diff --git "a/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_14_v1.json" "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_14_v1.json" new file mode 100644--- /dev/null +++ "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_14_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": "In 1961, at the age of 37, Scott was appointed Professor of Obstetrics and Gynaecology at the University of Leeds. At Leeds he continued to focus on reproductive immunology and was among the first to demonstrate that certain transient diseases in newborns were caused by the passage of antibodies from the mother to the foetus via the placenta. He showed that this was the case in neonatal hyperthyroidism, thrombocytopenia, and systemic lupus erythematosus. In a collaboration with his wife Olive, he also showed that anti-Ro antibodies, when crossing the placenta, could cause heart block in the foetus. Scott also tried to identify a cause for pre-eclampsia, a popular question for obstetric researchers at the time. He hypothesised that it was caused by an immunological mismatch between mother and foetus and although he found supportive anecdotal evidence for this theory, he was unable to prove it. While investigating whether antiphospholipid antibodies could cause pre-eclampsia, Scott discovered that these antibodies increase the risk of recurrent miscarriage; screening for these antibodies is now routine in women with recurrent miscarriage.", + "doc_fkgl": 4.138157894736846, + "wiki_fkgl": 15.267987012987017, + "doc_tree_depth": 4.5, + "wiki_tree_depth": 7.571428571428571, + "fkgl_delta": -11.129829118250171 + }, + { + "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": "Embolic stroke of undetermined source (ESUS) is an embolic stroke, a type of ischemic stroke, with an unknown origin, defined as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources. As such, it forms a subset of cryptogenic stroke, which is part of the TOAST-classification. The following diagnostic criteria define an ESUS:\n Stroke detected by CT or MRI that is not lacunar\n No major-risk cardioembolic source of embolism\n Absence of extracranial or intracranial atherosclerosis causing 50% luminal stenosis in arteries supplying the area of ischaemia\n No other specific cause of stroke identified (e.g., arteritis, dissection, migraine/vasospasm, drug misuse)", + "doc_fkgl": 15.20401179941003, + "wiki_fkgl": 17.051999999999996, + "doc_tree_depth": 4.888888888888889, + "wiki_tree_depth": 14.666666666666666, + "fkgl_delta": -1.8479882005899668 + }, + { + "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": "Selected works \n Murphy, Andrew J., Kevin J. Woollard, Anh Hoang, Nigora Mukhamedova, Roslynn A. Stirzaker, Sally PA McCormick, Alan T. Remaley, Dmitri Sviridov, and Jaye Chin-Dusting. \"High-density lipoprotein reduces the human monocyte inflammatory response.\" Arteriosclerosis, thrombosis, and vascular biology 28, no. 11 (2008): 2071\u20132077.\n Stafforini, Diana M., Larry W. Tjoelker, Sally PA McCormick, Darius Vaitkus, Thomas M. McIntyre, Patrick W. Gray, Stephen G. Young, and Stephen M. Prescott. \"Molecular basis of the interaction between plasma platelet-activating factor acetylhydrolase and low density lipoprotein.\" Journal of Biological Chemistry 274, no. 11 (1999): 7018\u20137024.\n Dichek, Hel\u00e9n L., Walter Brecht, Jianglin Fan, Zhong-Sheng Ji, Sally PA McCormick, Hassibullah Akeefe, LoriAnna Conzo et al. \"Overexpression of hepatic lipase in transgenic mice decreases apolipoprotein B-containing and high density lipoproteins Evidence that hepatic lipase acts as a ligand for lipoprotein uptake.\" Journal of Biological Chemistry 273, no. 4 (1998): 1896\u20131903.\n McCormick, S. P., Jennifer K. Ng, Stacy Taylor, Laura M. Flynn, Robert E. Hammer, and Stephen G. Young. \"Mutagenesis of the human apolipoprotein B gene in a yeast artificial chromosome reveals the site of attachment for apolipoprotein (a).\" Proceedings of the National Academy of Sciences 92, no. 22 (1995): 10147\u201310151.\n Jones, Gregory T., Andre M. Van Rij, Jennifer Cole, Michael JA Williams, Emma H. Bateman, Santica M. Marcovina, Meiying Deng, and Sally PA McCormick. \"Plasma lipoprotein (a) indicates risk for 4 distinct forms of vascular disease.\" Clinical chemistry 53, no. 4 (2007): 679\u2013685.", + "doc_fkgl": 17.108284910965327, + "wiki_fkgl": 9.74909090909091, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 6.846153846153846, + "fkgl_delta": 7.3591940018744175 + }, + { + "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 \nBaccouche was born to an African-American mother and Tunisian father on November 25, 1976 and brought up in Tunisia. She developed a brain tumor as a child which caused a disorder called hydrocephalus when she was eight years old. Hydrocephalus blocks cerebral fluid in the brain and creates pressure within the ventricles. In Baccouche's case, that pressure damaged her optic nerve causing her to lose all but 9% of her vision by the age of eight.", + "doc_fkgl": 3.5813553113553134, + "wiki_fkgl": 9.109871794871797, + "doc_tree_depth": 5.142857142857143, + "wiki_tree_depth": 6.5, + "fkgl_delta": -5.5285164835164835 + }, + { + "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": "Vertebral hemangiomas or haemangiomas (VHs) are a common vascular lesion found within the vertebral body of the thoracic and lumbar spine. These are predominantly benign lesions that are often found incidentally during radiology studies for other indications and can involve one or multiple vertebrae. Vertebral hemangiomas are a common etiology estimated to be found in 10-12% of humans at autopsy. They are benign in nature and frequently asymptomatic. Symptoms, if they do occur, are usually related to large hemangiomas, trauma, the hormonal and hemodynamic changes of pregnancy (causing intra-spinal bleeding), or osseous expansion and extra-osseous extension into surround soft tissues or epidural region of the spinal canal.", + "doc_fkgl": 11.942105263157895, + "wiki_fkgl": 15.914878504672899, + "doc_tree_depth": 6.4, + "wiki_tree_depth": 7.8, + "fkgl_delta": -3.9727732415150037 + }, + { + "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": "Source Localization (E/MEG) of Interictal activities in collaboration with Team DYNAMAP INS\nQuantification of Ictal versus Interictal networks in the context of the ANR grant \"FORCE\"\nTopological changes associated with partial epilepsies in the interictal period from SEEG signals or MRI bold connectivity \nIctal Networks: definition of different subtypes of premotor/motor seizures and parietal seizures, changes in ictal connectivity and correlated with d\u00e9j\u00e0 vu or loss of consciousness \nRole of thalamo-cortical synchrony in seizure termination showing that some patterns of termination are under the influence of thalamic outputs.\nModulation of Epileptogenic networks: vagal nerve stimulation VNS is efficient in epileptic patients provided that it induces a decrease of functional connectivity, effect of biofeedback in stress related seizures\nLarge scale brain networks in silico models in the context of the ANR grant \u201cVibrations\u201d: in collaboration with the team of F Wendling from LTSI Rennes and the TNG team of Viktor K. Jirsa at the INS: role of macroscale networks in epilepsy, Virtual Brain modeling in focal epilepsies\nThe work done in collaboration with Viktor K. Jirsa in the context of the Epinext network on the virtual epileptic patient is at the basis of the Epinov project.\nBartolomei has also been involved in animal research studies dealing with stress influence on epileptogenesis", + "doc_fkgl": 16.247417695473253, + "wiki_fkgl": 23.547142857142862, + "doc_tree_depth": 6.083333333333333, + "wiki_tree_depth": 14.0, + "fkgl_delta": -7.29972516166961 + }, + { + "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": "Human alphaherpesvirus 1 infects humans, most often as cold sores. It is very common and contagious; about 67% of the world population under the age of 50 has Human alphaherpesvirus 1. It is often acquired orally during childhood. It may also be sexually transmitted, including contact with saliva, such as kissing and mouth-to-genital contact (oral sex). The virus tends to reside in the trigeminal ganglia. This species appears to be particularly damaging to the nervous system, and some research has attributed Human alphaherpesvirus 1 infection to an increased risk of developing Alzheimer\u2019s disease. The virus interacts with the components and receptors of lipoproteins, which may lead to the development of Alzheimer's disease. However, evidence for a relationship with Alzheimer\u2019s disease is mixed. In 2011 Manchester University scientists showed that treating infected cells with antiviral agents decreased the accumulation of \u03b2-amyloid and tau protein, and also decreased replication of the virus.", + "doc_fkgl": 4.63312375249501, + "wiki_fkgl": 12.779333333333334, + "doc_tree_depth": 5.277777777777778, + "wiki_tree_depth": 6.888888888888889, + "fkgl_delta": -8.146209580838324 + }, + { + "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": "Background\nCandida albicans is a fungus that colonizes a large majority of the population (meaning it is present in the body but not causing an infection or any problems). Under certain conditions, however, it can cause an infection. The most common manifestations are thrush (a superficial Candida infection in the mouth) and vaginitis, also commonly referred to as a yeast infection. Several Candida species can also cause a serious infection known as invasive candidiasis, which can be systemic if blood borne (candidaemia). This is almost always restricted to those with compromised immune systems, such as patients undergoing chemotherapy or with advanced AIDS, or undergoing medical treatments.", + "doc_fkgl": 