diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1007_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1007_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..46a9993a4c016a7d778c1de731b99184fdf95286
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1007_en.txt
@@ -0,0 +1 @@
+A 51-year-old Japanese man developed gross hematuria. He visited a local hospital where he underwent abdominal computed tomography, which revealed many cysts with calcification inside the left kidney. He was then referred to our hospital for further examination. A blood test showed no abnormal findings. Urinary cytology yielded a pseudo-positive result (class 3). However, dynamic contrast-enhanced computed tomography revealed a mass, which showed enhancement in the early phase and appeared washed out in the late phase, in a cyst at the upper pole of the left kidney . Magnetic resonance imaging revealed a tumor with an abnormal signal on a diffusion-weighted image . Retrograde pyelography showed no wall irregularity at the left renal pelvis, and urinary cytology of samples from the left pelvis and urinary tract yielded negative results. He was diagnosed with left cystic renal cell carcinoma (cT1N0M0) and underwent retroperitoneal laparoscopic nephrectomy. The surgical specimen showed a cystic lesion filled with papillary formation . Microstones and brownish liquid retention were also observed inside the cystic lesion. Pathological examination revealed that the wall of the cystic lesion was covered with urothelial cells and high-grade urothelial carcinoma with renal parenchymal invasion. In immunohistochemical staining, GATA3, p63, and p40 were positive and PAX8 was negative. The definitive pathological diagnosis was urothelial carcinoma originating from the renal pyelocalyceal diverticulum, invasive urothelial carcinoma, high-grade (G3), and pT3. An additional residual ureterectomy and two courses of gemcitabine and cisplatin adjuvant chemotherapy were performed. Pathological examination showed no malignant findings of the residual ureter, and no recurrence was observed during the 12-month follow-up.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1012_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1012_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..40b9222334135316fd1b05d1fbcf1f3e0525e2bf
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1012_en.txt
@@ -0,0 +1,12 @@
+The present case reports a 37-year-old man suffering from metastatic osteosarcoma originating in the distal part of the left femur. In March 2018, the patient entered the hospital with pain in the left leg as the major symptom. An MRI scan showed a large tumor with extramedullary parts and an intraosseous diameter of 13 cm. The histological examination of the biopsy showed a mostly epithelioid, in part osteoblastic, high-grade osteosarcoma. In the CT scans of the thorax and abdomen, there was no metastasis detectable. Before surgery, the patient was treated with a neoadjuvant regimen analog to the EURAMOS-1 trial with two cycles of doxorubicin and cisplatin and four cycles of high-dose MTX. In the intermediate staging performed by a further CT scan before surgical resection of the tumor, there was still no sign of distant metastasis. In the restaging-MRI of the left thigh the tumor showed a decrease in size. Limb saving surgical resection of the entire tumor (R0) was performed in August 2018. The tumor showed regression with 30% vital tumor cells (grade IV Salzer-Kutschnik).
+Surgery was followed by an adjuvant chemotherapy analog to the EURAMOS-1-protocol containing two cycles of doxorubicin and cisplatin, two further cycles of Doxorubicin and eight cycles of high-dose MTX. The start of adjuvant chemotherapy was delayed for two weeks because of a wound infection.
+The final staging after the last chemotherapy cycle showed two new pulmonary metastases in the CT scan of the lung. Hence, curatively intended surgical resection was performed in April 2019.
+In September 2019, the patient had a seizure and in an MRI of the brain multiple cerebral metastases became visible. A neurosurgical resection of a symptomatic metastasis was performed, followed by a total brain irradiation with a boost on parafalcial and occipital metastases.
+In a systemic restaging performed by a total body FDG-PET-CT scan and an MRI of the brain, the patient then showed a rapid systemic disease-progression with metastases affecting the lung, the mediastinum, the left adrenal gland, the brain, soft tissue, bones, and the skin. (, , )
+In a molecular testing of the most recent tissue sample of the resected brain metastases, the tumor showed a high expression of PD-L1 (TPS 90% CPS 92%) but microsatellite stability (MSS). The patient was still in a good performance state (ECOG 1). A salvage chemotherapy containing the in osteosarcoma therapy established drugs ifosfamide and etoposide was not performed because of an acute kidney failure in the patient’s history and a high amount of cumulative neurotoxicity after the total brain irradiation. Benefit-risk ratio was not considered being favorable for this option. Referring to the case of a patient with advanced osteosarcoma reported by Nuytemans et al. , who reached a stabilization of disease-progression undergoing immunotherapy with nivolumab and ipilimumab, an individual therapy attempt with the same treatment combination was conducted, as there was no further established therapy and no ongoing study available.
+Starting in December 2019, we exposed the patient to the immunotherapy combination of Nivolumab 3 mg/kg and Ipilimumab 1 mg/kg every 3 weeks for four times analog to the established treatment protocol for kidney cancer. In the following restaging performed by a PET-CT scan and an MRI of the brain 3 months after starting the therapy, the patient showed a clear response to the therapy with a profound remission of all tumor lesions (, , ). In some of the lesions, a minimally elevated uptake of FDG remained residually, whereas the lesions were not metrically measurable any more in the corresponding CT scan. In brain MRIs, minimal residual structures were interpreted as gliosis after total brain irradiation and immunotherapy. A definite distinction between inflammation or scar and minimal tumor residuals was not possible in PET-CT scans and MRIs.
+In February 2020, the patient suffered from herpes zoster as a complication, which was treated with brivudine for 7 days.
+The patient developed a mild facial palsy of the right side in March 2020, which can be considered as a side effect of the immunotherapy. In an examination of the cerebrospinal fluid, a slightly increased cell count of 9/nl could be detected but no signs of VZV encephalitis or meningeosis carcinomatosa, respectively.
+In March 2020, the patient developed an immunotherapy-related pneumonitis with clinically mild symptoms but clear correlations in CT scans of the lung and noticeably reduced diffusion capacity in a subsequent lung-function examination. Therefore, immunotherapy had to be discontinued, and nivolumab maintenance could not be started according to protocol.
+For treatment of pneumonitis, the patient received prednisolone with an initial dose of 50 mg per day (0.5 mg/kg). Because of decreasing signs of pneumonitis in control CT scans and an improving diffusion capacity in lung function, prednisolone could be quickly tapered to 7.5 mg, and re-exposure to nivolumab was feasible in June 2020. In the actual PET-CT scan and MRI of the brain, the patient still showed a profound remission of all tumor lesions, and there was no detectable sign of a relapse (, ). Currently, prednisolone is completely tapered, and the patient undergoes nivolumab maintenance (240mg) every 2 weeks. The performance state has further improved, and the patient is starting reintegration into work.
+outlines the patient’s history.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1021_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1021_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e8e27ffc5ba34f576c3018dab06c3254c0bfa19b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1021_en.txt
@@ -0,0 +1 @@
+A 14-year-old girl was diagnosed with precursor B-cell acute lymphoblastic leukemia (B-ALL) at 7 years of age and treated per the protocol for the standard-risk group in the Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) ALL-B12 clinical trial at another hospital in February 2015. Molecular remission was achieved at the end of the consolidation therapy. Two years after treatment completion, she developed combined relapse in the bone marrow and central nervous system. Molecular remission was achieved with multi-agent and intrathecal chemotherapy, and umbilical cord blood transplantation (CBT) was performed 4 months after the diagnosis of relapse. The patient developed hemophagocytic lymphohistiocytosis (HLH) and exhibited delayed engraftment following CBT. Ten months after CBT, she developed autoimmune cytopenia with the production of anti-neutrophil antibodies, anti-erythrocyte antibodies, and platelet-associated IgG (PA-IgG), as well as pleural effusion and ascites. She was treated with prednisolone, cyclosporine, mycophenolate mofetil, and rituximab. Twenty-one months after CBT, she presented with dyspnea, dysuria, diarrhea, and disorders of consciousness and was diagnosed with combined second relapse in the bone marrow and central nervous system. The ferritin level was 10 606 ng/mL at the second relapse. She underwent multidrug chemotherapy, intrathecal chemotherapy, and whole-brain irradiation. Subsequently, she was referred to Keio University Hospital for CD19-targeted CAR-T cell therapy in September 2021, 1 month after diagnosis of the second relapse. CD19-targeted CAR-T cell therapy was performed, and 2.2 × 106/kg/dose of CAR-T cells were administered . Three to seven days after CAR-T cell therapy, the patient developed fever as grade 1 cytokine release syndrome. Pancytopenia requiring blood transfusion persisted for 2 months after CAR-T cell therapy. The patient remained in remission after the therapy and continued to receive TMP/SMX for PJP prophylaxis. The CD4+ T-cell counts remained above 200/μL from 3 months and above 500/μL from 6 months after CAR-T cell therapy. Phytohemagglutinin (PHA)-induced lymphocyte proliferation was normal. TMP/SMX therapy was discontinued 7 months after CAR-T cell therapy. CD19+ B-cell aplasia persisted, and IgG levels were maintained at 400–800 mg/dL with periodic immunoglobulin replacement therapy. Ten months after CAR-T cell therapy, she presented to our hospital with fever, cough, and dyspnea for 5 days. On admission, her body temperature was 38.0°C, and her O2 saturation was 91% on room air. Laboratory tests showed the following: white blood cell count, 8.0 × 109/L (normal range: 3.8–9.4 × 109/L) [band neutrophils, 4%; segmented neutrophils, 66%; lymphocytes, 21%; atypical lymphocytes, 2%; monocytes, 6%; eosinophils, 0%; basophils, 1%; CD4+ T-cell count, 771/μL; CD19+ B-cell count, 0/μL]; hemoglobin, 124 g/L (normal range: 118–149 g/L); hematocrit, 0.387 L/L (normal range: 0.350–0.436 L/L); mean corpuscular volume, 100 fL (normal range: 79.5–96.5 fL); platelet count, 92 × 109/L (normal range: 170–410 × 109/L); albumin, 3.3 g/dL (normal range: 3.8–4.8 g/dL); C-reactive protein, 1.24 mg/dL (normal range: 0–0.14 mg/dL); aspartate aminotransferase, 60 U/L (normal range: 13–28 U/L); alanine aminotransferase, 29 U/L (normal range: 9–29 U/L); lactate dehydrogenase, 535 U/L (normal range: 130–250 U/L); β-D glucan, 511 pg/mL (normal range: 0–11 pg/mL); KL-6, 643 U/mL (normal range: 0–500 U/mL); soluble IL-2R, 2494 U/mL (normal range: 121–613 U/mL); ferritin, 1163 ng/mL (normal range: 8–129 ng/mL); and IgG, 244 mg/dL (normal range: 861–1747 mg/dL). Chest radiography and computed tomography (CT) revealed diffuse ground-glass opacities in both lungs . Polymerase chain reaction (PCR) testing of the sputum showed positivity for Pj. PJP was diagnosed on the basis of the PCR test results, high β-D glucan and KL-6 levels, and characteristic CT findings. She was treated with immunoglobulin (250 mg/kg/day) for hypogammaglobulinemia and TMP/SMX (15 mg/kg/day of trimethoprim) and prednisolone (1.5 mg/kg/day) for PJP; this resulted in rapid amelioration of her symptoms. Immunoglobulin was administered only once. TMP/SMX was discontinued after 21 days, and prednisolone was tapered by 0.5 mg/kg/day every 5 days for 15 days. After treatment, the patient continued to receive TMP/SMX (4 mg/kg/day of trimethoprim) twice a week for PJP prophylaxis, along with periodic immunoglobulin replacement therapy to maintain her IgG levels above 600 mg/dL. Ten months after the treatment, there was no recurrence of PJP or any other complications.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1027_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1027_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..74fddb9382c5019eaa600e618b9deaf54a59c52d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1027_en.txt
@@ -0,0 +1,3 @@
+A 71-year-old man was referred to our clinic for treatment of an iatrogenic total iridodialysis. Just before the referral, his iris had been totally torn out and jammed into the hinge of a prechopper during the removal of an instrument during cataract surgery. Examination revealed a visual acuity (VA) of hand-motion in the left eye. A complete iris defect with remaining lens cortex, a ruptured posterior lens capsule with radial tear of the capsule, and an intraocular lens (IOL) implanted in the sulcus were noted . The totally dialyzed iris was sent to our clinic preserved in sterile cold balanced salt solution, packed in a sterile biopsy bottle surrounded by a towel to prevent direct contact with ice cubes, and was transported in an icebox.
+We decided to perform surgery under general anesthesia considering the patient’s poor cooperation due to dementia. To minimize IOL decentration during scleral fixation, we used a toric axis marker and marked the fixation axis . After the scleral flaps were in two positions 180° apart, a 10–0 polypropylene suture was passed through the bed of half-thickness scleral flaps 2.0 mm posterior to the limbus . A sulcus positioned IOL (PC-60 AD, HOYA Corporation, Tokyo, Japan) was repositioned and fixed by ab externo scleral sutures . We conducted a pars plana vitrectomy to remove the remaining lens cortex material and vitreous fibre anterior to the equator to avoid trapping the vitreous during the iris-fixating suturing . The preserved iris was examined. It did not show any signs of necrosis but kept its own color and morphology soundly . We spread out the iris on the patient’s cornea to estimate the range of damage and locate a wider part of the iris inferiorly to minimize the glare after iridopexy . A 10–0 Prolene on a CIF4 needle (Ethicon, Somerville, New Jersey, USA) was consecutively passed through the iris and sclera 1.0 mm posterior to the limbus at the 6’ O/C position . Properly using both an iris spatula and ocular viscoelastic devices (OVDs), we inserted the iris into the anterior chamber completely and unfolded it to its proper position . The estimated cool-to-anterior chamber insertion time of the preserved iris was 8 h. Four more points of ab interno scleral sutures (4’, 1:30, 10:30 and 8’ O/C positions in sequence) were made . Then, the remaining vitreous, OVDs, and dispersed iris pigments were removed using a vitreous cutter .
+One week postoperatively, intraocular pressure (IOP) increased up to 30 mmHg because of hyphema from the torn root of the iris ; however, 3 weeks postoperatively, hyphema decreased with improved VA (20/200) and lowered IOP (15 mmHg) . At 4 weeks postoperatively, a much improved VA (20/100) and lowered IOP (14 mmHg) were detected . At 7 weeks postoperatively, VA was 20/63, IOP was 14 mmHg and there were no signs of inflammation in the anterior chamber . Until 6 months postoperatively, the engrafted iris did not have any signs of atrophic change, depigmentation, or inflammation; the patient complained of minimal glare, and the uncorrected VA was 20/25 with the IOP of 13 mmHg .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1028_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1028_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..bc730f1f53a66e7eb0d0b10de6517dab425b225d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1028_en.txt
@@ -0,0 +1,3 @@
+A 54-year-old female patient developed chest tightness and shortness of breath following activity 2 years ago and occasionally coughed, with yellow, sticky sputum that was difficult to expel. The patient did not demonstrate any fever or receive systemic treatment prior to hospitalization. Despite subsequent recurrence of the same symptoms, the patient did not receive any systematic treatment. Half a month prior to admission, the symptoms recurred, with no obvious trigger. Right chest pain occurred upon performing light activity but could be gradually relieved with rest. Chest CT in the local hospital showed the lower lobe of the right lung was occupied, and the upper lobe of the left lung had nodular high-density opacity. After considering the upper and middle lobes and left pneumonia of the right lung, the patient received symptomatic anti-infective drugs. She reported that her symptoms did not significantly improve; thus, she was treated at the Second Hospital of Jilin University for further diagnosis and treatment. Physical examination showed coarse breath sounds in both lungs, weak breath sounds in the right lower lung, and a small number of crackles at the base of the right lung. Laboratory tests demonstrated the following results: white blood cell count, 2.5 × 109/L; neutrophil count, 1.61 × 109/L; hemoglobin level, 91 g/L; and β2-microglobulin count, 6.15 mg/L. Blood gas analysis without oxygen revealed the following results: pH, 7.45; PCO2, 37 mm Hg; PO2, 53 mm Hg; SaO2, 89%; immunoglobulin G levels, 19.8 g/L; immunoglobulin A levels, 52.5 g/L; complement C3 levels, 53.5 mg/dL; complement C4 levels, 14.3 mg/dL; SS A antibody (WB) status, positive (+++); 52 kDa protein antibody (WB) antibody status, positive (+++); and ribosomal P protein antibody (WB) status, weakly positive (+–). Antinuclear antibody (ANA) screening (IIF) revealed a ratio of 1:320 and an ANA fluorescence model nuclear particle type. Lip gland (lower lip) biopsy revealed multifocal lymphocytes around the mucus gland of the lip gland, with each foci being >50 lymphocytes. Ultrasound-guided right lung mass aspiration biopsy was performed, and the pathology revealed diffuse proliferation of plasmoid cells. The cells had a plasma cell phenotype and light chain restricted expression, which combined with immunohistochemical staining results to support non-Hodgkin’s B-cell lymphoma and plasma cell differentiation, leading us to suspect MALT lymphoma. Immunohistochemistry results were as follows: CD10 part (+), CD79a (+), Bcl-2 (+), CD3, CD5, CD20, CD56, Bcl-6, and cyclin D1 (–), Kappa (light chain restrictive expression), and Lambdn (light chain restrictive expression) .
+Subsequent positron-emission tomography CT showed that the soft tissue density mass in the lower lobe of the right lung was flaky and had a slight high-density shadow of approximately 90 × 75 × 120 mm in size. The maximum standardized uptake value was 13.2, and the multiple flaky and slight high-density opacities in both lungs were consistent with lymphoma accompanied by intrapulmonary invasion. Accordingly, the tumor stage was considered to be stage IVB according to the Ann Arbor classification of lymphoma. After a clear diagnosis was reached, the patient received 3 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) treatment starting October 2021. After combining the patient’s blood M protein, IGM-Kappa type persisted, globulin levels were >40 g/L, and a second pathology biopsy still showed obvious plasma cell differentiation. Accordingly, the R-CHOP regimen was administered for 4 cycles. Repeat examination after 6 cycles of chemotherapy showed that the SPD of intrapulmonary lesions was reduced by ≥50% . The patient was considered to have undergone partial remission based on the evaluation criteria of the treatment effect on Lugano lymphoma.
+Ethical approval for this study was provided by the Ethics Committee of the Second Hospital of Jilin University, China, on May 18, 2023.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1038_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1038_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b2c85248c229060f9d9a25de5ccfe1fe7e0ca9c0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1038_en.txt
@@ -0,0 +1,9 @@
+A 45-year-old male prisoner presented with necrosis on the penile shaft secondary to using a non-metallic penile constriction object. The patient reported a 5-day history of progressive penile pain, edema, and skin injury but no urinary symptoms. There was no notable medical background or history reported.
+Upon penile examination, the patient showed signs of malodor, purulent exudate, infected necrotic skin, and missing dermis on the dorsal and ventral aspects of the penile shaft . The distal penis was edematous and tender. The patient's vital signs were stable, and laboratory investigations were normal, with no fever present.
+Immediate treatment involved prescribing a combination of cephalosporin, gentamicin, and metronidazole, along with potent analgesia. Prompt operative management was then undertaken, which included urgent EUA, rigid cystoscopy, SPC insertion, and complete penile skin degloving. The procedure was performed under general anesthesia in the Lloyd Davis position, and a 16 Fr SPC was inserted under cystoscopy guidance. Complete skin degloving from the glans edge to the penile base and midline anterior scrotal skin was undertaken, along with circumcision. Buck's fascia was found to be intact . Following the procedure, a Jelonet dressing, blue gauze, and crepe bandage were applied.
+No early postoperative complications were reported, and the patient's laboratory investigations were normal. The patient remained afebrile and had stable vital signs. The patient was continued on the same antibiotics regimen.
+On the third- and seventh-day post-penile degloving, the patient had EUA, which revealed no necrotic tissue or infection. The penile tissue was healthy, and the wound was granulating. The penile wound was irrigated with peroxide, iodine, and saline and redressed. The microbiology team advised starting the patient on meropenem and clindamycin based on the penile skin microbiology results which showed the presence of Staphylococcus aureus and Beta-haemolytic streptococcus.
+On the eleventh day following penile degloving, a FTSG was performed from the groin area in a joint procedure involving the urology and plastic surgery teams. The wounds on the penile shaft and scrotum were found to be granulating and healthy. The wound edges and base were refreshed, and minimal excision of irregular benign subcutaneous tissue was performed. Hemostasis was achieved, and the wound was washed out with chlorhexidine and saline.
+Scrotal skin was mobilized with a sub-dartos layer to enable scrotal wound closure in layers. A urethral catheter was inserted to protect the urethra. The base of the penis was mobilized a few centimeters to enable penile fixation sutures at the base. The urethral and dorsal neurovascular bundle was identified and protected. The area of penile skin deficit was measured. Elliptical incisions were made in the bilateral groin creases to FTSG, which was then defatted. The FTSG was spirally inserted into the penile shaft, and Tisseel fibrin sealant (4 cc) was used. An Adaptic dressing and sponge gauze were applied and secured to the abdominal skin by prolene sutures. Groin closure was completed using staples.
+No early postoperative complications were reported, and the patient's vital signs and laboratory investigations were normal. The penile dressing was kept dry, and the penile glans were healthy with preserved sensation. The patient's hips were kept flexed to reduce tension in his groin wounds. Meropenem and clindamycin were continued.
+After a 20-day hospital admission, the patient was discharged back to the prison without antibiotics. The patient was clinically and vitally stable with clean wounds, which were healing . His laboratory investigations were normal, and a leg bag was attached to the SPC. The wound management plan was given to the prison medical team.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1060_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1060_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..af741c7ddf6543a1f95bdbad8e822c8a2d6f2227
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1060_en.txt
@@ -0,0 +1,8 @@
+A 33-year-old Chinese woman was admitted to our medical institution on May 21, 2018, owing to progressive distension in the upper abdomen.
+Two weeks before admission, she was diagnosed with LC, portal hypertension and splenomegaly, based on an upper abdominal computed tomography (CT) scan at another hospital. Although she was taking prescribed medication that exerted effects such as anti-hepatic fibrosis, inhibition of gastric acid secretion, and protection of the stomach, her symptoms did not improve. She developed progressive distension in the upper abdomen with sour regurgitation. There was no nausea, vomiting, diarrhea, or abdominal pain.
+The patient had a history of thrombocytopenia going back more than 10 years and she had undergone surgery for an ovarian cyst on the left side in 2011.
+No special personal and family history.
+Physical examination revealed dark discoloration and mild tenderness in the left lower abdomen; other examinations were normal.
+Complete blood cell count showed a reduced white blood cell count 3.1 × 109/L (normal range 3.5-9.5 × 109/L) and platelet count 74 × 109/L (normal range 125-350 × 109/L). Liver and renal functions, coagulation, and tumor markers were normal. Serum electrolytes were within the normal range. The levels of protein C, protein S, immunoglobulin (Ig) G, IgA, and IgM were also within normal limits. Serology for hepatitis B surface antigen, hepatitis C antibody, anticardiolipin antibodies, and lupus anticoagulant was negative. No other obvious abnormalities were discovered.
+Gastroscopy showed mild esophageal varices. Magnetic resonance imaging (MRI) revealed caudate lobe hypertrophy, cirrhosis, and dilated lumbar and hemiazygos veins . Dilated azygos veins and narrowed IVC were present . Hypersplenotrophy and dilated veins in the lower esophagus and surrounding the hilus lienis were also observed.
+To confirm the diagnosis of BCS, liver biopsy was performed under CT guidance. Histochemical staining (hematoxylin-eosin and Masson trichrome) showed hepatocyte degeneration, bridging fibrosis, sinusoidal dilatation, and areas of fibrous tissue with substantial hyperplasia .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1080_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1080_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eee9f0a37e48bddebe745d3246f9794c064bc6ac
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1080_en.txt
@@ -0,0 +1,6 @@
+The female proband was born to a 33-year-old G2P2 mother at 37-weeks gestation by spontaneous vaginal delivery without complications. Pregnancy was unremarkable except for possible clubfoot noted on ultrasound scan. Birth weight was 2,440 g (20th centile), length 45.5 cm (10th centile), and head circumference 31 cm (10th centile). A hemangioma on the neck was diagnosed at one week after birth. A small patent foramen ovale (PFO, 3 mm x 4 mm) was found at 12 months of age and has been followed without surgical intervention. The proband was referred for clinical genetic evaluation at the age of 26 months for dysmorphic features, speech delay and mild growth delay. She walked at 15–16 months and her fine motor skills were age appropriate. She had four-five words at two years of age. When last reviewed at three years nine months of age, she was able to pronounce words with three syllables and had more than one hundred words. She understood multistep commands and exhibited age-appropriate behavior.
+She had mild to slight conductive hearing loss at 500–4000 Hz with a notch or normal hearing at 2000 Hz and she used bilateral hearing aids from age two years 11 months until three years two months, when her 10–15 dB loss had improved. Her teeth were late to erupt and she was missing three primary teeth.
+At thee years and nine months of age, height was 90 cm (4rd centile), weight was 13.34 kg (16th centile) and occipitofrontal circumference was 48 cm (19th centile). She showed mild dysmorphic features, including sparse frontal hair with a high anterior hairline, hypertelorism with an interpupillary distance (IPD) measuring 5.8 cm (>97th centile), synophrys, a preauricular pit on the left side, short philtrum with a short columella, downturned corners of the mouth, and small, widely spaced teeth . She had a resolving hemangioma on the neck that measured five cm, pectus excavatum and a small, reducible umbilical hernia. Her fingers were small with mild fifth finger clinodactyly, but measurements did not show brachydactyly. The second toe overlapped the third toe on right foot.
+The proband’s brother was delivered at 39-weeks gestation to the same mother (30 years old, G1P1) without complications. His birth weight, length, and head circumference were 3,650 g, 49.0 cm, and 35 cm, respectively, and all were within the normal range. At age of 5 years, his growth and development were appropriate for age. He had small epicanthic folds and mild clinodactyly of the fifth fingers and toes with mildly small fifth toes, but there were no other findings.
+The proband’s mother is a 35-year old and typically developed female. She had an embolic stroke at age of 26 years. Investigations with an echocardiogram showed a PFO with an atrial septal aneurysm and the PFO was closed using a transcatheter approach. Her hypercoagulability workup was negative. She had dyslipidemia with a slightly elevated lipoprotein level. Her family history was unremarkable for cardiac disease.
+The proband’s father is a normal healthy male.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_108_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_108_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1813ac879c7d3b6e45300428921231af84b2dd52
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_108_en.txt
@@ -0,0 +1,3 @@
+An asymptomatic 41-year-old man underwent evaluation for employment health assessment and was accidentally discovered to have significant aortic dilatation. He reported a history of total repair of TOF with transannular patching at 2 years of age. Postoperatively, he underwent ambulatory follow-up for 21 years without any difficulty until he discontinued follow-up on his own because he was asymptomatic. Last transthoracic echocardiography (TTE) reports in his pediatric medical records at that time showed only trivial aortic regurgitation (AR) without any aortic root abnormality. On physical examination, he was 173 cm tall, weighed 65.6 kg, and his blood pressure was elevated to 165/60 mmHg; however, he had not received any medication. Contrast-enhanced computed tomography (CT) revealed significant aneurysmal aortic dilatation (maximum diameter of 88 mm at the sinus of Valsalva) . TTE revealed severe AR, without significant pulmonary regurgitation or residual VSD, and transesophageal echocardiography showed a slight shortening of the noncoronary cusp and poor coaptation of leaflets of the aortic valve at the central portion where a massive AR, which had 0.9 cm2 of regurgitant orifice area, could be seen. Cardiac magnetic resonance imaging revealed that significant pulmonary regurgitation flow and residual VSD could not be detected and that right ventricular (RV) ejection fraction was 37%, end-diastolic RV volume index was 201 ml/m2. He was referred to our department for surgical treatment of aortic root dilatation and AR.
+The procedure was performed through a midline sternotomy, after taping the left femoral artery and vein. Cardiopulmonary bypass was established after femoral arterial and bicaval cannulation. Left ventricular venting was initiated using a venting tube inserted through the right upper pulmonary vein. Exacerbation of AR and onset of ventricular fibrillation were observed after initiation of cooling, necessitating aortic clamping, and antegrade cardioplegic arrest. Inspection through the aortotomy revealed a dilatated aortic annulus (diameter 35 mm) and floppy aortic annulus and leaflets. All leaflets were thin and flail, and had irregular thickening which implied myxomatous degeneration. There was a stiff portion in the left ventricular outflow tract under the noncoronary and right coronary sinus, as a result of the VSD patch. Because we considered that valve-sparing aortic root replacement (VSARR) could be difficult, we performed the Bentall procedure using a 27-mm SJM Masters series Aortic Valved Graft (St. Jude Medical, Cardiology Division Inc., Minnesota), using felt strips in order to reinforce the aortic annulus. After cooling below 20 °C, we performed distal aortic anastomosis using a 28-mm J-Graft Shield Noe (27 mm ) (Japan Lifeline Co. Ltd., Japan) under deep hypothermic circulatory arrest with antegrade cerebral perfusion. After graft-to-graft anastomosis was performed, the patient was easily weaned from the bypass and showed an uneventful course except for the onset of ventricular fibrillation, which was controlled after short-termed assisted circulatory support.
+Histopathological examination of the ascending aorta specimens revealed cystic medial degeneration with some areas of mucopolysaccharides accumulation, collagen deposition, fragmentation, and loss of elastic lamellae across large areas of the media . The aortic valve showed mucoid degeneration with fragmentation of elastic fibers . The patient’s postoperative course was uneventful, and he was discharged on the 26th postoperative day.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1090_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1090_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e3a8cdadcfc30824552f5192e7a39e320b26815e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1090_en.txt
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+The patient described herein, a 10-year-old girl, is the first child of healthy non-consanguineous parents, born after an uneventful pregnancy affected by ID, attention deficit, behavioral and speech delay, hypotonia, facial dysmorphisms, eye anomalies. She also showed congenital malformations such as cerebral anomaly and forward anus. Her birth weight was 3,450 g (50th centile), length was 50,7 cm (50th centile), and head circumference was 34 cm (25-50th centile). The Apgar score was 9/9. Since the birth, the child has been subjected to a series of medical tests that revealed a complex clinical picture, such as a brain ultrasound that showed the presence of a slightly wider left ventricle. Furthermore, the presence of further forward anus relative to the sphincter floor was observed, so she was subsequently subjected to electro stimulation and submitted to surgery for the removal of vegetation skin. At 30 days visit, a cranial ultrasound showed a slightly dilated left ventricle, while there were not cardiologic alterations or skeletal anomalies. A brain MRI (Magnetic Resonance Imaging) confirm the presence of a wider left ventricle. Standard karyotype was normal, as well as X-Fragile test. The neuropsychiatric evaluation performed at the age of 4.7 years showed an I.Q. of 89 (Stanfod Binet scale) and a mental age of 3 years and 10 months. At last clinical evaluation, performed when she was 10 years old, the patient showed facial dysmorphisms such as prominent mandible and enlarged nasal root , in association with mild hypotonia, a hint of curvature of the trunk; a comprehensive neuropsychiatric evaluation has also been performed. The girl showed mild ID, with a greater operating capacity of verbal thought than visual-motor thought. If properly stimulated, the patient offers the best overall performance; she showed also graphomotor delay, handling and grip difficulties. Regarding the affective and relational behavior, the child was introverted and showed attention deficit. About the communication and language area, the child showed speech delay (dyslexia). Finally, audiological tests showed normal hearing, and eye exams showed exotropia.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1093_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1093_en.txt
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index 0000000000000000000000000000000000000000..335fa40b32105f335ad420c9af0cf1262ec957f0
--- /dev/null
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+A 53-year-old Canadian Caucasian woman, who was a clerical worker, presented to her family doctor with a five week history of progressive pain and black discoloration of the distal right third finger. She was initiated on acetylsalicylic acid and warfarin and referred to a regional tertiary care hospital.
+Her past medical history included depression and a diagnosis of Wolfe Parkinson White (WPW) syndrome, treated since childhood with verapamil. She was taking no other medications. She has never smoked and denied a history of Raynaud's type changes in her digits. Her connective tissue disease review of systems was also otherwise unremarkable.
+On examination in the emergency room, there was obvious digital necrosis of the distal right third finger with an adjacent area of pale swollen tissue with ulceration . Allen's test was abnormal with poor refill bilaterally. Capillaroscopic examination of the periungal regions did not reveal dilated capillary loops. No peripheral bruits were audible. A teleangiectasia lesion was evident on the fifth digit. No other skin changes, specifically sclerodactyly, were present. She was admitted to hospital for further investigations and consultation with vascular specialists.
+An angiogram revealed evidence of a bilateral obliterative vasculopathic process . Radiographs of the hands did not reveal any bony abnormality. Further investigations revealed a positive antinuclear antibody with titer > 1280 and anticentromere specificity. ACA were confirmed by enzyme-linked immunosorbent assay (ELISA) at greater than 100 U/mL. Anti-double stranded DNA, anti-Sjogrens Syndrome A, anti-Sjogrens Syndrome B and anti-ribonucleoprotein antibodies (anti-SSA, anti-SSB, anti-RNP), anti-Sm, anti-Scl-70, antineutrophil cytoplasmic antibodies, anticardiolipin antibodies, cryoglobulins, C3, C4, C-reactive protein, complete blood count, electrolytes, creatinine, hepatic transaminases, alkaline phosphatase and urinalysis were all normal or negative. Associated underlying pathology including cardiopulmonary, gastrointestinal and renal involvement were excluded through cardiology consultation, chest radiograph, echocardiogram, pulmonary function testing, high-resolution computerized tomography (CT) of the chest, 24 hour urine for creatinine clearance, serum chemistry and urinalysis, barium swallow, and CT abdomen and pelvis.
+In hospital she was initiated on clopidogrel bisulfate, pentoxifylline, topical nitropaste, a two week trial of prednisone, a seven day course of clindamycin and morphine for pain control. Nifedipine was later initiated as an out-patient. Gradually over the next two months the necrosis resolved with minimal tissue loss at the digit tip. She continues to be followed in the rheumatology out-patient clinic with periodic evaluations for potential evolution of connective tissue disease and in cardiology clinic for follow-up of her WPW.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1098_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1098_en.txt
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index 0000000000000000000000000000000000000000..534e0c4a971439e9a21effd8c42fb189c2462e03
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+A 3.5-year-old girl, Caucasian, who was a product of a consanguineous marriage (first-degree cousins, Fig. (timeline of case presentation) and Fig. a) was registered in our department due to petechia and nose bleeding. She was born at 37 weeks and 5 days of normal vaginal delivery. Her birth weight, head circumference, and height were 2.8 kg, 32 cm, and 46 cm, respectively. Although her development was in the normal range, the growth chart revealed that her height and head circumference were below the third percentile line, and her weight was around the 5th percentile line. In addition, she took zinc supplements due to her short stature. On physical examination, short stature, poor weight gain, microcephaly (head circumference; 46 cm) and skin hyperpigmentation were detected. She had a history of two-time hospital admission due to pneumonia.
+Due to petechia, complete blood count was performed and the results identified anemia (Hb: 7.2 g/dL), leukopenia (WBC: 1.5 × 103/μL with an absolute neutrophil count of 455), and thrombocytopenia (Platelet count: 9 × 103/μL). Other laboratory and imaging findings, including C3, C4, ANA, dsDNA, CH50, Immunoglobulin level, TORCH study, metabolic panel, biochemistry studies, abdomen and pelvic sonography, brain MRI, lumbosacral and both hands X-ray, and echocardiography were normal. In addition, bone marrow aspiration and trephine biopsy revealed presented megakaryocyte and moderate to severe hypocellular bone marrow.
+The patient had been on irradiated packed cell and platelet transfusion approximately every one month. She was a candidate for allogeneic bone marrow transplantation, but she did not have the HLA-match donor. She was under regular follow-up and occasionally referred due to epistaxis or pallor, and received irradiated packed cell and platelet.
+Written informed consent was obtained from the parents. Whole blood samples were collected using EDTA tubes. Genomic DNA was prepared from peripheral leukocytes of the patient using the QIAamp DNA Blood Mini Kit (Qiagen, Germany) and then NanoDrop (ND1000, USA) was used to measure DNA concentration.
+NGS covering immunological and hematological disorders was carried out on Illumina NextSeq500 machine to the sequence close to 100 million reads. Bioinformatics analysis of the sequencing results was performed using BWA aligner , GATK and annovar as well as different databases and bioinformatics software such as REVEL, MCAP, ESP6500,1000G, Clinvar, CADD-Phred, SIFT, PolyPhen, GERP, PhastCons, LRT, Mutation Assessor, Mutation Taster, phyloP46way_placental, phyloP100way_vertebrate, SiPhy_29way, FATHMM_pred, RadialSVM, ExAC. Kaviar, GME, gnomAD.
+To confirm the novel identified mutation, we performed Sanger sequencing of the genomic DNA from the proband. For this test, PCR was carried out for the patient’s DNA using the following primers: F-FANCF: CGCTGGGAGATTGACATG and R-FANCF: GACCCCAGTCTGTTAGCA (PCR product: 978 bp) to amplify a mutated region of FANCF. Then, Sanger sequencing was used to sequence amplified DNA with both forward and reverse primers using ABI BigDye Terminator Cycle Sequencing Kit (Applied Biosystems®, USA). The analysis of Sanger sequencing data was performed with NCBI BLAST and Codon Code Aligner software. Multiple sequence alignment analysis was performed using the SIB BLAST+ Network Service From to compare the amino acid sequence of human FANCF proteins with other proteins across different Kingdoms. STRING (STRING: functional protein association networks, ), tool and KEGG database (, ) were also used to explain the FA pathway and its protein network.
+Owing to suspicion to inherited bone marrow failure, chromosomal study with MMC on the peripheral blood lymphocyte culture of the proband was requested. To evaluate the types and rates of breakages and rearrangements in the chromosomes of the cells in the proband, GTG banding and the chromosome breakage test were performed on the patient’s blood sample. The blood sample was then cultured and treated with different concentrations of MMC.
+NGS revealed a novel, private, homozygous, frame-shift deletion mutation in the FANCF gene (FANCF-201, ENST00000327470.4, NM_022725: exon1, c. 534delG, p. G178 fs, position 22,625,277 on chromosome 11). Using Sanger sequencing, the mutation was confirmed in the proband as homozygous . The identified mutation has not been reported yet in any database of genomic variants including ESP6500, 1000 Genome Project, ExAC, Kaviar, GME, gnomAD, and our internal database (Bayan Gene), confirming the novelty of mutation. This is the first report of FANCF mutation in Iranian patient affected with autosomal recessive FA, complementation group F.
+The comparative amino acid alignment of FANCF protein across most kingdoms was also carried out. As shown in Fig. , most of the residues were highly conserved during evolution, and any frame shift mutations could be deleterious.
+In the cytogenetic study, 100 metaphase spreads were studied from cultures prepared by adding MMC and compared to age-related control. The chromosomal breakage scoring was performed on 5 different slides (one untreated with MMC, one with 150 nM MMC concentration, one with 300 nM MMC concentration and one normal control sample treated with these 2 concentrations of MMC). 25 metaphases were evaluated on each slide for chromosomal aberration (gaps or breaks or radial formations). The results showed about 7–8 breaks/cell on average. In comparison to normal control sample which showed 0.3–0.5 breakages/cell. There was no radial formation in the normal control sample. The study showed 46, XX with multiple breaks and radial formation (quadri and triradial), compatible with Fanconi Anemia .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1105_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1105_en.txt
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index 0000000000000000000000000000000000000000..413dde399a1ea10129eba52c2b49b1744362b0f2
--- /dev/null
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+An 18-day-old female was admitted to the paediatric intensive care unit because of a heart murmur and weak femoral pulses. The patient was in a good clinical condition with spontaneous breathing on room air and normal vital signs, except for a blood pressure gradient of 30 mmHg between the upper and the lower extremities. A transthoracic two-dimensional echocardiography was performed and confirmed the suspected diagnosis of aortic coarctation, with a systolic pressure gradient of 30 mmHg and a closed arterial duct . In addition, a total retrograde perfusion of the left circumflex coronary artery (LCX) was found, without visible ostial blood flow at the left aortic sinus (, online, Video S1). The left ventricle had a normal ejection fraction without regional wall abnormalities or mitral valve regurgitation. Because of uncertainty regarding the anatomy, a coronary angiography was performed, showing no left main coronary artery, but a single right coronary artery (RCA) arising from the aorta. The LCX was perfused retrogradely via collaterals of a normal right posterior descending artery and it reached the lateral wall of the ascending aorta, not flowing into it but into the right pulmonary artery (RPA) (, online, Video S2). Arising from the LCX, small branches of a rudimentary left anterior descending artery were seen. The pulmonary artery pressure was normal.
+At 23 days of age, surgery was performed with resection of the aortic coarctation, end-to-end anastomosis, and reimplantation of the left coronary artery (LCA) into the posterior aortic sinus, using a button technique without stretching or torsion of the coronary artery (, online, Video S3). The RPA defect was closed with a xenopericardial patch. On post-operative Day 4, the patient exhibited recurrent episodes of supraventricular tachycardia, which were successfully treated with flecainide. After surgery, routine coronary angiography was performed, showing normal, antegrade flow into the LCA without stenosis . The girl recovered well from the operation and was discharged home soon with normal troponin values.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1113_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1113_en.txt
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index 0000000000000000000000000000000000000000..0500081d6e9af47f481473552ae0123a8db90c17
--- /dev/null
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+A 55-year-old Turkish man was admitted to our clinic with complaints of nasal obstruction and headache lasting for years. There was a nasal mass in front of his left middle turbinate extending nearly down to the inferior turbinate in anterior rhinoscopic examination which had an unclear origin. The endoscopic examination revealed a mass extending from his superior nasal cavity toward his inferior turbinate on the left side. The opposite nasal cavity was obstructed by the deviated septum. As shown in Figures and , paranasal sinus CT scans showed the overextension of his superior turbinate toward his inferior turbinate on the left side, a severe nasal septum deviation to the right with a spur formation and bilateral inflammatory mucosal thickening in maxillary sinuses. After giving information to the patient about the surgery, resection of the inferior part of the extensive left superior turbinate, minimal invasive endoscopic sinus surgery and septoplasty by endoscopic technique was performed under general anesthesia. He was discharged from the hospital 1 day after the operation. He had an uneventful follow-up period and complete resolution of his complaints. Histologic analysis after surgery revealed turbinate tissue.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1114_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1114_en.txt
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index 0000000000000000000000000000000000000000..b3d1b0c5eff6404447b407f85d368e20589f1c38
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1114_en.txt
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+The patient, a 43-year-old female was admitted to hospital due to a right upper lobe space occupying lesion. Nine months after lung surgery, she was treated again for painless gross hematuria.
+During physical examination, the patient was found to have space occupying lesions in the right lung, and was first admitted to hospital for right lung lesion resection. After 9 mo, there was no obvious inducement for painless hematuria for 5 d, thus she was admitted to hospital again.
+Her past history was unremarkable. No other operations were performed during this period.
+Her family history was unremarkable.
+Nine months after lung surgery, the patient was admitted to hospital again due to sudden, painless hematuria. A mass of 2.0 cm × 1.0 cm × 1.0 cm could be touched under the right chest wall, with fair activity, tough quality and a clear boundary.
+The results of a hemogram, ESR, and other tumor markers (alpha fetoprotein, carcinoembryonic antigen, CA-125, CA-199) were all within the normal range, tuberculin skin test (5 TU PPD) was negative.
+Computed tomography (CT) image showed an irregular dense soft tissue lesion in the posterior upper lobe of the right lung, approximately 3.8 cm × 3.3 cm × 4.0 cm in size, and calcification in the periphery of the tumor .
+The CT density of both kidneys was uneven, with patchy slightly high-density shadows in the upper and lower pole of the right kidney and the middle parenchyma of the left kidney, and an unclear boundary. Enhanced CT showed mild to moderate inhomogeneous enhancement, and the density decreased slightly in the delayed phase. The degree of enhancement was lower than that of the surrounding normal renal parenchyma. Filling defects were found in the bilateral renal veins, which showed mild enhancement. Magnetic resonance imaging (MRI) showed multiple long T1, short T2 and diffusion-weighted imaging high signals in both kidneys. Similar signal clusters were found in the left renal pelvis and upper ureter. Two dimensional ultrasonography images showed that the volume of both kidneys was increased, and several extremely low echo masses were seen in the parenchyma, with unclear and irregular boundaries, the bilateral renal veins were widened and hypoechoic filling was seen inside. Color Doppler flow imaging (CDFI) showed no obvious blood flow signals in both renal veins, and no obvious blood flow signal was found in the renal lesions. The following were seen on contrast-enhanced ultrasonography (CEUS, Figure ): Multiple solid space occupying lesions were found in both kidneys, the contrast medium filled the heart rapidly during the arterial phase, showing slightly high enhancement, and low enhancement when the contrast agent withdrew in 60 s. Metastasis of synovial sarcoma was considered based on the patient’s medical history and imaging findings.
+According to chest wall ultrasonography , a very low echo mass approximately 1.5 cm × 1.4 cm × 2.0 cm in size was seen in the superficial subcutaneous fascia layer, with a clear boundary, regular, aspect ratio > 1, and the echo of the surrounding fat layer was increased. On CDFI, a spot strip blood flow signal was seen inside. CEUS showed that the contrast medium filled the heart rapidly (9 s) during the arterial phase, showing overall high enhancement. After 39 s, the contrast medium quickly withdrew and showed low enhancement.
+Combined with the immunohistochemical results, postoperative pathology of pulmonary lesions indicated synovial sarcoma. Pathology of the chest wall mass and kidney mass showed that the nucleus was fusiform or ovoid in shape under the microscope with hyperchromasia, the nucleoli were not obvious, cytoplasm was sparse and unclear, and the mitotic count was rare. Pathological diagnosis was synovial sarcoma metastases .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1128_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1128_en.txt
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index 0000000000000000000000000000000000000000..81dd9ae9b57e7d91dddcafe29cf657f06b8e7449
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1128_en.txt
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+A 77-year-old female with a history of chronic kidney disease and type II diabetes mellitus underwent workup for ongoing sinusitis, fatigue, malaise, and 20-pound weight loss. Patient quit smoking 30 years ago and denies any drug or alcohol use. She reports no significant family history including history of malignancy. MRI of the brain performed at an outside hospital to evaluate the extent of sinusitis revealed a posterior fossa lesion with surrounding edema causing compression on the fourth ventricle. The patient was transferred to our institution for neurosurgical evaluation. On presentation the patient was found to have mild cerebellar signs but an otherwise non-focal exam. Patient was surprised to learn of the cerebellar findings considering her lack of significant symptoms. MRI of the brain, including 3DT1, and T2 Flair showed an irregular enhancing lesion along the inferior & posterior surface of the right cerebellar hemisphere suggestive of an infiltrative malignancy . Based on these imaging findings, top differentials at the time included a metastatic disease process, an atypical meningioma, or a glioma. Upon retrospective review of this case and imaging findings, an additional differential was hypertrophic pachymeningitis. Contrast CT of the chest, abdomen, and pelvis was then performed and found to be negative for a primary malignancy. H1-MR-spectroscoy was not considered prior to resection. After discussion with the patient and her family, she elected to undergo open biopsy with or without further resection of the lesion. One week after her initial referral, she was taken to the operative theater and underwent a suboccipital craniotomy.
+An intraoperative frozen section biopsy was taken. Sections showed round or “whorled” structures, suggestive of meningioma. Additional tissue for permanent sections was requested. Permanent sections showed more of the well-circumscribed structures. Without frozen section artifact, the structures could be definitively characterized as necrotizing granulomas, involving both dura and cerebellum. The granulomas comprise central eosinophilic necrosis with surrounding epithelioid histiocytes and lymphocytes . No vasculitis was seen. Acid fast and Gomori methenamine silver (GMS) special stains were performed; they revealed no acid fast or fungal organisms.
+Given the frozen histology, imaging findings, and cerebellar symptoms further resection was completed to the point of gross total resection. cANCA and pANCA studies were sent and were found to be negative. The patient was discharged home on post-operative day 5 with a three-day steroid taper and referral to outpatient physical therapy. She returned for an office follow-up after 6 weeks and was informed that despite extensive work-up to explore the etiology of her granulomatous inflammation, no etiology was found. She had a follow-up MRI at this time which showed a non-enhancing fluid collection extending beyond the titanium mesh cranioplasty, differential to include seroma and pseudomeningocele. A follow up in 2 weeks was planned to monitor this fluid collection. At this appointment, it was found that the fluid collection under the incision was significantly decreased in size and continuing to resolve. Patient stated she was overall doing well. The current plan is to follow up in 1 year with an MRI. Patient stated she was happy with her recovery progress and plan of care moving forward.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1134_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1134_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b78f5d6a6739ffe0f960e1ed75056d4bd12ef5a2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1134_en.txt
@@ -0,0 +1,5 @@
+A 74-year-old Caucasian woman (patient 1) with no significant medical history presented with constant rotational vertigo, progressive gait ataxia with a tendency to fall to the right side and vertical diplopia increasing in right gaze. All symptoms were characterized by subacute onset with moderate progression over 6 months. Her elder sister, a 76-year-old Caucasian woman (patient 2) likewise presented with a 6-year-history of rotational vertigo, continuous gait ataxia and marked vertical diplopia. Symptoms were reported to have presented subacutely at onset and had initially been misdiagnosed as brainstem infarction.
+In both patients, neurological examination revealed remarkably similar symptoms including gaze-evoked nystagmus and a slight abduction deficit of the right eye as well as ataxia and dysmetria in the upper and lower extremities with right-sided predominance. Because of the pronounced gait ataxia of both patients, they depended on a wheeled walker. Upon motor, reflex and sensory examination, no relevant findings were elicited, in particular no signs of dysarthria, peripheral neuropathy, spasticity, areflexia, vegetative symptoms or fasciculations that could have pointed to one of the hereditary ataxias, such as SCA1, 2, 3 and 6. Neuropsychological assessment did not reveal any substantial cognitive or memory deficits. Cerebral MRI findings showed mild generalized atrophy and multiple white matter lesions in both patients . Except for glycated hemoglobin (HbA1c) levels, which were expectably elevated due to the existing T1DM, all other routine laboratory examinations were within normal limits. Comprehensive workup with extended autoimmune laboratory examinations revealed remarkably high serum and CSF GAD-ab levels in both siblings . Other autoantibodies were negative, in particular antibodies against the NMDA, AMPA or GABA(B) receptor, LGI1, Caspr2, MAG, glycin receptor, or onconeuronal antibodies. Further CSF analysis showed slight pleocytosis in patient 1 and oligoclonal immunoglobulin bands in both patients.
+In addition, the medical history of patient 1 revealed Hashimoto's thyroiditis with elevated serum antithyroid peroxidase antibody levels and recently diagnosed T1DM, whereas patient 2 exhibited a 7-year-history of Grave's disease with high levels of thyroid-stimulating immunoglobulins and a 6-year-history of insulin-dependent T1DM . Their family history revealed a 73-year-old brother suffering from rheumatism and another 75-year-old brother without relevant diseases.
+The diagnosis of cerebellar ataxia with GAD-abs was established in both siblings based on the subacute onset, CSF inflammation in patient 1, the very high GAD-ab titers, the partial response to immunotherapy, the age at onset and the typical constellation of insulin-dependent diabetes. Because of these findings, no genetic testing was performed. Since the detection of GAD-abs can occasionally indicate a paraneoplastic etiology [, ], we undertook full-body computed tomography scans in both patients as well as whole-body and brain positron emission tomography in patient 1, all of which showed no pathological findings, suggesting the absence of any malignancy.
+Plasma separation by immunoadsorption was used to eliminate pathogenic antibodies from the serum compartment by binding to the extracorporeal columns. For this, patient 1 received 5 cycles every other day which led to subtle improvement of gait ataxia. Extended treatment with a further 10 cycles of immunoadsorption eventually resulted in remarkable improvement of gait which allowed the patient to walk without her walking frame. In patient 2, 7 cycles of plasmapheresis were administered every other day and resulted in subjective improvement of gait disability, and a slightly diminished degree of gaze-evoked nystagmus was seen on follow-up examination. However, relevant impairment persisted so that immunosuppressive therapy was escalated in both women to 1,000 mg rituximab intravenously according to common practice . Both patients gave their written informed consent for data analysis and the publication of this case report.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1151_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1151_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1645e02840258070b62f6b72038b397965351ee9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1151_en.txt
@@ -0,0 +1,4 @@
+A 67-year-old Caucasian man presented to the emergency room because of a 4 days’ history of abdominal pain, with one episode of vomiting.
+The patient’s past medical history was significant for colonic diverticulosis and an episode of gastrointestinal bleeding one year before. The event had been investigated by two different gastroscopies, a colonoscopy and a MDCT, which produced inconclusive results. Ten months later he was newly admitted because of abdominal pain and fever at 38.0 C°, with valid urination and defecation. A CT of the abdomen was performed, which confirmed the colonic diverticulosis and revealed the presence of multiple diverticula of the small intestine, fat stranding, signs of inflammation as well as a small amount of free liquid in the abdomen. The patient was hence diagnosed with jejunal diverticulitis and managed conservatively with intra-venous antibiotics, with an apparent complete recovery.
+He re-presented to the emergency department two months later with acute abdominal pain. The pain was described as severe and constant, localized mainly in the lower abdomen with clinical signs of peritonitis. No change in bowel habits nor urinary symptoms were complained. His vital signs were stable, with a temperature of 37.2 C°; he appeared fully oriented and not in any acute distress. Laboratory examination reported a hemoglobin of 121 g/dL, a WBC count of 12.2 × 10E9/L and a CRP of 249 mg/L. Other laboratory data were within normal limit. An abdominal and pelvic contrast-enhanced computed tomography, with administration of oral contrast, was performed. Jejunum and ileum showed several diverticula as well as an inflammatory thick-walled mass involving different loops of the intestine. In addition, free fluid in the abdomen and a small amount of subdiaphragmatic air were reported (, ). On the basis of these findings, the diagnosis of perforated diverticulitis was hereby proposed.
+The patient underwent a diagnostic laparoscopy which revealed plenty of purulent yellowish liquid collected in the right abdomen and a conglomerate of intestinal inflamed loops. We hence decided to convert immediately the procedure to laparotomy. Large multiple diverticula were found covering a section of small intestine approximately 2.5 m long, without signs of obvious macro perforation. Among the middle distal tract of the jejunum and the middle distal tract of ileum, strong adhesions were identified . The involved segments of jejunum and ileum were connected by an intestinal loop free of signs of diverticulosis . There were no signs of bowel ischemia. Adhesiolisis was partially carried out, however, because of difficulties associated with the procedure, we opt to perform a double enterectomy, removing only those segments involved in the intestinal conglomerate and deeply affected by the pathology. Roughly 25 cm of ileum and 80 cm of jejunum were resected. Bowel continuity was restored with an ileo-ileal and a jejuno-jejunal anastomosis. Almost 700 cl of pus were drained and the peritoneal cavity was washed with 10 L of saline solution. The postoperative recovery was uneventful and the patient was discharged 8 days later. There were no signs of malignancy in the resected intestine.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1180_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1180_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ea0fedf4a04d76dc166cd31a1475b73aee4d57c3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1180_en.txt
@@ -0,0 +1,6 @@
+A 6-year-old boy presented to the neuro-ophthalmic clinic with swelling over the lateral aspect of his left eye for 15 days. The swelling was not painful, but had been progressive and associated with lacrimation and drooping of the eyelid. Concurrently, an asymptomatic midline swelling was evident over the patient’s neck which had been present for 2 months. A history of occasional low-grade fever and a decrease in appetite were also reported. There was no history of bleeding tendency or similar swellings elsewhere, neither of cough or hemoptysis.
+On examination, visual acuity was 6/6 in the right eye and 6/24 (6/6 with pinhole) in the left. The left upper eyelid demonstrated fullness over its lateral aspect with erythema of the overlying skin. A minimally mobile, non-pulsatile, non-compressible, diffuse and firm mass with mild tenderness was palpable in the lateral upper lid. There was mild ptosis and the eyeball was displaced inferomedially. Both the palpebral and bulbar conjunctivae were congested. Anterior and posterior segments in both eyes were normal. The pupils were 4 mm in diameter, with brisk direct and consensual light reactions and no relative afferent defect. The neck swelling was soft, fluctuant, non-tender and moved on deglutition.
+Ultrasonography (US) of the orbital lesion showed low reflectivity, while contrast-enhanced computed tomography demonstrated a ring-enhancing, low density lesion in the lateral extraconal space with medial displacement of the globe and lateral rectus . The lacrimal gland could not be separately visualized. Sections obtained from the brain were normal.
+Laboratory investigations revealed hemoglobin level of 9.3 g/dL, leukocyte count of 15,000 cells/mm3, and erythrocyte sedimentation rate of 48 mm in the first hour. Thyroid function tests demonstrated high levels of thyroid stimulating hormone (TSH), 25.75 milliunits per liter (normal, 0.3 to 5.0 mU/L), with T3 and T4 within standard limits. US of the neck revealed a cystic swelling measuring 3 × 2 cm in the left lobe of the thyroid gland. A technetium-99 scan was performed which revealed a hypofunctioning nodule involving the lower third of the left lobe, extending to the isthmus.
+US-guided fine needle aspiration of the orbital lesion was performed and the specimen underwent microscopic examination, and culture for bacteria, mycobacteria and fungi. Cytology demonstrated lymphocytes and a few giant cells, but no micro-organisms. Cultures remained sterile after 2 weeks. Fine needle aspiration from the neck mass revealed acid-fast bacilli, together with lymphocytes, and epitheloid and giant cells . Mycobacteria grew on the culture media incubated with the thyroid specimen. Chest X-ray and abdominal US were normal.
+Eventually, a diagnosis of thyroid gland TB with coexisting tuberculous orbital abscess was made and the patient received a 3-drug antitubercular regimen. The orbital and neck swelling resolved after 6 months of therapy and the child remained asymptomatic up to one year .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1185_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1185_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4b234a8b49d16a591748f1a9eebec0d7cce42184
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1185_en.txt
@@ -0,0 +1,25 @@
+A 10-year-old Kurdish boy presented with bone pain and fever associated with night sweats, shortness of breath, weight loss (5kg/month), purple purpuric spots over the skin and bleeding from the nose. The patient’s history dated back to 1 month before admission. On examination, we observed pallor, cachexia, dyspnea, fever, tachycardia, tachypnea, multiple petechiae and ecchymoses all over the skin, dilated tortuous veins over the chest, pulse rate 120bpm, respiratory rate 23cycles/minute, temperature 39°C and blood pressure 90/45mmHg. Moreover, we found multiple small cervical lymphadenopathies and mild splenomegaly 3cm below the left costal margin. The boy’s liver was tender 7cm below the right costal margin, and he had gross abdominal distention. The initial blood counts were hemoglobin 64g/L, white blood cell count 34 × 109/L, platelets 25 × 109/L and blasts 38% (Figure
+A). The blasts were homogeneous with a high nuclear to cytoplasmic ratio, inconspicuous nucleoli and open chromatin, and some of the blasts were vacuolated. Platelets were markedly reduced (Figure
+B). There was mediastinal widening visualized on a chest X-ray (Figure
+). MRI showed lumbosacral vertebrae with diffuse infiltration of the axial bone marrow of the lower dorsal and lumbar vertebrae, suggestive of bony metastases predominantly osteolytic in nature (Figure
+A–
+C). Bone marrow aspiration (BMA) showed no fragments but few areas of necrosis. Bone marrow biopsy showed marked BMN (Figure
+A and
+B). The first immunophenotyping was not conclusive, but the second was positive for CD3 and terminal deoxynucleotidyl transferase and negative for CD20, CD79a and CD10.
+After admission, the patient’s condition deteriorated and features of frank superior vena cava syndrome developed. The patient was treated with chemotherapy according to the ALL protocol, and complete remission was achieved on day 28. At the 24th week of chemotherapy, his condition relapsed on treatment. He returned to our hospital with fever, chest infection and 60% blasts observed on peripheral blood film, and the complete blood count revealed severe pancytopenia. The BMA was a dry tap, but the biopsy showed hypercellular marrow with extensive infiltration by mononuclear cells and disappearance of necrosis (Figure
+C and
+D). Treatment was reinitiated according to the ALL protocol (bone marrow relapsed protocol), after which he developed severe mucositis, uncontrolled septicemia and electrolyte imbalance. Eventually, that led to death.
