diff --git "a/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_10_v1.json" "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_10_v1.json" new file mode 100644--- /dev/null +++ "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_10_v1.json" @@ -0,0 +1,662 @@ +[ + { + "index": 0, + "label": "low_health_literacy", + "original_doc": "This is about a 20-year-old woman. She had a kidney problem since age eight that made protein leak into her urine. The problem first showed up when a big blood clot blocked veins in her brain, and a clot also went to her lungs. She took blood thinners and steroid pills. Later she took a medicine that calms the immune system to help her use fewer steroids. Tests showed no inherited blood-clotting problem. She had several flare-ups of the kidney problem. Steroid pills controlled them until 2017. After that she had no relapses. Her doctors stopped the blood thinner and the immune-calming medicine. One year later she had sudden, very bad belly pain all over. She threw up after eating. Both legs were swollen. Tests showed the kidney problem was back. A special X-ray picture (CT scan) showed a new clot in the main artery that feeds the small intestine. It was like a plug in a pipe that stops water. Blood could not reach the intestines. In surgery, most of her small intestine was dead. Taking out that much bowel would not allow life. She died 48 hours later.", + "wiki_anchor": "Heart condition \nRitvo developed cardiomyopathy, which had killed her brother Louis at the age of 38, as well as her father at age 73. She had been plagued by unusual fatigue since 1998, and her heart condition was formally diagnosed in January, 2001. She began taking medication and trained on a limited basis from 2003 to 2005, starting about 100 horses in that period, with 15 wins. However, her condition deteriorated. She started only one horse in 2005 and had no starters from 2006 until 2009. In 2008, at the age of 39, she was placed on a waiting list for a heart transplant. After a seven-month wait, an organ became available on November 13, 2008, and Ritvo received her new heart that day in an operation that lasted 17 hours. She had been hospitalized for most of the previous six months, and at the time of her surgery her doctors assessed her as having only about two weeks to live. She was discharged from the hospital seven days after her surgery. She later gave a letter to the hospital to pass on to the organ donor's family, but has never heard from them. Ritvo has stated that she wants the donor's family to know she is thankful for her new heart, but respects their privacy.", + "doc_fkgl": 4.138157894736846, + "wiki_fkgl": 9.658922558922558, + "doc_tree_depth": 4.5, + "wiki_tree_depth": 5.636363636363637, + "fkgl_delta": -5.520764664185712 + }, + { + "index": 0, + "label": "intermediate_health_literacy", + "original_doc": "A 20\u2011year\u2011old woman had a 12\u2011year history of idiopathic nephrotic syndrome that initially presented with extensive cerebral venous thrombosis and pulmonary embolism. She was treated with anticoagulation and oral corticosteroids, then mycophenolate mofetil as a steroid\u2011sparing agent. A comprehensive thrombophilia work\u2011up was negative. She experienced multiple relapses controlled with steroids until 2017, then remained in remission; anticoagulation and MMF were discontinued. One year later, she developed sudden diffuse abdominal pain with postprandial vomiting and bilateral leg edema. Laboratory tests confirmed a relapse of nephrotic syndrome. Abdominal CT showed acute superior mesenteric artery thrombosis causing acute mesenteric ischemia. At surgery, there was extensive small\u2011bowel necrosis not compatible with survival. She died 48 hours later.", + "wiki_anchor": "The term Mesoamerican Nephropathy has been in use in Central America and Mexico since 2012. Similar epidemics have been identified in both Sri Lanka and India, leading to the use of other terms that are not geographically specific, including Chronic Kidney Disease of unknown etiology (CKDu) or of non-traditional origin (CKDnt) and Chronic Interstitial Nephritis in Agricultural Communities (CINAC). Although the diseases are clinically similar and affect similar populations in each country, whether these are all manifestations of the same disease or different diseases with superficial resemblance remains to be definitively demonstrated. High prevalence of CKD with similar characteristics to MeN may exist outside of Mesoamerica, India, and Sri Lanka, although evidence so far is limited to small studies and clinician reports.", + "doc_fkgl": 15.20401179941003, + "wiki_fkgl": 19.80827868852459, + "doc_tree_depth": 4.888888888888889, + "wiki_tree_depth": 8.5, + "fkgl_delta": -4.604266889114562 + }, + { + "index": 0, + "label": "proficient_health_literacy", + "original_doc": "A 20\u2011year\u2011old woman had been followed since age eight for idiopathic nephrotic syndrome (NS) inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism, without sequelae and without personal or family thrombotic history. Kidney biopsy was deferred because there was no kidney failure, gross hematuria, hypertension, or extra\u2011renal signs suggestive of secondary NS at presentation. She was treated with an oral vitamin K antagonist and oral corticosteroids with good evolution. Subsequently, she had multiple steroid\u2011dependent relapses and was started on mycophenolate mofetil (MMF) as background therapy to spare corticosteroids and ensure normal growth. An exhaustive thrombophilia assessment was negative: homocysteine, fibrinogen, protein C, protein S, antithrombin III, factor V Leiden, JAK\u20112, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant, and anti\u2011\u03b22\u2011glycoprotein I antibodies were all normal. Anticoagulation was stopped after nine years. Several relapses occurred but were controlled with oral corticosteroids. NS remission was documented from 2017; MMF was gradually discontinued in 2019, and she remained asymptomatic without relapse.\n\nOne year later, she presented to the emergency department with acute intense diffuse abdominal pain without irradiation, associated with postprandial vomiting and bilateral lower\u2011limb edema for six hours. Examination showed intense epigastric tenderness with normal vital signs (BP 120/70 mm Hg, HR 83 bpm, SpO2 100% on room air) and no fever or neurological impairment. Urinalysis detected proteinuria. Hemogasanalysis showed metabolic acidosis with respiratory compensation. Labs revealed hypoalbuminemia, hypercholesterolemia, prothrombin time 90%, elevated D\u2011dimer, LDH, and creatine phosphokinase, with inflammatory markers (CRP 37 mg/L) and leukocytosis (26.4 \u00d7 10^3/\u00b5L); renal and liver function were normal. Urgent abdominal ultrasound showed a low\u2011to\u2011moderate intra\u2011abdominal effusion. Contrast\u2011enhanced CT demonstrated acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. She underwent emergency laparotomy: intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost the entire small bowel, rendering resection incompatible with life. She died 48 hours later.\n\nThis case illustrates catastrophic arterial thrombosis in the setting of NS despite a negative thrombophilia work\u2011up. NS is a hypercoagulable state with multifactorial mechanisms, including urinary loss of anticoagulant proteins (e.g., antithrombin III, protein S), increased fibrinogen, hemoconcentration, dyslipidemia, and systemic inflammation. While venous thromboembolism is more common in NS, superior mesenteric artery thrombosis is rare but often fatal, underscoring the need for high clinical suspicion and rapid imaging when severe acute abdominal pain occurs in patients with active or relapsing NS.", + "wiki_anchor": "In June 2013, preliminary results from a trial of the drug were presented at a conference of the European Hematology Association in Stockholm. On October 31, 2013, it was reported that the company which developed the drug, Array BioPharma (based in Boulder, Colorado), was planning on launching a phase III clinical trial of the drug to treat multiple myeloma. The study began in mid-2014, and paired filanesib with the proteasome inhibitor carfilzomib in several hundred patients. The study's primary endpoint was progression-free survival (i.e. the time until the cancer recurs). A previous trial had reported that 37% of patients receiving filanesib in conjunction with carfilzomib showed lower levels of paraprotein, also known as \"M protein\", whereas only 16% of controls (i.e. those receiving only carfilzomib) showed such a reduction. In addition, a report by the International Myeloma Working Group concluded that filanesib was \"effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients.\" According to Jatin Shah, an assistant professor at University of Texas MD Anderson Cancer Center, the primary adverse effect of treatment with filanesib observed in trials conducted thus far is reversible neutropenia, though it is possible that it may cause low blood cell counts as well. Shah et al. have conducted a phase II study of filanesib both by itself, and in combination with dexamethasone, presented at the annual meeting of the American Society of Hematology. In December 2013, further clinical trial results were presented, also at the annual meeting of the American Society of Hematology; the results concluded that 16 percent of patients who had received a median of six prior therapies responded to single-agent filanesib. In the week after this presentation, Array BioPharma's stock fell by 16%. In February 2014, a review was published by researchers from the University of Salamanca in Spain, which concluded that \"...some of these novel agents [to treat multiple myeloma] seem promising, such as monoclonal antibodies (anti-CD38 \u2014 daratumumab or anti-CS1 \u2014 elotuzumab) or the kinesin protein inhibitor Arry-520.\"", + "doc_fkgl": 17.108284910965327, + "wiki_fkgl": 14.619625377643505, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 9.363636363636363, + "fkgl_delta": 2.4886595333218224 + }, + { + "index": 1, + "label": "low_health_literacy", + "original_doc": "She is 34 years old and pregnant. She had a seizure and trouble speaking clearly. She was sent right away for a head MRI scan. The scan showed a pattern doctors call the \u201cMedusa head.\u201d This means the veins in her brain are arranged in an unusual way that she was born with. There is a small blood clot at the outer part of this vein pattern. The blood is also moving slowly closer to the main vein.", + "wiki_anchor": "Early life and illness\nCastellano was born on August 18, 1999, in Orlando, Florida, and grew up in and around central Florida with her mother, Desiree Castellano, and in New York City with her father, Marc Winthrop. She had three siblings: Kaitlyn, Jackson Winthrop, and Mattia Castellano. When she was 7 years old, Castellano began experiencing fevers and abdominal pain. When an X-ray on February 14, 2007 showed unusual anatomical displacements in her chest, she was diagnosed with neuroblastoma, a rare pediatric cancer of the peripheral nervous system.", + "doc_fkgl": 3.5813553113553134, + "wiki_fkgl": 14.042272727272728, + "doc_tree_depth": 5.142857142857143, + "wiki_tree_depth": 6.25, + "fkgl_delta": -10.460917415917415 + }, + { + "index": 1, + "label": "intermediate_health_literacy", + "original_doc": "A 34-year-old woman who is 8 weeks pregnant had a first-time generalized seizure with temporary slurred speech. Because she is pregnant and this was her first seizure, doctors obtained an urgent brain MRI. The MRI showed the classic \u201cMedusa head\u201d sign, which indicates a developmental venous anomaly (DVA)\u2014a vein pattern you are born with. Imaging also suggested a partial clot along the peripheral portion of the draining system and slower blood flow closer to the main draining vein. These findings support the diagnosis: a developmental venous anomaly with peripheral partial thrombosis and proximal slow flow.", + "wiki_anchor": "In about ten percent of cases, AGS presents at or soon after birth (i.e. in the neonatal period). This presentation of the disease is characterized by microcephaly, neonatal seizures, poor feeding, jitteriness, cerebral calcifications (accumulation of calcium deposits in the brain), white matter abnormalities, and cerebral atrophy; thus indicating that the disease process became active before birth i.e. in utero. These infants can have hepatosplenomegaly and thrombocytopaenia, very much like cases of transplacental viral infection. About one third of such early presenting cases, most frequently in association with mutations in TREX1, die in early childhood.", + "doc_fkgl": 11.942105263157895, + "wiki_fkgl": 14.550526315789476, + "doc_tree_depth": 6.4, + "wiki_tree_depth": 7.0, + "fkgl_delta": -2.6084210526315807 + }, + { + "index": 1, + "label": "proficient_health_literacy", + "original_doc": "A 34-year-old woman, 8 weeks pregnant and without other relevant history, presented with generalized convulsions and postictal dysarthria that resolved within two hours. On examination she was alert, oriented, and without focal language, motor, or sensory deficits; a right lateral tongue bite was noted. Laboratory tests and ECG were unremarkable. Given a first epileptic seizure in pregnancy, an urgent cranial MRI was performed. The protocol included 3D T1 pre- and post-contrast (axial, coronal, sagittal), axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and ADC mapping. MRI demonstrated multiple venous cortico-medullary vascular structures converging centripetally to a large central draining vein that emptied via the inferior anastomotic vein into the left transverse sinus, forming the classic \u201cMedusa head\u201d sign. On T1 post-contrast, the drainage vein showed increased signal with central hyphocaptation, suggesting partial thrombosis versus slow flow. On T2 and FLAIR, the parenchyma surrounding the drainage vein was hyperintense, without diffusion restriction, compatible with edema. Overall, the findings are diagnostic of a developmental venous anomaly with signs of partial peripheral thrombosis and more proximal slow flow, causing perilesional edema. Management was initiated with clexane 60 mg every 12 hours and levetiracetam 500 mg every 12 hours, with symptomatic improvement and stability after one week. Contextually, DVAs are typically benign venous variants; however, pregnancy-associated hypercoagulability may predispose to thrombosis. Partial thrombosis and impaired outflow in a DVA can lead to venous congestion and edema, manifesting clinically with seizures.", + "wiki_anchor": "Early cases\nA publication in the Journal of Medical Genetics in 1987 by Dr. I. Young and D. Madders of Leicester Royal Infirmary in the United Kingdom described the then-unknown condition when presenting \"a stillborn male infant with pre-maxillary agenesis, bilateral microphthalmos, alobar holoprosencephaly, hydrocephalus, ventricular and atrial septal defects, small penis, bilateral cryptorchidism, and bilateral upper limb postaxial polydactyly.\" Both doctors noted no use of drugs, alcohol or cigarettes by the mother, and the baby was delivered normally after forty-one weeks of gestation. It was the first child of the parents, who were not related and went on to have another child successfully however this child was a stillbirth. There was severe overlapping of the bones of the skull and a cleft lip in addition to the bilateral polydactyly. Of the organs, Young and Madders noted missing parts of the tricuspid valve and other small cardiac defects, as well as the holoprosencephaly. Both doctors consulted various medical databases and, after discounting Meckel syndrome due to a lack of renal abnormalities, concluded that this was a hitherto unclassified condition. After later classification, it was later named for the two doctors, though at the time of publication it was termed 'pseudotrisomy 13' due to similarities with the condition Trisomy 13. Another case in 1989 with similar symptoms was also published as an example of 'pseudotrisomy 13', and there was no evidence of an extra chromosome, further suggesting that Trisomy 13 was a separate condition.", + "doc_fkgl": 16.247417695473253, + "wiki_fkgl": 14.864777777777778, + "doc_tree_depth": 6.083333333333333, + "wiki_tree_depth": 8.0, + "fkgl_delta": 1.3826399176954745 + }, + { + "index": 2, + "label": "low_health_literacy", + "original_doc": "A 22-year-old woman had painful mouth sores. The sores made eating and drinking hard. The problem started after a fever. Small pimples showed up on her lips. She had been vaping for about one year. The checkup found no spots on the rest of her body. Her lips had crusts with a little blood. The corners of her mouth were raw and bled easily. Inside her mouth there were white sores with yellow edges. The sores were different shapes and sizes and were in several places. A test for the cold-sore virus was negative. The doctor said this was a mouth reaction called oral erythema multiforme. She was treated with salt-water compresses on the lips. She used a mouth rinse with an anti-swelling medicine (dexamethasone) mixed with a coating gel (hyaluronic acid). She put 2% miconazole cream on the sores at the mouth corners. She used petroleum jelly on her dry lips. She was told to stop vaping. Her mouth got better after one week of treatment.", + "wiki_anchor": "Clinical relevance\nInfections of the infratemporal space are rare. They may be significant however, as it is possible for infection to spread via emissary veins from the pterygoid plexus to the cavernous sinus, which may result in cavernous sinus thrombosis, a rare but life-threatening condition. \nThe signs and symptoms of an infratemporal space infection are swelling of the face in the region of the sigmoid notch, swelling of the mouth in the region of the maxillary tuberosity and marked trismus (difficulty opening the mouth), since some of the muscles of mastication are restricted by the swelling. Treatment of an abscess of this space is usually by surgical incision and drainage, with the incision being placed on the face (a small horizontal incision posterior to the junction of the temporal and frontal process of the zygomatic bone. or both on the face and inside the mouth.", + "doc_fkgl": 4.63312375249501, + "wiki_fkgl": 15.251034482758623, + "doc_tree_depth": 5.277777777777778, + "wiki_tree_depth": 8.2, + "fkgl_delta": -10.617910730263613 + }, + { + "index": 2, + "label": "intermediate_health_literacy", + "original_doc": "A 22-year-old woman presented with a month of painful stomatitis that made eating and drinking difficult. The illness began with a fever and pimple-like lesions on the lips. She had been vaping regularly for about one year. Examination showed no skin lesions elsewhere. The lips had serosanguineous crusts and erosions at the labial commissures that tended to bleed. Intraorally, there were multiple irregular white ulcers with yellowish borders on several sites of the oral mucosa. Anti\u2013HSV-1 IgG was non-reactive. The diagnosis was oral erythema multiforme, likely related to vaping. Management included normal saline compresses to the lips, a dexamethasone mouth rinse mixed with hyaluronic acid, 2% miconazole cream applied to the lip corner, petroleum jelly for dry lips, and stopping vaping. Her oral condition improved within one week.", + "wiki_anchor": "Denture-related stomatitis is a common condition where mild inflammation and redness of the oral mucous membrane occurs beneath a denture. In about 90% of cases, Candida species are involved, which are normally a harmless component of the oral microbiota in many people. Denture-related stomatitis is the most common form of oral candidiasis (a yeast infection of the mouth). It is more common in elderly people, and in those who wear a complete upper denture (a denture which replaces all the upper teeth, worn by someone with no natural teeth in their upper jaw). Denture-related stomatitis is more likely to develop when the denture is left constantly in the mouth, rather than removing it during sleep, and when the denture is not cleaned regularly.", + "doc_fkgl": 10.328562500000004, + "wiki_fkgl": 13.862536585365856, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 8.2, + "fkgl_delta": -3.533974085365852 + }, + { + "index": 2, + "label": "proficient_health_literacy", + "original_doc": "A 22-year-old woman presented to Oral Medicine with a 1-month history of painful oral ulcers causing