10.328562500000004, + "wiki_fkgl": 14.496867924528303, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 7.8, + "fkgl_delta": -4.168305424528299 + }, + { + "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": "EV-71 infection can be divided into four stages. Stage 1 of EV-71 infection is uncomplicated and can manifest as HFMD or herpangina. Other types of viruses such as Coxsackievirus A4, A5, A10, B2, and B5 can also cause HFMD. Incubation period (period of time from exposure of the virus to the appearance of symptoms) ranges from three to seven days. An infected person can spread the disease several days before the symptoms appear and peak one week after the onset of the disease. Common symptoms at this stage are fever, sore throat, exanthem (especially maculopapular rash) at palms, feet, and buttocks. The disease can also affect the oral cavity, causing vesicles (small blisters) and ulcers on the tongue and soft palate. If only the oral cavity is affected, without the involvement of other body parts, it is known as herpangina. Most HFMD and herpangina are mild diseases and will resolve by themselves. Stage 2 of the disease occurs a few days after stage I, and can be caused by EV-71 or echoviruses. Stage 2 is characterised by central nervous system involvement, causing meningoencephalitis, and polio-like syndrome such as poliomyelitis-like paralysis, and non-paralytic poliomyelitis (aseptic meningitis). EV-71 subgenotypes C1 and B5 are more likely to cause central nervous system infection when compared to subgenotype B4. Meningoencephalitis is the most common manifestation of the disease, while poliomyelitis-like paralysis is the least common. Stage 3 of the disease signifies involvement of the heart and lungs. Stage 4 of the disease signifies long-term neurological consequences after the child recovered from the illness.", + "doc_fkgl": 14.527236842105264, + "wiki_fkgl": 10.876139534883723, + "doc_tree_depth": 7.214285714285714, + "wiki_tree_depth": 6.2, + "fkgl_delta": 3.6510973072215407 + }, + { + "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": "Awards\n Alfred Kratochwil Award, The International Society of Ultrasound in Obstetrics and Gynecology (2011, Los Angeles)\n Lifetime achievement award, World Association of Perinatal Medicine (2015, Madrid)\n Sir William Liley Award, The International Society of The Fetus as a Patient (2016, Tirana)\nShort Oral Presentation Award, 26th World Congress on Ultrasound in Obstetrics and Gynecology (2016, Rome) -Clinical significance of 3D HDlive silhouette/flow in neurosonoembryology and fetal neurosonography- \n\"Magnificent achievements in the visualization of early human development\" Award (2019, Istanbul)\nJSOG Congress Encouragement Award, Japan Society of Obstetrics and Gynecology (2020, Tokyo)", + "doc_fkgl": 4.623939393939395, + "wiki_fkgl": 46.612087912087915, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 9.0, + "fkgl_delta": -41.98814851814852 + }, + { + "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": "Signs and symptoms \nSigns and symptoms are usually detectable prenatally or shortly after birth. In its severe manifestations, MSMDS has been associated with prune belly sequence. In less severe forms, the earliest signs of MSMDS are congenital fixed mydriasis (can be misdiagnosed as partial aniridia), and a PDA requiring surgical intervention. Most carriers of the mutation will eventually develop thoracic arterial disease between the ages of 10\u201325.", + "doc_fkgl": 11.214120481927715, + "wiki_fkgl": 13.838022388059702, + "doc_tree_depth": 5.4, + "wiki_tree_depth": 5.0, + "fkgl_delta": -2.6239019061319873 + }, + { + "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": "A cervical thymic cyst, also called thymopharyngeal duct cyst, is a fluid-filled mass that occurs when the thymopharyngeal duct, an embryonic structure connecting the nascent thymus with the embryonic pharynx, fails to close and disappear. A thymic cyst is typically a solitary mass on one side of the neck, and is usually found near the carotid sheath. Some cervical thymic cysts may extend into the mediastinum. It is usually asymptomatic. The diagnostic process includes differentiating between other causes of neck masses in infants and children, including branchial cleft cysts and cystic hygromas. The treatment is surgical excision. On histologic examination, the wall of the cyst includes thymic tissue, and may include parathyroid gland tissue because of the parathyroid gland's common embryonic origin with the thymus gland in the third pharyngeal pouch. Fewer than 100 cases of cervical thymic cysts have been reported in the medical literature.", + "doc_fkgl": 13.580182389937107, + "wiki_fkgl": 12.137089041095894, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 5.875, + "fkgl_delta": 1.443093348841213 + }, + { + "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": "Clinical Features \nCervical thymic cyst is a very rare pathology that is often incidentally found due to its asymptomatic nature. The patient usually notices a neck mass that grows slowly which triggers them to see a clinician and be admitted to the hospital. However, it can cause symptoms as it grows in size and compresses on other organs. These symptoms include difficulty breathing, difficulty swallowing, hoarseness of voice, among others. It causes neck swelling. Males are more commonly affected. Most cases occur in the first decade of life, as the thymus tends to atrophy after puberty. This lesion usually affects the left side of the neck.", + "doc_fkgl": 2.581463963963966, + "wiki_fkgl": 9.615235849056607, + "doc_tree_depth": 4.583333333333333, + "wiki_tree_depth": 5.5, + "fkgl_delta": -7.033771885092641 + }, + { + "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": "Lung cysts are seen in about 8% of the general population, with an increased prevalence in older people, and are not associated with emphysema. They may be part of the aging changes of the lungs, and cause a slight decrease in their diffusing capacity. The presence of multiple pulmonary cysts may indicate a need to evaluate the possibility of bullous or cystic lung diseases. Cavitation indicates workup for serious infection or lung cancer.", + "doc_fkgl": 12.728571428571431, + "wiki_fkgl": 12.21791095890411, + "doc_tree_depth": 5.166666666666667, + "wiki_tree_depth": 6.5, + "fkgl_delta": 0.5106604696673216 + }, + { + "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": "He was one of the original members of the New Haven County Medical Association, and served on the committees of correspondence and examination. In April, 1788, he reported a case of \"scirrhus in the pylorus of an infant,\" which was the first case on record of congenital hypertrophy of the pylorus in an infant. It was printed with the papers of the society, which appeared in their transactions entitled: \"Cases and Observations.\" In this paper Beardsley noted practically every feature of the disease we now know. He had attended the patient for three years at Southington, and when her death, at the age of five years, \"closed the painful melancholy scene\" he performed the autopsy. He speaks of the \"constant puking,\" which was first noted during the first week of life. Everything in the shape of food, the child took was almost instantaneously rejected and very little changed. The feces were small in quantity. He comments upon the leanness and wizened old look of the child, and states he had \"pronounced a scirrhosity in the pylorus months before the child's death,\" although he first attributed the condition to a deficiency of bile and gastric juices joined with a morbid relaxation of the stomach. Unfortunately, Beardsley did not know of the child's death \"until the second day after it took place. This late period, the almost intolerable stench, and the impatience of the people who had collected for the funeral, prevented so thorough an examination of the body as might otherwise have been made.\" At the autopsy Beardsley noted that the stomach was unusually large and distended. \"The pylorus was invested with a hard compact substance or scirrhosity, which so completely obstructed the passage into the duodenum as to admit with the greatest difficulty the finest fluid.\"", + "doc_fkgl": 15.644583333333337, + "wiki_fkgl": 12.345405405405405, + "doc_tree_depth": 6.769230769230769, + "wiki_tree_depth": 8.076923076923077, + "fkgl_delta": 3.299177927927932 + }, + { + "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": "The pathophysiology of acute respiratory distress syndrome involves fluid accumulation in the lungs not explained by heart failure (noncardiogenic pulmonary edema). It is typically provoked by an acute injury to the lungs that results in flooding of the lungs' microscopic air sacs responsible for the exchange of gases such as oxygen and carbon dioxide with capillaries in the lungs. Additional common findings in ARDS include partial collapse of the lungs (atelectasis) and low levels of oxygen in the blood (hypoxemia). The clinical syndrome is associated with pathological findings including pneumonia, eosinophilic pneumonia, cryptogenic organizing pneumonia, acute fibrinous organizing pneumonia, and diffuse alveolar damage (DAD). Of these, the pathology most commonly associated with ARDS is DAD, which is characterized by a diffuse inflammation of lung tissue. The triggering insult to the tissue usually results in an initial release of chemical signals and other inflammatory mediators secreted by local epithelial and endothelial cells.", + "doc_fkgl": 5.415573678290215, + "wiki_fkgl": 17.981291390728476, + "doc_tree_depth": 4.785714285714286, + "wiki_tree_depth": 9.166666666666666, + "fkgl_delta": -12.56571771243826 + }, + { + "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": "Illness, death, and legal cases\nMozian was diagnosed with pulmonary tuberculosis in 1951. It was treated medically and remained dormant until 1962 when it re-emerged. Mozian then declined to have orthodox medical treatment, turning instead to a chiropractor, Dr. Christopher Gian-Cursio, who treated Mozian without medical intervention but with a vegetarian diet and fasting. Mozian continued the regime in Florida at a clinic run by another chiropractor, Dr. Bernard Epstein. Although Mozian was briefly treated at a conventional hospital in Miami when his condition worsened, he died soon afterwards, aged 35.", + "doc_fkgl": 16.420789473684213, + "wiki_fkgl": 12.109615384615385, + "doc_tree_depth": 6.166666666666667, + "wiki_tree_depth": 6.4, + "fkgl_delta": 4.311174089068828 + }, + { + "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": "Causes\nPossible causes, alone or in conjunction, that produce the chronic cough include the following.