+The BMA at the time of diagnosis was diluted, and the slides appeared to show artefact with a few necrotic cells. The biopsy was a 1.6cm piece of tissue that consisted of a fragment of trabecular bone showing marked BMN, as shown in the image in Figure
+A (before treatment). The result of immunohistochemistry was not interpretable for the first specimen, but for the second the diagnosis was definitive as precursor T-cell ALL.
+During admission, we gave the patient intravenous fluid 3000ml/m2/day, allopurinol tablets 100mg/m2/dose and antibiotics. The patient’s condition subsequently deteriorated, and he developed progressive dyspnea, chest tightness, abdominal distention and fever. The patient was near to developing frank features of superior vena cava syndrome, but later he developed bilateral lower-limb weakness. The straight leg raising test was observed to be positive bilaterally. MRI of the dorsolumbosacral spine showed diffuse focal infiltration of the axial bone marrow of the lower dorsal and lumbar vertebrae causing altered hypointense T1-weighted signal intensity (Figure
+A and
+B). The image was suggestive of bony metastasis that was predominantly osteolytic in nature (Figure
+A and
+B). Incidental hepatosplenomegaly and bilateral renal enlargement were also observed (Figure
+C), but there was no pressure on the spinal cord.
+We started dexamethasone intravenous infusion at 6mg/m2. Seven days after the patient’s admission, we started induction therapy with vincristine 1.5mg/m2 intravenous bolus on days 7, 14, 21 and 28. Dexamethasone 6mg/m2 was administered daily, and daunorubicin 25mg/m2 was given on the days 1 and 7.
+Upon starting induction, the patient developed attacks of tonic-clonic contractions. We found computed tomography of the brain without contrast to be negative. Electrolyte measurements showed severe hypocalcemia, and we induced correction, which stabilized the convulsions. On day 28, BMA indicated a few fragments and megakaryocytes were seen. Erythroid and myeloid series were present with all stages of maturation. The data also indicated predominant neutrophils and histiocytes, but the cellular elements could not confirm an excess of blast cells. The bone marrow biopsy report showed 95% cellularity, which was composed predominantly of early-stage granulocytes and normal maturation stages of hematopoietic cells. The blasts constituted about 2% of total marrow nucleated cells. The myeloid to erythroid cell ratio was 8:1.
+After a 4-week induction period, complete remission was observed and we continued giving the early consolidation chemotherapy. Unfortunately, at the 24th week of treatment, the patient returned with fever, chest infection, neutropenia and thrombocytopenia, and we found the presence of a few blasts in the peripheral blood film. The patient was not responding to supportive treatment that included antibiotics and antipyretics. The follow-up analysis of BMA showed excessive bone marrow infiltration by mononuclear cells with multiple inconspicuous nucleoli. Both erythroid and megakaryocytic precursors were suppressed in BMA, whereas in relapsed biopsy no necrosis was observed (Figure
+C and
+D).
+On the reinduction therapy date, we followed a bone marrow relapsed protocol. On the 14th day of treatment reinduction, the patient developed severe anemia, thrombocytopenia and neutropenia. In addition, he developed grade IV mucositis with hypokalemia. The patient could not tolerate the complications, and he developed septicemia followed by sepsis. The patient’s death was an inevitable outcome. The overall survival period was 26 weeks after first diagnosis.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1188_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1188_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..edf2ad4c99cd00159d69ba2346bf5e041918a42f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1188_en.txt
@@ -0,0 +1,4 @@
+The proband was a 22-year-old Iranian woman (south of Iran, Fars province) with DHP deficiency whose parents are a first-degree cousins. There was not any symptoms in the proband until 20 years of age, when during her first pregnancy, elevated liver enzymes was detected during her routine laboratory evaluations (ALT of 147 U/L, reference range: < 31 U/L, AST of 108 U/L, reference range: < 31 U/L and Alk-P of 350 U/L, reference range: 64–306 U/L). She also had increased level of serum iron of 227 μg/dL, reference range: 50–170 μg/Dl and PT of 14.5 s, reference range: 10.5–11.5 s. A spontaneous abortion happened to her during the first trimester of pregnancy. She was evaluated and tested for autoimmune antibodies in which the negative results excluded autoimmune hepatitis as a disease leading to liver dysfunction. Thereafter, she was presented with bloody vomiting, diarrhea, jaundice, weight loss and bilateral mild mid frequency sensorineural hearing loss. Abdominal and pelvic ultrasonography was in favor of cirrhosis and in liver biopsy cryptogenic cirrhosis was confirmed. The patient was initially diagnosed as having glycogen storage disease by considering the clinical evaluation, and referred to genetic counseling where whole-exome sequencing was conducted to discover the underlying etiology. According to NGS results, for confirming the genotype-phenotype correlation, the patient was referred to evaluate the levels of dihydrothymine and dihydrouracil by HPLC tandem-mass spectrometry in which elevated levels of both were identified in the patient’s urine in comparison with the mean concentration observed in control group’s urine (dihydrothymine (μmol/mmol creatinine): patient = 148, controls = 1.4 ± 1.1 (n = 106), dihydrouracil (μmol/mmol creatinine): patient = 254, controls = 4.9 ± 3.2 (n = 106)). There was no history of such condition in other family members.
+All exons of protein coding regions and flanking introns belonged to the extracted DNA from the proband were captured and enriched by Whole Exome Sequencing method (Agilent sure select v5 exome capture kit). Next Generation Sequencing (NGS) method was conducted using illumina sequencing platform to sequence the libraries with mean > 80-100X coverage. The human reference genome (GRCH37/hg19) was downloaded in order to perform the alignment to Sequence reads using BWA program [, ]. Picard and GATK version 3.6 were used to identify the relevant variants [, ]. The VEP program was used to annotate the variants . In order to perform further annotation a set of related disease databases including OMIM, HGMD, GWAS, SwissVar and Clinvar as well as published variants were used. Filtering of common variants was done according to allele frequency in ExAC, 1000 Genome phase3, dbSNP147 and EVS. Some bioinformatics online softwares such as SIFT, polyphen2, LRT, mutation assessor and mutation taster2 were also used to discover the disease causing variants.
+In order to segregate the mutation, Sanger sequencing was conducted using ABI BigDye Terminator Cycle Sequencing Kit (Applied Biosystems®, USA) on extracted DNA (QIAamp DNA minikit, Qiagen, Germany) belonged to the patient and her family members (parents, sister and brother). Epoch Microplate Spectrophotometer (Bio Tek Instruments, USA) was utilized to calculate the quality of extracted DNA. Desired genomic region was amplified using following oligonucleotide PCR primer pairs: DPYS-E9-F: 5′-CACAAAAAGTGGGACAATCC-3′, DPYS-E9-R: 5′-GTGAAGCCTCTGACCTTGAT-3′. The obtained sequences were analyzed using Finch TV software and NCBI Blast.
+Liver biopsy specimens underwent RNA (total RNA) extraction via Invitrogen TRIzol Reagent (Thermo Fisher Scientific, USA) based on the company protocol. Quality of RNA was evaluated by Epoch Microplate Spectrophotometer (Bio Tek Instruments, USA). Normalized RNA samples were used to synthesis cDNA by Fermentas cDNA synthesis kit (Thermo Fisher Scientific, USA) per manufacturer’s instructions. In order to assess the DPYS gene expression SYBR Green Master Mix (Invitrogen) was used to perform the Real Time PCR in Rotor-Gene Q (QIAGEN, Germany) Real Time PCR cycler. The experiment was conducted in triplicate. In the current study, GAPDH (Glyceraldehyde 3-phosphate dehydrogenase) was used as an internal control gene. The following intron-spanning primer pairs were utilized in our study: DPYS-F: 5′-ACCCGACTTCCTCATGAATCT-3′, DPYS-R: 5′-CATCCGATCTTCAACACCATTCA-3′, for the gene of interest and GAPDH-F: 5′-ACAACTTTGGTATCGTGGAAGG-3′, GAPDH-R: 5′-GCCATCACGCCACAGTTTC-3′ for the reference gene (GAPDH PrimerBank ID: 378404907c2, ). Comparative threshold cycle method (2-∆∆CT) was used to compare the relative expression of DPYS gene between the patient’s liver tissue and her sister’s liver tissue who genetically confirmed to be unaffected (the liver biopsy was performed in her sister due to the increased levels of ALT, AST, Alk phosphatase and she was suspected to be affected with Autoimmune hepatitis due to a positive test for ANA and ASMA (titers ≥1:160)).
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1199_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1199_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f9e82401664ff4953b63c8070b97799d53643412
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1199_en.txt
@@ -0,0 +1,7 @@
+The present case is a 12-year-old boy who was admitted to the orthopedic department of our medical center due to chronic and severe pain in his left knee. He was not a professional athlete, and his activity level was typical for an adolescent. The parents stated a blunt traumatic injury to the affected knee about two years ago that triggered the knee pain in the patient. He had undergone conservative treatments, including non-steroidal anti-inflammatory drugs (NSAIDs) for the past six months and also a single dose of lidocaine and corticosteroid intra-articular injection three months ago that did not result in significant persistent improvements but temporarily relieved the pain.
+During the physical examination of the lower limbs at the time of admission, normal skin was observed without signs of injuries. There was a regional pain in the supra-lateral site of the patella in the 90° flexion position during ROM examination that was relieved with more flexion or extension. Moreover, point tenderness was felt in the lateral side of the patella directly on the condyle in the knee 90° flexion position. The patient's pain was not related to the activities. During the knee range of motion (ROM) examination, a mild click was also found when going from full extension to flexion at 100°. Knee ROM was 0–130°.
+The hyperflexion and hyperextension of the knee were associated with no pain. Knee stability was preserved in the valgus stress test and varus stress test. The extensor mechanism was normal, no mal-alignment was observed, and the patient's gait was intact. Other examinations, including pivot, McMurray, and Lachman tests, were normal. Neuromuscular examinations of lower limbs were normal. The patient's knee clinical appearance is shown in .
+The X-ray of the affected knee indicated no pathologies , but the left knee MRI showed significant hypertrophy of the synovial membrane .
+The patient underwent knee arthroscopy with suspicion of hypertrophic plica. A hypertrophic synovial plica in the lateral side of the left knee was observed. A complete resection of hypertrophic plica was performed. The surgery details are as follows: A systematic examination of the knee joint was performed. The patellofemoral, medial, and lateral compartments were evaluated for any signs of pathology. Cartilage surfaces, menisci, ligaments, and synovium were inspected thoroughly. Attention was directed towards the lateral compartment, specifically the lateral plica. The lateral plica was identified and assessed for any abnormalities, including thickening, fraying, or impingement. Subsequently, arthroscopic shavers and scissors were used carefully to resect the affected portion of the plica. Great care was taken to preserve surrounding structures and minimize trauma to the synovium. After resection, the knee joint was thoroughly irrigated with saline solution to remove debris. The arthroscope was used to confirm the successful resection of the lateral plica and to ensure the absence of any residual pathology.
+Moreover, an accidental finding of the knee arthroscopy was angiogenesis in the femoral condyle beneath the hypertrophic plica . Angiogenesis is commonly found in pathologic plica, caused by inflammation due to friction, with increased inflammatory cells and hyalinization .
+The patient's follow-up immediately and after six months showed complete remission without further knee pain. No ROM restrictions or complications are reported during flexion from 0° to 140°. Moreover, in the recent follow-up visit of this patient, 1.5 years after surgical resection, he did not suffer from any pain in the rest and physical activity. He also had a full knee range of motion without any limitation or lag. shows the follow-up MRI.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1202_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1202_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..97657688335bc7726aef3bb500a28bc5d5b1ef1d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1202_en.txt
@@ -0,0 +1,4 @@
+A 63-year-old man was diagnosed with schizophrenia at age 49 and had been treated at the outpatient department of Songde Branch of Taipei City Hospital since the diagnosis. His symptoms included delusional jealousy, persecutory delusion, irritability, self-destructive behaviour and self-talk. Sulpiride 600 mg/day was prescribed but he quit the outpatient follow-up 2 months later. From age 50, he had an average daily consumption of four standard drinks of alcohol. Drinking worsened his impulse control and caused him to get into conflicts with his neighbours. He had been admitted to the acute psychiatric ward of Songde Branch of Taipei City Hospital three times since age 55. Brain computed tomography was performed that showed mild bilateral frontal lobe atrophy, but no other significant abnormal findings were identified. Benzodiazepine and thiamine were given whenever he was admitted for the prevention of Wernicke’s encephalopathy and alcohol withdrawal symptoms. Neither acute confusion state nor obvious amnesia was noted during admission.
+Risperidone 4 mg/day was used at first during admission for about 1 month with significant improvement in his psychotic symptoms. Unfortunately, the side effect dysphasia occurred and the patient developed aspiration pneumonia. Therefore, risperidone treatment was ceased and quetiapine was prescribed with gradual increase in dosage to about 550 mg/day. However, the treatment efficacy was not satisfactory in this patient.
+At age 62, amisulpride at a dosage of 400 mg/day was prescribed instead in the outpatient department. After 6 months, obvious akathisia was noted, and he was transferred to Bali psychiatric centre for further treatment. The amisulpride dosage was tapered to 200 mg/day. His psychotic symptoms remained stable, but the side effects persisted, and amisulpride was further reduced to 50 mg/day gradually. His akathisia showed improvement, but he began to suffer from other forms of abnormal involuntary movements comprising dyskinesia mixed with dystonia and akathisia. The involuntary movements involved his trunk, head and neck, and four limbs. He kept twisting his body and head around or back and forth (Additional file : Video 1), which may be the dyskinesia symptoms mixed with the cervical dystonia. Further, the feeling of inner restlessness and a compelling need to be in constant motion meant that akathisia played a role in his abnormal involuntary movements. Meanwhile, the stepping movement could also be observed when he was made to sit (Additional file : Video 1). According to the patient and his family’s report, the abnormal involuntary movements, which were subsequent to the dosage reduction of amisulpride, never occurred previously.
+The symptoms persisted for 2 weeks until amisulpride was increased to 100 mg/day. He still had slightly involuntary movement of his head and body but with much declined severity (Additional file : Video 2). Besides the adjustment of antipsychotic dosage, we used propranolol 10 mg twice a day for treatment of his akathisia and biperiden 0.5 mg twice a day for some dystonia-like symptoms. Further, lorazepam (0.5 mg twice a day) was prescribed for supplementary treatment of akathisia and dyskinesia for about 2 weeks. After discharge, the patient got relapsed about 1 year later with poor treatment adherence. The abnormal involuntary movements were still noted, although very mild, even though he did not take any psychotropic medications for about 3 months.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_120_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_120_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8687d0b65b06a129c133e1a1369a29f4f9200322
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_120_en.txt
@@ -0,0 +1,4 @@
+A 52-year-old man was admitted in our institutional emergency department for chest pain, sweating, and vomiting. The patient had no medical history or known cardiovascular risk factors and denied any other symptoms. Blood pressure was 85/50 mmHg and heart rate 54 b.p.m. Intravenous fluid administration was started to manage hypotension. Twelve-lead electrocardiogram showed sinus rhythm with only non-specific ST-segment changes . Trans-thoracic echocardiogram showed normal global and regional left and right ventricular function and normal size of left and right chambers. In particular, left ventricular ejection fraction was 60%, left ventricular end-diastolic diameter was 45 mm, and right ventricular end-diastolic diameter was 38 mm. Troponin T levels were mildly elevated (3.0 and 5.0 ng/L at 0 and 3 h, respectively).
+The clinical presentation was consistent with non-ST-segment elevation acute coronary syndrome (ACS). Aspirin was administered and patient underwent coronary angiography, which revealed a patent large left anterior descending coronary artery providing collaterals to a large dominant right coronary artery draining into the pulmonary artery . Non-obstructive coronary artery disease was found. Right and left cardiac catheterization was concomitantly performed, showing a normal pulmonary artery pressure (24/10 mmHg, average 12 mmHg) and a non-significant left-to-right shunt (pulmonary venous oxygen saturation 95%; pulmonary artery oxygen saturation 80%; mixed venous oxygen saturation 76%; QP/QS: 1.3). Then, the patient was transferred to our Cardiac Care Unit for monitoring.
+After 2 days, a cardiac computed tomography (CT) angiography was performed to better define the coronary anatomy. CT angiography confirmed ARCAPA, excluded any other coronary anomalies and showed normal calibre of pulmonary arterial vessels (diameter of pulmonary trunk: 26 mm; ). Finally, a 99mTechnetium-gated single-photon emission computerized tomography (SPECT) with bicycle exercise test and then a 201Thallium-gated SPECT with dipyridamole were performed to assess the functional implication of the coronary anomaly , showing a reversible mild inferior perfusion defect without any significant difference between the two tests. Stress test was maximal: it lasted 9 min and the patient attained 154 b.p.m. (91% of target heart rate), 6.8 estimated metabolic equivalents and 180/85 mmHg as peak blood pressure. The patient experiences a subsequent event-free hospital stay, and was discharged on aspirin 100 mg and bisoprolol 2.5 mg. The patient was educated on actions to prevent future vaso-vagal episodes, including keeping adequate fluid intake (2 L/day), recognizing prodromes and lying down and performing counter manoeuvres in case of vaso-vagal symptoms. Also, in order to minimize gastrointestinal triggers the patient was visited by a gastroenterologist and diet recommendations were made.
+At 2-year follow up, the patient was asymptomatic and repeated myocardial scintigraphy with dipyridamole stress test was performed after beta-blocker washout. The test confirmed the reversible mild inferior perfusion defect, previously observed. Bisoprolol dosage was up-titrated to 3.75 mg daily and aspirin was maintained.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1221_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1221_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..92d94f7251f2fa0b81d131897b1ceb0b912f09cf
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1221_en.txt
@@ -0,0 +1,6 @@
+A 36-year-old Caucasian woman, gravida 3, para 2, presented to our antenatal outpatient clinic in the 10th week of gestation complaining of uterine prolapse and amenorrhea. Five years earlier, at the age of 31 years, she had her first spontaneous vaginal delivery, after 39 weeks of clinically unremarkable gestation and after a seven-hour labor. A living male baby weighing 2950 g, with Apgar scores of 10/10, was delivered. After that, a total uterine prolapse (POP-Q IV) was observed and, therefore, a pelvic reconstruction operation was scheduled. However, she missed the appointment and she was lost to follow-up.
+Four years later, at the age of 35 years, the patient had her first pregnancy in a prolapsed uterus and the delivery was performed by an elective caesarean section after 38 weeks of gestation. During this second pregnancy follow-up she experienced symptoms of heaviness, but no pelvic pain or urinary incontinence. Pelvic examination showed that the uterus persisted in the pelvis because of increased volume. The cervical os was closed, while the entire cervix was lying outside the vulva during the first three months and after week 18 it appeared completely inside. When the cervix was outside the vulva, it appeared enlarged and edematous with marked ectropion but it was not ulcerated. A live male baby weighing 3150 g, with Apgar scores of 10/10, was delivered with elective caesarian section. After that, a total uterine prolapse persisted but she refused any procedure for pelvic reconstruction; neither was a vaginal pessary used.
+One year later, at the age of 36 years, she presented again in our clinic with a 10-week pregnancy in a prolapsed uterus. A vaginal pessary was applied to keep the uterus inside the pelvis after manual reposition. The pessary was removed at the 24th week. The gravid uterus persisted in the abdominal cavity because it was increased in volume . She did not show any symptoms of heaviness or urinary incontinence. The cervix was lying at the os of the vulva (POP-Q II) without signs of dessication or ulceration. It was enlarged and edematous but showed no evidence of cervical incompetence.
+Serial transabdominal ultrasonograpic examinations showed a normally developing fetus in longitudinal position in the uterine cavity. Elective caesarean section was performed at the 38th week. A living, healthy female baby weighing 3030 g, with Apgar scores of 10/10, was delivered.
+The postnatal period was uneventful and she was discharged home four days later in good health. Normal postpartum uterine involution was observed. After that, a total uterine prolapse (POP-Q IV) was still observed .
+She is scheduled for follow-up examination and pelvic reconstruction surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1236_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1236_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4e7ec9a48806747976aee8d632a2f209ce6b398b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1236_en.txt
@@ -0,0 +1,2 @@
+A total laryngectomized 72-year-old male was admitted with a complaint of difficulty in swallowing the foods and intractable liquid leakage from the valve of the tracheoesophageal prosthesis. The examination revealed a prosthesis covered with crust and dry mucus. Patient history was obtained from medical records and it was revealed that he had been using the same voice prosthesis smoothly for 17 years without changing. In fact, he had no significant complication in this period. However, he had been experiencing some difficulties in swallowing and leakage around the valve for a year. In addition, he had a serious iatrophobia and refused the change of prosthesis for several times.
+He was questioned for his daily habits which might help to preserve the prosthesis for a long time Tracheoesophageal fistula construction was performed after total laryngectomy for voice and speech restoration. Furthermore, flexible fiber optic esophagoscopy was performed to evaluate the fistula in case of a lesion; however, no lesion was detected on the esophageal mucosa . The patient was referred to a psychologist to make him convinced regarding the prosthesis change. After the removal of the old prosthesis , a new voice prosthesis (20-F,16 mm) was inserted and no complication occurred.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1246_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1246_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..39f87991bd4dc0674427715e439bfab7eefdc2f5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1246_en.txt
@@ -0,0 +1,2 @@
+A 46-year-old man with a history of hypertension, smoking, and alcohol use experienced a stroke on waking up with left limb weakness (4/5) and slurring speech on August 30, 2020. He was diagnosed to have a right internal carotid artery (ICA) territory infarct based on non-contrast computed tomography (NCCT) at local hospital. Despite antiplatelet therapy with aspirin 100 mg/d and clopidogrel 75 mg/d, over the next 3 days, left limb weakness progressively worsened (2/5), accompanied by somnolence (GCS 3 + 5 + 6). Therefore, he was transferred to our hospital on September 2, 2020. The Glasgow Coma Scale (GCS) score was 13/15. The head NCCT revealed new infarcts in the right internal watershed area and CT perfusion (CTP) showed a 100.3 mL mismatch of bilateral cerebral hemispheres, indicating that a considerable penumbral region was present in the supply area of each internal carotid artery (ICA) . Emergent EVT was performed under general anesthesia. The patient received IV heparin (50 U/Kg) before the surgical procedure. Preprocedural angiogram showed a double-lumen sign in the ascending segment of the right ICA with severe stenosis of the true lumen and linear stenosis in the ascending segment of the left ICA, suggesting dissections . The anterior communicating artery (ACom A) and the right posterior communicating artery (PCom A) were not open, and the left posterior cerebral artery (PCA) mildly compensated the left middle cerebral artery (MCA) through ipsilateral PCom A . Because we judged that the right ICA was the main vessel responsible for stroke, and worried about the risk of hyperperfusion-related bleeding in the simultaneous treatment of bilateral ICAs, we decided to treat right ICA first. An 8F Envoy guide catheter (Johnson & Johnson Co. Ltd., New Brunswick, NJ, USA) and 5F MPA catheter were introduced into the distal common carotid artery (CCA) by applying a coaxial technique. After traversing the true lumen with a Trevo Pro 18 microcatheter over a Synchro-2 microwire (Stryker Corp., Fremont, CA, USA), a Solitaire FR 6 × 30 mm stent-retriever (Medtronic Inc., Wexford, PA, USA) was temporarily deployed at the key flow-limiting site . An angiogram showed an image of a patent true lumen with a significantly reduced false lumen. After observation of 30 min, blood flow was maintained well, and ipsilateral anterior cerebral artery (ACA) compensated left ACA through ACom A. Thus, the Solitaire stent was detached . After recovery from anesthesia, the muscle strength of left limb was improved from grade 2/5 to grade 3/5, but the somnolence was not improved with a 13/15 GCS. Repeated CTP revealed that the perfusion of the right anterior circulation recovered, but a large area of hypoperfusion in the left anterior circulation was still seen . Due to concerns about clopidogrel resistance, the dual antiplatelet regimen was adjusted to aspirin 100 mg/d and ticagrelor 90 mg twice daily. On the 6th day after the procedure, the patient suffered from a generalized seizure and became stupor with a 9/15 GCS. Further, the muscle strength of right limb was decreased to grade 2/5. But no new lesions were found on the emergent head NCCT. Nevertheless, head CTP showed a new core infarction of 18.2 mL in the left frontal lobe with a penumbra of 100.4 mL in the left anterior circulation . Then, an emergent EVT was performed again. The angiogram revealed that the right ICA was patent with an inadequate compensation to the left anterior circulation via ACom A, and left ICA was occluded . A triaxial assembly including an 8F Mach1 guide catheter (Boston Scientific, Marlborough, MA, USA), AXS Catalyst 6 (Stryker Corp.), and a Trevo Pro 18 microcatheter over a Synchro-2 microwire were navigated through the left dissected segment . Subsequently, the Catalyst 6 and guide catheter were successively withdrawn to the beginning of the ICA under continuous negative pressure application, namely the simple catheter-passing (SCP) technique. Several dark red emboli were captured by Catalyst 6. A repeated angiogram showed that the left ICA was successfully recanalized and the structure of the dissection was fully revealed . After traversing the true lumen with the Pro 18 microcatheter over a Synchro-2 microwire, a Solitaire FR 6 × 30 mm stent-retriever was temporarily deployed at the key flow-limiting site . A subsequent angiogram showed that the antegrade blood flow was significantly improved and the dissecting aneurysm disappeared. After observation of 30 min, the Solitaire stent was detached. After recovery from anesthesia, the patient's consciousness became clear with a 15/15 GCS, the tracheal intubation was removed on the following day, and the muscle strength of four limbs was significantly improved to grade 4/5. A repeated head NCCT showed infarction in the left frontal lobe, but repeated head CTP showed that the cerebral perfusion of bilateral anterior circulations was recovered .
+After 3 months of dual antiplatelet therapy, another 3 months of aspirin single antiplatelet therapy was followed. The modified Rankins Scale score (mRS) was 1 at the 90-day follow-up. Follow-up neck CTA at three months showed no residual lesion in both ICAs. No relapse of cerebral ischemic events during the 15-month follow-up occurred. A recent neck CTA showed that both ICAs remained patent without relapse of dissection .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1254_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1254_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fd7eef60c773e9596a4dd7028617e2ac88947f33
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1254_en.txt
@@ -0,0 +1,3 @@
+A 63-year-old man having received a heart transplant due to dilated cardiomyopathy (May 2012) was hospitalized at the Department of Internal Medicine in Ilava hospital, Slovakia (December 2012). The patient had dyspnoea, left-sided bronchopneumonia and fevers. He was treated with amoxicillin/clavulanate and ciprofloxacin. The left-sided hemiparesis becoming hemiplegia evolved during the hospitalization. The CT (computed tomography) of the brain revealed numerous focal changes in the brain parenchyma, and suspected infra- and supratentorial metastatic lesions.
+The patient was transferred to the ICU (Intensive Care Unit) of the Clinic of Infectology and Geographic Medicine (January 2013). His pulse was 75 BPM and blood pressure was 125/70 mm mercury. The patient had a headache, cough and he was afebrile, with hemiparesis on the left lower limb. Anti-oedemotous and switched antibiotic therapy by third-generation cephalosporin and metronidazole was initiated. The investigations were complemented by MRI (magnetic resonance imaging) of the brain, which did not prove metastases and showed numerous abscesses with a strong oedema supra- and infratentorially in the posterior cranial fossa. In the quest for the brain abscess etiology, biological materials were collected for serological and microbiological tests. Blood culture was sterile. The cerebrospinal fluid was negative for any bacteria and bacterial antigens (Neisseria meningitidis serotypes a, b, c, y, w135; Streptococcus group B; Haemophilus influenzae serotype b; Streptococcus pneumoniae; Escherichia coli K1). The mycological serology, antigens of Cryptococcus neoformans, Aspergillus spp. and Candida spp., was negative as well. The pus from the skin lesion was examined by the Gram staining technique, showing the presence of Gram-positive hyphae. Native preparation and Lactophenol Cotton Blue staining of the material from the skin biopsy revealed the same observation – numerous darkly pigmented fungal elements with septa. As a bacteriological examination was negative, the samples were further cultured on Sabouraud dextrose agar (SDA) (HPL SERVIS Ltd. Nesvady, Slovak Republic) or Sabouraud dextrose broth (SDB) (HPL SERVIS Ltd. Nesvady, Slovak Republic) with antibiotics. The SDA and SDB were incubated at both 25 °C and 37 °C. The growth rate was moderate and it took about 4–5 days of incubation. After that time, velvety, olivaceous, grey colonies with olivaceous, black reverse could be observed . Colonies did not produce any diffusible pigment. The slide culture of the mould was incubated at 25 °C and after 5–7 days showed dark-walled, septate hyphae with poor branching. The one-celled oval conidia (7.5–11 µm×2.5–4 µm) were smooth-walled and pale brown without pigmented hila. They formed long, coherent, sessile, lateral or terminal chains on undifferentiated hyphae . The fungus grew on SDA and malt agar at 42 °C, with the optimal growth temperature between 35 and 37 °C. The mould was urease positive, growth on 10% NaCl agar was negative and colonies could grow on media containing cycloheximide. Based on these results, the isolate was identified in our laboratory as C. bantiana. To confirm this observation, we performed DNA sequencing-based identification. DNA was extracted using a Qiagen kit according to the manufacturer’s protocol and used for PCR with a specific set of primers for the internal transcribed spacer (ITS) regions of the fungal rRNA gene ITS1 (5′-TCCGTAGGTGAACCTGCG-3′) and ITS4 (5′-TCCTCCGCTTATTGATATGC-3′) (Invitrogen) according to . The PCR products were sequenced twice in both directions and the consensus sequence (596 nt) was used for subsequent blastn analysis against the nucleotide database with standard blast settings. The consensus obtained was aligned with the sequence of the ITS1 and ITS2 region of C. bantiana strain 1394 (sequence ID GQ258793), which had the highest score (1037 bits). Over 578 nt of the alignment, 99% identity, 2 gaps and 8 mismatching nucleotides were observed. Other C. bantiana strain ITS sequences represented all 13 highest-scoring blast matches. Finally, the isolate was identified as C. bantiana based on morphological and physiological features, and on the DNA sequence analysis. The sequence obtained was registered in the genetic sequence database GenBank under accession number KM525668.
+Susceptibility testing to selected antimycotics was performed on RPMI medium by quantitative assay for determining the MIC (MIC Test Strip; Liofilchem). After 48–72 h of cultivation at 30 °C, the MICs of 0.006 mg posaconazole l−1, 0.125 mg voriconazole l−1, 0.016 mg itraconazole l−1 and 0.75 mg amphotericin B l−1, were evaluated. There are no standard guidelines for antifungal therapy and until now, it has not been confirmed that therapy alone can improve survival . The current recommendation for eradication of disease associated with dematiaceous fungi is a combination of total surgical excision followed by systemic antifungal therapy . Our patient received an intravenous administration of amphotericin B and intense anti-oedematous therapy. The status of the patient was not improved, retrograded neurological complications and accelerated respiratory insufficiency resulted in the patient’s death one month later (February 2013). As the death of the patient was classified as being due to systemic fungal infection, a pathological-anatomic autopsy was recommended. Finally, C. bantiana was isolated from autopsy material taken from the lung, brain and skin.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1269_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1269_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..22175c1dd0d521f813f16ff4715f27051a68079d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1269_en.txt
@@ -0,0 +1,2 @@
+A 16-year-old girl was diagnosed with TOF, secundum, and sinus venosus atrial septal defect (ASD) at birth. Additionally, she had Turner syndrome [46, X, del(X)(p11.2)] and a horseshoe kidney. She underwent total correction of TOF and ASD closure at the age of 14-months, including patch closure of the subarterial ventricular septal defect, direct closure of the ASD, resection of the infundibular muscle, and transannular patch extending to the main pulmonary artery. However, the diagnosis of PAPVR was missed. She was doing well at her annual outpatient clinic follow-up. At the age of 16, she developed dyspnea on exercise. Echocardiography demonstrated severe pulmonary regurgitation, mild tricuspid regurgitation, and D-shaped left ventricle (LV) with paradoxical septal motion along with RIV and sinus venous ASD. Computed tomography also confirmed RIV and PAPVR . The right upper pulmonary vein (RUPV) drained into the SVC and the right middle pulmonary vein (RMPV) showed dual drainage into the SVC and LA. Surgical repair of PAPVR, sinus venous ASD, and pulmonary regurgitation was planned.
+Redo-median sternotomy and bicaval venous cannulation were performed. SVC cannulation was performed with a 20 Fr angle catheter at the utmost distal SVC above the anomalous PV and RIV. Under mild hypothermia cardiopulmonary bypass and after pharmacological cardiac arrest, the lateral wall of the SVC was incised from just above the junction of the anomalous RUPV to just below the junction of anomalous RMPV . Systemic and pulmonary venous blood pathways were separated by bovine pericardial patch. Consequently, dual pulmonary venous blood flow was created; RUPV and RMPV drained directly or through the intra-atrial tunnel and sinus venous ASD into the LA . Pulmonary valve replacement was performed with a 25 mm Trifecta aortic bioprosthesis valve (St. Jude Medical, Inc., USA). The duration of bypass and aortic cross-clamp was 125 and 96 min, respectively. After an uneventful postoperative course, patient was discharged on postoperative day 6. Postoperative echocardiography demonstrated improvement of D-shaped LV and laminar flow through the SVC and PVs. Postoperative computed tomography showed a well-reconstructed SVC and pulmonary venous pathway without stenosis .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1273_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1273_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5bf4fbb3989be5a048cd8cc1b06d3d6ce15c5e8e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1273_en.txt
@@ -0,0 +1,6 @@
+An 86-year-old New Zealand European white man was diagnosed as having smoldering myeloma of IgA lambda subtype in June 2008. His diagnostic bone marrow aspirate showed 38% plasma cells. His paraprotein at diagnosis was 9 g/L and gradually increased to 46 g/L by mid-2016 without any evidence of end organ damage .
+His other medical history includes L2–3, L5–S1 spondylosis and early stage prostate adenocarcinoma, T2A Nx M0, Gleason grade 6, which was successfully eradicated with radical radiotherapy in 2000. He takes cholecalciferol 1.25 mg once monthly, cilazapril 2.5 mg daily, amitriptyline 10 mg daily, and paracetamol 1 g twice daily and is intolerant of Augmentin (amoxicillin-potassium clavulanate; diarrhea). He lives with his wife and is fully independent with all his activities of daily living. He does not smoke tobacco and he consumes two units of alcohol per day.
+In June 2016, he developed mild normochromic anemia of 104 g/L and 6 weeks later he was hospitalized with melena in the context of recent non-steroidal anti-inflammatory drug (NSAID) use for low back pain. No bleeding source was identified on upper and lower endoscopies. The ibuprofen was stopped and he was started on omeprazole. He was also found to be mildly vitamin B12 deficient with a raised methylmalonic acid, and was commenced on vitamin B12 treatment. His hemoglobin fell to a nadir of 72 g/L during the NSAID-induced gastrointestinal bleed, but quickly recovered to its new baseline of 92–97 g/L and remained unchanged for the next 12 months. With regards to his back pain, a computed tomography (CT) skeletal survey and subsequent magnetic resonance imaging (MRI) of his lumbar spine showed mild osteoporotic compression fractures of L1–4 without any evidence of lytic disease. A follow-up bone density scan confirmed osteoporosis with a T-score of −2.7 in the left neck of his femur. He was treated with a single dose of zoledronic acid in August 2016 and a weaning course of analgesia. Concordant with his hemoglobin, his paraprotein remained stable at 45–50 g/L over the subsequent 12 months. Given the absence of other myeloma-defining events and unclear etiology of the anemia, he continued with watchful observation.
+In August 2017, he was prescribed a 10-day course of roxithromycin 150 mg twice daily for a clinically diagnosed community-acquired pneumonia. He had presented to his general practitioner with a 10-day history of productive cough, malaise, and anorexia. His temperature was 37.4 °C, blood pressure 140/70 mmHg, heart rate 70 beats per minute, and O2 saturations 98% on room air. Focal crepitations were heard at his left base and the rest of his physical examination was unremarkable. On review 4 days later, he had clinically deteriorated with a temperature of 39.0 °C, blood pressure 140/70 mmHg, heart rate 100 beats per minute, and O2 saturations 97% on room air but his physical examination findings were otherwise unchanged. Cephalexin 500 mg twice daily for 1 week was added to his treatment regime. He completed full courses of both antibiotics with eventual complete recovery. No blood test or sputum sample was submitted to the laboratory, and a chest X-ray was not performed. He did not receive any corticosteroids or herbal remedies with his chest infection.
+At his next routine hematology follow-up a week later, his paraprotein level (quantified by capillary electrophoresis) had decreased by 57% from 46 to 20 g/L. Over the next 4 months, while off all treatment, it slowly increased to 23, 26 then 28 g/L. Quantitative IgA levels demonstrated a similar pattern, falling from 54 to 22 g/L, before increasing to 27, 31 then 33 g/L. His hemoglobin increased from a pre-treatment average of 97 to 123, 126 then 132 g/L over the next 4 months. The rest of his laboratory parameters remained stable; his creatinine was 102 mmol/L, adjusted calcium 2.3 mmol/L, and albumin 32 g/L. Serum free light chains were not measured. When reviewed 4 months after the course of roxithromycin, he was asymptomatic apart from his chronic intermittent low back pain, which was improving.
+His International Staging System was calculated as II in August 2016. Clearly, his myeloma had a favorable slow progressive phenotype, as evidenced by the prolonged latent phase (8 years) from diagnosis and the stability of symptoms and paraprotein despite being untreated.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1300_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1300_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3965563ef8c82b5c0fe00165caf42ebdec03f82a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1300_en.txt
@@ -0,0 +1,7 @@
+A 73-year-old woman presented to our institution with a 17-mo history of a mass originating in the right submandibular gland and a one-year history of excision of the right submandibular gland tumor.
+She found a 3 cm × 3 cm hard, fixed mass in her right submandibular region with local pain 17 mo prior. There was no restriction in mouth opening or facial nerve dysfunction. The nature of the mass was unclear until the surgery. Radiotherapy was recommended as an adjuvant therapy, so the patient accepted intensity modulated radiation therapy at a dose of CTV1 (right mandibular gland) 2.0 Gy/F; CTV2 1.8-2.0 Gy/F; and CTV1n 1.64 Gy/F. Regular follow-up was performed after radiotherapy. Local recurrence and metastasis were not observed until positron emission tomography-computed tomography (PET-CT) suggested bilateral lung metastasis a half month later.
+She accepted surgery to remove the right submandibular gland and mass 5 months later; after the surgery, she received radiotherapy (66 Gy/33 fractions/45 d).
+She denied smoking and had no personal or family history of the related disease.
+Physical examination revealed old surgical scars about 6 cm in length on the right submandibular angle with no superficial lymphadenopathy or other signs. There was no local pain or facial nerve dysfunction.
+Pathological analysis revealed the tumor type to be Ca ex PA. The main components of this malignant tumor were poorly differentiated carcinomas, including myoepithelial carcinoma and spindle cell carcinoma, while the sarcoma was classified as osteosarcoma. Immunohistochemical (IHC) analysis showed that the tumor cells were positive for PCK, S-100 protein, CK14, P63, calponin, CK5/6, and desmin; the proliferative activity of Ki-67 was 20% .
+After the second and fourth cycles of chemotherapy, head and neck enhanced magnetic resonance imaging (MRI), chest enhanced CT , and abdominal ultrasound were reviewed, which showed that the lung metastasis was controlled.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1305_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1305_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..bdb2b2a5cc0dc155996df2469ec2862d7afb809f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1305_en.txt
@@ -0,0 +1,4 @@
+A 25-year-old gentleman presented to our clinic with a complaint of recurrent pain and swelling on his right cheek of three-month duration. He visited a general practitioner each time, and the condition was resolved with analgesic and antibiotics. However, his symptoms got worse and he attended our Oral Surgery Clinic for consultation.
+The patient is a fit and healthy young man with no relevant medical history and no known history of allergy. Past surgical history revealed that he had underwent bimaxillary orthognathic surgery one and half year earlier in a local hospital. Although the postoperative period was uneventful, the surgical team informed him that there was a dislodged orthodontic appliance in his right cheek that must have occurred during the operation. The team explained to the patient that this accident was realized later on the next day after the surgery when the molar tube from the right maxillary second molar was found missing, and its presence was confirmed high up in the right maxillary-zygomatic buttress area shown in the postoperative X-ray image taken on the next day following the surgery. A series of further postoperative radiographs confirmed its location, lying outside the right maxillary antrum. Due to the pronounced postoperative facial oedema at that time, no attempt was made to remove the appliance. The absence of sign and symptoms during further follow-up sessions confirmed the decision to leave it in-situ with continuous clinical observation.
+On examination, there was no extraoral swelling noted. The mandible and maxilla seemed firm indicating good healing following previous mandibular saggital split and maxillary Le Fort I osteotomy sites and a stable class I dental occlusion. Intraorally, there was a sinus with slight pus discharge on the upper right buccal sulcus region adjacent to the upper right first premolar. All teeth in that quadrant were firm and vital. Tenderness was elicited upon palpation on the upper right vestibular region. We suspected the sinus track may originate from the dislodged appliance embedded in the cheek soft tissue. A periapical view was then taken with gutta-percha inserted into the sinus for foreign body localization purpose. The radiograph revealed the gutta-percha pointed towards the site of titanium plate and screws placed used for rigid fixation, and with the molar orthodontic tube appliance in its vicinity . A cone beam CT was performed to provide a 3D detailed location of the appliance and confirmed it to be located outside the maxillary antrum.
+The presence of the molar orthodontic tube foreign body reaction was suspected as the most probable cause of the recurrent right cheek pain and swelling associated with an intraoral discharging sinus. Exploration of the site was performed through the sulcular incision under general anesthesia. The dislodged molar tube was identified lying on the zygomatic bone just beneath the raised flap. It was removed by dividing some surrounding fibrous tissue strands. Just below it, one titanium straight bone plate with four screws used for fixing the previous Le Fort I osteotomy site was inspected and found to be rigidly embedded in normal bone. However, a decision was made to remove them based on the fact that they are present in an infected area. . The Le Fort I osteotomy site showed good healing with new bone formation. Patient had an uneventful recovery thereafter, and the orthognathic surgical team who attended him previously was informed of his progress.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1306_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1306_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a94bd9ea0283b82b5ade2607759481baf2961b1b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1306_en.txt
@@ -0,0 +1,9 @@
+A 19-year old Caucasian male presented to the University Hospital of Muenster emergency department after being unresponsive for 5 h. After consuming liquid methadone intravenously the night before, the patient awoke and immediately complained of partial bilateral hearing loss, walking impairment and numbness of both inner thighs.
+According to third-party history obtained from two accompanying friends (the patient was amnestic regarding the night before) the patient had consumed 3 × 2.5 mL of liquid methadone (produced for substitution therapy) intravenously. They reported observing unconsciousness, urinary incontinence, and a twist of his eyes. The patient and accompanying friends admitted to occasionally orally using illegally obtained methadone and cannabis but credibly denied consuming these substances or other opiods and illegal drugs in the days before. This was the first event of intravenous methadone abuse. The medical history of the patient was otherwise unremarkable.
+In the neurological examination the patient presented fluctuating consciousness, severe psychomotor and cognitive slowing (slowed speech, increased response latency, concentration deficits), mild paraparesis of the lower limbs, clonus when testing the left patellar reflex and symmetrical bilateral hypoesthesia of the inner thigh. Medical examination showed a heart rate of 76 beats per minute, blood pressure 121/73 mmHg, peripheral oxygen saturation of 97% and temperature of 36.8 °C. An electrocardiogram (ECG) showed only unspecific change of the ST-segment in V2 and V3. FAST-ultrasound did not reveal any abnormalities.
+Blood tests revealed a slightly elevated c-reactive protein (5.2 mg/dl; reference < .5 mg/dl), an elevated GOP (400 U /l; reference: < 30 U/l), GPT (118 U/l; reference < 40 U /l) and an increased creatin-kinase (7104 U/l; reference: < 174 U/l) and lactatdehydrogenase (563 U/l; reference 117–217 U/l). Sodium and potassium levels were within normal range. Intoxication screening of the urine was positive for methadone (2.55 mg/l) and cannabinoids (THC-COOH: 29 μg/l) but was negative for other drugs including non-methadone opioids and barbiturates, benzodiazepines, tricyclic antidepressive drugs, methamphetamines, cocaine, phencyclidine and paracetamol. An initial magnetic resonance imaging (MRI) showed multifocal, bilateral edema of the basal ganglia , of both cerebellar hemispheres as well as the capsula interna with diffusion restriction and apparent diffusion coefficient (ADC) signal reductions and fluid attenuated inversion recovery (FLAIR) imaging revealed hyperintense alterations in those areas. In addition, DWI and FLAIR imaging presented mild, confluent white matter abnormalities above the lateral ventricle (Supplementary figure A, B). A time-of-flight (TOF)-angiography was normal. An initial spinal tap and subsequent cerebrospinal fluid analysis revealed a disturbance of the blood-brain barrier but normal total protein (542 mg/l) and normal lymphocyte counts (4/μL) and no intrathecal antibody synthesis. An electroencephalogram (EEG) revealed intermittent deceleration without epileptic discharges.
+After admission, the patient was continuously awake and responsive and did not require intensive care treatment. Initially, walking was impaired without a need for a walking aid.
+A transesophageal echocardiography revealed no cardiac abnormalities and especially no endocarditis. Repeated blood cultures were negative. Ear-nose-throat consultation revealed an injury of the inner ear with a diminished ability to hear below 55 dB. We performed treatment with prednisolone for 3 days (days 7–9) at 1 mg per kilogram body weight, which did not cause any immediate conceivable improvement of hearing but the hearing ability improved continuously. The unsteady gait improved to an almost normal level between days 9–11 of inpatient treatment. In contrast, cognitive deficits remained unchanged with increased response latency, slowed speech and concentration deficits. Additionally, the hypoesthesia of the inner thigh remained unchanged.
+An additional MRI after 11 days revealed the known FLAIR-hyperintense lesions of basal ganglia, capsula interna and subtle abnormalities above the lateral ventricles (Supplementary figure C, D) as well as the cerebellar hemispheres , which were now ADC increased. Interestingly, new lesions were found in the crura cerebri bilaterally . Another spinal tap revealed an increase of lymphocytes (11/μl), but otherwise no pathological findings with a normal blood-brain barrier. Flow cytometry analysis of cerebrospinal fluid (CSF) cells revealed a shift in monocyte subtypes with a significant increase of the non-classical CD14 + CD16+ monocyte-fraction and decrease of the CD56bright natural killer cell-fraction in the lymphocyte subset in the CSF . Reference values had been previously collected from 29 patients (female: 58%, mean age: 24.1y + − 5.0 standard deviation (SD)) with psychsosomatic disorder (exclusion of inflammatory CNS disorder; CSF: less than 5 cells/μl, normal protein, no intrathecal antibody synthesis).
+With improved walking and hearing but considerable neurocognitive impairment we discharged the patient after 13 days to subsequent rehabilitation.
+A neuropsychological assessment on day 18 revealed mild-to-moderate overall cognitive impairments when compared with normative data stratified for age and education . Particularly tests assessing cognitive processing speed (e.g., TAP, SDMT, TMT, Time to copy a complex figure) showed consistent alterations from the norm. Learning efficiency of both verbal (RAVLT) and visual material (BVMT-R) was also impaired whereas recall from memory was only reduced for verbal but preserved for complex visual material. Interestingly, the patient showed preserved performance in tests for complex attention and higher executive functions such as planning abilities (D-KEFS Tower Test).
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1320_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1320_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5e38caf1ed13b8718fc61375e1ae39c5600a9235
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1320_en.txt
@@ -0,0 +1,7 @@
+A four-month-old previously well Sri Lankan male infant from an urban area presented with high grade fever of 102-103 °F of 2 days duration. He had conjunctival redness, bilateral pedal oedema, a scaly rash in the cheeks, and a sand-paper like papular erythematous rash on the trunk and bilateral upper and lower limbs. Both liver and spleen were palpable 2 cm below the costal margin. There was no redness in the tongue and no cervical lymphadenopathy. Other system examinations were normal, except for high blood pressure measured by both manual and electronic methods, which was above the 99th percentile.
+The initial full blood count showed a total white cell count (WBC) of 18,000/uL with a neutrophil leukocytosis of 53%, a platelet count of 552,000/uL and a haemoglobin of 12 g/dL. C-reactive protein (CRP) was 130 mg/dL and the erythrocyte sedimentation rate (ESR) was 10 mm in the 1st hour. Serum sodium was 134 mmol/L and potassium 5.4 mmol/L. Renal and liver function tests were normal. Covid-19 rapid antigen and PCR tests were negative.
+He was empirically initiated on intravenous cefotaxime and flucloxacillin based on the local sensitivity patterns, suspecting either a streptococcal or staphylococcal septicaemia. However, blood culture was sterile and high fever spikes continued despite continuous antibiotics. Ultrasound scan abdomen on day four was normal and 2D echocardiogram did not show any coronary artery dilatations. Atypical Kawasaki disease was suspected and intravenous immunoglobulin (IVIG) 2 g/kg was administered on day six, followed by aspirin 80 mg/kg/day in four divided doses. As the response was poor, investigations were repeated. CRP and ESR had risen to 143 mg/dL and 130 mm/1st hour respectively. Cerebrospinal fluid (CSF) showed polymorphs 10/mm3, lymphocytes 43/mm3, red cells 23/mm3 and protein 136 mg/dL. Antibiotics were escalated to intravenous meropenam and vancomycin. CSF culture showed no growth.
+Fever spikes continued on day ten and the child developed periungual desquamation in fingers and toes. 2D echocardiogram was repeated which showed dilated coronary arteries (left main coronary artery 5.3 mm, left anterior descending artery 6.5 mm, right coronary artery 5 mm) and a thin pericardial effusion suggestive of KD. A second dose of IVIG 2 g/kg was given and Aspirin dose increased to 100 mg/kg/day. Intravenous Methylprednisolone 30 mg/kg pulse therapy was given for 3 days followed by oral prednisolone. Fever settled for 72 hours, only to recur again. Repeat 2D echocardiogram on day fifteen showed progressive worsening of the coronary dilatation (LMCA 5.7 mm, LAD 9 mm, RCA 6 mm). Electrocardiogram (ECG) showed ST elevations in inferior leads which were persistent on serial ECGs. Cardiac Troponin I levels and Creatine-kinase levels were normal. Clopidogrel and warfarin were added while Aspirin was continued. Oral prazosin and furosemide were added to control the hypertension. His serum electrolytes, renal functions and ultrasound abdomen and kidney-ureter-bladder and renal artery doppler were normal. Extensive investigations in view of aetiology for hypertension such as renal angiogram, urinary and plasma metanephrines, renin-aldosterone levels were not performed as the preliminary investigations were normal and due to limitation of resources in the local setting. His 2D-Echocardiogram did not reveal left ventricular hypertrophy and ophthalmic assessment did not reveal hypertensive retinopathy which confirmed the acute onset of hypertension with the current illness.
+On day sixteen he developed a vesiculo-papular rash involving face, trunk and distal upper and lower limbs including the periungual regions and the perineum . It progressively evolved into bullous lesions. Biopsy of the rash revealed parakeratosis and neutrophils in the epidermis with broad papillae suggestive of guttate psoriasis . It did not show small or medium vessel vasculitis.
+Intravenous infliximab 5 mg/kg was administered on the 28th day of illness after screening for and excluding tuberculosis, followed by two more doses on the 2nd and 6th week after the initial dose. Fever responded to infliximab within 24 hours and the skin lesions showed gradual improvement. He developed a small joint arthritis involving proximal and middle inter-phalangeal joints of hands and feet on day 40 which showed a diurnal worsening . Oral Methotrexate was added. Repeat 2D echocardiogram on day 60 showed a reduction in the coronary artery diameters, finally indicating a therapeutic response (LMCA 5.3 mm, LAD 6.9 mm, RCA 5 mm). The infant was discharged on day 61 of illness on aspirin, warfarin and prazosin. Oral prednisolone, clopidogrel and methotrexate were gradually tailed off after discharge. Oral prednisolone 2 mg/kg dose was given for 6 weeks followed by gradual taper over a period of 3 months.
+On follow up, his arthritis and skin rash resolved completely. The hypertension which was present from the beginning of illness settled completely four and a half months from disease onset, enabling discontinuation of anti-hypertensive medications.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1352_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1352_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8369c69a87876f3be10312b59557cf5754a79dcf
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1352_en.txt
@@ -0,0 +1,4 @@
+A 59-year-old woman was diagnosed with IgG kappa MM in May 2002, when she presented with Durie-Salmon stage III A disease with lytic destruction of the pelvis. Fluorescence in situ hybridization (FISH) performed on a bone marrow aspirate in 2006 did not reveal any high-risk cytogenetic abnormalities. Induction therapy with vincristine/doxo-rubicin/dexamethasone was followed by double autologous stem cell transplantation after conditioning with high-dose melphalan (200 mg/m2), resulting in a PR that lasted for 2 years. At first relapse, 4 cycles of bortezomib and subsequent bortezomib maintenance were administered and led to a PR for further 3 years. Third-line treatment with lenalidomide, bendamustine and dexamethasone produced only a short-lived response. Therapeutic attempts with the Hsp-90 inhibitor AUY-922 (phase I-Ib/II study) and bortezomib/dexa-methasone resulted in disease progression. Salvage treatment using multidrug combinations of two novel agents (bortezomib plus lenalidomide), alkylating agents (cyclophosphamide or melphalan) and dexamethasone also failed to induce a durable response. With high-grade plasma cell infiltration of the bone marrow , increasingly severe pancytopenia developed, causing chronic fatigue and impaired quality of life and eventually led to treatment discontinuation.
+In August 2010, at the age of 68 and 8 years after primary diagnosis , we started treatment with pomalidomide (4 mg days 1–21 of a 28-day cycle) and low-dose dexamethasone (40 mg weekly) in combination with doxorubicin (4 mg days 1–4 by continuous infusion). Due to grade 3 thrombocytopenia, the pomalidomide dose was reduced to 2 mg from cycle 2 onwards, resulting in improved tolerability, serological PR and hematological improvement. However, myeloma therapy had to be stopped after six cycles due to the reactivation of a hepatitis B virus (HBV) infection (11.7 × 106 copies/ml), which the patient supposedly acquired in 1945 and which had never emerged during therapy before. Antiviral treatment with entecavir was initiated, which led to a sufficient drop in viral load (9.7 × 102 copies/ml).
+Five months after the interruption of antimyeloma treatment, the patient suffered from serological disease progression and a pathological humeral fracture requiring surgical treatment . To prevent further disease progression, one more cycle of pomalidomide/doxorubicin/dexamethasone was administered. For the subsequent cycles, doxorubicin was replaced by bendamustine (40 mg/m2 days 1–2) in light of the published data reporting an increased risk of HBV reactivation in patients receiving anthracyclines. However, two cycles of the new combination regimen resulted in transfusion-dependent anemia and grade 3 neutropenia, and only stable disease was observed.
+Since the patient was not eligible for treatment within one of the active clinical trials at our institution, individualized therapy was initiated, whereby pomalidomide (2 mg on days 1–21 of a 28-day cycle) was combined with bortezomib (1.3 mg/m2 day 1, 4), cyclophosphamide (250 mg days 1–3) and dexamethasone (10 mg days 1–3, weekly thereafter). As ninth-line therapy, this individualized combination regimen inhibited the progression of the bone lesions, and the patient continued to experience a good quality of life. When the symptoms of sensory polyneuropathy worsened after 18 cycles, bortezomib was reduced to 1.0 mg/m2 and the cycle length was extended to 43 days. Neuropathy improved gradually; however, we observed a steady rise in serologic disease activity. For the subsequent cycles, the pomalidomide dose was increased to 3 mg days 1–21 and the cycles were repeated on day 29, resulting in sustained PR. Due to an extended treatment-free interval after 34 cycles of pomalidomide + VCD (bortezomib/cyclophosphamide/dexamethasone), we observed an increase of serologic markers. More than 12 years after primary diagnosis and 4 years and 4 months after the first treatment with pomalidomide, regrettably, our patient succumbed to a fulminant pneumogenic septicemia in grade 1 neutropenia.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1372_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1372_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..687cdd8ce7fff769dc0f397ceb3d42327ed42925
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1372_en.txt
@@ -0,0 +1,2 @@
+A 67-year-old woman underwent PBSCT for therapy-related acute myeloid leukaemia and received azacitidine, busulfan and fludarabine therapy. Before PBSCT, she had been diagnosed with resolved HBV infection; HBsAg, negative; hepatitis B core antibody (HBcAb), positive (180.6 C.O.I.); and hepatitis B surface antibody (HBsAb), positive (36.9 mIU/mL). She had no history of HBV vaccination, but she experienced acute hepatitis B caused by blood transfusion for her child birth before PBSCT. Changes in HBsAb and HBcrAg during the course are presented in Fig. , as well as other liver function and viral status, alanine aminotransferase (ALT), HBsAg, HBcAb, HBeAg, hepatitis B e antibody (HBeAb) and HBV-DNA levels. Serum HBcrAg levels were determined via chemiluminescent enzyme immunoassay (LUMIPULSE®, Fujirebio Inc., Tokyo, Japan).
+She received rituximab for post-transplant lymphoproliferative disorder 26 months after PBSCT, her HBsAb decreased (8.6 mIU/mL) and HBV-DNA increased slightly to detectable though the levels of < 1.3 logIU/mL. Since she tested positive for HBV-DNA (1.4 logIU/mL) 103 days after the first rituximab therapy (day 0, Fig. H), the scheduled rituximab administration was skipped and the first entecavir treatment was started according to the Japanese guideline for HBV reactivation . Immediately after the first entecavir treatment, the HBV-DNA test became negative (day 63, Fig. H). Since her liver function (ALT levels) had been normal and both HBsAg and HBV-DNA remained negative during NA treatment , entecavir was terminated on day 376. According to the retrospective measurements, HBcrAg remained positive (3.6–3.9 logU/mL) while the HBV-DNA level was undetectable under the first entecavir treatment (day 63–455, Fig. D). One hundred forty-one days after entecavir cessation, the HBV-DNA test turned positive again (1.8 logIU/mL), suggesting HBV rebound (day 517). Her HBV-DNA level reached 5.2 logIU/mL (day 601, Fig. H), her liver function deteriorated and HBV infection worsened; ALT, HBsAg, HBcrAg, HBcAb and HBeAg were elevated to high levels at 280 U/L, 1101.8 IU/mL, 7.0 logU/mL (above the detection range), 727.3 C.O.I. and 1060 S/CO, respectively (day 658, Fig. A, B, D, E and F), even though entecavir treatment was resumed on day 615. The HBsAb level, which had been negative before the HBV rebound, further decreased (0.3 mIU/mL) when the HBV rebound was detected . ALT peaked at 455 U/L on day 685 when the levels for HBsAg, HBcrAg, HBeAg and HBV-DNA peaked out and declined . On the contrary, HBsAb and HBeAb levels increased to 292.8–1631.6 mIU/mL and 99.2–99.5%, respectively , after the rebound, resulting in HBsAg seroconversion with HBcrAg and HBV-DNA levels undetectable. The second entecavir treatment was terminated on day 986. HBV reactivation has not been detected 392 days after the second entecavir cessation, and both HBcrAg and HBV-DNA levels remained undetectable. No difference in medication adherence and renal function was observed between first and second entecavir treatment. Daily dose of entecavir was 0.5 mg for both first and second treatment.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1373_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1373_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c1a7b7add29b15aa29296b2f749c67b00cc429ba
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1373_en.txt
@@ -0,0 +1,7 @@
+A 19-year-old unmarried Chinese woman presented to the anorectal surgery clinic with a complaint of congenital anal atresia from birth.