difficulty eating and drinking. The episode began with fever followed by pimple-like lesions on the lips. She had used pod-type vapes for approximately one year, often trying different e-liquid flavors; she had never smoked conventional cigarettes. She reported no medication exposure prior to onset (no antibiotics, analgesics, anticonvulsants, NSAIDs, or antifungals), no drug or food allergies, and unhealthy eating habits. Extraorally, there were no lesions elsewhere on the body. The lips exhibited serosanguineous crusts with an erosive area at the right labial commissure that tended to bleed. Intraoral examination showed multiple painful white ulcers with yellowish edges, irregular and variable in size, on the labial and buccal mucosa, lateral and ventral tongue, and floor of mouth. Anti-HSV-1 IgG was non-reactive. Based on isolated oral mucosal involvement, absence of cutaneous lesions, and negative HSV serology, a diagnosis of vaping-related oral erythema multiforme, minor type, was established. Management comprised 0.9% NaCl\u2013moistened gauze compresses to the lips three times daily; a dexamethasone mouthrinse (1 mg in 10 mL hyaluronic acid) three times daily with a 30-minute post-rinse fasting period; 2% miconazole cream applied to the wound at the right labial commissure twice daily; and vaseline album (petrolatum) for dry lips. Adjunctive advice included brushing teeth and tongue twice daily (after breakfast and before bed), cessation of vaping, and avoidance of foods containing monosodium glutamate. At 1-week follow-up, the oral condition had improved. Ethical considerations: written informed consent was obtained; the case conformed to the Helsinki Declaration and had institutional approval. Context: Erythema multiforme is a mucocutaneous hypersensitivity reaction classically triggered by infections (e.g., HSV) or drugs; in this case, vaping exposure and frequent e-liquid flavor changes were considered plausible triggers in the absence of medication exposure and with non-reactive anti-HSV-1 serology.", + "wiki_anchor": "Fruit bodies have caps that are initially hemispherical to convex, but later become flattened, sometimes developing a low, broad umbo; the cap diameter is . Its surface is dry, and its color vinaceous, with lighter margins. The cap margin is curved downward, and has faint radial grooves. It may be irregular in instances where fruit bodies have grown together in clusters. The gills have an adnate to somewhat decurrent attachment to the stipe. They are somewhat closely spaced. Initially deep vinaceous, they become brownish with a reddish tinge after the spores mature. The stipe measures long by thick, and the same width throughout its length, or slightly thicker at the base. It has a fibrillose surface texture, and, in mature specimens, faint longitudinal grooves. It is wine-red with a whitish base. Young individuals have a silky white partial veil that later becomes fibrillose (as if made of threadlike fibers) and vinaceous in color. The flesh is reddish brown and lacks any discernible odor. The spore print is cinnamon brown. Due to its rarity, the edibility of the mushroom has not been definitively established, but one report suggests that it is \"harmless\", with a flavor of \"bland beef\".", + "doc_fkgl": 14.527236842105264, + "wiki_fkgl": 8.232244897959184, + "doc_tree_depth": 7.214285714285714, + "wiki_tree_depth": 5.428571428571429, + "fkgl_delta": 6.29499194414608 + }, + { + "index": 3, + "label": "low_health_literacy", + "original_doc": "At 32 weeks of pregnancy, a routine scan found one small lump inside the baby\u2019s heart. It caused no symptoms. This was the only problem seen. Doctors watched it with clinic visits until 39 weeks plus 1 day. Then the baby was delivered by C-section (a surgery to deliver the baby). After birth, the child had checkups on day 1, day 7, day 30, month 7, and month 12. At each visit, the child\u2019s growth and behavior were healthy for age. The heart lump stayed the same size; it did not grow or shrink. By 1 year old, there were no signs of a related condition called tuberous sclerosis complex.", + "wiki_anchor": "Otherwise the majority of AGS cases present in early infancy, sometimes after an apparently normal period of development. During the first few months after birth, these children develop features of an encephalopathy with irritability, persistent crying, feeding difficulties, an intermittent fever (without obvious infection), and abnormal neurology with disturbed tone, dystonia, an exaggerated startle response, and sometimes seizures.\nGlaucoma can be present at birth, or develop later. Many children retain apparently normal vision, although a significant number are cortically blind. Hearing is almost invariably normal. Over time, up to 40% of patients develop so-called chilblain lesions, most typically on the toes and fingers and occasionally also involving the ears. They are usually worse in the winter.", + "doc_fkgl": 4.623939393939395, + "wiki_fkgl": 14.77802955665025, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 4.857142857142857, + "fkgl_delta": -10.154090162710855 + }, + { + "index": 3, + "label": "intermediate_health_literacy", + "original_doc": "This case describes an isolated, asymptomatic fetal cardiac rhabdomyoma first detected at 32 weeks\u2019 gestation. The pregnancy was monitored as an outpatient until 39 weeks plus one day, when delivery occurred by cesarean section. Postnatal follow-up at day 1, day 7, day 30, 7 months, and 12 months showed normal growth and neurodevelopment. The intracardiac mass remained stable in size across all visits. Up to one year of age, the child did not meet any clinical diagnostic criteria for tuberous sclerosis complex (TSC).", + "wiki_anchor": "In about ten percent of cases, AGS presents at or soon after birth (i.e. in the neonatal period). This presentation of the disease is characterized by microcephaly, neonatal seizures, poor feeding, jitteriness, cerebral calcifications (accumulation of calcium deposits in the brain), white matter abnormalities, and cerebral atrophy; thus indicating that the disease process became active before birth i.e. in utero. These infants can have hepatosplenomegaly and thrombocytopaenia, very much like cases of transplacental viral infection. About one third of such early presenting cases, most frequently in association with mutations in TREX1, die in early childhood.", + "doc_fkgl": 11.214120481927715, + "wiki_fkgl": 14.550526315789476, + "doc_tree_depth": 5.4, + "wiki_tree_depth": 7.0, + "fkgl_delta": -3.336405833861761 + }, + { + "index": 3, + "label": "proficient_health_literacy", + "original_doc": "A 29-year-old gravida V para IV (3 spontaneous vaginal deliveries, prior cesarean for failed induction 4 years earlier) presented for ANC at 32 weeks by LNMP. Maternal labs: VDRL, HBsAg, and urinalysis negative; CBC within normal limits; blood group A Rh-positive. Obstetric ultrasound revealed normal fetal anatomy except the heart. Fetal echocardiography showed normal situs; atria of comparable size; normally positioned atrioventricular and semilunar valves with normal motion; ventricles comparable in size and contractility; left ventricle forming the apex; no ventricular septal defect. Two circumscribed, round, echogenic masses were noted on the left ventricular papillary muscles, measuring 18.2 \u00d7 8.3 mm and 13.5 \u00d7 8.3 mm. LVOT and RVOT anatomy and function were normal on 2D and color flow. Impression: cardiac rhabdomyoma. Given the association with tuberous sclerosis complex (TSC), detailed neurosonography and systemic evaluation were performed and were unremarkable. She continued routine ANC without complications to 39 weeks. At 39 weeks + 1 day, a cesarean section (repeat on request at term) delivered a 3200 g female, Apgar 10 and 10 at 1 and 5 minutes. Postoperative courses for mother and neonate were uneventful; discharge occurred on postoperative day 3. The neonate was evaluated on days 1, 7, and 30: physical examinations were normal; no seizure activity or new cutaneous lesions; mass dimensions were similar to the antenatal findings. At 7 months, development was age-appropriate; pediatric echocardiography showed well-circumscribed hyperechoic masses on both left ventricular papillary muscles measuring 21.8 \u00d7 9.2 mm and 14.7 \u00d7 8.5 mm, without left ventricular inflow obstruction. At 12 months, anthropometric and neurobehavioral development remained normal. Echocardiography again demonstrated well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and no left ventricular inflow obstruction. Up to one year of age, apart from the persistent intracardiac rhabdomyomas, the child met none of the clinical diagnostic criteria for TSC. Notably, while cardiac rhabdomyomas often regress spontaneously in infancy, these lesions were stable through 12 months.", + "wiki_anchor": "The lateral body wall folds, pulling the amnion in with it so that the amnion surrounds the embryo and extends over the connecting stalk, which becomes the umbilical cord, which connects the fetus with the placenta. If the ventral body wall fails to close, ventral body wall defects can result, such as ectopia cordis, a congenital malformation in which the heart is abnormally located outside the thorax. Another defect is gastroschisis, a congenital defect in the anterior abdominal wall through which the abdominal contents freely protrude. Another possibility is bladder exstrophy, in which part of the urinary bladder is present outside the body. In normal circumstances, the parietal mesoderm will form the parietal layer of serous membranes lining the outside (walls) of the peritoneal, pleural, and pericardial cavities. The visceral layer will form the visceral layer of the serous membranes covering the lungs, heart, and abdominal organs. These layers are continuous at the root of each organ as the organs lie in their respective cavities. The peritoneum, a serum membrane that forms the lining of the abdominal cavity, forms in the gut layers and in places mesenteries extend from the gut as double layers of peritoneum. Mesenteries provide a pathway for vessels, nerves, and lymphatics to the organs. Initially, the gut tube from the caudal end of the foregut to the end of the hindgut is suspended from the dorsal body wall by dorsal mesentery. Ventral mesentery, derived from the septum transversum, exists only in the region of the terminal part of the esophagus, the stomach, and the upper portion of the duodenum.", + "doc_fkgl": 13.580182389937107, + "wiki_fkgl": 13.431123401313517, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 8.272727272727273, + "fkgl_delta": 0.14905898862359024 + }, + { + "index": 4, + "label": "low_health_literacy", + "original_doc": "This is about a 13-year-old boy. He has had small growths in his throat since he was two years old. The growths were in his voice box and windpipe. They narrowed his breathing tube, so he had trouble breathing. It was like trying to breathe through a pinched straw. A chest scan showed several small cysts in his lungs. Doctors removed the throat growths. They also placed a breathing tube through a small hole in his neck to help him breathe. He got one dose of a medicine called bevacizumab (400 mg) through a vein. He also had breathing therapy. He got better. The problem has not come back during follow-up.", + "wiki_anchor": "Presentation\nYoung\u2013Madders syndrome is detectable from the fetal stage of development largely due to the distinctive consequences of holoprosencephaly, a spectrum of defects or malformations of the brain and face. Facial defects which may manifest in the eyes, nose, and upper lip, featuring cyclopia, anosmia, or in the growth of only a single central incisor, and severe overlapping of the bones of the skull. Cardiac and in some cases pulmonary deformities are present. Another signature deformity is bilateral polydactyly, and many patients also suffer from hypoplasia and genital deformities.", + "doc_fkgl": 2.581463963963966, + "wiki_fkgl": 15.361657303370787, + "doc_tree_depth": 4.583333333333333, + "wiki_tree_depth": 8.0, + "fkgl_delta": -12.780193339406821 + }, + { + "index": 4, + "label": "intermediate_health_literacy", + "original_doc": "A 13-year-old boy with recurrent respiratory papillomatosis since age two presented with breathing difficulty, noisy breathing (stridor), and hoarseness. Airway evaluation showed multiple nodules narrowing the larynx and trachea. Chest CT revealed several pulmonary cysts. He underwent surgical removal of the papillomatosis lesions and a tracheostomy. He received a single 400 mg intravenous dose of bevacizumab and respiratory therapy. He recovered well, and there has been no recurrence on follow-up.", + "wiki_anchor": "Tracheal deviation is a clinical sign that results from unequal intrathoracic pressure within the chest cavity. It is most commonly associated with traumatic pneumothorax, but can be caused by a number of both acute and chronic health issues, such as pneumonectomy, atelectasis, pleural effusion, fibrothorax (pleural fibrosis), or some cancers (tumors within the bronchi, lung, or pleural cavity) and certain lymphomas associated with the mediastinal lymph nodes.", + "doc_fkgl": 12.728571428571431, + "wiki_fkgl": 20.19440298507463, + "doc_tree_depth": 5.166666666666667, + "wiki_tree_depth": 12.5, + "fkgl_delta": -7.465831556503197 + }, + { + "index": 4, + "label": "proficient_health_literacy", + "original_doc": "A 13-year-old male from Cusco with recurrent respiratory papillomatosis (RRP) since age two (tracheostomy at age three) and a maternal history of genital papilloma presented after 16 days of predominantly nocturnal respiratory difficulty, inspiratory laryngeal stridor, and moderate dysphonia. He had previously received azithromycin and supplemental oxygen without improvement. On exam, there was mild subcostal retraction, decreased vesicular breath sounds over the left hemithorax, and scant wheezes predominating on the right; he required 4 L/min oxygen via binasal cannula. Laboratory studies showed WBC 8.03 \u00d7 10^3/\u03bcL, platelets 209 \u00d7 10^3/\u03bcL, hemoglobin 13.2 g/dL, and CRP 36.6 mg/L. Imaging included a chest study and head and neck tomography; chest tomography visualized several pulmonary cysts. Forty-eight hours after admission, he developed worsening stridor and respiratory distress, prompting emergent OR transfer for tracheostomy, microlaryngoscopy, and excision of papillomatous lesions. Intraoperative findings demonstrated extensive papillomatous disease with appendicular tumor-like lesions and ventricular bands involving the epiglottis, glottic surface, vocal cords, subglottis, and trachea to ring 5. Histopathology showed koilocytotic atypia consistent with HPV and mild focal dysplasia. Postoperatively, he was managed in the PICU with respiratory monitoring and was weaned off oxygen within 48 hours. He received a single intravenous dose of bevacizumab 400 mg and showed prompt clinical improvement. He completed a seven-day hospitalization with normalization of oxygen saturation and progressive oxygen weaning, then was transferred for ongoing care. He also received respiratory therapy. On telemonitoring at eight months, there was no evidence of recurrence or intercurrent events. Clinical context: RRP is typically HPV-related (often low-risk types) and can cause multifocal papillomas leading to airway stenosis; anti-VEGF therapy such as bevacizumab is used off-label to reduce angiogenesis and disease recurrence, and in this case was associated with a favorable short- to mid-term outcome.", + "wiki_anchor": "The trachea is the tube that carries air from the throat to the lungs. It is also commonly referred to as the windpipe. The trachea is one of the most important parts of the respiratory system and damage to the trachea can indicate a life-threatening emergency. The normal position of the trachea is straight up and down, running along the center of the front side of the throat. Certain conditions can cause the trachea to shift to one side or the other. This is a medical emergency that requires immediate medical attention to discover the cause of the shift and begin an appropriate course of treatment. There are several causes for a tracheal deviation, and the condition often presents along with difficulty breathing, coughing and abnormal breath sounds. The most common cause of tracheal deviation is a pneumothorax, which is a collection of air inside the chest, between the chest cavity and the lung. A pneumothorax can be spontaneous, caused by existing lung disease, or by trauma. Treatment varies, depending on the severity of the pneumothorax. Smaller pockets of air tend to dissipate on their own, while larger areas can cause complications and are usually vented by a needle in the chest. As soon as the pneumothorax is treated, the tracheal deviation also will resolve itself. A congenital lack of one lung, surgical removal of a lung or pleural fibrosis, which is an inflammation of the lung membranes caused by an infection. As a result of the wide range of causes of tracheal deviation, it is essential to seek medical attention so that an accurate diagnosis can be obtained.", + "doc_fkgl": 15.644583333333337, + "wiki_fkgl": 11.511749867233139, + "doc_tree_depth": 6.769230769230769, + "wiki_tree_depth": 7.785714285714286, + "fkgl_delta": 4.132833466100198 + }, + { + "index": 5, + "label": "low_health_literacy", + "original_doc": "This 54-year-old man had long-term kidney disease. He took steroids and other medicines that weaken the body\u2019s defenses for a long time. He came to the lung department with fever, cough with mucus, and trouble breathing. A scan showed many cloudy spots in both lungs, like frosted glass. Blood tests showed a lot of inflammation. This suggested an infection from germs such as bacteria, a virus, or a fungus. A blood test was positive for RSV antibodies. Tests for other germs were not positive. His immune system was weak. His antibody level (IgG) was low. His infection-fighting T cells (CD4 and CD8) were also low. Doctors gave strong medicines for infection and support to help his breathing. His illness got worse quickly. He died from breathing failure.", + "wiki_anchor": "An outbreak investigation was conducted on 93 symptomatic persons from Malaysia following a college retreat on January 17\u201319, 2012, on Pangkor Island. Predominant manifestations were fever (relapsing in about 50% of patients), myalgia, headache, and cough. Although only two patients were confirmed to be acutely infected with S. nesbitti, the remaining students and teachers in the group likely had the same infection, because nearly all had similar signs and symptoms with onset of illness within days of each other. In addition, 9 patients had a distinctive facial myositis, but sarcocysts could not be verified in all of them because only three patients agreed to provide a muscle biopsy specimen.", + "doc_fkgl": 5.415573678290215, + "wiki_fkgl": 13.589064220183484, + "doc_tree_depth": 4.785714285714286, + "wiki_tree_depth": 7.0, + "fkgl_delta": -8.173490541893269 + }, + { + "index": 5, + "label": "intermediate_health_literacy", + "original_doc": "A 54-year-old man with chronic kidney disease on long-term corticosteroids and immunosuppressants was admitted to respiratory medicine with fever, cough with sputum, and shortness of breath. Chest CT showed multiple bilateral ground-glass opacities. Laboratory studies showed elevated inflammatory markers, indicating possible bacterial, viral, or fungal infection. RSV antibodies were positive, while tests for other pathogens were negative. He was immunocompromised from prolonged corticosteroid and immunosuppressant use, with low total IgG and reduced CD4 and CD8 T-lymphocyte counts. Despite intensive anti-infective therapy and escalating respiratory support, his condition deteriorated rapidly, and he died from respiratory failure.", + "wiki_anchor": "Pathologies \nA. algerae, former genera Nosema and Brachiola, is an emerging human pathogen. It has caused severe myositis in patients taking immunosuppressive medication for rheumatoid arthritis or solid-organ transplantation. It also has led to skin abscesses and an infection of the false vocal cord in patients receiving chemotherapy for hematologic malignancies and caused keratitis in a man with no significant medical history. Cases discussed in Emerging Infectious Diseases in February 2014 show that A. algerae myositis caused fever, weight loss, fatigue, generalized muscle weakness and pain, dysphagia, glossitis, peripheral edema, and diarrhea. The journal concludes that \"A. algerae myositis is [an] uncommon infection and has a high case-fatality rate.