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T1 Age 2 13 56-year-old T2 Personal_background 14 30 African American T3 Sex 31 34 man T4 Clinical_event 49 58 presented E1 Clinical_event:T4 T5 Sign_symptom 64 72 diarrhea E2 Sign_symptom:T5 T6 Sign_symptom 74 85 weight loss E3 Sign_symptom:T6 T7 Sign_symptom 99 107 jaundice E4 Sign_symptom:T7 T8 Detailed_description 90 98 painless R1 MODIFY Arg1:T8 Arg2:E4 T9 Disease_disorder 140 154 adenocarcinoma E5 Disease_disorder:T9 T10 Biological_structure 162 178 head of pancreas R2 MODIFY Arg1:T10 Arg2:E5 T11 Disease_disorder 217 223 cancer E6 Disease_disorder:T11 T12 Detailed_description 207 216 localized R3 MODIFY Arg1:T12 Arg2:E6 T13 Disease_disorder 252 262 metastases E7 Disease_disorder:T13 A1 POLARITY E7 NEG T14 Detailed_description 244 251 distant R4 MODIFY Arg1:T14 Arg2:E7 T15 Diagnostic_procedure 183 197 initial workup E8 Diagnostic_procedure:T15 T16 Therapeutic_procedure 282 305 pancreaticoduodenectomy E9 Therapeutic_procedure:T16 T17 Therapeutic_procedure 320 338 surgical resection E10 Therapeutic_procedure:T17 T18 Detailed_description 311 319 complete R5 MODIFY Arg1:T18 Arg2:E10 T19 Disease_disorder 385 399 adenocarcinoma E11 Disease_disorder:T19 T20 Biological_structure 374 384 pancreatic R6 MODIFY Arg1:T20 Arg2:E11 T21 Detailed_description 348 373 moderately differentiated R7 MODIFY Arg1:T21 Arg2:E11 T22 Distance 344 347 5cm R8 MODIFY Arg1:T22 Arg2:E11 T23 Therapeutic_procedure 3448 3463 palliative care E12 Therapeutic_procedure:T23 T24 Therapeutic_procedure 441 459 surgical resection E13 Therapeutic_procedure:T24 T25 Detailed_description 432 440 complete R9 MODIFY Arg1:T25 Arg2:E13 T26 Diagnostic_procedure 463 487 pathological examination E14 Diagnostic_procedure:T26 T27 Sign_symptom 499 518 neoplastic invasion E15 Sign_symptom:T27 T28 Biological_structure 535 550 adjacent organs R10 MODIFY Arg1:T28 Arg2:E15 T29 Sign_symptom 608 614 cancer E16 Sign_symptom:T29 T30 Lab_value 616 622 T3N1M0 E17 Lab_value:T30 R11 MODIFY Arg1:E17 Arg2:E16 T31 Biological_structure 586 597 lymph nodes T32 Quantitative_concept 556 576 one out of the seven R12 MODIFY Arg1:T32 Arg2:T31 R13 MODIFY Arg1:T31 Arg2:E16 T33 Nonbiological_location 644 663 oncology department T34 Clinical_event 664 675 recommended E18 Clinical_event:T34 R14 MODIFY Arg1:T33 Arg2:E18 T35 Medication 701 713 chemotherapy E19 Medication:T35 T36 Detailed_description 692 700 adjuvant R15 MODIFY Arg1:T36 Arg2:E19 T37 Medication 719 730 gemcitabine E20 Medication:T37 T38 Dosage 732 741 1000mg/m2 T39 Administration 742 744 IV R16 SUB_PROCEDURE Arg1:E20 Arg2:E19 R17 MODIFY Arg1:T38 Arg2:E20 R18 MODIFY Arg1:T39 Arg2:E20 T40 Frequency 748 794 days 1, 8, 15 on a 28-day cycle for six cycles R19 MODIFY Arg1:T40 Arg2:E20 T41 Sign_symptom 831 841 recurrence E21 Sign_symptom:T41 A2 POLARITY E21 UNCERTAIN T42 Medication 906 918 chemotherapy E22 Medication:T42 T43 Clinical_event 923 