+Abdominal pain and distension appeared again 6 d prior and could not be relieved.
+The patient had a history of abdominal distension caused by constipation, and unformed loose stools were produced during defecation. At the age of 1 year, she was diagnosed but was not treated. Four months before admission, the patient was found to have abnormal bowel habits for 2-4 d a month, and the symptoms of abdominal pain and distension were relieved after resolving a large amount of loose stool. Computed tomography (CT) examination revealed intestinal obstruction, colon and rectum dilation with a large amount of contents, intestinal wall edema and thickening.
+The patient denied any family history of intestinal diseases.
+Physical examination on admission: There were no abnormalities in the general examination of skin and mucosa; however, the physical examination of the perineum showed that there was no anus in the normal anal position, but there was an anal incisure, and a red and swollen defecation fistula measuring 10 mm in diameter in the rectovestibular, and no abnormalities in the location or appearance of the labia majora, labia minora, vagina or urethra opening .
+No abnormality was found in routine blood and urine analyses.
+Auxiliary examination: (1) Abdominal CT: Rectal dilation with intestinal wall thickening, with a maximum diameter of approximately 10 cm ; (2) X-ray imaging: The distal end of the rectum was the blind end and located approximately 6 cm away from the anal notch ; (3) pelvic MRI: A gap was visible in the upper section of the transverse anal canal , the thickness of the internal sphincter of the anus was approximately 1 mm in the coronal position, some of the internal sphincter was discontinuous, the thickness of the external sphincter was approximately 2 mm in the sagittal position , the positions of the rectum, vagina and fistula were visible in the sagittal position, and the fistula was adjacent to the posterior wall of the vagina .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1386_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1386_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..11269f44a75e37621db64b015d79223a5db26a8f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1386_en.txt
@@ -0,0 +1,9 @@
+One year before his current presentation, a 38-year-old Sri Lankan man who had previously been well went to the local hospital with intermittent severe epigastric pain radiating to his back, in addition to vomiting. At this initial presentation, acute pancreatitis with high amylase levels was diagnosed. He had been consuming around 12 units of alcohol per week for a 12-year period. He did not have diabetes, hypertension, cholelithiasis, thromboembolic disease, or any other medical disease. He had no family history of significant medical illness. Following this presentation, he had intermittent episodes of epigastric pain, which subsided spontaneously without any medical treatment. At his current presentation, he had a 1-month history of steatorrhea and abdominal pain. His abdominal pain was intermittent and was associated with vomiting. He did not have fever. His initial serum amylase level was high. He was not immobilized. On the third day of admission, he developed progressive abdominal distention with bilateral ankle edema and normal urine output. He was not breathless.
+His physical examination revealed that his body mass index was 21.6 kg/m2. He was afebrile and pale and had ankle edema. He had a pulse rate of 80 beats per minute, and his blood pressure was 130/80 mmHg. His jugular venous pressure was elevated (8 cm). He was not tachypneic, and both lower zones of his lungs were dull to percussion. His breath sounds were reduced without any added sounds. His abdomen was tensely distended and tender, with gross ascites.
+The patient’s amylase level was rising. On day 1 of admission (1 month after symptoms started), his amylase level was 1331 U/L; on day 2, it was 1780 U/L; and on day 3, it was 3570 U/L. His amylase level remained elevated for 3 weeks. His white blood cell count (WBC) was 11.04 × 103 /μL with 70 % neutrophils. His hemoglobin level was 6.7 g/dl, with a hematocrit of 24.9 % on admission (normal 37–54 %). On day 2 of admission, his hematocrit was 25.6 %. His platelet count was 243 × 109/L. Hypochromic microcytic red blood cells (RBC) with a few pencil-shaped cells and macrocytes as well as hypersegmented neutrophils were visualized by mircroscopy. The patient’s reticulocyte index was normal, and the result of his Coombs test was negative. His serum ferritin level was 37.0 μg/L (normal 25–240 μg/L), his serum iron level was 13.4 μg/dl (normal 37–148 μg/dl), his total iron-binding capacity was 296 μg/dl (normal 274–385 μg/dl), and his iron saturation was 4.5 % (normal 15–50 %).
+The patient’s liver function tests were within normal range, except for a marginally low albumin level (aspartate aminotransferase 14 U/L, alanine transaminase 10 U/L, alkaline phosphatase 125 U/L, total bilirubin 18 μmol/L, total protein 48 g/L, albumin 32 g/L, globulin 16 g/L, international normalized ratio [INR] 1.23). His erythrocyte sedimentation rate was 56 mm/h in the first hour, and his C-reactive protein (CRP) levels were 35 mg/L on admission and 24 mg/L (normal 0–5 mg/L) after 48 hours. His serum ionized calcium on day 2 of admission was 0.91 mmol/L (normal 1.09–1.3 mmol/L), and it was 1.14 mmol/L with replacement of calcium on day 5. His serum creatinine concentration was within normal range throughout (75, 88, and 78 μmol/L; normal 60–120 μmol/L : on days 1,2 and 5 respectively), and his blood urea nitrogen level was normal (2.6 mmol/L, normal 2.9–8.2 mmol/L). His serum sodium level was 133 mmol/L, and his serum potassium concentration was 3.3 mmol/L. His random blood sugar level on admission was 126 mg/dl. Arterial blood gas analysis showed a pH of 7.5 with partial pressure of carbon dioxide of 31.4 mmHg, bicarbonate of 30.0 mmol/L, base excess of +8.0, lactate of 1.0 mmol/L (normal 1.0–2.5 mmol/L), oxygen saturation of 95.8 %, and partial pressure of oxygen of 73.4 mmHg. His fasting blood sugar level was 5.6 mmol/L (normal <5.6 mmol/L). His lipid profile was normal, with a normal triglyceride level of 120 mg/dl. His thyroid-stimulating hormone level was 0.97 mIU/L (normal 0.55–4.78 mIU/L), and his free thyroxine was 1.54 (normal 0.89–1.76).
+An ultrasound scan of the abdomen showed gross ascites with a normal liver and kidneys. Contrast-enhanced computed tomography (CECT) of the abdomen revealed two pancreatic pseudocysts, measuring 4.5 cm × 3.5 cm and 4.2 cm × 5 cm, respectively, in relation to the pancreatic head . The pancreatic duct and the rest of the pancreas were normal, without evidence of necrosis or changes of chronic pancreatitis. Gross ascites was visualized on both an ultrasound scan of the abdomen and a CECT scan. The patient’s bowel appeared normal. His peritoneal fluid was an exudate with 4.3 g/dl protein and a serum-to-ascites albumin gradient of −1.1 g/dl (<1.1 g/dl), a lactic acid dehydrogenase level of 527 U/L, WBC of 73 cells/mm3 with 90 % lymphocytes, and RBC of 1.6 × 109/mm3. His ascitic fluid amylase level was high at 3618 IU/L. No malignant cells were seen, and the patient’s Gram stain and acid-fast bacilli smear results were negative, with the culture remaining sterile. His adenosine deaminase level was normal (12 IU/L).
+One of the pseudocysts in the head of the pancreas was compressing the inferior vena cava (IVC), as shown in the CECT scans in Figs. , and . There were filling defects in the left common and internal iliac veins and both proximal external iliac veins, suggesting DVT . The patient’s IVC was patent. Multiple filling defects were seen in the right lower lobe pulmonary artery and in segmental branches of the left pulmonary artery, compatible with pulmonary embolism . The patient’s liver, gallbladder, spleen, kidneys, and adrenal glands were normal. He had bilateral atelectasis of the lung bases with minimal pleural effusions.
+Venous Doppler sonography of the patient’s lower limbs did not reveal DVT in the femoral and popliteal veins. The patient’s D-dimer level was 1.43 mg/L. His left ventricular ejection fraction was 55 %, with diastolic dysfunction visualized on a two-dimensional echocardiogram. His main pulmonary artery was normal, with a pressure gradient of 23 mmHg, and his right ventricular function was good.
+His antinuclear antibody and anticardiolipin antibody test results were negative. He had no nocturnal hematuria, and the findings in three consecutive early morning samples were negative for hemosiderin. The results of genetic testing for prothrombin gene mutation, factor V Leiden, and MTHFR gene mutation were negative. The results of the patient’s Ham test and the thrombophilia screen for antithrombin III as well as protein C and protein S deficiency were negative. His test result for dengue antibodies was negative. The results of his monospot test for Epstein-Barr virus, hepatitis B surface antigen, and hepatitis C antibodies were negative. His test result for HIV was also negative, and his VDRL was nonreactive. His upper gastrointestinal endoscopy was normal initially. His carcinoembryonic antigen level was 0.9 μg/L (normal <5 μg/L).
+After the diagnosis of DVT and pulmonary embolism was made, the patient was started on subcutaneous enoxaparin 1 mg/kg twice daily and warfarin to achieve a target INR of 2–3. Initially, he was kept nil orally; later, gradual enteral feeding was introduced. Calcium was replaced orally. Later, he developed bleeding into the peritoneal cavity with a high INR, and 6 U of blood were transfused. He was managed in the intensive care unit (ICU) during this period, and total parenteral nutrition was given. His bleeding settled spontaneously with INR correction. His ascitic fluid and large pseudocyst were drained using a pigtail catheter. The pigtail catheter was kept in place until the drainage stopped, and then it was removed. After 10 days in the ICU, the patient recovered and was discharged on oral warfarin to achieve a target INR of 2–3. He was planned to be treated with anticoagulation for 6 months because he did not have any other acquired or congenital risk factors for thromboembolism.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1399_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1399_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..989556f8b6b967de56249fef41994a22a8db980c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1399_en.txt
@@ -0,0 +1,3 @@
+A 62-year-old female with MFS was presented to the hospital for an emergency after being diagnosed with cerebral thromboembolism due to atrial fibrillation (AF). Apart from the acute endovascular thrombectomy, the patient was treated for congestive heart failure associated with aortic valve regurgitation with tachycardic AF. Echocardiography revealed severe regurgitation with reduced left ventricular ejection function (32%) and massive left ventricular diastolic dimension (88 mm). Aortic valve was tricuspid, and the eccentric regurgitation jet revealed prolapse of right coronary cusp. The aortic root was moderately dilated (42 mm). After 2 months of treatment, the patient was referred to our hospital for the surgical treatment of aortic valve regurgitation. The patient was free from the sequela of brain stroke, but complained of general fatigue consistent with a New York Heart Association class III condition with weakened leg muscle strength due to disuse syndrome. N-terminal pro-brain natriuretic peptide (NT-proBNP) level at admission was 3964 pg/mL. Sinus rhythm had been maintained after initiating oral amiodarone. The diameter of the aortic root in this patient was below the size required for indicating surgical treatment for MFS . In addition, the dimension and systolic function of the left ventricle suggested the progression of ventricular remodeling. Therefore, aortic valve replacement was selected primarily for the prevention of heart failure. In contrast, there were various options for the management of AF in the present case. Left atrial appendage closure was thought to be an appropriate treatment option to prevent recurrence of cerebral thromboembolism because AF had been effectively controlled by antiarrhythmics and the patient would receive coumadin following mechanical valve implantation. Thus, combined surgery involving aortic valve replacement and left atrial appendage (LAA) closure was planned in order to achieve early rehabilitation and return to daily life. Her chest XP revealed severe scoliosis . Spirometry showed normal lung function. A computed tomography was performed to determine the optimal intercostal space to access both the aortic valve and LAA . Three-dimensional reconstruction imaging showed that right lower hemisternotomy in a reverse “L” fashion was the optimal approach for clamping and incising the aorta with the ectopic origin of the right coronary artery arising from anteromedial surface of ascending aorta .
+The patient was intubated using a double-lumen tube and laterally positioned at approximately 30 degrees right-side up. A skin incision was made from the second intercostal space down to the xiphoid process, after which the chest was opened via right lower hemisternotomy. The surgical field was secured using a Kent retractor (Takasago medical Inc., Tokyo, Japan) and sternal retractor with the costal arch folded back. Cardiopulmonary bypass was established with femoral arterial and cavoatrial cannulation. The ascending aorta was cross-clamped using flexible aortic clamp . Cardiac arrest was obtained using bidirectional cardioplegia. An oblique aortotomy was created 10 mm medial to the ostium of the right coronary artery. The aortic valve cusp was then resected, and a 25-mm mechanical valve was implanted in the intra-annular position. After closing the aortotomy, the 40-mm AtriClip (Atricure Inc, Westchester, OH, USA) was applied to the stump of the LAA before releasing the aortic cross-clamp. The patient was carefully weaned from cardiopulmonary bypass, which required an intraaortic balloon pump for the treatment of perioperative low-output syndrome due to reduced left ventricular function. The extracorporeal circulation time and aortic cross-clamp time were 165 and 87 min, respectively. The total operative time was 303 min. Transfusion of 4 units of red blood cells and 6 units of fresh frozen plasma was required during the surgery.
+The patient was extubated on postoperative day 2, and the intraaortic balloon pump was removed 2 days after the extubation. Further, she was then transferred to the rehabilitation center for the management of her disuse syndrome on postoperative day 21; thereafter, she has been living independently without any cardiac and cerebrovascular event.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1420_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1420_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a0b5af54d07a2533136227414b155469ed09ed98
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1420_en.txt
@@ -0,0 +1,3 @@
+A 38-year-old female nursing technician presented a prior history of three episodes of anaphylaxis within one year, all in the workplace. She had a personal history of mild intermittent allergic rhinitis from childhood, for which antihistamines and nasal corticosteroid had been used only during exacerbated episodes. She had a family history of atopy and presented a positive prick test for aeroallergens (Dermatophagoides pteronyssinus and Blomia tropicalis). She tested negative for serum-specific immunoglobulin E (IgE) for latex.
+Because of her recurrent pattern of anaphylaxis and risk factor for latex allergy, a latex prick test using a standard commercial extract (500 mcg/ml; ALK Abelló, Spain) was performed. Five minutes after the puncturing, the patient developed a generalized rash, itchy skin, hoarseness, dyspnea, dry cough and a sensation of a foreign body in the oropharynx. Her vital signs were: blood pressure of 134 x 84 mmHg, heart rate of 130 bpm and peripheral oxygen saturation of 94%. The patient was placed in dorsal decubitus, with elevation of the lower limbs and 0.5 mg of adrenaline was applied intramuscularly in the upper third of the vastus lateralis muscle of the thigh, in addition to 200 mg of hydrocortisone and 50 mg of diphenhydramine intravenously, and inhalation of short-acting ß2-agonist. The patient presented progressive improvement of the condition without presentation of the late-phase reaction.
+The patient was evaluated in the context of another major study that was ongoing, and signed a free and informed consent statement for that study, which had been approved by the institution’s ethics committee, under the number 0538/10 on September 22, 2010.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_142_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_142_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c1a8611b414b35672f1d690e28ccd85e4742458c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_142_en.txt
@@ -0,0 +1,2 @@
+A 42-year-old woman had a medical history of melanoma excised in 2002. Following the surgery, she was placed on active surveillance. In 2021, she developed a left inguinal lymph node and liver nodules, which were confirmed to be metastatic melanoma positive for the BRAF V600E mutation through biopsy. Initially, she received a combination of immune checkpoint inhibitors (ICI), specifically anti-PD-1 and anti-CTLA-4, for nearly three months, with the only side effect being hypothyroidism. Due to disease progression under ICI treatment, she was switched to encorafenib/binimetinib (E/B). On the fourth day of E/B treatment, she developed serous retinopathy, which resolved after a brief temporary discontinuation of the targeted therapy. This allowed the resumption of the E/B regimen at a reduced dose. One week later, she experienced severe acute pain in her left shoulder, scoring 8 on the Visual Analog Scale, without any traumatic context. During the medical examination, she displayed no motor deficits, no movement limitations, and her deep tendon reflexes remained intact. Both X-ray and ultrasound examinations of the shoulder were normal, but a C5-C6 discopathy was noted on cervical spine X-ray. The patient received treatment with analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), which led to the resolution of pain within one month. However, this was followed by muscle weakness, prompting further investigations. An MRI of the cervical spine confirmed degeneration at the C5-C6 and C6-C7 levels, but without cervical radiculopathy. A lumbar puncture revealed no signs of inflammation, and serology testing for Lyme disease came back negative. Serum inflammatory markers remained within normal ranges, and the search for various autoantibodies, including antiganglioside antibodies, also yielded negative results. An electromyogram (EMG) was performed, revealing severe axonal denervation of the suprascapular nerve that did not respond to stimulation . The clinical presentation and EMG data led to the diagnosis of Parsonage-Turner syndrome. Given the temporal relationship with the oncological treatment and the absence of alternative triggers such as infection, vaccination, or mechanical events, the causality of the sequential use of ICI-targeted therapy was established. However, the E/B regimen was continued in the absence of an alternative treatment for her metastatic melanoma. The patient recovered and regained function in her arm through physical rehabilitation. No specific treatment was introduced, and corticoids were not administered because the diagnosis was made at a stage where the muscles were already atrophied, and the goal was to prevent the development of additional steroid-induced myopathy.
+Regular clinical evaluations and EMG assessments were conducted. At present, the patient is still undergoing treatment with E/B, with her oncological disease remaining stable. She is in good clinical condition, and there has been complete recovery of the suprascapular nerve.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1448_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1448_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f84a4edaf3eba6ff3302d36c9cc0a338d8f8266e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1448_en.txt
@@ -0,0 +1,2 @@
+A 76-year-old woman had an 8-year history of atrial fibrillation (AF) and severe TR. Her history included mild hypothyroidism and right upper lobectomy for lung carcinoma 11 years previously. For 2 years, she had complained of shortness of breath when lying in the left lateral decubitus position. She had felt dyspnea after mild exercise for 9 months. Recently, she had a sense of abdominal fullness. Although administration of diuretics was started, her symptoms did not completely improve, and she was referred to our department for surgical treatment. The follow-up chest X-ray showed a gradually protruding right-side shadow of the cardiac silhouette, and the cardiothoracic ratio on the chest X-ray reached 88% . The electrocardiogram showed AF with low fibrillatory wave amplitude. Echocardiography showed an enlarged right ventricular (RV) cavity and mild paradoxical motion of the ventricular septum. The tricuspid valve had no findings of an organic and constructive abnormality, with no severe tethering. The annular size of the tricuspid valve was 50 mm, and the tricuspid annular plane systolic excursion was 21 mm . Repeated preoperative cardiac catheterization showed slightly elevated wedge pressure with mild pulmonary hypertension, although LV function was preserved with a cardiac index of 4.0 . There was no L-R shunt disease. Computed tomography (CT) findings showed that the maximum size of the RA reached 121 mm . The change in dimension of the RA by CT showed that the size of the RA increased with time . Blood tests showed no liver dysfunction.
+Surgery was performed via median sternotomy. The pericardium was extremely thin on the RA side without any defect. There was no adherence in the pericardial cavity. Cardiopulmonary bypass was established by ascending aorta cannulation with bicaval drainage. The RA was extremely thin and the tricuspid valve annulus was enlarged, with a diameter of 55 mm, but there was no tricuspid structural abnormality. Tricuspid annuloplasty was performed on the beating heart using a 28-mm Carpentier-Edwards Physio tricuspid annuloplasty ring (Edwards Lifesciences, Irvine, CA, USA). Plication of the enlarged RA was performed, mainly at the interatrial septum, the free RA wall, including the appendage, and the space between the inferior vena cava and the tricuspid ring, in addition to the free RA wall, including the appendage . Additionally, closure of the left atrial appendage from the outside was performed to prevent left atrial thrombus formation. All procedures were performed on the beating heart. The postoperative course was uneventful. The pathological findings of the RA wall demonstrated thinning of the myocardium, inflammatory cell infiltrate, and few cardiomyocytes . Postoperative X-ray and CT showed reduced cardiac silhouette and RA volume . Postoperative echocardiography showed an ejection fraction of 58% and mild TR with a pressure gradient of 29 mmHg . The postoperative value of tricuspid annular plane systolic excursion (TAPSE) decreased after the operation. However, the patient’s symptoms were completely resolved, and she was discharged 3 weeks after surgery. The patient is doing well 2 years after surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1456_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1456_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a5cb1ad5f00aacc70770242e13f5482e603db15a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1456_en.txt
@@ -0,0 +1,7 @@
+A 81-year-old man with an adenocarcinoma of the prostate diagnosed one year earlier presented with a five month history of gradually progressive complaints of dyspnea. At the time of diagnosis of the prostate cancer, there had been no signs of metastases and since it was an asymptomatic grade 2 prostate cancer in a man of advanced age, a watchful waiting policy was followed. The medical history revealed hypertension and a transurethral resection of the prostate six years before presentation. The patient complained of dyspnea, progressive peripheral edema, orthopnea, and painful knees and thighs which made walking extremely difficult. There had been weight loss of ten kilograms over six months, with associated loss of appetite. No thoracic pain, hemoptysis or other pulmonary or cardiac complaints were present. The patient had been a heavy smoker for fifty years.
+On admission his blood pressure was 150/80 mmHg with an irregular pulse of 96 per minute, temperature 36.2°C, and he had a normal central venous pressure. The heart sounds were normal. Percussion and auscultation of the left lower lung revealed dullness with diminished breath sounds. These signs were indicative of pleural effusion. The liver was not enlarged. There was pitting edema especially at the lower extremities, but also of both hands, which were also noted to be remarkably large. Percussion of, and axial pressure on, the vertebrae was not painful. The patient refused rectal examination because of painful earlier experiences.
+Laboratory examination revealed the following data: ESR 35 mm in the first hour (normal: <7), CRP 134 mg/l (normal <10), hemoglobin 6.3 mmol/l (normal: 8.9–10.7) with a MCV of 82 fl (normal: 80–100), leukocytes 8.6 × 109/l (normal: 4.5–10.0) with 90% neutrophilic granulocytes (normal 40–70), normal blood platelets, electrolytes and liver enzymes. Creatinine was 77 μmol/l (normal: 64–108), alkaline phosphatase was elevated at 285 U/l (normal: 40–120), calcium was 1.95 mmol/l (normal: 2.15–2.68) with an albumin of 23.9 g/l (normal: 35–50 g/l) and a normal phosphate. Blood gas analysis showed a chronic compensated respiratory acidosis with an oxygen saturation of 80%.
+Electrocardiography showed atrial fibrillation with a left bundle branch block, similar to earlier ECGs. Chest X-ray revealed a large amount of pleural fluid on the left side and an enlarged heart without signs of vascular redistribution. There were no signs of tumor or pulmonary metastasis on chest X-ray.
+Analysis of the pleural fluid was performed. A total amount of 4.5 liters was evacuated. Cytological and biochemical analysis showed only lymphocytosis with no signs of malignancy or bacterial infection. Auramin and Löwenstein cultures were negative. An echocardiography showed good left ventricular function. Ultrasound investigation of the abdomen showed a dilated inferior caval vein without other abnormalities. The entire presentation was compatible with right-sided heart failure in a patient with probable pulmonary hypertension. On Computed Tomography Angiography (CTA) there were no pulmonary embolisms visible but a large amount of pleural fluid was seen in the left pleural cavity.
+Because of the elevated alkaline phosphatase, the bone pains and the previously diagnosed prostate cancer, skeletal scintigraphy was performed. It showed a 'super scan', meaning there was diffuse uptake throughout the entire skeleton. This was judged as fitting diffuse skeletal metastasis of the prostate cancer [Figure ]. However the prostate specific antigen was within the normal range at 1.4 μg/l (normal < 4.4)
+With the remarkably large hands in mind, additional investigations were carried out [Figure ]. A bone marrow examination showed no marrow disease nor malignancy. X-ray of the hands, humeri, femora and pelvis revealed extensive subperiosteal bone appositions compatible with generalized hypertrophic osteoarthropathy [Figure ]. Repeat of the earlier performed CTA indeed now showed a fluid-containing cavity in the lower left lobe surrounded by a large amount of pleural fluid at that side suggestive of a lung cancer. Bronchoscopy confirmed this diagnosis. The left main bronchus was stenotic with tumor totally occluding the left lower lobe and almost occluding the left upper lobe. Histological examination was not possible due to technical difficulties during the procedure. The diagnosis of incurable bronchial carcinoma with hypertrophic osteoarthropathy was made with the prostate cancer as an "innocent" bystander. Since the patient was rapidly deteriorating palliative care was given. The patient died several weeks after admission. Post mortum examination confirmed the clinical diagnosis. There was a large undifferentiated non-small cell lung carcinoma with a diameter of 10 cm and extension in the adventitia of the esophagus and lymphatic metastasis in the hili and mediastinum. Three liters of tumor-positive pleural fluid and extensive hypertrophic osteoarthropathy was seen without distant metastasis.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1461_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1461_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0d37f91d8e5d333010c15792f4c7a7cceda41c23
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1461_en.txt
@@ -0,0 +1,7 @@
+A 39-year-old woman demanded the resection of her primary renal carcinoma after receiving 6-mo target therapy.
+The patient was diagnosed with renal clear cell carcinoma with bone metastasis half a year ago. After receiving 6-mo target therapy, manifestations of bone lesions disappeared while the size of the renal mass increased. A partial nephrectomy was recommended for the treatment of her primary renal tumor.
+The patient had been on hormone for lupus nephritis treatment for 17 years.
+The patient had no markable personal and family history.
+On arrival at the urosurgery ward, the patient’s blood pressure (BP) was 128/76 mmHg, and her pulse rate was 77 beats per minute (bpm). No percussion pain was detected alongside her urinary system.
+Nothing abnormal was shown in the laboratory examinations.
+A mass with mixing density was found on her left kidney on the enhanced computed tomography (CT). Its size was about 5.6 × 4.4 × 4.8 cm.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1483_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1483_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8f9ac6225286bfdf0ced693b001e3eb6ac7a3ba5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1483_en.txt
@@ -0,0 +1,6 @@
+A 25-year-old Sri Lankan woman presented with several episodes of central abdominal pain, abdominal fullness, and non-projectile vomiting for 1-week duration. The vomitus was non-bilious, with undigested food particles and was noted particularly 1 to 2 hours after meals. Episodes of vomiting were accompanied with colicky central abdominal pain but these symptoms were only mild and between attacks she was completely asymptomatic. As she had had at least five similar episodes over the last 3 years, she sought medical advice. Most of those episodes were self-limiting, but she had a couple of hospital admissions during which she was managed conservatively. During one episode, she had noticed pruritus and darkening of urine as well, which again resolved spontaneously. She had undergone an upper GI endoscopy 1 year earlier which did not provide a positive finding. She had a past history of rectal polypectomy, at the age of 16 years, when she was investigated for painless per rectal bleeding, the histology of which was consistent with a tubular adenoma. Follow-up colonoscopies had not detected any further polyps.
+On examination, she had a body mass index of 20.3 kg/m2. She had a few scratch marks on her trunk and upper limbs confirming pruritus. She was not icteric or febrile. An abdominal examination was unremarkable and her gall bladder was not palpable. Succussion splash was not elicited. There was no mucocutaneous pigmentation.
+There was biochemical evidence of biliary obstruction with alkaline phosphatase (ALP) of 896 IU/L, a total bilirubin of 2.6 mg/dl and direct bilirubin of 2.2 mg/dL. An ultrasound scan of her abdomen detected intrahepatic and extrahepatic duct dilatation with a dilated common bile duct (CBD) of 11.5 mm without evidence of gallstones or CBD stones. She was found positive for fecal occult blood and was subjected to upper GI endoscopy and colonoscopy both of which were negative. Plain radiographies of her chest and abdomen were unremarkable. She was further investigated with a computed tomography (CT) enterogram and a magnetic resonance cholangiopancreatogram (MRCP). The CT enterogram revealed a large soft tissue mass causing duodenal intussusception into her proximal jejunum. Her CBD was found to be stretched to the left of the midline resulting in its dilatation of up to 12 mm at the lower end. MRCP also confirmed the absence of gall stones and other filling defects in her CBD . Based on these findings she underwent a small bowel enteroscopy which demonstrated a large duodenal polyp, originating from the second part of her duodenum and intussuscepting into the proximal jejunum beyond the duodenojejunal junction. The major duodenal papilla appeared stretched and elongated along the long axis of her duodenum. The rest of the enteroscopy study was normal. A biopsy was not taken because of the presence of intussusception.
+Even though it was possible to negotiate the scope beyond the polyp it was decided to go ahead with open surgery after two multidisciplinary team meetings because of the large size of the polyp, its critical location, and the presence of the intussusception. An intraoperative upper GI endoscopy was performed to localize the polyp because the polyp was not readily palpable through her duodenal wall. An oblique duodenotomy was done and a large polyp with a broad and long stalk was found. The origin of the stalk was at the second part of her duodenum, 1 cm below the ampulla. A polypectomy was done and the intussusception was reduced and the duodenum was closed transversely with 5/0 polydioxanone sutures . She had an uncomplicated recovery and was discharged on sixth postoperative day.
+On macroscopic examination the specimen was a polyp of 50 × 45 × 30 mm in size with a broad, 20 mm long stalk . On microscopic examination it was composed of a branching villous structure of small intestinal mucosa containing a core of smooth muscle. The overlapping mucosa was histologically normal. Thus, microscopically this was a hamartomatous polyp consistent with a Peutz–Jeghers polyp .
+Our patient became completely asymptomatic following surgery. She is followed up in general surgical clinic and is scheduled for routine upper GI endoscopy surveillance every 3 years.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1485_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1485_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..90002e5e489fc477bcf504afa22f9c9c971858b2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1485_en.txt
@@ -0,0 +1,6 @@
+A 62-year-old Chinese female was admitted to The First Hospital of Hebei Medical University with a two-day history of abdominal pain, especially in the subxiphoid region, as well as dyspnea, sweating, headache, and dizziness. She had received regular treatment for nine years for a coronary stent and had a nine-year hypertension history.
+The initial physical examination returned the following results: temperature = 36.2°C, heart rate = 90 beats per minute, respiratory rate = 18 breaths per minute, and blood pressure = 90/51mmHg. She was week and apathic. She had clammy skin, abdominal distension, and percussion sound on the abdomen. No obvious abnormalities were found in terms of auscultation and palpation of the lung and abdomen or in terms of the nervous system.
+The initial laboratory examinations revealed an increased neutrophil percentage (90%) and a decreased platelet count (PLT) . The serum biomarkers of glucose, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, total protein, albumin, and globulin returned values of 7.80 mmol/L (reference range: 3.90–6.10 mmol/L), 12.39 mmol/L (2.60–7.50 mmol/L), 194 μmol/L (41.0–73.0 μmol/L), 78.6 U/L (7.0–40.0 U/L), 111.3 U/L (13.0–35.0 U/L), 159 U/L (7–45 U/L), 354 U/L (50–135 U/L), 44.5 g/L (65.0–85.0 g/L), 29.1 g/L (40.0–55.0 g/L), and 15.4 g/L (20.0–40.0 g/L), respectively. The coagulation tests indicated a prolonged prothrombin time (21.6 s) (reference range: 9.4–12.5 s), an activated partial thromboplastin time (42.1 s) (25.1–36.5 s), and an extremely elevated D-dimer (43.49 mg/L) (0–0.55 mg/L), while the patient’s fibrinogen (3.50 g/L) (2.38–4.98 g/L) and thrombin time (14.9 s) (10.3–16.6 s) were normal. Among the heart biomarkers, the serum N-terminal pro-B type natriuretic peptide (NT-proBNP) level was markedly higher, while the patient returned a mildly high troponin I result and a normal creatine kinase–MB result. The arterial blood gas analysis indicated compensatory metabolic acidosis with a pH of 7.36 (reference range: 7.35–7.45), a partial pressure of carbon dioxide of 33.4 mmHg (35–45 mmHg), and a partial pressure of oxygen of 61.6 mmHg (80–100 mmHg). The routine urine tests indicated increased red blood cell (RBC) count (134 cells/μL) (reference range: 0–17), white blood cell (WBC) count (1264 cells/μL) (0–28 cells/μL), purulent cell count (32 cells/μL) (0–2 cells/μL), bacteria (325/μL) (0–340 cells/μL), fungi (0 cells/μL) (0–1 cells/μL), urine protein (2+) (negative), and occult blood (3+) (negative), with negative nitrite (negative). Hepatitis virus series, human immunodeficiency virus (HIV), and syphilis antibodies were negative. Pneumoclide IgM test showed that the antibodies of Legionella pneumophila type 1, mycoplasma pneumoniae, rickettsia Q, chlamydia pneumoniae, adenovirus, respiratory syncytial virus, influenza A virus, influenza B virus, and parainfluenza virus type 1, 2 and 3 were all negative. All other autoantibodies were negative.
+The computed tomography (CT) and CT angiography (CTA) examinations revealed a TAA rupture and no abnormality on both lungs, while the electrocardiogram (ECG) examination indicated a prolonged corrected QT interval. Finally, the cardiac ultrasound examination indicated left ventricular enlargement, thickening of the basal segment of the ventricular septum, and left ventricular diastolic dysfunction.
+Based on the general manifestations and the ECG, cardiac ultrasound, CT, CTA, and BNP results, the patient was diagnosed with a TAA complicated with heart failure, while a urinary tract infection was also considered. Other laboratory examinations, including serum procalcitonin (PCT), interleukin (IL)-6, and lymphocyte subset examinations, were also performed to identify the infection and immune function, along with a bacterial culture of blood and urine . Meanwhile, the cefazolin antibiotic was empirically administered as an anti-bacterial agent. An aortography operation, stent implantation involving the aortic branch, and an exploration of the right femoral artery and left brachial artery were performed immediately to target the TAA rupture and to determine the etiology of chest pain. The aortography procedure revealed a TAA 12 cm in diameter, while the bilateral renal arteries and bilateral iliac arteries were observed to be well developed. The surrounding tissue showed no inflammatory findings and no pus was discharged from the aortic aneurysm wall incision. During the operation, 10 units of cryoprecipitate and 200 mL of fresh frozen plasma were transfused. The operation was successful and resulted in a better recovery of blood flow . There were no clear differences in complete blood count, serum biomarkers, coagulation tests, and heart biomarkers, but the NT-proBNP level increased after the repair operation. During the whole procedure, the patient’s blood pressure continuously dropped, and they experienced acidosis aggravation and shock. The patient died 8 h after the operation. On the second day after death, both serum fungitec G test and serum glactomannan test were negative while both the blood and the urine cultures for bacteria and fungi showed positive for Pseudomonas aeruginosa.
+All procedures were performed in accordance with both the ethical standards of the institutional and/or national research committee(s) and the Helsinki Declaration (as revised in 2013). Written informed consent for publication was obtained from the patient’s legal husband.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1496_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1496_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b4d9933a52dc883afafd1631f942f1b0010551c5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1496_en.txt
@@ -0,0 +1,2 @@
+A 32-year-old woman was admitted to the ward with a two-month history of headaches, occasionally accompanied by nausea, vomiting, and vertigo. She had a chronic daily headache, starting in the morning and becoming worse in the upright position. The headaches manifested as a dull ache with moderate to severe intensity, which was constant during the day in the frontal and occipital regions bilaterally. Her headache got better when lying down. She also had a negative history of lumbar puncture, trauma, or manipulation. There was no fever, chills, dizziness, unsteady gait, blurred vision, diplopia, or photophobia. In her past medical history, previous headaches, Ehlers-Danlos, Marfan syndrome, polycystic kidney disease, and spontaneous retinal detachment were not detected; all these conditions are related to intra-cranial hypotension. In drug history, the use of oral contraceptive pills was positive, but she did not use any other drugs. On physical examination, her vital signs were normal, with blood pressure: 12080, pulse rate: 88/minutes, respiratory rate: 16/minutes, temperature: 37.2ºC orally. General physical examination indicated that the head, neck, abdomen, extremities, and skin were normal. In addition, in neurological examination, the patient was awake, obeyed requests, and was oriented to time, place, and person. Her speech was fluent, and all cranial nerves were intact. An ophthalmologic exam showed normal eye movement and reactive pupils, and normal fundoscopic exam was detected. In the motor system, there was no atrophy, and the muscle power was 5/5. The plantar reflex was bilaterally downward and deep tendon reflexes were all 2/2. Sensory and cerebellar tests were normal, and meningeal signs were absent. She had no family history of these diseases, nor any past history of any other diseases. She was a teacher and did not have any psychiatric disorders. The patient had normal complete blood count (CBC). Brain computed tomography (CT) and magnetic resonance venography (MRV) were normal. Brain MRI, with and without gadolinium, was performed; the MRI without gadolinium was completely normal, but in the MRI with gadolinium, meningeal enhancement was clearly seen ( and ).
+A lumbar puncture was conducted, revealing an opening pressure of 2 - 3 cm H2O with no leukocytes or erythrocytes, and with normal protein and glucose levels and regular lactate dehydrogenase (LDH) . The lumbar puncture clearly worsened her positional headache. Her CT myelography from the cerebrum end to the spine revealed a normal condition, without any leakage of CSF or abnormality. Therefore, we tried to increase the intracranial pressure (ICP) of the patient with hydration, using dextrose water serum and a high caffeine diet, including drinking tea, and reducing daily activity. After two days, a significant improvement was seen in her headache.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1498_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1498_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..202f98350ada49f771bceab4df82982f5a308a51
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1498_en.txt
@@ -0,0 +1,7 @@
+A 29-year-old man visited our urology clinic for a premarital medical examination, with complaints of occasional scrotal pain.
+For the previous month, the patient had experienced occasional minor pain in the testicles.
+The patient had no notable previous medical history.
+He denied any family history and had no specific past history.
+His height was 167 cm, and his weight was 57.9 kg. After physical examination, we found that he had no dysmorphisms and had a normal distribution of pubic hair and body hair. His external urethral meatus was in a normal position, and his penis had a normal appearance and size (5.7 cm, non-erectile).
+The results of the patient's serum test revealed that the luteinizing hormone (LH) concentration was elevated at 15.73 IU/L (normal range: 1.7-8.6 IU/L), and the follicle-stimulating hormone (FSH) concentration was elevated at 14.13 IU/L (normal range: 1.5-12.4 IU/L). However, the serum testosterone hormone concentration was 3.22 μg/L, which was in the normal range for adult males of 2.49-8.36 μg/L. Azoospermia was determined after repeated seminal analysis. Chromosomal analysis was performed twice on samples collected at different times, and 100 metaphases were analyzed in each analysis. Two different cell lines with the karyotype 45,X[93%] /46,X,+mar(Y)[7%] were observed by GTG banding. Fluorescence in situ hybridization analysis with screening of metaphase and interphase lymphocytes was carried out to confirm the result of the karyotype analysis. Two cell lines, one with one green signal for Xcen (182/200) and the other with one green signal and one red signal for Xcen and Ycen (18/200), respectively, were observed according to fluorescence in situ hybridization . All the metaphase and interphase lymphocytes showed one signal for Xcen but no SRY signal, except for cell lines containing SRY . Polymerase chain reaction amplification of 16 Y-STS gene loci (SRY, ZFY, sY86, sY84, CDY2, SMCY, sY127, sY134, sY1161, sY1191, sY254, sY255, DAZ, sY157, CDY1, ZFX, SMCX, DAZL) using a Y-chromosome microdeletion detection kit (Microread Gene; Beijing, China) demonstrated the presence of Y chromosome-derived sequences. The SRY and ZFY genes were not amplified in the AZF region . The negative amplification of SRY further confirmed the partial absence of the Y-chromosome sequence.
+Ultrasound scanning of the scrotum showed that both testicles were located in the scrotum, but the volumes (6.6 mL and 6.8 mL, respectively) were significantly smaller than the normal adult male testicle size (range: 15-23 mL). In addition, a normal-sized prostate and seminal vesicles were observed by internal genitalia ultrasound analysis.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1515_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1515_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3598f0f190baac56815ea5fbee10222ad1762b28
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1515_en.txt
@@ -0,0 +1,3 @@
+A 13-year-old boy was referred to Taleghani Children's Hospital with a complaint of swelling and pain in his Right lower quadrant and right testicle, erythema, and warmth on the scrotum without any Past medical history, drug history, and surgical history who had fallen to the ground three days ago. Ultrasound results revealed that the right testicular appendix is prominent, but it also has a hypoechoic structure that resembles the testicular parenchyma. This structure is above the right testicle and the medial part of the right epididymis, is wholly attached to the testicle, and has 17 × 12 mm dimensions. Furthermore, in color Doppler, the coloration is sharply increased .
+The above findings suggest extreme Epididymo-orchitis on the right and maybe a type A3 polyorchidism with adjacent extra testis or a bilobed testis.
+After treatment of the Epididymo-orchitis, Magnetic resonance imaging (MRI) was performed one month later. In axial and coronal T2 FISP images, a Hemi-testicular structure of similar signal intensity to that of the adjacent normal testis is noted on the right side, albeit with significantly decreased size due to the resolution of the inflammatory phase .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1516_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1516_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..214eb0d3e5a297360a356108fc4b84cefaa96756
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1516_en.txt
@@ -0,0 +1 @@
+A 43-year-old man with a tumor in his left leg was referred to our institute. The diagnosis was myxoid liposarcoma based upon biopsy findings. Radiation and chemotherapy were administered. Consequent wide resection with the surrounding normal tissue was performed. Two years after the initial surgery, when the patient was 45 years of age, metastasis appeared in the right neck region and the retroperitoneum, and resection of these lesions was performed. Seven years after the initial surgery, when the patient was 50 years of age, lung metastasis was found and resection was performed. Eight years after the initial surgery, when the patient was 51 years of age, recurrence was found in the thigh and involved the major vessels. Amputation at the thigh was carried out. Histological diagnosis of myxoid liposarcoma was confirmed in each of the resected materials. Chemotherapy was performed after every resection of metastatic and recurrent lesions. Ten years after the initial operation, at 53 years of age, the patient experienced back pain. Plain radiographs showed a compression type fracture in the second lumbar vertebra. MRI of all the vertebrae showed abnormally high signal intensity on T2-imaging with fat suppression in eight vertebrae: the fifth cervical vertebra (C5), the seventh, tenth, eleventh and twelfth thoracic vertebrae (T7, T10, T11 and T12), the second and fourth lumbar vertebrae (L2 and L4), and the second sacral vertebra (S2). High signal intensity on the MRI was seen throughout the entire vertebral body in L2 accompanied by deformity, suggestive of a pathological fracture. Extraskeletal extension of the lesion was seen in the T12, L2 and S2 vertebrae (Figure ). Bone scans showed negative findings except for the L2 fracture. FDG-PET was negative for all of the vertebrae, including the fractured L2 vertebra (Figure ). These examinations of bone scans and FDG-PET were performed within one month after the MRI examination. With a diagnosis of vertebral metastasis arising from myxoid liposarcoma, radiation and chemotherapy were administered. The patient was informed that data from his case would be submitted for publication, and his consent was obtained.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1558_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1558_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e0e071c7666d6546919dbbb46c8c48b0fcfd4a6e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1558_en.txt
@@ -0,0 +1,4 @@
+A 66-year-old man, affected by type II DM for 4 years and arterial hypertension for 10 years, developed severe non-proliferative diabetic retinopathy without macular edema just 2 years after DM diagnosis. The patient was treated with panretinal photocoagulation (PRP), because he had a poor glycometabolic control and was unable to adhere to a close follow-up. One year after PRP, he developed severe visual loss due to diffuse non tractional bilateral DME. Thus, the two eyes were treated with an IV triamcinolone injection 1 month apart (the right eye [RE] before the left eye [LE]) and laser grid photocoagulation was performed in both eyes 2 weeks after IV injection. After no visual recovery for over 2 months due to the persistence of macular edema in both eyes, an IV injection of bevacizumab was given in the RE, where a larger amount of intraretinal fluid and subfoveal neural detachment were observed. However, 1 week after the injection, anterior ischemic optic neuropathy (AION) with a residual visual acuity of hand motion was observed. During the entire period, the patient had poor glycometabolic control (glycated hemoglobin >9%, high hypertension, and hypercholesterolemia) and poor adherence to therapy. This fact could have influenced the patient’s poor response to therapy and the development of AION.
+As a result of this unfortunate adverse event, the patient refused an IV injection of bevacizumab in his LE. After informing the patient about the risks and benefits of different treatment options such as observation, off-label IV injections of steroids, and subtenon injections of IFNα, the patient signed an informed consent for a cycle of subtenon injections of IFNα.
+Before the treatment, the BCVA in the LE was 20/200. The patient received posterior subtenon injections of IFNα (1×106 IU/ml) three times (on Monday, Wednesday, and Friday) for a week in his LE, according to the following procedure: after the administration of topical 0.4% oxybuprocaine surface anesthesia, 1 ml of IFNα was slowly injected into the inferotemporal quadrant under the Tenon’s capsule, using a 27-gauge needle on a 2.5-ml syringe. The needle was moved toward the macular area, until the hub was firmly pressed against the conjunctival fornix. After the first injection, topical 0.3% netilmicin eye drops were prescribed three times a day for 7 days. During the period of IFN-α therapy, the patient had a good systemic condition and a good glycometabolic control (glycated hemoglobin = 6.9%).
+A complete ophthalmic examination including BCVA, indirect ophthalmoscopy, and SD-OCT of the macular region was conducted several times throughout the period of IV injection and laser grid therapy and, specifically, preoperatively, as well as at 1 week, 1 month, 4 months, and 1 year after the last injection of INFα. SD-OCT images were obtained using Spectralis OCT spectral-domain (Heidelberg Engineering GmbH, Heidelberg, Germany) and the baseline macular scan was set as the reference (Figure ). Fifteen months after the treatment, the BCVA in the LE was 20/40, with reduced cystoid macular edema but the SD-OCT highlighted the persistence of the photoreceptor inner segment/outer segment (IS/OS) disruption already highlighted at the baseline (Figure ). The patient gives his written consent for the use of his data and any accompanying images.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1566_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1566_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..640a688c70dbcf396adc325462adb11046363158
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1566_en.txt
@@ -0,0 +1,7 @@
+A 31-year-old woman presented at our Department due to infertility. Her medical history was unremarkable except unsuccessful attempts for pregnancy for the past 2.5 years. She had regular menstrual cycles since the age of 13 years. On clinical examination, she was normotensive and normokalemic without clinical signs of Cushing’s syndrome or hyperandrogenism. Her height, BMI and glucose homeostasis and bone mineral density proved to be normal (height: 170 cm, BMI: 19.8 kg/m2, fasting serum glucose: 5.0 mmol/l and HbA1c: 5.2%), and galactorrhoea was absent. Family history was also unremarkable. Initial laboratory findings indicated an increased serum prolactin level (93 ng/ml; reference range: 1.4–24 ng/ml), but this was due to macroprolactinemia (prolactin recovery after polyethylene glycol: PEG precipitation was 76%). Magnetic resonance imaging did not reveal any pituitary abnormality. A paternal cause of infertility was unlikely because her husband already had two children from his previous marriage. Detailed hormone laboratory investigations of the index patient suggested a partial resistance against glucocorticoids . After genetic counseling and written informed consent, Sanger sequencing of the coding region of the GR gene was performed. After identification of a pathogenic GR mutation, a family screening was indicated for the first degree relatives. Her 35-year-old, clinically healthy sister, who has no fertility problems (mother of a 10-year-old girl) was also genetically tested.
+All patients and family members underwent genetic counseling and informed consent for genetic testing was obtained from all individuals. Evaluation and treatment of human data have been performed in accordance with the Declaration of Helsinki and the study was approved by the Local Ethical Committee of Semmelweis University.
+Laboratory measurements were performed at the Central Laboratory of Semmelweis University. Fasting blood samples were obtained between 08:00 and 09:00 h. Plasma, salivary and urinary cortisol and plasma ACTH, serum estradiol, progesterone, sex hormone binding globulin (SHBG), testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), free thyroxin (fT4), prolactin and growth hormone (GH) concentrations were measured with an electrochemiluminescence immunoassay (Cobas E411, ROCHE, Indianapolis; Architect System, Lisnamuck, Longford, Ireland; IDS-iSYS, Immunodiagnostic Systems Ltd., Boldon, England), while serum dehydroepiandrosterone sulphate (DHEAS) and androstendione concentrations were determined with radioimmunoassay (Beckman Coulter Brea, California, USA).
+DNA was isolated from peripheral blood by a standard procedure using commercially available DNA isolation reagents (DNA Isolation kit from blood, Qiagen, San Diego, USA). The whole coding region of the GR was evaluated by Sanger sequencing as previously described by Koper et al. .
+Table summarises the main hormone laboratory findings of the index patient. During repeated measurements, serum cortisol levels in the morning were always elevated (between 26 and 35.4 μg/dl; reference range: 8–25 μg/dl) while plasma ACTH concentration was slightly above the upper limit or within the normal range (between 28.5 and 65 pg/ml; reference range: 7.2–63.3). Morning salivary cortisol levels (determined two times) were also elevated (1.36 and 1,13 μg/dl; reference range: < 0.690) but salivary cortisol collected at midnight was within the reference range (0.21 and 0.23 μg/dl; reference range < 0.430 μg/dl). A low dose (1 mg) overnight dexamethasone suppression test was performed twice, and showed an inadequate suppression of morning serum cortisol (10 and 15 μg/dl; reference range: l < 1.8 μg/dl). Repeated 24 h urinary free cortisol (UFC) concentrations were between 280 and 513 nmol/day (reference range: 100–379). Serum DHEAS was slightly elevated or normal (342 and 163 μg/dl, reference range: 130–330), and serum androstendione was increased (344 ng/dl; reference range 80-280 ng/dl). GH, SHBG, TSH, fT4, LH, FSH, testosterone, progesterone and estradiol levels were all normal (not shown in Table ).
+As shown in Fig. , a heterozygous missense mutation (c.2141G➔A) resulting in a Arg714Gln change was identified in exon 8 of the GR gene. The same mutation was found in the clinically healthy 35-year-old sister of the patient, who had normal steroid hormone levels. Other family members denied the clinical, genetic or hormonal screening. In addition, this variant was not detected in more than 60 patients and controls tested either for glucocorticoid resistance or Cushing’s syndrome in our Laboratory. Moreover it was not present in commonly used genetic databases including Exome Variant Server , Exac and SNPeffect .
+Molecular modeling and analyses were performed using the UCSF Chimera package . The coordinates of the GR ligand binding domain have been obtained from PDB structure 4UDC. Arginine at the position 714 is the member of helix 10 of the ligand binding domain (LBD) of the GR. It locates opposite side of the ligand binding pocket and relatively far from any known functional region. However, arginine has a large, positively charged side chain, which protrudes into a space created by helices 7–10 , but glutamine has a smaller, uncharged side chain, which may release helix 10 from its original position, which may lead to further conformational changes in the ligand-binding pocket. Nader et al. performed a complex functional testing of this mutation and using the quantification of the thickness of both the wild type and mutant Cα showed that the mutant LBD had an increased distance in root mean square deviation over the duration of the simulation compared to the wild type receptor, suggesting that the mutant structure binds the peptide with less affinity .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1584_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1584_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d6c8371b6fff1ae9c0b06908b9b5b338a5c8bc77
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1584_en.txt
@@ -0,0 +1,5 @@
+The patient was a 13-year-old Japanese boy, the first of three siblings from non-consanguineous parents. He had no history of statin exposure and no family history of neuromuscular disease. He was a basketball player and presented with progressive difficulties in shooting, running, and subsequently walking during the previous one month.
+Vital signs were normal (heart rate, 82 beats/min; respiratory rate, 15 breaths/min; blood pressure, 113/57 mmHg; body temperature, 36.5°C). Physical examination revealed grade 3/5 muscle weakness in the upper extremities and 4/5 in the lower extremities based on the Medical Research Council (MRC) scale (0–5) . The patient also presented with generalized erythematous skin rash . Other general physical examination findings were unremarkable.
+Serum levels of CK (19,306 U/L), aldolase (257 U/L), aspartate aminotransferase (274 U/L), and lactate dehydrogenase (1,471 U/L) were all elevated. Magnetic resonance imaging detected signal hyperintensity on T2-weighted imaging and short tau inversion recovery imaging for muscles in the proximal upper and lower extremities . Muscle biopsy showed necrosis and regeneration of muscle fibers . Immunohistochemistry demonstrated overexpression of major histocompatibility complex class 1 and membrane attack complex (C5b−9) on the sarcolemma and granular sarcoplasmic expression of p62 . As measured by quantitative enzyme-linked immunosorbent assay (Cosmic Corporation, Tokyo, Japan), anti-HMGCR antibody level was 2.9 IU/ml (reference value <1.0 IU/ml), while negative results were obtained for anti-signal recognition particle antibody and other myositis-associated antibodies, including anti-Jo-1, anti-Mi-2, anti-MDA-5, and anti-TIF-1 gamma antibodies. The patient was subsequently diagnosed with anti-HMGCR myopathy.
+Based on the consensus statement on the initial treatment for anti-HMGCR myopathy from the 224th European Neuromuscular Centre International Workshop , intravenous methylprednisolone (1 g/day for 3 days) followed by oral prednisolone (1 mg/kg/day), monthly IVIg (2 g/kg/dose, three times), and oral methotrexate (0.3 mg/kg/week) was started 3 months after the first evaluation. MRC scale scores for the upper and lower extremities normalized (grade 5/5) and serum CK (201 U/L), aldolase (8 U/L), aspartate aminotransferase (16 U/L), and lactate dehydrogenase (280 U/L) levels were all decreased by 3 months after treatment initiation. The patient resumed playing basketball at the same level as that before the onset of anti-HMGCR myopathy. The patient has continued to receive methotrexate monotherapy and as of the time of writing, has remained relapse-free for 2 years.
+We searched PubMed using the terms “myositis[mh]” and “necrosis[mh]” or “anti-HMGCR[tiab]” up to July 31, 2022. This electronic search identified 710 records. Inclusion criteria were as follows: (1) studies including patients with anti-HMGCR myopathy <18 years old; and (2) anti-HMGCR myopathy diagnosed by both anti-HMGCR antibody and compatible myopathological features such as prominent necrosis and regeneration of muscle fibers with mild or absent inflammatory infiltrates. Duplicated publications, conference abstracts, and other studies that did not report the detailed clinical features of patients were excluded. We excluded 697 articles based on these eligibility criteria. A total of 13 articles were included in the final review, containing 33 pediatric cases with anti-HMGCR myopathy as confirmed by positive results for anti-HMGCR antibody and consistent myopathological findings with detailed information . Clinical response to treatment was evaluated based on the definition of complete remission as normalized motor function and serum CK level and partial remission as improved but not normalized motor function and serum CK level. For the 34 pediatric patients, including our own case, median age at onset was 9 years [interquartile rage (IQR), 5–11 years] and a maximum serum CK level >5,000 IU/L was observed in 32 patients (94%). Skin rash was noted in 15 patients (44%). Among the 15 patients with skin rash, 12 (80%) presented with erythematous rash, 1 with hyperpigmentation, 1 with linear morphea scleroderma, and 1 with rash of unknown detail. Skin rash was localized in 10 patients (67%; on the extremities in 6 [40%] on the face or neck in 4 [27%]), generalized in 2 (13%), and unknown in the other 3. A significant positive correlation was confirmed between age at onset and maximum serum CK level (Pearson correlation coefficient = 0.45, P = 0.0074). In one patient diagnosed in infancy, maximum serum CK level was only 918 IU/L . Patients were stratified by age at onset before and after school age (7–17 years vs. <7 years) and clinical characteristics were compared between groups . The cumulative incidence of skin rash and median maximum serum CK level was significantly higher in pediatric patients ≥7 years old at onset than in those <7 years old.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1592_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1592_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7a1a9960a8b9e9870352d409f6693ef8f704f541
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1592_en.txt
@@ -0,0 +1,6 @@
+A 53-year-old homeless man was admitted to the hospital due to a right femoral neck fracture. His medical history included noninsulin-dependent diabetes mellitus. A physical examination performed at admission was unremarkable. There was no fever, lymphadenopathy, or other neurological defects. Laboratory tests revealed the following results: white blood cells, 4330 cells/mL; hemoglobin, 9.2 g/dL; and platelet count, 29,900 platelets/mL. C-reactive protein was negative, and only normochromic-normocytic anemia was present. He successfully underwent surgery for the femoral neck fracture, which was performed by an orthopedic surgeon. However, he had an episode of generalized seizures during the postoperative course, and phenytoin was administered. After this episode of generalized seizures, he was referred to our department for further examination and treatment.
+A computed tomography (CT) examination of the head that was conducted without contrast showed a high-density and extraaxial mass in the right parietal convexity, and peritumoral brain edema was clearly observed . Enhanced magnetic resonance imaging (MRI) revealed an extraaxial, dural-based, and homogeneously enhanced mass with clear borders that was compatible with a meningioma en plaque . The mass was iso- to hypointense on fluid-attenuated inversion recovery and T2 imaging sequences and iso- to hyperintense on T1 imaging. It was strongly suspected that the patient had a meningioma en plaque.The mass was exposed with a right frontotemporal craniotomy. The tumor appeared to be a meningioma en plaque, and it was extraaxial, xanthochromic, firm, nonaspiratable, and it seemed to have a high vascularity and was dural based. The tumor was tightly adhered to the adjacent cerebral cortex and was permeated by many pial arteries and veins of the brain surface. It is very difficult to preserve these pial vessels during the total removal of a tumor.
+A frozen section of the lesion showed inflammatory cell infiltration, which mainly consisted of lymphocytes and plasma cells, and the presence of these cells was initially interpreted as some kind of hematologic disorder or inflammatory pseudotumor . Paraffin-embedded sections, however, showed a hypercellular pattern with features of polymorphous and mixed inflammatory infiltrates that were composed mainly of histiocytes in a background of collagen fibers . The cytoplasm in some histiocytes was foamy and eosinophilic. Some histiocytes were seen to engulf viable lymphocytes, which was thought to reflect emperipolesis (lymphophagocytosis) .
+These histiocytes were immunopositive for S-100 protein and CD68, but negative for CD1α . All of these findings were consistent with extranodal RDD.
+The patient had incomplete left hemiparesis after surgery. A brain CT examination conducted without contrast revealed postoperative hemorrhage and a low-density lesion in the right frontal lobe, which seemed to be due to the sacrificed pial arteries from the brain-tumor interface. His seizures completely ceased.
+In order to find evidence of extra-CNS RDD, we performed a whole-body CT examination postoperatively, and findings of lymphadenopathy or other extranodal involvements were not found. The patient has been free of seizures since the surgery, and he recovered from his hemiparesis 6 months after the surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1600_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1600_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f72c5317dcd188849232fcb13b15f0727c8e8edd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1600_en.txt
@@ -0,0 +1,2 @@
+A 55-year-old male applied to our clinic with a sudden pain in his right shoulder, 2 years after a reverse total shoulder arthroplasty (RTSA) in another hospital due to rotator cuff arthropathy. He was a gardener and returned to his work after 2 months of the operation. His range of motion (ROM) was improved and had no pain in his daily activities after several months. However, almost 2 years from the initial surgery, he suddenly felt extreme pain in his shoulder when he tried to operate a vacuum cleaner. He applied to our clinic after trying painkillers for 3 weeks. A sharp pain in the shoulder, restrained ROM, and a loosening-like feeling were his major complaints at his admission with a normal neurovascular examination and without any comorbidities. Plain radiographs of his shoulder were taken and a RTSA with a broken humeral stem was determined . Further evaluation was done with a computed tomography of the right shoulder to evaluate any occult fracture around the shoulder girdle and bony fracture was excluded from the study.