\"", + "doc_fkgl": 16.420789473684213, + "wiki_fkgl": 14.29937090432503, + "doc_tree_depth": 6.166666666666667, + "wiki_tree_depth": 9.0, + "fkgl_delta": 2.1214185693591823 + }, + { + "index": 5, + "label": "proficient_health_literacy", + "original_doc": "A 54-year-old male with membranous nephropathy II and nephrotic syndrome on long-term oral glucocorticoids and immunosuppressants (immunocompromised) presented to the Department of Respiratory Medicine with 5 days of fever, cough, expectoration, and progressive dyspnea. He had a 20 pack-year smoking history and no family history of hereditary disease. A chest x-ray one month prior was normal. On admission (August 8, 2016): BMI 24.5 kg/m2, T 39.0\u00b0C, tachypnea 35 breaths/min, severe hypoxemia (SaO2 86%). Auscultation revealed good bilateral air entry with scattered diffuse crackles and rhonchi. Chest CT demonstrated multiple bilateral ground-glass opacities. Initial labs showed a normal WBC count with elevated neutrophils and increased inflammatory markers (CRP, ESR) and elevated (1\u21923)-\u03b2-D-glucan. Serology was positive for RSV antibodies on hospital day 4; other pathogen testing was negative. He had laboratory evidence of immunosuppression with decreased total IgG and reduced CD4 and CD8 T-lymphocyte counts, consistent with chronic exposure to corticosteroids and immunosuppressants.\n\nManagement: Immediate respiratory monitoring and supplemental oxygen were initiated. Empiric anti-infective therapy included antibiotics (moxifloxacin for 4 days, then cefminoxine for 8 days) and antifungal therapy (voriconazole for 10 days). The glucocorticoid and immunosuppressant doses were largely unchanged. After 10 days, clinical status and oxygenation worsened with radiographic progression. He was transferred to the Emergency ICU for noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, cotrimoxazole), antifungal therapy (micafungin), systemic corticosteroids (methylprednisolone 40 mg bid i.v.), and supportive care. Ganciclovir was added for possible viral coinfection (e.g., CMV). Five days later, chest x-ray showed further aggravation. Despite escalation to invasive ventilator-assisted ventilation, higher-dose methylprednisolone (80 mg bid), additional antibacterials (cefoperazone-sulbactam, tigecycline, cotrimoxazole), and continued micafungin, he developed rapid progression culminating in respiratory failure and death two days later.\n\nInterpretation: The presentation is consistent with severe viral pneumonia due to RSV in an immunocompromised host, with imaging showing multifocal ground-glass opacities and laboratory evidence of systemic inflammation. Elevated (1\u21923)-\u03b2-D-glucan prompted antifungal coverage, while broad-spectrum antibacterial and antiviral regimens addressed possible coinfections. Profound immunosuppression (low IgG, reduced CD4/CD8 T cells) likely contributed to rapid deterioration and refractory hypoxemic respiratory failure despite intensive anti-infective therapy and advanced respiratory support.", + "wiki_anchor": "Uncommon/Rare adverse effects include\n Tardive dyskinesia, an often irreversible adverse effect that usually results from chronic use antipsychotic medications, especially the high-potency first-generation antipsychotics. It is characterised by slow (hence tardive), involuntary, repetitive, purposeless muscle movements. \n Neuroleptic malignant syndrome, a potentially fatal complication of antipsychotic drug use. It is characterised by the following symptoms:\n- Muscle rigidity\n- Tremors\n- Mental status change (e.g. hallucinations, agitation, stupor, confusion, etc.)\n- Hyperthermia \u2014 elevated body temperature\n- Autonomic instability (e.g. tachycardia, high blood pressure, diaphoresis, diarrhoea, etc.)\n Urinary retention \u2014 the inability to pass urine despite having urine to pass.\n Blood dyscrasias e.g. agranulocytosis (a potentially fatal drop in white blood cell count), leukopaenia (a drop in white blood cell counts but not to as extreme an extent as agranulocytosis), neutropaenia (a drop in neutrophil [the cells of the immune system that specifically destroy bacteria] count), thrombocytopaenia (a dangerous drop in platelet [a cell found in the blood that plays a crucial role in the blood clotting process] counts), purpura (the appearance of red or purple discolourations of the skin that do not blanch when pressure is applied), eosinophilia (raised eosinophil [the cells of the immune system that specifically fights off parasites] count)\n Hepatitis \u2014 inflammation of the liver\n Jaundice\n Pigmentary retinopathy\n Anaphylactoid reactions\n Oedema \u2014 the abnormal buildup of fluids in the tissues\n Asthma\n Coma\n Seizures\n Confusional states\n Disorientation\n Incoordination\n Ataxia\n Tremors\n Peripheral neuropathy \u2014 nerve damage\n Numbness, tingling and paresthesias of the extremities\n Dysarthria\n Syndrome of inappropriate antidiuretic hormone secretion (SIADH)\n Tinnitus \u2014 falsely hearing ringing in the ears. \n Alteration in EEG patterns\n Paralytic ileus \u2014 cessation of the peristaltic waves that propel partially digested food through the digestive tract.\n Hyperpyrexia (elevated body temperature)\n Disturbance of accommodation\n Increased intraocular pressure\n Mydriasis", + "doc_fkgl": 16.479367816091955, + "wiki_fkgl": 18.121428571428577, + "doc_tree_depth": 6.15, + "wiki_tree_depth": 8.777777777777779, + "fkgl_delta": -1.6420607553366224 + }, + { + "index": 6, + "label": "low_health_literacy", + "original_doc": "A 34-year-old woman had new lower back pain. She saw blood in her urine. She also had a big bruise under the skin on her right buttock. She had never had bleeding problems before. Because these bleeding signs were serious, she was sent to the emergency room. Doctors did blood-clotting tests. One test mixed her blood with normal blood to see how it clotted. Another test looked for a blocker against a clotting protein called factor eight. These tests confirmed the diagnosis.", + "wiki_anchor": "Classification of blood clotting tests\nSubstantially all coagulometers used in laboratory diagnostics are based on the methods of testing of the hemostasis system created more than fifty years ago. The majority of these methods are good to detect defects in one of the hemostasis components, without diagnosing other possible defects. Another problem of the actual hemostasis system diagnostics is the thrombosis prediction, i.e. sensitivity to the patient's prethrombotic state. All the diversity of clinical tests of the blood coagulation system can be divided into 2 groups: global (integral, general) tests, and \u00ablocal\u00bb (specific) tests.", + "doc_fkgl": 4.512113821138211, + "wiki_fkgl": 14.21221276595745, + "doc_tree_depth": 4.444444444444445, + "wiki_tree_depth": 7.75, + "fkgl_delta": -9.700098944819239 + }, + { + "index": 6, + "label": "intermediate_health_literacy", + "original_doc": "A 34-year-old woman with no prior bleeding history developed lower back pain, passed a kidney stone, and then had three days of haematuria. She later developed painful thigh and right gluteal bruising after an intramuscular injection. Because the bleeding was extensive, she was transferred to the emergency department. Her coagulation work-up showed a markedly prolonged aPTT. A mixing study only partially corrected the aPTT, and factor VIII activity was very low with a measurable factor VIII inhibitor (8.64 BU/mL), confirming acquired haemophilia A, likely postpartum. She was treated with prednisone and cyclophosphamide, and received bypassing therapy (initially FEIBA, then switched to recombinant factor VIIa due to side effects). Her bleeding improved and she was discharged.", + "wiki_anchor": "In the safety and efficacy trial for prevention and treatment of bleeds, in hemophilia patients the success rate for treatment of bleeds was 84.5% (excluding bleeds for which there was no outcome reported) and out of a total of nine surgeries in nine patients performed during the trial, haemostasis was successful in all the surgeries and no treatment failures were reported. It is also used for perioperative management and routine prophylaxis to prevent or reduce the frequency of bleeding episodes. Turoctocog alfa is not indicated for the treatment of von Willebrand disease.", + "doc_fkgl": 11.051032608695653, + "wiki_fkgl": 13.388695652173912, + "doc_tree_depth": 5.0, + "wiki_tree_depth": 8.666666666666666, + "fkgl_delta": -2.3376630434782584 + }, + { + "index": 6, + "label": "proficient_health_literacy", + "original_doc": "A 34-year-old female, 2 months post\u2013cesarean section (37 weeks) with persistent postoperative wound bleeding and no childhood/adolescent bleeding history, presented with a 4-week illness. The clinical course began with lower back pain attributed to bilateral renal lithiasis; after spontaneous passage of a stone she had 3 days of haematuria and was given tranexamic acid q12h. Three weeks later she developed progressive pain and induration of the left distal thigh. Following intramuscular diclofenac for persistent pain, she developed ecchymosis and ongoing bleeding in the gluteal area despite compression. An outside \u201cparticular Doppler ultrasound\u201d reportedly showed deep venous thrombosis (left lower limb), and she was started on enoxaparin 30 mg SC q24h plus morphine and hospitalized. The next day she developed epigastralgia, blurred vision, HR 117 bpm, BP 113/85 mmHg, and SpO2 93%; enoxaparin was discontinued. Hemoglobin fell from 10.4 g/dL (day prior to admission) to 6.4 g/dL, prompting 2 units of packed red cells. With a working diagnosis of vasculitis, methylprednisolone was started and she was referred for further evaluation.\n\nOn admission she had severe pallor, extensive ecchymosis of the left thigh and lateral knee, and a right thigh haematoma. Hemogram: Hb 9.8 g/dL, normocytic, normochromic. Chemistry notable for glucose 160 mg/dL; AST 52 U/L, ALT 86 U/L. Coagulation profile showed isolated prolongation of the activated partial thromboplastin time (aPTT) to 91.2 s; the remainder of hemogram, biochemistry, electrolytes, liver profile, and coagulation parameters were within reference limits. Soft-tissue ultrasound of the right gluteal region revealed a subcutaneous collection (TCSC) with oedema extending to the upper third of the thigh. Repeat Doppler ultrasound of the left lower limb showed normal flow without thrombosis in the common femoral, superficial, or deep venous systems. Blood and urine cultures were negative. ANA, C3, C4, and ferritin were within reference ranges.\n\nGiven suspected acquired haemophilia, a mixing test demonstrated partial correction of the aPTT. Factor VIII activity was <1.0 U/dL, and a factor VIII inhibitor was detected at 8.64 Bethesda units/mL, confirming acquired haemophilia A, likely postpartum in onset. Therapy included prednisone 50 mg PO at breakfast plus 10 mg at lunch, cyclophosphamide 50 mg (2 tablets) PO q24h, and FEIBA for haemostasis. After 5 days, FEIBA was discontinued due to chest tightness, dyspnoea, and nausea (suspected adverse drug reaction) and replaced with activated recombinant factor VII (rFVIIa; NovoSeven). Clinical evolution was favourable, with decreasing ecchymoses and no new symptoms, and she was discharged.\n\nContext: Postpartum acquired haemophilia A is mediated by autoantibodies to factor VIII and typically presents with isolated aPTT prolongation, low FVIII activity, and an inhibitor measured in Bethesda units. Partial correction on mixing supports an inhibitor pattern. First-line immunosuppression (e.g., prednisone with or without cyclophosphamide) and bypassing agents (FEIBA or rFVIIa) are standard to control bleeding while eradicating the inhibitor.", + "wiki_anchor": "Early cases\nA publication in the Journal of Medical Genetics in 1987 by Dr. I. Young and D. Madders of Leicester Royal Infirmary in the United Kingdom described the then-unknown condition when presenting \"a stillborn male infant with pre-maxillary agenesis, bilateral microphthalmos, alobar holoprosencephaly, hydrocephalus, ventricular and atrial septal defects, small penis, bilateral cryptorchidism, and bilateral upper limb postaxial polydactyly.\" Both doctors noted no use of drugs, alcohol or cigarettes by the mother, and the baby was delivered normally after forty-one weeks of gestation. It was the first child of the parents, who were not related and went on to have another child successfully however this child was a stillbirth. There was severe overlapping of the bones of the skull and a cleft lip in addition to the bilateral polydactyly. Of the organs, Young and Madders noted missing parts of the tricuspid valve and other small cardiac defects, as well as the holoprosencephaly. Both doctors consulted various medical databases and, after discounting Meckel syndrome due to a lack of renal abnormalities, concluded that this was a hitherto unclassified condition. After later classification, it was later named for the two doctors, though at the time of publication it was termed 'pseudotrisomy 13' due to similarities with the condition Trisomy 13. Another case in 1989 with similar symptoms was also published as an example of 'pseudotrisomy 13', and there was no evidence of an extra chromosome, further suggesting that Trisomy 13 was a separate condition.", + "doc_fkgl": 11.779287370862324, + "wiki_fkgl": 14.864777777777778, + "doc_tree_depth": 6.208333333333333, + "wiki_tree_depth": 8.0, + "fkgl_delta": -3.0854904069154543 + }, + { + "index": 7, + "label": "low_health_literacy", + "original_doc": "This is about a 2-day-old newborn boy. He was born at full term by C-section at a private hospital. He came to the children\u2019s hospital because the right side of his scrotum (the sack that holds the testicles) was swollen since birth. In the emergency room, he looked well. His skin was pink and warm. His blood flow looked good. On exam, the right testicle was big and tight. It was not sore when touched. The skin was red and looked rubbed. A light test did not shine through the right side. The light did shine through the left side. There were no signs of a hernia. An urgent ultrasound scan was done. The scan showed the right testicle was larger and looked uneven inside. No blood was flowing to it. The doctors took him quickly to surgery to look inside the scrotum. In surgery, the right testicle was dead because it had twisted, like a kinked hose that stops flow. There was a small amount of fluid. They removed the right testicle. They fixed the left testicle in place to help prevent twisting.", + "wiki_anchor": "Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development and is normally included in an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam is conducted to detect various ailments, measure sexual development, or verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities (ex. varicocele), urethral opening abnormalities, problems related to uncircumcision (ex. phimosis), lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues and many others. In some instances (ex: Peyronie's disease) where a physical examination of the male genitals is not sufficient to diagnose an individual than an internal genital examination using imaging or ultrasounds will be needed for further evaluation.", + "doc_fkgl": 3.26104347826087, + "wiki_fkgl": 16.55666666666667, + "doc_tree_depth": 4.0, + "wiki_tree_depth": 8.571428571428571, + "fkgl_delta": -13.295623188405798 + }, + { + "index": 7, + "label": "intermediate_health_literacy", + "original_doc": "A full\u2011term male newborn, 2 days old and delivered by cesarean section, presented with a congenital right scrotal swelling. On arrival he appeared well perfused and stable. Examination showed the right testis was enlarged, tense, non\u2011tender, and visibly reddish with excoriated overlying skin. Transillumination was negative on the right and positive on the left; both hernia openings were normal. Doppler ultrasound showed the right testis was enlarged with a heterogeneous, darker appearance and no detectable blood flow; the left testis looked normal, with only a small amount of fluid. He was taken urgently to surgery. Intra\u2011operatively, the right testis was frankly nonviable due to intravaginal torsion, with minimal hydrocele. Surgeons removed the right testis (orchidectomy) and fixed the left testis in place (contralateral orchidopexy) to reduce the risk of future twisting.", + "wiki_anchor": "Diagnosis \nSince women can have signs and symptoms that could be attributed to other causes, diagnosis is based upon the symptoms that cannot be better accounted for by another diagnosis. Lab tests usually do not provide information that will aid in diagnosing. A visual exam is useful. The observations of the following may indicate lower estrogen levels: little pubic hair, loss of the labial fat pad, thinning and resorption of the labia minora, and the narrowing of the vaginal opening. An internal exam will reveal the presence of low vaginal muscle tone, the lining of the vagina appears smooth, shiny, pale with loss of folds. The cervical fornices may have disappeared and the cervix can appear flush with the top of the vagina. Inflammation is apparent when the vaginal lining bleeds easily and appears swollen. The vaginal pH will be measured at 4.5 and higher.", + "doc_fkgl": 11.784036259541985, + "wiki_fkgl": 10.794022988505748, + "doc_tree_depth": 5.375, + "wiki_tree_depth": 6.125, + "fkgl_delta": 0.9900132710362364 + }, + { + "index": 7, + "label": "proficient_health_literacy", + "original_doc": "A 2\u2011day\u2011old term male neonate, delivered by cesarean section at a private hospital, was referred for a congenital right scrotal swelling and presented to our children\u2019s hospital one day later. On ED arrival he was well hydrated, pink on room air with good perfusion. Physical exam: right hemiscrotum with an enlarged, tense, non\u2011tender, visibly reddish testis and overlying skin excoriation; transillumination negative on the right and positive contralaterally; both hernial orifices normal. Laboratory studies were obtained, and urgent inguinoscrotal Doppler ultrasonography demonstrated an enlarged right testis measuring 15.6 \u00d7 9.4 mm with heterogeneous hypoechoic echotexture, prominent rete testis, and absent intratesticular color Doppler flow. The left testis was normal in size, shape, and echotexture; there was minimal hydrocele. The patient underwent urgent scrotal exploration. Intra\u2011operatively there was frank necrosis of the right testis secondary to intravaginal testicular torsion, with minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed. Contextually, perinatal testicular torsion often presents at or shortly after birth and Doppler evidence of absent flow with heterogeneous hypoechoic parenchyma correlates with nonviability; salvage rates are low when presentation is delayed. Contralateral orchidopexy is commonly performed to mitigate future torsion risk.", + "wiki_anchor": "Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development and is normally included in an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam is conducted to detect various ailments, measure sexual development, or verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities (ex. varicocele), urethral opening abnormalities, problems related to uncircumcision (ex. phimosis), lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues and many others. In some instances (ex: Peyronie's disease) where a physical examination of the male genitals is not sufficient to diagnose an individual than an internal genital examination using imaging or ultrasounds will be needed for further evaluation.", + "doc_fkgl": 15.11899521531101, + "wiki_fkgl": 16.55666666666667, + "doc_tree_depth": 6.5, + "wiki_tree_depth": 8.571428571428571, + "fkgl_delta": -1.4376714513556585 + }, + { + "index": 8, + "label": "low_health_literacy", + "original_doc": "A 4-year-old boy had blood in his pee and swelling for 5 days. He then had headaches, nausea, and vomiting. He came to the hospital with seizures and very high blood pressure. Blood tests showed a low level of a protein called C3 and signs of a recent strep infection. This meant his kidney filters were inflamed after strep. His brain was affected by the very high blood pressure. Doctors suspected a problem called PRES, which is brain swelling from high pressure. A brain MRI confirmed this. His immune system also attacked his red blood cells. This made his blood level drop very low, to 5 g/dL. He was treated with medicines to lower his blood pressure, steps to protect his brain, and steroid medicines. He left the hospital after 31 days. Six months later, he had no symptoms.", + "wiki_anchor": "Epilepsies with onset in childhood are a complex group of diseases with a variety of causes and characteristics. Some people have no obvious underlying neurological problems or metabolic disturbances. They may be associated with variable degrees of intellectual disability, elements of autism, other mental disorders, and motor difficulties. Others have underlying inherited metabolic diseases, chromosomal abnormalities, specific eye, skin and nervous system features, or malformations of cortical development. Some of these epilepsies can be categorized into the traditional epilepsy syndromes. Furthermore, a variety of clinical syndromes exist of which the main feature is not epilepsy but which are associated with a higher risk of epilepsy. For instance between 1 and 10% of those with Down syndrome and 90% of those with Angelman syndrome have epilepsy.", + "doc_fkgl": 4.794388489208632, + "wiki_fkgl": 16.107085714285716, + "doc_tree_depth": 4.923076923076923, + "wiki_tree_depth": 6.428571428571429, + "fkgl_delta": -11.312697225077084 + }, + { + "index": 8, + "label": "intermediate_health_literacy", + "original_doc": "A 4-year-old boy presented after 5 days of visible blood in the urine and leg swelling, plus new headaches, nausea, and vomiting. He developed seizures with a hypertensive emergency. Labs showed low complement C3 and a high anti-streptolysin O (ASO) titer, consistent with acute post-streptococcal glomerulonephritis. He developed encephalopathy, and MRI confirmed posterior reversible encephalopathy syndrome (PRES) secondary to the hypertensive crisis. He also developed autoimmune hemolytic anemia, with hemoglobin falling to 5 g/dL. Treatment included antihypertensive therapy, neuroprotective measures, and corticosteroids. He was discharged after 31 days and remained asymptomatic at 6-month follow-up.", + "wiki_anchor": "Published writings (partial list) \n Jer Master, M.D.; Mary Allen Engle, M.D.; Gertrude Stern, M.D.; Carl H. Smith, M.D. \"Cardiac complications of chronic, severe, refractory anemia with hemochromatosis\" The Journal of Pediatrics, Volume 58, Issue 4, pp.