diff --git "a/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_15_v1.json" "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_15_v1.json" new file mode 100644--- /dev/null +++ "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_15_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": "Bleed Out begins by introducing Judie Burrows, the mother of the comedy director Steve Burrows, as an independent, globetrotting, retired school teacher who loved to travel. The film shifts to June 2009, where Judie is rushed to a hospital in Milwaukee, Wisconsin after suffering a hip fracture due to a fall from her bike. At the hospital, Judie undergoes a hip surgery and a rehabilitation process; afterwards, she is sent home where she endured a slow recovery despite the physical therapy. Five months after her initial hip surgery, Judie falls again, and is rushed to the hospital. She spends eight days in the hospital, calmed with painkillers, as the physicians try to understand where exactly the pain was coming from. After a week, the physicians concluded that Judie has broken her hip again and needs a rushed partial hip replacement surgery. Steve Burrows mentions that his mother, before the incident, was taking Plavix, which is a blood thinner, and states that it is usually suggested that the patient should be off the blood thinner a few days before the surgery. Nonetheless, despite being on blood thinners, Judie is cleared and undergoes her second hip surgery, where she loses about half of her body's blood volume.", + "doc_fkgl": 4.138157894736846, + "wiki_fkgl": 13.226189024390248, + "doc_tree_depth": 4.5, + "wiki_tree_depth": 7.75, + "fkgl_delta": -9.088031129653402 + }, + { + "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": "Kidney ischemia is a disease with a high morbidity and mortality rate. Blood vessels shrink and undergo apoptosis which results in poor blood flow in the kidneys. More complications happen when failure of the kidney functions result in toxicity in various parts of the body which may cause septic shock, hypovolemia, and a need for surgery. What causes kidney ischemia is not entirely known, but several pathophysiology relating to this disease have been elucidated. Possible causes of kidney ischemia include the activation of IL-17C and hypoxia due to surgery or transplant. Several signs and symptoms include injury to the microvascular endothelium, apoptosis of kidney cells due to overstress in the endoplasmic reticulum, dysfunctions of the mitochondria, autophagy, inflammation of the kidneys, and maladaptive repair.", + "doc_fkgl": 15.20401179941003, + "wiki_fkgl": 14.737741935483871, + "doc_tree_depth": 4.888888888888889, + "wiki_tree_depth": 8.666666666666666, + "fkgl_delta": 0.46626986392615777 + }, + { + "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": "Indications\nIndications for indocyanine green angiography include:\n Choroidal neovascularisation (CNV): Indocyanine green angiography is widely used to study choroidal neovascularization in patients with exudative age-related macular degeneration. In ICGA, CNV is seen as hyperflourescent spot or plaque. It is also useful in diagnosing and classifying CNV associated to serous pigment epithelial detachments in Nonexudative macular degeneration.\n Idiopathic polypoidal choroidal vasculopathy (IPCV)\n Pigmented choroidal melanomas\n Choroidal haemangioma: ICGA can be used to differentiate choroidal haemangioma from other intraocular tumors.\n Choroiditis: In multifocal choroiditis, lesions are visualized as hypoflourescent spots.\n Chorioretinopathy: In Central serous chorioretinopathy, using ICGA multifocal areas of choroidal hyperpermiability can be visualized. In birdshoot chorioretinopathy, lesions appear as symmetrical round or oval hypoflourescent spots. ICGA allows better visualization of lesions in serpiginous chorioretinopathy, punctate inner chorioretinopathy, acute zonal occult outer retinopathy etc. In multiple evanescent white dot syndrome, numerous hypoflourescent spots can be visualized using ICGA.\n Pigmented epithelial detachment\n Retinal angiomatous proliferation (RAP)\n Chorioretinal atrophy: ICGA help evaluating different stages of chorioretinal atrophy.\n Anterior uveitis: ICGA is rarely indicated in anterior uveitis, but it might be used to find out associated choroidal pathology.\n Stargardt disease: Numerous hypoflourescent spots are seen in ICGA.\n Angioid streaks: ICGA can be used for diagnosing angioid streaks and their associated ocular pathologies.\n Vogt\u2013Koyanagi\u2013Harada disease (VKH): ICGA is useful in diagnosing VKH. In VKH, delay in filling of the choriocapillaris along with larger choroidal vessel perfusion and multiple hypofluorescent spots are visible with ICGA.\n Sympathetic ophthalmia: Sympathetic ophthalmia is a bilateral, granulomatous form of uveitis. In sympathetic ophthalmia, numerous dark spots may be visible during the intermediate phase of ICGA.", + "doc_fkgl": 17.108284910965327, + "wiki_fkgl": 16.04865704772475, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 6.0, + "fkgl_delta": 1.0596278632405784 + }, + { + "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": "On the marble case of the sarcophagus dedicated to Crepereia Tryphaena was engraved a scene with a deep bas relief alluding to the girl's death. She is depicted as dormant on the funeral bed, with the head resting on her left shoulder. On the bed's side, near her feet, a veiled matrona is seated, staring at the deceased. At the bedside, a virile figure wearing a chlamys is posed in deep pain.", + "doc_fkgl": 3.5813553113553134, + "wiki_fkgl": 7.655000000000001, + "doc_tree_depth": 5.142857142857143, + "wiki_tree_depth": 6.25, + "fkgl_delta": -4.073644688644688 + }, + { + "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": "Neonatal cerebral sinovenous ischemic stroke \nNeonatal cerebral sinovenous ischemic stroke is a disease in the cerebral venous system caused by thrombosis. Thrombosis in this region will hinder outflow from the venous system, causing a surge in the central venous pressure. This will lead to intracranial hypertension, cerebral ischemia or wide spreading hemorrhage which may result in a permanent neurologic deficit or mortality. This disease has an incidence rate of between 2.6 and 2.69 in every 100,000 babies per year. However, mortality due to neonatal cerebral sinovenous ischemic stroke is rather rare.", + "doc_fkgl": 11.942105263157895, + "wiki_fkgl": 11.394285714285715, + "doc_tree_depth": 6.4, + "wiki_tree_depth": 6.0, + "fkgl_delta": 0.5478195488721802 + }, + { + "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": "Selected publications\nPV Parimi, WT Lu, P Vodo, S Sridhar, \"Imaging by flat lens using negative refraction\", Nature 426 (6965), 404-404, 2003\nS Sridhar, \"Experimental observation of scarred eigenfunctions of chaotic microwave cavities\", Physical review letters 67 (7), 785, 1991\nS Sridhar, A Kudrolli, \"Experiments on not \u2018\u2018hearing the shape\u2019\u2019of drums\", Physical review letters 72 (14), 2175, 1994\nC Versek, T Frasca, J Zhou, K Chowdhury, S Sridhar, \"Electric field encephalography for brain activity monitoring\", Journal of neural engineering 15 (4), 046027, 2018\nCodi A Gharagouzloo, Liam Timms, Ju Qiao, Zihang Fang, Joseph Nneji, Aniket Pandya, Praveen Kulkarni, Anne L van de Ven , Craig Ferris, Srinivas Sridhar, \"Quantitative vascular neuroimaging of the rat brain using superparamagnetic nanoparticles: New insights on vascular organization and brain function\", Neuroimage 163, 24-33, 2017\nPV Parimi, WT Lu, P Vodo, J Sokoloff, JS Derov, S Sridhar, \"Negative refraction and left-handed electromagnetism in microwave photonic crystals\", Physical review letters 92 (12), 127401, 2003\nS Sridhar, DH Wu, W Kennedy, \"Temperature dependence of electrodynamic properties of YBa 2 Cu 3 O y crystals\", Physical review letters 63 (17), 1873, 1989\nTangutoori, Shifalika; Baldwin, Paige; Sridhar, Srinivas, \"PARP inhibitors: A new era of targeted therapy Journal Article\", Maturitas, 81 (1), pp. 5\u20139, 2015.", + "doc_fkgl": 16.247417695473253, + "wiki_fkgl": 86.23317073170732, + "doc_tree_depth": 6.083333333333333, + "wiki_tree_depth": 8.0, + "fkgl_delta": -69.98575303623406 + }, + { + "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": "Education \nMoutsopoulos received a DDS degree from the Aristotle University of Thessaloniki in 1998. In 2003, she completed a certificate in periodontics at the University of Maryland School of Dentistry where she completed a PhD in immunology in 2006 in the department of diagnostic sciences and pathology. Her dissertation was titled Dissection of factors contributing to HIV susceptibility in mucosal associated lymphoid tissues. She completed graduate research in the laboratory of her doctoral advisor Sharon Wahl at the National Institute of Dental and Craniofacial Research (NIDCR). She was a research fellow at NIDCR from 2006 to 2008. Her doctorate and post doctorate work focused on immune-mediated pathologies that present in the oral cavity including Sj\u00f6gren syndrome, periodontal disease and chronic wound healing. While these are distinct disease entities, they share as a salient feature non-resolving inflammation and immune mediated tissue destruction of which the mechanisms have been in the center of her research interest.