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T1 Age 2 13 44-year-old T2 Sex 14 17 man T3 Disease_disorder 42 47 LCNEC E1 Disease_disorder:T3 #1 AnnotatorNotes E1 Large-cell neuroendocrine carcinoma T4 Biological_structure 55 61 thymus R1 MODIFY Arg1:T4 Arg2:E1 T5 Sign_symptom 72 82 metastasis E2 Sign_symptom:T5 T6 Biological_structure 67 71 bone R2 MODIFY Arg1:T6 Arg2:E2 T7 Nonbiological_location 88 106 different hospital T8 Clinical_event 27 36 diagnosed E3 Clinical_event:T8 R3 MODIFY Arg1:T7 Arg2:E3 T9 Date 107 125 3 years previously E4 Date:T9 T10 Diagnostic_procedure 147 151 ACTH E5 Diagnostic_procedure:T10 #2 AnnotatorNotes E5 Adrenocorticotropic hormone T11 Diagnostic_procedure 156 164 cortisol E6 Diagnostic_procedure:T11 T12 Lab_value 170 178 elevated R4 MODIFY Arg1:T12 Arg2:E6 R5 MODIFY Arg1:T12 Arg2:E5 T13 Diagnostic_procedure 190 216 magnetic resonance imaging E7 Diagnostic_procedure:T13 T14 Biological_structure 184 189 brain R6 MODIFY Arg1:T14 Arg2:E7 T15 Detailed_description 235 250 pituitary gland R7 MODIFY Arg1:T15 Arg2:E7 T16 Lab_value 255 261 normal R8 MODIFY Arg1:T16 Arg2:T15 T17 Diagnostic_procedure 272 300 immunohistochemical staining E8 Diagnostic_procedure:T17 T18 Biological_structure 308 327 thymic tumor tissue R9 MODIFY Arg1:T18 Arg2:E8 T19 Diagnostic_procedure 345 363 anti-ACTH antibody E9 Diagnostic_procedure:T19 T20 Lab_value 337 344 partial T21 Lab_value 364 374 positivity R10 MODIFY Arg1:T21 Arg2:E9 R11 MODIFY Arg1:T20 Arg2:E9 R12 SUB_PROCEDURE Arg1:E9 Arg2:E8 T22 Coreference 380 385 tumor E10 Coreference:T22 R13 IDENTICAL Arg1:E10 Arg2:E1 T23 Detailed_description 417 443 ectopically producing ACTH R14 MODIFY Arg1:T23 Arg2:E10 T24 Medication 467 479 chemotherapy E11 Medication:T24 T25 Medication 485 494 cisplatin E12 Medication:T25 T26 Medication 499 509 irinotecan E13 Medication:T26 R15 SUB_PROCEDURE Arg1:E12 Arg2:E11 R16 SUB_PROCEDURE Arg1:E13 Arg2:E11 T27 Detailed_description 552 590 problematic due to a lack of tolerance R17 MODIFY Arg1:T27 Arg2:E11 T28 Sign_symptom 606 618 hypertension E14 Sign_symptom:T28 T29 Disease_disorder 623 631 diabetes E15 Disease_disorder:T29 T30 Disease_disorder 646 667 ectopic ACTH syndrome E16 Disease_disorder:T30 R18 CAUSE Arg1:E16 Arg2:E15 R19 CAUSE Arg1:E16 Arg2:E14 T31 Medication 705 720 zoledronic acid E17 Medication:T31 T32 Sign_symptom 730 740 metastasis E18 Sign_symptom:T32 T33 Biological_structure 725 729 bone R20 MODIFY Arg1:T33 Arg2:E18 T34 Clinical_event 758 766 referred E19 Clinical_event:T34 T35 Nonbiological_location 774 806 Endocrine