{
"info": {
"nct_id": "NCT05491694",
"official_title": "To Evaluate the Efficacy and Safety of Toripalimab Combined With Chemotherapy (Epirubicin + Cyclophosphamide → Nab-paclitaxel + Carboplatin) in the Neoadjuvant Treatment of Triple-negative Breast Cancer After High-intensity Focused Ultrasound (HIFU) Induction",
"inclusion_criteria": "1. Female patients aged ≥ 18 years who require a negative pregnancy test for premenopausal and perimenopausal patients and promise to take reliable contraceptive measures during treatment;\n2. Histopathologically confirmed breast cancer patients who are negative for estrogen receptor (ER), progesterone receptor (PR), and HER-2 by immunohistochemistry; positive PD-L1 expression in tumor cells (≥ 1%);\n3. triple-negative breast cancer patients without distant metastasis;\n4. According to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, they have at least one evaluable target lesion;\n5. ECOG PS score: 0 - 1;\n6. New York Heart Association (NYHA) functional class I;\n7. Electrocardiogram without myocardial ischemia, echocardiography LVEF > 55%, cardiac markers: cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) test values within the normal range;\n8. Normal major organ function, Meet the following criteria:\n\nWBC ≥ 4.0 × 10 9/L,Neutrophil count (ANC) ≥ 1.5 × 10 9/L; platelet ≥ 100 × 10 9/L; hemoglobin ≥ 10 g/dL; serum creatinine ≤ 1.5 × upper limit of normal (ULN); aspartate aminotransferase (AST) ≤ 2.5 × ULN; alanine aminotransferase (ALT) ≤ 2.5 × ULN; total bilirubin ≤ 1.5 × ULN; serum creatinine ≤ 1.5 × ULN;\n\n9) The subject is able to understand the study procedures, voluntarily join the study, sign the informed consent form, have good compliance, and cooperate with the follow-up.\n\n-\nHealthy volunteers allowed\nMust be FEMALE\nMust have minimum age of 18 Years",
"exclusion_criteria": "1. Patients during pregnancy and lactation, women of childbearing age who refuse to take effective contraceptive measures during the study period; Patients with peripheral nervous system disorders caused by diseases or those with a history of significant mental disorders and central nervous system disorders;\n2. Serious or uncontrolled infections that may affect the evaluation of study treatment or study results, including but not limited to: active hepatitis virus infection, human immunodeficiency virus (HIV) antibody positive, lung infection, etc.;\n3. Known allergy to the active ingredients or other components of the study drug or surgical contraindications;\n4. In addition to cured basal cell carcinoma of the skin and cured cervical carcinoma in situ, other cancers are disease-free for less than 5 years;\n5. Severe liver disease (such as cirrhosis, etc.), kidney disease, respiratory disease or uncontrolled diabetes, active gastrointestinal ulcers and other need treatment;\n6. Need to receive other anti-tumor therapy (except ovarian function inhibitors) during neoadjuvant therapy as judged by the investigator;\n7. Patients who are participating in other clinical trials within one month;\n8. Patients with severe heart disease or discomfort, Expected intolerance to chemotherapy,Including, but not limited to: a. fatal arrhythmia or higher grade atrioventricular block (second-degree type 2 [Mobitz 2] atrioventricular block or third-degree atrioventricular block); b. unstable angina pectoris; c. clinically significant valvular heart disease; d. transmural myocardial infarction on electrocardiogram; e. uncontrolled hypertension;\n9. any other condition that in the opinion of the investigator would make the patient inappropriate for participation in this study.",
"miscellaneous_criteria": ""
},
"inclusion_lines": [
{
"identified_line": {
"line": "1. Female patients aged ≥ 18 years who require a negative pregnancy test for premenopausal and perimenopausal patients and promise to take reliable contraceptive measures during treatment;",
"criterions": [
{
"exact_snippets": "Female patients",
"criterion": "gender",
"requirement": {
"requirement_type": "value",
"expected_value": "female"
}
},
{
"exact_snippets": "aged ≥ 18 years",
"criterion": "age",
"requirement": {
"requirement_type": "minimum age",
"expected_value": {
"operator": ">=",
"value": 18,
"unit": "years"
}
}
},
{
"exact_snippets": "require a negative pregnancy test for premenopausal and perimenopausal patients",
"criterion": "pregnancy test",
"requirement": {