\u00a0Activation of chronic inflammatory pathways in various disease entities have been linked to genetic susceptibility of the host, though emerging evidence implicates microbial factors for the initiation of disease pathogenesis for the majority of chronic inflammatory and autoimmune pathologies.", + "doc_fkgl": 4.63312375249501, + "wiki_fkgl": 18.091288860103628, + "doc_tree_depth": 5.277777777777778, + "wiki_tree_depth": 8.625, + "fkgl_delta": -13.458165107608618 + }, + { + "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": "Greenspan's oral disease research interests centered on the epidemiology, etiopathogenesis and management of oral soft tissue diseases, notably those associated with HIV infection and other causes of immunosuppression, as well as aphthous ulcers, Sj\u00f6gren syndrome, and oral cancer/pre-cancer. These topics have led to broad explorations in epidemiology, public/global health, policy, implementation science and other areas. He served until 2005 as founding Director of the UCSF Oral AIDS Center (OAC), which was supported by the NIDCR for 20 years. The OAC continues its research on the pathogenesis of oral lesions associated with HIV infection. He was part of a team looking into the molecular pathogenesis of Epstein\u2013Barr virus-associated hairy leukoplakia. Hairy leukoplakia is a lesion that Deborah Greenspan and he discovered, and in 1985 they identified a connection between it and Epstein\u2013Barr virus (EBV).", + "doc_fkgl": 10.328562500000004, + "wiki_fkgl": 15.856503759398496, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 9.333333333333334, + "fkgl_delta": -5.527941259398492 + }, + { + "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": "Outbreak\nOn 11 January 1962, shortly after being appointed consultant pathologist at St Luke's Hospital in Bradford, pathologist Derrick Tovey received two almost identical severely abnormal blood samples from two unrelated people who had been admitted with unexplained fevers to two different hospitals, unusually on the same day. One case was Hettie Whetlock, a 49 year old cook from Bradford Children's Hospital, who was under observation at the Leeds Road Fever Hospital. The other was Jack Crossly, a 40-year-old abattoir worker who had been admitted to Tovey's own hospital, St Luke's, and who died shortly after the blood was taken. Tovey described the samples as showing \"a mild anaemia, leucopenia, thrombocytopenia and a striking blood film with nucleated red cells, myelocytes, fragmenting granulocytes and vacuolation of the protoplasm, condensed nuclear bodies and atypical plasma cells and some T\u00fcrck cells\". The findings were similar to a description of smallpox made by Kano Ikeda in 1925. After examining the man in the mortuary and without waiting for laboratory confirmation, the diagnosis was assumed and the regional medical officer convened a committee. One nurse and five children from A1 ward at the Bradford Children's Hospital were shortly suspected of having smallpox. One of these children had already been transferred to Wharfedale Hospital for observation. The result was that four hospitals were initially quarantined. All cases were transferred to Oakwell Hospital, the designated isolation hospital in Birstall.", + "doc_fkgl": 14.527236842105264, + "wiki_fkgl": 14.666098712446352, + "doc_tree_depth": 7.214285714285714, + "wiki_tree_depth": 8.5, + "fkgl_delta": -0.13886187034108843 + }, + { + "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": "There is usually overgrowth of at least one extremity, with possible overgrowth of face and body. Soft tissue and bony overgrowth proportionate to patient growth are the most common associated changes in DCMO. Typically there are no bone abnormalities on imaging. However, leg length discrepancy is observed in approximately half of patient cases. There have been cases of hemihypertrophy, which are associated with diffuse CM appearance. Although rare, there are reports of limb hypotrophy. Syndactyly and macrodactyly are observed in approximately one third of patients. DCMO is not commonly associated with developmental delay. Knowledge of diseases associated with DCMO in the fetus is limited. However, there is a reported case of a fetus with DCMO and a pleural effusion.", + "doc_fkgl": 4.623939393939395, + "wiki_fkgl": 11.3619243697479, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 6.2, + "fkgl_delta": -6.737984975808505 + }, + { + "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": "The congenital heart block is a rare disease that affects around 1 child in every 15,000\u201320,000 births. However, its high mortality (which can be as high as 85% in some severe cases) makes the early diagnosis and intervention very important. CHB can be isolated, where the fetus does not suffer from any other problems, or it can be a result of other diseases either in the child or in the mother.", + "doc_fkgl": 11.214120481927715, + "wiki_fkgl": 11.921690140845072, + "doc_tree_depth": 5.4, + "wiki_tree_depth": 7.666666666666667, + "fkgl_delta": -0.7075696589173575 + }, + { + "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": "Presentation \nIndividuals presenting with the PAL form of DLBCL-CI have typically been elderly males (male to female ratio 4:1 to 12:1) with a median age of 67 years (range 46\u201386 years). Most of these individuals have been Japanese with a long (median 37 years) history of pyothorax due to tuberculosis previously treated with a pneumothorax. However, uncommon cases of PAT have been reported in Western Countries, in non-Japanese individuals, in individuals who were not threatened with a pneumothorax, and/or in individuals who had other causes than tuberculosis for their pyothorax. Patients with PAL commonly present with back and/or chest pain, coughing, fever, shortness of breath, and radiological evidence of a pleural space tumor which may be very large. The tumor may extend into the chest wall, ribs, lung tissue, lymph nodes of the mediastinum, and diaphragm but usually has not disseminated beyond these areas, i.e. examinations of the peripheral blood, bone marrow, and distal lymph nodes typically do not show evidence of the disease. Individuals with non-PAL forms of DLBCL-CI present with tumorous growths in or around bone infections, skin ulcers, venous ulcers, metallic implants, artificial heart valves, intrauterine birth control devices, and implanted surgical mesh. The presentation of these cases is similar to that of PAL: afflicted individuals are most often middle-aged or elderly males who have a long-standing (almost always >10 years) history of inflammation, have recently developed pain and localized swelling, and on radiological examination have a discrete, sometimes large, tumor mass at the involved site.", + "doc_fkgl": 13.580182389937107, + "wiki_fkgl": 18.016219879518072, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 9.428571428571429, + "fkgl_delta": -4.436037489580965 + }, + { + "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": "THRLBCL commonly afflicts middle-aged individuals but has been diagnosed in rare pediatric cases. The disease usually presents with lymphadenopathy, i.e. bulky enlargements of lymph nodes in the neck, arm pit, or groin. However, most cases are at an advanced stage at diagnoses: further examinations frequently reveal that the disease has spread to multiple internal organs and tissues. The course of the disease is usually characterized as being poorly responsive to treatment: the disease's survival rates in past studies have been only ~46%. However, recent studies suggest that novel treatments can improve these survival rates.", + "doc_fkgl": 2.581463963963966, + "wiki_fkgl": 12.237021276595748, + "doc_tree_depth": 4.583333333333333, + "wiki_tree_depth": 5.8, + "fkgl_delta": -9.655557312631782 + }, + { + "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": "Childhood interstitial lung disease, sometimes abbreviated as ChILD, is a family of rare chronic and complex disorders that affect the lungs of children. In the lungs, these disorders affect the interstitium, which is the space around the alveoli. The alveoli are the air sacs of the lungs. For these disorders, the alveoli are typically impaired by inflammatory and fibrotic changes which can lead to dyspnea, diffuse infiltrates on chest radiographs, and abnormal pulmonary function tests.", + "doc_fkgl": 12.728571428571431, + "wiki_fkgl": 12.805166666666668, + "doc_tree_depth": 5.166666666666667, + "wiki_tree_depth": 6.5, + "fkgl_delta": -0.07659523809523705 + }, + { + "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": "Presentation \nIndividuals presenting with the PAL form of DLBCL-CI have typically been elderly males (male to female ratio 4:1 to 12:1) with a median age of 67 years (range 46\u201386 years). Most of these individuals have been Japanese with a long (median 37 years) history of pyothorax due to tuberculosis previously treated with a pneumothorax. However, uncommon cases of PAT have been reported in Western Countries, in non-Japanese individuals, in individuals who were not threatened with a pneumothorax, and/or in individuals who had other causes than tuberculosis for their pyothorax. Patients with PAL commonly present with back and/or chest pain, coughing, fever, shortness of breath, and radiological evidence of a pleural space tumor which may be very large. The tumor may extend into the chest wall, ribs, lung tissue, lymph nodes of the mediastinum, and diaphragm but usually has not disseminated beyond these areas, i.e. examinations of the peripheral blood, bone marrow, and distal lymph nodes typically do not show evidence of the disease. Individuals with non-PAL forms of DLBCL-CI present with tumorous growths in or around bone infections, skin ulcers, venous ulcers, metallic implants, artificial heart valves, intrauterine birth control devices, and implanted surgical mesh. The presentation of these cases is similar to that of PAL: afflicted individuals are most often middle-aged or elderly males who have a long-standing (almost always >10 years) history of inflammation, have recently developed pain and localized swelling, and on radiological examination have a discrete, sometimes large, tumor mass at the involved site.", + "doc_fkgl": 15.644583333333337, + "wiki_fkgl": 18.016219879518072, + "doc_tree_depth": 6.769230769230769, + "wiki_tree_depth": 9.428571428571429, + "fkgl_delta": -2.3716365461847353 + }, + { + "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": "Illness\nIn August 