\n Postnasal drip, when excess mucus is produced in the sinus of the nose and drips back towards the throat, causes a cough reflex, also known as upper airway cough syndrome. Postnasal drip coughing can be caused by the direct irritation of the postnasal drip or by inflammation of cough receptors in the upper airway. Postnasal drip cases contribute 34% of chronic cough cases.\n Asthma that affects the upper respiratory tract. Other causes such as cold air or chemicals breathed in can also induce coughing.\n Gastroesophageal reflux disease (GERD), a common condition where the backflow of stomach acid between the throat and the stomach causes irritation, can lead to chronic cough.\n Infections such as pneumonia, flu, common cold, tuberculosis or other infections in the upper respiratory tract often include coughing that can persist even after the infection has subsided. Chronic cough is commonly mistaken as a symptom of the infection known as whooping cough.\n Blood pressure drugs such as angiotensin-converting enzyme, which is commonly prescribed to individuals with high blood pressure and cardiac failure, are known to have a side effect of chronic cough.\n Chronic bronchitis, an inflammation in the major airways such as the bronchial tubules, causes the coughing of coloured sputum. Most carriers of chronic bronchitis have a history of smoking. Chronic bronchitis is on a spectrum of smoking-related lung disease also known as chronic obstructive pulmonary disease. Other lung diseases on the spectrum such as emphysema can co-exist with COPD. It accounts for 5% of chronic cough.\n Chemical irritants such as cigarette smoke or other irritants are a common factor that can lead to chronic cough. These irritants typically contribute towards chronic bronchitis.\n Other notable rare causes include aspiration, bronchiectasis, bronchiolitis, cystic fibrosis, laryngopharyngeal reflux, lung cancer, non-asthmatic eosinophilic bronchitis, sarcoidosis.", + "doc_fkgl": 16.479367816091955, + "wiki_fkgl": 11.61839826839827, + "doc_tree_depth": 6.15, + "wiki_tree_depth": 6.611111111111111, + "fkgl_delta": 4.860969547693685 + }, + { + "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": "Background \nThe blood test scam took place in the Indian state of West Bengal. Due to the region's lower level of economic development, the West Bengal medical system of the early 2000s was noted as being underfunded and thus providing substandard care. Despite these shortcomings, the Bengal medical system did contain a number of public and private blood banks, which provided the wider system with supply of blood. To ensure that donated blood was safe to use in blood transfusions, the various banks and hospitals used blood test kits to test blood for infectious diseases.", + "doc_fkgl": 4.512113821138211, + "wiki_fkgl": 12.428289473684213, + "doc_tree_depth": 4.444444444444445, + "wiki_tree_depth": 7.5, + "fkgl_delta": -7.916175652546002 + }, + { + "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": "Alfredo Pavlovsky (24 November 1907 \u2013 26 April 1984) was an Argentinian physician who discovered that haemophilia has two types (A and B). Pavlovsky graduated with his medical degree in 1931, then worked as Bernardo Houssay's assistant professor in physiology. In 1947 he reported in Buenos Aires that \"occasionally (in vitro) the blood of some of the haemophilic patients with a greatly prolonged clotting time ... when added to other haemophilic blood possessed a coagulant action nearly as effective as normal blood\". This was later shown to be due to the blood of people with haemophilia B providing the clotting factor factor VIII to correct the defect in those with the more common haemophilia A.", + "doc_fkgl": 11.051032608695653, + "wiki_fkgl": 12.124884955752215, + "doc_tree_depth": 5.0, + "wiki_tree_depth": 8.5, + "fkgl_delta": -1.0738523470565617 + }, + { + "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": "Addison Rerecich (October 1, 1999 \u2013 December 30, 2019) was an American double-lung transplant recipient who spent the longest documented duration of time using extracorporeal membrane oxygenation (ECMO) therapy at 93 days. She underwent the transplant at age 11 in 2011 and was the subject of a 2013 episode of Frontline on PBS. She suffered from Methicillin-resistant Staphylococcus aureus (MRSA), a difficult-to-treat staph infection.\n \nIn May 2011, Rerecich began showing a variety of symptoms including fatigue, hip pain, and a high fever. Her mother Tonya, a registered nurse, gave Addison ibuprofen to treat the symptoms and eventually took her to a local hospital. Doctors there suspected a virus, but the pain and fever continued to get worse over the following few days. Eventually, Tonya took her daughter to the Diamond Children's Medical Center, a part of the University of Arizona Medical Center.\n \nThe day she arrived at the hospital, Addison went into septic shock and was soon placed on ECMO therapy to sustain life. Doctors eventually discovered that she had contracted an antibiotic-resistant strain of MRSA (probably from a scrape or scab). Other complications she encountered during her five-month hospital stay included Stenotrophomonas maltophilia, e. coli, a drug-resistant form of pneumonia, a pulmonary embolism, and a stroke. She also underwent several surgeries.\n \nIn September 2011, Rerecich underwent a successful double-lung transplant surgery. She returned home in November 2011. The total medical cost of her hospital stay reached $6 million. Rerecich continued to engage in physical therapy and took dozens of medications daily to limit the chance of infection.", + "doc_fkgl": 11.779287370862324, + "wiki_fkgl": 12.345970330739302, + "doc_tree_depth": 6.208333333333333, + "wiki_tree_depth": 6.133333333333334, + "fkgl_delta": -0.566682959876978 + }, + { + "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": "Upon arriving at the hospital, Sacks was diagnosed with a torn quadriceps and was transferred to another hospital in Bergen to have an operation done to reattach the muscle. According to Sacks' surgeon Mr. Swan, the surgery was a success; however, Sacks was not convinced that it was. It had become quite obvious that the leg was not healing properly upon the arrival of the physiotherapist and Sacks' inability to contract the quadriceps no matter how hard he had tried. The following morning, Sacks was woken up to his leg hanging off the side of the bed and a feeling of nauseating estrangement towards the limb. Sacks had described it as a \"foreign inconceivable thing.\" Sacks, having experienced something similar to this with a patient of his from the past, determined that he must have acquired some form of \"anosognosia\" as a result of his accident. Unfortunately, the physicians treating Sacks did not acknowledge his illness on the basis that the operation was a success and anything that the patient was experiencing was simply a result of his own hysteria.", + "doc_fkgl": 3.26104347826087, + "wiki_fkgl": 12.392777777777777, + "doc_tree_depth": 4.0, + "wiki_tree_depth": 7.714285714285714, + "fkgl_delta": -9.131734299516907 + }, + { + "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": "Selected publications\n On the treatment of hydrocele, The Retrospect of Practical Medicine and Surgery, 1877, 75, 172\u2013174\n On the corpus Morgagni, with reference to diseases of the testicle. St Thos Hosp Rep 1874, 5, 73\u201384.\n On the different forms of hydrocele of the tunica vaginalis. St This Hosp Rep 1876, 7, 101\u2013118.\n Notes on diseases of the testis. London, 1880.\n Annotations on anaesthetics. St Thos Hosp Rep 1880, 10, 49, and 1882, 11, 23.\n Ambulance lectures: first aid to the injured. London, 1885.