"requirement_type": "result",
"expected_value": "negative"
}
},
{
"exact_snippets": "premenopausal and perimenopausal patients",
"criterion": "menopausal status",
"requirement": {
"requirement_type": "status",
"expected_value": [
"premenopausal",
"perimenopausal"
]
}
},
{
"exact_snippets": "promise to take reliable contraceptive measures during treatment",
"criterion": "contraceptive measures",
"requirement": {
"requirement_type": "commitment",
"expected_value": "promise to take reliable measures"
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"and_criteria": [
{
"exact_snippets": "Female patients",
"criterion": "gender",
"requirement": {
"requirement_type": "value",
"expected_value": "female"
}
},
{
"exact_snippets": "aged ≥ 18 years",
"criterion": "age",
"requirement": {
"requirement_type": "minimum age",
"expected_value": {
"operator": ">=",
"value": 18,
"unit": "years"
}
}
}
]
},
{
"or_criteria": [
{
"and_criteria": [
{
"exact_snippets": "require a negative pregnancy test for premenopausal and perimenopausal patients",
"criterion": "pregnancy test",
"requirement": {
"requirement_type": "result",
"expected_value": "negative"
}
},
{
"exact_snippets": "premenopausal and perimenopausal patients",
"criterion": "menopausal status",
"requirement": {
"requirement_type": "status",
"expected_value": [
"premenopausal",
"perimenopausal"
]
}
}
]
},
{
"exact_snippets": "promise to take reliable contraceptive measures during treatment",
"criterion": "contraceptive measures",
"requirement": {
"requirement_type": "commitment",
"expected_value": "promise to take reliable measures"
}
}
]
}
]
}
},
{
"identified_line": {
"line": "2. Histopathologically confirmed breast cancer patients who are negative for estrogen receptor (ER), progesterone receptor (PR), and HER-2 by immunohistochemistry; positive PD-L1 expression in tumor cells (≥ 1%);",
"criterions": [
{
"exact_snippets": "Histopathologically confirmed breast cancer",
"criterion": "breast cancer",
"requirement": {
"requirement_type": "confirmation method",
"expected_value": "histopathologically confirmed"
}
},
{
"exact_snippets": "negative for estrogen receptor (ER)",
"criterion": "estrogen receptor (ER)",
"requirement": {
"requirement_type": "status",
"expected_value": "negative"
}
},
{
"exact_snippets": "negative for ... progesterone receptor (PR)",
"criterion": "progesterone receptor (PR)",
"requirement": {
"requirement_type": "status",
"expected_value": "negative"
}
},
{
"exact_snippets": "negative for ... HER-2 by immunohistochemistry",
"criterion": "HER-2",
"requirement": {
"requirement_type": "status",
"expected_value": "negative"
}
},
{
"exact_snippets": "negative for ... HER-2 by immunohistochemistry",
"criterion": "HER-2",
"requirement": {
"requirement_type": "confirmation method",
"expected_value": "immunohistochemistry"
}
},
{
"exact_snippets": "positive PD-L1 expression in tumor cells (≥ 1%)",
"criterion": "PD-L1 expression in tumor cells",
"requirement": {
"requirement_type": "expression level",
"expected_value": {
"operator": ">=",
"value": 1,
"unit": "%"
}
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"and_criteria": [
{
"exact_snippets": "Histopathologically confirmed breast cancer",
"criterion": "breast cancer",
"requirement": {
"requirement_type": "confirmation method",
"expected_value": "histopathologically confirmed"
}
},
{
"exact_snippets": "negative for estrogen receptor (ER)",
"criterion": "estrogen receptor (ER)",
"requirement": {
"requirement_type": "status",
"expected_value": "negative"
}
},
{
"exact_snippets": "negative for ... progesterone receptor (PR)",
"criterion": "progesterone receptor (PR)",
"requirement": {
"requirement_type": "status",
"expected_value": "negative"
}
},
{
"and_criteria": [
{
"exact_snippets": "negative for ... HER-2 by immunohistochemistry",
"criterion": "HER-2",
"requirement": {
"requirement_type": "status",
"expected_value": "negative"
}
},
{
"exact_snippets": "negative for ... HER-2 by immunohistochemistry",
"criterion": "HER-2",
"requirement": {
"requirement_type": "confirmation method",
"expected_value": "immunohistochemistry"
}
}
]
}
]
},
{
"exact_snippets": "positive PD-L1 expression in tumor cells (≥ 1%)",
"criterion": "PD-L1 expression in tumor cells",
"requirement": {
"requirement_type": "expression level",
"expected_value": {
"operator": ">=",
"value": 1,
"unit": "%"
}
}
}
]
}
},
{
"identified_line": {