2019, the initial symptoms began to subside. At first he went for a doctor because it was difficult to defecate. There was also a tour of America during this time. Before that he went to the United States for medical treatment. After successfully conducting about 9 shows there, he returned to Sri Lanka and appeared for the medical examination. There he knew that a small lump in his stomach had turned into cancer. He stayed in the Apeksha hospital and underwent surgery. After few more days after surgery he went home and got sick again. The body temperature began to rise. Tests carried out there revealed that there was a disease in the liver which was because of the medication taken for the lumps in the intestines.", + "doc_fkgl": 5.415573678290215, + "wiki_fkgl": 7.452307692307691, + "doc_tree_depth": 4.785714285714286, + "wiki_tree_depth": 5.3, + "fkgl_delta": -2.036734014017476 + }, + { + "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": "Severe illness is possible, and in these instances respiratory support, such as a ventilator, may be required. Some children have experienced multiple organ failure. Such severe or critical cases were most common among children with certain underlying conditions, such as for example, asthma (and especially more severe cases of asthma) or those with weakened immune systems. Children are associated with lower mortality rates than other age groups, when infected with COVID-19. They are more likely to experience gastrointestinal symptoms than adults.", + "doc_fkgl": 16.420789473684213, + "wiki_fkgl": 12.871209876543208, + "doc_tree_depth": 6.166666666666667, + "wiki_tree_depth": 6.2, + "fkgl_delta": 3.5495795971410047 + }, + { + "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": "Presentation \nIndividuals presenting with the PAL form of DLBCL-CI have typically been elderly males (male to female ratio 4:1 to 12:1) with a median age of 67 years (range 46\u201386 years). Most of these individuals have been Japanese with a long (median 37 years) history of pyothorax due to tuberculosis previously treated with a pneumothorax. However, uncommon cases of PAT have been reported in Western Countries, in non-Japanese individuals, in individuals who were not threatened with a pneumothorax, and/or in individuals who had other causes than tuberculosis for their pyothorax. Patients with PAL commonly present with back and/or chest pain, coughing, fever, shortness of breath, and radiological evidence of a pleural space tumor which may be very large. The tumor may extend into the chest wall, ribs, lung tissue, lymph nodes of the mediastinum, and diaphragm but usually has not disseminated beyond these areas, i.e. examinations of the peripheral blood, bone marrow, and distal lymph nodes typically do not show evidence of the disease. Individuals with non-PAL forms of DLBCL-CI present with tumorous growths in or around bone infections, skin ulcers, venous ulcers, metallic implants, artificial heart valves, intrauterine birth control devices, and implanted surgical mesh. The presentation of these cases is similar to that of PAL: afflicted individuals are most often middle-aged or elderly males who have a long-standing (almost always >10 years) history of inflammation, have recently developed pain and localized swelling, and on radiological examination have a discrete, sometimes large, tumor mass at the involved site.", + "doc_fkgl": 16.479367816091955, + "wiki_fkgl": 18.016219879518072, + "doc_tree_depth": 6.15, + "wiki_tree_depth": 9.428571428571429, + "fkgl_delta": -1.5368520634261174 + }, + { + "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": "Affected soldiers presented with sudden onset of albuminuria, high blood pressure, swelling of legs or face, headache, sore throat and difficulty breathing and bronchitis. Casts were seen in the urine. It was distinguished from acute nephritis by its prolonged course and subsequent frequent relapses. Pathology revealed narrowing of small blood vessels in the kidneys, capillary thrombi, and a proliferation of cells affecting the capillary lumen, suggesting an underlying inflammation of blood vessels.", + "doc_fkgl": 4.512113821138211, + "wiki_fkgl": 13.227222222222224, + "doc_tree_depth": 4.444444444444445, + "wiki_tree_depth": 7.5, + "fkgl_delta": -8.715108401084013 + }, + { + "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": "Another factor that contributes to anemia in hospitalized people is the use of intravenous fluids. Infusion with large volumes of intravenous fluids dilutes the blood, causing a decreased hemoglobin and hematocrit level. This is not a true anemia, as no red blood cells are lost and the body eventually compensates for the effects of the infusion. However, the decreased hemoglobin and hematocrit may lead to unnecessary transfusion. Blood loss through surgery and through medical procedures such as central line placement also play a role, as does the use of certain drugs which can suppress the bone marrow's ability to produce red blood cells.", + "doc_fkgl": 11.051032608695653, + "wiki_fkgl": 12.836233009708739, + "doc_tree_depth": 5.0, + "wiki_tree_depth": 7.4, + "fkgl_delta": -1.7852004010130855 + }, + { + "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": "Departments \nThe TUM School of Medicine currently consists of 40 departments:\n Department of General Medicine\n Department of Anesthesiology\n Department of Ophthalmology\n Department of Biological Imaging\n Department of Surgery\n Department of Dermatology and Allergology\n Department of Nutritional Medicine\n Department of Gynecology\n Division of Perinatal Medicine and Perinatal Physiology\n Department of Vascular and Endovascular Surgery\n Department of History and Ethics of Medicine\n Department of Otolaryngology\n Department of Human Genetics\n Department of Pediatric Medicine\n Department of Clinical Chemistry and Pathobiochemistry\n Department of Internal Medicine I - Cardiology\n Department of Internal Medicine II - Gastroenterology\n Division of Nephrology\n Division of Clinical Toxicology\n Department of Internal Medicine III - Hematooncology\n Department of Medical Microbiology, Immunology and Hygiene\n Department of Medical Statistics and Epidemiology\n Department of Molecular Allergology\n Department of Molecular Immunology\n Department of Oral and Maxillofacial Surgery\n Department of Neurosurgery\n Department of Neurology\n Department of Neuroscience\n Department of Nuclear Medicine\n Department of Experimental Oncology and Therapeutic Research\n Department of Orthopedics and Sports Orthopedics\n Division of Sports Orthopedics\n Department of General Pathology and Pathological Anatomy\n Department of Preventive and Rehabilitative Sports Medicine\n Department of Pharmacology and Toxicology\n Department of Plastic Surgery and Hand Surgery\n Department of Psychiatry and Psychotherapy\n Department of Psychosomatic Medicine and Psychotherapy\n Department of Diagnostic and Interventional Radiology\n Division of Interventional Radiology\n Division of Diagnostic and Interventional Neuroradiology\n Department of Radiation Therapy and Radiooncology\n Department of Toxicology and Environmental Hygiene\n Department of Trauma Surgery\n Department of Urology\n Department of Virology", + "doc_fkgl": 11.779287370862324, + "wiki_fkgl": 107.59051282051283, + "doc_tree_depth": 6.208333333333333, + "wiki_tree_depth": 32.0, + "fkgl_delta": -95.81122544965051 + }, + { + "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": "Mr Doherty was from County Galway and prior to the proceedings had been an electrician and married with three children. He had started to complain of gastric discomfort by way of heartburn and acid reflux. He underwent a procedure to have resolved what had been established as \"a loose valve at the end of the oesophagus.\" After surgery, Mr. Doherty awoke and became aware of pain in his right shoulder. He had made inquiries with the nurse as to pain relief, which in his evidence to the court was not effective. He had mentioned to both a doctor and nurse prior to his discharge of his considerable pain. Later attending his own GP regarding the same complaint he was admitted to Beaumont Hospital, which in turn \"had raised a query with the surgeon.\" (in St. James'). One possibility it was contended was that his arm may have motioned off the table, but this was something with which the two neurologists gave conflicting reasons.", + "doc_fkgl": 3.26104347826087, + "wiki_fkgl": 9.42670756646217, + "doc_tree_depth": 4.0, + "wiki_tree_depth": 7.222222222222222, + "fkgl_delta": -6.1656640882013 + }, + { + "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": "A lesion at least \"high grade intramucosal neoplasia\" (high grade dysplasia) has:\n Severe cytologic atypia\n Cribriform architecture, consisting of juxtaposed gland lumens without stroma in between, with loss of cell polarity. Rarely, they have foci of squamous differentiation (morules).\nThis should be distinguished from cases where piles of well-differentiated mucin-producing cells appear cribriform. In such piles, nuclei show regular polarity with apical mucin, and their nuclei are not markedly enlarged.