+A one-stage operation was planned for revision. We used the previous incision line for the deltopectoral approach. After reaching the glenohumeral joint, the prosthesis was found to be dislocated and broken at the humeral tray of proximal stem. The model itself was a modular stem and due to the suspicion of infection, samples were taken from the surrounding synovium and joint fluid. Metallosis and debris tissue were debrided. The humeral stem and the glenoid hemisphere were removed with its cement and a cemented long humeral stem (SMR, Lima LTO, Udine, Italy) was placed . The glenohumeral joint was then reduced and the layers were anatomically closed. No post-operative complications were spotted. The synovial culture which had been taken for the suspicion of an infection was reported sterile. A frozen section analysis revealed active chronic synovitis, fibrosis, and giant cell reaction of foreign bodies. Shoulder physiotherapy with ROM and strengthening exercises were applied to the patient for 3-month postoperatively. No complication has occurred during his 3-year follow-up after surgery and the patient has nearly full ROM with only 20° of loss in abduction and has neither pain nor complaints. The patient was satisfied with result of the treatment and gained full function of his right shoulder.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1622_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1622_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3202b1291e9750f6eddbbce320c82c811c82ce79
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1622_en.txt
@@ -0,0 +1,4 @@
+A 71-year-old Japanese man with a BMI of 22.8 kg/m2 underwent RARP for prostate cancer. His initial PSA level, Gleason score, and dancer staging were 9.4 ng/mL, 4 + 4, and cT2bN0M0, respectively. The patient had a history of cerebral infarction and bipolar disorder. RARP was performed using the DaVinci Xi® system (Intuitive Surgical, Sunnyvale, CA, USA) with port placement as shown in Figure . Prostate resection was performed using transperitoneal antegrade and intraperitoneal posterior approaches. The trocars were removed under laparoscopic guidance. No abnormal appearance of the port site or sucking of the intestine was observed . The fascia of the external oblique abdominal muscle at this site was closed with a single knotted suture using 2-0 Vicryl® (Ethicon, Somerville, NJ, USA). The procedure was completed without any intraoperative complications; the total surgery and console duration were 151 and 118 min, respectively.
+Immediately after the surgery, subcutaneous emphysema was observed on X-ray , which improved on POD 1 . The patient had no significant complications on POD 1. On the morning of POD 2, the pelvic drain was removed; however, he exhibited coffee ground vomiting in the afternoon, twice in quick succession. His abdomen was soft but tympanic; no metallic sound was audible. Abdominal X-ray revealed a dilated large intestine but no fluid level . CT revealed an intestinal prolapse into a space between the internal and external oblique abdominal muscles at the 12-mm AIRSEAL® trocar site . Laboratory data from the investigations are summarized in Table . Diagnosis indicated a strangulated ileus due to TSH, and an emergency surgery was performed.
+The emergency surgery was initiated using a laparoscope. A 12-mm camera port and two 5-mm assistant ports were inserted. Observation of the abdominal cavity confirmed a prolapse of the small intestine at the 12-mm AIRSEAL® trocar site . The prolapsed intestine was carefully pulled out using Croce-Olmi forceps and it was found to be gangrenous . After restoring the prolapsed intestine into a normal position, the trocar site was closed using 0 PDS® suture (Ethicon) under laparoscopic guidance ; a 4-cm incision was made, and the gangrenous intestine, which extended up to 25 cm, was explored and resected . Finally, functional end-to-end anastomosis was performed using a surgical stapler, and the procedure was completed. No drain was placed.
+Three days after TSH repair (5 days after RARP), the patient started oral intake. The urethral catheter was removed 10 days after RARP (8 days after TSH repair), and he was discharged 15 days after TSH repair (17 days after RARP). Pathological examination of the prostate revealed adenocarcinoma, with pT2a, Gleason score 3 + 4, EPE0, RM0, v0, ly0, pn1, sv0. Six months after RARP, his PSA level was below the measurable limit, and he had no abdominal symptoms.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1625_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1625_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a62516d08b7afb275d128e7107cdc9ef6a1386a1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1625_en.txt
@@ -0,0 +1,2 @@
+A 27-year-old Caucasian man presented with frank hemoptysis preceded by a two-month history of shortness of breath and non-productive cough. Prior to this subacute illness, he was healthy, had no travel history, and was a long-distance endurance athlete. An intravenously-contrasted computerized tomogram of the chest revealed bilateral pulmonary emboli and a filling defect within his right ventricle. Duplex lower extremity ultrasonography was negative for deep vein thrombosis. Transesophageal echocardiography revealed a mass at his right ventricular apex spanning proximally as pedunculated extensions through the tricuspid valve. Gadolinium-enhanced cardiac magnetic resonance imaging (MRI) confirmed a complex mass obliterating his right ventricular apex, insinuated between the chordae tendineae of the tricuspid valve and terminating in lobular stalks (Additional file ). Surgical excision was recommended as the mass was felt to represent high risk for recurrent embolic events. The gross appearance of the mass was smooth, yellow and lobulated . Two distinct heads projected through the tricuspid valve and extensively insinuated between the chordae tendineae, requiring right ventricular endocardectomy with excision and replacement of the tricuspid valve. On histopathological examination, normal myocardium was covered by thickened fibrous endocardium with dense collagen, rare non-specific inflammatory cells with no eosinophils and a layer of arterioles, small veins and capillaries at the interphase with the myocardium . These findings are pathognomonic of endomyocardial fibrosis.
+Anticoagulation therapy was initiated post-operatively. Extensive work-up for coagulopathy was negative. Peripheral blood and bone marrow biopsy were normal; in particular, the percentage of eosinophils was normal at 2%. Cytogenetic study of the bone marrow showed no evidence of a malignant process. Other causes of endomyocardial fibrosis, including parasitic infections, carcinoid tumor and systemic diseases, such as Churg Strauss syndrome, periarteritis nodosa and Behçet syndrome, were excluded.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1659_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1659_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0e3ef443130b10dd6effd62976ab82772b6feaa5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1659_en.txt
@@ -0,0 +1,7 @@
+A 30 year old primagravid woman at 17 weeks gestation was found on routine prenatal ultrasound to have a complex right ovarian mass. She underwent surgery and was found to have a ruptured appendiceal mucinous neoplasm with a large volume pseudomyxoma peritonei syndrome. The right ovary and appendix were removed and an omental biopsy was performed. The final pathology confirmed a well-differentiated mucinous adenocarcinoma of appendiceal origin. She recovered without incident from this surgery and was referred for assessment to the Washington Hospital Center at 26 weeks gestation. In consultation with the patient and her obstetrician it was decided to preserve the pregnancy and schedule an early vaginal delivery at 35 weeks gestation.
+Following an uncomplicated vaginal delivery of a healthy baby, she underwent a staging CT. It showed no evidence of metastases within the liver parenchyma or outside of the peritoneal cavity. A large volume of mucinous cancer was imaged beneath right and left hemidiaphragm and in the pelvis. Small bowel except for the terminal ileum was spared. Preoperative tumor markers revealed an elevated CEA at 68.2 ng/mL (normal 0–5 ng/mL), CA-125 of 177 units/mL (normal 0–35 units/mL) and CA 19-9 of 361 units/mL (normal 0–37 units/mL).
+At 2 1/2 weeks after delivery, the patient underwent an abdominal exploration followed by cytoreductive surgery. She had thick, densely packed tumor covering most of the parietal peritoneal surface, with an especially large volume of disease in the lesser omentum, omental bursa and surrounding the porta hepatis. The stomach and the small bowel except for the terminal ileum were spared. An extensive cytoreduction surgery was performed including total anterior parietal peritonectomy and resection of tumor in the abdominal wall scar, greater and lesser omentectomy with stripping of the omental bursa, right and left upper quadrant peritonectomies including total diaphragm stripping bilaterally, splenectomy, electroevaporation of tumor on liver capsule, cholecystectomy, and a right hemicolectomy including the distal 15 cm of terminal ileum. A total pelvic peritonectomy with abdominal hysterectomy, left salpingo-oophorectomy and rectosigmoid colon resection was performed. The peritoneal cancer index score was 28 (out of a maximum of 39), and the cytoreduction was scored as complete (residual tumor less than 2.5 mm) . Intraoperative intraperitoneal heated chemotherapy was administered through the open coliseum technique, with 15 mg/m2 mitomycin C at 41.5°C for 90 minutes. A Tenckhoff catheter and Jackson-Pratt drains were inserted for early postoperative intraperitoneal 5-fluorouracil chemotherapy . Following completion of the hyperthermic intraoperative intraperitoneal chemotherapy an ileocolic and colorectal anastomosis was performed. The total operating time was 9 hours, and the blood loss was estimated at 350 mL, with 2 units of packed red blood cells and 4 units of fresh frozen plasma administered during the operation.
+On postoperative day 1 through 5, 900 mg intraperitoneal 5-fluorouracil in 1.5% dextrose peritoneal dialysis solution was administered daily for 23 hours. The patient developed uncomplicated neutropenia on postoperative day 16, with neutrophil count of 0.9 × 103/uL and a total leukocyte count of 1.3 × 103/uL, which was treated successfully with granulocyte colony stimulating factor. On postoperative day 18 she was diagnosed with a left lower extremity deep venous thrombosis and was treated with intravenous heparin which was converted to warfarin prior to discharge from the hospital. She had a postoperative ileus requiring nasogastric drainage for 2 weeks and received total parenteral nutrition during this time. She was discharged in good condition on postoperative day 24.
+Three weeks following surgery her tumor marker levels decreased with CEA at 0.5 ng/mL, CA 125 at 92.1 units/mL, and CA 19-9 at 10.6 units/mL. CA 125 normalized by 2 months post-operatively.
+After recovery from surgery, she was treated with the Xelox regimen (Xeloda 1000 mg/m2 bid for 14 days then 7 day rest and oxaliplatin 130 mg/m2 intravenous over 90 minutes on day 1) for 8 cycles over 24 weeks.
+In follow-up at five years after, the patient and her child are in good condition. She has had two episodes of transient small bowel obstruction treated conservatively. On her most recent clinical, radiologic and biochemical assessment at 5 years after her initial diagnosis she remains disease-free.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1661_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1661_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a3726e60d70e5cb5c8bfaf52aa3c1f6aece4effc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1661_en.txt
@@ -0,0 +1,15 @@
+A four-year-old female presented to the emergency department (ED) with an epinephrine
+auto-injector unintentionally injected and lodged in her lower jaw that entered
+through the gingiva. Radiographs of the skull and computed tomography (CT) revealed
+a hooked epinephrine auto-injector embedded between the lower central incisors
+beneath the gingival line, bent at an approximately 140° angle ( and ).
+An initial attempt was made by the parents to remove the object at home followed by
+an attempt at ED bedside, which proved to be difficult due to needle angulation. We
+consulted oral-maxillofacial surgery; the patient was sedated with intravenous
+ketamine, and under sedation the hook was pulled in a retrograde manner following
+the noted posterior-lateral trajectory of the bent needle tip on maxillofacial
+imaging . With some force,
+the needle was removed with care that it not accidentally discharge epinephrine into
+the patient. There was a very minor avulsion of gingival mucosa, which we learned
+did not interfere with patient’s oral intake or speech after following up
+with parent.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1693_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1693_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..67b50e6539dc155007ec9bf704d6183a5afe2d78
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1693_en.txt
@@ -0,0 +1 @@
+Our patient, a 71-year-old man, was admitted to our emergency department. He initially presented to his general practitioner with dizziness and palpitations, and was urgently transferred to hospital when his Holter electrocardiogram (ECG) demonstrated hundreds of episodes of nsVT. The patient's past medical history demonstrated a high cardiovascular risk profile, and included diabetes mellitus and hypertension. He had also previously been diagnosed with blue toe syndrome and peripheral arterial occlusive disease, for which he had previously been administered prostavasin therapy. No cardiac disease was known so far. A clinical examination, including a cardiovascular examination, was performed and was unremarkable. No relevant laboratory abnormalities were present. Continuous ECG monitoring and a 12 channel Holter ECG were performed, to detect the origin of the arrhythmia (, ). Multiple monomorphic, nsVTs were documented. The origin of the triggering ventricular extrasystole (VES) was septal. Based on the hospital’s own localization algorithm (adapted from), the left ventricular outflow tract (LVOT) aortic cusp region was the most likely origin of the nsVT. In a first step an echocardiography was performed. During this exam, an episode of an nsVT was recorded, including the triggering VES. All other values during sinus rhythm (SR) were normal (except a borderline left ventricular global longitudinal peak systolic strain and an aortic sclerosis) (see , ). During coronary angiography, one-vessel disease was revealed with a 70% obstruction of the left anterior descending artery and a 90% obstruction of the first diagonal branch. Both lesions were treated using in total three drug-eluting stents. After this procedure, no residual obstruction was left. Antiarrhythmic medication was optimized by intensifying the existing bisoprolol therapy and adding magnesium. During the three-channel 24 h Holter ECG after intervention only one further nsVT was documented. After a short monitoring period, the patient was supplied with a LifeVest® and was discharged. In the follow-up, the nsVTs reappeared after 6 weeks and the patient had to be sent to a specialized centre. In total, three electrophysiological studies were performed. Two endocardial approaches failed to terminate the arrhythmia. Finally, the arrhythmogenic LVOT area was treated by an epicardial ablation and an antiarrhythmic medication with sotalol instead of bisoprolol.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1697_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1697_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5af312398a7361d8b5e2b8e34d8e8c286f3b9954
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1697_en.txt
@@ -0,0 +1,6 @@
+A 52-year-old male patient came to our clinic for a consultation regarding rashes on his fingers, arms and legs. It was learned from the patient’s story that he had been screened for the novel coronavirus (2019-nCoV) because his wife had tested positive two days previously. A reverse transcription polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was found to be positive. The samples were obtained using a nasopharyngeal swab.
+He had complaints of mild weakness and myalgia and he had been using tablets of diltiazem (120 mg/day), doxazosin (4 mg/day), atorvastatin (10 mg/day) and acetylsalicylic acid (100 mg/day) for five years due to essential hypertension and coronary artery disease. The patient did not complain of coughing or dyspnea, and no lung involvement was detected on computed tomography (CT). In laboratory tests, acute-phase reactants were found to be within the normal range: procalcitonin 0.005 ng/ml, sedimentation 12 mm/h and C-reactive protein (CRP) 8 mg/l. The patient was accepted as a COVID-19 case and treatments with hydroxychloroquine (600 mg BID for one day and then 400 mg BID for the following five days) and azithromycin (500 mg daily for five days) were started. Two days after the onset of constitutional symptoms, vesicular skin lesions started to develop on the finger’s side as can be seen in .
+Informed consent was obtained from the patient for publication of clinical pictures, and permission to report on this case was granted by the local ethics committee.
+The patient’s first dermatological signs consisted of vesicles on the sides of his fingers and millimetric erythematous papulovesicular eruptions, which were concentrated on the extensor aspect of the lower legs and flexor aspect of the arms . Initially, the patient was evaluated as having irritant contact dermatitis, and administration of mometasone furoate ointment and cetirizine tablet (20 mg/day) was started. After three days, it was noticed that the patient’s existing lesions began to acquire a petechial-purpuric appearance and cherry angioma-like lesions appeared on his upper arms, extending from the inner side to the armpit, and on the upper lateral aspects of the trunk .
+In laboratory tests, antinuclear antibody levels, antithrombin-3 levels, complete blood count, liver function tests and coagulation parameters were found to be within the normal range and conditions that cause vasculitis were ruled out. No histopathological examination of the skin lesions was performed because the patient did not agree to undergo a biopsy.
+The patient developed severe weakness and severe muscle pain in his legs, which could be interpreted as restless leg syndrome. The skin manifestations gradually regressed leaving a reticular purpuric appearance. Some of the cherry angioma-like lesions disappeared after a brown crust had formed, while others persisted.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1703_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1703_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f5a1147ea8063121e6f73b068b4255b55e19dcff
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1703_en.txt
@@ -0,0 +1,4 @@
+A 63-year-old man presented with a one-day history of shaking chills and high fever. He got wet in the rain 5 days before he came to the hospital, and had a occupational history of septic tank servicer. He had no underlying medical conditions, and denied travel to any areas of endemic. Physical examination revealed blood pressure (80/50 mmHg), a pulse rate of 105 beats per minute and oxygen saturation of 98% on oxygen mask air, and tachypnea with wet rales in both lungs, no conjunctival suffusion and no ictericsclera. Abdominal examination revealed a mild right abdomen tenderness and suspicious positive percussion pain in the kidney area. The rest of the examination, including nervous system, was also unremarkable. Laboratory results showed normal white blood cell (WBC) count 9.14 × 109/L with platelets 7 × 109/L, neutrophils 93.1%, and hemoglobin 85 g/L. Biochemical analysis revealed the increased levels of C-reactive protein (CRP) 209.19 mg/L, procalcitonin (PCT) 68.42ng/mL, interleukin-6 (IL-6) > 5000pg/mL, lactate 5.85mmol/L, creatinine (Cr) 301umol/L, total bilirubin 27.1µmol/L, aspartate transaminase 213.1U/L, alanine transaminase 66U/L, alkaline phosphatase 54U/L, gamma-glutamyl transferase 55U/L, and N-terminal pro b-type natriuretic peptide (NT-proBNP) 3650.97pg/ml (< 125). Arterial blood gas (ABG) analysis showed evidence of type one respiratory failure with mixed respiratory and metabolic acidosis. Urinary analysis revealed the presence of numerous WBC and red blood cells (RBC). The transthoracic echocardiography revealed an ejection fraction of 60%, normal diastolic function and chamber sizes, and color Doppler ultrasonography showed mild mitral, tricuspid and aortic regurgitation. CT examination of chest and abdomen showed inflammation of the double lower lungs, and enlarged adrenal glands . The patient was diagnosed with pneumonia, and acute pyelonephritis with septic shock, and intravenous meropenem, fluid resuscitation and vasopressor were prescribed. We implemented the sepsis protocol following the complete hour-1 bundle .
+On the second day of admission, the patient developed gradually worsening dyspnea with severe hemoptysis and life-threatening hypoxia. Endotracheal intubation was done and patient was put on a ventilator. Immediately, large clots of blood were extracted from the endotracheal tube (ETT). Bedside chest X-ray demonstrated newly developed bilateral diffuse alveolar shadows suggesting diffuse pulmonary hemorrhages . We gave the patient a symptomatic treatment with posterior pituitary hormone, hemocoagulase, as well as blood component therapy.
+We performed further investigations regarding the etiology of the patient’s condition. Peripheral blood Metagenomic Next-generation Sequencing (mNGS) testing [RDP-seq®, Guangzhou Sagene Biotechnology Co., Ltd.], blood and endotracheal aspirate cultures were performed. The results of all cultures were negative after 2 days of incubation. The methods for mNGS were as follows. DNA was extracted from peripheral blood samples using the microbial DNA extraction kit (MAGEN, Guangzhou, China) according to the manufacturer’s protocol. The library was constructed according to the protocol for library construction Kit [Nextera XT®, Illumina™, USA]. High-throughput sequencing was performed on the Illumina™ Nextseq 550 DX®, sequencing platform (sequencing strategy: SE75), which is an FDA-approved and CE-IVD-certified sequencer. The mNGS sequence results have been uploaded to the NCBI data (accession number: SRR24583305). The mNGS data identified Leptospira interrogans with sequence number 23 and confidence of 99%. The sequence results of identifying Leptospira interrogans were shown in Supplementary material 1. According to the clinical and microbiological findings, the antimicrobial therapy was switched to piperacillin-tazobactam (TZP) plus doxycycline.
+Intravenous TZP 4.5 g every 8 h and doxycycline 0.1 g orally every 12 h were administered, and continued for 7 days along with supportive care. Ventilator support was offered for 5 days. Finally, the patient was weaned from the ventilator for successful extubation, and improved dramatically. Normal levels of renal function, cardio-respiratory functions, and hematological parameters were also improved by the end of ten days.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1705_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1705_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b1ce3fff7896d567541023ef86deab576bf6e202
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1705_en.txt
@@ -0,0 +1,6 @@
+A 70-year-old female with a history of primary angle closure glaucoma (PACG) status post laser peripheral iridotomy (PI) of both eyes (OU) presented for further management. She complained of discomfort and redness of the right eye (OD). Past medical history was significant for hypertension, gastroesophageal reflux disease and a cerebrovascular accident 15 years prior. Medications included atenolol, alprazolam, omeprazole, aspirin and topical prednisolone four times a day OD. The duration of topical prednisolone treatment was approximately 1 week prior to her presentation to our institution. The treatment was deemed necessary by the referring physician for her complaint of discomfort and redness. No other topical medications were given. Intraocular pressure (IOP) was 22 OD and 16 of the left eye (OS). Exam showed mild injection OD, shallow anterior chambers, patent PIs and cataracts OU. Gonioscopy demonstrated narrow angles with extensive peripheral anterior synechiae OU. Dilated fundus exam showed increased vessel tortuosity OU.
+Given the significant narrow angles despite patent PIs OU, cataract extraction with intraocular lens implantation OU was performed. She was treated postoperatively with topical moxifloxacin, nepafenac and prednisolone for a month. She did not receive dorzolamide or other sulfa derivatives. Postoperatively, the anterior chambers deepened and the angles opened significantly. IOP was noted to be 19 OD and 18 OS. No hypotony was detected throughout the entire course.
+Two months after cataract surgery, she developed 4 mm of proptosis, resistance to retropulsion, tortuous corkscrew blood vessels and an orbital bruit OD. Gonioscopy revealed the recurrence of narrow angles OD.
+A CCF was suspected and both computed tomography (CT) of the orbits with and without contrast and computed tomography angiography (CTA) of the head were performed. The CT orbits showed possible asymmetry of the superior ophthalmic veins (SOV). The CTA head showed atherosclerotic disease within the distal cavernous segments of the internal carotid arteries. As neither imaging modality was completely diagnostic and high suspicion for a CCF remained (based on the clinical examination findings), a six vessel cerebral angiogram was performed. The diagnostic cerebral angiogram showed a small indirect Barrow type D right carotid cavernous fistula with retrograde drainage into the right SOV . Early filling of the right SOV was seen on right internal carotid artery injection; however, there were no feeders large enough to be actually visualized. On injection of the right external carotid artery, there was filling of the cavernous sinus via small branches of the right accessory meningeal artery. Our patient did not have a suitable endovascular corridor to the CCF via the petrosal sinuses, therefore transfemoral venous embolization did not appear possible. The plan was for transarterial embolization and if satisfactory occlusion could not be achieved from embolization of the right accessory meningeal artery feeder, then an alternative approach through the right SOV was to be considered. When diagnostic cerebral angiography was repeated prior to the planed embolization procedure, it was noted that she had undergone spontaneous partial closure of her CCF and the procedure was aborted.
+One month later, our patient developed worsening vision and was noted to have a choroidal detachment OD . She declined further angiographic testing and was thus started on self-administered manual carotid jugular compressions. One month later, she was noted to have progressive worsening of her choroidal detachments and angle closure .
+She eventually opted for repeat surgical intervention but when diagnostic cerebral angiography was performed prior to the embolization procedure, significant thrombosis of the CCF was noted. There was virtually no filling of the SOV on angiography and no intervention was warranted. Examination two months later showed complete resolution of her choroidal detachments and open angles OU.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1723_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1723_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f09e9e6f60e431743662f92228459f7a5a20e24e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1723_en.txt
@@ -0,0 +1,8 @@
+A 70-year-old male patient visited our clinic because of poor cognitive function and gait disturbance.
+He was diagnosed with encephalitis following scrub typhus 23 years ago. The patient complained of poor memory. The patient was initially admitted to a local hospital with a high fever and headache 23 years ago. He developed neurological symptoms as mental change, visual disturbance, and weakness, according to medical history. The first MRI was conducted 7-d after onset. He was then transferred to a tertiary hospital to treat his symptoms, and the diagnosis of scrub typhus encephalitis was confirmed.
+No special previous medical history was reported.
+No special personal and family histories were found.
+Physical examination revealed narrow visual fields; however, he could read books and newspapers. His motor power on both extremities was intact without any pain. But fine movements of the left hand were poor, and he could only manage to walk indoors because of sensory impairment.
+Motor and sensory findings tested using objective tools were as follows: handgrip strength (right/left, kg), 32.3/31.3; two-point discrimination test (right/left, mm), 5/absence; and monofilament test (right/left, mm), 3.22/absence. The patient had impaired cognition, with a mini-mental status examination score of 14 and a Montreal cognitive assessment score of 10[-]. For a more detailed evaluation of cognition, we performed a computerized neuropsychological test .
+DTI data were acquired with a 3.0 T scanner Intera (Philips, Ltd., Best, The Netherlands) with a six-channel head coil and single-shot echo-planar imaging. For each of the 32 non-collinear diffusion-sensitizing gradients, we acquired 80 contiguous slices parallel to the anterior commissure-posterior commissure line. The imaging parameters were as follows: acquisition matrix = 112 × 112, field of view = 224 mm × 224 mm, TR/TE = 8973/80 ms, parallel imaging reduction factor (SENSE factor) = 2, EPI factor = 49, b = 1000 s/mm2, NEX = 2, and slice thickness = 2.0 mm (acquired voxel size = 2 mm × 2 mm × 2 mm). Analysis of the DTI data was performed using the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library (FSL: ) based on the probabilistic tractography method. Head motion artifacts and image distortion due to eddy current were corrected by affine multiscale two-dimensional registration. To reconstruct the Papez circuit, the following locations were considered as the regions of interest (ROIs): The thalamocortical tract-cingulate gyrus (seed ROI), the anterior limb of the internal capsule (target ROI 1) and the anterior thalamic nuclei (target ROI 2) on axial images; the fornix - mammillary body (seed ROI) on axial images and the crus of the fornix (target ROI) on coronal images; the mammillothalamic tract-anterior thalamic nucleus (seed ROI) and the portion of the isolated mammillothalamic tract (target ROI 1), and the mammillary body (target ROI 2) on axial images; the cingulum - the middle portion of the cingulum (seed ROI) and the posterior portion of the cingulum (target ROI) on coronal images. Additionally, we reconstructed the corticospinal tract (CST) as described in a previous study as we believed it would help to confirm whether specific neural tracts can reflect their related functions.
+The 7-d MRI onset showed small lesions in the left frontal and parietal lobes, and large lesions in the right superior parietal lobule and both occipital lobes. Compared with the 7-d MRI, the 23-year MRI findings indicated expanded lesions of encephalomalacia with marked dilation of both ventricles . Probabilistic DTT of the Papez circuit revealed that the left thalamocortical tract and right mammillothalamic tract could not be reconstructed; however, the anterior part of the fornix was found to be injured. Both CSTs were well preserved .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1732_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1732_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..41350dc6e4af587fbd7cc9eeaea551ce97202192
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1732_en.txt
@@ -0,0 +1,7 @@
+A 52-year-old male with a history of hepatitis C, genotype 1b, was nearing completion of a one-year course of treatment with pegylated interferon 2a (180 ug subcutaneously each week) and ribavirin (1200 mg orally each day). His initial hepatitis C viral RNA had declined from 2.2 × 106 IU/ml at onset of treatment, to <65 IU/ml by six months, and remained undetectable thereafter. Toward the end of his course of treatment, he developed fatigue, malaise, drenching night sweats, intermittent fever and chills. On the last visit for hepatitis C treatment, axillary and cervical lymphadenopathy was noticed. His symptoms were initially attributed to adverse effects of interferon α, prompting premature discontinuation of treatment after 10.5 months. One month after onset of symptoms, he presented to a nearby hospital for further workup.
+He was transferred to the Buffalo VA Western New York Healthcare System with complaints of malaise and left sided mid back pain. He had a documented weight loss of 40 lbs over the previous year. He appeared chronically ill and fatigued. He had a temperature of 101°F and a heart rate of 105 beats per minute. Generalized lymphadenopathy was noted, including cervical, axillary, inguinal and right epitrochlear lymph nodes. The nodes were 1–2 cm wide, firm, movable and nontender. He had left sided abdominal fullness and mild tenderness, but no guarding or rebound. The remainder of his examination was noncontributory.
+CBC revealed hemoglobin of 11.7 g/dl (13.5–17), white blood cell count of 7.6 K/cmm (4.4–10.7), platelet count of 511 K/cmm (140–375) and ESR of 80 mm/hr. Serum chemistries included a sodium of 130 mEq/L (135–145), creatinine of 0.9 mg/dl (0.7–1.4). SGOT was 68 units/l (12–34), SGPT: 95 units/l (25–65). A serum ELISA for human immunodeficiency virus was negative. Rheumatoid and anti-nuclear antibody titers were also negative.
+Computerized tomography (CT) scan of chest and abdomen revealed mild lymphadenopathy and multiple contrast enhancing hypodense lesions in the spleen .
+Initial clinical suspicion included lymphoma and he underwent a lymph node biopsy. Further history revealed exposure to numerous cats. He frequented a neighbor who had 6–9 cats, including kittens, with which the patient had played, and from whom he received numerous scratches. Serologic studies were sent for antibodies to Bartonella, Chlamydia, Toxoplasma and Brucella. He was given ibuprofen for symptomatic relief.
+A biopsy of an epitrochlear lymph node displayed necrotizing granulomata with peripheral palisading epithelioid cells, with an admixture of plasma cells and lymphocytes. Areas of stellate necrosis with microabscesses were evident, consistent with cat scratch disease . Stains for acid-fast bacilli and fungi showed no organisms. Lymph node biopsy material was cultured for routine pathogens, acid-fast bacilli and fungal organisms. Although the Gram stain displayed abundant white blood cells, all cultures were sterile.
+Over the next 3–4 days, the patient defervesced and improved symptomatically on ibuprofen alone. By the eighth day, serum antibody titers (IgG and IgM) for Bartonella henselae were reported as >1:16,384. He continued to improve without further treatment. Six months later he was doing well and had regained 25 lbs of weight. An abdominal CT scan revealed complete resolution of splenic lesions.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1787_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1787_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5c52cf324c3271ff570ba39273ff3b8be90f1e8c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1787_en.txt
@@ -0,0 +1,9 @@
+A 26-year-old female with no past medical history was referred to acute care by her primary care provider with fever and haematuria. She described 2 months of fevers up to 40°C, malaise and night sweats. Her primary care provider diagnosed a urinary tract infection due to a positive urine dipstick for blood and she received two courses of antibiotics that failed to improve symptoms. At presentation, she reported a dental scaling procedure 1 month after the onset of fevers. Blood cultures were obtained, and she was discharged to the community. Within 48 h, these grew S. gordonii, and she was recalled by the clinical infection unit.
+On examination, her respiratory rate was 16 breaths/min, SpO2 99%, blood pressure 116/74 mmHg, pulse 85 b.p.m., and temperature of 36.7°C. She had an early diastolic murmur loudest in expiration at the left lower sternal edge. There were no peripheral stigmata of infective endocarditis or signs of dental infection and no features of cardiac failure.
+An electrocardiogram showed sinus rhythm, normal PR interval, and T wave inversion in leads V2–V4. A chest radiograph showed clear lung fields. Blood tests showed normocytic anaemia with Hb 112 g/L, mean corpuscular volume of 88 fL, normal white cell count of 9.6 × 109g/L, and an elevated C-reactive protein of 81 mg/L. Urine culture showed no growth. Two subsequent sets of blood cultures grew S. gordonii, sensitive to penicillin with a minimum inhibitory concentration of 0.012 µg/mL .
+A transthoracic echocardiogram showed a BAV, moderate aortic regurgitation, and possible aortic root abscess. The left ventricle was mildly dilated (left ventricular internal diameter in diastole 5.3 cm) with concentric remodelling, and the ejection fraction was 57%. A transoesophageal echocardiogram revealed aortic valve vegetations and an anechoic lesion at the aortic root not in communication with the atria. This was interpreted as an aortic root abscess . There was severe aortic regurgitation with a valvular jet directed towards the anterior mitral valve leaflet in early diastole, followed by a mid-late diastolic septally directed jet originating through the abscess cavity (see , ). This confirmed a diagnosis of native aortic valve infective endocarditis secondary to S. gordonii.
+Two days later, the patient reported headaches and visual disturbance without focal neurology. A magnetic resonance imaging brain revealed dural enhancement overlying the left occipital lobe with associated signal change reported as a small empyema .
+On 14 February 2022, she was commenced on 2 g amoxicillin IV 6 hourly. Subsequent blood cultures were negative by 17 February.
+The cardiothoracic surgeons offered her mechanical or bioprosthetic valve replacement. She opted for mechanical valve replacement to reduce the likelihood of requiring redo surgery. Surgery was performed 5 days after admission. Intra-operatively, vegetations were present on the BAV, and a sub-valvular cavity was closed with a pericardial patch. This native aortic valve showed no growth after prolonged incubation. She received a 19 mm On-X mechanical aortic valve and post-operatively commenced warfarin therapy.
+After 2 weeks of inpatient antibiotics, she was discharged under the outpatient parenteral antibiotic therapy service on once-daily ceftriaxone for 4 weeks.
+She was followed up by clinical infection and cardiothoracic surgery services. A further MRI brain on 28 April 2022 showed resolution of the cerebral empyema, and she remains well with no further neurological symptoms.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1798_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1798_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..85a1ae8c273220e2b753ada4144fec2ac68bbdb6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1798_en.txt
@@ -0,0 +1,3 @@
+A 48-year-old white female patient was admitted for workup of chronic pericardial effusion, which was first detected during an episode of pneumonia 3 months earlier, but remained constant despite complete remission of pneumonia after antibiotic treatment. At the time of admission, the patient was in a stable haemodynamic condition, but suffered from progressive dyspnoea on exertion (New York Heart Association Class III).
+Lung auscultation on admission revealed diminished breath sounds and dull percussion sounds of the basal right lung. The rest of the physical examination, especially cardiac auscultation was inconspicuous with a regular rate and rhythm, normal heart sounds, and no murmurs. Initial vital parameters and laboratory testing were also normal. Bedside echocardiography demonstrated a large pericardial effusion up to 35 mm with ‘swinging heart’ phenomenon . Left and right ventricular systolic function as well as valvular function was normal. End-diastolic collapse of the right atrium and increased respiratory variation of mitral and tricuspid valve flow velocities have been noticed as indicators of a beginning haemodynamic relevance of the pericardial effusion, but diastolic right ventricle relaxation and vital parameters were not compromised. Because of the chronic setting of the large symptomatic pericardial effusion, pericardiocentesis was performed demonstrating a serous pericardial effusion with low cell count and no evidence of purulence or malignity. Besides the known pericardial effusion, computed tomography (CT) revealed an unclear mass in the pericardial space . The mass was attached to the anterior wall of the left ventricle, measuring 20 × 22 × 8 mm, and demonstrated pronounced peripheral uptake of contrast media. For additional non-invasive tissue characterization cardiac magnetic resonance imaging (CMR) was performed using a 1.5-T Magnetom Aera (Siemens Medical System). Cine MR images confirmed residual, partially organized pericardial effusion without haemodynamic relevance, as well as the previously described mass , demonstrating isointense signal on T1- and hyperintense signal on T2-weighted images . Most common entities of tumours in this location are pericardial cysts and lipomas, which both could be ruled out by T1- and T2-weighted MR images, fat saturation, and perfusion studies . After administration of gadolinium contrast, CMR first-pass perfusion depicted peripheral perfusion of the mass, suggesting a hypervascular tumour . Late gadolinium enhancement showed intense inhomogeneous signal after 5 min indicating slow blood flow . In regards to the marked arterial perfusion of the mass as well as its proximity to the left anterior descending artery (LAD) and its diagonal branches, coronary angiography was performed. Contrast injection led to a ‘tumour blush’, emphasizing the vascular characteristic of the tumour, and revealed feeding arteries from the LAD .
+With the diagnosis of chronic pericardial effusion, as well as an unclear hypervascular and hyperperfused tumour with peripheral contrast uptake on CT and CMR located within the pericardial space in close proximity to the LAD, a decision for open surgical exploration via anterolateral thoracotomy was made by our Heart Team. Intra-operative frozen section was indicative for a benign vascular tumour, most likely a haemangioma. Consequently, the tumour was removed completely and specimens were further evaluated. Histological workup revealed numerous, capillary-type small vessels within a fibro-oedematous background. Staining for CD31 and ETS-related gene (ERG) expression were positive, highlighting endothelial cells. Proliferation rate of less than 5% was assessed using Ki67-staining. Thus, the differential diagnosis of a malignant neoplasm including metastasis, which is much more common than primary pericardial tumours, could be excluded and the final diagnosis of a capillary-type haemangioma of the pericardium was made. After surgery, the patient rapidly improved and at follow-up 6 months after the initial presentation neither the tumour nor the pericardial effusion recurred.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1801_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1801_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fc2f78c5520e9af1eb62f6c50863564514cc08cc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1801_en.txt
@@ -0,0 +1,5 @@
+A 17-year-old Vietnamese female presented to the emergency department with chest pain, several weeks of fatigue, decreased appetite, a dry cough, and unintentional weight loss over 2 months. Her vital signs were normal and the physical exam was without virilization or cushingoid features. Physical exam was notable for clubbing and right flank tenderness. Initial laboratories obtained showed a normocytic anemia and normal electrolytes. CT-angiography of the chest revealed a 9.2 × 8 × 7.4 cm large heterogeneous hypervascular mass in the right lower lung, a similar-appearing 7.1 × 5.4 × 6.9 cm heterogeneous mass in the left adrenal gland, and a 3.4 cm hypodense mass in the right adrenal gland (shown in , ). CT abdomen and pelvis also showed a 1 cm lesion abutting the dorsal pancreas and a right adnexal enhancing mass.
+Further laboratory testing showed normal tumor markers: CA 19-9, AFP, beta-Hcg, CA 125, and CEA. Dopamine, epinephrine and norepinephrine levels were normal. Urine metanephrine to creatinine ratio, free metanephrines, and normetanephrines were normal. HVA and VMA were done for neuroblastoma screening and were in normal ranges. Testing for Echinococcus, tuberculosis, and Coccidioides was negative. Endocrine workup was normal with 17-hydroxyprogesterone at 81 ng/dL, aldosterone 2.0 ng/dL, renin 1.5 ng/mL/h, DHEAS 37 μg/dL, testosterone 14 ng/dL, progesterone less than 10 ng/dL, ACTH 29 pg/mL, and AM cortisol 18.2 μg/dL (shown in ). She underwent interventional radiology-guided biopsy of the left adrenal mass and was discharged.
+She was readmitted for chemotherapy after preliminary pathology from the adrenal mass returned ALK positive. Ancillary staining of the mass showed it was positive for ALK-1, WT1, and D240 , and it was sent to Mayo laboratory for consultation. MRI brain showed abnormal clival signal consistent with metastatic disease but no evidence of metastasis. MRI spine did show evidence of spinal metastasis. PET scan showed diffuse bony lesions. Due to evidence of metastasis and acute onset of hypoglossal nerve deficit, she received a 2-day course of palliative radiation therapy (8 Gy) to clival region and C4–C7. She was started on crizotinib, an ALK/ROS1 inhibitor, in December 2021. During her hospital stay, she endorsed persistent cough, headaches and also developed blurry vision after starting crizotinib, possibly a side effect of the medication. During this hospitalization, the final pathology from Mayo laboratory was received and was confirmed as a malignant ALK-positive neoplasm harboring DCTN1-ALK fusion transcript, likely representing ALK-positive histiocytosis. Immunohistochemistry performed showed CD163-positive cells, as well as scattered WT-1 positivity. Next-generation sequencing demonstrated the DCTN1-ALK fusion transcript . Follow-up CT abdomen and pelvis obtained 1 week after starting crizotinib showed a decrease in the size of lung and adrenal masses (shown in , ), with lung mass now 7.9 × 7.5 cm (previously 8.2 × 8), left adrenal mass now 7.6 × 5.6 (previously 8.2 × 6.2), and right adrenal mass 1.1 × 1.0 cm (previously 3 × 2 cm). She was discharged on crizotinib 400 mg BID.
+ALK-positive histiocytosis was originally reported in infants but more recently has been reported in older children and young adults, particularly of Asian origin. Most of these cases have been reported to have a KIF5B-ALK fusion mutation; however, there are a few reports of DCTN1-ALK fusion that was seen in our patient. DCTN1-ALK fusion mutations have also been rarely reported in non-small cell lung cancer, inflammatory myofibroblastic tumor, spindle cell variant of epithelioid cell histiocytoma, and juvenile myelomonocytic leukemia. Tumors with ALK fusions have been shown to respond to ALK-inhibitor therapy.
+She was seen a week later in oncology clinic, and the final pathology report showed the rare diagnosis of metastatic DCTN1-ALK fusion-positive histiocytosis. After 3 weeks on crizotinib, her hypoglossal nerve deficit resolved and headaches and cough had significantly improved. Follow-up PET scan 2 months later showed resolution of lesion in left occipital condyle and decreased avidity of the other bony lesions. The right lung mass and left adrenal mass had further decreased in size, and the right adrenal lesion was no longer seen. She continued on the same dose of crizotinib with good response. She had significant improvement in extracranial lesions on crizotinib, but May 2022 scans showed a small CNS lesion despite improved intracranial disease, suggesting sanctuary site disease on crizotinib. She was switched to lorlatinib, which has documented superior CNS penetration. Follow-up MRI brain 2 months later showed resolution of the left frontal lobe lesion. The most recent scan done in August 2022 demonstrated continued improvement while on lorlatinib, with right lower lobe mass and left adrenal mass continuing to decrease in size.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1848_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1848_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..be30972846e7b8e9b23fb0702bd723cc54114a17
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1848_en.txt
@@ -0,0 +1,8 @@
+A 20-year-old woman was admitted to our hospital (Imam Reza Hospital, Mashhad, Iran) with neck pain, fever, cough, and dyspnea. She had been diagnosed with dematomyositis 21 months prior. Her symptoms began in March 2014 with polyarthralgia and skin rash. Examination at that time showed presence of heliotrope rash, malar rash, and Gottron’s papules. Muscle forces were intact. Laboratory tests showed a hemoglobin level of 11.9 g/dL (12-16 g/dL), a white blood cell count of 6800/mm3 (4000-10000/mm3), a platelet count of 261×103/mm3 (150-450×103/mm3). Blood chemistry showed a glutamate-oxaloacetate transaminase level of 118 IU/L (5-40 IU/L), a glutamate-pyruvate transaminase level of 78 IU/L (5-40 IU/L), a creatine kinase level of 293 IU/L (50-190 IU/L), and an aldolase level of 5.1 IU/ml (＜7.6 IU/ml).
+Urine analysis was normal. Antinuclear antibodies, anti-double stranded DNA, and anti-Jo-1 were all negative. Electromyography was normal. Biopsy of the quadriceps femoris muscle showed no abnormal findings. She was diagnosed with possible DM based on cutaneous manifestations and elevated muscle enzymes. She was treated with prednisolone 50 mg daily and azathioprine 100 mg daily. Two months later, her arthralgia improved, but cutaneous manifestations had not changed. Laboratory tests showed the serum CK level had increased to 727 IU/L. Hydroxychloroquine was added to the previous regime.
+Two months later she was asymptomatic and the serum CK level was normal. Thus, prednisolone was tapered. She felt well until July 2015 when she complained of dyspnea. During chest examination, bilateral fine crackles were heard. Chest x-ray showed bilateral opacities and computed tomography (CT) scan showed bilateral ground glass opacities. Prednisolone dose was increased to 50 mg/day and a cyclophosphamide regimen of 1000 mg per month was initiated. After 2 months, she did not feel better and chest x-ray showed progression of fibrosis. An intravenous immunoglobulin (IVIG) regimen of 400 mg/kg/day for 5 days was prescribed. One month later, she was admitted for neck pain and increased dyspnea. She reported chills and fever for 10 days. Upon physical examination, she was febrile (T=38.2 °C) and her blood pressure was 120/90mmHg. A subcutaneous crepitus around her neck was detected. Muscle power was normal in all four limbs.
+Laboratory examination only revealed leukocytosis (23000, PMN 85%) and other laboratory tests (including CK and aldolase) were normal. Chest radiograph and CT scan of the thorax showed a progression lung involvement with subcutaneous emphysema, pneumomediastinum, thickening of interlobular septa, and a reticulonodular pattern (,).
+CT scan of paranasal sinuses also showed emphysema in parietal, temporal and occipital soft tissue. Furthermore, emphysema was seen in retropharyngeal space .
+The smear and culture of sputum were negative for infectious agents. Flexible bronchoscopy showed severe erythema in bronchial tree, but there was no apparent fistula or rupture. Bronchoalveolar lavage fluid was negative for infectious agents. Echocardiography and esophagoscopy were normal. Intravenous cefteriaxon (1g twice daily) and oral aziothromycin were initiated. On the third day of admission, her shortness of breath worsened. The blood O2 saturation was 82%. High-dose steroid pulse therapy (1g IV methylprednisolone for 3 days) and rituximab 500 mg per week for 4 weeks were initiated. Oxygen therapy and complete bed rest were prescribed.
+On the 5th day of admission, she transferred to the intensive care unit (ICU) due to severe hypoxemia. She developed bilateral severe pneumothrox. A chest tube was inserted into both pleural spaces. The patient was intubated andmechanical ventilation was initiated. After one week, percutaneous tracheostomy was done.
+Ix weeks after immunosuppressive therapy, emphysema and pneumomediastinum were restricted and the chest tube was disconnected (first right, then left). However, the patient died because of severe hypoxemia despite intensive immunosuppressive therapy and mechanical ventilation.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1852_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1852_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1b5f2aa6ce97a84656dd0980d7c6b18bcc87ab2c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1852_en.txt
@@ -0,0 +1,2 @@
+A 42-year-old female presented with 3-month history of mild chest tightness. Her medical history was unremarkable. Physical examination found that her left arm muscles were thicker than the contralateral ones . Breath sounds on auscultation were diminished at the upper left lung. Plain X-ray of the chest revealed a mass in the superior mediastinum . Computed tomography (CT) of the chest showed a mass, measuring 10 cm × 5.5 cm in size with fat densities in the middle superior mediastinum . On the post contrast images the tumor was slightly heterogeneously enhanced and the adjacent blood vessel was surrounded by the lesion with obscure boundary . Laboratory tests were negative.
+This large infiltrating mass was considered a tumor of liposarcoma. Taking into account the provisions of China’s health insurance and the practice of local surgeons, a biopsy during operation should be done to determine the pathological type. The patient was scheduled for a thoracotomy. During the operation, a large mass, invaded the left subclavian artery and brachiocephalic vein, was found in the anterior mediastinum. Since it was very difficult to dissect the mass completely from the mediastinal structures, especially the left subclavian artery, an incomplete resection was performed. Macroscopically, it was revealed a hard mass of 10 cm × 6 cm × 6 cm in size with a gray-yellowish in color and a sense of oily . Pathologic evaluation demonstrated mature adipose tissue with many hyperplastic blood vessels, being consistent with the typical findings of angiolipoma . The patient recovered very well and was discharged 7 days after the surgery. Considering the incomplete resection, we recommened that the patient undergo a strategic radiation therapy after 1 month of the surgery. After 7 months of follow-up the patient was clinically well and asymptomatic.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1854_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1854_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c149c2b21daed469cc03f04886919349a8189de4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1854_en.txt
@@ -0,0 +1 @@
+A healthy 18-year-old woman and thirty-nine-week pregnant woman suffered sudden onset of severe pain and was admitted to the obstetrics clinic. Myelomeningocele and breech presentation was previously diagnosed in fetus. In the ultrasonographic (USG) examination; fetal stress and hydrocephaly were determined and urgent cesarean was planned. A 2690 g. female baby was delivered with Apgar scores between seven to eight at an hour and five minutes. Swelling was determined on both her thighs in routine neonatal evaluation few minutes after the delivery. The neonate seemed irritated with the palpation of thighs. She was consulted to our department immediately. Antero-posterior and lateral radiographs of each femur were taken which revealed displaced femur shaft fractures on both sides . At first a pelvipedal cast was thought, however to avoid the lesion irritation on the lumbar skin, long leg splints were performed on both lower limbs for three weeks. The fractures healed uneventfully after three weeks . The follow-ups were continued at obstetric clinic during hospitalization. Myelomeningocele was repaired by plastic surgeons and neuro-surgeons ten days after her discharge from obstetric department.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1884_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1884_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..830f4008b2e005dacd619aab565e5f15fee268f2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1884_en.txt
@@ -0,0 +1,2 @@
+Our patient was a 76-year-old white female with a past medical history of chronic kidney disease (CKD), baseline creatinine 1.85 mg/dL (estimated glomerular filtration rate 27 ml/min/1.73 m2; creatinine range 1.5-2.5 mg/dL six months prior to admission), hypertension, gout and psoriatic arthritis, who was admitted to the hospital for evaluation of elevated creatinine (4.83 mg/dL). She had no previous history of major surgeries. She did have a remote history of therapeutic use of arsenic for psoriasis approximately four decades earlier. She also had past history of heavy nonsteroidal anti-inflammatory drugs use up till three years earlier, when she had an episode of AKI. Her family history was unremarkable. She had only a remote history of smoking. Six weeks earlier, she has been started on orlistat 120 mg three times a day for weight loss. The rest of her medications included vitamin-C supplementation (500 mg/day) calcium carbonate, sevelamer hydrochloride and sodium bicarbonate supplementation for CKD, pantoprazole and monthly infliximab infusions for psoriatic arthritis. Physical exam was non-contributory, with a weight of 71 kg, height 1.55 m and blood pressure of 144/61 mm Hg. Her body mass index calculated at 29.5 kg/m2. Urinalysis with microscopy was unremarkable, except for 5 WBCs/high power fields with no crystals or cast formation. Extensive serologic work-up (antinuclear antibody, anti-neutrophil cytoplasmic antibodies, hepatitis-B and C studies, serum protein electrophoresis with measurements of serum free light chains) remained unremarkable. Uric acid was only mildly elevated at 7.2 mg/dL. Parathyroid hormone level returned within normal limits. During the diagnostic work-up, however, renal ultrasound noted multiple non-obstructing stones. Despite appropriate medical therapy, including volume expansion and correction of serum bicarbonate, creatinine rose to 5.40 mg/dL. Due to the ongoing diagnostic uncertainty a percutaneous kidney biopsy was performed, revealing calcium oxalate crystals within tubular lumens with associated interstitial inflammation with associated features of acute tubular necrosis (-). A subsequent, 24-hour urine collection confirmed increased oxalate excretion (69.5 mg/24 hour; normal for the laboratory: 9.7 - 40.5 mg/24 hour specimen). Heavy metal screen (arsenic, cadmium, lead, mercury) from blood and 24-hour urine collection was unremarkable. Renal replacement therapy with intermittent hemodialysis was initiated for 5 consecutive sessions in eight days, which she tolerated well. Initial serum oxalate was 45 mm/l (normal <27, reporting limit > 10; ARUP Laboratories, Salt Lake City, UT/National Medical Services, Willow Grove, PA); subsequent values returned undetectable after renal dialysis begun. Repeated 24-hour urine collection before discharge documented ongoing excessive oxalate excretion (75 mg/24 hour) (.).
+During follow-up, despite good medical compliance, she failed her per os calcium-carbonate therapy to achieve effective gastrointestinal oxalate chelation. Thereafter, being aware of the potential interaction between proton pump inhibitor (PPI) and reduced bioavailability of CaCO3 (,), she was changed to calcium citrate 1040 mg three times daily with meals for the purposes of gastrointestinal oxalate binding agent and to decrease urinary oxalate excretion . Twenty-two months after her initial hospital presentation she continues to do well and serum creatinine gradually decreased to the 2.01–2.32 mg/dL range (estimated glomerular filtration rate 20-24 ml/min/1.73 m2) . Urine oxalate excretion came under acceptable control with per os calcium-citrate dosed at 2080 mg, to be taken three times a day with meals .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1894_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1894_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..27b0fc24fd05258c2dcf8be5e91d0a42df8bcfcd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1894_en.txt
@@ -0,0 +1,3 @@
+A 49-year-old woman who had developed end-stage renal disease as a result of diabetes and had been on maintenance CAPD (continuous ambulatory peritoneal dialysis) for 22 months underwent live-unrelated kidney transplantation in April 2006. Her clinical course was uneventful for the first six months after transplantation and she did not have any rejection episodes. She was maintained on cyclosporine (4 mg/kg/day), mycophenolate mofetil (2 g/day) and prednisolone (5 mg/day). Five months after transplantation, she presented with cellulitis of the right leg following minor trauma and was treated with intravenous cefazolin (4 g/day) and ceftriaxone (2 g/day). The signs and symptoms of cellulitis improved but 3 weeks later, multiple painful erythematous firm nodules of diameter 2 to 7 cm appeared on the anterior and posterior aspects of her right leg and the lower part of her right thigh, and some of the nodules became ulcerated [Additional file ]. The patient was febrile (39°C), her blood pressure was 130/90 mmHg, and her pulse rate was regular at 80/min. There was no evidence of edema or lymphadenopathy, and her systemic examination was unremarkable.
+Laboratory tests showed her hemoglobin was 8.6 g/dL, her total white cell count was 100,000/mm3, and her ESR was 125 mm for the first hour. Serum biochemistry showed her creatinine was 1.1 mg/dL, her fasting blood sugar was 191 mg/dL, her uric acid was 2.6 mg/dL and her lactate dehydrogenase was 625 IU/L. She was negative for cytomegalovirus (CMV) IgM, but positive for CMV IgG, which had also been positive prior to pretransplantation. Her chest X-ray was unremarkable. Right leg MRI showed severe thickening of the superficial soft tissue and skin, but no evidence of deep soft tissue or muscular structure involvement. Histological examination of deep incisional biopsies of some of the nodules revealed lobular panniculitis with infiltrating lymphocytes, neutrophils, multinucleated giant cells, foamy macrophages, fat necrosis and granulation tissue [Additional file ]. Hematoxylin-eosin (H&E) and periodic acid schiff (PAS) staining showed numerous broad, aseptate and irregularly branched fungal hyphae indicative of mucormycosis deposited within the hypoderm and vessel wall [Additional file ]. Specimen culture was negative for zygomycetes.
+Since a fungal etiology of the skin lesion was established, the involved tissues were surgically resected, followed by intravenous treatment with amphotericin B (1 mg/kg/day). After 7 days of antifungal therapy, the patient's serum creatinine concentration had increased to 2.5 mg/dL; hence we had to decrease the dose of amphotericin B to 0.5 mg/kg/daily, and continue treatment until she had received a total cumulative dose of 1200 mg amphotericin B over 6 weeks. Mycophenolate mofetil was discontinued during anti-fungal therapy. The skin lesions showed a dramatic response to therapy, with only hyperpigmentation remaining in the involved areas of the skin. Following cessation of amphotericin B, her serum creatinine concentration decreased to 1.1 mg/dL and remained stable.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1911_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1911_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7cf92de92cb965a2446873f07065150c16f90891
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1911_en.txt
@@ -0,0 +1,4 @@
+A 60-year-old Japanese woman with severe anemia complained of several episodes of black stool over the preceding 2 years. Upper and lower gastrointestinal tract endoscopies were performed at another hospital and the findings were unremarkable. She was referred to our hospital for further evaluation. Blood tests confirmed the known anemia (hemoglobin 7.2g/dL; normal range 13.0–15.5g/dL) with iron deficiency (iron 12μg/dL; normal range 50–140μg/dL).
+An abdominal CT showed a 3.0-cm low-density tumor in the ileum, indicative of an intestinal lipoma . Intermittent episodes of melena continued after admission, leading us to perform retrograde DBE to enable diagnosis and treatment.
+DBE images displayed a dumbbell-shaped tumor (30 × 35mm) on the anti-mesenteric side of the ileum, approximately 85cm from the ileocecal valve . A similar finding was shown by selective contrast-enhanced radiography . The cushion sign was detected when the biopsy forceps were pushed into the tumor. This sign usually confirms the diagnosis of intestinal lipomas. EUS revealed a hypo-echoic layer corresponding to the muscularis propria and a hyper-echoic layer corresponding to the fat tissue . These findings, which suggested that the tumor included areas outside the intestinal serosa, are not typical for a lipoma, despite the existence of a hyper-echoic layer corresponding to fatty tissue. Based on these findings inverted Meckel’s diverticulum was suspected as possible diagnosis and laparoscopic surgery was considered to be the appropriate treatment. A surgical specimen showed ectopic pancreatic tissue around the top of a tumor-like elevation, thus confirming our diagnosis.
+The postoperative course was uneventful and the patient was discharged with an improvement in anemia.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1932_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1932_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3a6cc43173fe88939457a40a2edad9e3557e3b42
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1932_en.txt
@@ -0,0 +1,7 @@
+A 76-year-old female presented with MDD with inadequate response to antidepressants, post-traumatic stress disorder, obsessive compulsive disorder, generalized anxiety disorder, pseudobulbar affect, insomnia, restless leg syndrome, constipation, back pain, gastroesophageal reflux disease, hyperlipidemia, and glaucoma. Smoking status was not disclosed. Hepatic, kidney, and thyroid function laboratory values were all within normal limits (e.g., albumin, AST, ALT, creatinine, BUN, total protein, globulin, alkaline phosphatase, and bilirubin total, thyroid-stimulating hormone). The medications prescribed by the primary care provider (PCP) to manage her various medical conditions are listed in Table .
+The patient’s chief complaint was uncontrolled depression despite multiple attempts with various antidepressants. These medications include bupropion, escitalopram, and venlafaxine which all resulted in the patient experiencing ADEs and/or inadequate depression control. In brief and based on medical history, the patient was initially started on bupropion which was discontinued as she experienced uncontrolled shaking. Escitalopram was then used for 2 months and was discontinued due to an unknown reaction. Subsequently, venlafaxine was used for 3 months without favorable outcomes. This led to the introduction of other medications, such as: sertraline, risperidone and duloxetine. Additionally, this patient was also treated with quetiapine, although initiation date of treatment was unknown. The timeline for her antidepressant trials and other concomitant medications, including prescription and over the counter, is depicted in Table .
+This participant had recently enrolled in the Program of All-inclusive Care for the Elderly (PACE). Within the PACE model, pharmacists and other healthcare practitioners collaborate to identify and mitigate medication-related problems . PGx testing is one of the initiatives utilized to further improve the care of PACE participants. Being newly introduced to the management of this patient, a clinical pharmacist recommended a PGx test to optimize MDD management; this recommendation was accepted by the PCP. A DNA sample was collected via buccal swab and analyzed by a genetic laboratory (CQuentia, Memphis, TN; Genetic Response Report) and the clinical pharmacist was consulted to interpret relevant pharmacogenomic results. The patient was identified as a CYP2C19 IM, with a CYP2C19*2|*17 genotype, and as a CYP2D6 IM, with a CYP2D6*1|*4 genotype.
+Although the clinical pharmacist assessed the complete drug regimen, only recommendations relevant to antidepressant and antipsychotic therapies will be discussed in this case report. It is also worth acknowledging that although the patient’s chief complaint was uncontrolled depression and focus was on the MDD diagnosis, there are common symptoms with regards to her present psychiatric comorbidities. DGIs were considered relevant for the metabolism of duloxetine and risperidone (CYP2D6), and for the disposition of sertraline (CYP2C19). The CYP2D6 IM phenotype is associated with reduced enzyme activity and decreased clearance of CYP2D6 substrates. Hence, the risk of toxicity is increased for risperidone and to a lesser extent for duloxetine; it should be noted that the major metabolic pathway for duloxetine is through CYP1A2 (70%), while the contribution of 2D6 is limited to 30%. Similarly, a CYP2C19 IM has reduced enzyme activity, which results in decreased sertraline clearance and increased risk of toxicity.
+The clinical pharmacist also identified three clinically significant DDIs . Quinidine, a potent CYP2D6 inhibitor, is expected to inhibit the metabolism of risperidone and duloxetine. Such inhibition occurs regardless of the time of administration of the drugs as this interaction is mechanistically a non-competitive inhibition. The CDSS, which is based on algorithms and several pharmacological factors, was used to determine the presence of drug-induced phenoconversion (patent: WO 2019/089725). Quinidine inhibition of CYP2D6 resulted in phenoconversion whereby this patient’s phenotype is converted from a CYP2D6 IM to a PM phenotype. When this interaction occurs, the plasma concentrations of risperidone and duloxetine are likely to be higher than predicted from the genotypic results alone. Lastly, DDIs were also identified by the CDSS on the CYP3A4 metabolic pathway; risperidone and quinidine are drugs with stronger affinity for the CYP3A4 enzyme than quetiapine. Consequently, these drugs are expected to competitively inhibit the metabolism of quetiapine when co-administered. When this interaction occurs, the plasma concentrations of quetiapine are likely to be significantly higher than predicted (CYP3A4 contributes to 75% of the total clearance of quetiapine), increasing the risk for toxicity. A similar mechanism of DDI occurs between sertraline —a CYP3A4 substrate with low affinity— risperidone, and quetiapine. CYP3A4 is responsible of 25% of the total clearance of sertraline, leading to moderately clinically significant changes in plasma concentrations of sertraline (if only this route of elimination is affected).