"line": "3. triple-negative breast cancer patients without distant metastasis;",
"criterions": [
{
"exact_snippets": "triple-negative breast cancer patients",
"criterion": "triple-negative breast cancer",
"requirement": {
"requirement_type": "presence",
"expected_value": true
}
},
{
"exact_snippets": "without distant metastasis",
"criterion": "distant metastasis",
"requirement": {
"requirement_type": "presence",
"expected_value": false
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "triple-negative breast cancer patients",
"criterion": "triple-negative breast cancer",
"requirement": {
"requirement_type": "presence",
"expected_value": true
}
},
{
"exact_snippets": "without distant metastasis",
"criterion": "distant metastasis",
"requirement": {
"requirement_type": "presence",
"expected_value": false
}
}
]
}
},
{
"identified_line": {
"line": "4. According to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, they have at least one evaluable target lesion;",
"criterions": [
{
"exact_snippets": "at least one evaluable target lesion",
"criterion": "evaluable target lesion",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 1,
"unit": "N/A"
}
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "at least one evaluable target lesion",
"criterion": "evaluable target lesion",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 1,
"unit": "N/A"
}
}
}
]
}
},
{
"identified_line": {
"line": "5. ECOG PS score: 0 - 1;",
"criterions": [
{
"exact_snippets": "ECOG PS score: 0 - 1",
"criterion": "ECOG PS score",
"requirement": {
"requirement_type": "range",
"expected_value": {
"comparisons": [
{
"operator": ">=",
"value": 0,
"unit": "N/A"
},
{
"operator": "<=",
"value": 1,
"unit": "N/A"
}
]
}
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "ECOG PS score: 0 - 1",
"criterion": "ECOG PS score",
"requirement": {
"requirement_type": "range",
"expected_value": {
"comparisons": [
{
"operator": ">=",
"value": 0,
"unit": "N/A"
},
{
"operator": "<=",
"value": 1,
"unit": "N/A"
}
]
}
}
}
]
}
},
{
"identified_line": {
"line": "6. New York Heart Association (NYHA) functional class I;",
"criterions": [
{
"exact_snippets": "New York Heart Association (NYHA) functional class I",
"criterion": "NYHA functional class",
"requirement": {
"requirement_type": "classification",
"expected_value": "I"
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "New York Heart Association (NYHA) functional class I",
"criterion": "NYHA functional class",
"requirement": {
"requirement_type": "classification",
"expected_value": "I"
}
}
]
}
},
{
"identified_line": {
"line": "7. Electrocardiogram without myocardial ischemia, echocardiography LVEF > 55%, cardiac markers: cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) test values within the normal range;",
"criterions": [
{
"exact_snippets": "Electrocardiogram without myocardial ischemia",
"criterion": "myocardial ischemia",
"requirement": {
"requirement_type": "presence",
"expected_value": false
}
},
{
"exact_snippets": "echocardiography LVEF > 55%",
"criterion": "left ventricular ejection fraction (LVEF)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">",
"value": 55,
"unit": "%"
}
}
},
{
"exact_snippets": "cardiac markers: cardiac troponin I (cTnI) ... test values within the normal range",
"criterion": "cardiac troponin I (cTnI)",
"requirement": {
"requirement_type": "test value",
"expected_value": "within the normal range"
}
},
{
"exact_snippets": "cardiac markers: ... brain natriuretic peptide (BNP) test values within the normal range",
"criterion": "brain natriuretic peptide (BNP)",
"requirement": {
"requirement_type": "test value",
"expected_value": "within the normal range"
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "Electrocardiogram without myocardial ischemia",
"criterion": "myocardial ischemia",
"requirement": {
"requirement_type": "presence",
"expected_value": false
}
},
{
"exact_snippets": "echocardiography LVEF > 55%",
"criterion": "left ventricular ejection fraction (LVEF)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">",
"value": 55,
"unit": "%"
}
}
},
{
"exact_snippets": "cardiac markers: cardiac troponin I (cTnI) ... test values within the normal range",
"criterion": "cardiac troponin I (cTnI)",
"requirement": {
"requirement_type": "test value",
"expected_value": "within the normal range"
}
},
{
"exact_snippets": "cardiac markers: ... brain natriuretic peptide (BNP) test values within the normal range",
"criterion": "brain natriuretic peptide (BNP)",