932 presented E23 Clinical_event:T43 T44 Quantitative_concept 869 879 two cycles R20 MODIFY Arg1:T44 Arg2:E22 T45 Quantitative_concept 892 901 six doses R21 MODIFY Arg1:T45 Arg2:E22 T46 Nonbiological_location 940 960 emergency department R22 MODIFY Arg1:T46 Arg2:E23 T47 Sign_symptom 987 994 dyspnea E24 Sign_symptom:T47 A3 TREND E24 INC T48 Detailed_description 976 986 exertional R23 MODIFY Arg1:T48 Arg2:E24 T49 Sign_symptom 1009 1018 orthopnea E25 Sign_symptom:T49 T50 Detailed_description 996 1008 three-pillow R24 MODIFY Arg1:T50 Arg2:E25 #1 AnnotatorNotes T50 technically a severity, but specific to orthopnea T51 Sign_symptom 1041 1048 dyspnea E26 Sign_symptom:T51 T52 Detailed_description 1020 1030 paroxysmal T53 Detailed_description 1031 1040 nocturnal R25 MODIFY Arg1:T53 Arg2:E26 R26 MODIFY Arg1:T52 Arg2:E26 T54 Sign_symptom 1053 1060 fatigue E27 Sign_symptom:T54 T55 Diagnostic_procedure 1066 1086 physical examination E28 Diagnostic_procedure:T55 T56 Diagnostic_procedure 1108 1131 jugular venous pressure E29 Diagnostic_procedure:T56 T57 Diagnostic_procedure 1133 1136 JVP E30 Diagnostic_procedure:T57 R27 IDENTICAL Arg1:E30 Arg2:E29 T58 Lab_value 1099 1107 elevated E31 Lab_value:T58 R28 MODIFY Arg1:E31 Arg2:E29 T59 Lab_value 1139 1167 10cm above the sternal angle E32 Lab_value:T59 R29 MODIFY Arg1:E32 Arg2:E29 T60 Sign_symptom 1180 1185 rales E33 Sign_symptom:T60 T61 Detailed_description 1170 1179 bibasilar R30 MODIFY Arg1:T61 Arg2:E33 T62 Sign_symptom 1201 1206 edema E34 Sign_symptom:T62 T63 Detailed_description 1193 1200 pitting T64 Lab_value 1190 1192 +2 E35 Lab_value:T64 R31 MODIFY Arg1:T63 Arg2:E34 R32 MODIFY Arg1:E35 Arg2:E34 T65 Biological_structure 1210 1232 both lower extremities R33 MODIFY Arg1:T65 Arg2:E34 T66 Diagnostic_procedure 1242 1254 auscultation E36 Diagnostic_procedure:T66 T67 Biological_structure 1234 1241 Cardiac R34 MODIFY Arg1:T67 Arg2:E36 T68 Sign_symptom 1266 1279 gallop rhythm E37 Sign_symptom:T68 T69 Sign_symptom 1318 1324 murmur E38 Sign_symptom:T69 T70 Biological_structure 1330 1340 precordium R35 MODIFY Arg1:T70 Arg2:E38 T71 Detailed_description 1305 1317 holosystolic T72 Detailed_description 1288 1290 S3 R36 MODIFY Arg1:T72 Arg2:E37 T73 Lab_value 1297 1304 grade 3 E39 Lab_value:T73 R37 MODIFY Arg1:T71 Arg2:E38 R38 MODIFY Arg1:E39 Arg2:E38 T74 Diagnostic_procedure 1350 1355 X-ray E40 Diagnostic_procedure:T74 T75 Biological_structure 1344 1349 chest R39 MODIFY Arg1:T75 Arg2:E40 T76 Sign_symptom 1363 1375 cardiomegaly E41 Sign_symptom:T76 T77 Disease_disorder 1416 1432 pleural effusion E42 Disease_disorder:T77 T78 Severity 1381 1385 mild T79 Severity 1389 1403 moderate-sized T80 Detailed_description 1404 1415 right-sided R40 MODIFY Arg1:T80 Arg2:E42 R41 MODIFY Arg1:T79 Arg2:E42 R42 MODIFY Arg1:T78 Arg2:E42 T81 Disease_disorder 1519 1543 congestive heart failure E43 Disease_disorder:T81 T82 Disease_disorder 1545 1548 CHF E44 Disease_disorder:T82 