\n Ambulance lectures on home nursing and hygiene. London 1885; 2nd edition, 1891\n Premiers secours \u00e0 donner aux malades et aux blesses. Paris, 1894.", + "doc_fkgl": 11.784036259541985, + "wiki_fkgl": 6.800603773584907, + "doc_tree_depth": 5.375, + "wiki_tree_depth": 4.583333333333333, + "fkgl_delta": 4.983432485957078 + }, + { + "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": "Thorax\nThe thorax is opaque black with grayish-white light stripes. The front half of the lateral stripes and the posterior part of the middle stripes are indistinct. The dorsum pile is entirely yellow. The scutellum is yellowish-brownish and shining, and it is wholly yellowish pilose. The mesonotum is rather dull blackish, with the sides being either aeneous or thinly greyish pollinose. It has a pair of broadly separated and almost whitish, slender stripes that are widest anteriorly and often scarcely evident on the posterior half. In some specimens, these stripes are practically absent, while in others, they reach the scutellum and slightly broaden behind. The pleura is thinly greyish pollinose. The narrow base of the scutellum is blackish, while the rest of it is yellow. The thorax is wholly greyish yellow pilose, with some black pile in front of the scutellum. The scutellum is yellow pilose.", + "doc_fkgl": 15.11899521531101, + "wiki_fkgl": 8.094582814445829, + "doc_tree_depth": 6.5, + "wiki_tree_depth": 5.454545454545454, + "fkgl_delta": 7.024412400865181 + }, + { + "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": "Patients with cerebellar degeneration experience a progressive loss of nerve cells (Purkinje cells) throughout the cerebellum. As well as this, it is common to incur an elevated blood protein level and a high volume of lymph cells within the cerebrospinal fluid, resulting in swelling and enlargement of the brain. The most characteristic signs and symptoms experienced by patients with cerebellar degeneration include:\n muscle weakness\n an uncoordinated, staggering walk\n quivering of the torso\n jerky arm and leg movements\n tendency to falling over\n dysarthria (difficulty in articulating speech)\n dysphagia (difficulty in deglutition/swallowing of solids and liquids)\n vertigo (dizziness)\n nystagmus (rapid, involuntary eye movements), causing sleep disturbances\n ophthalmoplegia (paralysis of extraocular muscles)\n diplopia (double vision)", + "doc_fkgl": 4.794388489208632, + "wiki_fkgl": 23.09678571428572, + "doc_tree_depth": 4.923076923076923, + "wiki_tree_depth": 8.666666666666666, + "fkgl_delta": -18.302397225077087 + }, + { + "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": "Patients with cerebellar degeneration experience a progressive loss of nerve cells (Purkinje cells) throughout the cerebellum. As well as this, it is common to incur an elevated blood protein level and a high volume of lymph cells within the cerebrospinal fluid, resulting in swelling and enlargement of the brain. The most characteristic signs and symptoms experienced by patients with cerebellar degeneration include:\n muscle weakness\n an uncoordinated, staggering walk\n quivering of the torso\n jerky arm and leg movements\n tendency to falling over\n dysarthria (difficulty in articulating speech)\n dysphagia (difficulty in deglutition/swallowing of solids and liquids)\n vertigo (dizziness)\n nystagmus (rapid, involuntary eye movements), causing sleep disturbances\n ophthalmoplegia (paralysis of extraocular muscles)\n diplopia (double vision)", + "doc_fkgl": 14.753525835866263, + "wiki_fkgl": 23.09678571428572, + "doc_tree_depth": 6.333333333333333, + "wiki_tree_depth": 8.666666666666666, + "fkgl_delta": -8.343259878419456 + }, + { + "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": "1978 Nicolae and Maya Simionescu, Bucharest and Yale University\n 1980 , Johns Hopkins University\n 1981 Gilbert Thompson, Hammersmith Hospital\n 1982 , University of Copenhagen\n 1983 , University of California\n 1984 and Una Ryan, University of Miami\n 1985 Earl Wood, Mayo Clinic\n 1986 , University of Antwerp\n 1987 , University of California\n 1988 , University of South Alabama\n 1989 , New Jersey Medical School and , University of Florida\n 1990 , Vanderbilt University\n 1991 , State University of New York, Syracuse\n 1992 Judah Folkman, The Children's Hospital, Boston\n 1993 Arthur Brown, Baylor College of Medicine\n 1994 John B. Barlow, University of Witwatersrand, South Africa\n 1995 and , University of Virginia, Charlottesville\n 1996 Robert Furchgott, State University of New York and Salvador Moncada, University College, London\n 1997 Russell Ross, University of Washington\n 1998 , Johns Hopkins University\n 1999 Victor J. Dzau, Harvard Medical School\n 2000 Robert J. Lefkowitz, Duke University Medical School\n 2001 Mark C. Fishman, Harvard Medical School\n 2002 Salim Yusuf, McMaster University\n 2003 Eric N. Olson, University of Texas Southwestern Medical Center\n 2004 , University of Louisville\n 2005 , Jr., Harvard Medical School\n 2006 Peter Carmeliet, University of Leuven\n 2007 not awarded\n 2008 , Harvard Medical School\n 2009 Peter Libby, Harvard Medical School\n 2010 , Stanford University School of Medicine\n 2011 , University of California, San Francisco\n 2012 Garret A. FitzGerald, Perelman School of Medicine, University of Pennsylvania\n 2013 David Ginsburg, University of Michigan\n 2014 , University of Cincinnati College of Medicine\n 2015 , University of Cincinnati College of Medicine\n 2016 Brian K. Kobilka, Stanford University School of Medicine\n 2017 John McMurray, University of Glasgow\n 2018 Dan M. Roden, Vanderbilt School of Medicine ; Nabil G. Seidah, Montreal Clinical Research Institute\n 2019 Joseph A. Hill, University of Texas Southwestern Medical Center", + "doc_fkgl": 14.958653673835126, + "wiki_fkgl": 18.297942804428043, + "doc_tree_depth": 5.866666666666666, + "wiki_tree_depth": 12.0, + "fkgl_delta": -3.339289130592917 + }, + { + "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": "He was active in establishing postgraduate programmes in surgical training and one of the early surgeons to perform aortic surgery in India in the 1950s. After being the first in India to perform a closed mitral valvotomy in 1952, within a year he repaired a coarctation of the aorta and by 1956 he had successfully attempted the first direct vision closure of an atrial septal defect. In the 1950s he turned his attention from aortic surgery to open heart surgery following numerous experiments on dogs. He subsequently led teams that performed two heart transplants in Bombay in 1968. Both recipients died on the day of their operation.", + "doc_fkgl": 6.522207792207791, + "wiki_fkgl": 12.606467289719628, + "doc_tree_depth": 5.571428571428571, + "wiki_tree_depth": 6.0, + "fkgl_delta": -6.084259497511837 + }, + { + "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": "The LeCompte maneuver is a technique used in open heart surgery, primarily on infants and children. The maneuver entails cutting the main pulmonary artery and moving it anterior to the aorta before reattaching the pulmonary artery during the following reconstruction of the great vessels. It allows the surgeon to reconstruct the right ventricular outflow tract without needing to connect the proximal and distal sections with a graft. It also enables the surgeon to avoid compressing the coronary arteries and relieves compression of the bronchi in cases where the pulmonary artery is severely dilated or aneurysmal. If both pulmonary arteries are not mobilized adequately, they can become stretched, leading to pulmonic stenosis.", + "doc_fkgl": 13.480000000000004, + "wiki_fkgl": 15.179711711711715, + "doc_tree_depth": 7.166666666666667, + "wiki_tree_depth": 7.4, + "fkgl_delta": -1.6997117117117106 + }, + { + "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": "Basic principle \nIt is said that hemoptysis is caused by the formation of anomalous anastomosis (bronchial artery-pulmonary artery shunt) between the bronchial artery and the pulmonary artery, and if the bronchial artery is embolized, hemorrhage will cease. This is a fundamental concept of BAE. Traditionally, BAE was mostly performed as an emergency hemostatic procedure. Recently, it is often performed as an elective catheter treatment to prevent recurrence after massive hemoptysis, or control chronic repetitive hemoptysis. Although it is termed bronchial artery embolization, various systemic arteries other than the bronchial artery (non-bronchial arteries) also form a shunt with the pulmonary artery and cause hemoptysis. Therefore, it is common to embolize such non-bronchial arteries, but the expression of bronchial artery embolization, BAE, rather than the universal expression \"arterial embolization\" is more common. The therapeutic outcomes are improving due to the combined approach such as spreading the treatment target to non-bronchial arteries, development of 3D-CT angiography following the development of MDCT, the advancement of devices such as coils and micro-catheters, and the evolution of therapeutic strategies. BAE has become the gold standard for hemoptysis for its dramatic improvement. Although the hemostatic effect is greatly affected by the underlying disease, some high-volume centers report hemostatic rate of about 90.4% within one year of treatment, and 85.9% even in two years after treatment. The occlusion of the blood vessels in the brain, heart, and kidneys, which are supplied by the so-called end arteries, can cause cerebral, myocardial, and renal infarctions. In BAE, both bronchial mucosal necrosis and pulmonary infarction seldom occur. It is presumed that this is because the pulmonary circulation is dually controlled by the bronchial artery and the pulmonary artery; and even if the blood flow in the bronchial artery is lost, blood flow from the pulmonary artery is slightly maintained.