Center at our hospital R21 MODIFY Arg1:T35 Arg2:E19 T36 Date 807 821 after 3 months E20 Date:T36 T37 Sign_symptom 831 852 sensation of weakness E21 Sign_symptom:T37 T38 Sign_symptom 878 891 hyperglycemia E22 Sign_symptom:T38 A1 TREND E22 INC T39 Diagnostic_procedure 895 915 physical examination E23 Diagnostic_procedure:T39 T40 Sign_symptom 925 937 hypertension E24 Sign_symptom:T40 T41 Sign_symptom 954 958 mass E25 Sign_symptom:T41 T42 Detailed_description 941 953 subcutaneous T43 Detailed_description 968 976 palpable R22 MODIFY Arg1:T42 Arg2:E25 R23 MODIFY Arg1:T43 Arg2:E25 T44 Biological_structure 984 998 anterior chest R24 MODIFY Arg1:T44 Arg2:E25 T45 Sign_symptom 1004 1011 redness E26 Sign_symptom:T45 T46 Sign_symptom 1016 1024 swelling E27 Sign_symptom:T46 T47 Biological_structure 1032 1046 left lower leg R25 MODIFY Arg1:T47 Arg2:E27 R26 MODIFY Arg1:T47 Arg2:E26 T48 Sign_symptom 1055 1060 fever E28 Sign_symptom:T48 A2 POLARITY E28 NEG T49 Sign_symptom 1062 1082 respiratory symptoms E29 Sign_symptom:T49 A3 POLARITY E29 NEG T50 Sign_symptom 1084 1093 hypoxemia E30 Sign_symptom:T50 A4 POLARITY E30 NEG T51 Sign_symptom 1098 1119 abnormal chest sounds E31 Sign_symptom:T51 A5 POLARITY E31 NEG T52 Diagnostic_procedure 1125 1142 oxygen saturation E32 Diagnostic_procedure:T52 T53 Detailed_description 1146 1160 pulse oximeter T54 Detailed_description 1164 1172 room air R27 MODIFY Arg1:T54 Arg2:E32 R28 MODIFY Arg1:T53 Arg2:E32 T55 Lab_value 1181 1184 97% R29 MODIFY Arg1:T55 Arg2:E32 T56 Diagnostic_procedure 1193 1209 respiratory rate E33 Diagnostic_procedure:T56 T57 Lab_value 1214 1235 13 breaths per minute R30 MODIFY Arg1:T57 Arg2:E33 T58 Diagnostic_procedure 1247 1266 laboratory findings E34 Diagnostic_procedure:T58 T59 Diagnostic_procedure 1272 1288 white blood cell E35 Diagnostic_procedure:T59 T60 Diagnostic_procedure 1293 1303 neutrophil E36 Diagnostic_procedure:T60 T61 Diagnostic_procedure 1316 1327 blood sugar E37 Diagnostic_procedure:T61 T62 Diagnostic_procedure 1329 1341 triglyceride E38 Diagnostic_procedure:T62 T63 Diagnostic_procedure 1347 1382 low-density lipoprotein cholesterol E39 Diagnostic_procedure:T63 T64 Lab_value 1407 1415 elevated R31 MODIFY Arg1:T64 Arg2:E39 R32 MODIFY Arg1:T64 Arg2:E38 R33 MODIFY Arg1:T64 Arg2:E37 R34 MODIFY Arg1:T64 Arg2:E36 R35 MODIFY Arg1:T64 Arg2:E35 R36 SUB_PROCEDURE Arg1:E35 Arg2:E34 R37 SUB_PROCEDURE Arg1:E36 Arg2:E34 R38 SUB_PROCEDURE Arg1:E37 Arg2:E34 R39 SUB_PROCEDURE Arg1:E38 Arg2:E34 R40 SUB_PROCEDURE Arg1:E39 Arg2:E34 T65 Diagnostic_procedure 1435 1444 potassium E40 