R43 IDENTICAL Arg1:E44 Arg2:E43 T83 Sign_symptom 1491 1505 fluid overload E45 Sign_symptom:T83 R44 CAUSE Arg1:E43 Arg2:E45 A4 POLARITY E43 MAYBE_POS A5 POLARITY E45 MAYBE_POS T84 Medication 1589 1599 furosemide E46 Medication:T84 T85 Administration 1572 1583 intravenous T86 Administration 1585 1587 IV R45 IDENTICAL Arg1:T86 Arg2:T85 R46 MODIFY Arg1:T85 Arg2:E46 T87 Sign_symptom 1632 1640 symptoms E47 Sign_symptom:T87 A6 POLARITY E47 MAYBE_NEG T88 Diagnostic_procedure 1658 1690 two-dimensional echocardiography E48 Diagnostic_procedure:T88 T89 Diagnostic_procedure 1692 1699 2D Echo E49 Diagnostic_procedure:T89 R47 IDENTICAL Arg1:E49 Arg2:E48 T90 Diagnostic_procedure 1729 1763 left ventricular ejection fraction E50 Diagnostic_procedure:T90 T91 Diagnostic_procedure 1765 1769 LVEF E51 Diagnostic_procedure:T91 R48 IDENTICAL Arg1:E51 Arg2:E50 T92 Lab_value 1774 1790 15 to 20 percent E52 Lab_value:T92 R49 MODIFY Arg1:E52 Arg2:E50 T93 Sign_symptom 1803 1814 hypokinesia E53 Sign_symptom:T93 T94 Detailed_description 1796 1802 global R50 MODIFY Arg1:T94 Arg2:E53 T95 Sign_symptom 1835 1855 mitral regurgitation E54 Sign_symptom:T95 T96 Severity 1826 1834 moderate R51 MODIFY Arg1:T96 Arg2:E54 T97 Diagnostic_procedure 1879 1886 2D Echo E55 Diagnostic_procedure:T97 T98 Sign_symptom 1918 1958 risk factors for coronary artery disease E56 Sign_symptom:T98 A7 POLARITY E56 NEG T99 Disease_disorder 1935 1958 coronary artery disease E57 Disease_disorder:T99 T100 Disease_disorder 1960 1963 CAD E58 Disease_disorder:T100 R52 IDENTICAL Arg1:E58 Arg2:E57 T101 Disease_disorder 1978 1992 cardiomyopathy E59 Disease_disorder:T101 A8 POLARITY E57 NEG A9 POLARITY E59 NEG T102 Disease_disorder 1994 1997 CMP E60 Disease_disorder:T102 R53 IDENTICAL Arg1:E60 Arg2:E59 T103 Detailed_description 1969 1977 ischemic R54 MODIFY Arg1:T103 Arg2:E59 T104 Disease_disorder 2036 2039 CMP E61 Disease_disorder:T104 T105 Medication 2073 2084 gemcitabine E62 Medication:T105 R55 CAUSE Arg1:E62 Arg2:E61 T106 Medication 2118 2128 carvedilol E63 Medication:T106 T107 Medication 2136 2175 angiotensin-converting enzyme inhibitor E64 Medication:T107 T108 Medication 2191 2200 diuretics E65 Medication:T108 T109 Clinical_event 2212 2222 discharged E66 Clinical_event:T109 T110 Nonbiological_location 2232 2240 hospital R56 MODIFY Arg1:T110 Arg2:E66 T111 Date 2241 2255 two days later E67 Date:T111 T112 Nonbiological_location 2297 2318 cardiology department T113 Clinical_event 2319 2330 recommended E68 Clinical_event:T113 T114 Medication 2348 2360 chemotherapy E69 Medication:T114 A10 POLARITY E69 NEG T115 Medication 2366 2377 gemcitabine E70 Medication:T115 A11 POLARITY E70 NEG R57 SUB_PROCEDURE Arg1:E70 Arg2:E69 T116 Sign_symptom 2261 2270 euvolemic E71 Sign_symptom:T116 T117 Clinical_event 2403 2410 advised E72 Clinical_event:T117 R58 MODIFY Arg1:T112 Arg2:E68 T118 Nonbiological_location 2383 2402 oncology department R59 MODIFY Arg1:T118 