\u00a0455\u2013463 (April 1961)\n Jer Master, C.S.B., \"Your children are in God's care\" Christian Science Journal (March 1994). Adapted from a lecture given on 21 November 1993. Retrieved 18 June 2013\n Jer Master, \"A Cure for Every Ill\" The Christian Science Journal (April 2006). Retrieved 16 June 2013. \n Jer Master, \"Spiritual Immunity\" Christian Science Sentinel (2 January 2006). Retrieved 17 June 2013", + "doc_fkgl": 14.753525835866263, + "wiki_fkgl": 7.55630740393627, + "doc_tree_depth": 6.333333333333333, + "wiki_tree_depth": 5.166666666666667, + "fkgl_delta": 7.197218431929993 + }, + { + "index": 8, + "label": "proficient_health_literacy", + "original_doc": "A 4-year-old male, two weeks post nasal impetigo treated with topical mupirocin and oral cefadroxil (dose/duration/adherence unknown), presented with 5 days of macroscopic glomerular haematuria and lower-extremity oedema, followed by 12 hours of headache, nausea, and vomiting, and arrived to the ED in convulsive status after 20 minutes of generalized tonic\u2013clonic seizures. On ED arrival he was afebrile, with non-evaluable BP, depressed consciousness, generalized hypertonia, and bilateral pretibial oedema. He was intubated and loaded with phenobarbital 10 mg/kg. In the ICU, BP was 134/94 mmHg (p95 for age 108/66; p95+12 120/78), consistent with hypertensive emergency. Initial labs: urinalysis with haematuria (>100 RBC/hpf), proteinuria 3+, leucocyturia 10\u201325/hpf; creatinine 0.3 mg/dL; anaemia Hct 21%, Hb 7 g/dL with normocytic, normochromic indices; leukocytosis 23,900/mm3; thrombocytosis 756,000/mm3; no elevation of acute-phase reactants; hypocomplementemia with C3 25 mg/dL (VN 80\u2013150) and normal C4. Throat rapid antigen for group A Streptococcus was positive and ASO positive. Non-contrast head CT was unremarkable. Renal ultrasound showed bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullary differentiation. The working diagnosis was nephritic syndrome due to complicated GNAPE with hypertensive emergency and status epilepticus. He required mechanical ventilation and phenobarbital; EEG the next day was normal; CSF was normal. Cefotaxime was started for Streptococcus pyogenes eradication and furosemide for diuresis. By day 2 he developed AKI (creatinine 0.99 mg/dL), hypertension, and 24-hour proteinuria 36.6 mg/m2/h without oliguria. Antihypertensive therapy included amlodipine and IV labetalol with initial control. After extubation at 48 hours, he deteriorated neurologically within 24 hours (GCS 8) with BP > p95+12 despite labetalol infusion up to 3 mg/kg/h, amlodipine 10 mg/day, and furosemide, necessitating reintubation and sodium nitroprusside infusion up to 3 mcg/kg/min with a planned gradual BP reduction of 25% per day to mitigate secondary neurologic injury. Given acute neurologic deficits with severe HTN in GN, PRES was suspected and confirmed by brain MRI on day 5 showing increased subcortical T2/FLAIR signal in bilateral symmetric occipital regions without diffusion restriction, consistent with vasogenic edema. Ophthalmologic exam was normal; repeat EEG showed occasional generalized voltage depression. Enalapril was added. Over 10 days, BP normalized with slow pharmacologic weaning; follow-up MRI on day 12 showed radiologic regression, and he was successfully extubated after 5 days. During the ICU course, Hb fell to 5 g/dL with normocytic, normochromic indices and no thrombocytopenia; hemolytic anemia was diagnosed given a positive direct Coombs test and hemoglobinuria. He required two packed RBC transfusions. Methylprednisolone 1 mg/kg/day was given for 72 hours. Stool culture and urinary antigen for Streptococcus pneumoniae were negative. Serologies for EBV and Parvovirus B19, ENA profile, ANCA, anti-dsDNA, anti-\u03b22 glycoprotein I, anticardiolipin, and lupus anticoagulant were all negative; all cultures (blood, urine, endotracheal aspirate, pharyngeal) were negative. ANA was positive at 1:160. Clinical status improved with BP control, rising complement levels, and resolution of proteinuria and haematuria; the direct Coombs remained positive on hospital day 9. He was discharged on day 31 normotensive, non-anaemic, with preserved renal function, no proteinuria or haematuria, normalized C3, and asymptomatic neurologically. Discharge medications: prednisone, amlodipine, enalapril, and folic acid. He remained asymptomatic with no recurrence at 6 months. Overall, the case represents GNAPE with hypocomplementemia (low C3) and elevated ASO complicated by hypertensive emergency causing encephalopathy and secondary PRES, plus autoimmune hemolytic anemia with Hb nadir 5 g/dL, successfully managed with antihypertensives, neuroprotective measures, and corticosteroids, with full clinical and radiologic recovery.", + "wiki_anchor": "Ciba-Geigy is a pharmaceutical laboratory which has manufactured and sold metoprolol tablets in Canada under the trade name \"Lopresor\" since 1977. Metoprolol is a prescription drug generally prescribed for hypertension. After Apotex obtained licenses to manufacture and sell metoprolol in Canada, its version of the tablets have had the same get-up (shape, size and colour) as those of Ciba-Geigy since 1986. Novopharm, another respondent joined in the action also manufactured tablets with the same get-up. The three drugs have been designated interchangeable pharmaceutical products by Ontario law, which means that a pharmacist may give a patient any one of them as long as the prescription does not specify no substitution.\nIn June 1986 the Ciba-Geigy brought passing-off actions against Apotex and Novopharm, alleging that its metoprolol tablets have a unique get-up by reason of their size, shape and colour and that this get-up has become associated with its product. In order to establish that Apotex and Novopharm were engaged in passing off by confusing the public with their products, Ciba-Geigy needed to prove that the customers of these drugs were likely to be misled by the similarity of the products. \n \nAt the trial level, Ciba-Geigy failed to establish that the customers, namely physicians and pharmacists that prescribe or dispense metoprolol, were confused in choosing the brand of metoprolol to give to patients due to the similar appearance of the tablets. For this reason, the Supreme Court of Ontario refused to issue an interlocutory injunction because Ciba-Geigy failed to show that there was a \"serious issue\" to be tried.\nAt the Court of Appeal, Ciba-Geigy argued that the customers affected by the passing-off should include ultimate consumer of the prescribed drug as they are likely to be confused by the similar appearance of the products in question. The Court of Appeal rejected its argument and dismissed the appeal.", + "doc_fkgl": 14.958653673835126, + "wiki_fkgl": 14.628095943144803, + "doc_tree_depth": 5.866666666666666, + "wiki_tree_depth": 8.0, + "fkgl_delta": 0.3305577306903231 + }, + { + "index": 9, + "label": "low_health_literacy", + "original_doc": "This 69-year-old man had heart bypass surgery in the past. For 2 months, he got very short of breath with light activity. Tests\u2014a heart tracing, a blood test, and an X-ray movie with dye of the heart arteries\u2014showed heart failure from poor blood flow after a bypass vein to the right heart artery failed. Doctors first opened a totally blocked artery on the left side of his heart. Then they used tiny natural detours between heart arteries to reach the right heart artery from the far end and open it. His breathing was better when he left the hospital. Six months later, his shortness of breath had not come back.", + "wiki_anchor": "Two days later, Mevoli attempted a CNF dive to on a single breath. He began to turn back at , but appeared to change his mind and dived downward again. Mevoli returned to the surface after 3 minutes and 38 seconds underwater, but fell backward into the ocean and lost consciousness. Safety divers and the event physician attempted to revive Mevoli, whose pulse disappeared. After resuscitation efforts had continued for 90 minutes, he was transported to Vid Simms Memorial Health Center, reportedly suffering from pulmonary edema. Mevoli died at 1:44\u00a0p.m. He was the first athlete to die in an international free-diving competition.", + "doc_fkgl": 6.522207792207791, + "wiki_fkgl": 9.75952380952381, + "doc_tree_depth": 5.571428571428571, + "wiki_tree_depth": 5.285714285714286, + "fkgl_delta": -3.2373160173160187 + }, + { + "index": 9, + "label": "intermediate_health_literacy", + "original_doc": "A 69-year-old man with prior coronary bypass surgery presented with two months of severe shortness of breath with mild activity (NYHA class III). He was diagnosed with heart failure due to ischemia after failure of a saphenous vein graft to the right coronary artery. This was supported by an abnormal ECG, elevated NT-proBNP, and a coronary angiogram; echocardiography also showed reduced pumping function. The team reopened a chronic total occlusion in the native right coronary artery using a retrograde approach through septal channels (septal surfing). To enable that route, they first re-opened the totally occluded left coronary artery. After the procedure, his dyspnea improved before discharge, and at 6 months he had no recurrence of shortness of breath.", + "wiki_anchor": "A 1988 review by Burch et al. analyzed their experience with the ACS looking at 31 patients. They indicated that \u201cfew technical maneuvers in surgery (are) as dramatic or desperate as the use of the atriocaval shunt\u00a0...\u201d Ninety percent of the patients were admitted in shock. In 74% the vena cava was directly involved. In addition to the laparotomy to access the retrohepatic space, a thoracotomy is necessary to find the atrium so that the stent\u2014usually a 36 French chest tube\u2014can be inserted. The stent is secured with tourniquets. Problems during surgery involve uncontrollable bleeding and technical problems in placing the shunt in a timely fashion. Six patients survived (about 20%).", + "doc_fkgl": 13.480000000000004, + "wiki_fkgl": 9.311891891891893, + "doc_tree_depth": 7.166666666666667, + "wiki_tree_depth": 5.25, + "fkgl_delta": 4.168108108108111 + }, + { + "index": 9, + "label": "proficient_health_literacy", + "original_doc": "A 69-year-old male with prior CABG presented with 2 months of severe dyspnea on mild exertion (NYHA III). ECG showed ST depression in II, III, aVF, and V4\u20136; NT-proBNP was 2640 pg/mL. Echocardiography demonstrated LV systolic dysfunction with LVEF 30%. His history included an inferior STEMI in 2009 with severe 3-vessel disease (proximal LAD CTO, 90% mid/distal LCx stenoses, 95% mid RCA stenosis) treated with CABG (LIMA\u2013LAD; sequential SVG to OM1, OM2, and PL). Current angiography via 6 Fr left radial access showed patent LIMA\u2013LAD and SVG\u2013OM1/OM2, but complete occlusion of the sequential SVG to PL. The native LM was occluded at the ostium and the native RCA was occluded in the mid segment with bridging collaterals. The strategy was to treat the native RCA CTO. Dual arterial access was obtained with an additional 6 Fr right femoral sheath. The right and left coronaries were engaged with 6 Fr AL 0.75 (Launcher; Medtronic) and 6 Fr EBU 3.5 (Launcher; Medtronic) guide catheters, respectively. An antegrade approach from the left radial artery failed: neither a Fielder XTR nor a Gaia 3 with a Finecross microcatheter could enter the distal true lumen. A parallel wire technique with a Crusade microcatheter and two Gaia 3 wires also failed. The team then switched to a retrograde approach via septal channels from the LAD through the occluded left coronary system. A Gaia 3 crossed the occluded LM and LAD to reach the distal LAD true lumen. A Sion wire was exchanged via a Finecross into the distal LAD, followed by dilation of the LM and proximal LAD with a 2.0 \u00d7 15 mm balloon. Septal surfing technique (SST) was then used to identify a viable septal channel. A Sion wire, supported by a 150-cm Finecross, was advanced retrogradely through a distal septal branch into the distal RCA. A Gaia 3 traversed the RCA CTO retrogradely into the proximal RCA true lumen and was advanced into a Guidezilla guide extension catheter positioned in the antegrade guide. The Finecross was delivered to the antegrade guide and an RG3 wire was externalized. The CTO segment was predilated with a 2.0 \u00d7 15 mm balloon and stented with two overlapping DES (2.5 \u00d7 38 mm and 3.0 \u00d7 38 mm), achieving an excellent angiographic result with TIMI 3 flow in all distal branches. Dyspnea was relieved at discharge, and at 6-month follow-up there was no recurrence of dyspnea.", + "wiki_anchor": "Ultrasonography of suspected or previously confirmed chronic venous insufficiency of leg veins is a risk-free, non-invasive procedure. It gives information about the anatomy, physiology and pathology of mainly superficial veins. As with heart ultrasound (echocardiography) studies, venous ultrasonography requires an understanding of hemodynamics in order to give useful examination reports. In chronic venous insufficiency, sonographic examination is of most benefit; in confirming varicose disease, making an assessment of the hemodynamics, and charting the progression of the disease and its response to treatment. It has become the reference standard for examining the condition and hemodynamics of the lower limb veins.\nParticular veins of the deep venous system (DVS), and the superficial venous system (SVS) are looked at. The great saphenous vein (GSV), and the small saphenous vein (SSV) are superficial veins which drain into respectively, the common femoral vein and the popliteal vein. These veins are deep veins. Perforator veins drain superficial veins into the deep veins. Three anatomic compartments are described (as networks), (N1) containing the deep veins, (N2) containing the perforator veins, and (N3) containing the superficial veins, known as the saphenous compartment. This compartmentalisation makes it easier for the examiner to systematize and map. The GSV can be located in the saphenous compartment where together with the Giacomini vein and the accessory saphenous vein (ASV) an image resembling an eye, known as the 'eye sign' can be seen. The ASV which is often responsible for varicose veins, can be located at the 'alignment sign', where it is seen to align with the femoral vessels.", + "doc_fkgl": 9.065632911392406, + "wiki_fkgl": 13.385312500000001, + "doc_tree_depth": 6.684210526315789, + "wiki_tree_depth": 6.615384615384615, + "fkgl_delta": -4.319679588607595 + }, + { + "index": 10, + "label": "low_health_literacy", + "original_doc": "A 51-year-old man came to us with sudden, painful vision loss in his left eye for three days. His right eye could see clearly (20/20). His left eye could only see hand movements. The back of his left eye showed swelling of the seeing nerve, a bulge in the layer under the retina, several patches of fluid under the retina, and wrinkles in the thin lining there. An MRI scan with contrast dye of the eyes and brain showed a small lump behind the eye where the eye nerve meets the white part of the eye. Tests for cancer and immune diseases were normal. The doctors diagnosed inflammation in the back part of the eye\u2019s white coat that forms a small lump (nodular posterior scleritis). They started high-dose steroid pills by mouth (prednisolone).", + "wiki_anchor": "Signs and symptoms \nThe conjunctiva provides lining for the inside of the eyelid as well as a coating for the sclera, the white portion of the eyeball. It typically serves to provide lubrication for the eye through the production of mucus and tears. When infected with AHC, patients will experience painful, red eyes, swelling of the conjunctival tissue, and frequent mucus discharge from the eyes accompanied by excessive tearing and subconjunctival hemorrhaging. This hemorrhaging is caused by the rupture of blood vessels beneath the conjunctiva giving the eyes a bright red appearance. Some patients also experience blurry vision and fever in addition to the common symptoms and one in every ten thousand cases exhibits paralysis similar to that of polio.", + "doc_fkgl": 6.597509398496243, + "wiki_fkgl": 14.026666666666667, + "doc_tree_depth": 5.875, + "wiki_tree_depth": 8.0, + "fkgl_delta": -7.4291572681704245 + }, + { + "index": 10, + "label": "intermediate_health_literacy", + "original_doc": "A 51-year-old man presented with 3 days of sudden, painful vision loss in the left eye. Visual acuity was 20/20 in the right eye and hand motion in the left eye. Left fundus findings included optic nerve head swelling, choroidal bulging, multiple areas of subretinal fluid, and RPE corrugations. Orbital/brain MRI with gadolinium showed a retrobulbar nodular mass enhancing at the junction of the optic nerve and sclera. Oncology and rheumatology evaluations were unremarkable. The clinical diagnosis was nodular posterior scleritis, and oral prednisolone was started.", + "wiki_anchor": "Conjunctival SCC is often asymptomatic at first, but it can present with the presence of a growth, red eye, pain, itching, burning, tearing, sensitivity to light, double vision, and decreased vision.\nSpread of conjunctival SCC can occur in 1\u201321% of cases, with the first site of spread being the regional lymph nodes. Mortality for conjunctival SCC ranges from 0\u20138%.\nDiagnosis is often made by biopsy, as well as CT (in the case of invasive SCC).", + "doc_fkgl": 11.54186046511628, + "wiki_fkgl": 10.445166666666669, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 8.0, + "fkgl_delta": 1.0966937984496106 + }, + { + "index": 10, + "label": "proficient_health_literacy", + "original_doc": "A 51-year-old male presented with acute, painful visual loss of the left eye (LE) for 3 days. Best-corrected distance visual acuity (BCDVA) was 20/20 OD and hand motion (HM) OS. Ocular motility and anterior segment were unremarkable OU. Fundus OS showed optic nerve head (ONH) swelling, choroidal bulging, multiple patches of subretinal fluid (SRF), and retinal pigment epithelial (RPE) corrugations; OD fundus was unremarkable.