"requirement": {
"requirement_type": "test value",
"expected_value": "within the normal range"
}
}
]
}
},
{
"identified_line": {
"line": "8. Normal major organ function, Meet the following criteria:",
"criterions": [
{
"exact_snippets": "Normal major organ function",
"criterion": "major organ function",
"requirement": {
"requirement_type": "status",
"expected_value": "normal"
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "Normal major organ function",
"criterion": "major organ function",
"requirement": {
"requirement_type": "status",
"expected_value": "normal"
}
}
]
}
},
{
"identified_line": {
"line": "WBC ≥ 4.0 × 10 9/L,Neutrophil count (ANC) ≥ 1.5 × 10 9/L; platelet ≥ 100 × 10 9/L; hemoglobin ≥ 10 g/dL; serum creatinine ≤ 1.5 × upper limit of normal (ULN); aspartate aminotransferase (AST) ≤ 2.5 × ULN; alanine aminotransferase (ALT) ≤ 2.5 × ULN; total bilirubin ≤ 1.5 × ULN; serum creatinine ≤ 1.5 × ULN;",
"criterions": [
{
"exact_snippets": "WBC ≥ 4.0 × 10 9/L",
"criterion": "WBC",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 4.0,
"unit": "× 10 9/L"
}
}
},
{
"exact_snippets": "Neutrophil count (ANC) ≥ 1.5 × 10 9/L",
"criterion": "Neutrophil count (ANC)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 1.5,
"unit": "× 10 9/L"
}
}
},
{
"exact_snippets": "platelet ≥ 100 × 10 9/L",
"criterion": "platelet",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 100,
"unit": "× 10 9/L"
}
}
},
{
"exact_snippets": "hemoglobin ≥ 10 g/dL",
"criterion": "hemoglobin",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 10,
"unit": "g/dL"
}
}
},
{
"exact_snippets": "serum creatinine ≤ 1.5 × upper limit of normal (ULN)",
"criterion": "serum creatinine",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 1.5,
"unit": "× ULN"
}
}
},
{
"exact_snippets": "aspartate aminotransferase (AST) ≤ 2.5 × ULN",
"criterion": "aspartate aminotransferase (AST)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 2.5,
"unit": "× ULN"
}
}
},
{
"exact_snippets": "alanine aminotransferase (ALT) ≤ 2.5 × ULN",
"criterion": "alanine aminotransferase (ALT)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 2.5,
"unit": "× ULN"
}
}
},
{
"exact_snippets": "total bilirubin ≤ 1.5 × ULN",
"criterion": "total bilirubin",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 1.5,
"unit": "× ULN"
}
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "WBC ≥ 4.0 × 10 9/L",
"criterion": "WBC",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 4.0,
"unit": "× 10 9/L"
}
}
},
{
"exact_snippets": "Neutrophil count (ANC) ≥ 1.5 × 10 9/L",
"criterion": "Neutrophil count (ANC)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 1.5,
"unit": "× 10 9/L"
}
}
},
{
"exact_snippets": "platelet ≥ 100 × 10 9/L",
"criterion": "platelet",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 100,
"unit": "× 10 9/L"
}
}
},
{
"exact_snippets": "hemoglobin ≥ 10 g/dL",
"criterion": "hemoglobin",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": ">=",
"value": 10,
"unit": "g/dL"
}
}
},
{
"exact_snippets": "serum creatinine ≤ 1.5 × upper limit of normal (ULN)",
"criterion": "serum creatinine",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 1.5,
"unit": "× ULN"
}
}
},
{
"exact_snippets": "aspartate aminotransferase (AST) ≤ 2.5 × ULN",
"criterion": "aspartate aminotransferase (AST)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 2.5,
"unit": "× ULN"
}
}
},
{
"exact_snippets": "alanine aminotransferase (ALT) ≤ 2.5 × ULN",
"criterion": "alanine aminotransferase (ALT)",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 2.5,
"unit": "× ULN"
}
}
},
{
"exact_snippets": "total bilirubin ≤ 1.5 × ULN",
"criterion": "total bilirubin",
"requirement": {
"requirement_type": "quantity",
"expected_value": {
"operator": "<=",
"value": 1.5,
"unit": "× ULN"
}
}
}
]
}
},
{
"identified_line": {
"line": "9) The subject is able to understand the study procedures, voluntarily join the study, sign the informed consent form, have good compliance, and cooperate with the follow-up.",
"criterions": [
{
"exact_snippets": "The subject is able to understand the study procedures",
"criterion": "understanding of study procedures",
"requirement": {
"requirement_type": "ability",
"expected_value": true
}
},
{
"exact_snippets": "voluntarily join the study",
"criterion": "voluntary participation",
"requirement": {
"requirement_type": "willingness",
"expected_value": true
}
},
{