+When performing the assessment and making recommendations, the clinical pharmacist considered several factors including previous unsuccessful medication trials, PGx test results and concomitant medications. Quetiapine has a low affinity for the dopamine 2 receptor, which is required for antipsychotic efficacy, therefore higher doses may be required for clinical effects for mood disorders and agitation. Additionally, quetiapine has mixed results for the treatment of dementia psychosis and agitation . Given this information and the DDI impacting the metabolism of quetiapine at CYP3A4, it was recommended that the PCP taper off the quetiapine while simultaneously optimizing the risperidone dose and frequency (targeting the lowest effective dose). Continued monitoring (e.g., EKG, palpitations) for risperidone was also suggested due to an increased risk of QTc prolongation caused by the presence of a DGI and a DDI at CYP2D6, and by the combination of quinidine , risperidone , rosuvastatin , quetiapine , and pantoprazole , which have all been associated with drug-induced QTc prolongation. Furthermore, it was recommended to optimize antidepressant therapy dosing based on clinical response and presence of ADEs.
+Over the next 8 weeks the aforementioned recommendations were accepted by the PCP, who before implementing had a thorough discussion with the patient’s psychiatrist to account for other non-PGx factors. Tapering of the quetiapine dose was attempted and risperidone did not require a further increase in dose. Antidepressant therapy was optimized by increasing the duloxetine dose from 30 mg to 60 mg daily, the patient was monitored closely during dose escalation. It was determined that the dose of sertraline would be re-assessed based upon therapeutic response to these changes. The PCP reported that the patient was experiencing less anxiety and better control of depression as frequent monitoring was continued.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1938_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1938_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..353a51cf1c041c6b8089850bde8a2218989a8f83
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1938_en.txt
@@ -0,0 +1,4 @@
+A 71-year-old Norwegian woman was admitted to a local hospital in Oslo only hours after returning from a four-week holiday to Thailand. She presented with rapid onset of nausea and vomiting associated with fever and exhaustion, and had also been complaining of fatigue for two days. She was febrile (39.5 °C), and had a respiratory rate of 26 min−1. The leukocyte count was 12×109cells ml−1 and the C-reactive protein (CRP) level was 9 mg l−1. Intravenous antibiotic therapy with ampicillin and gentamicin was commenced on suspicion of urosepsis, but the patient’s condition rapidly deteriorated the same evening, with increasing confusion and speech disturbances; nuchal rigidity was noted. Bacterial meningitis now appeared likely. The patient was administered 4 g of ceftriaxone and transferred to Oslo University Hospital (OUS).
+Upon arrival at OUS, the patient had obvious nuchal rigidity and incoherent speech, and was motorically agitated and confused. The Glasgow Coma Scale (GCS) score was assessed as 12, but downgraded to 9 during the initial evaluation, at which point she was intubated.
+A cerebral computed tomography (CT) scan with angiography showed no acute ischaemic lesions, haemorrhage, arterial occlusion, stenosis, or aneurism. Lumbar puncture yielded cloudy cerebrospinal fluid (CSF) under increased pressure, with 0.1 mmol l−1 glucose (serum glucose 11.1 mmol l−1), a protein level of 6.9 g l−1, and a leukocyte count of 2115 mm−3 with 87.3 % neutrophils. No microbes were found on an acridine orange stain of CSF. A nigrosin stain did not show any cryptococci, although the examiner noted the presence of unidentified elements. Treatment was changed to meropenem and vancomycin since the infection was presumably acquired in a region endemic for highly resistant bacteria.
+The patient’s condition deteriorated over the following twelve hours in spite of early initiation of antibiotic therapy. CRP increased to 269 mg l−1. A repeat cerebral CT scan showed general oedema, hydrocephalus and uncal herniation. External ventricular drainage with monitoring of intracerebral pressure (ICP) was established; ICP was measured to 80–90 mmHg. The patient remained unresponsive, with fixed dilated pupils. After observing that ICP remained consistently equal to mean arterial pressure, and examination indicated cessation of all cerebral functioning with no hope of improvement, active treatment was withdrawn three days after admission, and the patient was pronounced dead shortly thereafter. An autopsy was requested.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1940_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1940_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..39a36123df1902d8bb294c6a17825210715bb1fd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1940_en.txt
@@ -0,0 +1,4 @@
+A 29-year-old female presented with a 22-month history of progressive dysphagia, neck pain, and cervical myelopathy. Although she had no motor deficit, she exhibited impaired pin appreciation on the left side from C2–C7, bilateral Hoffman’s signs, and diffuse upper and lower extremity hyperreflexia.
+The computed tomography (CT) and full neuraxis enhanced MR studies showed a left-sided epidural enhanced mass from C2 to C7 compressing the spinal cord and displacing it to the right with a paravertebral extension [-].
+Three days after the presentation, a CT-guided biopsy was performed. However, due to the initiation of steroids (dexamethasone 4 mg every 6 h), the tumor had significantly decreased in size (e.g., repeat MRI showed that the lesion had profoundly regressed), and a biopsy was no longer feasible/ reliable [-].
+The next MR performed 2 weeks after cessation of steroids revealed significant tumor recurrence [ and ]. The repeated CT-guided biopsy revealed a granuloma in a background of nonneoplastic skeletal muscular and fibrous tissues. This was followed by an open anterior C5–C6 biopsy of the large recurrent extradural lesion; the latter confirmed the diagnosis of neurosarcoidosis (i.e., nonnecrotizing granulomatous lymphadenitis) neurosarcoidosis [ and ]. She was later discharged on 60 mg prednisone/day and placed on an 8-week taper. Three months later, she exhibited substantial clinical improvement.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1952_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1952_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2b8bab38582895e1cec7899d718d1abf5901ec89
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1952_en.txt
@@ -0,0 +1,5 @@
+A 55-year-old Greek woman was referred to our clinic for the management of a cystic lesion located in the tail of the pancreas. The lesion was discovered incidentally during her staging workup with abdominal ultrasound for invasive ductal adenocarcinoma of the left breast 16 months ago. Just after a modified radical left mastectomy had been performed, we further investigated the pancreatic lesion with a magnetic resonance imaging (MRI) scan, which revealed a space-occupying cystic lesion of maximum diameter of 5 cm located in the tail of the pancreas with calcifications of the wall and a central cystic component . Besides the chemo-, radio-, and hormonal therapy she received for her breast cancer, her past medical history also included hypothyroidism under hormone-replacement therapy.
+The findings in the physical examination were unremarkable. Blood investigation and tumor markers (CEA, CA 15-3, CA 19-9, and CA 125) were within normal limits. The possibility of a mucinous cystic neoplasm of the pancreas was considered, and a laparoscopic distal pancreatectomy and a splenectomy were chosen.
+The first distal pancreatectomy in pigs was described by Soper et al. in 1994; 2 years later, Gagner reported his first five cases of spleen-preserving laparoscopic distal pancreatectomy for insulinoma.
+In our case, the patient was placed in a modified lithotomy position, with the surgeon standing between the legs of the patient. We used a five-port technique, placing a 12 mm trocar left paramedian at about the level of the umbilicus, a 10 mm-trocar in the left upper quadrant of the abdomen on the anterior axillary line, a 10 mm-trocar in the subxiphoid region, a 5 mm-trocar in the left hypochondrium on the midclavicular line, and a 5 mm-trocar in the right hypochondrium in the midclavicular line as well . Pneumoperitoneum was established with the open Hasson technique through the 12 mm paramedian port. Exploratory laparoscopy did not reveal macroscopically evident intra-abdominal metastases. We used a 30-degree laparoscope and an ultrasonic dissector (UltraCision; Ethicon, Endosurgery). After entering the lesser sac, we identified the splenic artery at the upper border of the pancreas after its origin from the celiac axis, and we ligated, by using a disposable clip applicator (U.S. Surgical Corp., Norwalk, CT) . The mobilization of the pancreas started at the reflexion of the superior leaf of the transverse mesocolon on the pancreas. The plane at the inferior border of the body of the pancreas was opened with blunt dissection, gradually exposing the posterior surface of the pancreas. The splenic vein was gently dissected by using a right-angle dissector and was ligated with clips. After sufficiently mobilizing the pancreas, this was transected by using an endoGIA (45 × 2.5 mm) . Subsequent mobilization of the spleen from its attachments to the diaphragm, colon, and left kidney was performed. The specimen was retrieved through a vertical extension of the paramedian port site in a retrieval endobag (Autosuture, Norwalk, CT). A drain was placed in the splenic fossa. Estimated intraoperative blood loss was 320 ml, and no blood transfusion was required. The pathology report revealed a pancreatic tumor 5 cm in diameter. The lesion was multiloculated, contained a yellowish fluid and a thick, stiffened wall, consisting of dense fibrotic tissue with hyaline degeneration, calcifications, regions of ossific metaplasia, and microscopic foci of neoplasmatic tissue, compatible with cystic-solid pseudopapillary neoplasm of the pancreas. Seven reactive regional lymph nodes were harvested, and resection margins were free.
+The postoperative course was complicated by a pancreatic fistula (50 ml/d) grade B and a reactive left pleural effusion. On the fifth postoperative day, a CT scan of the abdomen was performed, and a subdiaphragmatic collection was drained under CT guidance. The patient's clinical condition was improved, and the patient was finally discharged on postoperative day 13. The patient's follow-up (with abdominal CT and biochemical tests yearly) in a time period of 36 months revealed no disease recurrence or development of diabetes.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1954_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1954_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..637802157da08086be64af7f9b6a33cc0f5bf9f6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1954_en.txt
@@ -0,0 +1,5 @@
+A 13 year old female living in a remote rural area came to our clinic with an 8 year history of deformities in the extremities which had gradually became worse till she was unable to walk. The patient over the years had developed recurrent fractures in her legs and arms after minor falls. The family was poor and lived in a remote area far away from proper medical facilities. She was treated by local healers for her fractures which resulted in bowing of legs and arms. There were no gastrointestinal symptoms of abdominal pain or diarrhea. She was brought to the clinic carried by her father. The patient used her arms to drag herself around the house and developed fractures followed by severe bowing of her arms. She had been diagnosed with rickets and iron deficiency anemia by doctors in community hospitals and had received Vitamin D and iron supplements many times without improvement. She had never had a complete workup to find out the cause of her rickets. The patient also had failure to thrive. On examination the patient was pale, weight was 11 kg and height 97 cm (below the 3rd percentile for her age) . She had severe bowing of her arms and legs.
+Due to the presence of anemia, failure to thrive and rickets the initial impression was malabsorption probably due to celiac disease and the laboratory work up was done accordingly.
+Initial laboratory investigations that were done are mentioned in Additional file : Table S1. X-rays of her upper and lower limbs showed diffuse osteopenia and bowing of both legs and forearms with blurring of the metaphyseal lines. It also showed dense transverse lines in tibia and ulna suggestive of looser’s zones indicative of severe rickets .Anti- endomysial antibodies titer was 80 (normal is negative), anti-tissue transglutaminase IgA was positive 75 U/ml (normal <2.5 U/ml) and anti-tissue transglutaminase IgG was negative. Upper endoscopy was done with small intestinal biopsy. The duodenum showed scalloping and fissuring of the small bowel suggestive of celiac disease. The histopathology report of the small intestine showed severe villous atrophy grade IV with crypt hyperplasia consistent with celiac disease. Old Marsh-Oberhuber classification: Type 3c: Total villous atrophy with completely flat mucosa and increased intraepithelial lymphocytes .
+The patient was started on a gluten free diet. She also was started on Vitamin D supplements, calcium and iron replacement. The patient returned for follow-up 5 months later, she was feeling better, her weight had increased to 14 kg and her height had increased to 97 cm. She had taken iron and calcium supplements for a very short period but she did continue on a gluten free diet. The family was very poor and on further questioning on their dietary habit, it lacked many of the main constituents and was very low in vitamin D for most of her life but she did live in a very sunny area and before becoming crippled she had adequate sun exposure. Her diet before diagnosis was found to consist mainly of grains and breads with little protein and after being diagnosed and receiving instructions on a gluten free diet it was changed to rice and potatoes. Laboratory investigations showed some improvement from 5 months earlier these are shown in Additional file : Table S1. The patient was seen by an orthopedic surgeon who wanted the general condition of the patient to improve before considering any surgery.
+The patient and her family were further instructed again on a gluten free diet emphasizing the available options. She was given further iron, calcium and Vitamin D replacement, the patient was not able to come back for follow up but 4 months later the family phoned and said she had markedly improved and had started walking.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1956_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1956_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..18555adf7966d31afe3057ba1be974bb1a74adf8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1956_en.txt
@@ -0,0 +1 @@
+A 56-year-old Caucasian man with a history of severe aortic insufficiency presented to the emergency department with twelve hours of continuous, crushing substernal chest pain. An inferior myocardial infarction was diagnosed by the electrocardiogram and serologic markers. Aspirin, clopidogrel, a statin and a beta-blocker were administered. At cardiac catheterization, the left ventricular end diastolic pressure (LVEDP) was 20 mmHg, and there was a complete occlusion of the right coronary artery (RCA) as well as a 50-75% stenosis of the left anterior descending artery. Angioplasty of the RCA was performed, but immediate re-occlusion occurred. The subsequent course was complicated by hypotension and severe hypoxemia that persisted despite intubation and mechanical ventilation with 100% oxygen. In an effort to lessen the risk of oxygen toxicity, the lowest FiO2 that maintained the oxygen saturation at least 90% was used. An FiO2 of 0.60 was thus chosen. A PEEP of 10 mmHg was required to maintain oxygenation due to the marked pulmonary congestion caused by severe aortic insufficiency. Transesophageal echocardiography with intravenous microbubbles demonstrated a significant right-to-left shunt through a patent foramen ovale . The right ventricle was dilated, and the free wall was akinetic. The patient was taken to the operating room for coronary artery bypass grafting, aortic valve replacement and closure of the atrial defect. Immediately following closure of the PFO the patient’s oxygen saturation rapidly improved to 100%. There was a slight decrease in the patient’s cardiac output post-operatively (from 5.4 to 5.0 L/min) following surgery. He was successfully weaned from the ventilator on post-operative day four and the remainder of the hospital course was uneventful.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1974_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1974_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4e88987df8ae22a0abc02716659701ff2c0b6435
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1974_en.txt
@@ -0,0 +1,12 @@
+A 25-year-old female Nigerian patient presented with chief complaints of recurrent fever of 1 month duration and bilateral neck swelling. Fever was described as low grade, continuous, associated with chills and rigor, and relieved only by the use of paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs). She also noticed bilateral anterior neck swellings about 2 weeks prior to presentation. Swelling was gradual in onset, not painful, and about the size of a peanut when first noticed with no significant increase in size afterwards. Swelling remained the same with swallowing and without any pressure symptoms. She denied any history of cough or contact with a person with chronic cough, and had no history of hoarseness, dysphagia, odynophagia, or stridor. There were other associated symptoms of night sweats, recurrent headaches, nausea, anorexia, and weight loss of about 5 kg at the time of presentation.
+Prior to her visit at our outpatient department, she has had multiple medical consultations and multiple courses of antimalarial given over the 1 month period preceding her visit. However, her symptoms were persistent with no resolution. She had no significant past medical or surgical history. History of medications used prior to presentation included three courses (at varying points of illness) of artemether and lumefantrine combination, oral (PO) amoxicillin, PO clotrimazole, PO cotrimoxazole, and PO cefuroxime.
+Physical examination findings revealed a young woman who was febrile with bilateral neck lump located at the bases of both the right and left anterior triangles of the neck, both measuring about 2 cm by 4 cm. Lumps were mildly tender and attached to underlying structure but not to the overlying skin. Vital signs at presentation: temperature 37.8 °C, pulse rate 96 beats per minute, blood pressure: 112/78 mmHg. There were no significant neurological, respiratory, cardiovascular, or abdominal findings.
+Preliminary laboratory investigations were essentially normal aside from an elevated erythrocyte sedimentation rate (ESR) value.
+Complete blood count:
+An assessment of tuberculous adenitis was made to keep in view T-acute lymphoblastic leukemia.
+The following further investigations were done:
+Mantoux test—no induration after 72 hours. Chest X-ray—normal radiograph.
+Neck ultrasonography scan (USS): bilateral septated complex cystic masses measuring 3.86 by 2.31 cm and 3.19 cm by 1.31 cm in the right and left lateral region close to the cervical vascular bundles.
+The patient was referred to a surgeon for further review, evaluation, and possible biopsy of the neck masses. A fine needle aspiration biopsy was opted for and done due to the peculiarity/difficult anatomy of neurovasculature in the neck region.
+Fine needle aspiration cytology (FNAC): smear of aspirates showed sheets of small- to medium-sized lymphocytes, neutrophils, and few immunoblasts. Also seen are macrophages that are entrapped within fibrillary strands. No atypical cell was seen.
+On the basis of these findings, an assessment of acute bacterial lymphadenitis was made and the patient was started on a course of PO levofloxacin for 2 weeks. The enlarged lymph nodes gradually regressed over the course of treatment, and on subsequent follow-up, the patient became symptom-free and has remained so.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1989_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1989_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e14c20c1b8d101fa41736dd09cb1755cbf5394a1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_1989_en.txt
@@ -0,0 +1,3 @@
+The patient is a 3-month-old girl born premature at 33 weeks’ gestation with accelerated head growth and a bulging fontanelle from post-hemorrhagic hydrocephalus. Treatment with a right frontal ventriculoperitoneal shunt with a programmable Medtronic Strata™ II valve was selected because of extreme ventriculomegaly with a very thin cortical mantle and unpredictable CSF drainage needs. The patient underwent a postoperative magnetic resonance imaging (MRI), which showed decreased ventricular size and confirmed the appropriate function of the shunt. Following imaging, the shunt was programmed to performance level 2.5, and was confirmed to be at this setting seven days later. Three days later, the patient was fussy and feeding poorly. The valve was found to be set at performance level 1.0, and was reprogrammed to 2.5. The following day, it was again back at 1.0, and an investigation was started to determine the cause of the maladjustment.
+Despite a lack of warnings regarding magnetic fields from the manufacturer, we hypothesized that the Vocera badge, a newly instituted device in our facility, might be responsible for the inadvertent valve changes. We found that sweeping a Vocera badge across a packaged Strata™ II valve caused the ball and valve mechanism to spin, changing the performance setting.
+Upon further investigation, we learned that the patient's head was brought into an adjacent position to the Vocera badge by nursing staff when held for feedings. This proximity of the valve and badge caused changes to the valve's setting. A policy was instituted prohibiting Vocera badges in the patient's room. Alerts were also placed in the electronic medical system. After institution of the new policy, the patient's shunt setting was correct for the remainder of the hospitalization.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_199_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_199_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8f151b7d4009beb0695e8617eec5fd08f4831c07
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_199_en.txt
@@ -0,0 +1,3 @@
+A 52-year-old North African man was transferred from an emergency unit to our department for unstable angina of 24 hours’ duration. He had a history of hypertension and dyslipidemia and he had smoked tobacco for 30 years. Progressive effort-induced angina and exertional dyspnea had been deliberately neglected for 10 years until recent onset of acute coronary syndrome. On clinical examination, he was hypertensive at 142/83 mmHg with a regular pulse at 59/minute and body mass index of 25 kg/m2. His heart sounds were normal without any additional sounds or murmurs. His lungs were clear to auscultation and there was no peripheral edema or jugular venous turgor. The auscultation of carotid arteries was normal.
+Resting electrocardiogram showed normal sinus rhythm at 55 beats per minute (bpm) without any ST segment changes. There were anteroseptal Q waves and inverted T-waves on apical and lateral leads. A transthoracic echocardiogram showed a normal LV size and function (LV ejection fraction at 68%) with normal motions of all segments . The LV filling pressures were low. Systolic pulmonary artery pressure was 24 mmHg and the right ventricular size and function were normal. Coronary angiography revealed total occlusion of LMCA with no antegrade flow in the left anterior descending artery (LAD) and the circumflex artery (Cx) . RCA was dominant and well developed; it irrigated the left coronary arterial network through an extensive collateral circulation . However, RCA had a significant stenosis .
+He was referred 2 days after coronary angiogram to surgery for elective on-pump CABG. Anesthesia was uneventful: cisatracurium besylate, midazolam, thiopental, and propofol. After median sternotomy, the internal thoracic arteries and the saphenous vein graft (SVG) were harvested. His right internal thoracic artery (RITA) was anastomosed to left internal thoracic artery (LITA) to make composite “LITA-RITA-Y” graft configuration. A cardiopulmonary bypass, performed by aortic and venous cannulation, was conducted under moderate systemic hypothermia. Myocardial protection was achieved with antegrade cold blood high potassium cardioplegia. We carried on with distal anastomoses of SVG to RCA, RITA to obtuse marginal branch, and, finally, LITA sequentially to diagonal artery and LAD. His postoperative course was uneventful and he was discharged at day 9. The 6-month control showed good recovery without residual chest pain or dyspnea and a normal physical examination without signs of heart failure. An electrocardiogram showed normal sinus rhythm at 63 bpm with no ST segment changes and persistence of anteroseptal Q waves, but disappearance of inverted T-waves on apical and lateral leads. An X-ray of his chest was normal without cardiomegaly; transthoracic echocardiography showed normal LV size and function with 62% of ejection fraction and normal segmental contractility.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2010_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2010_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..324ade6f00b4d0d7fbc8282e332b8c988220ddd8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2010_en.txt
@@ -0,0 +1,7 @@
+A female who is 59 years old. In 2016, CT showed dense nodule shadow, high-density lock strip shadow and fuzzy patch shadow in the left lower lung, and focal thickening of the left pleura. Therefore, “left chest wall tumor resection + left lower lung tumor resection” was performed. Pathological report showed that low to moderate malignant fibrosarcoma(fibromyxoid type). In 2018, a peanut sized tumor was found on the left chest wall, which was hard without tenderness and untreated. CT Reexamination in 2020 showed multiple solid nodules in both lungs with clear boundary; The left chest wall is a kind of round mass shadow, which seems to have a pedicle connected with the rear muscle and is unevenly strengthened. It increased like an egg within one year. The CT re-examination in 2021 showed that there were multiple solid nodules in both lungs and tumors on the left chest wall, and the tumors on the left chest wall were significantly larger than before. No abnormality was found in other examinations.
+General observation, the tumor is intact and well-defined, with a size of 6 × 5 × 4 cm, its texture is grayish white, with local areas showing alternating yellow and white. Although the tumor generally seems to have a clear boundary, it infiltrates into adjacent tissues under microscope. At low magnification, we can see that the tumor is composed of alternating collagen like and mucinous areas. There is migration or transition between the two areas, and we can also see a relatively clear boundary. At high magnification, the tumor cells are consistent in morphology, spindle or short spindle, and star shaped in the myxoid area, similar to fibroblasts. The nucleus is round or oval, deeply stained, and the chromatin is evenly distributed. The mitotic nucleus is not obvious; The cytoplasm was lightly stained and the cell boundary was unclear. The tumor cells are arranged in bundles, linear arrangement or disorderly distribution. The blood vessels in tumor cells are relatively rare, mostly arched, curved or arc-shaped. In myxoid areas, sometimes branching capillary networks similar to myxoid liposarcoma can be seen. In the local area, the density of tumor cells increased significantly, mixed with collagen fibers, and small focal sclerosing epithelioid fibrosarcoma appeared.
+Immunohistochemical results showed that SMA, Desmin, CD34, STAT6, S100, SOX10, HMB45 and Melan A were negative, EMA was weakly positive, MUC4 was diffuse and strongly positive, and Ki-67 index was low(3%). FISH results showed that DDIT3 gene mutation was not found, but FUS gene was break mutation.
+In order to find out whether there are mutations in other genes in low-grade fibromyxoid sarcoma except FUS-CREB3L2 fusion, FUS-CREB3L1 and EWSR1- CREB3L1 fusion [, , , ]. Subsequently, we conducted next-generation sequencing experiment, which showed that there were mutation in four gene MET, EGFR, KMT2B and RET. It is noteworthy that KMT2B mutation in Low-grade fibromyxoid sarcoma has not been reported.
+KMT2B belongs to a member of the histone lysine N-methyltransferase 2 family . KMT2 is divided into KMT2A, KMT2B, KMT2C, KMT2D, etc. of which the two have high homology (KMT2A and KMT2B, KMT2C and KMT2D). The first four are the most common gene changes in tumor types, among which the mutation rate is higher in melanoma, Endometrial carcinoma and lung cancer. The mutation frequencies of single genes in KMT2 family are KMT2D(18%), KMT2C(15%), KMT2A(9%)and KMT2B(8%) .
+KMT2B, also known as mixed lineage leukemia 2(MLL2), OMIM 606,834, is located on chromosome 19q13 12 , which has a similar gene structure to MLL1(KMT2A)located on chromosome 11q23 . The structural components of the gene include the catalytically active C-terminal SET domain, a CXXC domain, an AT hook and several plant homeotic domains(PHD)in the N-terminal region [, , ]. The CXXC recognizes and binds to non-methylated CpG DNA, being critical for the association of MLL2 to chromatin ,CXXC recognizes CpG islands of most promoters, and PDH is next to zinc finger(ZF)-CXXC, including PDH1-PDH4 , PDH possess a Cys4-His-Cys3 motif, mediating binding to methylated histone H3 , Although all MLL families contain PDH, PDH3 of MLL2 show different specificity, which mainly binds to H3K4me3 tails .The C-terminal SEF domain of KMT2B forms a complex with WRAD, host cell factors 1/2(HCF 1/2)and Menin [, –], the complex is responsible for the binding of PDH3 and H3K4me3, regulating bivalent developmental genes as well as stem cell and germinal cell Differentiation gene sets .In addition, MLL2 plays a key role in embryonic development, the deletion of MLL2 is related to early growth retardation, neural tube defects and apoptosis leading to embryonic death [–]. At the same time, MLL2 also has cancer promoting effects, including in colorectal cancer , gastric cancer , glioblastoma , etc.
+Epidermal growth factor receptor(EGFR) is a transmembrane glycoprotein. EGFR play key mediators in cell signaling pathways such as proliferation, apoptosis, angiogenesis and metastasis . It has been reported that FUS contains two targeted EGFR phosphorylation sites, mainly Y6 and Y304 in the FUS, suggesting that FUS can be phosphorylated by EGFR, which promoting FUS phosphorylation and inducing nuclear translocation through activated EGFR, so that FUS can mediate collagen production and creates a collagenous background. Therefore, EGFR-mediated FUS phosphorylation regulates FUS nuclear translocation and promotes transcription of fibrotic collagen genes .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2012_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2012_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..25c6327b61b16c42a49d7ba0c4f32bd4526a441a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2012_en.txt
@@ -0,0 +1,4 @@
+A 64-year-old Caucasian woman suffered from a first vertebral fracture in the second lumbar vertebra (L2) in 2004 following a fall from her bicycle. She did not obtain any treatment. Dual X-ray absorptiometry (DXA) revealed osteoporosis: lumbar T-score of − 3.2 standard deviation (SD). Our patient’s characteristics during follow up are summarized in Table . Her phosphorus and calcium levels were normal (plasma calcium concentration = 2.50 mmol/l; normal range 2.13 to 2.65 mmol/l), parathyroid hormone (PTH) concentration was normal (48 ng/l; normal range 15 to 65 ng/l), and vitamin D level was low (13.6 ng/ml; normal range 30 to 60 ng/l). She was included in the FREEDOM protocol, comparing denosumab (60 mg, subcutaneously, every 6 months, plus 1000 mg of calcium and 800 IU of vitamin D daily) with placebo for the treatment of postmenopausal osteoporosis in January 2005. The unblinding of the trial 3 years later showed that she had been randomized to the denosumab group. Several vertebral fractures occurred during this 3-year period: fifth thoracic vertebra (T5), eighth thoracic vertebra (T8), and an aggravation of the L2 fracture. She continued to participate in the extension protocol in open mode for 6 years, and then withdrew of her own volition, with a final injection of denosumab in July 2013; there were no new vertebral fractures during this entire period. DXA in September 2013 demonstrated increased bone mineral density (BMD) of 22.3% in her lumbar region (T-score, − 1.6 SD) and of 17.0% in her total left hip (T-score, − 1.1 SD). She was a former tobacco smoker and her medical history included osteoarthritis of the knee, a hiatus hernia, hypertension, amlodipine allergy, and colonic polyps. Calcaemia monitoring revealed a return to normal values until January 2012 (2.58 nmol/l; normal range 2.13 to 2.65 mmol/l). Check-ups while our patient was still on denosumab yielded values of 2.68 nmol/l in January 2013 and 2.73 in September 2013 .
+In May 2014, our patient complained of acute intense spinal pain that resisted standard painkillers and required treatment with opiates. An evaluation was carried out in hospital in June 2014. Spinal X-rays revealed fractures of the fourth thoracic vertebra (T4; wedge, grade 2), T5 (biconcave, grade 3), T8 (wedge, grade 3), ninth thoracic vertebra (T9; crush, grade 3), tenth thoracic vertebra (T10; wedge, grade 1), 11th thoracic vertebra (T11; crush, grade 3), first lumbar vertebra (L1; biconcave, grade 1), L2 (wedge, grade 2), and third lumbar vertebra (L3; biconcave, grade 2) . Bone scintigraphy revealed hypersignals in all these vertebrae except L2 and T5, and in several ribs. Magnetic resonance imaging (MRI) identified vertebra T4 in hypersignal on a T2-weighted sequence and hyposignal on a T1-weighted sequence, with no signs of infiltration or suspected lysis . T9, T10, T11, L1, and L3 also showed hypersignal, and T5, T8, and L2 were older vertebral fractures with no bone marrow edema. Lumbar and dorsal pain remained severe throughout this period of exploration, justifying bed rest. Biological tests revealed hypercalcemia, with plasma concentrations of 2.83 mmol/l for calcium (normal range 2.13 to 2.65 mmol/l) and 1.06 mmol/l for phosphate (normal range 0.70 to 1.30 mmol/l), hypercalciuria (17.1 mmol/24 hours; normal range 1.5 to 6.2 mmol/24 hours), a 25(OH) vitamin D3 concentration of 15 ng/ml (normal range 30 to 60 ng/l), a PTH concentration of 41 pg/ml (normal range 15 to 65 ng/l), a C-reactive protein (CRP) concentration of 1.3 mg/l (normal values < 5 mg/l), normal protein electrophoresis with no Bence Jones proteinuria, and a plasma creatinine concentration of 44 μmol/l (normal range 45 to 84 μmol/l). Blood formula, and plasma concentrations of thyroid-stimulating hormone (TSH), parathyroid hormone-related peptide (PTHrp), cortisol and 1,25(OH)2D were normal. Carboxy-terminal collagen crosslink (CTX) levels were very high (2.09 μg/l; normal values < 0.43 μg/l), but were difficult to interpret in the context of vertebral fracture. DXA performed 1 year after the last injection of denosumab revealed BMD losses of 6.0% in our patient’s lumbar region and 2.9% in her total hip.
+The association of fractures that are unusual for osteoporosis (T4), acute and persistent back pain, other rib fractures, and hypercalcemia were suggestive of a potential neoplasia, which led to systemic explorations, vertebral biopsy, and hyperparathyroidectomy and thyroidectomy (known goiter at the ultrasound exploration). A thoracic/abdominal/pelvic computed tomography (CT) scan showed only a heterogeneous multinodular goiter. Sesta-methoxy-isobutyl-isonitrile (MIBI) scintigraphy revealed a small area of fixation of the posterior lower right thyroid lobe and a lower lobe nodule displaying clear uptake. Fine-needle aspiration results were negative. A biopsy of the T4 was carried out under CT control and produced normal results. With hindsight, a gassy image of the upper facet of the T4 was suggestive of necrosis. A parathyroid neoplasia could have been evoked too. Surgery was performed at the end of July 2014 to remove the right upper parathyroid gland (13 × 10 × 2 mm; weight, 0.1 g), and histological analysis suggested nodular hyperplasia. Associated total thyroidectomy led to the detection of a dystrophic goiter with macrovesicular nodules and a 1 mm isthmic papillary microcarcinoma with no associated adenopathy.
+Her pain was initially acute but of the mechanical type with a generally favorable outcome. Her calcaemia normalized the day after surgery: 2.44 mmol/l, with a plasma PTH concentration of 51.5 ng/l (normal range 15 to 65 ng/l). A new bone densitometry evaluation was carried out in October 2016, at which time bone losses of 15.7% for the lumbar region (T-score, − 2.9 SD) and 15.5% for the total left hip (T-score, − 2.3 SD) were recorded . She continued to complain of disabling spinal pain. Her phosphorus and calcium evaluation results remained normal, as did her vitamin D levels, with the continuation of substitution treatment. Given the considerable decrease in BMD, she was placed on risedronate in September 2016, but this was badly tolerated. She was then placed on zoledronate (5 mg). Her calcaemia remained stable at 2.47 mmol/l (normal range 2.13 to 2.65 mmol/l). After two infusions (October 2016 and October 2017), a new DXA in August 2018 showed stabilization of the lumbar BMD (+ 0.5%) and a significant loss in the total hip BMD (− 8.5%). Her plasma calcium levels remained normal (2.60 mmol/l) and she did not have any new vertebral or peripheral fractures.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2048_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2048_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ee706f118653e9b52f407f874426748075d57324
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2048_en.txt
@@ -0,0 +1,3 @@
+A 57-year-old man was referred to neuro-oncology for brain MRI findings concerning for cortical laminar necrosis in the setting of metastatic melanoma. He was originally diagnosed with Stage IIIB (pT4bN1aM0) BRAF V600E-mutated cutaneous melanoma 6 years before evaluation with positive sentinel lymph node biopsy. Brain MRI at that time was normal. He had received multiple treatments throughout the years but for the past 30 months had been treated only with encorafenib and binimetinib with stable systemic disease. His medical history was otherwise unremarkable and he had no risk factors for vascular disease.
+Routine, asymptomatic surveillance brain MRI with contrast was obtained and was notable for gyriform T1 shortening in the right pars opercularis, new from most recent imaging performed 23 months prior . Contrast-enhanced T1-weighted imaging showed no discernable enhancement, T2-weighted sequences showed no local edema, and diffusion-weighted imaging showed no diffusion restriction. These findings were most consistent with cortical laminar necrosis from chronic infarction. Nonetheless, given his clinical history and lack of vascular risk factors, metastatic disease remained a diagnostic consideration and close interval follow-up was planned.
+Repeat MRI obtained 3 months later revealed gyral expansion in the region of the T1 shortening as well as a new contrast-enhancing adjacent nodule with vasogenic edema . Given imaging features, he underwent craniotomy revealing a subpial lesion that was grossly melanotic. The lesion followed and infiltrated gray matter in a gyriform pattern, with an adjacent melanotic nodule . A total resection was achieved utilizing subpial dissection to protect nearby Sylvian vessels. The surgical specimen showed cortical gray matter with infiltration by neoplastic cells in a primarily perivascular pattern with no definitive tumor mass. The neoplasm was composed of large cells with atypical nuclei and prominent nucleoli. The majority of the tumor cells showed melanin pigment. All these findings were consistent with a metastatic malignant melanoma. The tumor expressed the mutant BRAF V600E protein by immunohistochemistry. The patient recovered well without postoperative neurological deficit. He received Gamma Knife radiosurgery to the surgical bed with a dose of 9 Gy at the 50% isodose line.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2055_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2055_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..31478f1aeb6f8bc2a21ca51bd24d75cf6afae9c8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2055_en.txt
@@ -0,0 +1 @@
+A 51-year-old male with intellectual disability presented to our hospital due to fever. He denied any pain or other symptoms, and his vital signs were normal. Laboratory values were as follows: 11,500/mm3 white blood cells, 12.3 g/dL hemoglobin, 5 mg/L C-reactive protein, 12 U/L aspartate aminotransferase, and 9 U/L alanine aminotransferase. Initially, he was diagnosed with aspiration pneumonia based on chest X-ray and blood examination. However, an abdominal X-ray examination suggested a foreign body , and a computed tomography (CT) scan revealed a toothbrush in the duodenum . No abnormal ascites fluid, free air, and abdominal abscess were observed, and it looked as if the toothbrush was stuck in the liver. An upper gastrointestinal endoscopy was performed immediately following the CT studies. It was observed in the second part of duodenum, and there was a granuloma around the handle part of the toothbrush at the duodenal bulb . Endoscopic removal was attempted using a polypectomy snare and biopsy forceps. However, the toothbrush was deeply embedded into the duodenal mucosa, so it could not be safely removed. This case was diagnosed as duodenal incarceration of the toothbrush, and it was removed by laparoscopic surgery, which is less invasive than open surgery. The surgical procedure was as follows . First, we found that the hepatic hilum and duodenal bulb were adhered tightly and could not be detached by peeling. Therefore, the toothbrush was difficult to remove by making an incision in the duodenal bulb. For that, the transverse and ascending colons were detached from the retroperitoneum to expose the C-loop of the duodenum in which the toothbrush was incarcerated. After that, an incision was made on the caudal side of the second part of the duodenum, and the toothbrush was removed through the incision . The extraction hole was closed using a barbed suture, and the procedure was completed. The operation time and estimated blood loss were 201 min and a little, respectively. The extracted toothbrush was 15 cm in length . The patient’s postoperative course was uneventful without complications and a postoperative CT showed no changes in the liver . During the postoperative course, no abnormal values of liver function were observed; these results were consistent with those of the preoperative blood examination.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2057_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2057_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..10d8117ba88d11979d6f1bbc75ee867ca2847f81
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2057_en.txt
@@ -0,0 +1,2 @@
+A 30-year-old heterosexual male immigrant of Bulgarian origin presented to the emergency department complaining of suprapubic pain which started two days prior to admittance. No history of trauma, TB infection or previous surgery was reported whatsoever. He stated normal sex life, normal erection and ejaculation during intercourse. At the time of observation his vital signs were in normal range and on physical examination he presented suprapubic tenderness and his penis was noted to be abnormally large in circumference, painless but stiff to the feel with a markedly stricture at the middle of the penis shaft. The skin was depigmented in many areas largely at the base. No enlargement of the inguinal lymph nodes was noted (Legend 1). On digital examination a tender and mildly painful prostate was the main finding.
+At that point the patient reluctantly confessed that he has infused approximately 8–10 milliliters of liquid paraffin into his urethra by a small syringe some six months before and repeated the infusion three months ago. His purpose was to achieve penis enlargement. In order to avoid the entrance of the substance inside the rest of the urinary tract he tied a string around the base of the penis during the time of the infusion (matching to the decolorized region of figure ). The routine laboratory tests were unremarkable as well as the culture of urine specimen, which was sterile, while total PSA was slightly increased. During his short stay at the emergency department a suprapubic ultrasonographic evaluation was performed revealing moderate increase in prostatic diameter, borderline obfuscation and lateral lobe microcalcifications. Our patient refused any further urological consultation or psychiatric evaluation, strongly denied any treatment and absconded.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2070_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2070_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d378d5dcf4c49443a2128d48a1fbc1d9dba00a18
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2070_en.txt
@@ -0,0 +1,4 @@
+A 45-year-old Caucasian woman with typical bleeding and pressure symptoms caused by a solitary intramural fibroid contacted our Interventional Radiological Department, asking whether she could be offered UFE. A gynecological examination with ultrasound verified the diagnosis of a fibroid on the back wall of her uterus measuring about 7 cm and confirmed the indication for UFE.
+After standard preparation, arterial access was obtained by the retrograde puncture of her right femoral artery and insertion of a 5-Fr sheath (Radifocus Introducer II, Terumo Corporation, Tokyo, Japan). Angiography of the left internal iliac artery was performed in a crossover maneuver with a 4-Fr diagnostic catheter (Cobra II, Terumo Corporation). This revealed that her left uterine artery was relatively small but exceptionally twisted and tortuous . Selective arteriography using a microcatheter (2.7-Fr; Progreat, Terumo Corporation) revealed a bifurcation of her left uterine artery prior to the junction of the descending and transverse portions, with one branch crossing several centimeters above the other before rejoining at the ascending portion . Superselective catheterization of both branches of the transverse portion of the uterine artery confirmed the unusual anatomic variant . In particular, the lower transverse branch showed all the characteristic criteria for a uterine artery, in form and shape, supplying blood solely to the uterus. Because only the lower segment of the transverse portion had additional small vaginal branches, the upper segment was chosen for embolization of her left uterine artery.
+The embolization was subsequently performed using calibrated microspheres measuring 500–700 μm (Embosphere Microspheres, Biosphere Medical, Paris, France). Access to her right uterine artery was also obtained using a coaxial technique and a 5-Fr diagnostic catheter (RUC, Cook Medical, Bloomington, IN, USA) and the above-mentioned microcatheter. Embolization of her right uterine artery was performed in the appropriate manner. Angiography showed that the fibroid had a strongly right dominant vascular supply.
+Our patient’s post-intervention course was uneventful and she was discharged 2 days later. In the follow-up questionnaire 3 months later, our patient expressed herself sufficiently satisfied with the result of the UFE and stated that she would choose the procedure again.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2071_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2071_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..77ad3c4c1cf04e437a98df317ffef83d9dae6e4c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2071_en.txt
@@ -0,0 +1,6 @@
+A 51-year-old man inadvertently noticed a cervical mass that had been growing rapidly for 1 month. On May 26, 2020, the patient went to the outpatient department of Fudan University Shanghai Cancer Center. He had no dyspnea and was in good clinical condition with an Eastern Cooperative Oncology Group performance status score of 0. However, he complained of pain on touching the mass. Therefore, cervical ultrasound (US) and thyroid computed tomography (CT) were performed in May 2020. Imaging results showed calcified masses on both the lobes and isthmus of the thyroid, suggesting the possibility of thyroid carcinoma. The trachea was shifted to the right and invasion of the internal jugular vein and common carotid artery was observed . Additionally, thyroid CT revealed multiple enlarged cervical nodes at levels II, III, and IV on the left side, each measuring approximately 20 mm. Core needle biopsy (CNB) of the prevailing thyroid nodule confirmed the diagnosis of ATC . Our center performs either immunohistochemistry and/or next-generation sequencing (88-gene somatic mutation analysis panel) as a standard of care for molecular testing of the tumor. NGS revealed three mutations: NRAS c.182A > T (variant allele frequency [VAF] 4.0%), TP53 c.742C > T (VAF 4.9%), and TERT C228T (VAF 3.5%). It was showed in immunohistochemically stained slides that tumor cells were positive for AE1/AE3, CK19, PAX8, P53 (70%), Ki67 (80%), TTF-1, HBME-1 . The cells were negative for thyroglobulin, desmin, and p63. Physical examination revealed a hard nodule sized 2–3 cm in the thyroid region and the trachea was displaced to the right. Abdominal US, brain CT, and chest CT detected no additional metastases. The patient was diagnosed with ATC (cT4bN1bM0, IVB according to the American Joint Committee on Cancer [AJCC] Cancer Staging Manual, 8th Edition) and the tumor was considered unresectable.
+In June 2020, the patient was recruited for a clinical trial that combined multiple-target kinase inhibitors and anti-PD-1 antibodies in patients with advanced thyroid cancer (NCT04521348). He was administered three cycles of famitinib (20 mg/qd) and camrelizumab (200 mg/q3w). The patient exhibited a good clinical status, but suffered from famitinib-induced grade 3 hypertension, which was controlled with nifedipine and valsartan. Famitinib was discontinued for 3 days during the second cycle.
+After three cycles of treatment, CT showed partial response (PR) of the lesion according to the Response Evaluation Criteria in Solid Tumors (version 1.1) . The invaded internal jugular and common carotid arteries were separated. A multidisciplinary team for head and neck cancer offered the patient two main therapeutic options: surgical intervention or medical therapy. After discussion with the patient and his family members, the patient consented to total thyroidectomy and radical neck dissection, followed by radiotherapy.
+Total thyroidectomy with removal of lymph node group VI and left radical neck dissection (groups II, III, IV, and V) were performed in July 2020. Postoperative pathological examination identified a 35-mm (maximum diameter) lesion in the left thyroid lobe and some poorly differentiated tumor nests with degeneration. Necrosis, desmoplasia, calcification, chronic inflammatory infiltration, and foamy histiocyte aggregates were found in the surrounding areas. Cholesterol crystals were observed occasionally, which was consistent with the changes observed after treatment . A 12-mm (maximum diameter) lesion in the right thyroid lobe was diagnosed as papillary thyroid cancer. Necrosis, chronic inflammatory cell infiltration, foam cell aggregation, cholesterol crystals, and multinucleated giant cell reaction were observed in the anterior cervical mass, which was consistent with the changes after treatment. No definite residual carcinomas were observed. None of the 33 neck lymph nodes involved in neck dissection showed signs of metastatic carcinoma. Thus, the diagnosis of ATC was confirmed (ypT2N0M0, IVA according to AJCC Cancer Staging Manual, 8th Edition).
+Postoperative therapy included L-thyroxine (125 μg/d). Positron emission tomography CT showed no masses in the thyroid or neck lymph nodes and no distant metastasis. By August 2020, the patient had recovered well and received intensity-modulated radiation therapy (IMRT) with a dose of 60 Gy (in 30 fractions) to the thyroid bed and cervical nodal regions and 54 Gy to the mediastinal nodes . Following radiation therapy, camrelizumab (200 mg/q3w) was administered for maintenance for 11 cycles. CT was performed to assess the response to camrelizumab in January 2021 .
+Surveys of patient-reported outcomes were obtained approximately 24 months after the diagnosis. They showed a very good quality of life, including continuation of normal activities such as jogging.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_207_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_207_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..62b9c3a9e0b773925cfca800a05012960998a4a5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_207_en.txt
@@ -0,0 +1 @@
+A 61-year-old Japanese woman underwent resection of a malignant peripheral nerve sheath tumor of the hand when she was aged 43 years and was followed up by radiological examination. Chest radiography revealed a mass lesion in the left upper lung 18 years later. She was a current smoker but had no history of asbestos exposure, and presented no specific clinical symptoms. As a result of a detailed examination, she was diagnosed with clinical stage I lung adenocarcinoma. Simultaneously, contrast-enhanced computed tomography (CT) detected a 20-mm enhancing nodule with slow growth on the right diaphragm . 18-Fluoro-2-deoxyglucose positron emission tomography revealed that the maximum standard uptake value of the nodule was 3.5 . Ultrasonography (US) revealed a low-echoic lesion, and early enhancement was observed on Sonazoid-enhanced US . These results indicated that the lesion was a hypervascular tumor of borderline malignancy, such as solitary fibrous tumor (SFT). After a left upper lobectomy for lung adenocarcinoma, the patient was referred to our department for surgical resection of the peritoneal tumor. Laboratory data at the time of presentation were as follows: white blood cell count, 7240 cells/μL; hemoglobin level, 14.2 g/dL; platelet count, 10.4 × 104 cells/μL; aspartate transaminase, 22 IU/L; alanine aminotransferase, 24 IU/L; total bilirubin, 0.57 mg/dL; albumin, 4.1 g/dL; creatinine, 0.58 mg/dL. Serum tumor markers, such as proteins induced by vitamin K absence or antagonist II and alpha-fetoprotein, were within the normal range (25 μg/mL and 2.1 ng/mL, respectively). Laparoscopic tumor resection was performed. Intraoperative findings are shown in Fig. . A thin pedunculated tumor was found to originate from the peritoneal surface of the right diaphragm. The tumor was compressing liver segment 8 but without apparent invasion. Well-developed capillary vessels were observed around the tumor. The pedicle of the tumor was clipped at its origin and divided, and a tumorectomy was completed. Gross examination showed a 28 × 20 x 11 mm3 brown–red tumor with a smooth cut surface . Histopathological examination revealed papillary architecture with focal small aggregates of mesothelial cells . Glandular lumen formation, indicative of an adenomatoid pattern, was partially observed. Immunohistochemical analysis showed that the tumor cells were positive for cytokeratin 5/6 (CK 5/6) and calretinin, and negative for carcinoembryonic antigen (CEA), thyroid transcription factor-1 (TTF-1), cluster of differentiation 34 (CD34), and signal transducer and activator of transcription 6 (STAT6) . In addition, hot-spot mutations in TNF receptor associated factor 7 (TRAF7) were not detected by Sanger sequencing, and the tumor cells displayed negative immunostaining for L1 cell adhesion molecule. Fluorescence in situ hybridization (FISH) showed no homozygous deletion of 9p21 or hemizygous deletion of NF2 (data not shown). Based on these results, the patient was diagnosed with localized adenomatoid mesothelioma. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. She remains alive and is being monitored in an outpatient setting. No recurrence was noted 6 months after surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2096_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2096_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..df34d97a85d8fa91fe59a4b70d5c9504a1b3079d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2096_en.txt
@@ -0,0 +1,3 @@
+A 20-year-old female with no significant past medical history presented with progressive weakness of the right lower limb for 7 months with tingling and numbness of the same limb for 6 months. The weakness in her limb was insidious in onset, which was initially noticed by slipping of slippers but gradually progressed to the point that she needed support while walking. She had a history of mild back pain for 1 month. Her bowel and bladder habits were normal. She had no history of shortness of breath, difficulty swallowing, blurring of vision, double vision, auditory disturbances, abnormal body movements, or trauma of any kind. She had no family history of malignancy or other tumors.
+Her general condition was fair, her vitals were stable, and there were no positive findings on the general examination. The findings of higher mental function examination and other neurological examinations were within normal limits. Other neurological examination findings have been depicted in Table .
+With this history and examination in mind, we suspected the possibility of a mass compressing the spinal cord clinically. Subsequently, MRI scans of her spine and brain were conducted to identify any apparent pathology.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2127_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2127_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..008775e82b804555cf88179a2ba049f1bcea8da9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2127_en.txt
@@ -0,0 +1,5 @@
+A 23-year-old critically-ill male with history of Burkitt’s lymphoma, with graft-versus-host disease (GVHD) requiring high-dose corticosteroids, was admitted to the Emergency Department following a 2 days history of somnolence and confusion with evolving respiratory distress requiring endotracheal intubation. On admission neurological examination, he would open eyes to painful stimuli and continued to follow commands.
+Initial CT head revealed a flame hemorrhage in the left gyrus rectus suspicious for vascular origin and a hypodensity in the left thalamus suspicious for an established infarction. An angiogram performed the next day demonstrated six fusiform aneurysms: three at the frontopolar branch and one at the orbitofrontal branch of the left anterior cerebral artery (ACA); 1 at the frontopolar branch of the right ACA; and one at the anterior temporal artery of the left middle cerebral artery (MCA); . Body imaging revealed cavitary lung lesions. The patient was started on broad spectrum antibiotics, antifungals, and antiviral medications.
+The location of hemorrhage pointed to the left ACA branch aneurysms as the source. Surgery was chosen to allow for inspection of all lesions under direct vision for ruptured status as well as obtain tissue for microbiological purposes. A bicoronal craniotomy, parent vessel sacrifice, and excision of the three aneurysms arising from the left ACA were performed on postbleed day 2. Intraoperatively, the aneurysms were friable, thin walled, and prone to bleeding. The right ACA aneurysms were managed conservatively. Microbiology confirmed angioinvasive S. apiospermum infection. Vericonazole, amphotericin B, and caspofunging were started empirically and continued throughout the disease process.
+CT scan obtained due to neurological deterioration on postbleed day 4 revealed new left frontal intracerebral hemorrhage and intraventricular hemorrhage (IVH). An emergency external ventricular drain was placed and a follow-up angiogram was obtained revealing interval growth of the left orbitofrontal artery aneurysm. Since microbiological diagnosis was available, endovascular parent vessel occlusion was recommended and preceded uneventfully. An interval angiogram on postbleed day 7 demonstrated three new fusiform aneurysms of the right ACA, a new aneurysm of the left anterior choroidal artery (AChA), and the left posterior communicating artery (PCOMA) and confirmed a stable appearing left anterior temporal artery aneurysm. Due to the rapid development of new aneurysms, as well as the hemorrhagic presentation, the treatment was recommended. A3–A3 revascularization was attempted to avoid ACA sacrifice; however, due to the friable nature of the diseased vessels, this was unsuccessful and parent vessel sacrifice had to be performed. An intraoperative angiogram demonstrated a new anterior communicating artery (ACOMA) aneurysm, which was left untreated at the time of surgery. On further follow-up imaging, the ACOMA aneurysm continued to enlarge and, therefore, was treated with endovascular A1 occlusions on postbleed day 9. Finally, continued surveillance imaging demonstrated interval growth of the previously identified left AChA and PCOMA aneurysm, which were ultimately treated with parent vessel sacrifice.
+Despite multiple parent vessel sacrifice, the patient recovered neurologically, continued to follow commands with upper extremities with expected, severe paraparesis in the lower extremities. His follow-up MRI confirmed a thalamic infarct which was already seen on admission imaging and new, incomplete ACA territory infarctions in keeping with the previous surgeries and parent vessel sacrifice of the bilateral ACAs. Due the severe systemic and pulmonary disease, the patient remained intubated and ventilated and underwent a tracheostomy procedure. His subsequent course was complicated with septic shock from multidrug resistant pseudomonas superinfection of the cavitary lung lesions and the patient died 6 months after the hemorrhagic presentation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2128_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2128_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..384157a1651c40641aba4e4639d82c4a48c4ec30
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2128_en.txt
@@ -0,0 +1,3 @@
+A 32-year old gentleman was admitted to our trauma department with a painful, immobile right knee. He sustained the injury externally rotating his knee whilst in “slight flexion” while he was moving from the driver’s seat to the passenger’s seat of his car. He had a history of two previous lateral patellar dislocations on same knee. The first event was 15 years prior, when his knee twisted in flexed position while pushing a car. He was taken to the emergency department where it was successfully reduced under sedation. The second event was four years prior, when he sustained an injury while pushing a van, this time with the right knee fully extended. On this occasion, his patella spontaneously reduced and he did not seek any medical intervention. Our patient had no other significant past medical or surgical history and explained his right knee was completely asymptomatic prior to this current event.
+On examination, there was an obvious deformity suggesting lateral displacement of the patella with a sulcus in the skin evident over the femoral groove. Furthermore, the knee was held fixed in 15 degrees of flexion. Due to patient positioning difficulties we were unable to obtain true AP and lateral views on X-ray. The radiographs demonstrated a laterally displaced and a mal-rotated patella in the vertical plane (see Figs. and ). A manipulation under sedation was attempted unsuccessfully. A further attempt of reduction under a femoral nerve block had again been unsuccessful.
+Our patient was subsequently taken to theatre where one final attempt of closed reduction was carried out under general anaesthetic and muscle relaxation. Ultimately, this failed and an open reduction was performed. The patient was positioned supine and an anterior midline skin incision was used. Complete rupture of the medial patellofemoral ligament (MPFL) was identified with the patella situated lateral to the lateral femoral condyle, everted by approximately 100 degrees. There were no visible deficiencies of the femoral condyles or the patellar articular surface. The patella was carefully reduced by direct manipulation. Following manipulation, the knee joint was washed out with normal saline and the medial patella retinaculum was repaired. After the repair, patella tracking was satisfactory with full range of flexion and extension. Post-operative radiographs confirm the patella in a satisfactory position in the antero-posterior and lateral planes (see Figs. and ). The patient was placed in an extension splint for comfort purposes immediately post-operatively. No weight bearing restrictions were applied. Early mobilization was encouraged after 5 days and the patient was referred for early physiotherapy. At 3 months follow-up, our patient had no further episodes of dislocation, full range of knee extension and flexion, and normal patella tracking. A hypermobility assessment at this stage revealed a Beighton score of 2 with extension beyond 10 degrees of both elbows only.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2129_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2129_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e541c377662735ae8ae310fbfa7d20f0e3eec559
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2129_en.txt
@@ -0,0 +1,3 @@
+A 510 g Caucasian female infant without prenatally diagnosed anomalies was delivered to a previously healthy 37-year-old mother (gravida 7, para 4, ab 2) at 25.7 weeks gestation via cesarean section after pathological findings on cardiotocography and growth retardation. Apgar scores were 3, 6, and 7. The patient was intubated immediately after birth, and broad-spectrum antibiotics (ampicillin + cefotaxime) were started. EA/TEF (Gross type C) was diagnosed via chest x-ray after a nasogastric tube was unable to pass the esophagus. A Replogle tube was placed in the upper pouch with continuous suction, and an umbilical vein catheter was established. Cardiac and renal ultrasound were normal; no additional malformations were diagnosed. The three older siblings of the patient do not have any congenital anomalies and are all healthy.
+On the first day of life (DOL) (10 hours after birth) open TEF clipping was performed via an extrapleural approach in the incubator at the neonatal intensive care unit using a titanium clip (operation time 36 minutes). To reduce the operative trauma in the initial neonatal period and enable extubation after 6 days, we decided to postpone the placement of a gastrostomy. Therefore, we applied total parenteral nutrition (TPN), which resulted in a constant elevation of direct bilirubin (maximum of 200 mg/dl). At 22 DOL (weight 725 g), we created an open gastrostomy (operation time 58 minutes). After steady weight gain (2510 g), we performed a thoracoscopic primary esophageal anastomosis (operation time 93 minutes) at 3 months of age, without tension and without any perioperative adverse events . The patient was weaned from mechanical ventilation after 4 days. A transanastomotic tube was left in place until an upper contrast swallow study was performed 7 days after surgery. After 14 days, the patient was completely on oral feeds.
+Upper endoscopy including balloon dilatations started routinely after 1.5 months postsurgery. There was no event of complete stricture. However, we performed eight dilatations during the first year of life until the anastomotic stenosis resolved. Although the patient experienced one to three respiratory infections per year, there were no events of aspiration pneumonia or sepsis. Currently, the patient swallows effortlessly at the age of 4 years and thrives well [15 kg (Percentile 28); 100 cm (Percentile 24)].
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2150_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2150_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d525a06a33b28d9248560fa1b83c6aa3b671454a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2150_en.txt
@@ -0,0 +1,6 @@
+We report a case of a 28 years old woman, in 33 week of her first pregnancy, who was admitted to our department for severe right flank pain, detected in right hypochondrium, associated with nausea, vomiting, and irritative bladder symptoms. Personal and familial histories were unremarkable. The patient was hemodynamically stable without hematuria, lumbar pain or other urological symptoms. Physical examination revealed no specific findings, a good general condition, an axillary temperature of 38°C, blood pressure of 120/75 mmHg and a heart rate of 78 bpm. Abdominal palpation revealed no masses. The only pathological laboratory test parameter was the hemoglobin 8,7 g/dl and hematocrit of 25,5%, that required the transfusion of two red cell concentrate units.
+Abdominal ultrasound examination revealed a mass, with mixed echogenity, without acoustic shadowing well circumscribed, expanding at the upper pole of right kidney . The mass confirmed with MRI, measuring approximately 7 × 7 × 5 cm in size with evidence of recent extensive retroperitoneal bleeding, with right perirenal and intrarenal hematoma..
+After a couple of hours she was developed an episode of fetal bradycardia, hypotension, and a hematocrit continued to decline, despite repeated blood transfusion, which combined with symptoms of intense lumbar pain and hematuria.
+Considering the hemodynamic instability of the patient, emergency cesarean delivery, under general anaesthesia, was undertaken, because of foetal distress. Exploration of the retroperitoneal space after foetal extraction, confirmed the presence of a large haematoma and the renal mass., which occupied the intrarenal space . Right nephrectomy was performed, and the haemorrhaging contents was evacuated. .
+The histological study of the resected mass revealed the presence of with admixture of mature adipose tissue, smooth muscle, and thick-walled blood vessels.
+A healthy male infant was delivered and the patient had an uneventful recovery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2161_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2161_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b8aada230d906dee92826f1b7abac94043e77da5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2161_en.txt
@@ -0,0 +1,8 @@
+A 34-year-old G4P3 Caucasian woman was followed up antenatally because of a stillbirth in her previous pregnancy. She had had mild pre-eclampsia in her first pregnancy and a Caesarean section was carried out after unsuccessful induction of labor. Her second pregnancy and delivery were uneventful. The reason for the stillbirth in her third pregnancy was found to be an umbilical cord knot.