Diagnostic_procedure:T65 T66 Lab_value 1455 1464 decreased T67 Lab_value 1468 1477 2.8 mEq/L R41 MODIFY Arg1:T66 Arg2:E40 R42 MODIFY Arg1:T67 Arg2:E40 T68 Diagnostic_procedure 1493 1514 lactate dehydrogenase E41 Diagnostic_procedure:T68 T69 Lab_value 1516 1524 468 IU/L R43 MODIFY Arg1:T69 Arg2:E41 T70 Diagnostic_procedure 1527 1540 beta-D glucan E42 Diagnostic_procedure:T70 T71 Lab_value 1542 1553 370.8 pg/mL R44 MODIFY Arg1:T71 Arg2:E42 T72 Diagnostic_procedure 1556 1560 ACTH E43 Diagnostic_procedure:T72 T73 Lab_value 1562 1573 354.1 pg/mL R45 MODIFY Arg1:T73 Arg2:E43 T74 Diagnostic_procedure 1580 1588 cortisol E44 Diagnostic_procedure:T74 T75 Lab_value 1590 1600 49.1 μg/dL R46 MODIFY Arg1:T75 Arg2:E44 T76 Lab_value 1619 1627 elevated R47 MODIFY Arg1:T76 Arg2:E44 R48 MODIFY Arg1:T76 Arg2:E43 R49 MODIFY Arg1:T76 Arg2:E42 R50 MODIFY Arg1:T76 Arg2:E41 T77 Diagnostic_procedure 1643 1648 serum E45 Diagnostic_procedure:T77 T78 Diagnostic_procedure 1666 1677 aspergillus E46 Diagnostic_procedure:T78 T79 Diagnostic_procedure 1679 1686 candida E47 Diagnostic_procedure:T79 T80 Diagnostic_procedure 1692 1713 cryptococcus antigens E48 Diagnostic_procedure:T80 R51 SUB_PROCEDURE Arg1:E46 Arg2:E45 R52 SUB_PROCEDURE Arg1:E47 Arg2:E45 R53 SUB_PROCEDURE Arg1:E48 Arg2:E45 T81 Lab_value 1653 1661 negative R54 MODIFY Arg1:T81 Arg2:E46 R55 MODIFY Arg1:T81 Arg2:E47 R56 MODIFY Arg1:T81 Arg2:E48 T82 Diagnostic_procedure 1717 1754 cytomegalovirus pp65 antigenemia test E49 Diagnostic_procedure:T82 T83 Lab_value 1770 1778 negative R57 MODIFY Arg1:T83 Arg2:E49 T84 Diagnostic_procedure 1982 2001 Computed tomography E50 Diagnostic_procedure:T84 T85 Diagnostic_procedure 2003 2005 CT E51 Diagnostic_procedure:T85 R58 IDENTICAL Arg1:E51 Arg2:E50 T86 Sign_symptom 2086 2093 lesions E52 Sign_symptom:T86 T87 Biological_structure 2081 2085 bone T88 Biological_structure 2059 2065 thymic T89 Detailed_description 2070 2080 metastatic R59 MODIFY Arg1:T87 Arg2:E52 R60 MODIFY Arg1:T88 Arg2:E52 R61 MODIFY Arg1:T89 Arg2:E52 T90 Sign_symptom 2132 2141 opacities E53 Sign_symptom:T90 T91 Texture 2119 2131 ground-glass R62 MODIFY Arg1:T91 Arg2:E53 T92 Detailed_description 2110 2118 multiple R63 MODIFY Arg1:T92 Arg2:E53 T93 Biological_structure 2145 2155 both lungs R64 MODIFY Arg1:T93 Arg2:E53 T94 Sign_symptom 2020 2046 progression of the disease E54 Sign_symptom:T94 T95 Diagnostic_procedure 2191 2213 bronchoalveolar lavage E55 Diagnostic_procedure:T95 T96 Diagnostic_procedure 2215 2218 BAL E56 Diagnostic_procedure:T96 R65 IDENTICAL Arg1:E56 Arg2:E55 T97 Biological_structure 2227 