\u00a0In the case of non-bronchial arteries, it is empirically known that some collateral circulations also develop. In addition, direct hemorrhage from the pulmonary artery is rare (less than 5%), which requires embolization of the pulmonary artery.", + "doc_fkgl": 9.065632911392406, + "wiki_fkgl": 15.126699101796408, + "doc_tree_depth": 6.684210526315789, + "wiki_tree_depth": 6.857142857142857, + "fkgl_delta": -6.061066190404002 + }, + { + "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": "This condition is frequently associated with dry eye disease since sensations of dryness and burning in the eye are a common symptom of both neuropathic eye pain and dry eye, but ocular neuropathic pain should be considered as a disease in its own right. Neuropathic pain patients may have little or no signs of aqueous dry eye, and frequently respond poorly to conventional dry eye treatments. Unlike conventional dry eye disease, there may be little or no sign of ocular surface damage, (the condition is sometimes referred to as \"pain without stain\"), however patients may also have symptoms of dry eye but with pain symptoms that are out of proportion to the dry eye presentation.", + "doc_fkgl": 6.597509398496243, + "wiki_fkgl": 18.034782608695654, + "doc_tree_depth": 5.875, + "wiki_tree_depth": 8.0, + "fkgl_delta": -11.437273210199411 + }, + { + "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": "The sensation of pain has been described by patients as \"burning eyes\", \"terrible, unrelenting pain\", a feeling of \"a knife in my eye\" or \"paper cuts\". The pain is usually described as being located in and around the eye, but can progress to the surrounding areas of the face and head. A signature characteristic of ocular neuropathic pain is inadequately explained levels of severe, constant pain in relation to little or no sign of ocular surface damage. Providers have reported their patients describing excruciating, consistently high levels of pain, or even requesting surgical removal of the painful eye.", + "doc_fkgl": 11.54186046511628, + "wiki_fkgl": 14.675204081632653, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 8.5, + "fkgl_delta": -3.133343616516374 + }, + { + "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": "In a recent publication, Andreas Flammer and his group at the Clinic of Cardiology at Zurich University performed retinal vessel analysis in 74 patients with compensated chronic heart failure, 74 patients with cardiovascular risk factors and 74 healthy controls. The primary endpoint, flicker-induced dilatation of retinal arterioles (FIDart), was significantly reduced in patients with chronic heart failure: 0.9% versus 2.3% in persons with risk factors and 3.6% in healthy individuals. The researchers concluded that retinal vessel analysis may represent a new and useful method to non-invasively monitor microvascular abnormalities in heart failure.\nIn patients with diabetes mellitus, those suffering from cardiovascular disease showed significant differences in arterial maximum constriction after flicker light stimulation compared to patients with diabetes but without cardiovascular disease. This difference in reaction pattern and lack of arterial constriction in DM is thought to provide a suitable marker to monitor progression.\nIn a cohort of 10,407 participants, analysing the retinal vessel caliber led to the reclassification of 21% of low-risk women to carrying an intermediate risk.\nPatients recovering from a myocardial infarction and included in an exercise based cardiac rehabilitation programme showed marked improvement in the retinal microvacular response.", + "doc_fkgl": 14.661870129870131, + "wiki_fkgl": 16.604249999999997, + "doc_tree_depth": 5.473684210526316, + "wiki_tree_depth": 8.142857142857142, + "fkgl_delta": -1.9423798701298658 + }, + { + "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": "Experience during the Continuation War\nKoivunen was a Finnish soldier, assigned to a ski patrol on 15 March 1944 along with several other Finnish soldiers. Three days into their mission on 18 March, the group was attacked and surrounded by Soviet forces, from whom they were able to escape. Koivunen became fatigued after skiing for a long distance but could not stop. He was carrying his patrol's entire supply of army-issued Pervitin, or methamphetamine, a stimulant used to remain awake while on duty. He consumed the entire supply of Pervitin, and had a short burst of energy, but soon entered a state of delirium and eventually lost consciousness. Koivunen later recalled waking up the following morning, separated from his patrol and having no supplies. In the following days, he escaped Soviet forces once again, was injured by a land mine, and stayed in a ditch for a week, waiting for help. Having skied more than 400\u00a0km (248.5\u00a0mi), he was found and admitted to a nearby hospital, where his heart rate was measured at 200 beats per minute, and he weighed only 43\u00a0kg (94.8\u00a0lbs). In the week that Koivunen was gone, he subsisted only on pine buds and a single Siberian jay that he caught and ate raw. He was found, and survived, until he died in 1989 at the age of 71.", + "doc_fkgl": 6.542719298245618, + "wiki_fkgl": 9.600603378921964, + "doc_tree_depth": 4.823529411764706, + "wiki_tree_depth": 6.9, + "fkgl_delta": -3.057884080676345 + }, + { + "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": "Balanced anesthesia is an anesthetic method for surgical patients during their operation, which was proposed by John Lundy in 1926. The purpose of balanced anesthesia is not only to be less dangerous than using only one drug for general anesthesia but also to minimise the potential adverse side effects which may be caused by the anesthetic agents. The concept of balanced anesthesia is that of applying two or more medications or techniques in order to ease pain, relax the muscles, and have autonomous reflexes suppressed in the patient. In other words, it is an anesthesia method to maintain stable vital signs. There are numerous factors that come into play when the anesthetist decides to use this method of anesthesia. These factors include, but are not limited to: patients' major organ functions, general condition and compensatory capacity. By making use of adequate types and appropriate amounts of agents and accurate anesthesia methods, the anesthetist will promote a successful, safe, and efficient surgery.", + "doc_fkgl": 12.910294117647059, + "wiki_fkgl": 14.414782608695656, + "doc_tree_depth": 6.444444444444445, + "wiki_tree_depth": 8.285714285714286, + "fkgl_delta": -1.5044884910485976 + }, + { + "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": "Category and symptoms \nThere are different types of cardiomyopathy which include a hypertrophic cardiomyopathy which makes the heart muscles to enlarge and thicken; dilated cardiomyopathy happens when the ventricles enlarge and weaken; restrictive cardiomyopathy makes the ventricles to stiffen; Hypertrophic cardiomyopathy is an inherited one from one generation to another and dilated cardiomyopathy results due to heavy alcohol consumption, use of cocaine and viral infections. The signs and symptoms of cardiomyopathy include; shortness of breath, fatigue, swelling in the legs, dizziness, lightheadedness, fainting during physical activities, irregular heartbeats, chest pain after heavy meals and unusual sounds associated with heartbeats. Gorillas inhabited the forests of central sub-Saharan Africa whereby they were divided into two species; the eastern gorillas and the western gorillas. They are much closer to humans because the DNA reveals a higher percentage between 95 and 99%. They fall under kingdom Mammalia same as the human and both have the same origin of common ancestors. Gorillas are considered to be a single species with three subspecies i.e. the western lowland gorilla, the eastern lowland gorilla and the mountain gorilla. Both the species became one after their forest habitat shrank and ended up separating. With gorillas that were captive by human, started developing fibrosing cardiomyopathy due to the foods that humans used to give them like biscuits diet which had much sugar and this made it difficult with digestion because of their hindgut digesters which processed food in their extra-long large intestines instead of their stomachs and had lesser energy distribution in their bodies. The new diet lowered the body fat and cholesterol and ended up affecting the bacteria living in gorillas\u2019 stomachs. A heart attack in humans occurs due to chest pain, sweating or even shortness of breath that results due to coronary artery having a problem in supplying blood into the heart muscle while with the gorillas, it happens due to the diet that the ones in captives used to take. Humans, who do not suffer from an acute coronary heart attack, do end up having a heart failure due to a gradual decrease of blood supply in the arteries. Both gorillas and humans have an unusual form of interstitial myocardial fibrosis whereby a normal myocardium in both humans and gorillas are quite similar to each other. The gorilla's heart fibrosis has been distributed in an unorderly manner in the cardiac muscle as seen in human.", + "doc_fkgl": 13.475840409207162, + "wiki_fkgl": 16.250911701363965, + "doc_tree_depth": 6.2631578947368425, + "wiki_tree_depth": 8.0, + "fkgl_delta": -2.7750712921568024 + }, + { + "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": "Works\n A Rare Type of Bladder Ulcer in Women; Report of Cases (1915)\n A Rare Type of Bladder Ulcer: Further Notes, with a Report of Eighteen Cases (1918)\n Ureteral stricture : an important etiologic factor in the so-called essential hematurias (1922)\n End results in one hundred cases of ureteral stricture (1924)\n Ureterocele : report of ten cases (1935)\n An unusual obstetric injury causing detachment of bladder and urethra from the symphisis pubis and complete epispadias (1937)\n The urinary tract in relation to the diagnosis of abdominal and pelvic lesions (1937)", + "doc_fkgl": 6.041, + "wiki_fkgl": 39.11181818181818, + "doc_tree_depth": 5.125, + "wiki_tree_depth": 7.75, + "fkgl_delta": -33.07081818181818 + }, + { + "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": "Though patients often present a diverse variety of symptoms, a case was observed in which a female adult with duplication of the colon, rectum, anus, urinary bladder, urethra, uterus, cervix, vagina, and external genitalia exhibited no detrimental effects. This suggests that rarely seen cases of complete duplication of the urogenital and gastrointestinal tract are often asymptomatic.", + "doc_fkgl": 12.18240740740741, + "wiki_fkgl": 19.772857142857145, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 13.0, + "fkgl_delta": -7.5904497354497344 + }, + { + "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": "He was one of the original members of the New Haven County Medical Association, and served on the committees of correspondence and examination. In April, 1788, he reported a case of \"scirrhus in the pylorus of an infant,\" which was the first case on record of congenital hypertrophy of the pylorus in an infant. It was printed with the papers of the society, which appeared in their transactions entitled: \"Cases and Observations.