\n\nMultimodal imaging was obtained: OCT (OptoVue, Inc., Fremont, CA, USA; software version 2018.0.0.18) demonstrated mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid, and mild retinal thickening. Indocyanine green angiography (ICGA) showed a geographic macular hypocyanescent area OS. Blue-autofluorescence (BAF) revealed a geographic macular area with speckled autofluorescence. B-scan ultrasonography showed optic nerve enlargement. Fluorescein angiography (FA) demonstrated vascular leakage at the ONH (hot disc) and a geographic patchy hypofluorescent area with speckled hyperfluorescent margins measuring approximately three disc diameters. Orbital and brain MRI with gadolinium revealed a retrobulbar nodular enhancing mass at the optic nerve\u2013sclera junction. Oncology consultation was unremarkable.\n\nGiven concern for malignancy and the enhancing orbital nodule, the patient underwent transconjunctival lateral orbitotomy one week after presentation. Intraoperatively, a pink localized scleral nodule with edematous Tenon was identified. With a clinical diagnosis of nodular posterior scleritis, sub-Tenon triamcinolone acetonide was administered. The patient declined admission and intravenous corticosteroids; oral prednisolone 50 mg/Kg was initiated. Rheumatologic and infectious work-up, including PPD (tuberculosis), chest X-ray, serum ACE (sarcoidosis), and C-ANCA (Wegener granulomatosis), was unremarkable.\n\nAt the one-week postoperative follow-up, BCDVA was 20/20 OD and counting fingers at 2 meters OS. SRF had resolved, and the macula was atrophic. Oral prednisolone was tapered over three months.", + "wiki_anchor": "\u25cfOpRegen\u00ae, a single-injection retinal pigment epithelium cell replacement therapy currently in a Phase 1/2a multicenter clinical trial for the treatment of advanced dry age-related macular degeneration (\u201cAMD\u201d) with geographic atrophy (GA). There currently are no therapies approved by the U.S. Food and Drug Administration (\u201cFDA\u201d) for dry AMD, which accounts for approximately 85-90% of all AMD cases and is the leading cause of blindness in people over the age of 60. Interim data from 9 months of follow-up post-injection for Cohort 4 was reported in September 2021, highlights improved baseline visions and smaller areas of GA compared to prior cohorts. Overall, OpRegen has proven to be well tolerated to date with no serious adverse events not previously reported. Overall, 8/12 of Cohort 4 patients' treated eyes showed above baseline visual acuity at the last assessment, while 9/12 of the patients' untreated eyes were below baseline visual acuity at the same assessment interval. In May 2022, data was presented at the 2022 Association for Research in Vision and Ophthalmology Annual Meeting: OpRegen Phase 1/2a clinical results support the potential for OpRegen to slow, stop or reverse disease progression in geographic atrophy secondary to age-related macular degeneration. 12-month primary endpoint data suggested OpRegen was well tolerated with an acceptable safety profile. Preliminary evidence of visual function and outer retinal structure improvements observed in five Cohort 4 patients with GA and impaired vision. In December 2021, Lineage announced that the company entered a $670 million exclusive worldwide collaboration Genentech, a member of the Roche Group, for the development and commercialization of OpRegen.", + "doc_fkgl": 14.661870129870131, + "wiki_fkgl": 16.78976447876448, + "doc_tree_depth": 5.473684210526316, + "wiki_tree_depth": 8.1, + "fkgl_delta": -2.1278943488943476 + }, + { + "index": 11, + "label": "low_health_literacy", + "original_doc": "A 78-year-old man from the Amhara region of Ethiopia had a permanent heart pacemaker because of a complete heart block. He was scheduled for prostate surgery. Before surgery, the anesthesia and heart doctors advised switching his pacemaker to a steady, fixed beat to lower the chance of problems. He could not afford that change. He chose to go ahead with the operation. He signed consent for the plan. After surgery, he also gave permission to share his case. For anesthesia, he got a numbing injection in the lower back (a combined spinal\u2013epidural). The team used 2.5 ml of strong numbing medicine (0.5% bupivacaine) and a tiny dose of fentanyl (50 micrograms). Standard monitors were used, and his heart was watched closely. His vital signs stayed steady, with only small changes. His blood pressure stayed good with IV salt water. After surgery, he went to the recovery room. He got pain medicine after 4 hours and an extra dose through the epidural. Six hours after surgery, he moved to the ward in stable condition. The epidural pain control continued for 72 hours. He went home in stable condition about 88 hours after surgery.", + "wiki_anchor": "Treatments\nAlthough intractable pain is not curable, there are treatments. The aim of IP treatment is to appreciate the pain caused by the root condition in order to minimize or reverse the neurological, endocrine, and cardiac changes. The specific treatments depend on the cause of the pain, the physician's preference, and the patient's health and preferences. These treatments can be used on their own, but are commonly combined with one another. Not every patient will respond to every treatment, but some more common treatments include:\n Surgical repair, such as spinal fusion for scoliosis\n Opioid medications\n Medical cannabis and/or cannabinoid therapy\n TENS unit\n Spinal cord stimulator (SCS) \u2013 utilizes the gate control theory to block painful signals by sending benign electrical signals along the nerve roots.\n Intrathecal pain pump \u2013 delivers a very small amount of the chosen medication directly to the thecal space (next to the spinal cord, even closer than an epidural)\n Epidural, nerve root, and/or trigger point corticosteroid injections\n mu-Opioids \u2013 depending on the specific drug, opioids can be oral, transdermal, IV, intramuscular, subcutaneous, transmucosal, sublingual, intranasal, epidural, or intrathecal. Examples include morphine, hydromorphone, oxymorphone, hydrocodone, oxycodone, codeine, and buprenorphine.\n methadone \u2013 methadone is a mu-opioid, kappa-opioid, and NMDA receptor antagonist. It is used for neuropathic pain, however it is also useful for other types of pain, such as bone pain, and musculoskeletal pain.", + "doc_fkgl": 6.542719298245618, + "wiki_fkgl": 16.03540540540541, + "doc_tree_depth": 4.823529411764706, + "wiki_tree_depth": 7.875, + "fkgl_delta": -9.492686107159791 + }, + { + "index": 11, + "label": "intermediate_health_literacy", + "original_doc": "A 78-year-old man from the Amhara region, Ethiopia, with a permanent pacemaker placed for complete heart block was scheduled for retropubic prostatectomy. The anesthesia and cardiology teams recommended switching his dual-chamber, rate\u2011modulated pacemaker to an asynchronous mode perioperatively to reduce the risk of electromagnetic interference during surgery. He could not afford reprogramming and chose to proceed with the existing plan after informed consent; permission to publish the case was obtained after the operation. He received combined spinal\u2013epidural anesthesia at L3\u2013L4 using 0.5% isobaric bupivacaine 2.5 ml (12.5 mg) plus fentanyl 50 \u00b5g. Standard ASA monitoring was applied with special attention to cardiac stability. Intraoperatively, he remained stable with minimal changes in vital signs; blood pressure was supported with isotonic saline as needed. Postoperatively, he was monitored in the PACU, received analgesia at 4 hours with an epidural top\u2011up, and was transferred to the ward about 6 hours after surgery in stable condition. Epidural analgesia was continued for 72 hours. He was discharged at the 88th postoperative hour in good condition.", + "wiki_anchor": "While there are no definitive data showing that long-duration space flight is associated with cardiac arrhythmias, there are observational data that have been documented over many years that are suggestive of cardiac electrical changes during long flights. For example, during Skylab, all 9 American crewmembers exhibited some form of rhythm disturbance. Most of these rhythm disturbances consisted of single PVCs and were clinically insignificant. However, one crewmember experienced a 5-beat run of ventricular tachycardia during a lower-body negative pressure protocol, and another had periods of \u201cwandering supraventricular pacemaker\u201d during rest and following exercise. More recently, it has been shown that the corrected QT interval (QTc), a marker of ventricular repolarization, was prolonged slightly in a small number of astronauts after long-duration space flight. In-flight Holter monitoring was not performed during these space flights. Thus, it is not known whether this prolongation was associated with any known arrhythmias. In-flight Holter monitoring was undertaken in the early Space Shuttle era.", + "doc_fkgl": 12.910294117647059, + "wiki_fkgl": 15.189715189873418, + "doc_tree_depth": 6.444444444444445, + "wiki_tree_depth": 6.25, + "fkgl_delta": -2.2794210722263593 + }, + { + "index": 11, + "label": "proficient_health_literacy", + "original_doc": "A 78-year-old male from the Amhara region of Ethiopia with a 7-year history of a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy for BPH after prior TURP 3 months earlier. Comorbidities included long-standing hypertension (amlodipine 5 mg daily, enalapril 10 mg BID, atorvastatin 10 mg daily) and type 2 diabetes mellitus (metformin 500 mg BID; NPH insulin 20 IU AM/10 IU PM). Preoperative evaluation showed complete bundle branch block on ECG; electrophysiology assessment demonstrated LVH due to hypertensive heart disease with mild diastolic dysfunction and an EF of 62%. Abdominal ultrasound showed an 82-ml prostate; AP chest X-ray was normal with a left-sided pacemaker in situ; electrolytes and troponin were normal. He had a frailty score of 5.5, METs 3.4, and an RCRI class III, indicating an estimated 10.1% risk of major adverse cardiac events within 30 days and intermediate surgical risk. Multidisciplinary planning recommended reprogramming the dual-chamber, rate\u2011modulated pacemaker to an asynchronous mode to mitigate intraoperative electromagnetic interference risk. Due to financial and logistical constraints, reprogramming was not performed; risks were disclosed, and he consented to proceed. Preoperatively, usual medications were continued (with a lower morning NPH dose at two\u2011thirds); diazepam 5 mg PO was given at midnight for anxiolysis. On the day of surgery, random blood glucose was checked and managed with a sliding scale. Team communication emphasized CIED precautions (electrosurgery pad positioned away from the device; emergency drugs and defibrillator immediately available). Dexamethasone was given for PONV prophylaxis and paracetamol for preemptive analgesia. ASA standard monitoring was applied and baselines recorded. An L3\u2013L4 combined epidural\u2013spinal anesthetic was performed using 0.5% isobaric bupivacaine 12.5 mg (2.5 ml) plus fentanyl 50 \u00b5g, achieving a sensory level to T7. The procedure used a midline infraumbilical incision; monopolar cautery at low voltage (20 mA) with bipolar low\u2011voltage cautery for hemostasis. Intraoperative hemodynamics remained within 10% of baseline without cardiorespiratory events; blood pressure was maintained with isotonic saline. Postoperatively, he was transferred to PACU with vigilant monitoring; analgesia was administered at 4 hours with an epidural top\u2011up, and he was transferred to the ward approximately 6 hours after surgery in stable condition. Epidural analgesia was continued for 72 hours. He was discharged at the 88th postoperative hour in stable condition, with cardiology follow\u2011up advised. Informed consent was obtained, and permission for case report publication was granted after the operation.", + "wiki_anchor": "Rate-dependent bundle branch block\n As a result of underlying heart disease, this cardiac conductive tissue can become damaged from ischemia (a deprivation of oxygenated blood). This damage results in the inability of this neural-like tissue to conduct electrical signals and control the heart as efficiently as before, resulting in the cardiac abnormality known as a bundle branch block (BBB). This can affect either side of the heart, and is described as a right or left BBB. Some BBB are permanent and involve a complete bundle blockage while others are dependent on the underlying activity of the heart. For example, certain situations of excessive or reduced heart rate (tachycardia or bradycardia, respectively) can cause a BBB known as a rate-dependent bundle branch block (RDBBB). This manifests in a similar fashion to a regular bundle branch block, but occurs only under conditions that affect contractile rate. Tachycardia-dependent bundle branch block (TDBBB) can affect either ventricle in the heart, and occurs when the heart's rate of contraction reaches an elevated level and becomes uncoupled from the heart's refractory period (the time it takes for a cardiac cell to \"reset\" for future contraction). Thus the cell is unable to contract by the time the next electrical stimuli is present, and a blocking of this signal occurs. This prolongation of the refractory period is related to a decreased sodium channel response in damaged tissue that shows an inactivation of sodium channels responsible for repolarization.", + "doc_fkgl": 13.475840409207162, + "wiki_fkgl": 15.65118549511855, + "doc_tree_depth": 6.2631578947368425, + "wiki_tree_depth": 7.6, + "fkgl_delta": -2.1753450859113883 + }, + { + "index": 12, + "label": "low_health_literacy", + "original_doc": "A 52-year-old woman had burning when she peed and had to pee very often for a long time. She tried many treatments for bladder infections, but the problem did not go away. Regular scans and lab tests looked normal. A camera test that looked inside her bladder showed the lining was red and irritated, with tiny bits floating in the urine. Later, the lab saw a live larva (a baby insect) in her urine under the microscope. That finding explained her symptoms. She was told to keep very clean. She was also told to drink plenty of water every day.", + "wiki_anchor": "The bacterium is found naturally in fresh water. It can contaminate hot water tanks, hot tubs, and cooling towers of large air conditioners. It is usually spread by breathing in mist that contains the bacteria. It can also occur when contaminated water is aspirated. It typically does not spread directly between people, and most people who are exposed do not become infected. Risk factors for infection include older age, a history of smoking, chronic lung disease, and poor immune function. Those with severe pneumonia and those with pneumonia and a recent travel history should be tested for the disease. Diagnosis is by a urinary antigen test and sputum culture.", + "doc_fkgl": 6.041, + "wiki_fkgl": 9.967786697247707, + "doc_tree_depth": 5.125, + "wiki_tree_depth": 5.75, + "fkgl_delta": -3.9267866972477066 + }, + { + "index": 12, + "label": "intermediate_health_literacy", + "original_doc": "A 52-year-old woman had ongoing dysuria and urinary frequency despite multiple treatments for presumed infections. Cystoscopy showed bladder redness and debris, while imaging and routine lab tests were unremarkable. Eventually, a live larva was identified in the urine, confirming the cause of her symptoms. Management focused on better personal hygiene and increased fluid intake.", + "wiki_anchor": "The larva, which is a triungulin, changes in appearance as it develops. The new larva is whitish and has long legs that allow it to be mobile. During this more mobile stage, it parasitizes a grasshopper egg case. From there, it becomes a sedentary grub. When it becomes a sedentary grub it darkens to a reddish-brown color with darker bands, and the legs shrink.", + "doc_fkgl": 12.18240740740741, + "wiki_fkgl": 6.917625000000001, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 5.2, + "fkgl_delta": 5.264782407407409 + }, + { + "index": 12, + "label": "proficient_health_literacy", + "original_doc": "A 52-year-old woman presented with a three-year history of urinary frequency, dysuria, and dribbling, along with intermittent passage of red and black thread-like material in the urine. Episodes with these discharges were associated with headache, fever, and chills, and she reported intermittent periurethral and genital pruritus. She had been repeatedly treated for recurrent urinary tract infections without clinical improvement. She denied recent travel, camping, hiking, farming, swimming, or insect bites. Past surgical history included pilonidal sinus surgery (8 years prior) and hysterectomy (7 years prior). Two years before the current visit, she was hospitalized for evaluation. Examination revealed a well-appearing patient with normal vital signs. Laboratory testing, including complete blood count, urinalysis, and serum chemistries, was within normal limits. Abdominopelvic CT was unremarkable. Cystoscopy demonstrated erythema and hyperemia of the bladder mucosa, suspended intravesical debris, and dilatation of the left ureteral orifice. Schistosomiasis was suspected and she received praziquantel at appropriate dose and duration, without improvement. A second infectious diseases consultation raised suspicion for urinary myiasis, and ivermectin was prescribed, again without benefit. She underwent bladder irrigation with polyethylene glycol; no visible larvae were recovered from the washings, and she experienced self-limited hematuria for two days post-procedure. A subsequent random urinalysis was normal. However, a 24-hour urine collection demonstrated a live larva on light microscopy. The specimen was isolated and identified morphologically by an entomologist as Sarcophaga spp. Final management emphasized personal hygiene measures and liberal oral hydration.", + "wiki_anchor": "Diagnosis \nDue to the atypical presentation and rarity of the infection, it takes a physician longer to diagnose than more common types of bladder infections. Diagnosis requires a personalized investigation with consideration to risk factors and symptoms. Radiology of the abdominal or pubic region has proven to be an important tool in reaching a definitive diagnosis of conditions causing gas in the urinary tract. Computer tomography, or CT scans, are of most help due to their high sensitivity in detecting gas and air bubbles. However, radiology is normally not the first tool used to diagnose. Most diagnoses are made by chance after imaging examination. Sometimes, even when patients don't show symptoms, their Emphysematous cystitis infection level can be very advanced already. Gas in the bladder wall will often have the appearance of cobblestone or a \u201cbeaded necklace\u201d with the use of conventional radiography. Delayed diagnosis can lead to a severe infection, extension of the uterus, rupturing of the bladder, and death. Emphysematous cystitis has an overall mortality rate of 7%. However, surgery is only considered in severe cases where the disease progresses involving the ureters, kidneys, or adrenal glands. When required, surgery may be extensive.", + "doc_fkgl": 14.957394957983198, + "wiki_fkgl": 13.258269230769233, + "doc_tree_depth": 5.411764705882353, + "wiki_tree_depth": 6.416666666666667, + "fkgl_delta": 1.6991257272139642 + }, + { + "index": 13, + "label": "low_health_literacy", + "original_doc": "A 36-year-old woman had a long-term bowel disease (ulcerative colitis). She came in with chest pain that kept getting worse. She also had shortness of breath, sweating, and felt sick to her stomach. For months she had felt very tired and had night sweats. Her heart test (EKG) showed signs of a heart attack in the lower part of the heart. Doctors did a dye X-ray to look at the heart arteries. It showed bad blockages in two heart pipes. They opened the most blocked pipe right away with a balloon and a tiny mesh tube (stent). While looking, the team worried the main body artery (aorta) was swollen. Blood tests showed mild inflammation. A special CT scan showed the aorta wall looked thick and scarred, with tight narrow spots in several arteries. This pointed to a rare illness that causes swollen big arteries, called Takayasu arteritis. She started strong anti-inflammatory and immune medicines (prednisone and methotrexate). Later she had heart bypass surgery to improve blood flow. She did well after treatment.", + "wiki_anchor": "Constipation\n Diarrhoea\n Vomiting\n Upper abdominal pain\n Indigestion\n Joint pain\n Muscle spasms\n Pain in extremities\n Asthenia\n Peripheral oedema\n Folliculitis\n Upper respiratory tract infection (including pharyngitis, nasopharyngitis, rhinitis)\n Skin papilloma\n Eosinophilia\n Lymphopenia\n Insomnia\n Anxiety\n Depression\n Diabetes mellitus\n Hypercholesterolaemia\n Hyperlipidaemia\n Hypertriglyceridaemia\n Hyperglycaemia\n Loss of appetite\n Dizziness\n Hypoaesthesia\n Peripheral neuropathy\n Eye pruritus\n Conjunctivitis\n Dry eye (including xerophthalmia)\n Vertigo\n Flushing\n Hypertension\n Angina pectoris\n Arrhythmia (including atrioventricular block, tachycardia, atrial fibrillation, ventricular extrasystoles, bradycardia)\n QT interval prolonged\n Palpitations\n Cough\n Dyspnoea\n Abdominal distension\n Abdominal discomfort\n Taste changes\n Flatulence\n Abnormal liver function\n Bone pain\n Back pain\n Erythema\n Hyperhidrosis\n Contusion\n Acne\n Dermatitis (including allergic, exfoliative and acneiform)\n Night sweats\n Fever without an infectious cause\n Chest pain (including non-cardiac chest pain)\n Chest discomfort\n Decreased haemoglobin\n Increased blood amylase\n Increased blood alkaline phosphatase \n Gamma-glutamyltransferase increased\n Weight increased\n Increased blood insulin\n Increased lipoprotein (including very low density and high density)", + "doc_fkgl": 5.827348837209307, + "wiki_fkgl": 68.41405797101449, + "doc_tree_depth": 5.066666666666666, + "wiki_tree_depth": 10.0, + "fkgl_delta": -62.58670913380518 + }, + { + "index": 13, + "label": "intermediate_health_literacy", + "original_doc": "A 36-year-old woman with ulcerative colitis developed a week of worsening chest pressure with autonomic symptoms (such as sweating and nausea). Her electrocardiogram showed ST-segment elevation in the inferior leads, consistent with an inferior-wall heart attack. She also reported several months of fatigue and night sweats.