2243 right B5 segment T98 Detailed_description 2249 2262 150 mL saline R66 MODIFY Arg1:T97 Arg2:E55 R67 MODIFY Arg1:T98 Arg2:E55 T99 Lab_value 2268 2304 62.7% of the BAL fluid was recovered R68 MODIFY Arg1:T99 Arg2:E55 T100 Diagnostic_procedure 2310 2320 cell count E57 Diagnostic_procedure:T100 T101 Detailed_description 2328 2337 BAL fluid R69 MODIFY Arg1:T101 Arg2:E57 T102 Lab_value 2342 2357 0.61×105 per mL R70 MODIFY Arg1:T102 Arg2:E57 T103 Diagnostic_procedure 2367 2387 cell differentiation E58 Diagnostic_procedure:T103 T104 Detailed_description 2395 2404 BAL fluid R71 MODIFY Arg1:T104 Arg2:E58 T105 Lab_value 2409 2426 17.0% macrophages T106 Lab_value 2428 2445 81.0% lymphocytes T107 Lab_value 2451 2467 2.0% neutrophils T108 Lab_value 2476 2496 CD 4/8 ratio of 0.57 R72 MODIFY Arg1:T105 Arg2:E58 R73 MODIFY Arg1:T106 Arg2:E58 R74 MODIFY Arg1:T107 Arg2:E58 R75 MODIFY Arg1:T108 Arg2:E58 T109 Diagnostic_procedure 2498 2502 Gram E59 Diagnostic_procedure:T109 T110 Diagnostic_procedure 2504 2517 Ziehl-Neelsen E60 Diagnostic_procedure:T110 T111 Diagnostic_procedure 2523 2539 Grocott staining E61 Diagnostic_procedure:T111 T112 Lab_value 2549 2557 negative R76 MODIFY Arg1:T112 Arg2:E61 R77 MODIFY Arg1:T112 Arg2:E60 R78 MODIFY Arg1:T112 Arg2:E59 T113 Diagnostic_procedure 2561 2586 polymerase chain reaction E62 Diagnostic_procedure:T113 T114 Detailed_description 2615 2624 BAL fluid R79 MODIFY Arg1:T114 Arg2:E62 T115 Diagnostic_procedure 2642 2664 Pneumocystis jirovecii E63 Diagnostic_procedure:T115 T116 Lab_value 2629 2637 positive R80 MODIFY Arg1:T116 Arg2:E63 R81 SUB_PROCEDURE Arg1:E63 Arg2:E62 T117 Disease_disorder 2666 2669 PCP E64 Disease_disorder:T117 #3 AnnotatorNotes E64 Pneumocystis pneumonia T118 Medication 2741 2770 sulfamethoxazole/trimethoprim E65 Medication:T118 T119 Dosage 2772 2780 12 g/day R82 MODIFY Arg1:T119 Arg2:E65 T120 Duration 2786 2793 3 weeks E66 Duration:T120 T121 Therapeutic_procedure 2795 2816 Anti-cortisol therapy E67 Therapeutic_procedure:T121 T122 Medication 2822 2832 metyrapone E68 Medication:T122 R83 SUB_PROCEDURE Arg1:E68 Arg2:E67 T123 Dosage 2876 2886 small dose R84 MODIFY Arg1:T123 Arg2:E68 T124 Disease_disorder 2909 2926 hypercortisolemia E69 Disease_disorder:T124 T125 Medication 2938 2945 insulin E70 Medication:T125 T126 Medication 2955 2964 potassium E71 Medication:T126 T127 Medication 3003 3012 cefazolin E72 Medication:T127 T128 Disease_disorder 3039 3049 cellulitis E73 Disease_disorder:T128 T129 Biological_structure 3057 3071 left lower leg R85 MODIFY Arg1:T129 Arg2:E73 T130 Disease_disorder 