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T1 Sign_symptom 58 65 dyspnea E1 Sign_symptom:T1 T2 Detailed_description 47 57 exertional R1 MODIFY Arg1:T2 Arg2:E1 T3 Date 69 78 July 2010 E2 Date:T3 T4 Age 2 13 69-year-old T5 Sex 14 17 man T6 History 100 153 smoking for more than 40 years, 20 cigarettes per day T7 Family_history 159 196 parents and 1 brother had lung cancer T8 History 202 239 past medical history was unremarkable T9 History 248 272 no occupational exposure T10 Sign_symptom 296 303 dyspnea E3 Sign_symptom:T10 T11 Detailed_description 285 295 exertional R2 MODIFY Arg1:T11 Arg2:E3 T12 Clinical_event 312 320 admitted E4 Clinical_event:T12 T13 Nonbiological_location 328 364 People's Hospital of Shunde District R3 MODIFY Arg1:T13 Arg2:E4 T14 Diagnostic_procedure 369 385 echocardiography E5 Diagnostic_procedure:T14 T15 Diagnostic_procedure 390 431 computed tomography pulmonary angiography E6 Diagnostic_procedure:T15 T16 Diagnostic_procedure 433 437 CTPA E7 Diagnostic_procedure:T16 R4 IDENTICAL Arg1:E7 Arg2:E6 T17 Diagnostic_procedure 440 456 Echocardiography E8 Diagnostic_procedure:T17 T18 Disease_disorder 486 489 PAH E9 Disease_disorder:T18 #1 AnnotatorNotes E9 Pulmonary arterial hypertension T19 Severity 479 485 severe R5 MODIFY Arg1:T19 Arg2:E9 T20 Diagnostic_procedure 503 530 pulmonary arterial pressure E10 Diagnostic_procedure:T20 T21 Diagnostic_procedure 532 535 PAP E11 Diagnostic_procedure:T21 R6 IDENTICAL Arg1:E11 Arg2:E10 T22 Lab_value 541 549 104 mmHg R7 MODIFY Arg1:T22 Arg2:E10 T23 Sign_symptom 575 583 enlarged E12 Sign_symptom:T23 T24 Biological_structure 559 570 right heart R8 MODIFY Arg1:T24 Arg2:E12 T25 Diagnostic_procedure 589 613 right ventricle diameter E13 Diagnostic_procedure:T25 T26 Lab_value 615 620 57 mm R9 MODIFY Arg1:T26 Arg2:E13 T27 Diagnostic_procedure 623 627 CTPA E14 Diagnostic_procedure:T27 T28 Disease_disorder 656 659 PAH E15 Disease_disorder:T28 T29 Disease_disorder 672 680 thrombus E16 Disease_disorder:T29 T30 Biological_structure 688 723 upper lobe artery of the right lung R10 MODIFY Arg1:T30 Arg2:E16 T31 Coreference 774 776 PE E17 Coreference:T31 #2 AnnotatorNotes E17 pulmonary embolism T32 Biological_structure 738 756 region in the lung R11 MODIFY Arg1:T32 Arg2:E17 T33 History 847 937 did not have connective tissue disease, drug use, history of chemotherapy, or HIV test (+) R12 IDENTICAL Arg1:E17 Arg2:E16 T34 Disease_disorder 962 966 IPAH E18 Disease_disorder:T34 #3 AnnotatorNotes E18 Idiopathic pulmonary arterial hypertension T35 Disease_disorder 981 983 PE E19 Disease_disorder:T35 #4 AnnotatorNotes E19 pulmonary embolism T36 Medication 1005 1013 warfarin E20 Medication:T36 T37 Dosage 1015 1029 2.5 mg per day R13 MODIFY Arg1:T37 Arg2:E20 T38 Diagnostic_procedure 1051 1081 international