\" In this paper Beardsley noted practically every feature of the disease we now know. He had attended the patient for three years at Southington, and when her death, at the age of five years, \"closed the painful melancholy scene\" he performed the autopsy. He speaks of the \"constant puking,\" which was first noted during the first week of life. Everything in the shape of food, the child took was almost instantaneously rejected and very little changed. The feces were small in quantity. He comments upon the leanness and wizened old look of the child, and states he had \"pronounced a scirrhosity in the pylorus months before the child's death,\" although he first attributed the condition to a deficiency of bile and gastric juices joined with a morbid relaxation of the stomach. Unfortunately, Beardsley did not know of the child's death \"until the second day after it took place. This late period, the almost intolerable stench, and the impatience of the people who had collected for the funeral, prevented so thorough an examination of the body as might otherwise have been made.\" At the autopsy Beardsley noted that the stomach was unusually large and distended. \"The pylorus was invested with a hard compact substance or scirrhosity, which so completely obstructed the passage into the duodenum as to admit with the greatest difficulty the finest fluid.\"", + "doc_fkgl": 14.957394957983198, + "wiki_fkgl": 12.345405405405405, + "doc_tree_depth": 5.411764705882353, + "wiki_tree_depth": 8.076923076923077, + "fkgl_delta": 2.6119895525777928 + }, + { + "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": "Diagnosis\nThe diagnosis may be provisionally made on clinical grounds. Ophthalmologists, neurologists, cardiologists, and pediatricians are some of the specialists who can make the diagnosis. Because of the widespread impact of the disease, it is most likely to be a collaborative effort. Acute lactic acidosis and heart disease are the greatest threats to life and must be treated promptly. Yet, more than half of newborns die before they reach their second birthday, and some live a decade or more. In terms of severity, there is a considerable range. Further diagnostic tests include serum and urine analysis for lactic acid, a chest X-ray (or cardiac CT or MRI) and echocardiography. Biopsies from cardiac and skeletal muscle will show the presence of lipid and glycogen. testing for mitochondrial abnormalities, ANT deficiency, and decreases of respiratory chain complexes I and IV can also be done.", + "doc_fkgl": 5.827348837209307, + "wiki_fkgl": 11.75347417840376, + "doc_tree_depth": 5.066666666666666, + "wiki_tree_depth": 6.0, + "fkgl_delta": -5.926125341194453 + }, + { + "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": "There are many causes contributing to blood vessel disorder including high blood cholesterol and calcium levels, blood clot formation and inflammation of arteries. It is found that age, sedentary lifestyle, diets rich in lipids, smoking, diabetes and family history of cardiovascular diseases are common risk factors. A mild degree of blood vessel disorder may be asymptomatic. Blood tests on cholesterol and calcium level can be performed to monitor the risk of having the disorder. Additionally, techniques such as angiography and ultrasound imaging are useful tools for diagnosis. It can be treated by both medication or surgery, depending on the type of blood vessel disorder.", + "doc_fkgl": 14.593809523809526, + "wiki_fkgl": 13.408461538461541, + "doc_tree_depth": 5.888888888888889, + "wiki_tree_depth": 8.166666666666666, + "fkgl_delta": 1.1853479853479847 + }, + { + "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": "Ethel J. Finck and Mordecai Halpern, (1971) The Nutrient Supplement-Enhanced Celiac Angiogram. Radiology 1971 101:1, 79-83.\nLayne, T. A., Finck, E. J., & Boswell, W. D. (1978). Transcatheter occlusion of the arterial supply to arteriovenous fistulas with Gianturco coils. American Journal of Roentgenology, 131(6), 1027-1030.\n McNeese, S., Finck, E., & Yellin, A. (1980). Definitive treatment of selected vascular injuries and post-traumatic arteriovenous fistulas by arteriographic embolization. American journal of surgery, 140 2 , 252-9.\n Yellin, A., Lundell, C., & Finck, E. (1983). Diagnosis and control of posttraumatic pelvic hemorrhage. Transcatheter angiographic embolization techniques. Archives of surgery, 118 12 , 1378-83.\n Quinn, M. F., Lundell, C. J., Klotz, T. A., Finck, E. J., Pentecost, M., McGehee, W. G., & Garnic, J. D. (1987). Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism. American Journal of Roentgenology , 149 (3), 469-471.\n Blickenstaff, K.L., Weaver, F., Yellin, A., Stain, S., & Finck, E. (1989). Trends in the management of traumatic vertebral artery injuries. American journal of surgery, 158 2 , 101-5; discussion 105-6.\n Robinson, David & Teitelbaum, George & Pentecost, Michael & Weaver, Fred & Finck, Ethel. (1993). Transcatheter embolization of an aortocaval fistula caused by residual renal artery stump from previous nephrectomy: A case report. Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 17. 794-7. 10.1016/0741-5214(93)90130-E.", + "doc_fkgl": 16.972754430379748, + "wiki_fkgl": 13.579927325581401, + "doc_tree_depth": 6.380952380952381, + "wiki_tree_depth": 5.7727272727272725, + "fkgl_delta": 3.3928271047983465 + }, + { + "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": "Technique \nThe Yasui procedure is done via a median sternotomy and uses cardiopulmonary bypass. If there is a patent ductus arteriosus, the surgeon begins by closing it. The surgeon then connects the separated parts of the aorta together. The surgeon then transects the pulmonary artery and aorta and frees them from surrounding tissue, then makes an incision into the right ventricle to allow them to assess the ventricular septal defect and remove excess muscle bundles in cases of extensive right ventricular hypertrophy. If the ventricular septal defect is smaller than the pulmonary valve, the surgeon will enlarge the defect. The surgeon then uses a patch, commonly made of bovine (cow) pericardium or the child's own tissue, to create a tunnel between the ventricular septal defect and the pulmonary valve. This allows for blood to flow from the left ventricle to the pulmonary valve. After creating this tunnel, the surgeon connects the aortic and pulmonary roots (Damus-Kaye-Stansel anastomosis).", + "doc_fkgl": 5.730088652482269, + "wiki_fkgl": 13.03317675159236, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 6.25, + "fkgl_delta": -7.3030880991100915 + }, + { + "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": "The LeCompte maneuver is a technique used in open heart surgery, primarily on infants and children. The maneuver entails cutting the main pulmonary artery and moving it anterior to the aorta before reattaching the pulmonary artery during the following reconstruction of the great vessels. It allows the surgeon to reconstruct the right ventricular outflow tract without needing to connect the proximal and distal sections with a graft. It also enables the surgeon to avoid compressing the coronary arteries and relieves compression of the bronchi in cases where the pulmonary artery is severely dilated or aneurysmal. If both pulmonary arteries are not mobilized adequately, they can become stretched, leading to pulmonic stenosis.", + "doc_fkgl": 11.984808362369339, + "wiki_fkgl": 15.179711711711715, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 7.4, + "fkgl_delta": -3.1949033493423755 + }, + { + "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": "Description \nThe dorsal vertebrae have spool-shaped centra which are about 1.4 times longer than high, making them more elongated than those of herrerasaurids. Several areas on the dorsals are incised, such as the sides of the centrum (which each have a shallow depression) and the rear of the neural arch (which has postzygapophyseal centrodiapophyseal and centrodiapophyseal fossae). There were likely three sacral vertebrae, with at least the first one articulating with the hip akin to the \"primordial\" first sacral of other reptiles. This contrasts with Saturnalia in which the first sacral vertebra is an incorporated dorsal vertebra without the hallmarks of a primordial sacral. The sacral vertebrae were thick and wide, but not fused to each other or their respective sacral ribs. The most complete sacral rib was fan shaped when seen from above and has a cross section which gradually curves upwards towards the front, also unlike Saturnalia which has a more L-shaped cross section. The caudal vertebrae increase in length and gradually reduce the size of their transverse processes from the base of the tail to the tip. Caudals at the base of the tail have pronounced midline keels along their entire lower edge. This characteristic is seemingly unique to Nhandumirim, as the only other dinosauromorphs with ventral keels in proximal caudals are Dracoraptor (which had paired, not midline, keels) and Efraasia (in which they were restricted to the front third of the centrum). The zygapophyses of the caudals are short, unlike the longer joints of herrerasaurids and neotheropods.", + "doc_fkgl": 16.455087719298245, + "wiki_fkgl": 11.455704454907643, + "doc_tree_depth": 7.0, + "wiki_tree_depth": 8.3, + "fkgl_delta": 4.999383264390602 + }, + { + "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": "The ovarian yolk sac tumors, also known as endodermal sinus tumors, are accountable for approximately 15.5% of all OGCTs. They have been observed in women particularly in