\n Invasive adenocarcinoma commonly displays:\nVarying degrees of gland formation with tall columnar cells\nFrequently desmoplasia\nDirty necrosis, consisting of extensive central necrosis with granular eosinophilic karyorrhectic cell detritus. It is located within the glandular lumina, or often with a garland of cribriform glands in their vicinity.", + "doc_fkgl": 11.784036259541985, + "wiki_fkgl": 15.651724137931037, + "doc_tree_depth": 5.375, + "wiki_tree_depth": 6.666666666666667, + "fkgl_delta": -3.8676878783890523 + }, + { + "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": "Presentation \nPT-DLBCL is by far the most common form of testicular cancer in men >60 years of age. It usually develops in this age group (median age ~65 years old, range 10\u201396 years) and presents as a painless testicular mass or swelling in one testis or, in ~6% of cases, both testes: PT-DLBCL is the most common testicular cancer to present with disease in both testicles. About 30-40% of afflicted individuals present concurrently with hydrocele testis, i.e. an enlarged testis due to the accumulation of clear fluid. The tumors commonly increase in size at a rapid pace, may advance locally to involve the epididymis, spermatic cord, scrotal skin, and/or regional lymph nodes, and may cause sharp scrotal pain. About 10% to 33% of individuals have B symptoms such as fever, night sweats, and weight loss. Initial laboratory studies show increases in serum lactate dehydrogenase levels in a third of cases. Some 80% of individuals present with either localized Ann Arbor stage I or locally advanced Ann Arbor stage II disease. The remaining ~20% of cases have disseminated Ann Arbor stage III or IV disease that has spread to the abdominal lymph nodes, Waldeyr's ring of lymphoid tissue that surrounds the nasopharynx and oropharynx, contralateral testis, skin, lung, and, most seriously, the parenchyma of and/or the leptomembranes surrounding either the brain or spinal cord.", + "doc_fkgl": 15.11899521531101, + "wiki_fkgl": 13.493064275037373, + "doc_tree_depth": 6.5, + "wiki_tree_depth": 8.125, + "fkgl_delta": 1.625930940273637 + }, + { + "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": "January \nOn January 23, the first presumptive case in Canada was admitted to Sunnybrook Health Sciences Centre in Toronto and placed into a negative pressure chamber. The patient, a male in his 50s who travelled between Wuhan and Guangzhou before returning to Toronto on January 22, contacted emergency services following rapid onset symptoms. The presumption of infection in the patient was made after a rapid test was done at Public Health Ontario's Toronto laboratory, and was announced on January 25. Final testing conducted at the National Microbiology Laboratory in Winnipeg, Manitoba confirmed the presumptive case on January 27. Authorities said that the patient was experiencing respiratory problems but was in stable condition. His condition later improved and he was released from hospital on January 31.", + "doc_fkgl": 4.794388489208632, + "wiki_fkgl": 15.663, + "doc_tree_depth": 4.923076923076923, + "wiki_tree_depth": 6.333333333333333, + "fkgl_delta": -10.868611510791368 + }, + { + "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": "All affected children have persistent fever. Other clinical features vary. The first symptoms often include acute abdominal pain with diarrhoea or vomiting. Muscle pain and general tiredness are frequent, and low blood pressure is also common. Symptoms can also include pink eye, rashes, enlarged lymph nodes, swollen hands and feet, and \"strawberry tongue\". Various mental disturbances are possible. A cytokine storm may take place, in which the child's innate immune system stages an excessive and uncontrolled inflammatory response. Heart failure is common. Clinical complications can include damage to the heart muscle, respiratory distress, acute kidney injury, and increased blood coagulation. Coronary artery abnormalities can develop (ranging from dilatation to aneurysms).", + "doc_fkgl": 14.753525835866263, + "wiki_fkgl": 11.334545454545456, + "doc_tree_depth": 6.333333333333333, + "wiki_tree_depth": 4.2, + "fkgl_delta": 3.4189803813208073 + }, + { + "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": "Oligomeganephronia \nOligomeganephronia (or oligomeganephronic hypoplasia) is a rare pediatric renal disease where the number of nephrons is reduced but is distinctly enlarged. Tubules are also enlarged. This type of hypoplasia is more prevalent in males with a ratio of three-to-one and is caused by either renal-coloboma syndrome, branchiootorenal syndrome, acro renal syndrome, or wolf-hirschhorn syndrome. Both kidneys are affected symmetrically unless paired with unilateral agenesis, which is uncommon. Morphology is normal. The combined length of both kidneys is 80% or lower than a single normal kidney and the glomerular filtration rate is reduced to 30% of the normal. The number of renal lobes is reduced to five to six or occasionally as few as one or two. The number of nephrons per lobe is reduced as well. Malformations of the urinary tract and nephrosclerosis are absent and vesicoureteral reflux is insignificant. Unlike segmental hypoplasia, hypertension is rarely present in this type. The affected are generally born premature or small for their gestational age. Most cases are sporadic but some are inherited. It's been reported that the affected person can have a twin or sibling with the same condition. In the first few years of the affected individual's life, dehydration, polyuria and polydipsia are present, followed by hyperfiltration alongside proteinuria, with progressive renal failure to come after, its onset determined by the combined renal mass. The end-stage renal disease occurs between six months and seventeen years.", + "doc_fkgl": 14.958653673835126, + "wiki_fkgl": 10.554893617021275, + "doc_tree_depth": 5.866666666666666, + "wiki_tree_depth": 5.4, + "fkgl_delta": 4.4037600568138515 + }, + { + "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": "With her PhD in educational psychology, Code accepted a one-year post-doctoral research fellowship at the Harvard Graduate School of Education in Assessment and Learning Technologies. During her post-doctoral fellowship Code had surgery for an implantable cardioverter-defibrillator She was later hospitalized with end-stage heart failure and placed on the heart transplant waiting list, during which she received a left ventricular assist device. A donor was found in 2014 but complications during the surgery led to her being sent into a medically induced coma for eight days. When she awoke from her coma, it was discovered that she had severe delirium and muscle atrophy. Her heart transplant journey is documented on her blog Heart Failure to Harvard and in I am the Clinical Trial for the JACC: Heart Failure journal.", + "doc_fkgl": 6.522207792207791, + "wiki_fkgl": 15.228375000000003, + "doc_tree_depth": 5.571428571428571, + "wiki_tree_depth": 7.2, + "fkgl_delta": -8.706167207792213 + }, + { + "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": "Surgical career\nIn 2014, the first artificial heart transplantation procedure in the Sultanate was done by a cardiac surgery team led by Al Sabti, for a patient suffering from heart failure. In April 2015, a cardiac surgery team of Sultan Qaboos University Hospital has managed to plant a valve inside a valve in the aorta and mitral valves through a catheter. A first-of-its-kind surgery in the world done on a pregnant woman. The cardiac surgery team was led by Al Sabti. Dr. Hilal contributed in the first Thoracab procedure done in Oman and Middle East. In 2013 a team of cardiac surgeons, under the leadership of Dr. Hilal, and cardiac anesthetists at Sultan Qaboos University Hospital, successfully conducted TAVI procedures to four patients aged over 75 years.", + "doc_fkgl": 13.480000000000004, + "wiki_fkgl": 11.369178852643419, + "doc_tree_depth": 7.166666666666667, + "wiki_tree_depth": 7.166666666666667, + "fkgl_delta": 2.110821147356585 + }, + { + "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": "356 citations: Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. Valentina O Puntmann, Tobias Voigt, Zhong Chen, Manuel Mayr, Rashed Karim, Kawal Rhode, Ana Pastor, Gerald Carr-White, Reza Razavi, Tobias Schaeffter, Eike Nagel. JACC: Cardiovascular Imaging 6 (4), 475\u2013484.\n 355 citations: Cardiac catheterisation guided by MRI in children and adults with congenital heart disease. Reza Razavi, Derek LG Hill, Stephen F Keevil, Marc E Miquel, Vivek Muthurangu, Sanjeet Hegde, Kawal Rhode, Michael Barnett, Joop van Vaals, David J Hawkes, Edward Baker. The Lancet 362 (9399), 1877\u20131882.\n 208 citations: A registration-based propagation framework for automatic whole heart segmentation of cardiac MRI. X Zhuang, KS Rhode, RS Razavi, DJ Hawkes, S Ourselin. IEEE transactions on medical imaging 29 (9), 1612\u20131625.\n 206 citations: Patient-specific electromechanical models of the heart for the prediction of pacing acute effects in CRT: a preliminary clinical validation. Maxime Sermesant, Radomir Chabiniok, Phani Chinchapatnam, Tommaso Mansi, Florence Billet, Philippe Moireau, Jean-Marc Peyrat, K Wong, Jatin Relan, Kawal Rhode, Matthew Ginks, Pier Lambiase, Herv\u00e9 Delingette, Michel Sorine, C Aldo Rinaldi, Dominique Chapelle, Reza Razavi, Nicholas Ayache. Medical image analysis 16 (1), 201\u2013215.\n 197 citations: A system for real-time XMR guided cardiovascular intervention. Kawal S Rhode, Maxime Sermesant, David Brogan, Sanjeet Hegde, John Hipwell, Pier Lambiase, Eric Rosenthal, Clifford Bucknall, Shakeel A Qureshi, Jaswinder S Gill, Reza Razavi, Derek LG Hill. IEEE transactions on medical imaging 24 (11), 1428\u20131440.\n 169 citations: Intensity-based 2-D-3-D registration of cerebral angiograms. John H Hipwell, Graeme P Penney, Robert A McLaughlin, Kawal Rhode, Paul Summers, Tim C Cox, James V Byrne, J Alison Noble, David J Hawkes. IEEE transactions on medical imaging 22 (11), 1417\u20131426.", + "doc_fkgl": 9.065632911392406, + "wiki_fkgl": 12.435493381468117, + "doc_tree_depth": 6.684210526315789, + "wiki_tree_depth": 8.785714285714286, + "fkgl_delta": -3.369860470075711 + }, + { + "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": "Lesions involving the whole optic nerve cause complete blindness on the affected side, that means damage at the right optic nerve causes complete loss of vision in the right eye.\n Optic neuritis involving external fibers of the optic nerve causes tunnel vision.\n Optic neuritis involving internal fibers of the optic nerve causes central scotoma. lf unilateral central scotoma is detected, careful observation of the temporal visual field of other eye is essential to rule out the possibility of compressive lesions at the junction of optic nerve and optic chiasm.