normalized ratio E21 Diagnostic_procedure:T38 T39 Diagnostic_procedure 1083 1086 INR E22 Diagnostic_procedure:T39 R14 IDENTICAL Arg1:E22 Arg2:E21 T40 Lab_value 1096 1107 1.5 and 2.5 R15 MODIFY Arg1:T40 Arg2:E21 T41 Medication 1113 1123 slidenafil E23 Medication:T41 T42 Dosage 1146 1165 20 mg twice per day R16 MODIFY Arg1:T42 Arg2:E23 T43 Sign_symptom 1182 1189 dyspnea E24 Sign_symptom:T43 A1 TREND E24 DEC T44 Medication 1235 1246 medications E25 Medication:T44 T45 Duration 1251 1258 1 month E26 Duration:T45 T46 Diagnostic_procedure 1276 1279 PAP E27 Diagnostic_procedure:T46 T48 Lab_value 1304 1313 decreased T49 Lab_value 1317 1324 72 mmHg R18 MODIFY Arg1:T48 Arg2:E27 R19 MODIFY Arg1:T49 Arg2:E27 T50 Sign_symptom 1338 1362 other symptoms and signs E29 Sign_symptom:T50 T51 Lab_value 1363 1388 failed to further improve R20 MODIFY Arg1:T51 Arg2:E29 T52 Medication 1408 1419 medications E30 Medication:T52 T53 Duration 1424 1432 6 months E31 Duration:T53 T54 Date 1437 1447 March 2011 E32 Date:T54 T55 Clinical_event 1452 1456 went E33 Clinical_event:T55 T56 Nonbiological_location 1464 1501 Kyorin University affiliated hospital R21 MODIFY Arg1:T56 Arg2:E33 T57 Nonbiological_location 1505 1510 Japan R22 MODIFY Arg1:T57 Arg2:T56 T58 Diagnostic_procedure 1546 1561 catheterization E34 Diagnostic_procedure:T58 T59 Biological_structure 1534 1545 Right heart R23 MODIFY Arg1:T59 Arg2:E34 T60 Diagnostic_procedure 1571 1574 PAP E35 Diagnostic_procedure:T60 T61 Lab_value 1575 1588 72/34/47 mmHg R24 MODIFY Arg1:T61 Arg2:E35 T62 Diagnostic_procedure 1590 1624 pulmonary capillary wedge pressure E36 Diagnostic_procedure:T62 T63 Diagnostic_procedure 1626 1630 PCWP E37 Diagnostic_procedure:T63 R25 IDENTICAL Arg1:E37 Arg2:E36 T64 Lab_value 1632 1644 17/5/10 mmHg R26 MODIFY Arg1:T64 Arg2:E36 T65 Diagnostic_procedure 1646 1660 cardiac output E38 Diagnostic_procedure:T65 T66 Lab_value 1661 1670 4.3 L/min R27 MODIFY Arg1:T66 Arg2:E38 T67 Diagnostic_procedure 1672 1694 cardiac ejection index E39 Diagnostic_procedure:T67 T68 Lab_value 1695 1708 2.36 L/min/m2 R28 MODIFY Arg1:T68 Arg2:E39 T69 Diagnostic_procedure 1714 1743 pulmonary vascular resistance E40 Diagnostic_procedure:T69 T70 Diagnostic_procedure 1780 1784 CTPA E41 Diagnostic_procedure:T70 T71 Disease_disorder 1806 1814 thrombus E42 Disease_disorder:T71 A2 POLARITY E42 NEG T72 Biological_structure 1822 1857 upper lobe artery of the right lung R29 MODIFY Arg1:T72 Arg2:E42 T73 Disease_disorder 1904 1908 IPAH E43 Disease_disorder:T73 T74 Medication 1926 1936 sildenafil E44 Medication:T74 T75 Dosage 1938 1957 20 mg 3 times a day R30 MODIFY Arg1:T75 Arg2:E44 T76 Medication 1963 1972 sorafenib E45 Medication:T76 T77 Dosage 1974 1991 400 mg once a day R31 MODIFY Arg1:T77 Arg2:E45 T78 Therapeutic_procedure 2002 