Arg2:E72 T119 Diagnostic_procedure 2419 2426 testing E73 Diagnostic_procedure:T119 T120 Sign_symptom 2439 2447 ischemia E74 Sign_symptom:T120 A12 POLARITY E74 UNCERTAIN T121 Disease_disorder 2462 2465 CMP E75 Disease_disorder:T121 R60 CAUSE Arg1:E74 Arg2:E75 T122 Medication 2488 2500 chemotherapy E76 Medication:T122 T123 Medication 2506 2517 gemcitabine E77 Medication:T123 A13 POLARITY E76 UNCERTAIN A14 POLARITY E77 UNCERTAIN R61 SUB_PROCEDURE Arg1:E77 Arg2:E76 T124 Sign_symptom 2560 2570 recurrence E78 Sign_symptom:T124 A15 POLARITY E78 UNCERTAIN T125 Date 2588 2603 Two weeks later E79 Date:T125 T126 Diagnostic_procedure 2627 2655 myocardial perfusion imaging E80 Diagnostic_procedure:T126 T127 Diagnostic_procedure 2657 2660 MPI E81 Diagnostic_procedure:T127 R62 IDENTICAL Arg1:E81 Arg2:E80 T128 Sign_symptom 2723 2729 defect E82 Sign_symptom:T128 T129 Biological_structure 2709 2722 inferior wall R63 MODIFY Arg1:T129 Arg2:E82 T130 Sign_symptom 2761 2769 ischemia E83 Sign_symptom:T130 A16 POLARITY E83 NEG T131 Severity 2684 2708 small- to moderate-sized R64 MODIFY Arg1:T131 Arg2:E82 T132 Detailed_description 2678 2683 fixed R65 MODIFY Arg1:T132 Arg2:E82 T133 Diagnostic_procedure 2775 2792 ejection fraction E84 Diagnostic_procedure:T133 T134 Diagnostic_procedure 2794 2796 EF E85 Diagnostic_procedure:T134 R66 IDENTICAL Arg1:E85 Arg2:E84 T135 Diagnostic_procedure 2801 2804 MPI E86 Diagnostic_procedure:T135 T136 Lab_value 2833 2849 17 to 20 percent E87 Lab_value:T136 R67 MODIFY Arg1:E87 Arg2:E84 T137 Sign_symptom 2869 2880 hypokinesia E88 Sign_symptom:T137 T138 Detailed_description 2862 2868 global T139 Severity 2855 2861 severe R68 MODIFY Arg1:T139 Arg2:E88 R69 MODIFY Arg1:T138 Arg2:E88 T140 Therapeutic_procedure 2920 2941 heart failure therapy E89 Therapeutic_procedure:T140 T141 Clinical_event 2956 2965 admission E90 Clinical_event:T141 T142 Nonbiological_location 2973 2981 hospital R70 MODIFY Arg1:T142 Arg2:E90 T143 Disease_disorder 2986 2989 CHF E91 Disease_disorder:T143 T144 Detailed_description 2990 3002 exacerbation R71 MODIFY Arg1:T144 Arg2:E91 T145 Date 3009 3025 two months later E92 Date:T145 T146 Medication 3051 3061 furosemide E93 Medication:T146 T147 Therapeutic_procedure 3080 3101 heart failure therapy E94 Therapeutic_procedure:T147 T148 Detailed_description 3066 3076 adjustment R72 MODIFY Arg1:T148 Arg2:E94 T149 Administration 3048 3050 IV R73 MODIFY Arg1:T149 Arg2:E93 T150 Diagnostic_procedure 3105 3112 2D Echo E95 Diagnostic_procedure:T150 T151 Diagnostic_procedure 3174 3191 systolic function E96 Diagnostic_procedure:T151 T152 Lab_value 3159 3170 improvement E97 Lab_value:T152 R74 MODIFY Arg1:E97 Arg2:E96 T153 Date 3126 3144 a few months later E98 Date:T153 T154 Diagnostic_procedure 3200 3204 LVEF E99 Diagnostic_procedure:T154 T155 Lab_value 3208 3218 40 percent E100 Lab_value:T155 R75 MODIFY Arg1:E100 Arg2:E99 T156 Diagnostic_procedure 3236 3253 functional