\n Other symptoms include absence of direct light reflex, afferent pupillary defect, defective colour vision, decreased contrast sensitivity, generalized decrease in visual sensitivity etc.", + "doc_fkgl": 6.597509398496243, + "wiki_fkgl": 15.376357142857142, + "doc_tree_depth": 5.875, + "wiki_tree_depth": 8.4, + "fkgl_delta": -8.778847744360899 + }, + { + "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": "Most commonly the melanocytoma is found on or adjacent to the optic nerve as the optical melanocytoma. The lesion can be found at any age. Location and size could lead to clinical symptoms. While the melanocytoma is generally considered to be a benign tumor, it has a potential for growth, recurrence, and transformation to a malignant melanoma. Because malignant transformation is rare, optical melanocytomas can usually be observed. Thus, in asymptomatic patients, regular observation by fundoscopy is indicated, perhaps supported by ocular ultrasonography.", + "doc_fkgl": 11.54186046511628, + "wiki_fkgl": 11.841144578313251, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 4.833333333333333, + "fkgl_delta": -0.2992841131969719 + }, + { + "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": "Indications\nIndications for indocyanine green angiography include:\n Choroidal neovascularisation (CNV): Indocyanine green angiography is widely used to study choroidal neovascularization in patients with exudative age-related macular degeneration. In ICGA, CNV is seen as hyperflourescent spot or plaque. It is also useful in diagnosing and classifying CNV associated to serous pigment epithelial detachments in Nonexudative macular degeneration.\n Idiopathic polypoidal choroidal vasculopathy (IPCV)\n Pigmented choroidal melanomas\n Choroidal haemangioma: ICGA can be used to differentiate choroidal haemangioma from other intraocular tumors.\n Choroiditis: In multifocal choroiditis, lesions are visualized as hypoflourescent spots.\n Chorioretinopathy: In Central serous chorioretinopathy, using ICGA multifocal areas of choroidal hyperpermiability can be visualized. In birdshoot chorioretinopathy, lesions appear as symmetrical round or oval hypoflourescent spots. ICGA allows better visualization of lesions in serpiginous chorioretinopathy, punctate inner chorioretinopathy, acute zonal occult outer retinopathy etc. In multiple evanescent white dot syndrome, numerous hypoflourescent spots can be visualized using ICGA.\n Pigmented epithelial detachment\n Retinal angiomatous proliferation (RAP)\n Chorioretinal atrophy: ICGA help evaluating different stages of chorioretinal atrophy.\n Anterior uveitis: ICGA is rarely indicated in anterior uveitis, but it might be used to find out associated choroidal pathology.\n Stargardt disease: Numerous hypoflourescent spots are seen in ICGA.\n Angioid streaks: ICGA can be used for diagnosing angioid streaks and their associated ocular pathologies.\n Vogt\u2013Koyanagi\u2013Harada disease (VKH): ICGA is useful in diagnosing VKH. In VKH, delay in filling of the choriocapillaris along with larger choroidal vessel perfusion and multiple hypofluorescent spots are visible with ICGA.\n Sympathetic ophthalmia: Sympathetic ophthalmia is a bilateral, granulomatous form of uveitis. In sympathetic ophthalmia, numerous dark spots may be visible during the intermediate phase of ICGA.", + "doc_fkgl": 14.661870129870131, + "wiki_fkgl": 16.04865704772475, + "doc_tree_depth": 5.473684210526316, + "wiki_tree_depth": 6.0, + "fkgl_delta": -1.386786917854618 + }, + { + "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": "Career\nUpon earning her PhD, Taddio co-published Effect of neonatal circumcision on pain response during subsequent routine vaccination with Joel D. Katz. Their study found that boys who were given anesthetic cream during their circumcision experienced less pain during the process than those with a placebo cream. As an assistant professor of pharmacy at U of T and SickKids Hospital pharmacist, she led the first study to look at anticipatory pain responses in newborns. To reach this conclusion, the research team studied how infants who received heel lances over the first 24\u201336 hours of life (compared to a control group) reacted to a Venipuncture procedure. It was found that the babies who received heel lances had increased pain responses. Her work reached beyond newborns and in 2005, Taddio helped establish a new topical anesthetic in order to reduce pain for children having IVs inserted. She was subsequently awarded the Early Career Award from the Canadian Paediatric Society.", + "doc_fkgl": 6.542719298245618, + "wiki_fkgl": 13.224658780709735, + "doc_tree_depth": 4.823529411764706, + "wiki_tree_depth": 7.857142857142857, + "fkgl_delta": -6.6819394824641165 + }, + { + "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": "He was born in Ia\u0219i in an old Moldavian boyar family, the son of Theodor Burghele and Fenareta, n\u00e9e Stoianovici. He studied at the Faculty of Medicine of the University of Ia\u0219i (1922\u20131928), obtaining in 1929 an MD degree with thesis Mycotic splenomegaly. He then took specialization courses at the Urology Clinic of the University of Vienna (1930\u20131931). Upon returning to Romania, he started working at the surgical and urological clinic led by Nicolae Hortolomei at , in Bucharest. In 1937 Burghele became lecturer in the Department of Surgery at Col\u021bea Hospital and in 1940 he was promoted to associate professor. In 1941 he was conscripted, and in 1942 he served as doctor in Tiraspol. In 1946, when a urinary tract surgery clinic was set up at Panduri Hospital, he was appointed professor at the Faculty of Medicine of the University of Bucharest, and took over the management of the clinic.", + "doc_fkgl": 12.910294117647059, + "wiki_fkgl": 12.748476190476193, + "doc_tree_depth": 6.444444444444445, + "wiki_tree_depth": 7.428571428571429, + "fkgl_delta": 0.16181792717086552 + }, + { + "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": "356 citations: Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. Valentina O Puntmann, Tobias Voigt, Zhong Chen, Manuel Mayr, Rashed Karim, Kawal Rhode, Ana Pastor, Gerald Carr-White, Reza Razavi, Tobias Schaeffter, Eike Nagel. JACC: Cardiovascular Imaging 6 (4), 475\u2013484.\n 355 citations: Cardiac catheterisation guided by MRI in children and adults with congenital heart disease. Reza Razavi, Derek LG Hill, Stephen F Keevil, Marc E Miquel, Vivek Muthurangu, Sanjeet Hegde, Kawal Rhode, Michael Barnett, Joop van Vaals, David J Hawkes, Edward Baker. The Lancet 362 (9399), 1877\u20131882.\n 208 citations: A registration-based propagation framework for automatic whole heart segmentation of cardiac MRI. X Zhuang, KS Rhode, RS Razavi, DJ Hawkes, S Ourselin. IEEE transactions on medical imaging 29 (9), 1612\u20131625.\n 206 citations: Patient-specific electromechanical models of the heart for the prediction of pacing acute effects in CRT: a preliminary clinical validation. Maxime Sermesant, Radomir Chabiniok, Phani Chinchapatnam, Tommaso Mansi, Florence Billet, Philippe Moireau, Jean-Marc Peyrat, K Wong, Jatin Relan, Kawal Rhode, Matthew Ginks, Pier Lambiase, Herv\u00e9 Delingette, Michel Sorine, C Aldo Rinaldi, Dominique Chapelle, Reza Razavi, Nicholas Ayache. Medical image analysis 16 (1), 201\u2013215.\n 197 citations: A system for real-time XMR guided cardiovascular intervention. Kawal S Rhode, Maxime Sermesant, David Brogan, Sanjeet Hegde, John Hipwell, Pier Lambiase, Eric Rosenthal, Clifford Bucknall, Shakeel A Qureshi, Jaswinder S Gill, Reza Razavi, Derek LG Hill. IEEE transactions on medical imaging 24 (11), 1428\u20131440.\n 169 citations: Intensity-based 2-D-3-D registration of cerebral angiograms. John H Hipwell, Graeme P Penney, Robert A McLaughlin, Kawal Rhode, Paul Summers, Tim C Cox, James V Byrne, J Alison Noble, David J Hawkes. IEEE transactions on medical imaging 22 (11), 1417\u20131426.", + "doc_fkgl": 13.475840409207162, + "wiki_fkgl": 12.435493381468117, + "doc_tree_depth": 6.2631578947368425, + "wiki_tree_depth": 8.785714285714286, + "fkgl_delta": 1.0403470277390454 + }, + { + "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": "Although her vital signs were normal and her burns continued healing, she developed a high fever, vomiting, and diarrhea. The blood, stool, and urine tests the doctors conducted came back with no indication of another underlying illness. The doctors decided her central line, through which her fluids were being administered, could have an infection and subsequently removed it. Her daughter's condition worsened. Josie began to suck on the washcloth when given her bath and at night, her eyes began rolling back into her head.", + "doc_fkgl": 6.041, + "wiki_fkgl": 10.207238095238097, + "doc_tree_depth": 5.125, + "wiki_tree_depth": 5.2, + "fkgl_delta": -4.166238095238096 + }, + { + "index": 12, + "label": "intermediate_health_literacy", + "original_doc": "A 52-year-old woman had ongoing dysuria and urinary frequency despite multiple treatments for presumed infections. Cystoscopy showed bladder redness and debris, while imaging and routine lab tests were unremarkable. Eventually, a live larva was identified in the urine, confirming the cause of her symptoms. Management focused on better personal hygiene and increased fluid intake.", + "wiki_anchor": "The biology of Cydistinae larva and adult females are not known, as only adult males have been described thus far. But, given that all the known larvae and neotenic larva-like females of the closely related Rhagophthalmidae and Phengodidae are bioluminescent, live in leaf litter and soil, and feed on millipedes, the larva and females of the Cydistinae likely possess similar characteristics.", + "doc_fkgl": 12.18240740740741, + "wiki_fkgl": 17.583688524590162, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 7.0, + "fkgl_delta": -5.4012811171827515 + }, + { + "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": "Vaginal trichomoniasis\nLitschgi has investigated the use of SolcoTrichovac both as a therapeutic and as a recurrence prophylactic measure. On the latter subject he reported enrolling 114 women with trichomoniasis into a randomized, double-blind, placebo-controlled study, 66% of whom had case histories of recurrent vulvovaginitis. All patients as well as their sexual partners received systemic and/or local nitroimidazole treatment. 