2013 PAH therapy E46 Therapeutic_procedure:T78 R32 SUB_PROCEDURE Arg1:E45 Arg2:E46 R33 SUB_PROCEDURE Arg1:E44 Arg2:E46 T79 Medication 2023 2031 warfarin E47 Medication:T79 T80 Therapeutic_procedure 2032 2055 anticoagulation therapy E48 Therapeutic_procedure:T80 R34 SUB_PROCEDURE Arg1:E47 Arg2:E48 T81 Administration 2018 2022 oral R35 MODIFY Arg1:T81 Arg2:E47 T82 Dosage 2057 2076 2.5–3.75 mg per day R36 MODIFY Arg1:T82 Arg2:E47 T83 Diagnostic_procedure 2113 2116 INR E49 Diagnostic_procedure:T83 T84 Lab_value 2134 2141 2 and 3 R37 MODIFY Arg1:T84 Arg2:E49 T85 Sign_symptom 2165 2172 dyspnea E50 Sign_symptom:T85 T86 Diagnostic_procedure 2198 2201 PAP E51 Diagnostic_procedure:T86 T87 Lab_value 2237 2251 around 95 mmHg R38 MODIFY Arg1:T87 Arg2:E51 T47 Detailed_description 1283 1299 echocardiography R17 MODIFY Arg1:T47 Arg2:E27 T88 Detailed_description 2216 2232 echocardiography R39 MODIFY Arg1:T88 Arg2:E51 T89 Date 2256 2270 September 2011 E28 Date:T89 T90 Clinical_event 2275 2282 visited E52 Clinical_event:T90 T91 Nonbiological_location 2287 2314 Shanghai Pulmonary hospital R40 MODIFY Arg1:T91 Arg2:E52 T92 Nonbiological_location 2318 2323 China R41 MODIFY Arg1:T92 Arg2:T91 T93 Sign_symptom 2348 2355 dyspnea E53 Sign_symptom:T93 T94 Diagnostic_procedure 2357 2384 Arterial blood gas analysis E54 Diagnostic_procedure:T94 T95 Diagnostic_procedure 2397 2401 PaO2 E55 Diagnostic_procedure:T95 T96 Lab_value 2406 2413 63 mmHg R42 MODIFY Arg1:T96 Arg2:E55 R43 SUB_PROCEDURE Arg1:E55 Arg2:E54 T97 Diagnostic_procedure 2419 2436 oxygen saturation E56 Diagnostic_procedure:T97 T98 Lab_value 2437 2440 93% R44 MODIFY Arg1:T98 Arg2:E56 R45 SUB_PROCEDURE Arg1:E56 Arg2:E54 T99 Diagnostic_procedure 2442 2460 lung function test E57 Diagnostic_procedure:T99 T100 Disease_disorder 2477 2500 obstructive dysfunction E58 Disease_disorder:T100 T101 Severity 2472 2476 mild R46 MODIFY Arg1:T101 Arg2:E58 T102 Detailed_description 2508 2529 pulmonary ventilation R47 MODIFY Arg1:T102 Arg2:E58 T103 Diagnostic_procedure 2531 2539 FEV1/FVC E59 Diagnostic_procedure:T103 T104 Lab_value 2540 2546 62.06% R48 MODIFY Arg1:T104 Arg2:E59 T105 Diagnostic_procedure 2548 2553 FEV1% E60 Diagnostic_procedure:T105 T106 Lab_value 2565 2570 80.9% R49 MODIFY Arg1:T106 Arg2:E60 T107 Detailed_description 2554 2564 Prediction R50 MODIFY Arg1:T107 Arg2:E60 T108 Diagnostic_procedure 2655 2659 DLCO E61 Diagnostic_procedure:T108 T109 Diagnostic_procedure 2602 2653 diffusing capacity of the lungs for carbon monoxide E62 Diagnostic_procedure:T109 T110 Lab_value 2585 2594 reduction R51 MODIFY Arg1:T110 Arg2:E62 R52 IDENTICAL Arg1:E61 Arg2:E62 T111 Lab_value 2660 2663 42% R53 MODIFY Arg1:T111 Arg2:E62 T112 Diagnostic_procedure 2675 2684 walk test E63 Diagnostic_procedure:T112 T113 Detailed_description 