"exact_snippets": "sign the informed consent form",
"criterion": "informed consent",
"requirement": {
"requirement_type": "ability",
"expected_value": true
}
},
{
"exact_snippets": "have good compliance",
"criterion": "compliance",
"requirement": {
"requirement_type": "quality",
"expected_value": "good"
}
},
{
"exact_snippets": "cooperate with the follow-up",
"criterion": "follow-up cooperation",
"requirement": {
"requirement_type": "ability",
"expected_value": true
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "The subject is able to understand the study procedures",
"criterion": "understanding of study procedures",
"requirement": {
"requirement_type": "ability",
"expected_value": true
}
},
{
"exact_snippets": "voluntarily join the study",
"criterion": "voluntary participation",
"requirement": {
"requirement_type": "willingness",
"expected_value": true
}
},
{
"exact_snippets": "sign the informed consent form",
"criterion": "informed consent",
"requirement": {
"requirement_type": "ability",
"expected_value": true
}
},
{
"exact_snippets": "have good compliance",
"criterion": "compliance",
"requirement": {
"requirement_type": "quality",
"expected_value": "good"
}
},
{
"exact_snippets": "cooperate with the follow-up",
"criterion": "follow-up cooperation",
"requirement": {
"requirement_type": "ability",
"expected_value": true
}
}
]
}
},
{
"identified_line": {
"line": "Healthy volunteers allowed",
"criterions": [
{
"exact_snippets": "Healthy volunteers allowed",
"criterion": "volunteer health status",
"requirement": {
"requirement_type": "status",
"expected_value": "healthy"
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "Healthy volunteers allowed",
"criterion": "volunteer health status",
"requirement": {
"requirement_type": "status",
"expected_value": "healthy"
}
}
]
}
},
{
"identified_line": {
"line": "Must be FEMALE",
"criterions": [
{
"exact_snippets": "Must be FEMALE",
"criterion": "gender",
"requirement": {
"requirement_type": "expected_value",
"expected_value": "female"
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "Must be FEMALE",
"criterion": "gender",
"requirement": {
"requirement_type": "expected_value",
"expected_value": "female"
}
}
]
}
},
{
"identified_line": {
"line": "Must have minimum age of 18 Years",
"criterions": [
{
"exact_snippets": "minimum age of 18 Years",
"criterion": "age",
"requirement": {
"requirement_type": "minimum",
"expected_value": {
"operator": ">=",
"value": 18,
"unit": "Years"
}
}
}
]
},
"logical_structure": {
"and_criteria": [
{
"exact_snippets": "minimum age of 18 Years",
"criterion": "age",
"requirement": {
"requirement_type": "minimum",
"expected_value": {
"operator": ">=",
"value": 18,
"unit": "Years"
}
}
}
]
}
},
{
"identified_line": {
"line": "-",
"criterions": []
},
"logical_structure": {
"and_criteria": []
}
}
],
"exclusion_lines": [
{
"identified_line": {
"line": "1. Patients during pregnancy and lactation, women of childbearing age who refuse to take effective contraceptive measures during the study period; Patients with peripheral nervous system disorders caused by diseases or those with a history of significant mental disorders and central nervous system disorders;",
"criterions": [
{
"exact_snippets": "Patients during pregnancy",
"criterion": "pregnancy",
"requirement": {
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},
{
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}
},
{
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}
},
{
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},
{
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}
},
{
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},
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{
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{
"and_criteria": [
{
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{
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}
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]
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{
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},
{
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},
{
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"expected_value": false
}
},
{
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"expected_value": true
}
},
{
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"expected_value": true
}
},
{
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]
},