status E101 Diagnostic_procedure:T156 T157 Lab_value 3231 3235 poor E102 Lab_value:T157 R76 MODIFY Arg1:E102 Arg2:E101 T158 Disease_disorder 3269 3272 CMP E103 Disease_disorder:T158 T159 Medication 3282 3293 gemcitabine E104 Medication:T159 A17 POLARITY E104 NEG T160 Medication 3294 3306 chemotherapy E105 Medication:T160 A18 POLARITY E105 NEG R77 SUB_PROCEDURE Arg1:E104 Arg2:E105 T161 Medication 3407 3419 chemotherapy E106 Medication:T161 A19 POLARITY E106 NEG T162 Disease_disorder 3369 3386 pancreatic cancer E107 Disease_disorder:T162 T163 Sign_symptom 3351 3361 recurrence E108 Sign_symptom:T163 T164 Disease_disorder 3518 3532 cardiomyopathy E109 Disease_disorder:T164 T165 Detailed_description 3510 3517 dilated R78 MODIFY Arg1:T165 Arg2:E109 T166 Medication 3550 3561 gemcitabine E110 Medication:T166 R79 CAUSE Arg1:E110 Arg2:E109 T167 Medication 3658 3669 gemcitabine E111 Medication:T167 T168 Medication 3670 3682 chemotherapy E112 Medication:T168 R80 SUB_PROCEDURE Arg1:E111 Arg2:E112 T169 Sign_symptom 3696 3725 risk factors for ischemic CMP E113 Sign_symptom:T169 A20 POLARITY E113 NEG T170 Disease_disorder 3747 3750 CAD E114 Disease_disorder:T170 T171 History 3736 3750 history of CAD T172 Sign_symptom 3770 3781 hypokinesia E115 Sign_symptom:T172 T173 Detailed_description 3763 3769 global R81 MODIFY Arg1:T173 Arg2:E115 T174 Diagnostic_procedure 3785 3792 2D Echo E116 Diagnostic_procedure:T174 T175 Sign_symptom 3805 3813 ischemia E117 Sign_symptom:T175 A21 POLARITY E117 NEG T176 Diagnostic_procedure 3817 3820 MPI E118 Diagnostic_procedure:T176 T177 Diagnostic_procedure 3845 3862 systolic function E119 Diagnostic_procedure:T177 T178 Lab_value 3826 3837 improvement E120 Lab_value:T178 R82 MODIFY Arg1:E120 Arg2:E119 T179 Medication 3888 3899 gemcitabine E121 Medication:T179 A22 POLARITY E121 NEG T180 Medication 3925 3936 gemcitabine E122 Medication:T180 T181 Disease_disorder 3945 3959 cardiomyopathy E123 Disease_disorder:T181 R83 CAUSE Arg1:E122 Arg2:E123 * OVERLAP E1 E2 E3 E4 E5 E8 E6 E7 R84 BEFORE Arg1:E7 Arg2:E9 * OVERLAP E9 E10 E11 E13 R85 BEFORE Arg1:E13 Arg2:E14 * OVERLAP E14 E15 E16 R86 BEFORE Arg1:E16 Arg2:E18 * OVERLAP E18 E19 E21 R87 BEFORE Arg1:E21 Arg2:E22 R88 BEFORE Arg1:E22 Arg2:E23 * OVERLAP E23 E24 E25 E26 E27 E28 E29 E33 E34 E36 E37 E38 E40 E41 E42 E45 E46 E47 T182 Date 1646 1654 next day E124 Date:T182 R89 BEFORE Arg1:E47 Arg2:E124 * OVERLAP E124 E48 E50 E53 E54 E55 E56 E57 E59 E61 E62 R90 BEFORE Arg1:E62 Arg2:E63 * OVERLAP E63 E64 E65 R91 BEFORE Arg1:E65 Arg2:E66 * OVERLAP E66 E67 E71 E68 E69 E72 E73 E74 E75 E76 E78 A23 POLARITY E73 UNCERTAIN R92 BEFORE Arg1:E78 Arg2:E79 * OVERLAP E79 E80 E82 E83 E84 E88 R93 BEFORE Arg1:E88 Arg2:E89 R94 BEFORE Arg1:E89 Arg2:E90 * OVERLAP E90 E91 E92 R95 BEFORE Arg1:E92 Arg2:E93 * OVERLAP E93 E94 R96 BEFORE Arg1:E94 Arg2:E95 * OVERLAP E95 E98 E96 E99 E101 E103 E104 R97 BEFORE Arg1:E104 Arg2:E108 * OVERLAP E108 E107 E106 E12