+In the pregnancy reported here, our patient had polymorphic eruption of pregnancy (PEP) from 26 weeks' gestation and had three separate courses of oral steroids. Anti-D-antibodies were also found to be increased but in quantitative analyses their concentration, however, remained low. She was hospitalized once for a short period in late pregnancy because of an abnormal fetal heart rate recording.
+At 36 weeks' gestation, a hypoechoic, 3.6 × 4.2 cm rounded mass was noted within the placenta on ultrasound examination . An ultrasound scan with umbilical artery Doppler measurement after 28 weeks' gestation was normal and it is likely that the leiomyoma had gone unnoticed probably because no special attention had been paid to the placenta on that occasion. Another explanation could be that the leiomyoma grew very rapidly in the third trimester of pregnancy and it was too small to draw appropriate attention in earlier scans.
+She had induction of labor due to worsening of PEP at 38 weeks' gestation. A viable male infant weighing 3330 g was delivered with Apgar scores of 9 at one minute and 9 at five minutes. The placenta was removed without difficulty.
+A round-shaped nodule was noted on the maternal surface of the otherwise normal placenta. The size of the nodule was 4 × 4 × 3 cm. It had a pale cut surface without hemorrhage, necrosis or calcification .
+Histologically, the nodule was composed of bundles of smooth muscle cells. Nuclei were round or oval shaped and there were no atypical features or mitotic activity . No attached myometrium was identified.
+Immunohistochemistry was positive for the smooth muscle actin antigen (Neomarkers, 1:500). Factor VIII related antigen (Dako, 1:750) and CD34 (Becton-Dickinson 1:20) marked only the endothelial cells, whereas cytokeratin of low molecular weight (Becton-Dickinson, 1:20), placental alkaline phosphatase (Dako 1:20) and desmin (Biogenex, 1:50) were negative. The method used for labeling was streptavidin-biotin. The tumor cells were positive for progesterone receptors but negative for estrogen receptors which is typical for leiomyomas during pregnancy .
+Chromosomes of the tumor were studied from paraffin sections by the fluorescence in situ hybridization technique with X- and Y-chromosome-specific probes and the tumor was found to carry XX chromosomes.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2170_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2170_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b43277dae57de3e569f84a2dbf8d972334764742
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2170_en.txt
@@ -0,0 +1,2 @@
+A 32-year-old man was admitted to our hospital to undergo surgery for colon cancer associated with pancolitis-type UC that had been diagnosed 20 years previously. He was simultaneously diagnosed with PSC ; therefore, his UC was considered PSC-related. PSC and UC had been well-controlled until the development of severe colitis, diagnosed as toxic megacolon 5 years previously and treated using aminosalicylates, azathioprine, and adalimumab; cholangitis was also present, which was treated with endoscopic biliary stenting. After colitis and cholangitis were treated, the patient had been well, and his liver function remained acceptable. However, his total bilirubin level gradually increased to approximately 5–8 mg/dl and colon cancer developed. Surveillance colonoscopy revealed two superficial neoplastic lesions. Slightly elevated lesions were detected in the ascending and transverse colon . Pathological biopsy findings indicated well-differentiated tubular adenocarcinoma in the ascending colon and an adenoma in the transverse colon. Because mucosal reddening was observed in the colon (Mayo endoscopic subscore 1–2), we diagnosed UC-related colon cancer. Isolated proctocolectomy was initially considered, but the patient’s liver function progressively deteriorated with severe concurrent portal hypertension. The Child–Pugh classification was C (score 11), and the Model for End-Stage Liver Disease score was 15. Because his UC-related colon cancer was diagnosed as T1bN0M0 stage I, we expected a postoperative outcome similar to that of sporadic colon cancer [–], which has an estimated 5-year survival rate of > 90% according to the Japanese Society for Cancer of the Colon and Rectum sporadic cancer data . Therefore, we eventually decided to perform LDLT before restorative proctocolectomy.
+LDLT for PSC was performed using a relatively small-for-size (463 g; ratio of the graft volume to the recipient standard liver volume, 38.9%) right liver graft from his 27-year-old wife. Because their blood types were incompatible, rituximab was administered for 2 weeks before surgery. During surgery, severe adhesion was observed between the right lobe and diaphragm with multiple collateral veins that contributed to a large amount of bleeding; however, LDLT was successfully performed without any other significant complications. Biliary reconstruction using Roux-Y hepaticojejunostomy (instead of duct-to-duct reconstruction) was performed, as generally adopted for LT for PSC. The operative time was 619 min and the estimated blood loss was 16,761 g. The postoperative course was uneventful except for the development of small-for-size syndrome with massive ascites (1120 ml/day). The peak total bilirubin level was 20 mg/dl at 10 days after surgery. The patient was discharged on postoperative day 20 after his liver function had normalized. Basic immunosuppression medication consisted of tacrolimus, steroids, and mycophenolate mofetil. There were no signs of rejection. Follow-up colonoscopy was performed at 1 month after LDLT, and no exacerbation of colon cancer was detected. Three months after LDLT, we performed restorative proctocolectomy with ileal pouch–anal anastomosis. Severe adhesion was observed in the upper abdomen. After resection of the colon, a J-pouch was constructed and returned to the abdomen. A hand-sewn ileal pouch–anal anastomosis was created and a temporary diverting ileostomy was constructed. The operative time was 572 min and the estimated blood loss was 1445 g. The postoperative course was uneventful, and the patient was discharged on postoperative day 16. Severe inflammation was observed in the whole resected colonic mucosa, and the right colon was brown because of mucosal hemorrhages . Two superficial neoplastic lesions were detected in the ascending and transverse colon. Pathological examination revealed well-differentiated to moderately differentiated adenocarcinoma in the mucosa of the ascending colon without lymph node metastasis . A low-grade tubular adenoma was observed in the transverse colon . Infiltration of inflammatory cells to the submucosa was observed in the colon. After surgical dilatation of the anastomosis stricture, ileostomy reversal was performed 10 months after proctocolectomy. The patient was well thereafter, with good liver and bowel functions and without tumor recurrence, at > 1 year after proctocolectomy. The entire clinical course of this case is shown in Fig.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_220_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_220_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5b35779ce4a62f8047fba776414c5bea2e615285
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_220_en.txt
@@ -0,0 +1 @@
+A 60-year-old female known case of hypertension and diabetes on treatment had undergone bilateral total knee replacement in 2002. The patient was treated with oral bisphosphonate therapy for osteoporosis, 70mg alendronate once a week orally from 2003 to 2007 (4 years) and then from 2009 to 2013 (4 years). The patient presented to the hospital in January 2013 with pain in the right side of the jaw and pain during mastication since 6 months. From her history, clinical examination and radiological findings she was diagnosed to have osteonecrosis of her right posterior body mandible . This was treated by way of sequestrectomy and saucerization in January 2013 and stoppage of Alendronate. There was no history of the patient having any dental procedure while on alendronate. In March 2013, she was admitted with complaints of pain and swelling over the right thigh following a history of trivial fall, and after clinical examination and history taking, X-rays were done which showed an atypical right displaced subtrochanteric fracture through the focally thickened lateral cortex of proximal femur . The fracture was managed surgically with proximal femoral nailing . The knee replacement was unrelated to the sub-trochanteric fracture. For the subtrochanteric fracture of femur, regular follow-ups were done postoperatively with serial X-rays. Blood investigations were done, and serum calcium was 9.5mg/dl, and serum Vitamin D3 was 20ng/ml which was optimized with 6,00,000 IU of intramuscular Vitamin D3 and maintained by oral Vitamin D3 medications. At 3 months, the fracture was in delayed union , and hence, the patient was started on injection Teriparatide 20mcg subcutaneous for a period of 18 months. The patient was kept non-weight bearing. The 6 months X-ray showed further progression in fracture healing , and the patient was allowed partial weight bearing. In October 2013, 10 months after stopping Alendronate, she again came with the complaint of pain in the right side of the jaw; X-rays showed relapse of ONJ sequestrectomy was done on the right mandible. In February 2014, 13 months after stopping Alendronate, the patient came with the increased pain of the right mandible and was diagnosed as a fracture of the right mandible; the fracture was operated on and fixed with a plate in February 2014 . Meanwhile, the patient continued injection Teriparatide. At 1year postoperatively, the atypical femoral subtrochanteric fracture had healed and the patient was allowed full weight bearing. 24 months postoperatively, X-rays confirmed solid union of the atypical subtrochanteric femoral fracture . On recent review, the patient walks full weight bearing without the need of any support, with a normal gait and is completely asymptomatic as regards the femur as well as the jaw.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2212_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2212_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..313ff361c56a6d3514779fcddd8abe924d9ec743
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2212_en.txt
@@ -0,0 +1,5 @@
+A 24-year-old woman was referred to the ENT service with the presentation of a painless mass in the right supraclavicular region from 2 years ago. The mass had increased in size over that time. The patient had no history of trauma, surgery, inflammation, fever, nocturnal sweating, weight loss, dysphagia, shortness of breath, or hoarseness. Furthermore, there was no history of cutaneous neoplasms, visceral malignancies, or family members with similar presentation. In her past medical history, she had multiple sclerosis and is being treated with rituximab.
+A physical examination revealed a 3×4 cm firm, semi-mobile, semi-compressible, none tender, round mass in the right supraclavicular region. The skin over the swelling was normal and non-adherent to the underlying mass.
+There was no abnormal pulsation or bruit. Moreover, no cervical lymphadenopathy was appreciated. The CT scan of the neck with contrast revealed a heterogeneous solid mass measuring 40×25×20 mm infiltrated the most distal part of the right sternocleidomastoid muscle in the base of the neck containing mottled hyperemic foci. The CT scan report was compatible with mesenchymal sarcoma . FNAC showed benign-looking follicular cells. Then ultrasonography of the neck was performed, with a normal thyroid on both sides. A heterogeneous focus contained multiple tubular, tortuous foci and low flow without connection to the right thyroid in the inferior-lateral region of the sternocleidomastoid muscle insertion on the right. The first diagnosis was vascular malformation. Doubting the FNA's answer, the FNA repeated, which was bloody. According to the findings, the decision was made to perform surgery. The surgical dissection showed a thrombosed vascular mass of the supraclavicular region originating in the sternocleidomastoid muscle .
+The pedicle of the mass in the muscle was ligated, and the swelling was excised completely. Furthermore, there was no recurrence of the tumor at the 6-month follow-up. Histopathological examination confirmed the diagnosis of cavernous hemangioma.
+A macroscopic inspection of the surgically excised specimen showed a well-defined mass lesion 4.3 × 3.2 × 2.5 cm, revealing a brownish-red solid cut surface with a soft consistency. Microscopic inspection showed a benign vascular lesion featuring cavernous hemangioma composed of large dilated vascular channels lined by flat endothelium .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2223_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2223_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a2d0e23af360534a494447c195064d60a2d004b0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2223_en.txt
@@ -0,0 +1 @@
+An 88-year-old white woman with a history of vascular dementia and idiopathic pulmonary fibrosis (IPF) presented with a 4.5 cm left-sided level III anterior cervical lymph node . Prior to her onset of dementia and IPF, she was otherwise healthy. Her family history was not relevant for hematologic malignancies or cancer. She denied tobacco smoking. In addition to her neck mass, she developed night sweats and 1.8 kg (4 pound) weight loss. No lymph nodes were detected in her right supraclavicular, axillary, and inguinal regions. Auscultation of her lung bases revealed dry crackles. Hepatomegaly and splenomegaly were not observed. A computed tomography (CT)-guided core needle biopsy was done on September 16, 2014. A core, rather than excisional biopsy was considered given her severe lung disease and inability to tolerate general anesthesia. Tissue examination showed B cells of follicular origin, admixed with high-grade large cells . Flow cytometry showed clonal B cell population (36% of total cellularity) positive for CD10, CD19, and CD20 . Cells were Kappa-restricted associated with < 1% natural killer (NK) cells. Examination of her tumor biopsy showed a CD4:CD8 ratio of 9:1 without aberrant T cell antigen expression. EBV in situ hybridization was not performed. Positron emission tomography (PET-CT) revealed single uptake above the clavicle on the left side with standardized uptake value (SUV) of 4.9 confirming stage 1B disease. Her International Prognostic Index (IPI) was 2 points: low intermediate risk group; age > 60 years, lactate dehydrogenase (LDH) of 599, stage 1, Eastern Cooperative Oncology Group (ECOG) of 0. In addition, given her history of dry coughing and shortness of breath, a chest CT was obtained, which revealed honeycombing, bronchial wall thickening, and subpleural ground glass opacities suggesting interstitial pneumonitis . Her symptoms were controlled with inhaled β-agonists without administration of orally administered or systemic steroids. Her peripheral blood flow cytometry detected increased proportion of cells with cytotoxic potential including human leukocyte antigen-antigen D related (HLA-DR) + T cells (57%, normal 9–36%; absolute count of 884/mm3, normal 177–692/mm3) and double positive (DP) CD4/CD8 T cells (4%, normal 0–2%; absolute count of 62 mm3, normal 0–50 mm3) . After discussion of treatment options, she opted for best supportive care. Three months later, during a routine follow-up examination, it was noted that the lymph node had completely regressed. Ultrasonographic and clinical remission were documented in October 2016, 25 months after her initial CT-guided biopsy. She died with progressive respiratory insufficiency attributed to IPF without evidence of lymphoma in December 2016.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2226_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2226_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8b66b34292cbb6ba0a7244994c1a593a8cabbf41
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2226_en.txt
@@ -0,0 +1 @@
+Having made a bet with his friend on whether yew or juniper is more poisonous, a 39-year-old Caucasian healthy man consumed a decoction from needles of the common yew (Taxus baccata) at approximately midnight. Gradually, weakness, nausea and vomiting began. Subsequently, clonic spasms developed in his extremities, followed by heart failure and blood circulation arrest. Urgent resuscitation, assisted via telephone, was started according to the instructions given by the dispatch center and lasted for five minutes. The emergency call was received at 7.30 a.m., and an ambulance arrived at 7.35 a.m. He arrived in the emergency department at 8.15 a.m., where bradyarrhythmia of 25 to 30 beats/min shifted to ventricular tachycardia (fibrillation) with repeated defibrillation. Indirect heart massage by means of an AutoPulse® (Zoll Medical Corporation, Chelmsford, MA, USA) device and extended cardiopulmonary resuscitation (CPR) were performed the entire time. Blood circulation was supported with noradrenaline 0.1mg/min intravenously. Adrenaline was repeatedly administered at a total dose of 6mg intravenously, plus sodium bicarbonate 300ml 8.4%, calcium gluconicum 10ml, calcium resonium 6 in graduated measures into a nasogastric tube, amiodarone 450mg intravenously and potassium and magnesium hydrogen aspartate 20ml intravenously. External and internal stimulation of the heart was ineffective. Taking into account the known cause of the blood circulation arrest and the probable absence of a delay in CPR, the introduction of venoarterial extracorporeal membrane oxygenation (VA-ECMO) was indicated as a rescue support therapy until the blood circulation was stabilized. DigiFab® (digoxin-reactive Fab protein, Protherics Inc., Brentwood, TN, USA) 120mg intravenously as an antidote was administered. Gradually, his blood circulation stabilized, and his heart rate was restored. Concurrently, clinical and laboratory signs of adult respiratory distress syndrome were observed. Corticotherapy with methylprednisolone 125mg intravenously once daily was started. VA-ECMO was successfully disconnected the next day; his oxygenation improved, and his Glasgow Coma Scale score was 3. An attempt to discontinue the use of sedation led to the development of generalized spastic activity. Our patient was evaluated for serious post-hypoxic encephalopathy with generalized myoclonic seizures. After a protracted, intensive rehabilitation period and symptomatic therapy, our patient was bedridden and breathing spontaneously, with minimal cortical reactivity and a persisting serious neurological deficit. It is not clear if our patient’s improvement was due to the therapy with DigiFab® or the result of supportive therapy. A native computed tomography (CT) scan of the brain showed slight hypodensity in the basal ganglia and post-ischemic changes after prolonged hypoxemia .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2282_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2282_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..057df0ee19b1f23b4886b78813370e284b72c467
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2282_en.txt
@@ -0,0 +1 @@
+The patient was a 19-year-old African American woman who underwent uncomplicated full-thickness-penetrating keratoplasty in her right eye (OD) for advanced keratoconus. One week after surgery, she sustained a blunt trauma to OD that resulted in graft dehiscence from 3 to 5 o'clock, which was repaired surgically. Postoperatively, she received a topical steroid (prednisolone) 4 times a day tapered to 3 times a day at 3 months. Four months after surgery, her uncorrected vision was 20/60 in OD, with 6 dpt of against-the-rule astigmatism. Two corneal sutures were removed with the guidance of topography. Four days later, the patient presented with redness, irritation, and sudden decrease in vision in OD to count fingers at 2 feet with intraocular pressure (IOP) of 11 mm Hg. Corneal examination showed diffuse haziness with stromal edema, Descemet membrane folds, and an incomplete Khodadoust line . A diagnosis of acute corneal rejection was made. Intravenous pulse methylprednisolone (Solu-Medrol), 1 g daily for 3 days, was initiated, in addition to an hourly topical steroid (prednisolone). At 3 days after initiation of treatment, the patient was seen to have progression of the Khodadoust line and no improvement in graft rejection. At that point, a 1-mL subtenon injection of 40 mg/mL of triamcinolone was placed in the superotemporal quadrant. The patient was asked to continue topical steroid drops and was started on oral prednisone, 60 mg/day. Seen a week later, she showed improvement in vision to 20/80 in OD, although it was fuzzy according to the patient. There was a remarkable clearance of corneal edema and improved clarity in the superior half of the graft, with the inferior half remaining hazy . IOP was 16 mm Hg. The patient was observed for another week with no further improvement. On the basis of the response to the initial subtenon triamcinolone injection, she received additional injections of 0.5 mL of triamcinolone (40 mg/mL) in the inferonasal and inferotemporal quadrants. Four days later, the corneal graft rejection had completely resolved, with no keratic precipitates and with complete resolution of corneal edema and haze . Her vision improved to 20/50, and IOP remained stable at 14 mm Hg. Topical prednisolone was decreased to 8 times a day for 2 weeks and subsequently to 4 times a day. Oral prednisone was tapered to stop. At her last follow-up, 5 months after the injections, the corneal graft remained clear.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2283_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2283_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7303b4325b886bad09f35b29c1e3c5df0e1b669e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2283_en.txt
@@ -0,0 +1,7 @@
+A 39-year-old Indonesian male presented to the digestive clinic department with a 7-day history of jaundice. Jaundice was associated with epigastric discomfort, nausea, loss of appetite, and skin itch. He had a history of benign brain tumors and underwent craniotomies three times, at ages 16, 17, and 24. The type of brain tumor and specific procedure are not well known by the patient. Six months before the onset of jaundice, he was diagnosed with diabetes mellitus and began taking oral diabetic medications. The family history was remarkable; it was revealed that two of the four siblings of the patient have similar conditions. Both of his siblings underwent brain tumor resection, total pancreatectomy, and nephrectomy for Von Hippel-Lindau (VHL)-associated tumors. Vital signs were within normal range, and physical examination revealed jaundice on the skin and sclera, epigastric pain, and a palpable lump in the epigastric region and both of his flanks.
+Laboratory workup revealed elevated bilirubin levels, with serum total bilirubin of 6.54 mg/dL and conjugated bilirubin of 5.24 mg/dL. The contrast-enhanced MRI of abdomen with MRCP revealed dilatation of biliary tree consisting of right and left intrahepatic bile duct, common hepatic duct, cystic duct, and common bile duct without the presence of stone with suspicion partial obstruction by multiple cysts in the pancreas with diameters ranging from ±0.5–5 cm with ring enhancement, multiple cyst lesion with ring enhancement in both kidney and gallbladder hydrops with cholecystitis . PET/CT scan showed an ametabolic hypodense lesion in the left side of the cerebellum, multiple hypodense nodules or cysts with multiple calcifications covering the entire pancreas, a solid hypermetabolic nodule in the left adrenal gland with suspicious pheochromocytomas, and an ametabolic hypodense multiple lesion in both kidneys. All radiologic findings correspond to von-Hippel-Lindau disease .
+Total pancreatoduodenectomy was decided after considering the lesion in the entire pancreas, which contains solid and cystic nodules, also the presence of endocrine pancreatic insufficiency. Following an evaluation of his fundamental condition and the exclusion of any contraindications, surgery was scheduled.
+Intraoperatively, it was discovered that the cysts were seen in the entire pancreas with dilatation of biliary tree . Therefore, total pancreaticoduodenectomy was performed and followed by reconstruction with end-to-side choledochojejunostomy, side-to-side gastrojejunostomy, and subhepatic drainage was placed .
+The histopathological findings showed multiple serous cystic neoplasms with calcification. Immunohistochemically, the report further confirmed multicystic pancreatic hamartoma with neuroendocrine cell hyperplasia and the lesion still showed an islet of Langerhans structure. Diagnosis is supported by diffuse positive in Cytokeratin 19 (CK19) and CK7 in cystic lesions, negative CEA, positive synaptophysin and chromogranin in nodular lesions, and positive Ki67% (0.2 %) which exclude adenocarcinoma or neuroendocrine tumor findings .
+The management of the patient is optimally performed by an interprofessional healthcare team. Glycemic control after total pancreatectomy is handled and monitored by an endocrinologist. The insulin regimen prescribed for the patient was as follows: 10 IU of basal insulin taken in the evening, 8 IU and 10 IU of rapid-acting insulin given bolus during breakfast and dinner, respectively. The treatment for exocrine insufficiency was enzyme-substitution drug, which contains amylase, protease, deoxycholic acid, dimethylpolysiloxane, vitamin B1, vitamin B2, vitamin B6, niacinamide, and calcium pantothenate. In addition, with radiologic findings of multiple cyst lesions in both kidneys and a solid nodule in the left adrenal gland with suspicion of pheochromocytoma, close monitoring by a urologic surgeon was advised.
+After three months of follow-up, the patient's main complaints were unstable blood glucose levels with variations of about 60 up to 400 mg/dL and an average of 200 mg/dL checked by a home-use blood glucose meter. Moreover, the patient report having at least three loose bowel movements each day and oftentimes fatty stool (steatorrhea) after overindulging in a high-fat diet. At six months follow-up, the blood glucose was controlled within the range 80-200 mg/dL and could take a normal low-fat diet without steatorrhea.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2285_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2285_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f3c5bbb443ab8563456dd1eb1b3b33e213a7f241
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2285_en.txt
@@ -0,0 +1,4 @@
+A 16-year-old girl complained of pain in her right knee for one year and claudication while walking for two weeks. The patient said that pain had gradually developed in the lower part of the thigh one year ago. The pain increased during walking and was relieved after rest. Physical examination showed that the right knee joint had a valgum deformity , the lower part of the right thigh did not touch an obvious mass, the inner side of the lower part of the right thigh had local tenderness, and the flexion and extension function of the knee joint was acceptable. X-ray showed valgum deformity in the right knee, osteolytic bone destruction in the metaphyseal segment of the right femoral shaft, discontinuity of the medial cortex and sclerosis at the edge of the lesion, and separation could be seen inside. We classified the knee valgum deformity according to Ranawat . On the full-length positive X-ray of both lower limbs, a femoral tibial angle < 10° is type I, a femoral tibial angle of 10°-20° is type II, and a femoral tibial angle > 20° is type III. The femoral tibial angle of this patient was 19.7°, which belonged to Ranawat type II . It can be seen that the eccentric, osteolytic and well-defined focus of the femoral metaphysis on the X-ray . CT showed that the medial bone cortex at the metaphyseal segment of the femur was fractured, with eccentric osteolytic destruction and sclerotic margins . MRI showed a low signal in the metaphyseal segment of the femur, a fractured medial cortex and a clear edge on the T1 image . Puncture pathology showed that nonossifying fibroma was possible but that giant cell tumor of bone could not be excluded . The patient was young and had a long history. The focus originated from one side of the bone cortex, and map-like eccentric osteolytic destruction was present at the metaphyseal segment of femur, with a clear boundary, sclerotic edge, no involvement at the bone end, separation in the focus, and secondary valgum deformity. It was more likely to be non ossifying fibroma after multidisciplinary discussion. The operation plan was curettage, osteotomy, orthopedic bone grafting and internal fixation.
+We completed the relevant preoperative situation of the patient and planned to carry out expanded tumor curettage and osteotomy. The patient's valgum deformity was located in the distal femur, and there was no deformity of the tibia. The amount and direction of osteotomy were designed according to the Miniaci method. The ankle joint center (B) and knee joint center (C) were connected on the full-length film of both lower limbs, and the line was extended to the proximal end. The position of the osteotomy hinge point (A) was 5 mm above the lateral condyle of the femur and approximately 5–10 mm inward from the lateral cortex. This point was the center of the circle (A). The line was rotated between this point (A) and the center of the femoral head (O) and intersected the extension of line BC at D. The rotation angle (∠ OAD = 19.5°) was the osteotomy degree . The hinge point was taken as the apex, and an isosceles triangle was made toward the medial cortex of the distal femur. The top angle of the triangle was the osteotomy degree mentioned above, and the length of the bottom edge was 1.26 cm, which was the length of the medial cortex of the femur to be corrected .
+We made a medial incision in the distal femur. An oval window was opened on the medial bone cortex, with a window area of approximately 5 × 1 cm. The diseased tissue in the medullary cavity was scraped off, the medullary cavity was ground with a grinding drill, the medullary cavity was burned with an electric knife, and finally, the tissue was soaked in anhydrous alcohol for five minutes. According to the preoperative design, two Kirschner wires were inserted and served as the osteotomy positioning guide needle. The angle was checked via fluoroscopy and determined to be too small; then, another Kirschner wire was implanted. On fluoroscopy, the osteotomy angle was good. The outermost two Kirschner wires were equivalent to two sides of the isosceles triangle planned in the preoperative design. The Kirschner wires intersected 5–10 mm inside the cortex of the lateral condyle of the femur, which was the hinge point of the osteotomy . The distance between the two Kirschner wires (red lines on Fig. C) was the bottom edge of the isosceles triangle planned preoperatively and was approximately 1.26 cm . A wedge-shaped osteotomy was made with a pendulum saw was used to control the osteotomy depth, stopping when it was close to the contralateral cortex and protecting the contralateral hinge; then the osteotomy end was closed slowly . After fluoroscopic examination indicated that the mechanical axis of right lower limb was satisfactory, the medial plate of the distal femur was implanted . The flexion and extension function of the knee joint was good, and the fracture end was stable. After washing, the broken end medullary cavity was implanted with allogeneic bone, and the drainage tube was placed and sutured layer by layer.
+The patient performed muscle strengthening by isometrically contracting the quadriceps femoris in the hospital bed. When there was no obvious pain, knee flexion and extension exercises were started. The incision was changed regularly to observe whether there was an infection. Postoperative pathology showed giant cell lesions, proliferation of stromal spindle cells, local bleeding and new bone formation . Combined with the medical history, the final diagnosis is considered nonossifying fibroma. The full-length X-ray of the lower limbs showed that the mechanical axis of right lower limb had been corrected. The femoral tibial angle was 5°, the range of motion of the knee was 0° -130°. There was no tumor recurrence five months after operation, X-ray showed that the lateral fracture line was blurred but not completely healed, and the bone graft in the medullary cavity was partially absorbed. One year after the operation, there was also no tumor recurrence, the lateral fracture line was completely healed, and obvious osteogenesis was present in the medullary cavity .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2292_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2292_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d854ef7d61cb84f28f94e09ccb88492d2f7c418a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2292_en.txt
@@ -0,0 +1,4 @@
+A 65-year-old female with a history of type 2 diabetes mellitus, systemic arterial hypertension and long-standing right hearing loss. She began his condition 21 days before his initial evaluation in July 2023, presenting with moderate to intense holocranial headache that partially subsided with the use of non-steroidal anti-inflammatory drugs. She had previously been diagnosed with dementia due to retrograde memory and language disorders. In the neurological examination with Glasgow 13 points (O:4, V:3, M:6), mental functions with global aphasia, isocoria of 3 mm, preserving photomotor and consensual reflexes, right side conduction hearing loss, preserved motor function, sensitive without response to pain in the right hemibody. No evidence of intracranial hypertension or history of seizures. A simple and contrasted tomography was performed, showing the presence of two lesions at the level of both ventricular trigone each one apparently, which were confirmed by magnetic resonance imaging (MRI) scan indicating periventricular lesions with extension to the white matter of the temporal and parietal lobes, a clear reduction of the ventricular space of both atrium was observed, no communication between these lesions through fibers of the corpus callosum, with mostly uniform enhancement at gadolinium contrast , and restriction to diffusion. Metastasis, high-grade glioma, and lymphoma were considered as a differential diagnosis, which was complemented by a thoracic and abdominal tomography without evidence of systemic lesions. Serological studies were performed , viral profiles for EBV, CMV, and HIV, as well as tumor markers, which were all negative. Subsequently, a spectroscopy study was performed 8 days before treatment with dexamethasone, where peaks of choline and creatine were observed, a high choline/creatine (Cho/Cr) ratio, with peaks of lipids and lactate, as well as a decrease in N-acetyl aspartate (NAA), suggestive of malignancy and presence of areas of necrosis.
+A temporal craniotomy with a transulcal T2–T3 approach guided by a neuronavigation system was performed. Biopsy samples were taken. The tumor was identified as infiltrative and diffused in the white matter, with gray color, soft consistency, and necrotic core. The ventricle was not opened. No complications were presented.
+Histopathology revealed diffuse large B-cell lymphoma with an angiocentric pattern with positive immunohistochemical staining for CD20 and Ki67 in 70% .
+The patient had a complicated course due to pneumonia, was discharged from the hospital 15 days after surgery, and was referred to an oncology center.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2329_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2329_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..436558db50bc7c191a2b2730aed2b2328fddda9b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2329_en.txt
@@ -0,0 +1,2 @@
+A 79-year-old man visited our institution because of an extensive IVC tumor and a small right renal tumor. He had had edema in bilateral lower extremities for 2 months and also felt abdominal distension from 3 weeks before. He underwent CT and blood test to investigate the cause of his symptoms at the hospital where his type 2 diabetes mellitus was being treated. CT showed an extensive intravenous tumor in the IVC causing hepatic ischemia and ascites and concurrently indicated small right renal tumor. He visited our department due to suspected IVC-TT associated with RCC. His blood test revealed abnormal values of Hb (11.1 g/dL), AST (191 U/L), ALT (446 U/L), and CRP (4.73 mg/dL), but other laboratory data were within normal range. Dynamic CT, abdominal MRI, and US were performed . Dynamic CT revealed a renal mass of 15 mm in size on the right lateral aspect in corticomedullary phase, suggesting RCC. The intravenous tumor was enhanced heterogeneously, expanding the lumen and extending from the right atrium to the L4 vertebral level and also into the bilateral renal veins with right-sided predominance. This intravenous tumor was suspected to have arisen from the smooth muscle of the IVC wall, such as leiomyosarcoma, rather than TT associated with RCC because the renal tumor was too small for extensive IVC thrombus and the direct invasion of the small renal tumor into the renal vein could not be detected by MRI and US. To confirm the histological diagnosis, we performed biopsies of both the intravenous and renal tumors. Eight days after the patient's first visit to our hospital, he simultaneously underwent an ultrasound-guided biopsy for the small renal tumor and a percutaneous transvenous biopsy for the intravenous tumor. The procedure of the percutaneous transvenous technique is summarized in Table and Fig. . Based on pathological findings and no finding of other metastatic lesions, the final diagnosis was clear cell RCC with IVC-TT .
+The patient's general condition rapidly deteriorated from KPS 60 at his initial visit to 40 in just 3 weeks. Therefore, he and his family chose supportive care at their home, and declined surgery and systemic therapy such as immune checkpoint inhibitors.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_233_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_233_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d042c48f6f93c4cea3e5d782b26020113d87da3d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_233_en.txt
@@ -0,0 +1,8 @@
+A one-year-and-10-month-old Taiwanese girl was admitted to our hospital because of acute gastroenteritis with severe vomiting and diarrhea for two days.
+The index patient was referred to our genetic clinic because of unusually severe hypokalemia. She had been recently admitted to our hospital because of acute gastroenteritis with severe vomiting and diarrhea for 2 d. On admission, we noted generalized weakness. Laboratory investigations showed severe hypokalemia (1.9 mmol/L) . The patient was treated with intravenous potassium supplementation (potassium chloride, 0.15 mEq/kg of body weight per hour) under the diagnosis of hypokalemia related to acute gastroenteritis. The patient’s symptoms gradually improved after treatment. Therefore, the patient was discharged, and post-discharge follow-up was suggested.
+Based on the birth history, the girl was previously healthy and denied any systemic diseases.
+During a consultation held at our hospital, the patient’s mother said that her 7-year-old daughter was also diagnosed with hypokalemia at another hospital, but no further investigations were performed. In addition, her 17-year-old daughter had been experiencing muscle cramps and muscle pain associated with a severe reduction in daily activities for several years.
+No history of salt-craving, tetany, motor developmental delay, arthralgia, or arthritis was observed. Her growth parameters and blood pressure were also within the normal range.
+During outpatient follow-up, recurrent severe hypokalemia (2.6 mmol/L) was observed. Subsequent laboratory investigations, including blood analysis, showed metabolic alkalosis with hypokalemia (2.9 mmol/L) and borderline hypomagnesemia (1.9 mg/dL). Normal thyroid, adrenal function, plasma renin, and aldosterone levels were noted. Urinalysis revealed renal potassium wasting (urine potassium 39 mmol/L, urine potassium-creatinine ratio 15.6 mmol/mmol, transtubular potassium gradient (TTKG) 8.9), increased level of urine chloride (64 mmol/day), and hypocalciuria (0.4 mg/dL, urine calcium to creatinine ratio 0.01). Based on the above laboratory findings, a renal tubular disorder was highly suspected. Further, family history revealed that the hypokalemia might have been due to genetic processes.
+Laboratory investigations showed that potassium levels were as follows: eldest daughter, 1.9 mmol/L; second eldest daughter, 4.1 mmol/L; third eldest daughter, 2.1 mmol/L; and index patient, 2.4 mmol/L. In addition, the potassium levels of the mother and father were 4.5 mmol/L and 4.2 mmol/L, respectively. To date, some autosomal recessive tubular disorders presenting with hypokalemia, metabolic alkalosis, and hypocalciuria have been established in the family.
+Venous blood samples were obtained from the three affected individuals with severe hypokalemia and their parents after detailed informed consent. Blood samples were sent to the DNA diagnostics laboratory (SOFIVA GENOMICS). According to their established protocols, the laboratory performed an exon-wide sequencing analysis of the gene SLC12A3. Genetic analysis of the gene SLC12A3 in the three affected individuals with severe hypokalemia revealed compound heterozygous mutations of the gene SLC12A3: c.179C>T in exon1 and c.965-1_976delinsACCGAAAATTTT in exon8, respectively. These two mutations are known to be associated with GS . Both parents were heterozygous carriers of GS-associated mutations found in their daughters. The mother was the carrier of c.179C>T, and the father was the carrier of c.965-1_976delinsACCGAAAATTTT (see Figure ).
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2342_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2342_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..951de88e0324ea35956b3e024c7f0e723559cc7d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2342_en.txt
@@ -0,0 +1,3 @@
+A 32-year-old, unrestrained male driver was involved in head-on motor vehicle accident at high speed. He was initially evaluated at the pre-hospital setting and was reported to be hemodynamically stable. On arrival, his score on the Glasgow Coma Scale was 15, blood pressure 110/75 mm Hg, pulse rate 100/min, and respiratory rate 17/min. The patent had a deep scalp laceration, signs of recent nasal bleeding and facial bruising suggestive of a high-energy head injury while he was also complaining of a mild mid-epigastrium pain.
+On exam, the patient was alert and oriented. The chest wall was not tender to palpation. Auscultation of the chest wall did not reveal any pathology. The abdomen was non-distended, soft with mild tenderness however to palpation of the upper abdomen (mid-epigastrium). Motor and sensory function of all extremities was intact. The urine was grossly clear. Initial radiographic studies included a supine chest film that besides a widened mediastinum was generally inconclusive. Ultrasonography in the trauma unit did not show any abnormal fluid collection. The initial hematocrit value was 39.5% and blood gas pH was 7.37 with a base deficit of 3.8. Meanwhile the patient started complaining of nausea and several blood-spotted vomiting episodes were noted. An investigation in the direction of a traumatic brain injury was conducted with a standard protocol head Computed Tomography (CT) scan. No evidences of midline shift were observed. The presence of a possible intracranial hematoma or a cranial bone fracture was ruled out. Notable oedema of the facial soft tissues, without however underlining fractures, was an additional finding. Approximately, six hours after the initial imaging evaluation, the persistence of patient’s symptoms i.e. vomiting as well as the migration of pain into the lower thorax dictated an additional workup. A second chest x-ray was obtained. (Figures . An elevated left hemi-diaphragm with the stomach in the left chest was observed. Abdominal CT scan confirmed the presence of a left-sided diaphragmatic tear with herniation of abdominal context within the left hemi-thorax. (Figures .
+The patient underwent emergency laparotomy via a midline incision where a near total herniation of the stomach into the left hemithorax was observed. No resection was necessary as there were no ischemic changes or signs of perforation of the involved organ. The stomach was then successfully reduced into the abdomen revealing the hernia opening about 5 cm in length. (Figures . A primary repair with interrupted non-absorbable sutures was carried out without the use of a prosthetic mesh. (Figures . The relatively small size of the hernia opening was the main argument for this approach. A chest tube was not necessary as pleura was not violated and a pneumothorax was not present. Operating time was 45 minutes. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2347_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2347_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3bcfb50c052bd146b76c1836bb7cc1876855fdc9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2347_en.txt
@@ -0,0 +1,2 @@
+The patient was a 38-year-old single man from Kerman city who was admitted in Shahid Beheshti Hospital of Kerman four years ago because of aggression and behavioral change for the first time. According to the patient, he has been using oral Ritalin for the past 6 months and in the recent months, he has diluted tablets in water and injected intravenously and after injection, the shape and meaning of objects have changed for him. He had sometimes injected even up to 4 Ritalin tablets. According to the patient, he feels that he has parasitic infection and he sees cockroaches with blue color crewel on his body and because of that he has burned different parts of his body by cigarettes to destroy them. Also, he sees these bugs on the floor and around objects and because of that he fired house items many times and even fired his bed, TV and personal computer (PC). Even once, his entire house was burned in fire. Sometimes he washed objects with water to destroy bugs. He would stand under the shower for hours to send away these bugs. People around him have always seen him playing with water or fire. Along with these symptoms, he was suspicious to others and believed that they have prepared amulet for him and followed him sometimes. He complained of sleeplessness and restlessness. In physical examination, multiple skin abscesses and acute cellulitis caused by injections were visible on different areas of his body and there was bilateral pitting edema on his legs. He had also tachycardia and there was no problem in the brain CT scan and heart echocardiography.
+In psychological condition examination, he was restless and to some extent irritable. He also had flight of ideas and noted vision and touch fantasies as well as delirium of harm and damage and being under control. Attention was reduced but immediate, near and far memories were natural. Also, knowledge of time, place and person was normal. Impairment in judgment and vision was evident. The patient was hospitalized for the diagnosis of psychotic disorder due to Ritalin injection and after preventing Ritalin consumption and recovery from infection symptoms, fornication signs were resolved. In later interviews with the patient, schizophrenic symptoms such as deliriums of pessimism and being under control were detected and the patient was treated for schizophrenia diagnosis. After discharge, in spite of regular medication, he was hospitalized for two times and both times it was after Ritalin tablet injections and he was discharged after disease symptoms were controlled and there was no obstacle for medication. By preventing Ritalin consumption after discharge, he has not experienced psychotic symptoms yet and his background disease is under control with anti-psychotic drugs.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2350_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2350_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..66422146f254feebe2c7916e839389f221ea2421
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2350_en.txt
@@ -0,0 +1,3 @@
+First case is a 62-year-old female patient hospitalized in our clinic due to chest pain with a history of arterial hypertension and diabetes mellitus. Cardiac biomarkers showed: serum creatinine kinase level of 82 IU/L, creatinine kinase-myocardial band level of 33.6U/L and troponin-T level of 684ug/L. Electrocardiography characterized with ST segment depression in V1-V3. Transthoracic echocardiography (TTE) presented regional wall motion abnormality in the entire severely hypokinetic inferior wall.
+The invasive coronary angiography revealed the left coronary artery arising from the right coronary sinus sharing a same ostium with right coronary artery . The proximally and distally stenosed left anterior descending artery (LAD) associates with calcified atherosclerotic medial and distal right coronary artery (RCA) stenosis. The second case is a 47-year-old male who presented to emergency department with chest pain. He also had arterial hypertension and positive familial history for ischemic heart disease. Cardiac biomarkers: serum creatinine kinase, creatine kinase-myocardial band and troponin-T presented with normal values. Electrocardiography showed atypical ST segment changes in leads V4-V6. Transthoracic echocardiography (TTE) did not present regional wall motion abnormalities.
+A coronary angiogram showed an anomalous right coronary artery arising from the left Valsalva sinus from a separate ostia with the left coronary artery . Medial and distal segments of LAD were tortuous.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2356_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2356_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..83f1cb4050b0be980b8bc6e1851dab3fa69d343b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2356_en.txt
@@ -0,0 +1,10 @@
+The patient was a 27-year-old woman who first visited our hospital 4 years prior because of pain in the left femur. She was diagnosed with a left femoral synovial sarcoma with simultaneous multiple lung metastases. After chemotherapy, the primary lesion and lung metastasis decreased, and she underwent extensive resection of the primary lesion and lung metastases. During follow-up, abdominal computed tomography (CT) revealed a mass in the pancreatic tail. Before that time, only a chest CT was performed, and the abdomen was not evaluated. No notable hematology abnormalities were observed, and tumor markers (carcinoembryonic antigen: 0.7 ng/mL and carbohydrate antigen: 19–9: 7 U/mL) were within the normal ranges.
+Contrast-enhanced thoracoabdominal CT revealed a large, 35-mm tumor in the pancreatic tail showing heterogeneous contrast enhancement without calcification or bleeding. Lymphadenopathy and distant metastases were not observed.
+Abdominal magnetic resonance imaging revealed that the tumor in the pancreatic tail was similar to that in the primary left femoral lesion, showing a low signal on the T1-weighted image, a slightly hyperintense tumor containing multiple cystic components on the T2-weighted image, and a high signal on the diffusion-weighted image. The inside of the pancreatic tail tumor was heterogeneous and partly showed a water signal that was indicative of necrosis. 18F-fluorodeoxyglucose positron emission tomography CT revealed abnormal fluorodeoxyglucose accumulation only in the tumor of the pancreatic tail, with no other metastatic findings .
+The preoperative diagnosis was synovial sarcoma recurrence of pancreatic tail metastasis, and laparoscopic distal pancreatectomy was planned. However, 2 weeks after the outpatient consultation, she developed left upper quadrant abdominal pain at night after drinking a small amount of alcohol, and she visited our emergency department. Her vital signs were as follows: pulse, 66 beats/min; respiration, 18 breaths/min; blood pressure, 100/60 mmHg; and temperature, 36.8 °C. Physical examination revealed tenderness and rebound pain in the left upper quadrant of the abdomen. Hematology findings revealed leukocytosis (13,400 cells/mm3) and anemia (hemoglobin: 11.0 g/dL).
+Contrast-enhanced abdominal CT performed in the emergency department revealed ascites with high CT values in the liver surface and pelvis , and leakage of contrast medium in the anterior of the pancreatic tail tumor to the omental bursa . The diagnosis was intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tail tumor, and an urgent distal pancreatectomy was, therefore, performed.
+During the emergency surgery, approximately 1500 mL of hematoma was observed during laparotomy, and bleeding from the tumor of the pancreatic tail was identified after opening the omentum . The splenic artery and vein were isolated and individually ligated to control the bleeding. The pancreas was dissected with linear stapling devices for over 15 min, and distal pancreatectomy was performed . The operation time was 123 min, including the hematoma suctioning, and the amount of bleeding was 1530 mL; the patient required four units of concentrated red blood cell transfusion.
+Ascites cytology was performed during the emergency surgery and after surgery, and the results were negative.
+According to the International Study Group of Pancreatic Fistula classification, a pancreatic fistula of the grade “biochemical leak” was observed, and she was discharged on postoperative day 18.
+Analysis of the resected specimen showed that the capsule of the pancreas tail tumor was ruptured, and the tumor parenchyma was exposed . Upon histological examination, hematoxylin and eosin staining revealed the presence of monophasic spindle cells that grew solidly with stag horn-like vessels. Immunohistochemistry revealed that the tumor cells were positive for B-cell lymphoma 2 and CD99 but lacked expression of CD34, alpha-smooth muscle actin, desmin, and S100. Some of the tumor cells tested positive for epithelial membrane antigen. The MIB-1 proliferation index identified via MIB-1 staining was approximately 70%, indicating a high-grade sarcoma, and the tumor was compatible with synovial sarcoma metastasis to the pancreas . The resection margin of the pancreas was negative; however, tumor cells were exposed from the capsule owing to tumor rupture, and tumor cells were observed in the hematoma.
+Regarding the follow-up after discharge, the patient has been carefully monitored without chemotherapy, because the target lesion has been previously resected, and confirmed to be in relapse-free survival for 6 months.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2360_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2360_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..86b842529f0e317adc4c582dccf4fb94b7a577f9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2360_en.txt
@@ -0,0 +1,2 @@
+A 47-year-old male was brought to the emergency department from his primary care physician’s office after complaining of blurred vision and pain in his left eye for the prior four weeks. The patient initially dismissed these symptoms as a headache or optic neuritis, which he had previously experienced due to his medical history of multiple sclerosis. However, his vision gradually deteriorated over time, with the appearance of floaters and a significant increase in pain two weeks prior to presentation. On physical examination, the patient’s left eye had a visual acuity of 20/60 and a superior temporal field cut. Unfortunately, his right eye had previously suffered vision loss due to optic neuritis and could only perceive light. The intraocular pressure in the left eye was 14 millimeters of mercury (mm Hg), while the right eye’s pressure was 11 mm Hg. The patient’s neurologic examination was otherwise unremarkable.
+The ophthalmologic exam revealed left conjunctival injection and ciliary flush. Dilated ophthalmic examination showed peripheral retinal whitening in the superonasal area of the left eye, as well as high-grade inflammation in the anterior chamber (3+ cell) and vitreous cavity (2+ cell) . Laboratory testing revealed a rapid plasma reagin titer of 1:256, with the patient testing negative for HIV. He was treated with intravenous penicillin 4 million units every 4 hours for 14 days. Ultrasonography of the eye revealed echogenic particles within the vitreous, with a possible undulating membrane that moved freely and swirled on dynamic exam . The patient’s retina was attached, and the diameter of the optic nerve was within normal limits.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2382_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2382_en.txt
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index 0000000000000000000000000000000000000000..c1e0451d657df648a6f3a7d9fb5af12554a99d6f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2382_en.txt
@@ -0,0 +1,3 @@
+A 66-year-old Macedonian male presented with symptoms of constipation and blood in the stool (hematochezia) for 3–4 months before seeing a gastroenterologist. Review of his medical records revealed no family history of note. The outer anal examination revealed old thrombosed hemorrhoids, and endoscopy revealed an obstructive neoplastic mass located 5–7 cm from the anus. The tumor tissue showed diffuse ulcerations and bled when touched. Eight biopsy specimens were taken for pathohistological examination. The diagnosis of mucinous AC with signet ring cells was made. Radiographic examination showed no pathological findings in the liver, pancreas, spleen and lungs, but revealed a tumor mass in the left lower kidney pole with infiltrating border that caused compression to the collector system. Preoperative computed tomography confirmed synchronous tumors in the kidney and rectum . The patient was admitted to the University Clinic of Abdominal Surgery in Skopje for surgical treatment. Laboratory tests showed elevated values for the enzymes lactate dehydrogenase (612 U/L), alkaline phosphatase (387 U/L) and C-reactive protein (up to 45.7 mg/L). A medial laparotomy was performed, with surgical resection of the anterior rectal area, simultaneously with left nephrectomy. Carcinosis in the small pelvis was observed.
+Tissue samples were analyzed at the Institute of pathology, Faculty of Medicine in Skopje. Gross rectal examination of tissue specimens showed a rectal tumor measuring 5.5 cm infiltrating into the perirectal fat. The kidney contained a yellowish round tumor measuring 5 cm, with necrosis and hemorrhage. The adrenal gland was slightly enlarged into perirenal fat. The tissue specimens were fixed in formalin, embedded in Paraffin and routinely stained with hematoxylin & eosin stain. Microscopic analysis revealed PSRCCR with nodal metastasis, lymphatic and vascular tumor emboli and uncommon metastasis to synchronous RCC and to the adrenal gland . The tumor was classified as Stage IV according to the pTNM/UICC staging system. All specimens were analyzed immunohistochemicaly with CK20, CDX2, vimentin, RCC, E-cadherin and the mismatch repair (MMR) proteins MLH1, MSH2, MSH6 and PMS2. Signet ring cells were positive for CDX2 and CK20 . The absence of expression of E-cadherin in the metastasized cells indicated that they were the same as those in the primary carcinoma .
+There was nuclear expression only of MMR protein MSH6, whereas the MMR proteins MLH1, MSH2 and PMS2 showed loss of the nuclear signal . Therefore, the tumor was further analyzed molecularly using the ABI 310 DNA analyzer (Applied Biosystems, Foster City, CA, USA), which revealed a microsatellite stable (MSS) tumor. Molecular analysis showed mutations in TP53 and ERBB2, as determined by next-generation sequencing of AKT1, BRAF, EGFR, ERBB2, FOXL2, GNA11, GNAQ, KIT, KRAS, MET, NRAS, PDGFRA, PIK3CA, RET and TP53. The patient died a few months after surgical treatment.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2401_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2401_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..39c786b98d05307cca5c7848f8e5adad06987aa2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2401_en.txt
@@ -0,0 +1 @@
+A 32-year-old asymptomatic woman with a mediastinal mass found by CT scan 2 years ago was admitted to our hospital. Physical examination and laboratory tests showed no significant abnormalities. Contrast-enhanced chest CT scan revealed a sharply marginated mass, 24 × 33 mm in size, in the right superior mediastinum . A right-sided video-assisted thoracoscopic thoracotomy was performed, a 3 cm uniport through the 4th intercostal at midaxillary line was made to perform the procedure. Intraoperatively, a 4 × 3 cm mass was found in the right superior mediastinum, which was originated from the right vagus nerve. The boundary of the tumor was clear, and the tumor was excised completely . Grossly, the tumor was encapsulated by a complete envelope, with yellow-colored solid component inside . Histologic examination revealed that the tumor was formed by spindle cells and loose myxoid tissue, which clarified the diagnosis as schwannoma . The patient recovered uneventfully after the surgery, and was discharged on the 3rd postoperative day.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2402_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2402_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d86e2037d2da0de31cad29dec866a100590b3004
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2402_en.txt
@@ -0,0 +1,5 @@
+A 60-year-old Caucasian male from Austria presented with dyspnoea, intermitted claudication and fatigue. In the last 2 months he noticed an unvoluntary weight loss of 15 kg. Physical examination showed an indolent resistance on the right flank. Blood sample in a peripheral vein showed results within normal ranges (haemoglobin 13.1 g/dl, white blood cell count 6.7 G/l; polymorphonuclear cells 63.5%, lymphocytes 13.5%, monocytes 9.0%, eosinophils 13.0%, basophils 0.5%, platelet count 158 G/l; serum creatinine 1.16 mg/dl), whereas urinary analysis showed microhaematuria and proteinuria.
+An ultrasound (US) examination (Acuson Sequoia, California, USA) of the abdomen and pelvis showed a large and hypoechoic retroperitoneal mass surrounding the right kidney with extension into the right renal hilum and no evidence of urinary obstruction. The contralateral kidney appeared to be normal.
+A 4-row helical CT examination (4 Volume Zoom, Siemens, Erlangen, Germany) of the whole body with a standard examination protocol showed a retroperitoneal mass (with 14.8 × 11.5 cm size) from the right kidney and infiltrating Gerota’s fascia (see ). Lymphadenopathy was detected in the lower part of mediastinum and in the retroperitoneal space with borderline size values. Beside infitrative destruction of the flanking right rip no further infiltration of other organs or metastasis was found. The volume of liver and spleen was within normal range.
+Scintigraphically, a radioisotope Tc-99m bone scan showed no suspicious lesions.
+US guided percutaneous biopsy of the retroperitoneal mass was performed under local anaesthesia. Immunohistochemical stains were positive for bcl-2, bcl-6, CD10, CD20 and negative for CD 5, CD23, Cyklin D1. The histological diagnosis was a grad 2 low proliferating follicular non-Hodgkin lymphoma (NHL). Chemotherapy was started according to the CHOP scheme. The tumor responded well to the chemotherapy and about 70% of regression was achieved after six courses of chemotherapy. Thereafter a nephrectomy with complete lymph node dissection and dissection of the retroperitoneal mass has been performed. Final diagnosis was a primary renal non-Hodgkin lymphoma (NHL).
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2418_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2418_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..346d46c00cf699f1e3831c0112bc98890866d6fd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2418_en.txt
@@ -0,0 +1,8 @@
+A 53-year-old Chinese female presented to the Emergency Department of our hospital for persistent abdominal pain and distension for over two months. Two months ago, the patient went to a local hospital and obtained a transvaginal ultrasound that revealed thickened bilateral fallopian, suggesting adnexitis. She was treated with antibiotics, but the pain persisted. The serum CA125 and CA724 levels were elevated (469U/ml and 33.4U/ml, respectively). Abdomen and pelvis computed tomography (CT) showed heterogeneous stomach and bilateral adnexal masses, suggesting adnexal lesions or the Krukenberg tumor. She was then referred to the emergency room of our hospital.
+In our hospital, she received thorough examinations. A gynecological examination revealed an abdominopelvic mass with an unclear boundary. The transvaginal ultrasound showed a 3.9×2.3cm solid pelvic mass with ascites . The abdominal and pelvic enhanced CT, the pelvic magnetic resonance imaging (MRI), and the positron emission computed tomography (PET-CT) all revealed irregular, heterogeneous, and plump bilateral adnexal masses with diffusely thickened peritoneum, omentum, and mesangium, multiple soft-tissue nodules, slightly thickened intestinal wall, abdominal and pelvic effusion, and multiple enlarged lymph nodes . The serum CA125 level was 439U/mL. The chest X-ray showed no abnormality. The patient underwent bilateral tubal sterilization more than 20 years ago and was found with a Helicobacter pylori infection two months ago. She went into natural menopause for one year and gave birth to two children. Personal and family history were unremarkable.
+Considering the possibility of ovarian or gastrointestinal malignancies, the patient was admitted to our hospital. After admission, the patient developed aggravated abdominal distension with an increase in body temperature to 39℃. After four days of intravenous anti-inflammatory, the patient underwent diagnostic laparoscopy with omentum and peritoneum biopsies in a stable condition, which suggested poorly differentiated carcinoma according to intraoperative consultation. About 2 liters of tawny ascites were drained for cytology confirmation during the operation, which revealed no tumor cells. The surgical findings showed multiple white granular tumor implants studding the omentum, peritoneum, and the surface of the diaphragm, liver, intestine, and uterus. A 9×9×3cm omental cake enclosed part of the intestine and was fixed. The omentum and intestine obscured bilateral ovaries and fallopian tubes. Combined with laboratory, imaging, and surgical findings, the possibility of advanced (stage IV) ovarian cancer was considered. Given the difficulty in performing satisfactory cytoreductive surgery, the patient was treated with three cycles of neoadjuvant chemotherapy with Paclitaxel-albumin, Carboplatin, and Bevacizumab.
+After chemotherapy, the patient’s serum CA125 level was reduced to 107 U/mL. Imaging examination showed reduced abdominal and pelvic effusion, while abdominopelvic lesions were roughly the same as before . The pathological findings of the previous operation excluded the common types of epithelial ovarian carcinoma, breast carcinoma, and neuroendocrine neoplasm. Still, the diagnosis could not be confirmed due to the poor differentiation characteristics of the tumor cells. Upper GI endoscopy and colonoscopy were performed to distinguish gastrointestinal tumors, but no mucosal lesions were identified . The patient further underwent cytoreductive surgery, which showed a 20×10×4cm extensive gritty nodular omental cake densely adhered to the pelvic wall and part of the intestine and mesentery . The mesostenium and mesocolon were extensively thickened with contracture and stiff morphology. A heterogeneous mass about 2.5cm in diameter was found on the surface of the small intestine. The posterior wall of the uterus closely adhered to the rectum, and bilateral ovaries were enlarged with a solid nodular appearance . Total hysterectomy and bilateral salpingo-oophorectomy were performed. The omentum, small intestinal mass, and left pelvic lymph nodes were also removed. All specimen was submitted for pathological confirmation. It was an unsatisfactory cytoreductive surgery (R2), with the postoperative residuals being the diffuse thickened malignancy lesions in the mesentery. The patient recovered in a stable condition without any complications and was discharged home 13 days after surgery.
+Microscopic examination showed malignancy infiltration in bilateral ovaries involving the omentum, peritoneum, mass on the small intestine surface, and the serosa of the uterus and bilateral fallopian tubes. The tumor cells were uniform monotonous medium-sized round and oval with small-to-moderate eosinophilic cytoplasm, enlarged nuclei, high nuclear/cytoplasmic ratio, and uneven chromatin . Lymphatic vascular involvement and lymph node metastases were frequently observed . Solid sheets and nests of typically undifferentiated cells infiltrating surrounding normal omental tissue were present, with no abrupt keratinization . Comparing the two surgical specimens, there was no significant regression of tumor cells after neoadjuvant chemotherapy . Malignancy infiltration was found on the serosa of the uterus, while typical structures of the endometrium and myometrium remained, suggesting that it was not a primary uterine neoplasm . It is noteworthy that although the malignancies significantly infiltrated the ovary, most of the ovarian cortical and corpus albicans were intact. The lesions were mainly close to the ovarian hilus and surrounded by large blood vessels , so the possibility of secondary ovarian malignancy cannot be excluded.
+IHC was conducted to help confirm the diagnosis . Tumor cells positively expressed monoclonal ER, INI1(SMARCB1), BRG1(SMARCA4), and ARID1a, with patchy expressions of monoclonal PR, P16, Syn, SATB2, and CK8/18. The β-Catenin and P120 were positive in the cytoplasm. The Ki-67 labeling index was approximately 30%. There was no expression of CK pan , p40 , p63 , and other IHC markers (i.e., CD56, CK7, WT-1, TTF-1, Desmin, C-myc, CgA, CDX2, INSM1, SSTR2, SSTR5). Details of all the IHC results were listed in . Based on the morphological and IHC features, 14 malignancies with similar morphology were compared, including ovarian serous carcinoma, ovarian clear cell carcinoma, ovarian germ cell neoplasms, ovarian sex cord-stromal neoplasms, neoplasms associated with the SWI/SNF complex, colorectal carcinoma, invasive lobular carcinoma of the breast, poorly differentiated hepatic cholangiocarcinoma, low grade endometrial stromal sarcoma, high grade endometrial stromal sarcoma, rhabdomyosarcoma, malignant peripheral nerve sheath tumors, histiocytic sarcoma, and plasmacytoma . Additionally, to distinguish it from Ewing sarcoma, dual-color break-apart FISH was conducted to test for EWSR1 gene rearrangements, which revealed a negative result.
+Finally, we conducted NUT immunostaining (clone C52B1) and revealed diffusely positive expression in the nucleus of tumor cells . However, the FISH experiment found no disruption or translocation of the NUTM1 gene locus . We subsequently identified the gene fusion of MXI1 exon 5 (NM_130439.3) to NUTM1 exon 3 (NM_175741.3) via a targeted RNA-based NGS platform (DA8600, Daan Gene, Guangzhou, China) on tissue samples, which finally confirmed NUT carcinoma two months after cytoreductive surgery . Besides, we also identified the gene fusion of MTMR3 exon 5 (NM_021090.4) to SFI1 exon 3 (NM_001007467.3).