3087 3090 PCP E74 Disease_disorder:T130 A6 POLARITY E74 NEG T131 Diagnostic_procedure 3138 3156 respiratory status E75 Diagnostic_procedure:T131 T132 Sign_symptom 3118 3130 exacerbation E76 Sign_symptom:T132 A7 POLARITY E76 NEG R86 MODIFY Arg1:E76 Arg2:E75 T133 Medication 3197 3226 sulfamethoxazole/trimethoprim E77 Medication:T133 T134 Dosage 3232 3249 prophylactic dose R87 MODIFY Arg1:T134 Arg2:E77 T135 Medication 3255 3265 metyrapone E78 Medication:T135 T136 Dosage 3302 3312 250 mg/day R88 MODIFY Arg1:T136 Arg2:E78 T137 Diagnostic_procedure 3322 3336 blood cortisol E79 Diagnostic_procedure:T137 T138 Lab_value 3359 3373 decline slowly R89 MODIFY Arg1:T138 Arg2:E79 T139 Medication 3462 3476 hydrocortisone E80 Medication:T139 T140 Detailed_description 3437 3448 temporarily R90 MODIFY Arg1:T140 Arg2:E80 T141 Disease_disorder 3521 3531 cellulitis E81 Disease_disorder:T141 A8 TREND E81 DEC T142 Biological_structure 3506 3520 left lower leg R91 MODIFY Arg1:T142 Arg2:E81 T143 Disease_disorder 3533 3536 PCP E82 Disease_disorder:T143 A9 TREND E82 DEC T144 Disease_disorder 3542 3555 hyperglycemia E83 Disease_disorder:T144 T145 Therapeutic_procedure 3579 3590 laminectomy E84 Therapeutic_procedure:T145 T146 Therapeutic_procedure 3595 3612 radiation therapy E85 Therapeutic_procedure:T146 T147 Disease_disorder 3617 3640 spinal cord compression E86 Disease_disorder:T147 T148 Sign_symptom 3687 3692 tumor E87 Sign_symptom:T148 T149 Detailed_description 3669 3679 metastatic T150 Biological_structure 3680 3686 spinal R92 MODIFY Arg1:T150 Arg2:E87 R93 MODIFY Arg1:T149 Arg2:E87 R94 CAUSE Arg1:E87 Arg2:E86 T151 Medication 3694 3704 Octreotide E88 Medication:T151 T152 Clinical_event 3739 3749 discharged E89 Clinical_event:T152 T153 Date 3757 3765 68th day E90 Date:T153 * OVERLAP E3 E1 E2 E4 R95 BEFORE Arg1:E4 Arg2:E5 * OVERLAP E5 E6 E7 E8 E10 R96 BEFORE Arg1:E10 Arg2:E11 R97 BEFORE Arg1:E11 Arg2:E14 * OVERLAP E14 E15 E16 E17 E18 R98 BEFORE Arg1:E18 Arg2:E19 * OVERLAP E19 E20 E21 E22 E23 E24 E25 E26 E27 E28 E29 E30 E31 E32 E33 E34 E40 E41 E42 E43 E44 E45 E49 E50 E54 E52 E53 R99 BEFORE Arg1:E53 Arg2:E55 * OVERLAP E55 E57 E58 E59 E60 E61 E62 E64 R100 BEFORE Arg1:E64 Arg2:E65 * OVERLAP E65 E66 E67 E69 R101 BEFORE Arg1:E69 Arg2:E70 * OVERLAP E70 E71 E72 E73 R102 BEFORE Arg1:E73 Arg2:E74 * OVERLAP E74 E76 E75 R103 BEFORE Arg1:E75 Arg2:E77 R104 BEFORE Arg1:E77 Arg2:E78 * OVERLAP E78 E79 E80 R105 BEFORE Arg1:E80 Arg2:E81 * OVERLAP E81 E82 E83 R106 BEFORE Arg1:E83 Arg2:E84 * OVERLAP E84 E85 E86 E87 E88 R107 BEFORE Arg1:E88 Arg2:E89 * OVERLAP E89 E90