\n\nUrgent coronary angiography found severe two-vessel coronary artery disease. The right coronary artery was the culprit lesion and was opened successfully with a stent. Because the interventional team suspected inflammation of the aorta (aortitis), additional workup was done. Inflammatory markers were mildly elevated, and CT angiography showed fibrotic thickening around the aorta with significant narrowing in multiple arteries, pointing to Takayasu arteritis.\n\nShe started treatment with prednisone and methotrexate. After stabilization, she underwent delayed coronary bypass surgery and did well.", + "wiki_anchor": "COVID-19 Cardiomyopathy \nPatients with Covid-19 frequently experience heart issues. According to studies, people who have had previous cardiovascular conditions like cardiomyopathy, hypertension, coronary heart disease, or arrhythmia are more likely to become critically ill from SARS-CoV-2 infection. Myocarditis may result from a direct viral infection of the myocardium. Cardiovascular biomarkers like troponin, lactate dehydrogenase, high sensitivity amino-terminal B-type natriuretic peptide, creatinine kinase, and creatinine kinase myocardial band, which indicate myocardial damage, increase in concentration in response to covid-19. Hundreds of studies have reported myocarditis/myopericarditis caused by Covid-19 infection in living patients, with a male predominance (58%), and a median age of 50 years.", + "doc_fkgl": 14.593809523809526, + "wiki_fkgl": 17.64788349514563, + "doc_tree_depth": 5.888888888888889, + "wiki_tree_depth": 6.8, + "fkgl_delta": -3.0540739713361056 + }, + { + "index": 13, + "label": "proficient_health_literacy", + "original_doc": "A 36-year-old female with ulcerative colitis (well controlled on sulfasalazine, ferrous fumarate, and intermittent prednisone for flares) presented with 1 week of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, the ECG was in sinus rhythm with ST-segment elevation in the inferior wall. She endorsed a 6-month history of general malaise, fatigue, and night sweats, and had experienced exertional precordial pain that progressed to occur at rest. Physical examination revealed no murmurs or peripheral pulse abnormalities.\n\nEmergency coronary angiography demonstrated severe 2-vessel coronary disease: a severe 90% ostial lesion in the left coronary trunk (left main) and a severe 99\u2013100% subocclusive ostial lesion in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful placement of a drug-eluting stent. The hemodynamicist noted possible aortitis given arch involvement and vessel friability during balloon advancement and recommended an inflammatory/etiologic evaluation prior to definitive management of the left main lesion.\n\nLaboratory testing showed mild anemia (hemoglobin 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated ESR 42 mm/h, CRP 4.9 mg/L (normal <1), and elevated high-sensitivity troponin. Autoimmunity panel: normal complement C3/C4, negative ANA, anti-DNA, and ENA profile; non-reactive VDRL. Cardiac MRI with contrast demonstrated acute non-transmural infarction of the left ventricular inferior wall and subendocardial ischemia in the anteroseptoapical region at rest, with mild aortic and mitral insufficiency and preserved biventricular systolic function.\n\nComputed tomographic angiography of the chest/abdomen/pelvis showed periaortic fibrotic wall thickening involving the aortic root, arch, and abdominal aorta, with severe left coronary trunk stenosis, mild left subclavian and left vertebral artery stenoses, and severe inferior mesenteric artery stenosis. The differential included IgG4-related disease versus Takayasu arteritis. Total IgG was 1,600 mg/dL (ref 700\u20131,600) with IgG1 1,024 mg/dL (elevated) and normal IgG2 456 mg/dL, IgG3 98.8 mg/dL, and IgG4 13.6 mg/dL, findings not supportive of IgG4-related aortitis. Takayasu arteritis was diagnosed clinically and by imaging.\n\nImmunosuppression was initiated with prednisone 60 mg daily and methotrexate 20 mg weekly (parenteral) with folic acid 1 mg daily. After 3 weeks of therapy, she underwent myocardial revascularization surgery using the left internal mammary artery graft to the descending anterior artery (LAD) and an aortocoronary bypass to the circumflex artery. Intraoperatively, the aortic root and ascending aorta appeared healthy. She was discharged home in good general condition and remains under ambulatory follow-up.\n\nContext: Takayasu arteritis is a large-vessel granulomatous vasculitis affecting the aorta and its major branches that can produce aorto-ostial coronary lesions (as in this case, involving the left main and right coronary ostia), leading to myocardial ischemia/infarction. The mildly elevated inflammatory indices, periaortic fibrotic thickening, and multifocal arterial stenoses on CTA are characteristic, and the lack of IgG4 elevation argues against IgG4-related aortitis. The staged approach\u2014urgent culprit-vessel PCI followed by immunosuppression and delayed CABG\u2014is consistent with management principles aiming to control vascular inflammation before definitive surgical revascularization.", + "wiki_anchor": "Mania, may be more common in those that either have or have a family history of bipolar disorder.\n Depersonalisation\n Panic disorder\n Akathisia\n Restless legs syndrome\n Elevated liver enzymes\n Hyperprolactinaemia (elevated serum prolactin)\n Galactorrhoea (lactation that is not associated with pregnancy or breastfeeding)\n Abnormal laboratory value\n Abscess\n Adrenergic syndrome\n Cellulitis\n Chills and fever\n Cyst\n Hernia\n Intentional overdose\n Neck rigidity\n Pelvic pain\n Peritonitis\n Substernal chest pain\n Ulcer\n Angina pectoris\n Arrhythmia\n Atrial arrhythmia\n Atrial fibrillation\n Bundle branch block\n Cerebral ischaemia\n Cerebrovascular accident (stroke)\n Congestive heart failure\n Extrasystoles\n Low cardiac output\n Myocardial infarct (heart attack)\n Myocardial ischaemia\n Pallor\n Phlebitis\n Pulmonary embolus\n Supraventricular extrasystoles\n Thrombophlebitis\n Thrombosis\n Varicose vein\n Vascular headache\n Angioedema\n Contact dermatitis\n Erythema nodosum\n Herpes zoster\n Hirsutism\n Maculopapular rash\n Photosensitivity\n Skin discolouration\n Skin ulcer\n Diabetes mellitus\n Hyperthyroidism\n Hypothyroidism\n Thyroiditis\n Aphthous stomatitis\n Bloody diarrhoea\n Bulimia\n Colitis\n Duodenitis\n Oesophagitis\n Faecal impaction\n Faecal incontinence\n Gastritis\n Gingivitis\n Haematemesis (vomiting blood)\n Hepatitis\n Ileus\n Jaundice\n Melaena (black faeces as a result of bleeding in the stomach)\n Salivary gland enlargement\n Stomach ulcer\n Stomatitis\n Tongue oedema\n Tooth caries\n Tooth malformation\n Breast atrophy\n Female lactation\n Haematuria (blood in the urine)\n Kidney calculus (kidney stones)\n Abnormal kidney function\n Kidney pain\n Mastitis\n Nephritis\n Oliguria\n Urethritis\n Urine abnormality\n Vaginal candidiasis\n Eosinophilia\n Iron deficiency anaemia\n Leucocytosis\n Lymphoedema\n Lymphocytosis\n Microcytic anaemia\n Monocytosis\n Normocytic anaemia\n Increased alkaline phosphatase\n Bilirubinaemia\n Dehydration\n Gout\n Hyperphosphataemia (elevated levels of phosphate in the blood)\n Hypocalcaemia (low blood calcium)\n Hypoglycaemia (low blood sugar)\n Hypokalaemia (low blood potassium)\n Hyponatraemia (low blood sodium)\n Obesity\n Arthrosis\n Bursitis\n Cartilage disorder\n Myositis\n Osteoporosis (brittle bones)\n Tetany\n Abnormal electroencephalograph\n Abnormal gait\n Choreoathetosis\n Circumoral paraesthesia\n Delirium\n Delusions\n Diplopia\n Drug dependence\n Dysarthria\n Euphoria\n Fasciculations\n Grand mal convulsions\n Hyperalgesia\n Hysteria\n Increased libido\n Manic depressive reaction\n Meningitis\n Myelitis\n Neuralgia\n Neuropathy\n Nystagmus\n Psychosis\n Psychotic depression\n Increased reflexes\n Stupor\n Withdrawal syndrome\n Hiccup\n Lung fibrosis\n Increased sputum\n Voice alteration\n Emphysema \n Pulmonary oedema\n Amblyopia\n Specified cataract\n Conjunctival oedema\n Corneal lesion\n Corneal ulcer\n Exophthalmos\n Eye haemorrhage\n Glaucoma\n Hyperacusis\n Otitis externa\n Photophobia\n Retinal haemorrhage (bleeding into the retina)\n Taste loss\n Anisocoria\n Deafness\n Activation syndrome", + "doc_fkgl": 16.972754430379748, + "wiki_fkgl": 76.21914860681115, + "doc_tree_depth": 6.380952380952381, + "wiki_tree_depth": 10.0, + "fkgl_delta": -59.246394176431394 + }, + { + "index": 14, + "label": "low_health_literacy", + "original_doc": "A 36-year-old woman had trouble swallowing. Tests found she was born with an unusual shape of the main body artery in her chest. The artery curves to the right in a mirror-image pattern. It wraps around a main branch of the airway. The side branches of the artery come off in the reverse order from normal. Most people with this have no symptoms. Problems happen only if the artery squeezes the space in the middle of the chest. This can press on the food pipe or the windpipe. Surgery may be needed if there is strong pressure on these tubes, a bulge or a tear in the chest artery, or a pouch on the artery bigger than 2 cm. There is no one-size-fits-all treatment. Care is tailored to the person\u2019s symptoms and body anatomy. This patient did not receive any treatment.", + "wiki_anchor": "Risks \nA review published in 2011 stated tumescent liposuction was safe. During the first decade of the treatments use, deaths were reported with the treatment as the cause of death, dating back to 1999. By 2002, 23 deaths in five years had been reported in the European literature. Tierney et al (2011) said, \"The most frequent complications were bacterial infections such as necrotizing fasciitis, gas gangrene, and different forms of sepsis. Further causes of lethal outcome were hemorrhages, perforation of abdominal viscera, and pulmonary embolism.\" Complications in this procedure are rare and typically minor. The most common include: skin irregularity, lumpiness, dimpling, loose skin, numbness, infections and scarring. However, these type of minor complications can easily be corrected in most cases.", + "doc_fkgl": 5.730088652482269, + "wiki_fkgl": 10.983130165289257, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 6.375, + "fkgl_delta": -5.253041512806988 + }, + { + "index": 14, + "label": "intermediate_health_literacy", + "original_doc": "A 36-year-old woman had dysphagia due to a congenital right aortic arch with mirror-image branching.\nIn this rare pattern, the aorta runs to the right, wraps around the right main bronchus, and the head-and-arm arteries branch in the reverse order of normal.\nMost people have no symptoms unless the aorta or an associated bulge compresses the esophagus or trachea.\nSurgery is considered for major airway or esophageal compression, aneurysmal disease, thoracic aortic dissection, or a Kommerell diverticulum larger than 2 cm.\nThere is no standard operation; treatment is tailored to the person\u2019s anatomy and symptoms.\nIn this case, imaging showed external compression of the upper esophagus with a small Kommerell diverticulum (about 1.3 cm), so no intervention was performed and her symptoms improved.", + "wiki_anchor": "In fact, gastroplasty can be used when the length of the intra-abdominal esophagus is short and for anti-reflux action such as Nisson fundoplication, it is necessary to increase the intra-abdominal length of the esophagus.\nAt this time, part of the upper part of the stomach is separated by a stepper, i.e. the stapler fires longitudinally along the esophagus and increases the length of the stomach inside the abdomen.\nAt this time, a tongue is created from the stomach that can be easily rotated on the new esophagus and all kinds of fundoplication operations such as Nissen fundoplication can be done easily.\nIt was devised by John Leigh Collis (1911\u20132003), a British cardiothoracic surgeon, in 1957.", + "doc_fkgl": 11.984808362369339, + "wiki_fkgl": 13.799130434782608, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 8.5, + "fkgl_delta": -1.814322072413269 + }, + { + "index": 14, + "label": "proficient_health_literacy", + "original_doc": "A 36-year-old female presented with dysphagia and longstanding cervical and upper thoracic pain; she also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit after barium ingestion showed a posterior and lateral right impression on the proximal esophagus extending 3.5 cm craniocaudally, with an estimated maximal esophageal stenosis of 60%. Cervical and thoracic CT revealed a congenital anomaly of the aortic arch: a right aortic arch with mirror-image branching. The arch originated from the aortic root, coursed above the right stem bronchus, and gave rise to the three supra-aortic trunks as follows: (1) left brachiocephalic artery (giving rise to the left common carotid artery and the left subclavian artery), (2) right common carotid artery, and (3) right subclavian artery. The aortic arch then passed posterior to the esophagus and exhibited a small anterior saccule measuring 1.3 cm, consistent with a Kommerell diverticulum. This configuration formed a vascular ring around the tracheo-esophageal pair, bounded posterolaterally on the right by the aortic arch, posterolaterally on the left by the Kommerell diverticulum, laterally on the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. Gastroscopy confirmed endoluminal impact of extrinsic compression. Given minimal clinical repercussions and absence of nutritional disorders, no surgical cure was performed. The evolution was favorable with patient-reported spontaneous amelioration of symptoms.\n\nContext: Right aortic arch with mirror-image branching is a rare anomaly of embryologic development. The vast majority of patients are asymptomatic unless mediastinal structures are compressed. Indications for surgery include major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection, or a Kommerell diverticulum larger than 2 cm. There is no standardized treatment; management is individualized according to clinical presentation and anatomic configuration.", + "wiki_anchor": "Though shallower, the nearly complete braincase of Arcovenator is otherwise similar in size to those of Majungasaurus and Carnotaurus; it was thus initially estimated as being about long, but it was estimated in 2016 as being in length. The skull roof exhibits as a unique diagnostic character a midline foramen, possibly housing the pineal gland, situated on the posterior surface of a slight dome formed by frontal bones as moderately thick as in Aucasaurus, thus less so than for Rajasaurus, though more than those of Rugops. Less characteristically, above the orbit is a low fossa with a small fenestra bordered by the lacrimal, frontal, and postorbital. The parietal bordering the supratemporal fenestrae forms ridges medially on the latter's respective anteromedial margins which, as they approach the parietal eminence, fuse into a sagittal crest. The postorbital is intermediate between the plesiomorphic T-shaped condition of Eoabelisaurus and the derived inverted L-shaped one of Carnotaurus due to the unique feature of having a sheet of bone linking its ventral and posterior processes. It has, in a similar autapomorphic fashion, a thick, rough-surfaced process dorsal to the eye socket that extends to the lacrimal, forming a bony brow ridge, and in a less notable way, a lateral rugose tuberosity on the extremity of its ventral process. The paroccipital processes have remarkable accessory dorsal and ventral bony bars, that thus bound depressions lateral to the foramen magnum. The ear region closely resembles that of Majungasaurus, though differing most substantially on a laterally directed basipterygoid process, with the shorter crista prootica and the smaller extent of a groove anterior to the 2nd and 3rd cranial nerve foramina being minor deviances from Majungasaurinae's type. The squamosal is similar to that of the latter except for a less prominent parietal process. Generally, the external bone ornamentation is more subdued than that of Majungasaurus. The tall teeth (3-5.5\u00a0cm) have denticles on the apical portion of the mesial carina and along the length of the distal one, with varying density.", + "doc_fkgl": 16.455087719298245, + "wiki_fkgl": 15.737288519637463, + "doc_tree_depth": 7.0, + "wiki_tree_depth": 8.454545454545455, + "fkgl_delta": 0.7177991996607815 + }, + { + "index": 15, + "label": "low_health_literacy", + "original_doc": "This story is about a 62-year-old white North African woman. She was diagnosed in 2021 with a rare condition called Von Hippel\u2013Lindau disease. This condition caused growths in several parts of her body. She had a tumor in a bone near her left ear. She had a tumor in the left adrenal gland, which sits above the kidney. She had cancer in her left kidney. Her right kidney had many cysts. She also had growths in her pancreas. She received several treatments. She had radiation treatment. She had surgery to remove the left adrenal gland. She had surgery to remove the left kidney. She had major surgery on the pancreas and nearby small intestine. Later, ultrasound and MRI scans showed a lump with both fluid and solid parts near the left ovary and tube. Keyhole surgery looked inside the pelvis. It found cyst-type tumors in the thin support tissue next to both fallopian tubes. Doctors then removed the uterus and both ovaries and tubes. The lab checked the tissue. It showed tumors of the same type on both sides in the thin support tissue around the tubes and the uterus. These findings fit with Von Hippel\u2013Lindau disease.", + "wiki_anchor": "Diagnosis \nDue to the atypical presentation and rarity of the infection, it takes a physician longer to diagnose than more common types of bladder infections. Diagnosis requires a personalized investigation with consideration to risk factors and symptoms. Radiology of the abdominal or pubic region has proven to be an important tool in reaching a definitive diagnosis of conditions causing gas in the urinary tract. Computer tomography, or CT scans, are of most help due to their high sensitivity in detecting gas and air bubbles. However, radiology is normally not the first tool used to diagnose. Most diagnoses are made by chance after imaging examination. Sometimes, even when patients don't show symptoms, their Emphysematous cystitis infection level can be very advanced already. Gas in the bladder wall will often have the appearance of cobblestone or a \u201cbeaded necklace\u201d with the use of conventional radiography. Delayed diagnosis can lead to a severe infection, extension of the uterus, rupturing of the bladder, and death. Emphysematous cystitis has an overall mortality rate of 7%. However, surgery is only considered in severe cases where the disease progresses involving the ureters, kidneys, or adrenal glands. When required, surgery may be extensive.", + "doc_fkgl": 5.262667512690356, + "wiki_fkgl": 13.258269230769233, + "doc_tree_depth": 5.15, + "wiki_tree_depth": 6.416666666666667, + "fkgl_delta": -7.995601718078877 + }, + { + "index": 15, + "label": "intermediate_health_literacy", + "original_doc": "A 62-year-old white North African woman with Von Hippel\u2013Lindau (VHL) disease diagnosed in 2021 developed several VHL-related tumors: a left petrous bone tumor, a left pheochromocytoma, left renal cell carcinoma, a multicystic right kidney, and pancreatic masses. She was treated with radiotherapy to the petrous bone lesion, left adrenalectomy, left nephrectomy, and cephalic duodenopancreatectomy for the pancreatic tumors. During surveillance, ultrasound and MRI showed a solid\u2013cystic mass in the left adnexal (ovary/tube) region. Laparoscopy then identified cystic tumors in the mesosalpinx on both the right and left sides. She underwent hysterectomy with removal of both adnexa. Pathology confirmed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, a pattern consistent with VHL.", + "wiki_anchor": "Signs and symptoms\nMany lymphoceles are asymptomatic. Larger lymphoceles may cause symptoms related to compression of adjacent structures leading to lower abdominal pain, abdominal fullness, constipation, urinary frequency, and edema of the genitals and/or legs. Serious sequelae could develop and include infection of the lymphocele, obstruction and infection of the urinary tract, intestinal obstruction, venous thrombosis, pulmonary embolism, chylous ascites and lymphatic fistula formation.