their early ages, and rarely after 40 years of age. The critical pathologic features are a smooth external surface and capsular tears due to their rapid rate of growth. A study consisting of 71 individual cases of ovarian yolk sac tumor provides evidence to the proliferation of the tumor. In one of the cases, the pelvic examination revealed normal activity until a 9\u00a0cm and 12\u00a0cm sized tumor was discovered 4 weeks later. In another case, a 23\u00a0cm tumor was discovered in a pregnant woman who was monitored regularly and had normal findings until oophorectomy became essential. Histologically, these tumors are characterized by mixed solid and cystic components. The mixed solid components are characterized by a soft gray to yellow solid components accompanied with significant hemorrhage and necrosis. The cysts are approximately 2\u00a0cm in diameter and populated throughout the tissue which results in giving the neoplasm a \u2018honeycombed appearance\u2019.", + "doc_fkgl": 5.262667512690356, + "wiki_fkgl": 12.947424581005588, + "doc_tree_depth": 5.15, + "wiki_tree_depth": 6.777777777777778, + "fkgl_delta": -7.684757068315232 + }, + { + "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": "A mucinous cystic neoplasm is an abnormal and excessive growth of tissue (neoplasm) that typically has elements of mucin and one or more cysts. By location, they include:\nPancreatic mucinous cystic neoplasm. These lesions are benign, though there is a high rate of progression to cancer. As such, surgery should be pursued when feasible. The rate of malignancy present in MCN is about 10 percent. If resection is performed before invasive malignancy develops, prognosis is excellent. The extent of invasion is the single most important prognostic factor in predicting survival.\nMucinous cystic neoplasms of the liver are a type of liver cancer in which tissue similar to the stroma of ovary occurs.", + "doc_fkgl": 13.893053097345135, + "wiki_fkgl": 10.941428571428574, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 5.375, + "fkgl_delta": 2.9516245259165608 + }, + { + "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": "Presentation\nThe majority of BP cases have been diagnosed in Caucasians with only rare cases being diagnosed in individuals of Asian, or African descent. At least 6 cases of BP have been reported to occur in women during their pregnancies. BP tumors commonly present as multinodular, mobile, well-circumscribed masses 3 to 8 centimeters in widest diameter located in the periphery of a breast. Rarely, these tumors have been less than 3 centimeters in widest diameter or larger than 8 centimeters in widest diameter; in one case, the PB tumor, termed giant juvenile papillomatosis, was 20\u2009centimeters in widest diameter. While usually a single tumor, BP tumors have presented as two or more tumors in one breast or bilateral disease, i.e. tumors in both breasts. In a review of 354 reported cases of PB: 344 occurred in females (~96%), 6 in males (~2%), and 2 (~0.6) in individuals whose sex was not mentioned; the individuals ranged from 7 months to 81 years (average age 26 years); 316 (~90%) individuals complained of a palpable mass, 2 (~0.6%) of pain, 2 (~0.6%) of nipple discharge (this discharge may be bloody), and 1 (0.3%) of a palpable mass plus nipple discharge; 18 (~5%) had an entirely symptomless breast tumor detected by breast cancer screening methods; 25 (~7%) individuals had an associated breast carcinoma at diagnoses and 68 (19%) had a family history of breast cancer. The breast cancers associated with BP are mammary secretory carcinomas, lobular carcinoma in situ, invasive lobular carcinoma, ductal carcinoma in situ, and invasive ductal carcinoma. A positive family history of breast cancer together with recurrent bilateral PG is a risk factor for developing these breast cancers. The genetic diseases associated with BP are Cowden disease, Noonan syndrome, Proteus syndrome, and neurofibromatosis type 1.", + "doc_fkgl": 15.117090909090908, + "wiki_fkgl": 13.91224489795918, + "doc_tree_depth": 6.071428571428571, + "wiki_tree_depth": 7.555555555555555, + "fkgl_delta": 1.2048460111317283 + }, + { + "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": "In 1957, Louisiana hospitals were hit with a virulent outbreak of staphylococcus that threatened both newborns and surgical patients. Though staph infections had been eradicated through the use of penicillin, the bacteria had become resistant to penicillin. Greene, \"the only bacteriologist within a hundred miles\", was asked by public health officials to help halt the outbreak. He later said: \"I wasn't a physician, but they asked for help so I advocated a return to the old protocols of Semmelweis and Nightingale: wash your hands, wear gowns, isolate patients. It worked, so we published a paper on how we'd handled the crisis\".", + "doc_fkgl": 7.468333333333334, + "wiki_fkgl": 12.149386138613863, + "doc_tree_depth": 6.125, + "wiki_tree_depth": 6.166666666666667, + "fkgl_delta": -4.68105280528053 + }, + { + "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": "Fibrosing cardiomyopathy is a disease commonly caused by a heart failure in great apes, most specially the males. When fibrosing cardiomyopathy attacks a healthy heart, it comes with a bacterium or a virus that makes the muscles of the heart turn into fibrous bands which makes them unable to pump blood in the blood streams. When a gorilla is stressed, or the food it eats, then catecholamine which is a harmful substance is released in the heart muscle that make the C-reactive protein that is found in blood plasma produced by the liver to swell, causing rheumatoid arthritis.", + "doc_fkgl": 12.996079027355623, + "wiki_fkgl": 14.488775510204082, + "doc_tree_depth": 5.714285714285714, + "wiki_tree_depth": 12.0, + "fkgl_delta": -1.4926964828484586 + }, + { + "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": "Dr. Denton Cooley implanted the first temporary artificial heart, in an operation at St. Luke's Episcopal Hospital in Houston. The recipient was 47-year-old Haskell Karp of Skokie, Illinois, whose diseased heart was removed from his chest and replaced by the Liotta TAH plastic and fabric mechanical pump, developed by Dr. Domingo Liotta. Sixty-five hours after the implantation of the mechanical heart, Karp received a donor heart from a 40-year-old woman whose body had been flown in from Lawrence, Massachusetts. However, Karp survived only 32 hours after the new heart was implanted, before he succumbed to pneumonia caused by Pseudomonas bacteria; another artificial heart implant would not take place until 1981.\n Popular, but controversial, The Smothers Brothers Comedy Hour was abruptly canceled by the CBS television network. CBS President Robert Wood explained that the show's two producers, Dick Smothers and Tommy Smothers, \"consistently had failed to deliver tapes\" of their programs in time for CBS executives and local TV stations to review the content, and added that it was \"abundantly clear\" that the brothers were \"unwilling to accept the criteria of taste established by the network's program practices department.\" \n Also popular and controversial, singer Jim Morrison of The Doors appeared with his attorney before the Los Angeles office of the FBI to answer federal charges of \"interstate flight to avoid prosecution\" in relation to his indecent exposure at his March 1 concert in Miami. By arrangement, Morrison was arrested and immediately released upon posting of a $5,000 bond. By then, The Doors' 1969 concert dates had been canceled and the group was blacklisted by the Concert Hall Managers' Association.\n Born: Mo Cowan, American lawyer and interim United States Senator from Massachusetts\n Died: U.S. Army Staff Sergeant F\u00e9lix Conde Falc\u00f3n, 31, was killed in the Vietnam War while leading a charge against a large complex of enemy bunkers at Ap Tan Hoa. Almost 35 years later, the case of the Puerto Rican non-commissioned officer would be reviewed and Falc\u00f3n would be awarded the Medal of Honor for his bravery.", + "doc_fkgl": 12.497337640821737, + "wiki_fkgl": 15.108724035608315, + "doc_tree_depth": 5.96, + "wiki_tree_depth": 8.454545454545455, + "fkgl_delta": -2.611386394786578 + }, + { + "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": "Technique \nThe Yasui procedure is done via a median sternotomy and uses cardiopulmonary bypass. If there is a patent ductus arteriosus, the surgeon begins by closing it. The surgeon then connects the separated parts of the aorta together. The surgeon then transects the pulmonary artery and aorta and frees them from surrounding tissue, then makes an incision into the right ventricle to allow them to assess the ventricular septal defect and remove excess muscle bundles in cases of extensive right ventricular hypertrophy. If the ventricular septal defect is smaller than the pulmonary valve, the surgeon will enlarge the defect. The surgeon then uses a patch, commonly made of bovine (cow) pericardium or the child's own tissue, to create a tunnel between the ventricular septal defect and the pulmonary valve. This allows for blood to flow from the left ventricle to the pulmonary valve. After creating this tunnel, the surgeon connects the aortic and pulmonary roots (Damus-Kaye-Stansel anastomosis).", + "doc_fkgl": 5.185050449959093, + "wiki_fkgl": 13.03317675159236, + "doc_tree_depth": 4.526315789473684, + "wiki_tree_depth": 6.25, + "fkgl_delta": -7.848126301633268 + }, + { + "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": "The longitudinal intestinal lengthening and tailoring (Bianchi) procedure is a form of autologous intestinal reconstruction. The small bowel is divided longitudinally in the midline, preserving one leaf of mesentery with its blood supply to each half. This results in two vascularized segments of small bowel which can then be rejoined end-to-end to restore continuity of the small bowel. There are also another ways of performing this procedure. it is one of the surgical therapeutic options along with other surgical options such as small bowel segmental reversal, artificial intestinal valve construction, electrical pacing of the small bowel, serial transverse enteroplasty, or transplantation in treatment of short gut syndrome.", + "doc_fkgl": 16.9342905982906, + "wiki_fkgl": 15.363476635514022, + "doc_tree_depth": 5.8, + "wiki_tree_depth": 9.2, + "fkgl_delta": 1.570813962776576 + }, + { + "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": "Invasive growth and metastasis\nThe results of numerous experimental and clinical studies of malignant neoplasms have indicated that invasive growth and metastasis are the main manifestations of tumor progression, which constitute two closely related processes.