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]
},
{
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}
},
{
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}
},
{
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]
}
},
{
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{
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}
},
{
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]
},
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{
"and_criteria": [
{
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}
}
]
},
{
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}
]
}
},
{
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{
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"criterion": "basal cell carcinoma of the skin",
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}
},
{
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"criterion": "cervical carcinoma in situ",
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}
},
{
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"criterion": "other cancers",
"requirement": {
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"expected_value": {
"operator": "<",
"value": 5,
"unit": "years"
}
}
}
]
},
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{
"not_criteria": {
"and_criteria": [
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}
},
{
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}
},
{
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}
}
]
}
},
{
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}
},
{
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"expected_value": true
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},
{
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"expected_value": true
}
},
{
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}
},
{
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}
]
},
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},
{
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}
},
{
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},
{
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]
},
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}
]
}
}
],
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"failed_inclusion": [],
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{
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},
{
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},
{
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}
]
},
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}
},
{
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},
{
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}
}
]
},
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}
},
{
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{
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"criterion": "heart disease",
"requirement": {
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"expected_value": "severe"
}
},
{
"exact_snippets": "discomfort",
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"requirement": {
"requirement_type": "presence",
"expected_value": true
}
},
{
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"expected_value": true
}
},
{
"exact_snippets": "fatal arrhythmia",
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}
},
{
"exact_snippets": "higher grade atrioventricular block (second-degree type 2 [Mobitz 2] atrioventricular block or third-degree atrioventricular block)",
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}
},
{
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}
},
{
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}
},
{
"exact_snippets": "transmural myocardial infarction on electrocardiogram",
"criterion": "myocardial infarction",
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}
},
{
"exact_snippets": "transmural myocardial infarction on electrocardiogram",
"criterion": "myocardial infarction",
"requirement": {
"requirement_type": "detection method",
"expected_value": "electrocardiogram"
}
},
{
"exact_snippets": "uncontrolled hypertension",
"criterion": "hypertension",
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}
}
]
},
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}
}
},
{
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{
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}
}
]
},
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}
}
],
"failed_miscellaneous": []
}