\nOn clinical examination the skin may be reddened and swollen and a mass felt. Ultrasonography or CT scan will help to establish a diagnosis.\nOther fluid collections to be considered in the differential diagnosis are urinoma, seroma, hematoma, as well as collections of pus. Also, when lower limb edema is present, venous thrombosis needs to be considered.", + "doc_fkgl": 13.893053097345135, + "wiki_fkgl": 15.336552538370718, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 7.571428571428571, + "fkgl_delta": -1.4434994410255833 + }, + { + "index": 15, + "label": "proficient_health_literacy", + "original_doc": "A 62-year-old Tunisian Arab postmenopausal woman with Von Hippel\u2013Lindau (VHL) disease (diagnosed 2021) had multisystem involvement. In 2021 she had a 6 cm left petrous bone endolymphatic sac tumor managed with radiotherapy; a 6 cm left pheochromocytoma treated with left adrenalectomy (pathology: pheochromocytoma); and a ruptured left renal mass treated with left nephrectomy (microscopy: multifocal clear-cell renal cell carcinoma, nuclear grade 2). In 2022 she underwent cephalic duodenopancreatectomy for a pancreatic mass; histology showed three serous cystadenomas and two well-differentiated neuroendocrine tumors. In January 2021, surveillance abdominal\u2013pelvic CT incidentally identified a 4 cm solid\u2013cystic left adnexal mass suspected to be malignant; this was confirmed on transvaginal ultrasound and pelvic MRI and classified O-RADS 5. Gynecologic exam was unremarkable. At laparotomy via a midline infraumbilical incision, a well-defined solid\u2013cystic mass was found in the left adnexa. There was no ascites, no peritoneal carcinomatosis, and the right adnexa appeared grossly normal without exocystic vegetations. Peritoneal cytology was obtained. Left adnexectomy was performed and the specimen sent for frozen section, which was inconclusive, raising the differential of a borderline tumor versus a VHL-associated tumor. Given her postmenopausal status, total hysterectomy with right adnexectomy was completed. Final histology demonstrated bilateral clear-cell papillary cystadenomas of the Fallopian tubes and broad ligament, measuring 0.5 cm on the right and 4 cm on the left. The tumors were composed of tightly packed papillae with fibrous cores lined by monolayered epithelium, consistent with VHL-associated mesosalpinx/broad ligament lesions. The postoperative course was uneventful; 1-month postoperative evaluation was normal. She has been followed every 4 months with normal pelvic ultrasound for 2 years, and was recently readmitted to neurosurgery for recurrence of a brain tumor.", + "wiki_anchor": "Staging \n An infant rated at Stage 0 would be considered as having normal female external genitalia.\n Stage 1 has a mildly large clitoris and slightly reduced vaginal opening size. This degree may go unnoticed or may be simply assumed to be within normal variation.\n For Stage 2, genitalia are obviously abnormal to the eye, with a phallus intermediate in size and a small vaginal opening with separate urethral opening. Posterior labial fusion will be present.\n Stage 3 shows a further enlarged phallus, with a single urogenital sinus and almost complete fusion of the labia.\n Stage 4 looks more male than female, with an empty scrotum and a phallus the size of a normal penis, but not quite free enough of the perineum to be pulled onto the abdomen toward the umbilicus (i.e., what is termed a chordee in a male). The single small urethral/vaginal opening at the base or on the shaft of the phallus would be considered a hypospadias in a male. X-rays taken after dye injection into this opening reveal the internal connection with the upper vagina and uterus. This common opening can predispose to urinary obstruction and infection.\n Stage 5 denotes complete male virilization, with a normally formed penis with the urethral opening at or near the tip. The scrotum is normally formed but empty. The internal pelvic organs include normal ovaries and uterus, and the vagina connects internally with the urethra as in Stage 4. These infants are not visibly ambiguous are usually assumed to be ordinary boys with undescended testes. In most cases, the diagnosis of CAH is not suspected until signs of salt-wasting develop a week later.\n Stage 6 indicates normal male presentation, with no hypospadias present and normal testes.", + "doc_fkgl": 15.117090909090908, + "wiki_fkgl": 10.940407239819006, + "doc_tree_depth": 6.071428571428571, + "wiki_tree_depth": 6.0625, + "fkgl_delta": 4.1766836692719025 + }, + { + "index": 16, + "label": "low_health_literacy", + "original_doc": "A 59-year-old man with type 1 diabetes came to the hospital with heart failure. A heart ultrasound showed big clumps of germs stuck to two heart valves, the mitral and the aortic valves. His blood test grew a germ called Staphylococcus warneri. This is a kind of staph that usually lives on the skin and is normally harmless. Doctors found he had an infection on his own heart valves (native valve endocarditis). He later had surgery to replace both the mitral and the aortic valves. Looking back, small lab changes and weight loss that began about four months earlier may have been early warning signs. He had not been on immune-weakening medicines and did not have any implanted medical devices.", + "wiki_anchor": "Morphology and classification \nStaphylococci spp. are a genus of gram positive cocci of 0.5 - 1 \u03bcm diameter. Staphylococcus pseudintermedius is a non-motile and non-spore forming, facultatively anaerobic bacterium. It appears primarily as grape-like clusters morphologically, but can also be seen as individual or paired cocci. This clustered configuration, as well as the positive catalase test, differentiates staphylococci spp. from streptococci spp., which manifests in chains. Due to its ability to clot blood, S. pseudintermedius subcategorized into a group of coagulase positive (CoPS) staphylococci. CoPS strains typically express more virulence factors. This CoPS characteristic is a contributing factor to its biochemical similarities to S.aureus.", + "doc_fkgl": 7.468333333333334, + "wiki_fkgl": 12.732257281553398, + "doc_tree_depth": 6.125, + "wiki_tree_depth": 5.222222222222222, + "fkgl_delta": -5.263923948220064 + }, + { + "index": 16, + "label": "intermediate_health_literacy", + "original_doc": "A 59-year-old man with long-standing type 1 diabetes presented with acute heart failure. An echocardiogram showed large vegetations on the mitral and aortic valves. Blood cultures were positive for Staphylococcus warneri, a coagulase\u2011negative staphylococcus commonly found on the skin. He was diagnosed with native valve endocarditis. After medical stabilization, he ultimately underwent replacement of both the mitral and aortic valves. In retrospect, mild laboratory abnormalities and several months of weight loss beginning about four months earlier were likely early signs of endocarditis. He had no history of immunosuppressive therapy and no implanted medical devices.", + "wiki_anchor": "History and taxonomy \nIn 1988, Freney et al. isolated two previously unidentified Staphylococcus species from human clinical specimens: S. schleiferi and S. lugdunensis. The former species was named schleiferi in honor of German microbiologist Karl Heinz Schleifer, to mark his significant contributions to the taxonomy of gram-positive bacteria. Later in 1990, a coagulase-positive subtype was isolated from dogs and cats by Igimi et al. This led to the classification of Staphylococcus schleiferi into two distinct subspecies, the coagulase-negative S. schleiferi schleiferi and the coagulase-positive S. schleiferi coagulans. Both S. schleiferi subspecies have since been reported to be linked to an array of infections in humans and companion animals.", + "doc_fkgl": 12.996079027355623, + "wiki_fkgl": 12.400925925925925, + "doc_tree_depth": 5.714285714285714, + "wiki_tree_depth": 7.0, + "fkgl_delta": 0.5951531014296982 + }, + { + "index": 16, + "label": "proficient_health_literacy", + "original_doc": "A 59-year-old Japanese man with a 28-year history of type 1 diabetes on intensive multiple-dose insulin therapy (BMI 18.4 kg/m2, undetectable C\u2011peptide, HbA1c ~9.0%) and remote, asymptomatic chronic severe (grade III) aortic regurgitation (diagnosed 16 years earlier without subsequent follow\u2011up) presented with acute decompensated heart failure. He had never undergone surgery or prosthetic device implantation and had no history of immunosuppressive therapies.\n\nEight days after a routine visit, he developed dyspnea and fever >38\u2103. On arrival: BP 192/82 mmHg, HR 118/min, orthopnea, SpO2 80%. Exam: Levine 3/6 systolic murmur; no Osler nodes, Janeway lesions, or conjunctival petechiae. Labs: WBC 20,800/\u03bcL, CRP 6.06 mg/dL, CK\u2011MB 6.0 IU/L, troponin T negative. CXR showed pulmonary congestion with cardiomegaly (CTR 55%). ECG had ST elevation in V1\u2013V4, but emergent echocardiography showed no systolic dysfunction. He was diagnosed with acute heart failure due to valvular disease and treated with non\u2011invasive positive pressure ventilation and nitrates.\n\nTransthoracic echocardiography demonstrated severe aortic regurgitation and severe mitral regurgitation with a mobile mitral vegetation. Transesophageal echocardiography identified a 16.5\u00d76\u2011mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2\u00d75\u2011mm nonmobile vegetation on the noncoronary cusp of the aortic valve, raising strong suspicion for native valve endocarditis (NVE). Head CT and MRI showed no cerebral infarction or hemorrhage.\n\nRetrospective review revealed subtle abnormalities starting four months pre\u2011admission: mildly elevated WBC, albumin decreased to 3.0 g/dL the following month, and gradual hemoglobin decline over two months, with a 4\u2011kg weight loss. EGD and whole\u2011body CT were unrevealing. He partially regained weight and labs nearly normalized except for a CRP of 0.54 mg/dL. At the last pre\u2011admission visit (8 days prior), WBC was 9,300/\u03bcL, Hb 13.1 g/dL, Alb 3.0 g/dL, CRP 4.18 mg/dL, and diastolic BP had fallen; he remained afebrile and asymptomatic aside from weight loss.\n\nEmpiric antibiotics were initiated with ampicillin\u2013sulbactam 12 g/day plus gentamicin 120 mg/day. Three admission blood culture sets all grew Staphylococcus warneri, a coagulase\u2011negative staphylococcus (CoNS) and resident skin flora (MICs: ABPC/S \u22648 \u03bcg/mL; GM \u22641 \u03bcg/mL; CEZ \u22642 \u03bcg/mL), confirming S. warneri IE. Per Japanese Circulation Society guidance, emergency surgery is generally recommended for NYHA III\u2013IV heart failure or urgent surgery for NVE with mobile vegetation >10 mm and severe valve dysfunction. Because heart failure improved rapidly and appropriate antibiotics were started (reducing embolic risk), and given poorly controlled type 1 diabetes increasing operative risk, elective surgery was planned after stabilization of infection and glycemia. Antibiotics were narrowed to cefazolin 6 g/day; dental evaluation showed no periodontitis.\n\nAfter four weeks of antibiotics, surgery revealed a bicuspid aortic valve with intact aortic and mitral annuli and no abscess. Large vegetations were exenterated, and both valves were replaced with mechanical prostheses. The postoperative course was uneventful; he was discharged on postoperative day 22 without apparent embolism and has remained recurrence\u2011free for over two years. This case represents NVE due to the resident CoNS S. warneri in a patient without prosthetic material or immunosuppression, with prodromal laboratory abnormalities and weight loss evident up to four months before presentation.", + "wiki_anchor": "A third situation is one in which the medical staff deems that CPR will be of no clinical benefit to the patient. This includes, among other cases: a patient in severe septic shock and/or multiple organ dysfunction syndrome whose organ damage cannot be contained and reversed any longer, one who has had an acute stroke that has irreversibly damaged vital brain functions needed for life beyond repair (i.e., in the brain stem), or who has advanced and incurable metastatic cancer, and one with severe pneumonia which is no longer treatable with assisted ventilation methods and medication, which all have very little or no realistic probability of success. There is also a low probability of success for patients with severe hypotension that resulted from shock or severe illness or injury, and has not responded to treatment (and which was not induced), severe cases of acute or chronic kidney failure or end stage kidney disease (where dialysis and other renal replacement therapies either are no longer working or were not adequate, and where a transplant either cannot be found or is not an option), end-stage AIDS and its accompanying severe opportunistic illnesses (which are not responding to antiretroviral and drug therapy and/or the white blood cell count is too low), or those who are older than about 70 and/or homebound (where they and/or their guardians, instead of a DNR order, have authorized such half measures and the law permits it).", + "doc_fkgl": 12.497337640821737, + "wiki_fkgl": 27.000714285714285, + "doc_tree_depth": 5.96, + "wiki_tree_depth": 10.666666666666666, + "fkgl_delta": -14.503376644892548 + }, + { + "index": 17, + "label": "low_health_literacy", + "original_doc": "A 27-year-old woman had many cancers in her large intestine and rectum. She also had an inherited condition that causes many polyps.\n\nShe had robot-assisted surgery to remove the entire colon and rectum. The team also removed lymph nodes from the whole area. They used a surgical robot called Hugo RAS.\n\nThe robot work had three steps.\n\nStep 1: Her head was tilted down. The team removed the right side of the colon with its nearby tissue, up to the bend near the liver.\n\nStep 2: They removed the left side of the colon with its nearby tissue. They also removed the rectum with the tissue around it. They took deeper lymph nodes.\n\nStep 3: Her body was kept flat. The team tied off the main blood vessels along the main artery that feeds the intestines.\n\nAfter the robot part was finished, they took the removed bowel out through the anus. Through a small cut at the belly button, they made a pouch from the small intestine. They connected this pouch to the anus.\n\nThe surgery took about 10 and a half hours. Blood loss was very small. Recovery after surgery went smoothly.", + "wiki_anchor": "Christopher D. M. Fletcher (born March 13, 1958) is a British pathologist who has written more than 500 peer reviewed articles and was a chairman of the World Health Organization's Working Group on the Pathology and Genetics of Tumours of Soft Tissue and Bone. He graduated from London's St. Thomas's Hospital Medical School and got his M.D. degree from the University of London in 1991. Later on, he became a postdoc at the Royal College of Pathologists, from which he also graduated in 1988. He was trained at St Thomas' Hospital and was president of the Association of Directors of Anatomic and Surgical Pathology from 2003 to 2006. Currently he is a Professor of Pathology at Harvard Medical School, president of both the Arthur Purdy Stout Society and the International Society of Bone & Soft Tissue Pathology and is also a surgical pathologist at the Brigham and Women's Hospital. He also works for the Dana\u2013Farber Cancer Institute in Boston, Massachusetts as chief of onco-pathology.", + "doc_fkgl": 5.185050449959093, + "wiki_fkgl": 12.915759202453987, + "doc_tree_depth": 4.526315789473684, + "wiki_tree_depth": 9.333333333333334, + "fkgl_delta": -7.730708752494895 + }, + { + "index": 17, + "label": "intermediate_health_literacy", + "original_doc": "A 27-year-old woman with familial adenomatous polyposis and multiple colorectal cancers underwent robot-assisted total proctocolectomy with complete lymph node dissection using the Hugo RAS system. The robotic work was organized into three steps: 1) in Trendelenburg position, ascending colon complete mesocolic excision up to the hepatic flexure; 2) descending colon complete mesocolic excision and total mesorectal excision with D3 lymph node dissection; and 3) in a flat position, central vessel ligation along the superior mesenteric artery. After undocking, the specimen was removed transanally. An ileal pouch was created through a small umbilical incision and then connected to the anus (ileal pouch\u2013anal anastomosis). The operation lasted 632 minutes with minimal blood loss, and the postoperative course was uneventful.", + "wiki_anchor": "In fact, gastroplasty can be used when the length of the intra-abdominal esophagus is short and for anti-reflux action such as Nisson fundoplication, it is necessary to increase the intra-abdominal length of the esophagus.\nAt this time, part of the upper part of the stomach is separated by a stepper, i.e. the stapler fires longitudinally along the esophagus and increases the length of the stomach inside the abdomen.\nAt this time, a tongue is created from the stomach that can be easily rotated on the new esophagus and all kinds of fundoplication operations such as Nissen fundoplication can be done easily.\nIt was devised by John Leigh Collis (1911\u20132003), a British cardiothoracic surgeon, in 1957.", + "doc_fkgl": 16.9342905982906, + "wiki_fkgl": 13.799130434782608, + "doc_tree_depth": 5.8, + "wiki_tree_depth": 8.5, + "fkgl_delta": 3.13516016350799 + }, + { + "index": 17, + "label": "proficient_health_literacy", + "original_doc": "A 27-year-old woman with multiple colorectal cancers on a background of familial adenomatous polyposis (FAP) underwent robot-assisted total proctocolectomy (TPC) with lymph node dissection of the entire colorectal region using the Hugo RAS system. Preoperative CT showed multiple nodal swellings along the inferior mesenteric artery (IMA) and middle colic artery without distant metastases. After multidisciplinary review, robot-assisted TPC was performed under approvals from the Evaluating Committee for Highly Difficult New Medical Technologies (H-0051) and the Kyoto University IRB.\n\nUnder general anesthesia in lithotomy with arms tucked, a 5-cm vertical umbilical incision was made and a wound protector placed. After pneumoperitoneum, 4 robotic and 2 assistant trocars were inserted. Instruments included a camera, monopolar curved shears (right hand), bipolar fenestrated forceps (left hand), and Cadiere/double-fenestrated forceps (reserve arm). Two table positions (Trendelenburg and flat) were used with specific docking tilts; arm cart angles were unchanged. The robotic procedure comprised three steps, followed by transanal specimen extraction, ileal pouch construction via a small umbilical laparotomy, and ileal pouch\u2013anal anastomosis (IPAA).