+One week after diagnosis, the patient developed fever and an increased burden of malignancy, with imaging of advanced diffusely thickened peritoneum, omentum, and mesangium, progressed multiple metastatic lymph nodes, and newly developed abdomino pelvic effusion. Unfortunately, although the patient was adequately informed and the potential feasibility of antitumor therapy was introduced, the patient refused further treatment due to financial difficulties and decided to be discharged to a local hospital for symptomatic relief and supportive treatment. She developed systemic symptoms and passed away four months and 18 days after cytoreductive surgery .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2430_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2430_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e7ad4824e163ba065a293cc9081ca36c64c35c20
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2430_en.txt
@@ -0,0 +1,14 @@
+The patient was admitted for recurrent lower extremity edema for 9 mo, abdominal distension for 7 mo, and aggravation for half a month.
+A 53-year-old rural Chinese woman visited Dafang County People’s Hospital. Symptoms began to appear nine months ago, during which edema and abdominal distension of both lower extremities recurred, and these gradually worsened during the previous two months. Our initial liver function examination showed elevated alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL); decreased albumin/globulin (ALB/GLO) ratio . Examination of blood cells indicated decreased white blood cells (WBCs), red blood cells (RBCs), hemoglobin (HB), and platelets (PLTs) . Examination of coagulation function indicated an increased international normalized ratio (INR), prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT), and decreased fibrinogen (FIB) . An upper abdominal computed tomography (CT) showed liver cirrhosis . Examination of thyroid function showed an elevated level of thyroid stimulating hormone (TSH) and a decreased level of free triiodothyronine (FT3) . We therefore initially considered a diagnosis of “decompensated stage of cirrhosis and subclinical hypothyroidism”.
+She tested negative for hepatitis viruses and negative for autoimmune hepatitis, and the cause of cirrhosis was unknown. She was subsequently hospitalized twice for abdominal distension with yellow staining of the sclera, but these symptoms resolved after administration of a liver protectant and a diuretic to reduce swelling. After discharge, she still reported repeated abdominal distension and discomfort, which gradually became worse from 2020 Oct 1. Since the initial presentation, her liver function indexes have fluctuated. The thyroid function tests indicated a decreasing level of triiodothyronine (T3) and an increasing level of TSH, indicating progression from subclinical hypothyroidism to clinical hypothyroidism.
+She reported loss of vision 30 years ago, with no obvious cause, and had no history of long-term heavy drinking, taking a Chinese medicine, exposure to toxic substances, surgery, or trauma.
+We designated the index patient as proband II-1, and analyzed her pedigree . She had five siblings (3 sisters, 2 brothers), all of whom had night blindness, and one sister (II-4) was completely blind. Her parents had no night blindness or impaired vision, but their marriage was consanguineous (first cousins).
+We performed serum biochemical examinations of the father (I-1) and all siblings . The mother (I-2) was too old to travel to our institution for testing. The AST level was elevated in all 7 individuals, and fasting blood glucose was decreased in the father and 4 siblings. Two siblings had elevated levels of high density lipoprotein cholesterol (HDL-C), and one had a low level. The T3 Level was low in two siblings, and the TSH level was high in three siblings. Some of the siblings also had elevated levels of TBIL and apolipoprotein A-I (APOA1).
+CT examinations showed that neither the father (I-1) nor the mother (I-2) had cirrhosis . Sibling II-2 had cirrhosis , but siblings II-3, II-5, and II-6 did not . Abdominal color ultrasound indicated that sibling II-4 had a fatty liver.
+A physical examination indicated she had a BMI of 22.22. There was also evidence of chronic liver disease, visible spider nevi, and palmar erythema. She had no vision in either eye, and no K-F rings in the corneas. A cardiopulmonary examination showed no obvious abnormalities. Her abdomen was slightly distensible and was positive for shifting dullness. There was moderate pitting edema in both lower limbs.
+2020 Oct 14: Blood lipid analysis indicated an HDL of 1.42 mmol/L. Hepatitis A virus, hepatitis B virus, and hepatitis C virus related tests were all negative.
+2021 Jan 17: All antibody tests for autoimmune liver diseases were negative.
+2021 Jul 16: Examination of ascites indicated the Rivalta test was negative, the WBC count was 50 × 106/L, total protein (TP) was 5.50 g/L, adenosine deaminase (ADA) was 3.4 U/L, glucose (GLU) was 8.71 mmol/L, and lactate dehydrogenase (LDH) was 48.8 U/L.
+2020 Oct 15: Color Doppler ultrasonography of the thyroid showed bilateral thyroid cysts.
+2020 Oct 23: A plain CT scan of the upper abdomen with enhancement showed cirrhotic ascites with splenomegaly .
+We suggested more extensive examination of a liver biopsy to clarify the cause of cirrhosis, but this was not possible because the patient did not consent. The index patient was one of 6 siblings; II-2 was similar (night blindness complicated with cirrhosis and hypothyroidism), II-5 was completely blind in both eyes, and the other three had obvious night blindness. We considered the possibility of GLD, and suggested molecular genetic analysis. After receiving informed consent, we collected peripheral blood samples for whole-exome sequencing . The results indicated the presence of the deletion/insertion mutation C.802-8_810delinsGC (homozygous) in the cytochrome P450 4V2 (CYP4V2) gene and the transcoding mutation C.413dupA (heterozygous) in the dual oxidase activator 2 (DUOXA2) gene. The same CYP4V2 mutation was present in I-1, I-2, II-2, II-3, II-5, II-6, II-3, and II-5 also had the DUOXA2 mutation. Patient II-4 did not receive genetic testing because he lived in Tianjin.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2439_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2439_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b8b3c60d03faf931bcd2136595150273d5aa314f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2439_en.txt
@@ -0,0 +1,4 @@
+A 69-year-old woman presented to the emergency department due to worsening dyspnea and subsequent loss of consciousness. She had a 2-year history of progressively worsening wheezing and stridor, and had been diagnosed with asthma. However, treatment with bronchodilators and steroid inhalers failed to resolve the symptoms. An arterial blood gas sample on 15 L/min of oxygen demonstrated type II respiratory failure (pH 6.87, PaO2 63.6 Torr, and PaCO2 181.0 Torr). The patient was immediately intubated with a single-lumen endotracheal tube, but arterial carbon dioxide levels remained elevated (pH 6.81, PaO2 345.0 Torr, and PaCO2 194.0 Torr). Chest roentgenography indicated a round mass shadow at the lower tracheal level above the carina . An emergent chest computed tomography scan revealed a tumor in the trachea, which almost completely obstructed the lower tracheal lumen and located just above the carina. Bilateral pneumonia was also observed (A-B). Bronchoscopy revealed a large vascular neoplasm with a smooth yellowish-white surface in the lower region of the trachea, causing almost complete airway obstruction .
+Because complete excision of the tracheal tumor was considered possible, surgery was performed for complete excision of the tumor to relieve airway constriction. The patient was initially placed in a supine position, and venovenous extracorporeal membrane oxygenation was performed. The inflow cannula was directed into the right internal jugular vein and the outflow cannula was directed into the right common femoral vein. Ventilation was stopped, and gas exchange was performed via VV ECMO. After positioning the patient in the left decubitus position, a right posterolateral thoracotomy was performed through the fourth intercostal space. We performed carinal resection coupled with reconstruction. Anastomosis was performed as a modified montage-type carinal reconstruction (A-D). A latissimus dorsi flap was used for anastomotic reinforcement. The VV ECMO was dislodged following closure of the thoracotomy, and the patient was extubated for 3 h in the intensive care unit after surgery.
+There were no postoperative complications, and the patient was discharged 11 days later. Postoperative CT performed 2 months after surgery demonstrated no evidence of stenosis at the site of the anastomosis .
+Macroscopic findings showed a 15 mm-sized, well-demarcated heterogeneous tumor (A). Histologically, the tumor showed biphasic proliferation of the epithelial component and chondromyxoid stroma with cartilage formation (B-C). Necrosis and mitotic figure were absent. Immunohistochemically, the epithelial tumor cells were diffusely positive for AE1/AE3, CK7, S100, and SMA in various proportions. The Ki-67 labeling index was approximately 1 %. Histological analysis confirmed that the tumor was a pleomorphic adenoma of the trachea, and that the surgical margins were disease-free. She was doing well without local or distant recurrence at her follow-up visit 12 months after surgery, and is currently being followed up as an outpatient.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2440_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2440_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..31df0fae2fa58b5f3d5b8c2a147d0c5d94193c7a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2440_en.txt
@@ -0,0 +1,4 @@
+A 62-year-old woman with type-2 diabetes mellitus and high blood pressure came to the emergency department with nine days of malaise, high-grade fever, cough, and progressive dyspnea, which led to acute respiratory failure that required invasive mechanical ventilation. A polymerase chain reaction for the SARS-CoV-2 virus was positive. Chest radiography showed bilateral ground-glass opacities and alveolar infiltrates. Biochemical analyses showed leukocytosis (13 000 cells/mm3) with neutrophilia (11 900 cells/mm3), lymphopenia (510 cells/mm3), and an elevated hs-C reactive protein (5 mg/dl), with preserved renal and liver function. She was started on IV dexamethasone and transferred to the intensive care unit.
+On the third day, the patient had a sudden hemodynamic collapse with hypotension, tachycardia, and increased blood lactate levels, requiring vasopressor support. An electrocardiogram showed ST-segment elevation in the precordial leads with diffuse T-wave inversion . Transthoracic echocardiography showed severe left ventricular (LV) systolic dysfunction, with regional wall motion abnormalities characterized by extensive mid and apical dyskinesia with preserved mobility in the basal segments (Supplementary Video). Hs-Troponin I was measured and found to be 8000 ng/L (reference value: 14 ng/L). An emergency coronary angiography was performed to rule out an acute ST-elevation myocardial infarction. We documented normal flow in all coronary arteries and no relevant obstructions.
+Left ventriculography showed diffuse apical dyskinesia with basal segment hyperkinesia and apical ballooning, consistent with an apical variant of Takotsubo syndrome (TTS) (Supplementary Video).
+She was started on levosimendan and her hemodynamic parameters and clinical status improved, which allowed us to withdraw vasopressors. We continued the management of severe COVID-19 pneumonia with respiratory support. Echocardiography showed normal wall motion in all territories and recovery of LV function on day seven (Supplementary Video). The patient had a good clinical evolution, was weaned from respiratory support, and was discharged with complete recovery after one month of hospitalization.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2455_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2455_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..94234bd19e32155b269b89d11ecf2313b1300d12
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2455_en.txt
@@ -0,0 +1,2 @@
+A 75-year-old female patient presented with sudden-onset flaccid paraparesis for 1 day. The patient had a history of diabetes and hypertension. Neurological examination showed grade 2–3 motor weakness of both legs, decreased deep tendon reflex, loss of anal tone, and numbness below the T4 dermatome. There was no fever, cardiopulmonary symptoms, pain of extremities, or palpable lymph nodes. Magnetic resonance imaging (MRI) revealed an intramedullary mass lesion on T2-T4 with cord swelling and edema from C7 to T6. The lesion was iso-intense on T2-weighted images (WI) and iso- to slightly low-intense on T1-WI with heterogeneous enhancement . No additional lesions were found on the brain and whole-spine MRI. Whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) confirmed the single lesion on T2-4 with a maximum standardized uptake value (SUVmax) of 3.14 and no systemic lesion . Leg weakness deteriorated to G1 prior to surgery.
+Under the laminectomy of T2-T4 and opening the dura, enlarged thoracic cord with a normal superficial appearance was noted. Midline myelotomy allowed the identification of a white-gray-colored and soft-natured mass lesion with an ill-defined boundary . The mass lesion was located at the central portion with a slight deviation on the right inside the cord. Gross total removal was achieved under intraoperative neuro-monitoring with no signal change. The patient showed no change in neurologic function after surgery. Histological examination revealed diffuse infiltration of foamy (lipid-laden) histiocytes with uniform nuclei and abundant cytoplasm . On immunohistochemical staining, foamy histiocytes showed diffuse and strong expression of CD163 and CD68 (histiocytic marker) , and there were negative for CD1a, S100, and BRAFV600E mutation . No systemic lesions were noted on the preoperative radiological examinations; therefore, we confirmed this case as variant ECD with isolated intramedullary involvement. There was no recurrence or new development of mass lesions on MRI and whole-body FDG-PET/CT at 12-month follow-up . The patient became self-standing and aid-walkable with recovery of anal tone and sensory impairments. Unfortunately, sudden paraplegia occurred again at 18-month follow-up, which was confirmed that it was developed by unknown originated thoracic cord infarction. There was no evidence related with recurrence or new lesion of ECD on spine MRI and whole-body FDG-PET/CT .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_248_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_248_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c99820cf917bc2ef36cd5d632bf1f8dd5a67f99c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_248_en.txt
@@ -0,0 +1,13 @@
+The case is a 26 years old lady who had referred to a gynecologist because of infertility 2 years ago. She has married 8 years ago and after 2 years, she decided to have child. During the first two years of marriage they used natural method for contraception and she had not used any OCP or IUD. Her menarche was at the age of 14 and from then on she has a regular and normal monthly menstruation.
+She had a negative past medical history with no sign or symptoms of neurologic diseases such as anxiety or depression. She had also no history of any clinical disease, pelvic or abdominal surgery, and extensive weight loss and drug or alcohol abuse.
+In her family history the only positive clues were; the presence of hypothyroidism, diabetes and vitiligo in her mother and aunts. In physical exams: BMI=23, secondary sexual signs were normal and there was no sign or symptom of hirsutism, acne or any other systemic disease. Evaluation of her husband revealed normal male factor and spermogram. Laboratory findings included: serum FSH, serum LH, serum prolactin, TSH, testosterone, progesterone and estradiol which all of them were at the normal range.
+Post coital test (PCT) and histrosalpangography were normal. Diagnostic laparoscopy showed no signs of tubal adhesion or endometriosis. After seven months and performing primary and secondary evaluation, she was diagnosed as a case of unexplained infertility and IVF was suggested for her.
+About 9 months ago, the patient had a medical consultation because of diarrhea and 3 kg of weight loss. She reports a history of 12 months intermittent, non bloody and osmotic diarrhea which consists of normal bowel habits intervals. There was no history of fatty stool or consumption of laxatives.
+Lab findings:
+HB: 11.8 (NL: 12-16) MCV: 76 (NL: 80-95)
+MCH: 27 (NL: 36-48) Serum Fe: 110 (NL: 80-180)
+TIBC: 320 (NL: 250-460) Serum Ferritin: 54 ngr/ml (12-300) CRP: +ESR: 18 S/E: negative
+OB: negative. AST: 29 IU (NL: 5-40)
+ALT: 31 IU (NL: 8-40)
+Considering iron deficiency anemia, intestinal signs and the history of 4 years infertility, we became suspicious to celiac disease and checked serological factors (total IgA and tTG).
+The positive results of these tests (Total IgA>40 and tTG>30) followed by upper GI endoscopy and biopsy of the second portion of duodenum. The obtained tissues were observed by two expert pathologists and they reported severe malabsorption with flattening of villi, hyperplasia of crypts and total atrophy of mucosa which was presenting stage III of modified marsh classification ( and ). Based on patient's history and serologic and pathologic findings diagnosis of CD was confirmed and she received a complete gluten free diet. After 3 months all her clinical features including; diarrhea, flatulence and anemia were eradicated and pregnancy occurred.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2533_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2533_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8d0235e99ff20bcd1ba0f01b44f974390d30b337
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2533_en.txt
@@ -0,0 +1,4 @@
+A 20-year-old male presented to the casualty with a history of an injury to the back of the head as a result of a fall. He complained of severe pain in the neck and shoulder region with difficulty in raising both arms and in gripping objects. On examination, Glasgow coma score was 15/15 and the vitals were within normal limits. There was no evidence of head injury, raised intracranial pressure, respiratory distress or paradoxical breathing.
+Local examinations findings revealed tenderness in the upper cervical spinal level and severe spasm of the para- spinal muscles.
+On neurological examination, he had weakness of both arms, more on the right, involving the C5 to T1 distribution and brisk reflexes. There was no sensory deficit. The only other abnormality on neurological examination was brisk reflexes in the lower limbs but power was intact. There was no involvement of the cranial nerve(s).
+Open mouth odontoid view radiograph and a computed tomography (CT) scan of the cervical spine showed a type III undisplaced odontoid fracture. MRI showed a signal abnormality in the spinal cord at the level of the cervicomedullary junction extending up to the body of C2 vertebra. The patient was treated with traction in Gardner Wells tongs for six weeks. Upon removal of the traction a sterno-occipital-mandibular immobilizer immobilizer (SOMI) brace was applied for another six weeks. His neurological deficit improved in traction and upon discharge. He had no complications from the treatment. At three-month follow-up, he had achieved full neurological recovery. MRI at 3-months follow-up showed that the lesion had regressed to a cystic lesion adjacent to the base of the odontoid.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2542_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2542_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9b29baf863936b398cc59e2296f66add75e73c70
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2542_en.txt
@@ -0,0 +1,3 @@
+This 29-year-old Asian female, who was otherwise in previously good health, presented with recurrent episodes of severe headache, nausea, and vomiting. She described the headache as “pulling” downward, triggered by standing, and resolving when supine. She reported having had axial tension and rotatory manipulation of her neck one week prior to the onset of her symptoms but denied immediate symptoms afterward. She experienced increasingly painful headaches over the 2 weeks following her chiropractic manipulation. She had no known prior history of trauma, dural structural pathology, or connective tissue disease.
+Physical exam was normal with no neurological deficits. Previous cervical magnetic resonance imaging (MRI) with and without contrast had been unremarkable. Cervical MRI at presentation revealed only a CSF-isodense ventral extradural fluid collection in the lower cervical spine and upper thoracic spine without any mass effect on the thecal sac . There was no meningeal enhancement, perineural cyst, dural ectasia, or abnormal venous engorgement.
+The patient was managed conservatively with bed rest for 2 weeks and made a complete spontaneous recovery. Follow-up cervical MRI at 6 months demonstrated decreased size of ventral extradural fluid collection . The patient is doing well presently (1 year subsequent to chiropractic procedure).
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2549_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2549_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2198fbcb14b15878e6730b32d25f92607eecca0e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2549_en.txt
@@ -0,0 +1,12 @@
+A 35 year old woman came to the hospital with unexplainable abdominal pain, accompanied by vomiting. The patient had been taking her medication regularly for five years after the diagnosis of lupus nephritis and had been taking medications irregularly until two months prior to the onset of LE. There was no history of intestinal diseases in her family. Our study was approved by the Medical Ethics Committee of Xinqiao Hospital of Army Medical University (No. 2022-125-01) and received informed consent from the patient.
+The physical examination upon admission and the pressure of blood, temperature, pulse rate, respiratory rate was normal.
+On physical examination, the patient had diffused abdominal pain and pressing pain, without rebound tenderness. Laboratory tests revealed a high antinuclear antibody titer (ANA 1:100) and lower titers of C3 and C4. According to the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria[,], which added antinuclear antibodies to the entry criterion and provided an improved SLE diagnosis of combined sensitivity and specificity, the admission criterion ANA was equal or greater (1:80), the kidney biopsy of International Society of Nephrology (ISN) class IV lupus nephritis (diffuse proliferative glomerulonephritis) was 10 score, lower complement C3 and C4 was a score of 4, and the total score was 14 (≥ 10). The diagnosis of SLE was clear. The sensitive indicator of active SLE often was a reduced level of complement C3.
+An abdominal contrast enhancement computed tomography (CT) was performed the day after admission. CT showed that there was marked and dramatic whole colon and rectum edema with the target sign or doughnut sign [,], and the thickened intestinal wall was about 4mm to 13mm from the rectum to ascending colon. Ischemic and congestive changes were seen locally in the same bowel , which could be seen as partially discontinuous with the ischemic segment intestinal wall, with gas shadows of a discontinuous mucosal line . The mesenteric vessels were increased and thickened with the comb sign [,], which was accompanied by mesenteric fat attenuation , bilateral ureter-hydronephrosis and ascites .
+In previous reports, an active disease of SLE was related to flares of LE, so LE was regarded as the expression in SLE. Consequently, we administered 10 mg of methylprednisolone sodium succinate and 100 mL of 0.9% sodium chloride, hydroxychloroquine (100 mg) and nutrition support. After one week of the treatment, the symptoms, laboratory tests, and intestinal abnormalities on CT images were improved. A follow-up CT was performed 7 d before discharge and revealed no abnormal findings . The patient has been treated with a methylprednisolone and hydroxychloroquine tapering. The timeline for treatments and efficacy evaluations of this case is summarized in Figure .
+She had no family history of intestinal diseases.
+The kidney biopsy of ISN class IV lupus nephritis (diffuse proliferative glomerulonephritis).
+She has no personal and family history.
+On admission, the blood pressure was 93/72 mmHg, the body temperature was 36.5 °C, the pulse rate was 116/min, and the respiratory rate was 20/min.
+On physical examination, diffuse abdominal pain and pressing pain, without rebound tenderness.
+The admission criterion ANA is equal or greater (1:80), the kidney biopsy of ISN class IV lupus nephritis (diffuse proliferative glomerulonephritis) was 10 scores, lower complement C3 and C4 was 4 scores, the total scores was 14(≥ 10). The diagnosis of SLE is clear. A reduced level of complement C3 is often a sensitive indicator of active SLE.
+An abdominal contrast enhancement CT was performed the day after admission. CT showed that there was marked and dramatic whole colon and rectum edema with the target sign or doughnut sign [,], and the thickened intestinal wall was about 4mm to 13 mm from the rectum to ascending colon. Ischemic and congestive changes were seen locally in the same bowel , which could be seen as partially discontinuous with the ischemic segment intestinal wall, with gas shadows of a discontinuous mucosal line . The mesenteric vessels were increased and thickened with the comb sign [,], which was accompanied by mesenteric fat attenuation , bilateral ureter-hydronephrosis and ascites .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2556_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2556_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a457b3a974cc9a8055c66ddbe6f8410e3ec46ae8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2556_en.txt
@@ -0,0 +1,8 @@
+A previously healthy 29-year-old Arab female was brought by her father to the emergency department of Aster Sanad Hospital for severe upper abdominal pain. The pain started 1 week previously and progressed, becoming severe at the time of admission. It was radiating to the left shoulder and was associated with nausea, anorexia, low-grade fever, and vomiting. Moreover, the pain was reduced upon lying flat and exacerbated by movement. The patient mentioned that she went to see her family in a nearby village where she was in indirect contact with domestic animals. Past medical history and systemic review analysis were unremarkable. Normal saline 0.9% NaCl (500 mL) and intravenous acetaminophen 1 g were given to the patient in the emergency room.
+Initial general physical examination showed hemodynamic stability as per the following: pulse rate 97 beats/minute, respiratory rate 18 breaths/minute, blood pressure 113/95 mmHg, oxygen saturation 96%, and temperature 38 °C. On admission, the Glasgow Coma Scale (GCS) score was 13. Abdominal examination showed generalized abdominal tenderness, muscle guarding, and rigidity in the upper part of the abdomen, eliciting the findings of acute peritonitis. Hypoactive bowel sounds were heard on auscultation. Cardiopulmonary and peripheral vascular examinations were unremarkable.
+An emergency computerized tomography (CT) scan with contrast was ordered upon admission . Evidence of multiple variable-sided hypodense lesions was seen scattered in the spleen. Evidence of mild to moderate intraperitoneal hyperdense free fluid collection was seen at the perisplenic, perihepatic, lower abdominal, and pelvic regions; probably hemorrhagic fluid. Normal CT appearance of the intra- and extrahepatic biliary radicles was observed. Normal appearance of the pancreas was observed, with preserved surrounding fat planes. Both kidneys were of normal size. No masses, stones, or back pressure changes were detected. Normal appearance of both adrenal glands, and all of the different segments of the small and large bowel loops, was noted.
+Complete blood count (CBC), coagulation profile, and creatinine tests were ordered upon admission. The CBC showed the following: red blood cell (RBC) count 3.67 × 106/UL (low), hemoglobin 9.8 g/dL (low), hematocrit 29.5% (low), red cell distribution width–coefficient of variation (RDW–CV) 16.3% (high), and red cell distribution width–standard deviation (RDW-SD) 48.8 FL (high). Coagulation profile results were normal. Creatinine level was 41 µmol/L (low).
+An emergent explorative laparotomy with splenectomy was performed. Before the surgery, pneumo-meningococcal and flu vaccine was given. Under general anesthesia and aseptic technique, the skin was draped. A midline skin incision was done. Upon exploration, blood was found to be all over the abdomen. There were ruptured bleeding cysts in the spleen, as shown in Fig. . Hence, ligation of splenic vessels was done followed by the removal of the spleen. Omentoplasty in the cyst space was performed. A drain was inserted in the pelvis and fixed. Finally, the dissected spleen was sent for pathological examination.
+Pathological examination of the splenectomy specimen revealed a spleen weighing 900 g and measuring 18 cm × 4 cm × 6 cm, with an intact capsule, smooth surface with focal laceration, and preserved hilum. Cut section of the spleen revealed dark brown homogeneous splenic tissue with no nodules or masses detected.
+Microscopic examination of sections prepared from the submitted spleen revealed splenic tissue with marked congestion in cords, with dilated sinusoids, and packed with RBCs. There were numerous cystic lesions lined by fibrous tissue with no identified epithelial or endothelial cell lining, and containing blood and fibrinous debris, with adjacent chronic inflammatory cell infiltrate. There were other foci in the spleen that showed proliferation of sinusoid-like channels, lined with plump endothelial cells and filled with blood. Diagnosis of congestive splenomegaly, with splenic peliosis and splenic vascular hamartoma, was established.
+The patient was discharged with the following medications: amoxicillin/clavulanic acid 1 g [twice daily (BID) for 1 week], diclofenac 50 mg (every 12 hours for 1 week), paracetamol 1 g [three times daily (TID) for 1 week], pantoprazole 40 mg (once daily for 1 week), and enoxaparin 40 mg injection subcutaneously (once daily for 7 days). There were no postsurgical complications. On follow-up after 1 week from discharge, the patient was well but displayed thrombocytosis with a platelet count of 1,000,000/μL. Thus, she was prescribed low-dose aspirin of 81 mg.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2562_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2562_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..125a6d34689505c60ea36bc671bf374e9a56c8ea
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2562_en.txt
@@ -0,0 +1,3 @@
+A 19-year-old Japanese woman presented with a left temporal headache. Magnetic resonance imaging (MRI) of the brain revealed a well-defined, heterogeneously enhanced tumor in the left temporal lobe, approximately 10 mm in size, showing high-intensity on T2-weighted images . The patient underwent a left frontal-temporal craniotomy and total resection. These tumor cells had less than 1 mitosis per 10 high-power fields. The primary histopathological diagnosis at that time was low-grade glioma. The patient was discharged after treatment and followed up without any additional treatment. No clear local recurrence was detected during 3 years of follow-up and the patient subsequently elected to stop further medical examinations.
+However, 12 years after the initial treatment, the patient returned with a left temporal headache, diplopia and tinnitus. MRI showed a local recurrence of the tumor around the surgical cavity with prominent perifocal edema and a second resection was performed. Intraoperatively, the tumor was prominently hypervascular, with many feeding arteries from the dura, and a part of the tumor was weakly positive for 5-aminolevuinic acid-based photodynamic diagnosis (PDD). Hematoxylin and eosin (H&E) staining showed an astrocytic tumor lesion with necrosis, microvascular proliferation, invasion and multiple mitoses (5 mitotic counts per 10 high-power fields). No EGBs were observed. . Immunohistochemical (IHC) stains were positive for oligo2, and tumor cells were retained for INI1 and ATRX staining. Approximately 21% of these cells were positive for Ki-67 but negative for IDH1-R132H. Furthermore, the specimen from the initial surgery was revisited and the diagnosis was changed to PXA of WHO grade II based on histology showing spindle shaped cells, pleomorphic nucleated cells and EGBs . Reticulin fibers were not stained and CD34 staining was negative in both tumor resections . As recurrence happened after the PXA resection, APXA was expected due to poorer histological findings; however, the tumor had no characteristic feature of PXA such as EGB, leading to a diagnosis as GBM by histological classification because of nuclear atypia, mitotic activity, a diffuse growth pattern, microvascular proliferation and necrosis . The patient received chemotherapy (temozolomide) and conformal radiation therapy accordingly and outpatient follow-ups have detected no obvious symptoms for over 1 year after surgery.
+Additionally, specimens of each resection were sent to the National Cancer Center Research Institute and MLPA (Multiplex Ligation-dependent Probe Amplification) was performed for 1p, 19q, CDKN2A, IDH1 R132H (c.395G > A), R132C (c.394C > T), IDH2 R172K (c.515G > A), R172M (c.515G > T) and Pyrosequence for IHD1 R132, IDH2 R172, BRAF V600E, H3F3A K27, H3F3A G34, HIST1H3B, TERT C228T, FGFR1 N546, and FGFR1 K656. The analysis detected a BRAF V600E mutation in both the initial and recurrent tumors, with mutant allele findings at 16 and 49%, respectively. Both 1p/19q and CDKN2A were intact in the initial specimen, but a 19q deletion and CDKN2A homozygous deletion were detected in the recurrent specimen. IDH1/IDH2, H3F3A, HIST1H3B, TERT, and FGFR1 were intact in both specimens. From this analysis the tumor was assumed to have been derived from pleomorphic xanthoastrocytoma.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2572_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2572_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e40f41e84356cc868825b2f2d8d1594ed8851bd4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2572_en.txt
@@ -0,0 +1,5 @@
+A 55-year-old Asian (Japanese) woman presented with low back pain and right leg radiating pain without any apparent cause. She received conservative treatment, such as pain killer administration and lumbar root block injection under the diagnosis of lumbar disc herniation at the right L5/S. However, her symptoms gradually worsened until she could not walk because of severe right leg pain and mild muscle weakness. She then referred to our hospital for surgical treatment.
+Physical examination revealed a positive Lasègue sign and the range of the straight leg raising test was 20° on the right side. The right patellar tendon reflex was normal; however, the right ankle jerk reflex absent. On the manual muscle test (MMT), mild muscle weakness (4/5) was observed in the right tibialis anterior (TA), peroneal longus et brevis (PL et B), extensor hallucis longus (EHL), flexor hallucis longus (FHL), and triceps surae (TS). Although there was occasional mild numbness in the right lower leg, no obvious hypoesthesia was noted in the definitive area.
+On plain radiograph, spina bifida occulta at the L5 neural arch was detected in the anteroposterior direction, and slight disc space narrowing at the L4/5 and L5/S intervertebral disc levels was seen in the lateral direction . Myelography and computed tomography (CT) following myelography (CTM) showed a defect in the right L5 and S1 nerve roots . Magnetic resonance (MR) images revealed a herniated nucleus pulposus (HNP) on the right side at the L5/S1 intervertebral disc level . Our preoperative diagnosis was right S1 radiculopathy originating from a usual HNP that compresses the right S1 nerve root in accordance with the findings of L5 radiculopathy suspected by muscle weakness of the TA, EHL, and PL et B.
+We planned lumbar discectomy under a microscope. First, wide fenestration at the right L5/S interlaminar space was performed to identify the right S1 nerve root that was compressed by HNP. However, an anomaly of the conjoined right L5–S1 nerve root was observed. There was no adhesion between the yellow ligament and neural tissue. The epidural space was filled with sufficient adipose tissue. An HNP extruding from the right L5/S intervertebral disc space was confirmed beneath the conjoined right L5–S1 nerve root, which was severely compressed and shifted backward. Mild adhesion between the conjoined right L5–S1 nerve root and capsule of the HNP was observed. Next, to ensure safe discectomy, the area of the fenestration was enlarged while assuring that the facet joint was not disrupted. Although the conjoined right L5–S1 nerve root was very thick and less mobile, some pieces of HNP could be removed piece by piece from the axillary part of the conjoined right L5–S1 nerve root. After these decompressive procedures, the tightness of the conjoined right L5–S1 nerve root decreased, but its mobility did not improve much . The laterality of the thickness and exit angle of the conjoined right L5–S1 nerve root was retrospectively confirmed on preoperative T2 coronal MR images and MR neurography .
+Postoperatively, right leg pain was immediately alleviated and complete improvement of muscle weakness was achieved 1 week later (5/5). At 6 months after surgery, she complained of mild pain at the back and the bilateral thighs, similar to myalgia but was able to walk without any support .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2596_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2596_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..69be97d4c000fb1fac261b90c52986fa8497c636
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2596_en.txt
@@ -0,0 +1,6 @@
+A 67 years-old Tujia nationality man was admitted to our institution in June 2022 with a history of dysphagia, slight chest pain when obstruction, and dyspnea when climbing stairs or going uphill. Gastroscope showed that a new organism which was 29 to 35 cm away from the esophagus could be seen protruding from the lumen, with rigid wall, central ulceration, covered with filthy moss, brittle texture, and easy to bleed when touched. Then he was diagnosed with esophageal squamous cell carcinoma by endoscopic biopsy. On June 14th, echocardiography revealed the presence of an intracardiac mass inside the right ventricle . The echocardiography showed there is a slight increase in echogenicity in the right ventricle, and considering the possibility of an embolus based on medical history, a space occupying lesion needs to be excluded, further examination is recommended; widening of the aortic sinus and ascending part; mild symmetrical thickening of the left ventricular wall; mitral valve, tricuspid valve, aortic valve, pulmonary valve local regurgitation; left ventricular diastolic dysfunction. Then thoracic computed tomography was requested for a better assessment about the mass intracardiac . The thoracic computed tomography results were as follows: Space occupying lesions in the middle and lower thoracic segments of the esophagus. Considering the possibility of esophageal cancer, multiple lymph nodes in the mediastinum are shown, follow-up is recommended. There are scattered solid and sub-solid nodules in both lungs, and metastatic tumors need to be excluded. It is recommended to follow up closely. Double emphysema; there is a little chronic inflammation in the medial segment of the middle lobe of the right lung, the lower lingual segment of the upper lobe of the left lung, and the lower lobe of both lungs. Right ventricular filling defect shadow, considering thrombosis, reexamination is recommended.
+Overall, the mass was suspected to be tumor or embolus. Hypersensitive D dimer is 543 ng/mL and Color Doppler ultrasound of blood vessels in extremities showed no thrombus. We chose to treat esophageal cancer first after multi-department consultation and communication with the patient family. On June 17th, 2022, single drug chemotherapy of pabolizumab 200 mg + albumin paclitaxel 400 mg was performed successfully. After treatment, swallowing obstruction and chest pain slightly improved but the patient developed skin itching and rash.
+On June 21st, Review color ultrasound showed a right intraventricular mass (48 × 17 mm) , the boundary is clear, the shape is regular, and the base is wide. It swings with the heart beating. Part of the echo located in the outflow tract of the right ventricle, and part of the outflow tract is about 10.3 mm wide. After the consultation of cardiac surgery in our hospital, the patient underwent cardiac tumor resection and intraoperative frozen biopsy on June 27, 2022. The surgical process is as follows: after successful tracheal intubation under general anesthesia, the patient is placed in a flat position, with a jugular vein catheter, a radial artery catheter, and a urinary catheter. After routine iodine disinfection, the patient is covered with a cloth. The sternum is incised in the middle of the sternum, and the skin is cut subcutaneously. The sternum is longitudinally sawn, bone wax is used to stop bleeding, the sternum is opened, and a pericardium is cut. The patient is suspended, and the ascending aorta is intubated, the superior and inferior vena cava is intubated, and the left atrium is intubated. Extracorporeal circulation is established routinely. After cardiac arrest, cut open the right atrium and conduct intracardiac exploration: The tumor is located on the anterior wall of the right ventricle, widely distributed from the apex to the distal end of the right ventricular outflow tract. The surface of the tumor is uneven, crispy, and the base is wide. The pulmonary artery trunk is blocked, and the tumor is gradually removed. A small amount of tumor tissue is taken and sent for intraoperative frozen pathological examination. The heart cavity is repeatedly rinsed with ice and saline, and the pulmonary artery blocking forceps are removed. No tumor tissue is found in the pulmonary artery during exploration. The intraoperative frozen pathological report is “metastatic malignant tumor.” The tricuspid valve was well closed during the right ventricular injection test, and the right atrial incision was sutured. After rewarming, the ascending aorta was opened. The heart was defibrillated once and the cardiopulmonary bypass was paralleled, gradually stopping the extracorporeal circulation. After removing the extracorporeal circulation, a temporary cardiac pacing lead was placed on the surface of the right ventricle, and a pericardial mediastinal drainage tube was placed to completely stop bleeding. After counting the number of pairs, the chest closure surgery was completed layer by layer. Return to the CCU ward safely.
+Pathological examination (frozen section) on June 27, 2022 was reported: Cardiac space-occupying, malignant tumor with massive necrosis, consistent with the metastasis of poorly differentiated squamous cell carcinoma, it is recommended to examine the esophagus. Immunohistochemistry: 35BH11 (−), CK (+++), P63 (+++). KI-67 35% (+), P40 (+++) . Besides that, the reason the mass has been considered as an esophagus metastasis is that intracardiac lesions from esophagus cancer are described in the literature.[
+The second and third cycles of anti-tumor treatment were performed on August 4, 2022 and August 30, 2022. Review SD (stable disease). From September 26, 2022 to November 10, 2022, he was given palliative chest radiotherapy, prescription dose: PGTVnd: 69.0 Gy/30f. PCTV: 51.0 Gy/30f, PGTV: 60.0 Gy/30f. The patient maintained a stable weight during radiotherapy . By the computed tomography and enhanced CT, it can be seen that the treatment in the 3 months has significantly improved the patient condition .
+It is pity that, due to the outbreak of COVID-19, the patient eventually suffered from severe pulmonary infection on Dec 19th. The infection rapidly progressed and worsened under the influence of various inflammatory factors. And the patient was died of the acute respiratory distress syndrome 2 weeks later.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2603_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2603_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f20e0d38f87057e0142ce1c9377c1c1fd786c039
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2603_en.txt
@@ -0,0 +1,8 @@
+A 40-year-old man with history of intravenous drug use presented to the emergency department with altered mental status and dyspnoea. He was afebrile and haemodynamically stable. Auscultation of the chest revealed bibasilar lung crepitations and a 3/6 holosystolic murmur at the left upper sternal border and apex. Neurological exam revealed no focal deficits. The patient denied any relevant past medical and surgical history.
+Laboratory tests identified a neutrophilic leucocytosis (white blood cell count 13.6 K/μL, reference range 4.5–11 K/μL; absolute neutrophil count 11.7 K/μL, reference range 1.9–8 K/μL) and elevated C-reactive protein (75.2 mg/L, reference range 0–5 mg/L). 12-lead EKG showed normal sinus rhythm (SR) with no conduction disturbances . Transthoracic echocardiogram identified left ventricle (LV) dilation with an ejection fraction 54%, apical akinesis, aortic and mitral valve vegetations with severe regurgitation of both valves (, ). Brain CT showed an acute SAH , with acute obstructive hydrocephalus . Computed tomography angiography revealed a 4-mm irregular-shaped aneurysm arising from a RMCA branch .
+The patient was intubated and an EVD was emergently placed. Digital subtraction angiography (DSA) documented a ruptured fusiform mycotic aneurysm in a distal parietal branch of the RMCA . Under fluoroscopic guidance, a Headway Duo micro-catheter was advanced over a 0.014’’ micro-guidewire into the RMCA. Embolization of the aneurysm was achieved with deployment of six coils, followed by n-butyl cyanoacrylate glue embolization . Final DSA showed excellent aneurysm obliteration (Raymond Roy Grade 1; ). Blood cultures were collected before empiric antibiotic therapy with Vancomycin 1 gr IV every 12 h and Ceftriaxone 2 g IV daily was started.
+On Day 3, the patient became febrile (38.2°C) and EKG showed new STE in Leads II, III, aVF, V3–V4 . Troponin-I was 8 ng/mL (cut-off <0.03 ng/mL). Serial troponin levels showed a decreasing trend. A conservative approach without diagnostic coronary angiography was pursued, as the patient was at prohibitive risk for surgical or percutaneous revascularization if significant coronary artery disease was confirmed, given the attendant bleeding risk in the setting of recent SAH and EVD placement.
+On Day 5, the patient developed bilateral upper limb paresis. Cerebral angiography demonstrated RMCA and anterior cerebral artery vasospasm, which was treated with Verapamil, Nimodipine, Milrinone, and monitored with transcranial Doppler.
+Transesophageal echocardiography (TEE; and , , ) identified a Sievers Type 0 bicuspid aortic valve with a large vegetation (1.8 × 1 cm) arising from the left cusp; there was associated left cusp perforation resulting in severe AR; perivalvular infection was also seen, with an aortic root abscess, and pseudo-aneurysm formation. The mitral valve also had a large vegetation (2.4 × 1.2 cm) with anterior mitral leaflet aneurysm and perforation, resulting in severe MR. There was no TEE evidence of left main (LM) coronary ostium obstruction. Blood cultures revealed growth of Streptococcus salivarius; Ceftriaxone and Vancomycin were continued according to microbiological sensitivities.
+On Day 7, an EKG showed SR with new 1st degree atrio-ventricular block and stable V3–V5 STE. The clinical course was then complicated by development of hypotension, acute pulmonary oedema, pneumonia, and progressive left upper extremity weakness due to cerebral vasospasm, requiring intra-arterial Verapamil and stent angioplasty at the first segment of the RMCA. Electrocardiogram showed stable V3–V5 STE and accelerated junctional rhythm with retrograde P waves .
+On Day 15, fluctuating conscious levels and neurological deficits prompted CT-angiography, which showed worsening basilar artery vasospasm and a new mycotic aneurysm in the distal M2 left middle cerebral artery branch (, ). The patient progressively deteriorated with rising intracranial pressure and drainage of blood from the EVD. There was also additional cardio-respiratory decompensation. Head CT showed a new left parieto-temporal intraparenchymal haematoma from a ruptured left distal mycotic aneurysm, with rightward midline shift and left lateral ventricle effacement (, ). Electrocardiogram showed worsening anterior STE with new bigeminy and multifascicular block without discernible P waves . Following multidisciplinary team meetings and Ethics committee reunion, the patient was managed conservatively and subsequently passed away on Day 24.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2605_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2605_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fd4f6709d0c5470210a9f0b3d6ebb7466f279a8b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2605_en.txt
@@ -0,0 +1,4 @@
+An 82-year-old Caucasian woman with a history of hypertension and osteoporosis was referred to a pulmonologist for outpatient diagnostic evaluation of persistent cough and signs of atelectasis on chest X-ray. A following chest CT with intravenously administered ICM (loversol 741 mg/ml) showed atelectasis and ground-glass nodules in the upper lobe of the right lung. A pulmonary function test revealed restricted lung disease, which was deemed the cause of her pulmonary complaints. Additionally, the chest CT showed a large multinodular goitre . This warranted no further action at the time because the patient was asymptomatic and laboratory findings only showed subclinical hyperthyroidism.
+Ten days after the chest CT, the patient was seen by her general practitioner. At that time she had some complaints of exertional dyspnoea, but was able to walk up to thirty minutes to do grocery shopping. Physical examination at that time revealed a heart rate of 84 bpm and blood pressure of 170/80 mmHg.
+One month after chest CT the patient presented at the emergency department with complaints of fatigue, loss of appetite, dyspnoea and palpitations. She was not able to climb the stairs in her house and slept in a chair for two nights. Physical examination showed atrial fibrillation based tachycardia up to 160 bpm, a blood pressure of 160/70 mmHg, a saturation of 93 %, and no fever. Thyroid specific symptoms, such as myxoedema or tremor were not present. Blood tests revealed elevated inflammatory parameters, which in combination with a new consolidation in the right lung on chest X-ray pointed towards pneumonia. The blood tests also revealed a suppressed thyroid stimulating hormone (TSH) and increased T4, indicating hyperthyroidism . The estimated glomerular filtration rate was 90 ml/min. Further patient history was negative for thyroid disease and additionally tested TSH-receptor antibody levels were below the limit of detection.
+The patient was admitted to the geriatric ward and antibiotic treatment for pneumonia was initiated. Prior medication (enalapril, simvastatin, budesonide/formoterol inhaler and calcium carbonate/colecalciferol) was continued with exception of alendronate which was temporarily halted. An endocrinologist was consulted and thiamazole and metoprolol were administrated to treat hyperthyroidism and tachycardia. In the following days, CRP increased from 46 mg/l on admission to 207 mg/l on day three before decreasing to 27 mg/l on day five. During admission no fever was found and blood cultures were unremarkable. A cardiologist was consulted and treatment with digoxin and apixaban was started for atrial fibrillation based tachycardia. The tachycardia appeared to be therapy resistant and the patient developed peripheral oedema. Furosemide was started, the metoprolol dose was increased and eventually verapamil was started. Also non-medication interventions were applied such as fluid restriction. Despite these interventions, little to no effect was observed. The patient persistently showed oedema, tachycardia and exertional dyspnoea. Chest X-ray was performed twice after admission and showed increasing pleural effusion with signs of cardiac decompensation. Given the limited therapeutic options, echocardiography was considered as non-contributory to improved patient outcomes by the cardiologist. The patient’s condition slowly deteriorated until eventually she was found unconscious with deep hypoxemia. Resuscitation was attempted but to no avail and the patient passed away. Autopsy revealed a right lower lobe bronchopneumonia and a hypertrophic heart with recent subendocardial ischemia in the area between the left and right coronary system. Based on the area of ischemia, hypertrophy of the left ventricle and absence of coronary artery occlusions, demand ischemia was deemed the cause of death. Most likely caused by the combination of pneumonia and persistent tachycardia Fig. .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2608_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2608_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1a02637bd267e34bfc597e4db04f2e6365120102
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2608_en.txt
@@ -0,0 +1,6 @@
+A 64-year-old woman, with medical history of hypertension that was treated with amlozin (5 mg, Sumitomo Pharma, Japan) and azilsartan (20 mg, Towa, Japan), was initially admitted to another institution due to temporary back and abdominal pain. Her abdominal ultrasonography raised suspicion of CAA. Consequently, she was referred to our institution for further evaluation and treatment of CAA.
+At the time of presentation at our institution, she was asymptomatic, and her laboratory results were within the normal range (Additional file ). Enhanced computed tomography (CT) revealed that the CA and SMA converged into the aorta via the CMT. The CAA was a saccular aneurysm and located approximately at the median of the CA, with a diameter of 26 × 28 mm . Notably, no significant stenosis was present on the CMT. The patient was diagnosed with CAA, complicated by CMT. She was a good candidate for surgery since her CAA was > 20 mm .
+Selective visceral angiography was performed to evaluate the visceral circulation of each branch, especially that of the CA and SMA. Angiography revealed that the branches from the CA were only the common hepatic artery (CHA) and splenic artery (SA). We found no discernible microbranches originating directly from the primary CA duct . The left gastric artery (LGA) originated from the aorta. Angiography of the LGA with balloon occlusion of the CMT revealed collateral circulation to the proper hepatic artery (PHA) via the right gastric artery (RGA) and to the SA via the short gastric artery (SGA) , suggesting that hepatic circulation could be maintained even after occlusion of the CHA.
+Based on these anatomical findings, we determined that the safety landing zone for stenting of the CA was not sufficient. In addition, coil embolization of the CAA itself posed a potential risk of coil migration, which could lead to severe complications. Because of the patient's relatively young age, preserving the anatomical antegrade visceral circulation was considered more important than pursuing a less invasive approach through endovascular therapy (EVT). Regarding open surgical procedures, several options are available, such as aneurysmectomy, aneurysmorrhaphy, aortoceliac bypass, aortohepatic bypass, or ligation [, ]. Based on CT and angiography findings, simple CAA resection would suffice and be a less invasive surgical procedure for open surgery; therefore, direct CAA resection was performed.
+After the induction of general anesthesia, the abdomen was opened through a midline incision. The pancreas was exposed through an incision in the omentum. Since the CAA was located behind the pancreas on preoperative CT, the CAA was approached with caution to separate it from the pancreas. The portal vein, CMT, CHA, and SA were eventually exposed . Following systemic heparinization, direct resection of the CAA and subsequent reconstruction of the CA were performed after clamping the CHA, SA, and proximal CA . The total operative time was 249 min, and blood transfusion was not required.
+On postoperative enhanced CT, the visceral circulation of the CA and SMA was preserved . Histological analysis of the CAA revealed degenerative true aneurysm, with no evidence of abnormalities, such as lack of elastic fibers or cystic medial necrosis . The patient was discharged uneventfully on postoperative day 10. A follow-up CT one year later demonstrated no sign of recurrence of the CA or the development of new visceral aneurysms.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2613_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2613_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d1148bb2aced91995c2fd79bdb594717ffd849ca
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2613_en.txt
@@ -0,0 +1,3 @@
+A 76-year-old-male presented to his General Practitioner (GP) complaining of right-sided abdominal pain that had been ongoing for more than 4 weeks. His medical background was significant for hypercholesteraemia and a long history of pipe-smoking. His medications are limited to oral atorvastatin 20 mg once daily. He was referred to the endoscopy unit to undergo colonoscopy. During the procedure, a polypoid lesion was noted to be protruding from the appendiceal orifice. There was clinical concern that it represented an adenomatous polyp or malignancy therefore biopsies were taken. Due to its location, it was not feasible to endoscopically remove the lesion. Biopsies demonstrated benign colonic tissue only. A Computed Tomography (CT) of the abdomen and pelvis demonstrated dilatation of the appendiceal orifice of more than 2 cm, a thickened irregular appearing appendix and an irregular soft tissue nodule measuring 1.2 cm adjacent to the tip and abutting the bladder. His laboratory tests were within the normal range. The case was discussed at the weekly multi-disciplinary team meeting. Given the unusual overall endoscopic and imaging findings where the concern was for a malignant process, in addition to the patient's symptoms the decision was made to perform a laparoscopic right hemicolectomy by a consultant colorectal surgeon. At surgery the appendix mass was densely adherent to the bladder peritoneum and was carefully dissected free.
+The microscopic examination confirmed an overall double lumen in the appendix, furthermore the separate nodule that was attached the tip of the appendix represented a further nodule of appendiceal tissue (, ). Special stains showed a thickened fibrotic wall but there was no infiltration of the wall by a pathological process, e.g. amyloid. No mass was identified to suggest an intussusception of the appendix. The histological features confirmed two separate lumens. Moreover, the separate nodule of appendiceal tissue was thought to represent autoamputation of the tip but no faecal material was present to suggest it was previously intact with the main appendix. It may represent a developmental anomaly.
+The patient made an uneventful recovery and was discharged home on day ten and was able to return to his normal living activities at his 4-week and 2-month clinic review.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2631_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2631_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..051941c86cb4d71fec42f8589754e29cb2864b81
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2631_en.txt
@@ -0,0 +1,6 @@
+Herein, we describe the case of a 73 year-old man in good health, who developed widely disseminated sebaceous carcinoma including metastases to brain, visceral organs, lymph nodes, and bone.
+He initially presented in late October 2016 for removal of a rapidly growing nodule in the anterior abdominal wall. Two days later he developed confusion, urinary incontinence and progressive aphasia. Emergent magnetic resonance imaging (MRI) of the brain showed 4 enhancing gray-white matter junctional lesions, the two largest measured 3.8 × 3.3 cm in the right frontal lobe and 2.3 × 2.5 cm in the left frontal lobe. Two smaller enhancing lesions in the right parietal lobe measured 8 mm and 4 mm in diameter. In November 2016, he underwent craniotomy and resection of bilateral frontal lobe tumors, and he made a full neurologic recovery and went on to receive post-operative gamma knife radiosurgery to the resection cavities and the small parietal brain lesions .
+His case was reviewed in melanoma tumor boards at the Masonic Cancer Clinic, University of Minnesota. Sections of tumor revealed sheets of epithelial cells with moderate eosinophilic cytoplasm and areas of tumor infiltrating lymphocytes . Cells exhibited nuclear pleomorphism and increased mitotic activity , desmoplastic stromal reaction and necrosis . Immunohistochemical staining was positive for cytokeratin AE1/AE3 and cytokeratin 7, and negative for S100, HMB45, Melan-A, CD45, calretinin, ERG, p40, TTF1, CDX2, and GATA3. The immunoprofile ruled out melanoma, mesothelioma, lymphoma, sarcoma with epithelioid features, and most visceral carcinomas. Microscopic examination revealed intracytoplasmic lipid vesicles , confirmed by diffuse membranous reactivity for adipophilin [, ] . The findings supported a histopathologic diagnosis of sebaceous carcinoma. Importantly, additional tumor testing confirmed high expression of PD-L1 in 100% of tumor cells . Commercial genomic testing using next-generation sequencing (Foundation Medicine, Massachusetts, USA) confirmed the tumor was microsatellite stable and carried a mutational burden of 17 mutations/Mb. Table also shows various somatic mutations in genes for regulatory transcription factors, DNA repair proteins, growth factor receptors, and targetable MAPK signaling proteins. Several of the affected genes have also been described in cases of sebaceous carcinoma reported in the COSMIC database .
+Initial staging positron emission tomography-computed tomography (PET/CT) revealed evidence of widely disseminated disease involving lung and liver, muscle, bone, and multi-compartment bulky lymphadenopathy in chest and abdomen . Standard chemotherapy approaches using platinum-based chemotherapy were reviewed. However, the patient and family strongly favored a less toxic therapy, considering advanced age and quality of life concerns. Given the strong rationale for use of checkpoint inhibitors in several other tumor types, moderately high tumor mutational burden (17 muts/Mb), and strong PD-L1 expression the patient opted for anti-PD1 immunotherapy. He initiated off-label treatment with pembrolizumab (2 mg/kg, every 3 weeks) in December 2016.
+Follow up PET/ CT scan 3 months after the initiation of anti-PD1 therapy revealed remarkable improvement in lymph nodes, lung, and soft tissue, however, there were multiple new and enlarging hepatic and osseous metastases initially worrisome for progression. After multidisciplinary review, the findings were felt consistent with pseudo-progression and immunotherapy was continued. Restaging PET/ CT obtained after 6 months of treatment showed further significant improvements in all previously noted lesions , with residual FDG activity seen in small mediastinal and abdominal lymph nodes. To further characterize the patient’s innate and adaptive immune status at the time of his near complete response, a flow cytometry study of peripheral blood was performed. Lymphocyte subset analysis showed evidence of circulating CD45RA-CD27+ central memory (CM) and effector memory (EM) T cells, and a population of mature CD16 + CD57+ NK cells .
+He continued on pembrolizumab, however, after 10 months of therapy he developed severe fatigue and orthostatic hypotension requiring hospitalization. Laboratory testing showed him to have secondary adrenal insufficiency with low (< 0.7 mcg/dL) serum cortisol and low (< 11 pg/mL) ACTH levels. He began 1 mg/kg prednisone with a prolonged steroid taper, and during high dose steroid therapy pembrolizumab dosing was interrupted. In December 2017, with 12 months of follow-up, restaging PET/CT was obtained and showed new FDG avid mediastinal and abdominal lymph nodes and a new hepatic and small bowel lesion . Biopsy of the liver lesion in January 2018 confirmed recurrent metastatic sebaceous carcinoma, and repeat immunohistochemical staining showed tumor cells continued to express high levels of PD-L1 (not shown). After discussion, the patient elected to restart immunotherapy, and he was continued on maintenance adrenal replacement therapy with hydrocortisone (10 mg/5 mg). Recent restaging studies demonstrate growth of the mediastinal metastases and a reduction in the size of the hepatic and small bowel metastases, suggestive of pseudoprogression and a durable ongoing response to pembrolizumab (Additional file ).
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2635_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2635_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8ce2cddf38205798bd56c10dc42505fa63a91ae5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2635_en.txt
@@ -0,0 +1,6 @@
+A 33-year-old nulligravid woman with newly diagnosed AA (WHO grade III, IDH1 negative) presented to our office for fertility preservation. The patient had undergone a craniotomy with complete resection of her right parietal lobe tumor one month prior, and was scheduled to start chemotherapy and radiation in the next month. Her neuro-oncologist recommended that she undergo fertility preservation prior to chemo-radiation. The fertility preservation did not delay the anticipated start of her chemo-radiation treatment.
+The patient had no significant medical or gynecological history. On physical exam, the patient was a healthy-appearing woman. She had left lower extremity weakness and instability. Transvaginal ultrasound demonstrated a normal-appearing uterus and ovaries bilaterally. A dominant follicle was noted on her right ovary; therefore, it was decided to administer HCG 10,000 IU at the time of her presentation to trigger ovulation, thus enabling the initiation of gonadotropins two weeks later. The patient had a high antral follicle count (6 on right, 7 on left).
+The patient received low dose gonadotropins: 1 ampule of Human Menopausal Gonadotropin (Menopur®, Ferring Pharmaceuticals, Parsippany, NJ, USA), 75–187.5 IU of FSH (Gonal F®, EMD Serono, Rockland, MA, USA) for 10 days and cetrorelix acetate (Ganirelex®, GnRH antagonist, EMD Serono, Rockland, MA, USA) for the last 6 days. Final oocyte maturation was triggered with Lupron Luprolide Acetate (Lupron®, GnRH agonist, SANDOZ Pharmaceuticals, Princeton, NJ, USA) 40u. Twelve oocytes were retrieved transvaginally under ultrasound guidance. Eight embryos developed and were vitrified in liquid nitrogen (6 on day 3 and 2 on day 5 post-retrieval).
+The patient returned to our Center one year later after she was cleared by her neuro-oncologist following the completion of chemotherapy and radiation. The patient had 6 weeks of radiation therapy with Temozolomide (Temodar®, Merck&Co, Inc., Whitehouse Station, NJ, USA) followed by 6 months of maintenance dose. Her last dose of chemotherapy was one month prior to returning to the office. The patient had maintained regular cycles post chemotherapy. The patient underwent a frozen-thaw natural cycle embryo transfer of a single day-3 embryo with vaginal progesterone (Crinone®, Actavis, Parsippany, NJ, USA) luteal phase support. The patient remained on Keppra® 500 TID (levetiracetam, UCB Pharmacueticals, Brussels, Belgium) and Lactulose throughout the pregnancy. A viable singleton pregnancy was seen on ultrasound 1 month later. The patient delivered a healthy female baby weighing 7lbs 5 oz. at term.
+The patient returned two years later desirous of another pregnancy. Her neurological status had been stable, was tumor free and was cleared by her oncologist to conceive again. This time the patient was treated with Estrace® (estradiol, Warner Chilcott, Rockaway, NJ, USA) 6 mg a day and underwent a frozen-thaw cycle with a single day-5 blastocyst transferred. The patient conceived with a viable singleton pregnancy and delivered a healthy male at term weighing 6lbs.
+Throughout the patient’s treatment regimen for fertility preservation and frozen embryo transfers, no adverse or unanticipated events were encountered.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2639_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2639_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dba45acf180d33746d576f7355f395bbf0a962d7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2639_en.txt
@@ -0,0 +1,5 @@
+A 24-year-old female, gravida 2, para 2, who had previously undergone a Caesarean section at a rural hospital two years ago, arrived at the emergency room with a gradual onset of abdominal distension, abdominal pain, and absolute constipation for two days. She also experienced nausea and frequent vomiting of greenish material however, there is no fever, burning urination, or chest pain. There was no history of renal colic or intestinal obstruction.
+The patient was vitally stable upon examination. The abdomen was distended with mildly generalized tenderness, but there was no guarding or rigidity. Superficial palpation revealed no abnormalities, but deep palpation revealed a globular mass on the left iliac fossa (pedunculated) with clearly defined edges. On auscultation bowel sounds were present.