61 patients were additionally vaccinated with SolcoTrichovac, 53 patients with placebo. At the first follow-up check, 6 weeks after the first injection, 3 patients in each group still had motile trichomonads. Among the patients that were pronounced cured at this visit, a total of 15 reinfections (33.3%) were recorded in the placebo group during the follow-up period from month 4 to month 12 after the first injection, whilst in the verum group there were no new infections. Harris designed a similar randomized, double-blind, placebo-controlled study with 198 participants and reported a reinfection rate of 21.6% in the placebo group, in contrast to 3.1% in the SolcoTrichovac group 8 months after completing the course of three injections. Further studies have confirmed the efficacy of lactobacillus vaccines as a powerful complementary treatment and recurrence prophylactic measure in trichomoniasis.", + "doc_fkgl": 14.957394957983198, + "wiki_fkgl": 13.04773892773893, + "doc_tree_depth": 5.411764705882353, + "wiki_tree_depth": 5.75, + "fkgl_delta": 1.9096560302442676 + }, + { + "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": "Recently, an operation was carried out by the SQUH medical team of surgeons headed by Dr. Hilal Al Sabti. The patient, who is a mother of three, was suffering from a rare heart condition known as automatic coronary dissection, which disease affects the coronary arteries of the heart and occurs more often in women under the age of 50 years. The woman was having elevated heart enzymes and the dissection in coronary arteries are expanding to the branch arteries. The surgical team successfully performed an operation by replacing three arteries in the heart. The procedure was accompanied by the use of a new technique that demonstrated the advanced skills of the surgical team. A medical team at Sultan Qaboos University Hospital has managed to save the patient's life. SQUH added that \u201cThe surgery will be documented and published as a scientific paper in a refereed international scientific journal, so that the benefit is widespread among specialists in cardiothoracic surgery around the world,\u201d.", + "doc_fkgl": 5.827348837209307, + "wiki_fkgl": 13.06675925925926, + "doc_tree_depth": 5.066666666666666, + "wiki_tree_depth": 8.285714285714286, + "fkgl_delta": -7.2394104220499536 + }, + { + "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": "Diagnostic gap \nCardiovascular disease in women may be misdiagnosed or underdiagnosed in women for a number of reasons. CVD, especially heart attacks, often presents symptoms in women differently than in men due to anatomical and hormonal differences. Research has shown that women may present with symptoms that are classically associated with heart attacks, such as chest pain and shortness of breath, but also with atypical symptoms such as neck, jaw, arm, or shoulder discomfort, nausea or vomiting, heartburn or indigestion, fatigue, headaches, and palpitations. Some healthcare providers may misidentify the causes of these symptoms, attributing them to gastrointestinal or psychological causes instead.", + "doc_fkgl": 14.593809523809526, + "wiki_fkgl": 16.91382352941177, + "doc_tree_depth": 5.888888888888889, + "wiki_tree_depth": 8.75, + "fkgl_delta": -2.3200140056022427 + }, + { + "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": "Recently, an operation was carried out by the SQUH medical team of surgeons headed by Dr. Hilal Al Sabti. The patient, who is a mother of three, was suffering from a rare heart condition known as automatic coronary dissection, which disease affects the coronary arteries of the heart and occurs more often in women under the age of 50 years. The woman was having elevated heart enzymes and the dissection in coronary arteries are expanding to the branch arteries. The surgical team successfully performed an operation by replacing three arteries in the heart. The procedure was accompanied by the use of a new technique that demonstrated the advanced skills of the surgical team. A medical team at Sultan Qaboos University Hospital has managed to save the patient's life. SQUH added that \u201cThe surgery will be documented and published as a scientific paper in a refereed international scientific journal, so that the benefit is widespread among specialists in cardiothoracic surgery around the world,\u201d.", + "doc_fkgl": 16.972754430379748, + "wiki_fkgl": 13.06675925925926, + "doc_tree_depth": 6.380952380952381, + "wiki_tree_depth": 8.285714285714286, + "fkgl_delta": 3.9059951711204874 + }, + { + "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": "Recently, an operation was carried out by the SQUH medical team of surgeons headed by Dr. Hilal Al Sabti. The patient, who is a mother of three, was suffering from a rare heart condition known as automatic coronary dissection, which disease affects the coronary arteries of the heart and occurs more often in women under the age of 50 years. The woman was having elevated heart enzymes and the dissection in coronary arteries are expanding to the branch arteries. The surgical team successfully performed an operation by replacing three arteries in the heart. The procedure was accompanied by the use of a new technique that demonstrated the advanced skills of the surgical team. A medical team at Sultan Qaboos University Hospital has managed to save the patient's life. SQUH added that \u201cThe surgery will be documented and published as a scientific paper in a refereed international scientific journal, so that the benefit is widespread among specialists in cardiothoracic surgery around the world,\u201d.", + "doc_fkgl": 5.730088652482269, + "wiki_fkgl": 13.06675925925926, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 8.285714285714286, + "fkgl_delta": -7.336670606776991 + }, + { + "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": "At the hospital, Lee takes a memory test and has a CT scan done. The results display a dark spot and the neurologist thinks she has vasculitis. An MRI was done the next morning and Dr. Volpi concluded that she had a left thalamic stroke. The stroke damaged her left thalamus which in turn affects the right. Christine Lee had a hole/flap called patent foramen ovale (PFO) in her heart which was an undiagnosed birth defect. This created a blood clot that went through her body and made its way into her brain. The doctor determined this cause with a bubble test and echocardiogram.", + "doc_fkgl": 11.984808362369339, + "wiki_fkgl": 5.931923076923077, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 4.857142857142857, + "fkgl_delta": 6.052885285446262 + }, + { + "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 \nScorpaena brasiliensis has a many spined, compressed oblong-shaped body, tapering towards the tail. It has a quite short head and snout with an obvious occipital pi and either a small or absent posttemporal spine. There are two spiny points on the preorbital bone above the mouth while the suborbital ridge has three spiny points, the two anterior points being blunt. There are five spines on the preoperculum, the uppermost having a supplementary spine with the next spine being almost the same size as the third spine, with the fourth and fifth spines being medium to small sized. The mouth has thin bands of small teeth on the jaws, palatine, and vomer. There are well developed tentacles above the eyes. The dorsal fin has 12 spines and 9 soft rays, the anal fin has 3 spines and 5 soft rays and the pectoral fin has 16-20 fin rays. The body is covered in large, smooth scales and the lateral line is complete. The caudal fin is rounded. The background color may be red, brown, greenish-brown, yellow or white. They are paler on the lower body than on the upper and the lower parts of the head and body and the inside surface of base of pectoral fins have small, round dark spots. The pectoral fins can either be green-brown or yellow in the center. There are 3 or 4 brown blotches along the flank below the lateral line and there is no large blotch at the front of the dorsal fin. the caudal fin hash two vague dark bars, one across the center of fin and the other on the rear margin. This species has a maximum published total length of , although is more typical.", + "doc_fkgl": 16.455087719298245, + "wiki_fkgl": 8.050175438596494, + "doc_tree_depth": 7.0, + "wiki_tree_depth": 6.333333333333333, + "fkgl_delta": 8.404912280701751 + }, + { + "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": "Presentation \nT-cell/histiocyte-rich large B-cell lymphoma most commonly afflicts middle-aged (i.e. 49\u201357 years old) individuals but has been diagnosed in persons aged 4 to 92 years. The disease has a male predominance ranging between 1.7:1 to 3:1 in different studies. In a review of 36 reported pediatric cases, the male to female ratio was 4:1. Patients typically present with enlarged lymph nodes in the neck, arm pit, and groin areas but on further examination are found to have involvement of their spleen (31% of cases), liver (52% of cases), bone marrow (27% of cases) and lung/or (13%) as determined by finding enlarged spleens and/or livers on physical examination or medical imaging; abnormal results on liver function tests, and/or THRLBCL infiltrates in bone marrow biopsies. Rare cases of the disease have presented with involvement of the skin (termed primary cutaneous THRLBCL), thyroid