"text":"+","label":"LAB_VALUE","start":2089,"end":2090},{"text":"D2\u201340","label":"DIAGNOSTIC_PROCEDURE","start":2093,"end":2098},{"text":"+","label":"LAB_VALUE","start":2100,"end":2101},{"text":"S-100","label":"DIAGNOSTIC_PROCEDURE","start":2104,"end":2109},{"text":"-","label":"LAB_VALUE","start":2111,"end":2112},{"text":"SMA","label":"DIAGNOSTIC_PROCEDURE","start":2115,"end":2118},{"text":"+","label":"LAB_VALUE","start":2120,"end":2121},{"text":"CD7","label":"DIAGNOSTIC_PROCEDURE","start":2124,"end":2127},{"text":"-","label":"LAB_VALUE","start":2129,"end":2130},{"text":"epithelium CK19","label":"DIAGNOSTIC_PROCEDURE","start":2133,"end":2148},{"text":"+","label":"LAB_VALUE","start":2150,"end":2151},{"text":"AFP","label":"DIAGNOSTIC_PROCEDURE","start":2154,"end":2157},{"text":"-","label":"LAB_VALUE","start":2159,"end":2160},{"text":"HCG","label":"DIAGNOSTIC_PROCEDURE","start":2163,"end":2166},{"text":"-","label":"LAB_VALUE","start":2168,"end":2169},{"text":"9 days","label":"DURATION","start":2178,"end":2184},{"text":"recovery","label":"THERAPEUTIC_PROCEDURE","start":2188,"end":2196},{"text":"returned","label":"CLINICAL_EVENT","start":2210,"end":2218},{"text":"home","label":"NONBIOLOGICAL_LOCATION","start":2219,"end":2223},{"text":"complications","label":"SIGN_SYMPTOM","start":2232,"end":2245},{"text":"follow-up","label":"CLINICAL_EVENT","start":2249,"end":2258},{"text":"blood routine","label":"DIAGNOSTIC_PROCEDURE","start":2287,"end":2300},{"text":"liver renal function","label":"DIAGNOSTIC_PROCEDURE","start":2302,"end":2322},{"text":"coagulation routine","label":"DIAGNOSTIC_PROCEDURE","start":2324,"end":2343},{"text":"ultrasound scan","label":"DIAGNOSTIC_PROCEDURE","start":2349,"end":2364},{"text":"30 days","label":"DATE","start":2368,"end":2375},{"text":"abnormality","label":"SIGN_SYMPTOM","start":2394,"end":2405},{"text":"adverse or unanticipated event","label":"SIGN_SYMPTOM","start":2410,"end":2440}],"tokens":["A ","4 and a half years old"," ","male"," child ","presented"," to our ","hospital"," for ","abdominal"," ","swelling",".\nThe child ","occasionally"," felt ","stomach ache"," that was ","relieved for no reason",".\nThe child showed no obvious ","tenderness"," and ","rebound",".\nHe was ","born as a premature baby in the 32nd week of his mother's pregnancy",".\nHis medical history included ","inguinal hernia on 2 sides",", but he had only received an ","operation for the left inguinal hernia",".\n","No family or genetic history was found",".\n","Physical examination"," of this child showed that the ","abdomen"," was ","obviously"," ","bulging",".\nThe ","mass"," could be touched ","below umbilicus"," ","about 3 fingers",".\nThere were no other positive signs.\nThe results of ","laboratory tests"," were ","almost normal",", including ","alpha-fetoprotein"," (","AFP",") level.\nThe ","Child\u2013Pugh score"," was ","less than 5",".\n","Abdominal"," ","ultrasonography"," showed an ","uneven"," ","lesion"," in the ","liver"," and a diagnosis of ","HB"," was considered.\n","Enhancement"," ","computed tomography"," (","CT",") scanning showed a ","large"," ","mass"," in the ","left upper abdomen"," and ","left lobe of the liver"," with an ","irregular edge",".\nThe size of the ","mass"," was ","12.3\u200a\u00d7\u200a10.2\u200a\u00d7\u200a7.2\u200acm"," (Fig.1).\nThere was an ","uneven nodular shadow"," and the ","edge was obvious"," when the ","mass"," was enhanced.\n","Calcification"," and an ","expanded bile duct"," were not observed.\nThe ","left branch of the portal"," was ","pressed"," and the ","distant part was shown to be unclear",".\n","Abnormal"," was not observed in the ","right branch",".\nAccording to the medical history, the diagnosis of ","HB"," was considered.\nWe did not recommend a ","biopsy"," to the patient because it might cause bleeding and tumor diffusion.\nAn ","operation"," was necessary.\nThe patient underwent ","DVSS surgery"," ","with sufficient preparation",".\n","Exploration"," showed an ","extrahepatic"," ","12\u200a\u00d7\u200a10\u200acm"," ","mass"," in the ","left lobe of the liver"," (Fig.2).\nAfter the operation, the ","sample"," was ","split",".\nThe edge of the ","tumor"," was clear but ","no envelope",".\n","Tremelloid"," ","mesenchyme"," was seen on the section (Fig.2C).\nThe pathological examination showed that the ","sample"," was ","grey red"," and ","14\u200a\u00d7\u200a13\u200a\u00d7\u200a7\u200acm"," in size.\nThe color of the ","section"," was ","grey red"," and ","grey white",".\n","MHL"," was diagnosed (Fig.3).\n","Immunohistochemistry results"," (Fig.4) were the following: ","mesenchymal CD34"," (","+","), ","D2\u201340"," (","+","), ","S-100"," (","-","), ","SMA"," (","+","), ","CD7"," (","-","), ","epithelium CK19"," (","+","), ","AFP"," (","-","), ","HCG"," (","-",").\nAfter ","9 days"," of ","recovery",", the patient ","returned"," ","home"," without ","complications",".\nA ","follow-up"," examination, which included ","blood routine",", ","liver renal function",", ","coagulation routine",", and ","ultrasound scan"," at ","30 days",", did not show any ","abnormality",".\nNo ","adverse or unanticipated event"," was presented.\n"],"ner_labels":[0,5,0,65,0,13,0,48,0,12,0,69,0,22,0,69,0,22,0,69,0,69,0,39,0,39,0,39,0,34,0,24,0,12,0,22,0,69,0,69,0,12,0,27,0,24,0,42,0,24,0,24,0,24,0,42,0,12,0,24,0,22,0,69,0,12,0,26,0,22,0,24,0,24,0,22,0,69,0,12,0,12,0,67,0,18,0,79,0,22,0,22,0,18,0,69,0,69,0,12,0,22,0,22,0,69,0,12,0,26,0,24,0,75,0,75,0,22,0,24,0,22,0,8,0,69,0,12,0,18,0,22,0,18,0,22,0,22,0,12,0,18,0,15,0,79,0,18,0,15,0,15,0,26,0,24,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,24,0,42,0,32,0,75,0,13,0,48,0,69,0,13,0,24,0,24,0,24,0,24,0,19,0,69,0,69,0]}