\n\t\nA malignant tumor is defined by its capacity to initiate a biological phenomenon known as the metastatic cascade, a complex multi-stage process in which cell invasion precedes further cancer progression and the formation of metastases in distant organs and tissues. Massive metastatic lesions lead to the development of organ failure. The range between the \u201cend\u201d points of a complex invasive metastatic process\u2013an invasion of the primary tumor into surrounding tissues and the formation of metastatic foci\u2013comprises several stages, the passage of which is strictly necessary for the successful development and subsequent progression of tumor growth: intravasation, survival and presence in the systemic circulation, extravasation with subsequent colonization of organs by tumor cells, and the formation of clinically detectable metastases. Tumor growth is accompanied by increasing pressure on surrounding extracellular matrix structures, whereas the tissue microenvironment works to retain its functional-anatomic integrity by increasing pressure on the tumor cells. The factors limiting the growth of malignant neoplasms include the basement membrane and various components of the surrounding stroma, increased interstitial pressure, limited oxygen supply to tumor cells and the production of reactive oxygen species, and persistent contact with immune system cells. Due to intratumoral heterogeneity, some tumor cells may undergo regression and death, while others, resilient against opposing microenvironmental factors, acquire an aggressive phenotype and the capacity to metastasize.", + "doc_fkgl": 14.549020678891925, + "wiki_fkgl": 22.618757763975157, + "doc_tree_depth": 6.681818181818182, + "wiki_tree_depth": 8.428571428571429, + "fkgl_delta": -8.069737085083233 + }, + { + "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": "One of the most frequent causes of ankle pain (accounting for around 85 percent of total ankle problems - according to the National University of Health Sciences (NUHS)) a sprain occurs when the ankle is twisted, causing the ligaments to be over-stretched, or even (in the most severe cases) torn. Most ankle sprains are lateral sprains that occur when the foot rolls, causing the side of the ankle to be pressed to the ground. Small blood vessels rupture in the process and cause the ankle to swell and damage may also occur to the ligaments, these constituting a short band of tough, flexible, fibrous connective tissues holding the bones together. Rolling of the ankle may also damage cartilage or tendons. A sprained ankle will usually display signs of swelling and bruising for one to two weeks, although more serious cases may take several months to heal fully.", + "doc_fkgl": 5.560996503496504, + "wiki_fkgl": 13.821287671232877, + "doc_tree_depth": 4.916666666666667, + "wiki_tree_depth": 7.666666666666667, + "fkgl_delta": -8.260291167736373 + }, + { + "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": "In 1967 he became the first Professor of Orthopaedic Surgery at the University of St Andrews transferring to the University of Dundee when the bulk of the medical school moved there. Smillie was regarded as an excellent technical surgeon and an inspiring teacher. He became an influential authority on knee conditions. His book Injuries of the knee joint, first published in 1946, became widely read throughout the English-speaking world and was to be published in five English language editions and a Spanish edition. Diseases of the knee Joint, first published in 1974 went to three editions and was also published in Spanish. Smillie was an enthusiastic advocate of removal of the injured meniscus and developed instruments and techniques to facilitate this procedure. From the 1980s advances in technology and understanding of the adverse consequences of meniscectomy led to a more conservative approach being adopted. In 1981 Smillie was elected president of the International Society of the Knee.", + "doc_fkgl": 9.454666666666668, + "wiki_fkgl": 12.958017515923569, + "doc_tree_depth": 5.454545454545454, + "wiki_tree_depth": 6.625, + "fkgl_delta": -3.5033508492569005 + }, + { + "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": "Indications \nLabral reconstruction, while still a relatively novel technique, has demonstrated utility and efficacy in treating labral tears in patient's whose native labral tissue is far too damaged for arthroscopic debridement or repair. It is most often utilized in order to surgically correct the damage resulting from femoroacetabular impingement (FAI), a condition in which the femoral head articulates imperfectly with the acetabular cup. Labral damage resulting from FAI or other conditions exists on a spectrum, with varying degrees of labral damage necessitating different surgical management. The most mild degrees of labral damage can be managed with arthroscopic debridement, a procedure in which the damaged tissue is excised with an arthroscopic shaver or electrocautery device. More moderate damage responds better to arthroscopic labral repair, a procedure in which surgical anchors are drilled into the bony acetabular rim and sutures are used to reapproximate the damaged labral tissue. The most severe degrees of labral pathology is often unresponsive to labral repair, with damage far too diffuse for focal debridement. In these cases, labral reconstruction is the best option for not only restoring the biomechanics of the acetabular labrum, but for treatment of the patient's pain.", + "doc_fkgl": 11.863529411764706, + "wiki_fkgl": 16.317261287934866, + "doc_tree_depth": 5.75, + "wiki_tree_depth": 7.857142857142857, + "fkgl_delta": -4.45373187617016 + }, + { + "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": "Andrew De La Pena was five months old when he received a new heart in 1986 at Stanford University School of Medicine, in an operation led by Norman Shumway. Edward Stinson led the donor team and the donor heart was flown to Stanford on a 2-seater fighter plane with the pilot only, that is without the donor team. The story made headlines and was published in the New York Times Magazine and then picked up by Reader's Digest who published an article entitled \"A New Heart for Andrew\" in 1988. He later survived Hodgkins Lymphoma and Hurricane Katrina and at the age of 32, was reunited with the donor parents.", + "doc_fkgl": 4.0628178694158095, + "wiki_fkgl": 12.513181818181817, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 7.75, + "fkgl_delta": -8.450363948766007 + }, + { + "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": "Embolic stroke of undetermined source (ESUS) is an embolic stroke, a type of ischemic stroke, with an unknown origin, defined as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources. As such, it forms a subset of cryptogenic stroke, which is part of the TOAST-classification. The following diagnostic criteria define an ESUS:\n Stroke detected by CT or MRI that is not lacunar\n No major-risk cardioembolic source of embolism\n Absence of extracranial or intracranial atherosclerosis causing 50% luminal stenosis in arteries supplying the area of ischaemia\n No other specific cause of stroke identified (e.g., arteritis, dissection, migraine/vasospasm, drug misuse)", + "doc_fkgl": 13.757534883720933, + "wiki_fkgl": 17.051999999999996, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 14.666666666666666, + "fkgl_delta": -3.2944651162790635 + }, + { + "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": "Causes \nThe following factors are suggested as pathogenesis of ESUS:\n Subclinical atrial fibrillation: Detectable in ~2.7-30% of ESUS patients, depending on duration and modality of ECG monitoring.\n Patent foramen ovale (PFO): Deep vein thrombosis may result in paradoxical embolism in patients with PFO. About 40% of patients with cryptogenic stroke have PFO compared with 25% of the general population. However, the actual embolic source can often not be identified. \n Non-stenotic arterial plaques: Complicated plaques with signs indicative of intra-plaque haemorrhage in an ipsilateral carotid artery are detected in 1 in 4 of patients with cryptogenic stroke. Aortic arch atherosclerosis is believed to be a specific cause of ESUS, particularly with plaques >4\u00a0mm diameter.\n Further cardiopathies: the risk of ischaemic stroke is increased by supraventricular tachycardias. This also applies to patients with elevated NT-proBNP levels and patients with atrial enlargement in cardiac ultrasound.\n Other causes: Arterial dissections, infection-related vasculopathies (esp. Varicella zoster virus), thrombophilia, cancer-related thrombosis, migraine, Fabry disease and other genetic, autoimmune or rheumatic causes.", + "doc_fkgl": 12.237704402515725, + "wiki_fkgl": 14.46412924424973, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 6.9, + "fkgl_delta": -2.226424841734005 + } +] \ No newline at end of file