\n\nStep 1: Ascending colon complete mesocolic excision (CME) from a caudal approach, completed through hepatic flexure mobilization.\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME to completion of splenic flexure mobilization, and total mesorectal excision (TME) to full exposure of the intersphincteric space. This corresponds to a D3 lymph node dissection of the left colon/rectum.\n\nStep 3: After undocking and repositioning the patient flat, CVL along the superior mesenteric artery (SMA) was performed, ligating the ileocolic, right colic, and middle colic vessels; the inferior mesenteric vein (IMV) was ligated at its root (exposed in Step 2).\n\nTransanal and small laparotomy procedures: After transection of the terminal ileum, a transanal specimen extraction was performed with complete rectal mucosectomy from just below the dentate line due to multiple adenomas in the anal canal. An ileal pouch was constructed via the small umbilical incision, its reach to the anal canal confirmed, and a transanal hand-sewn IPAA was completed. No diverting ileostomy was created.\n\nAll three steps were completed without conversion. Following undocking after Step 3, laparoscopy confirmed hemostasis, specimen extraction, and anastomotic integrity. Total operative time was 632 minutes (Step 1: 36 min; Step 2: 160 min; Step 3: 188 min; positioning/docking/specimen extraction/anastomosis: 248 min). Estimated blood loss was 20 mL. Postoperatively, the course was uneventful: flatus and initiation of liquids on POD 1, advancement to a solid diet on POD 3, with a functional ileal pouch and satisfactory anal function.\n\nFinal pathology identified two sigmoid cancers (S1: Type 0-Ip, 55 \u00d7 50 mm, tub1, T1b, ly0, v0; S2: Type 0-Isp, 55 \u00d7 50 mm, tub1, Tis, ly0, v0) and one rectal cancer (R1: Type 0-Ip, 40 \u00d7 35 mm, tub1, Tis, ly0, v0). Lymph node status: 18/89 positive, all in sigmoid/rectosigmoid stations (#241, #242, #251), yielding UICC pT1bN2b stage.", + "wiki_anchor": "Throughout history, many different types and techniques have been developed in order to complete a parotidectomy and consequently, many different names have been associated with each type. However, there are really only two main distinctions to be made in parotidectomies:\n The specific nerve(s) to be dissected or not dissected\n The amount of gland excised\nIt is important to note that the specific surgery chosen is based on preservation of the facial nerve in order to avoid significant morbidities (diseases). Furthermore, there are still many controversies regarding the choice of surgery and incidence of cancer recurrence. Below indicates the various and main techniques typically associated with a parotidectomy:\n Extracapsular dissection - excision of the parotid tumor surrounded by some millimetres of healthy tissue, without searching and exposing the main truck of the facial nerve.\n superficial (near surface) or lateral (side) parotidectomy - excising all the parts of the gland superficial or lateral to the facial nerve.\n\u2013partial superficial parotidectomy - superficial parotidectomy where the surgeon excises only the portion of the gland surrounding the neoplasm. Only some nerves of the face are dissected during this procedure.\n\u2013formal superficial parotidectomy - superficial parotidectomy where the cervicofacial and temporofacial nerves are dissected.\n total parotidectomy - total removal of the deep part of the parotid gland. Typically performed if neoplasm is affecting deep part of parotid gland. Surgeon tries to remove the gland apart from the facial nerve, yet dissecting all branches of the facial nerves. This method can be done using the transcervical surgical approach.\n\u2013transcervical approach - less invasive procedure that involves cutting only a small incision in the neck.\n radical parotidectomy - Typically performed if malignant neoplasm is impinging on facial nerve. Facial nerve excised in addition to parotid gland.", + "doc_fkgl": 14.549020678891925, + "wiki_fkgl": 13.291645390070926, + "doc_tree_depth": 6.681818181818182, + "wiki_tree_depth": 7.0, + "fkgl_delta": 1.2573752888209988 + }, + { + "index": 18, + "label": "low_health_literacy", + "original_doc": "A 65-year-old man had a swollen right middle finger after a motorcycle crash 6 months earlier. The middle joint stayed bent, and the fingertip bent backward. He could not fully straighten the finger. An X-ray showed no broken bones. The problem was in the soft tissues and tendon on top of the finger. Before surgery, the middle joint could bend from 45 to 110 degrees but could not straighten. The doctors repaired the top tendon using a small strip from another tendon in the same finger. They put the middle joint in a straight splint for 2 weeks. After 2 weeks, he started gentle bending and straightening exercises for that joint. One month after surgery, the middle joint moved from 0 to 90 degrees. Two months after surgery, movement went back to normal. His hand function score (DASH) improved from 50 to 4.2.", + "wiki_anchor": "TFCC lesion \nThe TFCC is a fibrous structure covering both the radiocarpal and distal radioulnar joint. Tears in this ligament occur commonly after a person falls or secondary to a wrist fracture. Abnormalities in the TFCC are classified with the Palmer Classification, which divides the tears in a traumatic or degenerative stage.\nBoth stages of TFCC tears are treatable with an arthroscopic intervention, although the degenerative stage is operated according to the \"Arthroscopic wafer procedure\". In this procedure, the surgeon debrides the TFCC and a limited part of the ulnar head. If the patient has a Class 1 TFCC tear, a different arthroscopic technique is used. Damaged tissue will be debrided until fresh edges are available for arthroscopic repair. Good to excellent results have been reported on TFCC Class 1B repair for 85-90% of the patients. And 90% of the results for the Arthroscopic wafer procedure were good to excellent.", + "doc_fkgl": 5.560996503496504, + "wiki_fkgl": 10.734000000000002, + "doc_tree_depth": 4.916666666666667, + "wiki_tree_depth": 5.9, + "fkgl_delta": -5.1730034965034974 + }, + { + "index": 18, + "label": "intermediate_health_literacy", + "original_doc": "A 65-year-old man developed persistent swelling and a boutonniere deformity of the right middle finger after a motorcycle fall six months earlier. He could not fully extend the finger. On exam, the finger showed edema with flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Active PIP range of motion (ROM) was 45\u2013110 degrees. X\u2011rays of the right hand (AP/oblique) showed no bone injury, indicating a soft-tissue problem consistent with a central slip injury. The patient underwent reconstruction of the central slip using a partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. A PIP extension splint was used for 2 weeks. Active and passive PIP ROM exercises began after 2 weeks. One month after surgery, PIP ROM improved to 0\u201390 degrees, and by 2 months it returned to normal. Hand function, measured by the DASH score, improved markedly from 50 to 4.2.", + "wiki_anchor": "Signs and symptoms \nAt the beginning, affected individuals often notice the loss of pain and temperature sensation or all sensory modalities in their feet. As the disease progresses, the sensory abnormalities may extend up to the knees. However, they often do not notice sensory loss for a long time. Many affected individuals only become aware of the disease when they notice painless injuries and burns or when they seek medical advice for slowly healing wounds or foot ulcers. Foot ulcerations may appear due to permanent pressure, such as long walks or badly fitting shoes. Minor wounds or blisters may then lead to deep foot ulcerations. Once infection occurs, complications such as inflammation and destruction of the underlying bones may follow. Affected individuals who do not lose sensation may experience spontaneous pain. In addition, many affected individuals exhibit, to a variable degree, symmetrical distal muscle weakness and wasting.", + "doc_fkgl": 9.454666666666668, + "wiki_fkgl": 12.373197278911569, + "doc_tree_depth": 5.454545454545454, + "wiki_tree_depth": 6.222222222222222, + "fkgl_delta": -2.9185306122449006 + }, + { + "index": 18, + "label": "proficient_health_literacy", + "original_doc": "A 65-year-old male presented with six months of swelling and boutonniere deformity of the right digit III following a motorcycle accident on January 1, 2023. He initially self-managed with analgesics and did not seek care. He reported inability to fully extend the right middle finger. Examination demonstrated edema and a boutonniere posture (PIP flexion, DIP hyperextension). Active PIP ROM was 45\u2013110 degrees, with passive PIP ROM within normal limits. Radiographs of the right hand (AP/lateral) revealed no osseous pathology, supporting a soft-tissue etiology consistent with a central slip injury. \n\nSurgical technique: Central slip defect reconstruction was performed using the partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. Under anesthesia and tourniquet control in the supine position, a midlateral incision was made on the ulnar aspect of the middle phalanx centered at the PIP joint with dorsal oblique extension, and a transverse incision was made over the MCP flexion crease proximal to the A1 pulley. The ulnar digital neurovascular bundle was identified and protected. Full-thickness dorsal flaps were elevated to expose the central slip and extensor mechanism to the PIPJ. Scar and pseudotendinous tissue were excised. The central slip was not amenable to primary repair; therefore, the ulnar slip of the FDS was selected for reconstruction. The ulnar neurovascular bundle was mobilized to visualize the periosteal insertion of the A3 pulley. The extensor tendon was mobilized and tenolyzed; the dorsal PIP capsule was incised with removal of interposed tissue. The A3 pulley periosteal insertion and the volar capsule of the PIP joint were incised longitudinally. A 2\u20130 non-absorbable monofilament suture was placed around the ulnar FDS slip at the PIP level. Through the proximal incision, the flexor sheath and A1 pulley were incised longitudinally to expose the FDS; the ulnar slip was isolated and transected, preserving the radial slip. The previously placed 2\u20130 suture facilitated delivery of the distally based ulnar FDS slip distally. A 2.8\u2011mm dorsal-to-volar bone tunnel was drilled at the base of the middle phalanx; an elevator protected the FDP, volar plate, and volar structures. With the PIP reduced in full extension, the FDS slip was passed through the tunnel and routed through the intact proximal segment of the central slip/extensor tendon. A tendon weaver completed a Pulvertaft weave under appropriate tension with the PIP in full extension and reduction, secured with 3\u20130 non-absorbable suture. The capsule and central slip reconstruction margins were approximated; adhesions were released and lateral bands mobilized. Tenodesis effect, posture, stability, and motion were assessed. Wounds were irrigated, the tourniquet deflated, hemostasis obtained, and capillary refill confirmed. Skin was closed with horizontal mattress sutures. A sterile dressing and a well-padded PIP extension splint were applied to allow early DIP and MCP motion.\n\nPostoperative course: First wound check at postoperative day 4; the patient received meloxicam 7.5 mg PO BID and doxycycline 100 mg PO BID for 3 days. A second wound visit occurred 3 days later. At 2 weeks, the back slab and external sutures were removed, and active and passive PIP ROM exercises were initiated. By 3 weeks, the wound had healed and PIP ROM was 0\u201390 degrees. At 1 month, PIP ROM improved to 0\u2013100 degrees, with continued functional gains. After 7 weeks of rehabilitation, he returned to work with PIP ROM 0\u2013110 degrees. Overall function improved substantially, with the DASH score decreasing from 50 to 4.2.\n\nInterpretation: Clinical and radiographic findings were concordant with a chronic central slip injury producing boutonniere deformity (PIP flexion, DIP hyperextension due to dorsal apparatus disruption and volar migration of lateral bands). Reconstruction using an ulnar FDS slip via bone tunnel and Pulvertaft weave restored PIP extension and yielded progressive ROM gains and marked functional recovery.", + "wiki_anchor": "Stasis papillomatosis is a disease characterized by chronic congestion of the extremities, with blood circulation interrupted in a specific area of the body. A consequence of this congestion and inflammation is long-term lymphatic obstruction. It is also typically characterized by the appearance of numerous papules. Injuries can range from small to large plates composed of brown or pink, smooth or hyperkeratotic papules. The most typical areas where injuries occur are the back of the feet, the toes, the legs, and the area around a venous ulcer formed in the extremities, although the latter is the rarest of all. These injuries include pachydermia (thickening of the skin), lymphedema, lymphomastic verrucosis and elephantosis verrucosa. The disease can be either localized or generalized; the localized form makes up 78% of cases. Treatment includes surgical and pharmaceutical intervention; indications for partial removal include advanced fibrotic lymphedema and elephantiasis. Despite the existence of these treatments, chronic venous edema, which is a derivation of stasis papillomatosis, is only partially reversible. The skin is also affected and its partial removal may mean that the skin and the subcutaneous tissue are excised. A side effect of the procedure is the destruction of existing cutaneous lymphatic vessels. It also risks papillomatosis, skin necrosis and edema exacerbation.", + "doc_fkgl": 11.863529411764706, + "wiki_fkgl": 13.768417874396135, + "doc_tree_depth": 5.75, + "wiki_tree_depth": 7.166666666666667, + "fkgl_delta": -1.9048884626314297 + }, + { + "index": 19, + "label": "low_health_literacy", + "original_doc": "A 23-year-old man came to the emergency room with a sudden, very bad headache. He also felt sick, threw up, and felt heavy pressure in his chest. His blood pressure was high and he was breathing fast. A quick heart test looked like a major heart attack. He was rushed for a procedure to check and open the heart arteries. The heart arteries looked normal. A head CT scan then showed bleeding in the space around his brain. A team of specialists cared for him, but he got worse quickly. He went into cardiac arrest and died.", + "wiki_anchor": "Five days later, her fianc\u00e9, a young Navajo man, was en route to her funeral in Gallup when he suddenly became severely short of breath. By the time paramedics brought him to the Indian Medical Center emergency room, he had stopped breathing and the paramedics were performing cardiopulmonary resuscitation. The young man could not be revived by doctors and died. The physicians, recalling the similar symptoms and death of the young woman, reported his death to the New Mexico Department of Health.", + "doc_fkgl": 4.0628178694158095, + "wiki_fkgl": 12.119634146341465, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 5.5, + "fkgl_delta": -8.056816276925655 + }, + { + "index": 19, + "label": "intermediate_health_literacy", + "original_doc": "A 23-year-old man came to the emergency department with a sudden severe headache, nausea, vomiting, and chest heaviness. His initial vital signs showed high blood pressure and a fast breathing rate. An emergency ECG showed a heart attack pattern (STEMI), so he was urgently sent for percutaneous coronary intervention; the angiogram revealed normal coronary arteries. Further evaluation with a brain CT identified a cisternal subarachnoid hemorrhage (bleeding around the brain). Despite coordinated care by multiple teams, his condition rapidly worsened, leading to cardiac arrest and death.", + "wiki_anchor": "Five days later, her fianc\u00e9, a young Navajo man, was en route to her funeral in Gallup when he suddenly became severely short of breath. By the time paramedics brought him to the Indian Medical Center emergency room, he had stopped breathing and the paramedics were performing cardiopulmonary resuscitation. The young man could not be revived by doctors and died. The physicians, recalling the similar symptoms and death of the young woman, reported his death to the New Mexico Department of Health.", + "doc_fkgl": 13.757534883720933, + "wiki_fkgl": 12.119634146341465, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 5.5, + "fkgl_delta": 1.6379007373794678 + }, + { + "index": 19, + "label": "proficient_health_literacy", + "original_doc": "A 23-year-old male with a 23 pack-year smoking history, no alcohol use, and no illicit drug use presented with 2 hours of sudden severe frontal headache, nausea, vomiting, and chest heaviness. He was distressed but alert and oriented. Vitals: BP 178/103 mmHg, RR 26/min, T 38.9\u00b0C, HR 87/min, SpO2 94%. Exam: normal vesicular breath sounds; cardiovascular and abdominal exams inconclusive; neurological exam notable for neck stiffness, dilated but light-reactive pupils, normal plantar reflexes, and no focal deficits. ECG showed ST-segment elevation >2 mm in V2\u2013V5, consistent with STEMI; he received a 300 mg aspirin load and was urgently transferred for PCI. Troponin was elevated at 1.48 mg/dl (normal <0.16 mg/dl). Femoral-access coronary angiography demonstrated normal coronary arteries with TIMI 3 flow. Post-angiography ECG showed normal sinus rhythm with LVH; echocardiography revealed normal ventricular function without RWMA. Subsequent workup found lymphocytosis and mildly elevated CRP. Non-contrast CT brain demonstrated a cisternal subarachnoid haemorrhage with extension anterior to the right temporal lobe. Abdominal ultrasound was negative for polycystic kidney disease; cerebral CT angiography was planned to exclude aneurysm. Nimodipine 60 mg q4h was initiated with a BP target of 160/100 mmHg. On day 2, he acutely deteriorated with cardiac arrest; after CPR, GCS was 6, and he was intubated and mechanically ventilated in the ICU. Owing to instability, repeat CT brain and planned cerebral CTA were not performed. He received multidisciplinary ICU care with NG feeding, IV fluids, antibiotics, a proton pump inhibitor, and nimodipine. On day 8, he developed ventricular fibrillation and, despite CPR and more than five defibrillation attempts, could not be resuscitated and died.", + "wiki_anchor": "1996 - Advisory Board Asian-Pacific Society of Interventional Cardiology\n1996 - Associate Professor of Medicine Chief, Division of Interventional Cardiology Cardiovascular Center, Asan Medical Center University of Ulsan, College of Medicine, Seoul, Korea\n1998 - Editorial Board Interventional Cardiology Bulletin\n2000 - Professor of Medicine Chief, Division of Interventional Cardiology Cardiovascular Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea\n2002 - Chairman Cardio Vascular Research Foundation\n2004 - Editorial Board Current Cardiology Reviews\n2004 - Editorial Advisory Future Cardiology\n2004.3 - 2008.2 Chairman The Korean Society of Interventional Cardiology\n2004.12 - Director Clinical Research Center for Ischemic Heart Disease\n2006 - 2008 President Asian Pacific Society of Interventional Cardiology\n2006.09 - Director Asan Heart Institute\n2006 - 2010 Editorial Board Catheterization and Cardiovascular Interventions \n2008.02 - Associate Editor for the Pacific Rim Euro Intervention\n2008.02 - Editorial Board Journal of American College of Cardiology: Cardiovasular Interventions\n2008.07 - 2010 International Advisory Board Circulation Journal-The Japanese Circulation Society\n2008 - 2010 Editorial Board The American Journal of Cardiology \n2009 - 2011 International Associate Editor European Heart Journal \n2009 - 2011 Associate Editor Interventional Cardiology\n2009 - 2010 Director, International Affairs Committee The Korean Society of Cardiology\n2009.7 - International Associate Editor Circulation Journal - The Japanese Circulation Society\n2009.11.23 - Chairman Heart Institute, Asan Medical Center", + "doc_fkgl": 12.237704402515725, + "wiki_fkgl": 23.854280879864636, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 10.0, + "fkgl_delta": -11.61657647734891 + } +] \ No newline at end of file