gland, thymus, gastrointestinal tract, pancreas, jaw bone, nasopharynx, brain, tongue, uterus, stomach, and soft tissues. Many patients will also complain of having systemic B symptoms such as fever, night sweats, weight loss, and malaise.", + "doc_fkgl": 5.262667512690356, + "wiki_fkgl": 13.30514367816092, + "doc_tree_depth": 5.15, + "wiki_tree_depth": 8.166666666666666, + "fkgl_delta": -8.042476165470564 + }, + { + "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": "Simple hypoplasia \nSimple hypoplasia is characterized by either one kidney weighing 50% or less of that of the normal, or the combined weight of both kidneys being less than 33% of that of the normal. Often accompanied by hypertension. The number of lobules and calyces is reduced to five or fewer, compared to the usual ten or more. Enlargement of the nephrons isn\u2019t present in this type, considering it\u2019s associated with oligomeganephronia. The histology is normal. Cysts or dysplasia are absent and apart from its decreased size, every other facet of the kidneys is unaffected. If unilateral, the contralateral kidney can undergo hypertrophy to compensate for the affected kidney, and renal function stays normal. If bilateral, progressive renal insufficiency is expected.", + "doc_fkgl": 13.893053097345135, + "wiki_fkgl": 11.275692148760331, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 5.125, + "fkgl_delta": 2.6173609485848033 + }, + { + "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 \nPT-DLBCL is by far the most common form of testicular cancer in men >60 years of age. It usually develops in this age group (median age ~65 years old, range 10\u201396 years) and presents as a painless testicular mass or swelling in one testis or, in ~6% of cases, both testes: PT-DLBCL is the most common testicular cancer to present with disease in both testicles. About 30-40% of afflicted individuals present concurrently with hydrocele testis, i.e. an enlarged testis due to the accumulation of clear fluid. The tumors commonly increase in size at a rapid pace, may advance locally to involve the epididymis, spermatic cord, scrotal skin, and/or regional lymph nodes, and may cause sharp scrotal pain. About 10% to 33% of individuals have B symptoms such as fever, night sweats, and weight loss. Initial laboratory studies show increases in serum lactate dehydrogenase levels in a third of cases. Some 80% of individuals present with either localized Ann Arbor stage I or locally advanced Ann Arbor stage II disease. The remaining ~20% of cases have disseminated Ann Arbor stage III or IV disease that has spread to the abdominal lymph nodes, Waldeyr's ring of lymphoid tissue that surrounds the nasopharynx and oropharynx, contralateral testis, skin, lung, and, most seriously, the parenchyma of and/or the leptomembranes surrounding either the brain or spinal cord.", + "doc_fkgl": 15.117090909090908, + "wiki_fkgl": 13.493064275037373, + "doc_tree_depth": 6.071428571428571, + "wiki_tree_depth": 8.125, + "fkgl_delta": 1.6240266340535356 + }, + { + "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": "Staphylococcus borealis is a bacterial species, member of the genus Staphylococcus, closely related to Staphylococcus haemolyticus and described in 2020. Its cells are Gram positive, coccoid in shape, with a diameter of 0.65 to 1.23\u00a0\u00b5m and form clusters. Additionally, they are facultative anaerobic, coagulase negative and catalase positive. The type strain (51-48T = CCUG 73747T = CECT 30011T) was isolated from human blood culture at the University Hospital of North Norway (Troms\u00f8, Norway), in 1997. Four additional strains included in the description were isolated from skin swabs, from healthy volunteers. The genome sequence of the type strain is deposited in DNA Data Bank of Japan, European Nucleotide Archive and GenBank under the accession number JABVEJ000000000.", + "doc_fkgl": 7.468333333333334, + "wiki_fkgl": 12.221885964912286, + "doc_tree_depth": 6.125, + "wiki_tree_depth": 6.666666666666667, + "fkgl_delta": -4.753552631578952 + }, + { + "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": "Infective endocarditis \nOf human diseases caused by G. adiacens, infective endocarditis (IE) is the most common. Among the members of the genus Granulicatella, G. adiacens seems to be more capable of causing IE, possibly due to its capacity to bind to the cardiac valvular tissue. IE from NVS species has been described as indolent-onset, often in the setting of preexisting heart valve damage. The aortic and mitral valves are most commonly affected. More often than not, IE due to NVS produces detectable vegetations, although other classic IE signs (e.g., Osler nodes) are usually not present. Treatment failure is frequently observed, and approximately 1/4 of cases require prosthetic valve replacement.", + "doc_fkgl": 12.996079027355623, + "wiki_fkgl": 10.45993883792049, + "doc_tree_depth": 5.714285714285714, + "wiki_tree_depth": 7.0, + "fkgl_delta": 2.536140189435134 + }, + { + "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": "Presentation \nIndividuals presenting with the PAL form of DLBCL-CI have typically been elderly males (male to female ratio 4:1 to 12:1) with a median age of 67 years (range 46\u201386 years). Most of these individuals have been Japanese with a long (median 37 years) history of pyothorax due to tuberculosis previously treated with a pneumothorax. However, uncommon cases of PAT have been reported in Western Countries, in non-Japanese individuals, in individuals who were not threatened with a pneumothorax, and/or in individuals who had other causes than tuberculosis for their pyothorax. Patients with PAL commonly present with back and/or chest pain, coughing, fever, shortness of breath, and radiological evidence of a pleural space tumor which may be very large. The tumor may extend into the chest wall, ribs, lung tissue, lymph nodes of the mediastinum, and diaphragm but usually has not disseminated beyond these areas, i.e. examinations of the peripheral blood, bone marrow, and distal lymph nodes typically do not show evidence of the disease. Individuals with non-PAL forms of DLBCL-CI present with tumorous growths in or around bone infections, skin ulcers, venous ulcers, metallic implants, artificial heart valves, intrauterine birth control devices, and implanted surgical mesh. The presentation of these cases is similar to that of PAL: afflicted individuals are most often middle-aged or elderly males who have a long-standing (almost always >10 years) history of inflammation, have recently developed pain and localized swelling, and on radiological examination have a discrete, sometimes large, tumor mass at the involved site.", + "doc_fkgl": 12.497337640821737, + "wiki_fkgl": 18.016219879518072, + "doc_tree_depth": 5.96, + "wiki_tree_depth": 9.428571428571429, + "fkgl_delta": -5.518882238696335 + }, + { + "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": "Liver tests are performed before and after the operation. During surgery, the duodenum should be repositioned in close proximity with the CBD to ensure a tension-free anastomosis. 8 incisions are made, with one in the CBD and one in the duodenum. Sutures are performed between the incisions to create a new pathway. Postoperative complications include inflammation and narrowing within the surgical site and sump syndrome. Given that the duodenum is in a diseased state, or a tension-free anastomosis cannot be created, a CDD should not be performed and alternative bypass procedures could be considered.\nCurrently, CDD accounts for approximately 1% of all biliary operations to provide CBD drainage. 38% of the patients undergo CDD as a primary operation (first treatment given for a disease) and 60% of the patients undergo CDD as a secondary procedure (a surgical procedure which is performed to improve conditions found to exist during the primary surgery). CDD is more often performed in the elderly with the mean age of the patients being around 61 years.", + "doc_fkgl": 5.185050449959093, + "wiki_fkgl": 12.53078431372549, + "doc_tree_depth": 4.526315789473684, + "wiki_tree_depth": 6.888888888888889, + "fkgl_delta": -7.345733863766398 + }, + { + "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 histopathology of colorectal cancer of the adenocarcinoma type involves analysis of tissue taken from a biopsy or surgery. A pathology report contains a description of the microscopical characteristics of the tumor tissue, including both tumor cells and how the tumor invades into healthy tissues and finally if the tumor appears to be completely removed. The most common form of colon cancer is adenocarcinoma, constituting between 95% and 98% of all cases of colorectal cancer. Other, rarer types include lymphoma, adenosquamous and squamous cell carcinoma. Some subtypes have been found to be more aggressive.", + "doc_fkgl": 16.9342905982906, + "wiki_fkgl": 13.961148936170215, + "doc_tree_depth": 5.8, + "wiki_tree_depth": 7.0, + "fkgl_delta": 2.9731416621203834 + }, + { + "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": "In addition to her research activities, she has contributed to numerous international meetings, giving international keynote lectures. She dedicates much of her career to service within her field, including roles as Vice-Chair of the \u2018Ophthalmic Tumor Writing Group\u2019, 7th & 8th Ed\u2019ns AJCC/TNM Classification (since 2005), as a member of the International Society of Ophthalmic Pathology (and President from 2011\u2013present), a member for the Association for Research in Vision and Ophthalmology (ARVO) (and Vice-President between 2017-2018), and she has been a trustee of ARVO Anatomy-Pathology-Oncology group & an ARVO Board Member (2013 - 2018). Coupland was also Chair of the \u2018Ophthalmic Pathology Working Group\u2019 of the European Society of Pathology (2013- 2018), the European Society of Medical Oncology (ESMO), where she was Pathology rep on the \u201cClinical Trials Committee\u201d (>2015\u2013present). She has also served on the Mucosal Melanoma Guidelines Writing group (2016-2018), the ACCEA Merseyside Regional Committee for National Awards (>2011\u2013present), the National Cancer Research Institute CM-Path Workstream 4 \u2013 Molecular technologies, Digital Pathology (>2016\u2013present). She is an elected committee member of the Pathological Society of Great Britain and Ireland and served on the Education & Training Subcommittee (2016-2019. She was a Committee Member of the WHO Eye Tumour Writing Group (2016-2018). She was a member of the European Ophthalmic Oncology Group (and Secretary between 2008\u20132011, and President (between 2011-2014). Coupland is an active patient advocate, and part of the OcuMelUK patient support group and the NCRI Lymphoma Biological Studies Subgroup (Chair from 2008-2011).