2666 2674 6-minute R54 MODIFY Arg1:T113 Arg2:E63 T114 Lab_value 2689 2694 385 m R55 MODIFY Arg1:T114 Arg2:E63 T115 Diagnostic_procedure 2739 2743 HRCT E64 Diagnostic_procedure:T115 T116 Diagnostic_procedure 2702 2737 high-resolution computed tomography E65 Diagnostic_procedure:T116 R56 IDENTICAL Arg1:E64 Arg2:E65 T117 Biological_structure 2696 2701 Chest R57 MODIFY Arg1:T117 Arg2:E65 T119 Biological_structure 2788 2806 interlobular septa T120 Sign_symptom 2830 2837 nodules E66 Sign_symptom:T120 T121 Sign_symptom 2847 2858 enlargement E67 Sign_symptom:T121 T122 Biological_structure 2862 2885 mediastinal lymph nodes R60 MODIFY Arg1:T122 Arg2:E67 T118 Sign_symptom 2774 2784 thickening E68 Sign_symptom:T118 T123 Texture 2767 2773 smooth R58 MODIFY Arg1:T123 Arg2:E68 R59 MODIFY Arg1:T119 Arg2:E68 T124 Detailed_description 2808 2815 diffuse T125 Biological_structure 2816 2829 centrilobular R61 MODIFY Arg1:T125 Arg2:E66 R62 MODIFY Arg1:T124 Arg2:E66 T126 Diagnostic_procedure 2903 2918 catheterization E69 Diagnostic_procedure:T126 T127 Biological_structure 2891 2902 right heart R63 MODIFY Arg1:T127 Arg2:E69 T128 Diagnostic_procedure 2933 2936 PAP E70 Diagnostic_procedure:T128 T129 Lab_value 2941 2954 83/34/53 mmHg R64 MODIFY Arg1:T129 Arg2:E70 T130 Diagnostic_procedure 2959 2963 PCWP E71 Diagnostic_procedure:T130 T131 Lab_value 2968 2980 14/6/11 mmHg R65 MODIFY Arg1:T131 Arg2:E71 T132 Diagnostic_procedure 2982 3007 Acute vasodilator testing E72 Diagnostic_procedure:T132 T133 Lab_value 3012 3020 negative R66 MODIFY Arg1:T133 Arg2:E72 T134 Diagnostic_procedure 3022 3042 Coronary angiography E73 Diagnostic_procedure:T134 T135 Diagnostic_procedure 3047 3051 CTPA E74 Diagnostic_procedure:T135 T136 Lab_value 3062 3068 normal R67 MODIFY Arg1:T136 Arg2:E74 R68 MODIFY Arg1:T136 Arg2:E73 T137 Diagnostic_procedure 3080 3101 ventilation/perfusion E75 Diagnostic_procedure:T137 T138 Diagnostic_procedure 3103 3108 V’/Q’ E76 Diagnostic_procedure:T138 R69 IDENTICAL Arg1:E76 Arg2:E75 T139 Biological_structure 3070 3079 pulmonary R70 MODIFY Arg1:T139 Arg2:E75 T140 Biological_structure 3110 3114 lung R71 MODIFY Arg1:T140 Arg2:E75 T141 Sign_symptom 3129 3170 matched ventilation and perfusion defects E77 Sign_symptom:T141 T142 Diagnostic_procedure 3172 3194 Bronchoalveolar lavage E78 Diagnostic_procedure:T142 T143 Lab_value 3205 3213 elevated T144 Lab_value 3226 3229 65% R72 MODIFY Arg1:T143 Arg2:E78 R73 MODIFY Arg1:T144 Arg2:E78 T145 Biological_structure 3234 3263 hemosiderin-laden macrophages R74 MODIFY Arg1:T145 Arg2:T143 R75 MODIFY Arg1:T145 Arg2:T144 T146 Diagnostic_procedure 3273 3284 Golde score E79 Diagnostic_procedure:T146 T147 Lab_value 3285 3287 80 R76 MODIFY Arg1:T147 Arg2:E79 R77 SUB_PROCEDURE Arg1:E79 Arg2:E78 T148 Disease_disorder 3347 3351 IPAH E80 