--- a
+++ b/processing/MACCROBAT/28250304.ann
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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