\nIn terms of scientific publishing and scholarship, she has been a member of the Editorial Board of the journal Investigative Ophthalmology & Visual Science since 2016, an Associate Editor for Acta Ophthalmologica (since 2014), and was an Associate Editor (pathology) for Graefe's Archives for Clinical and Experimental Ophthalmology. She was a Reviewing Editor of \u201cOcular Immunology and Inflammation\u201d (between 2013-2018) and an Editorial Board Member of BMC Cancer (between 2010 and 2018).", + "doc_fkgl": 14.549020678891925, + "wiki_fkgl": 19.681290322580647, + "doc_tree_depth": 6.681818181818182, + "wiki_tree_depth": 7.7, + "fkgl_delta": -5.132269643688723 + }, + { + "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": "Signs and symptoms\nDisease severity varies greatly, even between family members with identical mutations. Age of onset is highly variable, although symptoms usually appear between 8 and 15 years of age. Patients usually lose the ability to ambulate 10 \u2013 20 years after symptoms appear. Milder forms present with symptoms other than weakness, such as muscle aches, cramps, or exercise intolerance, and people in this group can retain ambulation beyond age 60. Weakness is symmetric, progressive, and proximal (on or close to the torso), usually affecting the hip girdle and shoulder girdle muscles. Hip weakness can manifest as a waddling gate. Shoulder weakness can manifest as winged scapulas. Muscle contractures, especially of the Achilles tendon, and scoliosis can also occur.", + "doc_fkgl": 5.560996503496504, + "wiki_fkgl": 11.629737394957985, + "doc_tree_depth": 4.916666666666667, + "wiki_tree_depth": 6.0, + "fkgl_delta": -6.068740891461481 + }, + { + "index": 18, + "label": "intermediate_health_literacy", + "original_doc": "A 65-year-old man developed persistent swelling and a boutonniere deformity of the right middle finger after a motorcycle fall six months earlier. He could not fully extend the finger. On exam, the finger showed edema with flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Active PIP range of motion (ROM) was 45\u2013110 degrees. X\u2011rays of the right hand (AP/oblique) showed no bone injury, indicating a soft-tissue problem consistent with a central slip injury. The patient underwent reconstruction of the central slip using a partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. A PIP extension splint was used for 2 weeks. Active and passive PIP ROM exercises began after 2 weeks. One month after surgery, PIP ROM improved to 0\u201390 degrees, and by 2 months it returned to normal. Hand function, measured by the DASH score, improved markedly from 50 to 4.2.", + "wiki_anchor": "Signs and symptoms\nDisease severity varies greatly, even between family members with identical mutations. Age of onset is highly variable, although symptoms usually appear between 8 and 15 years of age. Patients usually lose the ability to ambulate 10 \u2013 20 years after symptoms appear. Milder forms present with symptoms other than weakness, such as muscle aches, cramps, or exercise intolerance, and people in this group can retain ambulation beyond age 60. Weakness is symmetric, progressive, and proximal (on or close to the torso), usually affecting the hip girdle and shoulder girdle muscles. Hip weakness can manifest as a waddling gate. Shoulder weakness can manifest as winged scapulas. Muscle contractures, especially of the Achilles tendon, and scoliosis can also occur.", + "doc_fkgl": 9.454666666666668, + "wiki_fkgl": 11.629737394957985, + "doc_tree_depth": 5.454545454545454, + "wiki_tree_depth": 6.0, + "fkgl_delta": -2.175070728291317 + }, + { + "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": "Due to the rarity of this syndrome, treatments have been decided on a case-by-case basis. Spinal manipulative therapy and physiotherapy exercises have been used in those with uncomplicated neck-tongue syndrome, resulting in improvements in symptoms. Other methods of symptom management have included: non-steroidal anti-inflammatory drugs, gabapentin, steroid injections and cervical collars. One case report of a 54 year old woman with persistent symptoms, who did not respond to use of a cervical collar or pharmacological pain management treatments, underwent a bilateral C2 spinal nerve resection. She experienced partial relief of symptoms after recovery. Examination of the resected nerve fibers showed loss of both myelinated and unmyelinated nerve fibers, this is a possible explanation for the symptoms associated with NTS, however, further study is needed for a definitive answer. Since NTS is a rare disorder, prognoses differ for each individual based on the suggested cause of NTS symptoms and the form of treatment used. However, it has been reported that familial forms of NTS often exhibit symptoms during adolescence, which spontaneously resolve during adulthood.", + "doc_fkgl": 11.863529411764706, + "wiki_fkgl": 15.352420520231217, + "doc_tree_depth": 5.75, + "wiki_tree_depth": 7.25, + "fkgl_delta": -3.488891108466511 + }, + { + "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": "On 14 November 2020, around 18:30 EET, a fire broke out in the COVID-19 ward of the Piatra Neam\u021b Emergency Hospital in Piatra Neam\u021b, Romania. The fire killed ten people and injured another four, including two doctors. All the deceased people were patients receiving treatment for COVID-19. Many in the ward were on ventilators. The fire brought back to the public's attention the state of the Romanian health system, as well as the political interference in hospital management.", + "doc_fkgl": 4.0628178694158095, + "wiki_fkgl": 10.160666666666668, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 6.2, + "fkgl_delta": -6.097848797250858 + }, + { + "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": "In a true subarachnoid hemorrhage, there is higher attenuation on CT scans of the basal cisterns, and blood that has leaked from a vessel or formed a hematoma is more highly attenuated due to the absorption of plasma. Pseudosubarachnoid hemorrhages have been observed in as much as 20% of patients resuscitated from non-traumatic cardiopulmonary arrest. Patients with pseudosubarachnoid hemorrhages may have worse prognoses than those with true subarachnoid hemorrhages because of underlying disease processes and decreased cerebral perfusion with elevated intracranial pressure. The identification of a pseudosubarachnoid hemorrhage as opposed to a true subarachnoid hemorrhage may therefore change a patient's treatment plan.", + "doc_fkgl": 13.757534883720933, + "wiki_fkgl": 17.029509803921574, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 7.25, + "fkgl_delta": -3.271974920200641 + }, + { + "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": "Indications\nIndications for indocyanine green angiography include:\n Choroidal neovascularisation (CNV): Indocyanine green angiography is widely used to study choroidal neovascularization in patients with exudative age-related macular degeneration. In ICGA, CNV is seen as hyperflourescent spot or plaque. It is also useful in diagnosing and classifying CNV associated to serous pigment epithelial detachments in Nonexudative macular degeneration.\n Idiopathic polypoidal choroidal vasculopathy (IPCV)\n Pigmented choroidal melanomas\n Choroidal haemangioma: ICGA can be used to differentiate choroidal haemangioma from other intraocular tumors.\n Choroiditis: In multifocal choroiditis, lesions are visualized as hypoflourescent spots.\n Chorioretinopathy: In Central serous chorioretinopathy, using ICGA multifocal areas of choroidal hyperpermiability can be visualized. In birdshoot chorioretinopathy, lesions appear as symmetrical round or oval hypoflourescent spots. ICGA allows better visualization of lesions in serpiginous chorioretinopathy, punctate inner chorioretinopathy, acute zonal occult outer retinopathy etc. In multiple evanescent white dot syndrome, numerous hypoflourescent spots can be visualized using ICGA.\n Pigmented epithelial detachment\n Retinal angiomatous proliferation (RAP)\n Chorioretinal atrophy: ICGA help evaluating different stages of chorioretinal atrophy.\n Anterior uveitis: ICGA is rarely indicated in anterior uveitis, but it might be used to find out associated choroidal pathology.\n Stargardt disease: Numerous hypoflourescent spots are seen in ICGA.\n Angioid streaks: ICGA can be used for diagnosing angioid streaks and their associated ocular pathologies.\n Vogt\u2013Koyanagi\u2013Harada disease (VKH): ICGA is useful in diagnosing VKH. In VKH, delay in filling of the choriocapillaris along with larger choroidal vessel perfusion and multiple hypofluorescent spots are visible with ICGA.\n Sympathetic ophthalmia: Sympathetic ophthalmia is a bilateral, granulomatous form of uveitis. In sympathetic ophthalmia, numerous dark spots may be visible during the intermediate phase of ICGA.", + "doc_fkgl": 12.237704402515725, + "wiki_fkgl": 16.04865704772475, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 6.0, + "fkgl_delta": -3.8109526452090243 + } +] \ No newline at end of file