Disease_disorder:T148 T149 Disease_disorder 3393 3397 PVOD E81 Disease_disorder:T149 A3 POLARITY E81 UNCERTAIN #5 AnnotatorNotes E81 Pulmonary veno-occlusive disease T150 Therapeutic_procedure 3445 3456 PAH therapy E82 Therapeutic_procedure:T150 T151 Therapeutic_procedure 3491 3516 anticoagulation treatment E83 Therapeutic_procedure:T151 T152 Medication 3533 3541 warfarin E84 Medication:T152 A4 POLARITY E84 NEG T153 Detailed_description 3568 3578 by himself R78 MODIFY Arg1:T153 Arg2:E84 T154 Date 3579 3595 sometime in 2014 E85 Date:T154 T155 Diagnostic_procedure 3813 3828 monitor D-Dimer E86 Diagnostic_procedure:T155 A5 POLARITY E86 NEG T156 Sign_symptom 3859 3866 dyspnea E87 Sign_symptom:T156 T157 Disease_disorder 3940 3955 pulmonary edema E88 Disease_disorder:T157 T158 Severity 3917 3926 not fatal R79 MODIFY Arg1:T158 Arg2:E88 T159 Detailed_description 3907 3911 many R80 MODIFY Arg1:T159 Arg2:E88 T160 Date 3979 3991 January 2015 E89 Date:T160 T161 Clinical_event 4000 4006 rushed E90 Clinical_event:T161 T162 Nonbiological_location 4010 4018 hospital R81 MODIFY Arg1:T162 Arg2:E90 T163 Sign_symptom 4031 4038 dyspnea E91 Sign_symptom:T163 T164 Detailed_description 4052 4063 exacerbated R82 MODIFY Arg1:T164 Arg2:E91 T165 Lab_value 3882 3888 stable R83 MODIFY Arg1:T165 Arg2:E87 T166 Diagnostic_procedure 4065 4069 CTPA E92 Diagnostic_procedure:T166 T167 Disease_disorder 4079 4087 thrombus E93 Disease_disorder:T167 T168 Biological_structure 4095 4122 right main pulmonary artery R84 MODIFY Arg1:T168 Arg2:E93 T169 Medication 4133 4144 Rivaroxaban E94 Medication:T169 T170 Therapeutic_procedure 4166 4191 anticoagulation treatment E95 Therapeutic_procedure:T170 T171 Sign_symptom 4233 4240 dyspnea E96 Sign_symptom:T171 T172 Sign_symptom 4260 4275 too ill to walk E97 Sign_symptom:T172 T173 Duration 4321 4332 half a year E98 Duration:T173 T174 Activity 4293 4316 bound to his wheelchair E99 Activity:T174 T175 Disease_disorder 4345 4348 PAH E100 Disease_disorder:T175 T176 Disease_disorder 4363 4367 PVOD E101 Disease_disorder:T176 A6 POLARITY E101 MAYBE_POS T177 Disease_disorder 4402 4404 PE E102 Disease_disorder:T177 T178 Severity 4385 4401 life-threatening R85 MODIFY Arg1:T178 Arg2:E102 T179 Therapeutic_procedure 4416 4436 lung transplantation E103 Therapeutic_procedure:T179 T180 Date 4455 4471 Six months later E104 Date:T180 T181 Therapeutic_procedure 4523 4543 lung transplantation E105 Therapeutic_procedure:T181 T182 Detailed_description 4513 4522 allogenic T183 Detailed_description 4502 4512 sequential T184 Detailed_description 4492 4501 bilateral R86 MODIFY Arg1:T182 Arg2:E105 R87 MODIFY Arg1:T183 Arg2:E105 R88 MODIFY Arg1:T184 Arg2:E105 T185 Therapeutic_procedure 4556 4606 veno-arterial extra-corporeal membrane oxygenation E106 Therapeutic_procedure:T185 T186 Therapeutic_procedure 4608 4615 VA-ECMO E107 Therapeutic_procedure:T186 R89 IDENTICAL Arg1:E107 Arg2:E106 T187 Date 4656 4669 July 29, 2015 E108 Date:T187 T188 Diagnostic_procedure 4671 4680 Histology E109 Diagnostic_procedure:T188 T189 Biological_structure 4688 4711 explanted lung specimen R90 MODIFY Arg1:T189 Arg2:E109 T191 Disease_disorder 4852 4856 PVOD E110 Disease_disorder:T191 T192 Disease_disorder 4871 4873 PE E111 Disease_disorder:T192 T193 Disease_disorder 4886 4890 IPAH E112 Disease_disorder:T193 A7 POLARITY E112 NEG T190 Lab_value 4734 4743 occlusion T194 Biological_structure 4719 4733 pulmonary vein R91 MODIFY Arg1:T194 Arg2:T190 R92 MODIFY Arg1:T190 Arg2:E109 T195 Lab_value 4773 4781 embolism T196 Biological_structure 4763 4772 pulmonary R93 MODIFY Arg1:T196 Arg2:T195 T197 Biological_structure 4789 4811 right pulmonary artery R94 MODIFY Arg1:T197 Arg2:T195 R95 MODIFY Arg1:T195 Arg2:E109 T198 Sign_symptom 4911 4915 well E113 Sign_symptom:T198 T199 Sign_symptom 4924 4931 dyspnea E114 Sign_symptom:T199 A8 POLARITY E114 NEG T200 Duration 4936 4952 more than 1 year E115 Duration:T200 T201 Diagnostic_procedure 4992 5008 echocardiography E116 Diagnostic_procedure:T201 T202 Diagnostic_procedure 5038 5041 PAP E117 Diagnostic_procedure:T202 T203 Lab_value 5020 5034 normalizations R96 MODIFY Arg1:T203 Arg2:E117 T204 Sign_symptom 5055 5063 enlarged E118 Sign_symptom:T204 A9 POLARITY E118 NEG T205 Biological_structure 5064 5092 right ventricle of his heart R97 MODIFY Arg1:T205 Arg2:E118 * OVERLAP E1 E2 E3 R98 BEFORE Arg1:E3 Arg2:E4 * OVERLAP E4 E5 E6 E8 E9 E10 E12 E13 E14 E15 E16 E17 E18 E19 R99 BEFORE Arg1:E19 Arg2:E20 * OVERLAP E20 E21 E23 R100 BEFORE Arg1:E23 Arg2:E24 * OVERLAP E24 E25 E26 E27 R101 BEFORE Arg1:E27 Arg2:E29 * OVERLAP E29 E30 E31 R102 BEFORE Arg1:E31 Arg2:E32 * OVERLAP E32 E33 E34 E35 E36 E38 E39 E40 E41 E42 E43 T206 Lab_value 1744 1758 7.3 Wood units R103 MODIFY Arg1:T206 Arg2:E40 R104 BEFORE Arg1:E43 Arg2:E46 * OVERLAP E46 E48 E49 R105 BEFORE Arg1:E49 Arg2:E50 * OVERLAP E50 E51 R106 BEFORE Arg1:E51 Arg2:E28 * OVERLAP E28 E52 E53 E54 E57 E58 E59 E60 E62 E63 E65 E68 E66 E67 E69 E70 E71 E72 E73 E75 E77 E78 E80 E81 R107 BEFORE Arg1:E81 Arg2:E82 * OVERLAP E82 E83 R108 BEFORE Arg1:E83 Arg2:E84 * OVERLAP E84 E85 R109 BEFORE Arg1:E85 Arg2:E86 * OVERLAP E86 E87 E88 R110 BEFORE Arg1:E88 Arg2:E89 * OVERLAP E89 E90 E91 E92 E93 R111 BEFORE Arg1:E93 Arg2:E94 * OVERLAP E94 E95 E96 E97 R112 BEFORE Arg1:E97 Arg2:E99 * OVERLAP E99 E98 R113 BEFORE Arg1:E98 Arg2:E100 * OVERLAP E100 E101 E102 R114 BEFORE Arg1:E102 Arg2:E103 * OVERLAP E103 E104 E105 E106 E108 R115 BEFORE Arg1:E108 Arg2:E109 R116 BEFORE Arg1:E109 Arg2:E110 * OVERLAP E110 E111 E112 R117 BEFORE Arg1:E112 Arg2:E113 * OVERLAP E113 E114 E115 E116 E117 E118