+TWBCs were 8.1, hemoglobin was 9.8, random blood glucose was 99 mg/dl, platelets were 329, blood urea was 27, serum creatinine 0.7, the c-reactive protein was 27, serum potassium was 3.3 mmol/l, abdominal ultrasound was normal, erect abdominal x-ray revealed multiple air-fluid levels , while supine revealed a dilated loop of the small intestine. A diagnosis of intestinal obstruction was made, and the patient was optimized before being taken to the theatre. under general anesthesia with tracheal intubation, a midline incision was made with a scalpel, and unipolar diathermy subcutaneous tissue was cut, the muscle was separated, and intraoperative findings showed that the small intestines were found to be adhesively obstructed by a pink mass attached to the jejunum on two closed sites (hanging on it) with serosal attachment, it was firm on consistency measured 10 × 10 cm as illustrated in Fig. . The adhesion was released by scissors and the serosal layer was closed by interrupted sutures, then the intestinal and the abdominal cavity was washed, after which, the drain was placed on the pelvic cavity and then the wound closed in layers.
+The macroscopic examination revealed a cyst filled with gauze, while the histopathological examination demonstrated gauze material surrounded by fibromuscular connective tissue and mature adipose tissue, with foci of mixed inflammatory cellular infiltration and foreign body giant cell reaction but no malignant features.
+The patient received one unit of blood without complications, in the postoperative course the patient was nill per mouth, and receive intravenous fluids and antibiotics for five days. The patient was vitally stable on follow up, with good urine output, and the drain was removed on the fourth day. The patient was discharged on the fifth day and scheduled to see a referring clinic two weeks later.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2654_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2654_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ddde2dcff3226a0b3e364c635400f112abe1dd80
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2654_en.txt
@@ -0,0 +1,3 @@
+Our patient was a 71-year-old Caucasian non-Hispanic male who presented with chronic left knee pain after undergoing a TKA 18 months prior. He had an uncomplicated past medical history of hypertension, hyperlipidemia, and reflux, which were well controlled with medical management. He was 70 inches tall and weighed 215 lbs. He had no history of any additional surgeries. He was married and lived at home with his wife. He was now retired and prior to his surgery maintained an active lifestyle including exercise and daily life activities. His social history included social alcohol consumption and was negative for tobacco use .
+Following his TKA, the patient complained of persistent and progressively worsening post-operative pain of his knee. Orthopedic evaluation determined his implant to be normally functioning without evidence of hardware loosening or infection. On presentation, he described the pain as sharp, 7/10 (VAS) in severity though poorly defined, with radiation to the left ankle, and associated paresthesias in the same distribution. On physical exam, he experienced symptoms of hyperesthesia and allodynia along the anterior aspect of his knee. His postsurgical incision was well healed, without evidence of erythema, swelling, or gross changes in color. Strength was 5/5 with flexion and extension of the lower left leg, but was limited by guarding due to pain. His right lower extremity had 5/5 strength in all myotomes, and otherwise he had 5/5 strength in the left leg with flexion and extension of the thigh, inversion, eversion, plantar flexion, and dorsiflexion of his left foot.
+Given his symptomatology of hyperesthesia, allodynia, preserved strength, and absence of orthopedic aberrancy, a diagnosis of postsurgical CRPS of the left lower extremity was made. Initial management of his pain was conservative including physical therapy, non-steroidal anti-inflammatory, muscle relaxant, neuropathic, and opioid medications, which provided little or no relief of symptoms. Following a trial of lumbar sympathetic block, he reported improvement in pain, with a reduction on VAS to 3/10, lasting approximately 1 month in duration. Given a dramatic improvement in his knee symptoms, he subsequently underwent a successful SCS trial and uneventful implantation of two 16-contact Boston Scientific leads with a Boston Scientific Spectra WaveWriter™ SCS system. His generator was programmed to provide simultaneous traditional paresthesia-based therapy at a frequency of 50 Hz along with the combination of burst therapy at a frequency of 450 Hz, with six pulses per burst, as well as sub perception stimulation therapy at a frequency of 1.2 kHz. Upon first post-procedural follow-up, the patient experienced dramatic pain relief, reporting complete resolution of his symptoms. Moreover, at 6 months post SCS implantation, he continued to experience complete resolution and had successfully completed an opioid wean to discontinuation.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2672_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2672_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c32008bcf3f94bff4e63876b9782b30c9fa88f67
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2672_en.txt
@@ -0,0 +1,4 @@
+A 77-year-old woman was referred to our department after she requested surgical treatment for a tumor located near the gastric fornix. She underwent a preventive esophagogastroduodenoscopy 2 years and 7 months prior to the referral. The examination had revealed a submucosal tumor-like lesion in the fornix, which measured 10 mm. After this diagnosis, she was referred to her previous physician. Contrast enhanced computed tomography (CT) revealed a low density, round mass, measuring approximately 20 mm that was located between the upper stomach and left lateral segment of the liver . Additionally, magnetic resonance imaging (MRI) revealed that the mass showed a high signal intensity on T2-weighted imaging and seemed to be distinct from the stomach . It was determined that the tumor would require careful follow-up. A follow-up MRI was performed 5 months later, and it showed slight growth of the tumor. An endoscopic ultrasonography (EUS) was also performed, and it revealed a cystic structure continuous with the gastric wall. Contrary to the previous CT and MRI results that suggested the presentation of an extra-gastric tumor, the EUS results suggested that a gastrointestinal stromal tumor (GIST) could not be ruled out. Owing to the conflicting results, the patient was referred to the endoscopy division of our hospital two years ago for detailed examination. On admission, abnormal symptoms such as fever, anemia, and jaundice were not observed, and her performance status was good (Eastern Cooperative Oncology Group score of 0). She had a history of Sjögren syndrome but had no history of other systemic diseases such as diabetes and hypertension. She had no history of smoking and alcohol abuse. Additionally, she had no family history of malignant diseases. Laboratory studies were within normal range. The EUS was re-examined, and it was concluded that the cystic tumor with solid components did not to originate from either the liver or the stomach. Fine-needle aspiration biopsy was not performed considering the risk of tumor dissemination (according to Japanese Clinical Practice Guidelines for GIST, 3rd edition, it is contraindicated to perform EUS-FNA for extramurally grown submucosal tumor ). The differential diagnoses considered for the tumor were bronchogenic cyst, epidermoid cyst, lymph node with cystic degeneration, and neurogenic tumor. Since a few malignant findings were observed, regular follow-ups were recommended for the patient. These examinations indicated that there was gradual growth in the size of the tumor. A follow-up EUS performed 1 year and 6 months after admission revealed that the cystic tumor had grown to 25 mm in diameter, and there seemed to be no continuity between the tumor and the stomach . However, the CT scan showed an unclear part of the boundary between the tumor and the gastric wall . We could not completely exclude the possibility of GIST, and we explained the results to the patient. She requested surgical resection, following which we planned for a surgery at our division.
+Since the tumor was rather small (less than 3 cm in diameter), we decided to resect the tumor using laparoscopic approach. The tumor was located close to the upper stomach, and we planned to place the trocars using the same arrangement as in upper gastrointestinal surgery. The patient was placed in the supine position with legs apart; the brunt port was inserted from the umbilicus; a 12 mm trocar and three 5 mm trocars were placed in the reverse trapezoid position in the upper abdomen; and the Nathanson’s retractor (HEIWA MEDICAL INSTRUMENTS Co., Ltd. Bofu, Yamaguchi, Japan) was placed in the epigastrium as the liver retractor . An initial laparoscopic examination revealed a firm, completely encapsulated mass located on the left of the diaphragm . Since the tumor was relatively small and visibility was good, we decided to continue with the laparoscopic approach. Partial diaphragmectomy with complete inclusion of the tumor was performed using laparoscopic coagulation shears . The tumor was packed in a plastic bag and then extracted via the umbilical incision. The defect of the diaphragm was directly closed by a running suture using the 3-0 V-Loc™ absorbable suture (Medtronic plc, Minneapolis, MS, USA) . The total operating time was 59 min. The intraoperative blood loss was negligible. A video recording of the surgical procedure has been provided in the Additional file .
+The tumor measured 2.5 × 2.0 × 1.8 cm and was well encapsulated . The cut section of the tumor showed a tan or yellow solid component and cystic abnormalities. On microscopic examination, it was found that the tumor was surrounded by a pink fibrous capsule with a cystic area . Under low magnification power, the tumor showed a pattern of alternating highly cellular Antoni type A and less cellular Antoni type B areas . The tumor was composed of spindle cells with bland, twisted nuclei and indistinct cytoplasmic border arranged in short bundles or interlacing fascicles . In the Antoni type A area, the spindle cells showed nuclear palisading. Upon immunohistochemical analysis, the tumor cells showed diffuse positivity for both the S100 and SOX10 proteins . It was concluded that the tumor was a benign diaphragmatic schwannnoma.
+There were no postoperative complications. The patient was discharged on the fifth postoperative day and is doing well 4 months after the surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2676_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2676_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..674a96ea4da4d7db2510f54aa9a8eb4210c55a13
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2676_en.txt
@@ -0,0 +1,7 @@
+A 56-year-old woman presented with epigastric pain without heartburn, acid reflux, or abdominal distension and in a good overall condition. Her diet, faeces, and urine were normal, and she had no recent changes in body weight.
+The patient experienced epigastric pain for the past 20 d.
+The patient had a history of cervical spondylosis and had undergone bilateral pterygium surgery in the past. There was no history of drinking or smoking.
+No special personal or family history.
+The patient’s vital signs were stable and physical examination was unremarkable.
+Preoperative blood tests, such as routine blood examination, liver function, and serum tumour markers of the digestive system, showed no abnormalities.
+Gastroscopy revealed a submucosal protuberance of the gastric antrum approximately 15 mm in diameter that had a smooth surface, scattered congestion, and an opening at the top . EUS revealed a submucosal protuberance of approximately 1.19 cm × 0.89 cm on the posterior wall of the gastric antrum. The protuberance was round, similar to mixed echogenic masses, predominately hypoechoic with unclear boundaries, and originating from the submucosa. We considered the possibility of a heterotopic pancreas. An abdominal CT scan showed no obvious abnormal thickening or enhancement shadow of the gastric antrum . Surgical contraindications were absent, and endoscopic submucosal dissection was performed with informed consent from the patient and her family. The lesion was located on the posterior wall of the gastric antrum. After marking and submucosal injection of methylene blue, glycerine fructose, adrenaline, and sodium hyaluronate, the lesion was cut with a dual knife (KD-650L; Olympus, Tokyo, Japan) and peeled off layer by layer. The recovered tissue was biopsied. While inspecting the wound, a strip of white foreign body was found under the wound that could not be pulled out using forceps .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2677_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2677_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..daa4aee9732c3196a448dec02d44232f94a86218
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2677_en.txt
@@ -0,0 +1,2 @@
+A 70-year-old Japanese woman presented with a history of neck pain for 14 days before visiting our hospital. She had not been exposed to tuberculosis and had no history of recent head or neck injuries or diabetes mellitus. Her neck motion was slightly limited and she did not present with any neurological abnormality. Plain lateral X-ray showed calcification in the interlaminar space at C5-C6. Magnetic resonance imaging (MRI) showed low signal on both T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) . Her neck pain was relieved gradually with nonsteroidal anti-inflammatory drugs (NSAIDs). Two months after her initial admission, her severe neck pain recurred. She had a moderately high fever (37.5 °C) on her second admission, and her neck pain was so severe that she could not move her neck in any direction. She did not complain of any joint pain suggesting arthritis. A physical examination revealed a severely limited range of motion of her neck in all directions. Her motor strength and sensation of her upper and lower extremities were unremarkable, and she had normal deep tendon reflexes. Her visual analog scale (VAS) pain score was 100 mm at her second visit, white blood cell count was 7800/mm3 (normal range, 3500–9300/mm3), and C-reactive protein was 5.13 mg/dL (normal range, 0–0.3 mg/dL). Computed tomography (CT) showed a high-density area between the C5 and C6 laminae with suspected calcification of the yellow ligament . MRI showed intermediate-signal intensity on T1WI, and high-signal intensity on T2WI surrounding a low-signal region on both T1WI and T2WI with cord compression , suggesting pseudogout attack or epidural abscess. Although NSAIDs were administrated, her neck pain persisted. Surgical decompression with C6 laminectomy and removal of the C5-C6 yellow ligament was performed 2 weeks after her second admission. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. There were visible calcifications in the yellow ligament, and dura adhered to the yellow ligament. Histologically, CPPD crystals were found in the fluid , and she was diagnosed with a pseudogout attack of the yellow ligament. Our patient’s postoperative course was unremarkable. Her neck pain decreased, and laboratory data normalized 3 weeks after the operation.
+Six months postoperatively she had no further severe neck pain. At a follow-up evaluation 7 years after initial onset, our patient had complete relief of neck pain, and there were no neurological abnormalities.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2679_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2679_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dd9f0912d0cdcaf22af30ee3e4cf5c771d256aef
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2679_en.txt
@@ -0,0 +1,5 @@
+A 72-year-old Asian (Indian) man presented to our Cornea and Anterior Segment Service with a referral diagnosis of scleritis in his left eye. He had a history of having had cataract surgery in his left eye at another facility 6 weeks earlier with good postoperative vision.
+The medical history suggested that his postoperative vision was good until day five. He complained of severe pain and diminution of vision in his operated left eye on the fifth postoperative day. With a working diagnosis of SINS his primary ophthalmologist put him on systemic and topical corticosteroids. However, when his vision continued to decrease and pain persisted, his ophthalmologist started topical natamycin every hour, and topical ciprofloxacin every 2 hours while continuing topical prednisolone acetate every 2 hours. This new treatment, however, did not help improve his condition.
+At presentation to us his visual acuity was counting fingers at 1 meter in his right eye and 2.5 meters in his left eye. Apart from a cataract (grade 3 nuclear sclerosis) his right eye was apparently within normal limits. A slit-lamp examination of his left eye showed a well demarcated area of scleral necrosis predominately involving the area posterior to the posterior lip of the scleral incision. The anterior lip of the scleral wound was also involved . The sclera around the necrotic region was congested. His cornea was clear. There were 2+ cells in the anterior chamber. As he was very symptomatic a detailed fundus evaluation could not be done but his posterior pole appeared to be within normal limits.
+A presumptive diagnosis of SINS was made. The wound was scraped, and necrotic tissue was debrided and sent for microbiological evaluation. Microscopy in potassium hydroxide and calcofluor white stain revealed fungal filaments. Donor sclera of an appropriate size (7.5mm × 11mm) was patched over the thinned sclera . The donor sclera which was preserved in absolute alcohol was obtained from the eye bank. After cleaning the preserved sclera with Ringer’s lactate solution and 5% povidone solution, it was cut according to the area excised. It was sutured with 6–0 polyglactin suture with the surrounding sclera and with 10–0 nylon suture with the limbal portion of cornea.
+He was started on topical natamycin (5%) every hour, cyclosporine (0.1%) two times a day, homatropine three times a day and systemic itraconazole 100mg two times a day. A systemic evaluation was done postoperatively to rule out any other etiology of the scleritis. Blood studies showed a normal total and differential count and an erythrocyte sedimentation rate of 14mm/hour. Rheumatoid factor and anti-nuclear antibody were negative. Liver function tests were within normal limits. All antifungals were discontinued on the 18th day following the scleral graft as there was no evidence of active infection. He was initiated on topical prednisolone acetate (1%) eight times a day and homatropine (2%) eye drops at bed time. He was regularly examined by the primary ophthalmologist. At the last examination in the fifth postoperative month, he was symptom free and his vision was 6/36. An area of retinal pigment epithelium alteration was seen hazily due to posterior capsular opacity. The graft was healthy and vascularized .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2702_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2702_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6496af9428d5e3bc5e2c71c2e0bb36673003d23b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2702_en.txt
@@ -0,0 +1,3 @@
+A 75-year-old expatriate female who had recently returned from her home country of El Salvador presented to our Canadian Tertiary Centre with progressive shortness of breath, orthopnoea, and syncopal episodes over the preceding month. She had no chest pain, gastrointestinal, or neurological symptoms. She first emigrated from El Salvador to Canada 30 years ago. Her medical history was significant for hypertension, Type 2 diabetes, and chronic kidney disease (baseline eGFR 30 mL/min/1.73 m2). Her home medications included nifedipine 60 mg once daily, metformin 1 g twice daily, gliclazide 30 mg once daily, and linagliptin 2.5 mg twice daily. She was afebrile (36.2°C) with a blood pressure of 103/73 mmHg, a heart rate of 138 beats per min (b.p.m.), and oxygen saturation of 97% on room air. Electrocardiogram (ECG) demonstrated new onset atrial flutter/fibrillation, with left anterior fascicular block, prolonged QTc of 512 ms. Additional investigations supported congestive heart failure with NT pro-BNP measuring 15 600 ng/L (normal range ≤125 ng/L), high-sensitivity troponin T 21 ng/L (normal range <14 ng/L), and an enlarged cardiac silhouette on chest X-ray. Transthoracic echocardiogram (TTE) revealed an LVEF of 15–20% with severe global hypokinesis, left-ventricular end-diastolic diameter (LVEDD) of 50 mm, mild tricuspid and mitral regurgitation, and a mild-to-moderate-sized pericardial effusion . Transoesophageal echocardiogram confirmed no thrombus, and the patient underwent direct-current cardioversion. Restoration of sinus rhythm provided substantial symptom improvement and return of her ejection fraction to previous baseline of 35%. Unfortunately, she later developed cardiogenic shock due to ongoing volume overload and required IV furosemide 40 mg twice daily with IV infusion of milrinone upwards of 0.375 μg/kg/min for 3 days. Myocardial perfusion imaging showed no reversible ischaemia and sustained LVEF of 30–35%. She was stabilized off inotropic support and discharged on metoprolol 25 mg twice daily, amiodarone 200 mg once daily, nitroglycerin 0.2 mg/h patch, hydralazine 100 mg three times a day, furosemide 20 mg once daily, and apixaban 2.5 mg twice daily for a CHADS2 score of 4. Further left-ventricular (LV) enhancement therapy with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) was not initiated due to acute on chronic kidney impairment. Workup for non-ischaemic cardiomyopathy revealed a normal thyroid-stimulating hormone, normal ferritin, and unremarkable serum and urine protein electrophoresis. However, serology was positive for T. cruzi IgG antibody by ELISA IgG and confirmed by an immunoblot assay. Both tests were done at the National Reference Centre for Parasitology in Montreal, Canada, and reviewed by clinical microbiologists.
+She represented to hospital 3 weeks later with a new congestive heart failure symptomatology and suspected pneumonia. Initial ECG revealed atrial flutter. However, she self-converted to sinus rhythm and clinically improved with diuresis and antibiotics. She was discharged but returned to the emergency department the same day after witnessed syncope at home. She was bradycardic on arrival (heart rate 37 b.p.m.) and then developed conscious polymorphic VT . Her potassium was low at 2.4 mmoL/L (normal range 3.5–5.0 mmoL/L) with a magnesium of 0.8 mmoL/L (normal range 0.7–1.2 mmoL/L) and a prolonged QTc of 663 ms. She required 3 shocks for recurrent VT and was stabilized with a temporary pacemaker, potassium, and magnesium supplementation. She did not require cardiopulmonary resuscitation. TTE revealed LVEF 25–30% with a moderate-sized circumferential pericardial effusion without tamponade that was not amenable to pericardiocentesis. She received cardiac resynchronization therapy with defibrillator (CRT-D) implantation prior to discharge due to multiple indications including recurrent VT, reduced LVEF, and widened QRS concerning for need for biventricular pacing. She was not a favourable candidate for cardiac ablation due to her age. At this time, she was initially thought to have end-stage cardiomyopathy given her symptoms and reduced LVEF. However, on multidisciplinary discussion between the infectious diseases and cardiology teams, it was concluded that the acute reduction in LVEF was due to atrial flutter/fibrillation and once the dysrhythmia was abolished, the improved LVEF and global hypokinesia with upper limit of normal LVEDD would be more in keeping with early Chagas cardiomyopathy. The constellation of clinical findings, the patient demographic origin, and positive serology with confirmatory immunoblot assay strongly pointed to this sequalae being most probably due to Chagas disease. While a cardiac MRI would have been valuable, it was not feasible given her renal function and the prolonged wait time for this modality during the current COVID-19 pandemic. Therefore, the plan was to initiate treatment with benznidazole, the primary anti-trypanosomal agent approved by Health Canada. Benznidazole was requested from South America via the Health Canada Special Access Programme and arrived at our hospital ∼8 weeks later.
+The patient remained stable with NYHA Class II symptoms when seen a month later in outpatient follow up. Device interrogation showed 97% biventricular pacing with underlying sinus bradycardia. Repeat TTE revealed stable LVEF 25–30% and moderate-to-severe global hypokinesis. She received benznidazole 150 mg orally twice daily for 60 days (equivalent to 5 mg/kg/day for a 60-day course). The patient tolerated this medication well with no adverse effects, which commonly include abdominal pain, dermatitis, leukopenia, weight loss, or peripheral neuropathy. One month after completing benznidazole therapy, she reported significant symptom improvement with baseline NYHA Class I symptoms and no further syncopal episodes or CRT-D shocks. She did not develop other complications of Chagas disease such as gastrointestinal symptoms, thromboembolism, or syncopal episodes. She remained on metoprolol 150 mg twice daily, hydralazine 100 mg three times a day, furosemide 20 mg once daily, and apixaban 2.5 mg twice daily. Repeat TTE several weeks after completing benznidazole showed improved LVEF of 45–50% with regression towards mild hypokinesia. She has ongoing follow up with cardiology and infectious diseases services, demonstrating sustained cardiac functional improvement even 12 months later with an LVEF of 60% and reversal of hypokinesis to normal global function.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2708_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2708_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ad2d0e3bb88b50d4325d10c6db495afccc228c09
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2708_en.txt
@@ -0,0 +1,3 @@
+A 56-year-old nonsmoking female presented with cough and chest tightness for 20 days with no past medical history. Vital signs were stable except diminished left lung sounds were noted in chest auscultation. She was then found to have a large left-sided pleural effusion in CT scan . Pleurocentisis revealed a clear fluid with yellow supernatant. The laboratory analysis of the fluid revealed the following: total protein, 41 g/L (serum protein, 67 g/L) and WBC count 3700 cells/ml (13% polymorphs and 87% lymphocytes). No organisms were seen on Gram stain, and no acid-fast bacilli ware seen on auramine stain. Cultures of the pleural effusion specimens and tumor markers were also negative. No malignant cells were seen, only mesothelial cells and lymphocytes. An enhanced CT scan performed one week later indicated a 6.2 cm × 4 cm oval-shaped lesion with significant enhancement, with maximum enhanced CT value approximately 125Hu . Magnetic resonance imaging (MRI) demonstrated a 6.2 cm × 4 cm well-defined, oval-shaped lesion with suspected invasion of intervertebral foramen, placed in the left costovertebral space . Before operation, it was diagnosed as neurogenic tumor.
+Complete resection was performed by video-assisted thoracoscopic surgery (VATS). On direct visualization, there was a lesion in the posterior mediastinum close to left paravertebral region with moderate hardness, not adhering to the surrounding spine, mediastinum or chest. The capsule was complete and the boundary was clear. Thoracoscopic resection was performed successfully, and the estimated intraoperative bleeding was 200 ml. The size of lesion was approximately 6 cm × 5 cm × 3.5 cm and was sent for routine pathology.
+Histopathology revealed a cavernous hemangioma composed of varying size and dilated cavernous sinuses, with an inner wall lined with vascular endothelium . In addition, makers including CD34, CD31 and SMA positive , Ki-67 staining was positive (2%). The patient’s post-operative recovery was uneventful and discharged from hospital on the third day after surgery. No recurrence was not noted at 14 month follow-up.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_272_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_272_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..378af6ff1c89bfb089041c4c92170ed3e6efef17
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_272_en.txt
@@ -0,0 +1,6 @@
+We present the case of a 60-year-old female patient of mixed race (Honduran) from an urban area of Honduras, with a pathological history of arterial hypertension and type 2 diabetes mellitus under control (metformin 500 mg and enalapril 10 mg). In December 2015, she presented to a local medical service with dysphonia that had progressed over 2 months; it was exacerbated by singing and accompanied by orthopnea that had progressed over a month. She denied odynophagia, weight loss, dysphagia, and hyporexia. She had no relevant family history.
+Physical examination showed a good general condition, mesomorphic biotype, and stable vital signs. During the segmental physical examination, a soft mass was palpated within the anterior region of the neck; it was painless and mobile on swallowing and had irregular margins without inflammatory signs.
+Ultrasound (US) of the neck showed a solid ovoid tumor located in the left thyroid lobe. It had well-defined borders, an approximate dimension of 37 × 24 × 37 mm, and a volume of 17 mL. The right thyroid lobe was normal with a dimension of 34 × 11 × 10 mm and a volume of 2 mL. The thyroid isthmus and adjacent vascular structures had no obvious abnormalities. One week later, fine needle aspiration (FNA) biopsy was performed on a single nodule. FNA was also performed for some lymph nodes suggestive of malignancy. The anatomopathological report confirmed ATC. Laboratory tests showed elevated thyroid stimulating hormone levels .
+Computed tomography of the neck performed a month later showed that the thyroid mass covered the entire left lobe, with predominant vascularity toward the periphery. The tumor extended to the isthmus and the right lobe, where the neoplasm replaced the inferior pole. There was also evidence of multiple adenopathies with loss of morphology, and all were larger than 8 mm. There were findings suggestive of infiltration of the perithyroid muscles and displacements of the trachea and carotid sheath; there was no infiltration of the other adjacent structures.
+A total thyroidectomy and bilateral central radical dissection were performed in February 2016 in a second-level care unit and sent for a pathological study. The macroscopic description of the right thyroid lobe measuring 25 × 10 mm is as follows: the external surface is rough partially covered by fibrous adhesions, at the cut of a soft consistency of gray color, with small areas of light brown color, separated by the isthmus where colored areas are observed light brown and left thyroid lobe measuring 55 × 30 × 20 mm, external surface is rough covered by fibrous adhesions, when cut with a mass that replaces the entire lobe, without viable thyroid tissue (see Fig. ). Microscopic study revealed an anaplastic thyroid carcinoma (stage IV B) with focal involvement of soft tissues and lymph nodes with macrometastasis (see Figs. , , , and ). There were no postoperative complications. No immunohistochemical study was performed.
+Subsequently, five cycles of chemotherapy with doxorubicin (60 mg/m2) were completed in 6 months. She did not receive any other form of therapy. Currently, the patient is under oncological surveillance (control appointments with imaging studies and hormonal tests every 6 months since her intervention). The most recent follow-up appointment was in February 2021; she showed no signs of recurrence. She has achieved 5 years of complete remission and has maintained optimal health.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2731_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2731_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f6d6c828de71df17b0a944dcd310eb9a681cc17a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2731_en.txt
@@ -0,0 +1,9 @@
+An 80-year-old woman presented to the hospital with a two-month history of pain in both legs.
+Two months ago, pain initially manifested in both legs during hospitalization for UTI. The pain was vague, heavy and diffuse, ranging from the knee to the pelvis. Because the pain shortly resolved and no abnormalities were observed on physical examination, no further evaluation was performed for the leg pain. She was placed on a 2-wk antibiotic therapy for UTI. Subsequently, she was discharged and the antibiotic was discontinued because of improvements in clinical symptoms (to normal), as demonstrated by laboratory examinations. However, after discharge, the pain recurred and worsened over time.
+The patient had a 10-mo history of hypertension with medication.
+On admission, the patient’s vital signs were within normal range. She complained of diffuse tenderness in both lower extremities, without definite erythema, warmth, or edema. Muscular strength in both legs was normal, and there were no limitations of movement.
+Complete blood count revealed normal white blood cell count (WBC), with a neutrophil percentage slightly elevated at 73.4%. Serum C-reactive protein levels significantly increased to 112.82 mg/L (normal range 0-5 mg/L) and the erythrocyte sedimentation rate was 33 mm/h. Other biochemistries and urinalysis were normal. Knee joint aspiration revealed WBC of 24000/μL [PMN (polymorphonucleocytes) 90%] and RBC of 100/μL.
+Physical examination revealed no prominent local inflammation; however the pain did not resolve continuously. So, bone scan was performed, and revealing diffuse increased uptake in the shaft of both femurs (more severe in the left than the right) and the periarticular bones of both knee joints . Because these findings can be equally observed in the context of tumors and osseous infections, magnetic resonance imaging (MRI) was performed.
+Large intramedullary lesions with diffuse irregular contours were observed in both mid- to distal femurs, both proximal tibiae, and both patellae. Multiple T2 high and T1 low SI fluid collections with peripheral thick enhancement were observed, extending from diaphysis to epiphysis. Diffuse enhancement of surrounding soft tissue was observed along the periosteum with focal cortical disruption in the medial portion of the supra-condyle of the right femur .
+An imaging test suspected osseous infection and involvement of the knee joint, we performed joint aspiration and cultures. The joint fluid analysis revealed WBC of 24000/μL (PMN 90%), RBC of 100/μL, and culture-negative. Considering the MRI findings, the possibility of osseous infection was high. Exclusion of bone tumor through histopathological examination was necessary for the following reasons: (1) The involvement of bones other than the lumbar vertebrae is rare in adult osteomyelitis caused by the hematogenous spread of infection; and (2) Increased uptake on bone scan can similarly be observed in bone tumor.
+Surgical drainage and biopsy were performed. Gross examination revealed grey colored pus-like discharge and inflammatory tissue in the femoral medulla, and periosteal reactions were observed in the cortex. Extended-spectrum beta-lactamases (ESBL)-producing E. coli was observed in tissue- and bone cultures. This bacterium was the previously observed pathogen, which demonstrated same antibiotic sensitivities, as observed in the previous UTI. Similarly, pathological findings indicated acute osteomyelitis.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2743_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2743_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9f0dfb3262ce4bf2ef804aa3e02d15fc49bc454e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2743_en.txt
@@ -0,0 +1,7 @@
+A 54-year-old woman was admitted to the hospital because of blood in the sputum and hemoptysis.
+A 54-year-old woman was admitted to the hospital because she had seen blood in her sputum for more than 4 mo and had had hemoptysis for 1 wk. The hemoptysis occurred without a clear reason. The coughed-out blood was bright red in clots and was accompanied by a large quantity of white and nonviscous sputum. The patient did not sweat excessively either during the day or night, did not feel cold or have a fever, did not feel chest tightness or shortness of breath, and had no dizziness or headache.
+The patient had undergone surgical removal of gallbladder polyps more than 20 years ago, and had received minimally invasive surgery for breast fibroma more than 2 years ago.
+The patient had no history of smoking or consuming alcohol, and there was no family medical history.
+On admission, the patient's temperature was 36.7°C, with a heart rate of 78 beats/min, blood pressure of 110/68 mmHg, and respiratory rate of 16 breaths/min. The patient exhibited clear consciousness and compliance throughout the examination. Her trachea was in a neutral position, there was no cyanosis in her mouth or lips, and no swollen lymph nodes were identified in the supraclavicular region of either side. The breathing sound of both lungs was clear; no obvious rale was heard. The heart rhythm was regular; no obvious pathological noise was heard. The patient’s abdomen was flat and soft; no tenderness or rebound pain was identified. Edema in her lower extremities was not evident, and no clear pathological signs were found in the nervous system.
+Her hemoglobin level was relatively low at 98 g/L; the remaining routine blood examination results, C-reactive protein level, liver and kidney function indicators, and electrolyte levels were all within the normal range. A laboratory examination indicated that the levels of the tumor indices neuron specific enolase (NSE), carbohydrate antigen (CA)-724, CA-125, CA19-9, carcinoembryonic antigen, and alpha-fetoprotein were in the normal range.
+A computer tomography (CT) image of the patient that had been obtained in November 2017 showed atrophy in the middle lobe of her right lung as well as bronchiectasis in the left lung and the middle lobe of the right lung accompanied by infections. Numerous nodules with a diameter of 0.3 to 0.5 cm were identified in the middle lobe of the right lung . Another CT image obtained in March 2018 revealed that the bronchiectasis in the middle lobe of her right lung was accompanied by atelectasis, which was more observable than the atrophy in the same location in the previous CT image .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2746_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2746_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..02eb308f7a617ec28102f949491931b02549f7bf
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2746_en.txt
@@ -0,0 +1,3 @@
+A 64-year-old male presented with left upper quadrant pain of 1 week duration. The pain was worse when standing and relieved on lying down. On physical examination, no palpable abdominal mass was found. Computed tomography (CT) scan of the abdomen revealed a 6.7 × 4.4 × 3.3 cm, heterogeneously enhancing circular mass in the left retroperitoneum . The enhanced scan showed uneven enhancement. The fat space around the mass was blurred and the left perirenal fascia was thickened. No lesion was seen in either of the kidneys. Moreover, there were no congenital renal abnormalities such as horseshoe kidney or ectopic kidney. The patient has a 2-year history of hypertension with the highest recorded blood pressure of 160/130mmHg and the patient reports taking regular medications. Based on clinical examination and radiological assessment, a clinical diagnosis of ectopic pheochromocytoma was made. Subsequently, tumor resection was performed through transperitoneal approach. After resecting the tumor, the resected specimens were immediately fixed in 10% formalin.
+On gross examination of a 10 cm well-delineated mass , the section was grayish-white, solid, and hard. Microscopically, the mass had a partial envelope, with a few residual lymphatic follicles at the border . Most of the structure was destroyed by tumor cells. The tumor was mainly composed of hornlike tubules and tubular papillary structures, covered by a single layer of epithelium . Fibroconnective tissue hyperplasia is seen in the interstitium, with an infiltration of lymphocytes and neutrophils. The tumor is accompanied by mass necrosis . At higher magnification, tumor cells were found to be cuboid, columnar and shoe-shaped, with deeply stained nuclei, protrusion nucleoli, and pathological mitosis . No normal renal tissue was seen. The initial diagnosis was metastatic lymph node malignancy, and the differential diagnosis included renal collecting duct carcinoma, papillary renal cell carcinoma, medullary carcinoma, high-grade urothelial carcinoma, among others. An immunohistochemical study was performed, using the DaKo EnVision method. The tumor cells indicated a strong reactivity for CK7, CK19, CK18, PAX8, and EMA. To further exclude other tumor entities, we also stained for Melan-A, Inhibin-a, OCT3/4, Syn, CgA, which were all negative. The Ki-67 index focally reached to 30–40% of tumor cells . As no identifiable normal renal tissue was found, the possibility of this mass developing in a supernumerary kidney, was ruled out. Thus, combined with morphological and immunohistochemical evaluation, the final pathological diagnosis was metastatic collecting duct carcinoma of lymph nodes. No further nephrectomy was performed because the patient had no significant detectable masses, cysts or other abnormalities, in either kidney on enhanced CT. The patient was subsequently discharged and close follow-up was recommended.
+Three months later, the patient underwent abdominal CT examination in the outpatient department and was surprised to find a mass occupying shadow about 2.5 cm in size at the left renal hilum. Furthermore, multiple nodules of different sizes were observed retroperitoneally, with the largest lesion of 2.7 × 2.2 cm . The diagnosis was considered to be renal malignancies with retroperitoneal lymph node metastasis. The oncologist recommended radiation therapy and chemotherapy. At that time, the patient was extremely thin and lived in a rural area, making it difficult to travel back and forth. Therefore, the patient refused treatment. Five months later, the patient underwent another CT review in the outpatient department, which revealed a soft tissue mass with a diameter of 3.6 cm in the lower part of the left kidney and multiple soft tissue shadows in the renal portal area, which was considered to be renal malignant tumor with metastasis . Again, the patient refused treatment. Currently, the patient is still alive, 11 months after being diagnosed with collecting duct cancer.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2749_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2749_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..018c0510612e8bdda0c748903926414f86f623b0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2749_en.txt
@@ -0,0 +1,3 @@
+A 17-year-old female patient was admitted to our outpatient clinic with pain located over the right thenar eminence since 6 months. The pain became worse when grasping objects. No history of trauma could be elicited. Clinical examination revealed free range of motion of the wrist joint and unremarkable peripheral blood flow and motor function without paresthesia of the fingers. Nevertheless, a pulsating vessel could be felt over the thenar eminence . The patient described pain when pressure was applied directly onto the vessel. Sonography showed a subcutaneously located vessel with arterial perfusion pattern . A magnetic resonance angiography was performed revealing a large calibered SPBRA with a superficial course and the absence of the superficial palmar arch . Splinting for 2 weeks did not cause symptom relief. Since the pain persisted for another 2 months, an operative procedure consisting of arterial transposition was suggested.
+Due to the absence of information about a superficial course of the SPBRA causing pain in the literature, we have specifically tailored the following approach: an incision was made along the thenar crease. Following elevation of the skin flap, the macroscopically unremarkably appearing SPBRA could be located within the subcutaneous tissue over the abductor pollicis brevis muscle . The muscle was tunneled using a curved clamp and carefully dissected using cautery. Thereafter, the artery was transposed beneath the muscle. The muscle was re-approximated using interrupted absorbable sutures without compressing the SPBRA .
+Postoperatively, a splint with adduction of the thumb was applied. The postoperative course was uneventful. The skin sutures and the splint were removed after 2 and 4 weeks, respectively. At latest follow-up, 1 year following the surgical procedure, the patient was free of symptoms with free range of motion of the thumb joint and no signs of weakness of the M. abductor pollicis brevis. Sonography showed a patent vessel beneath the abductor pollicis brevis muscle.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2799_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2799_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ce9577c0bf9538c0d6eebe2d7c87dbcf51da15ec
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2799_en.txt
@@ -0,0 +1,5 @@
+A 30 year old woman was diagnosed with end stage renal disease which was suspected to be a complication of previous malarial illness. Haemodialysis was initiated in 2000 and a deceased donor kidney transplant was performed in 2005. Immunosuppression was by cyclosporin, azathioprine and prednisone, without induction therapy. The post-transplant course was stable with good renal function. The patient developed diabetes mellitus in 2010 and was placed on insulin. Parathyroidectomy was performed in 2011 for hyperparathyroidism. She was treated in hospital once in 2012 for a urinary tract infection.
+Renal function deteriorated over a period of 6 months in 2014, serum creatinine increasing from a baseline of less than 100 to more than 300 μmol/l. This prompted the performance of a transplant biopsy. Chronic allograft nephropathy was diagnosed and immunosuppression changed to tacrolimus (target serum trough level 5-7 ng/ml), mycophenolate mofetil (1 g twice daily) and prednisone (10 mg/day). Renal function remained stable until rapid deterioration occurred early in 2015 due to suspected non-adherence to immune suppressants during a foreign visit. Three steroid pulses (methylprednisolone 250 mg daily) were administered, and a repeat transplant biopsy was performed. The histological appearance was essentially unchanged. Renal function improved somewhat with serum creatine decreasing from an initial value of 640 μmol/l to 395 μmol/l, and then stabilising at a new baseline of about 380 μmol/l after one further dose of methylprednisone 500 mg. Subsequently viral infection due to cytomegalo-, and BK-virus occurred at different times. The virus infections were diagnosed by quantitative serum PCR for CMV and by urine PCR for BK virus. CMV infection, which presented as a febrile illness, was treated because of a sustained viral load of 250–671 copies/ml. Treatment was by induction with intravenous gancyclovir and maintenance with oral valgancyclovir. The BK viral load in the urine was 269,000 copies/ml. Immunosupression was progressively reduced to a tacrolimus target trough level of 5 ng/ml, mycophenolate mofetil 500 mg twice daily and prednisone 5 mg daily and viral disease remained quiescent. Late in 2014 and during 2015 the patient developed recurrent episodes of severe bacterial urinary tract infection which were accompanied by SIRS response. She was admitted to hospital on five occasions with intervals of one to 2 months. The infections responded each time to empiric (usually amoxicillin/clavulanic acid) and/or directed (on occasion switched to a carbapenem) antibiotic therapy for 10–14 days. Initially Klebsiella pneumoniae was cultured from urine and blood, but on the last 3 occasions Escherichia coli (E. coli) was cultured, each time with similar antibiotic sensitivity. Ultrasound of the transplant, vesicocystourography and cystoscopy were non-contributory to the causation of recurrent infection apart from grade 2 reflux into the transplant ureter. Various prophylactic antibacterials were prescribed without success. On each occasion of admission for sepsis the graft was tender and it was decided to perform an FDG-PET/CT scan. This revealed a metabolically active lesion in the upper pole of the transplanted kidney, suggestive of an abscess . Attempted aspiration of the lesion did not yield pus after several passes, and was followed by a core needle biopsy. The biopsy yielded poor non-diagnostic tissue, but a positive culture of an E. coli with the same antibiotic sensitivity spectrum as that cultivated from urine and blood. The biopsy was repeated and this time yielded diagnosable material. Routine histological sections were stained with haematoxylin and eosin and revealed renal tissue with a prominent infiltrate of cryptococcus round yeast bodies. The fungal elements were organised into groups in a myxoid and inflammatory background in most of the tissue. Alcian blue staining demonstrated a thick mucinous fungal capsule. The microscopy confirmed the presence of chronic allograft nephropathy. There were areas of prominent interstitial fibrosis with atrophic tubuli and occasional sclerotic glomeruli. There were no specific features of BK virus nephropathy present. The biopsies had not been specifically cultured for fungal pathogens as the finding was unexpected. At the time of discarding the plates at 48 h, there had been no fungal growth.
+On the basis of the radiological and histological appearances, a diagnosis of cryptococcoma of the transplanted kidney was made. Investigation for systemic cryptococcosis was commenced. An uncontrasted brain and lung CT scan was normal. Cerebrospinal fluid examination yielded the following: glucose 3.6 mmol/l, protein 0.29 g/l and adenosine deaminase 1.5 u/l. There were no cells present. India ink staining and cryptococcus latex antigen test (CLAT) of the fluid were negative. Bacterial and fungal culture were negative. The lungs were examined clinically, and radiographically by plain X-ray and CT scan. They were found to be normal. The serum cryptococcus latex antigen test (s-CLAT) was negative. Multiple subsequent blood and urine specimens were negative for fungal culture.
+The patient was treated with fluconazole 400 mg daily with the intention of continuing for 6 to 12 months. During this time the patient remained chronically ill with nausea, anorexia and loss of weight, as well as the recurrent urinary tract infections. On follow-up FDG-PET/CT scan after 2 months the cryptococcoma showed a significant increase in size and intensity . A gastroscopy was performed for the upper gastro-intestinal symptoms. A mucosal mass was seen, biopsy of which revealed Kaposi sarcoma.
+Throughout her protracted illness the patient remained unwilling to accept any reduction of the immunosuppression for fear of losing the kidney. Eventually, in light of poor renal function and life-threatening infections, she acceded to reduction and cessation of immunosuppressants, and was started on haemodialysis. Treatment for the cryptococcosis was escalated by adding 200 mg of fluconazole after each dialysis session. The lesion in the kidney which had become detectable on ultrasound was apparently unchanged. The patient died soon after initiation of dialysis during admission to hospital for an episode of severe sepsis.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2824_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2824_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..746d2bc781aa7944a2d2d98d8b2e58ac5d0f42d7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2824_en.txt
@@ -0,0 +1,2 @@
+After 1 month of conservative treatment elsewhere, a 76-year-old Japanese woman who was previously healthy presented at our hospital with bilateral severe buttock and lower extremity pain, without a history of injury. She had a history of diabetes, hypothyroidism, and right breast cancer treated surgically 30 years previously. She had no appreciable familial or psychosocial history. Examination revealed the following: severe pain in the buttocks and posterior femoral area, positive straight-leg-raising tests at 30 degrees bilaterally, positive Valleix pain point and superior gluteal nerve pain point tests bilaterally, and negative femoral nerve-stretching tests bilaterally. The patient’s visual analogue scale (VAS; 100 mm) scores for lower extremity pain and numbness were 100/100 mm. By contrast, she had no motor deficit or dysfunction of the bladder or bowel. X-ray findings showed mild spondylosis. Magnetic resonance imaging (MRI) revealed a solitary intradural extramedullary mass at L2/3 with low T1, high T2, and uniform contrast enhancement with gadolinium . Myelography showed a total block of contrast below L2/3 and capping of contrast by the mass . The diagnosis was a solitary intradural extramedullary cauda equina tumor (a suspected schwannoma). The patient desired tumor extirpation because of the severe pain, so we evaluated her general status. A chest computed tomographic scan showed a suspected left breast cancer and lung metastasis . Brain MRI showed one small mass in the temporal lobe of the left side with a diameter of about 5 mm, a suspected metastasis . We considered a cauda equina tumor metastatic from the breast cancer. After obtaining informed consent, we performed an L1–3 laminectomy and tumor extirpation. Bloody cerebrospinal fluid was observed after the dura mater incision was made. The tumor was involved with the intact cauda equina, and careful division of adhesions was performed. After cutting the filum terminale (conglutinated with the tumor), the tumor was extirpated en bloc .
+Postoperatively, the patient experienced pain relief. The pathology of the metastasis was adenocarcinoma. The result of cerebrospinal fluid cytology was negative. The patient started chemotherapy for breast cancer. At the 3-month postoperative follow-up, her VAS score was decreased for the lower extremity pain (from 100 to 0 mm) and numbness (from 100 to 20 mm). MRI showed no local relapses at the surgical incision. The lower extremity pain relief was maintained and was satisfactory during the postoperative course. Radiation therapy was performed to treat the brain metastasis after the surgery. The patient died 9 months postoperatively of Trousseau syndrome and brain metastasis due to breast cancer.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2834_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2834_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8fb4a4422725341b143005231218fbcd31142f0b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2834_en.txt
@@ -0,0 +1,3 @@
+A 58-year-old-woman presented to clinic with a 4-month history of a lump in her right breast close to the axilla. There was no history of nipple discharge or any skin changes. Her most recent screening mammogram was unremarkable and had been performed approximately 2 years and 6 months prior to presentation. There was no family history of breast or ovarian cancer. On examination, a firm non-tender mass measuring 2×2 cm was noted in the right upper quadrant of the breast and the axillary tail, which was not attached to the underlying structures. Mammography revealed a dense irregular mass in the axillary tail and a circumscribed nodule in the 6 O'clock periareolar region. An asymmetric density was also seen in the central right breast. There was no evidence of axillary lymphadenopathy. Ultrasound demonstrated a lobulated solid mass in the axillary tail measuring 2.2×1.8×1.5 cm, and a simple cyst measuring 1.1×0.8×0.7 cm in the peri-areolar region at 6 O'clock. Normal appearing lymph nodes were seen in the right axilla.
+Fine needle aspiration cytology of the right breast axillary tail revealed a poorly differentiated invasive carcinoma consistent with mammary duct origin. Biopsy of the areolar region of the right breast revealed a typical duct hyperplasia in a background of dense stromal fibrosis. The patient underwent right-sided total mastectomy with sentinel lymph node biopsy.
+On histopathological examination, the specimen revealed a tumor measuring 2.6 cm in greatest dimension, with resection margins negative for tumor. Skin and nipple were negative for tumor. It was an infiltrating ductal carcinoma with metaplastic features of chondroid differentiation ( and ). The tumor was estrogen receptor (ER), progesterone receptor (PR), and HER-2 negative with 0% nuclear staining. Immunohistochemical stains for pan cytokeratin on the sentinel lymph nodes were negative. Tumor cells showed some degree of anisocytosis with a nuclear pleomorphism score of 3, and mitotic figures in tumor cells were frequent with an average of eight mitoses or more per square mm. The overall ELSTON grade of invasive carcinoma was grade 3. Ki-67 index was 52% with strong nuclear staining. Adjuvant chemotherapy with AC-T (Adriamycin, Cytoxan, and Taxol) was initiated. The patient tolerated chemotherapy well initially but developed taxol-induced sensory neuropathy leading to early discontinuation of taxol. She is currently undergoing surveillance with no evidence of recurrent disease.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2906_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2906_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2e2d44d56dd5aa3c52601ff9d2d40bd8df6d5cd3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2906_en.txt
@@ -0,0 +1,5 @@
+A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. The mechanism of her injury compromised vigorous internal rotation of the femur on the tibia with the knee in flexion. She complained of mild pain in both the medial and lateral aspects of her knee joint. Her right knee was locked in 35° of flexion.
+Physical examination demonstrated negative Lachman-Noulis and anterior drawer tests. Clicks or catches were not detected by palpation during flexion, extension, and rotary motions of her knee joint. There was tenderness in her medial and lateral joint line. Results of standard anteroposterior and lateral roentgenograms were normal. A magnetic resonance imaging (MRI) evaluation demonstrated the tears in both menisci of the right knee , while the anterior and posterior cruciate ligaments were found to be intact .
+Our patient had no relevant medical history. Her physical examination and laboratory tests were unremarkable. No diseases of the connective tissue or other deficiency of the ligaments were detected.
+She underwent a knee arthroscopy in the next 24 hours, and the diagnosis of combined injury of bicompartmental bucket-handle tears with an intact anterior cruciate ligament was confirmed . Arthroscopic evaluation also revealed a discoid lateral meniscus. Moreover, a grade III chondral lesion (graded on the Outerbridge classification), less than 1 cm2 in size, was detected on the medial femoral condyle . A partial medial and lateral meniscectomy was then performed. The decision was made because of the discoid lateral meniscus and the quality of the ruptured part of the medial meniscus. The torn tissue - approximately 40% of the mediolateral width of each meniscus - was removed. The cartilage defect was repaired by drilling therapeutic holes (approximately 0.5 to 1.0 mm in diameter) into the subchondral bone marrow space underlying the region of the cartilage lesion (microfracture technique) .
+At our patient's follow-up examination six months after her injury, clinical tests demonstrated that her right knee was stable, had a full range of motion and had no tenderness. The functional outcome was evaluated using Lysholm scoring. At the time of her presentation to our emergency department she had a Lysholm score of 75, while six months after her injury, her Lysholm score had increased to 85 . She was satisfied with the outcome of the operation and returned to her pre-injury activities.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2910_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2910_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..973a3dc1c67388ae3027a35c67bbd10ff133b71d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2910_en.txt
@@ -0,0 +1,10 @@
+A 58-year-old female had a three year-history of multiple stress fractures and muscle weakness. Her medical history included well-controlled type 2 diabetes (HbA1c 43 mmol/mol) for nearly 20 years. Her BMI was 39 kg/m2 and she was on metformin, long-acting insulin and pioglitazone. She was a current smoker with a smoking history of 27 pack years and her dietary calcium intake was considered normal. Skeletal growth had been normal, and she had not suffered from bone fractures or abnormal skeletal pains previously. She did not have a family history of skeletal, metabolic or hormonal disorders.
+Three years prior to diagnosis the patient presented with multiple fragility fractures and increasing bone pain. Fractures were found in the vertebrae , right femur, sacrum and lateral condyle of the right tibia, and in the left talus. She complained of progressive muscle weakness and diffuse bone pains in her back and lower extremities.
+One year later, dual-energy X-ray absorptiometry (DXA) demonstrated osteopenic bone mineral density (T-scores of lumbar vertebrae 3-4 and the femoral neck were -0.8 SD, and -2.3 SD, respectively). Basic biochemistry in primary care was unremarkable (data not shown). Pioglitazone treatment, initiated four years before the first fragility fracture, was suspected to underlie the multiple, low-intensity fractures and therefore discontinued. At this point, type 2 diabetes was considered as another predisposing factor.
+During the year before the diagnosis, she suffered from a stress fracture of the left femur with significant dislocation , which was treated with total hip arthroplasty, as well as a stress fracture of the right femur that was treated with an intramedullary nail . Within the next months, she also suffered from stress fractures of the right distal femur, tibia and humerus.
+A year before correct diagnosis of TIO, teriparatide, calcium carbonate (1000 mg daily) and cholecalciferol (20 µg daily) supplementations were initiated to enhance recovery of bone strength after pioglitazone treatment.
+The patient was referred to the University Hospital Endocrine Unit. At this time point, the patient had not been able to walk for two years, was bedridden and had lost 30 kg of weight (from 106 to 78kg), and she needed constant pain medication (oxycodone 50 mg, gabapentin 1800 mg and paracetamol 3 grams daily). Biochemical tests revealed hypophosphatemia, combined with high serum FGF23-concentration (C-terminal, EIA-method, MVZ Labor Dr. Limbach & Kollegen, Heidelberg, Germany), inappropriately normal 24-hour urinary phosphate secretion, and increased serum alkaline phosphatase concentration . Alphacalcidol (0.25 µg twice daily) and phosphate supplementation (Phosphate Sandoz 500 mg twice daily, reduced dose due to diarrhea) were started. Calcium carbonate 1000 mg and cholecalciferol 20 µg daily were continued and teriparatide was discontinued. A bone biopsy from the iliac crest demonstrated osteomalacia. Genetic testing for hypophosphatemia [mutations in the DMP-1, ENPP1, FGF23, PHEX and SLC34A3 genes ] was negative. Computed tomography (CT) of the thorax and abdomen revealed no tumors. An additional, complete physical examination revealed a palpable mass in the right mandible. Ultrasound and CT confirmed a tumor with invasive growth in the right mandible . Cytologic analysis of a fine needle aspiration taken from the tumor demonstrated myoepithelial-like cells.
+After the diagnosis was confirmed, the tumor of the right mandible was operated. Histopathological examination of formalin-fixed and paraffin-embedded slides demonstrated a 2.6 cm phosphaturic mesenchymal tumor with multinucleated, osteoclast-like cells , with minimum tumor free resection margins of 0.5 mm. The Ki-67 proliferation index in hot spots was 10-15%. Immunohistochemical studies showed positive vimentin staining but negative CD34, EMA, and CKPAN stainings, compatible with a phosphaturic mesenchymal tumor and the diagnosis of TIO . The histologic samples were re-evaluated by an expert pathologist in the National Institutes of Health, USA.
+Postoperatively, the patient needed prolonged treatment of 10 days in the intensive care unit. Both intravenous and p.o. phosphate supplementations were warranted to correct for severe hypophosphatemia . After surgery, the concentration of serum ionized calcium remained in the normal range, 1.16-1.25 mmol/l (reference range 1.15-1.30 mmol/l). Administration of calcium carbonate 1000 mg and cholecalciferol 20 µg daily was continued. Due to muscle weakness, the patient was dependent on mechanical ventilation for four days. Thereafter, she needed continuous positive airway pressure (CPAP) through a tracheostomy. During that time, to maintain sufficient blood pressure levels, norepinephrine infusion had to be maintained for one week after surgery. She was on enteral nutrition during the postoperative days 1-11 (1500 kcal daily from third postoperative day). On the third postoperative day, the patient presented with respiratory alkalosis for six hours after fiberoptic bronchoscopy, with a pH of 7.52-7.60 and low/normal pCO2 (3.6-4.9 kPa), and elevated pO2 (13.2-59.8 kPa), base excess (BE) (2.5-5.7 mmol/l) and bicarbonate (HCO3) concentrations (27-30 mmol/l) (reference ranges 7.35-7.45, 4.5-6.0 kPa, 9.3-12.3 kPa, -2.5-2.5 mmol/l and 22-24 mmol/l, respectively). From the fourth postoperative day onwards, arterial pH remained within normal range. The patient was decanylated one week postoperatively . She received subcutaneous short-acting insulin (4-12 units daily) for hyperglycaemia.
+Phosphate supplementations were administered for eight weeks. The patient received oxandrolone for one week because of extreme weakness and lack of spontaneous respiratory activity in order to improve muscle function and the recovery of lean body mass . Skeletal and limb pains relieved soon, and muscle weakness alleviated within the succeeding months. The patient was able to take a few steps after four months of rehabilitation.
+After two years of rehabilitation, the patient was able to walk 100 meters with a walker and shorter distances without any help. She has not suffered from any further fractures or bone pains. After surgery, serum phosphate concentration has remained normal. Serum FGF23 concentrations decreased immediately after the operation and have remained slightly increased . Due to the vertebral fractures, DXA of the spine was unreliable.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2928_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2928_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..14f2cc84f2611e82b9adcfcd7ca8a1ac439871f7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2928_en.txt
@@ -0,0 +1,4 @@
+A 48-year-old multiparous woman was admitted to our hospital's gynecology ward with a history of heavy menstrual bleeding and pelvic pain. She had undergone an abdominal myomectomy in 2006, a caesarean section in 2010 and hypertension under treatment. Physical examination revealed an enlarged uterus. Subsequent pelvic ultrasound showed markedly lobular and enlarged uterus containing intramural uterine leiomyomas, the two largest measuring respectively 6.4 × 5.4 cm, and 4.2 × 4.8 cm. Blood testing found a haemoglobin level of 7.4 g/dl although the patient's vital signs were stable.
+After discussing the various treatment options, the patient consented to hysterectomy by laparotomy. Intraoperative examination showed severe adhesions fusing the bladder to the uterus and the uterus to the small bowel. After adhesiolysis, intra-abdominal visualization revealed an enlarged uterus containing two fundal intramural myomas as diagnosed by ultrasound. The adnexa on both sides were normal and there were no fluid collections or other significant findings suggestive of malignancy throughout the abdomen. Due to the many difficulties associated with the total hysterectomy, including obesity, anaemia, a large uterus and adhesions from previous operations, a subtotal hysterectomy was decided in order to complete the procedure safely. The patient was discharged a few days after surgery without any complications.
+Macroscopic examination revealed a bosselated, large uterus with multiple leiomyomas. Microscopic examination showed tumors with features of conventional leiomyoma and a mesenchymal tumor proliferation with a fasciculate architecture composed of fusiform tumorous cells with STUMP. It showed cell necrosis with atypical cells and karyorrhexis; however, there was no evidence of a mitotic activity . On immunohistochemical analysis, the smooth muscle cells expressed AML (, A), P53 wild-type (, A) and desmin (, B). The Ki-67 proliferation index was low (<1 %) (, B).
+For optimal oncological care, our case was discussed in a multidisciplinary team meeting (MDTM). The consensus was that no adjuvant therapy would be offered considering the lack of benefit of adjuvant therapy in the current literature. However, it was recommended to keep the patient in close follow-up, every six months for five years, by a gynaecologic oncologist, including clinical and computed tomography (CT) scan. A 6-month follow-up thoraco-abdomino-pelvic CT scan revealed no evidence of local recurrence or distant metastasis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2930_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2930_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..59ab9e28a1f941dc6001104b0c2a9f089e9880e1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2930_en.txt
@@ -0,0 +1,3 @@
+In this report, the case of a 27-year-old Italian woman (height, 164 cm; weight, 55 kg) was presented during the second month of her first pregnancy. She had no history of illness until 25 years of age, when she developed general fatigue and bleeding tendency and the symptoms led to diagnosis of Gaucher disease. The diagnosis was based on anemia, thrombocytopenia, elevated levels of serum acid phosphatase and angiotensin-converting enzyme, hepatomegaly, splenomegaly, the presence of Gaucher cells in bone marrow aspiration. No other family members were suffering from the disease. DNA analysis of the GBA gene revealed that she was heterozygous for the c.1448T > C (p.L444P) mutation. The treatment for the patient started with 19-38 units/kg of imiglucerase (Cerezyme; Genzyme, MA, USA) every two weeks. The patient underwent elective splenec-tomy at age 26 years for massive splenomegaly. Menorrhagia improved, hemoglobin concentration and platelet count normalized, biomarkers of disease (chitotriosidase, acid phosphatase, and angiotensin-1-converting enzyme) improved, and liver volumes decreased. The patient became pregnant at 27 years of age and, with informed consent, continued imiglucerase treatment throughout all pregnancy, as previously described at Salesi Mother and Child Teaching Hospital of Ancona (Italy) in the year 2012. Genetic counseling was performed at the first obstetric examination and a prenatal testing for Gaucher disease and amniotic fluid sampling (16th week) were carried out, thereby, the existence of the disease and other chromosomic anomalies was excluded.
+By the second month of pregnancy, monthly obstetric ultrasound and blood sampling were performed and by week 20 of gestation bi-weekly determinations of blood counts revealed that hemoglobin levels were ranging from 9.8 to 10.9 g/dl and platelet counts from 96,000 to 135,000/mm3. The prothrombin time and partial thromboplastin time were normal. The biophysical profile studies, as well as Doppler analysis, were repeated every two weeks in outpatient clinic of our teaching hospital. In the 39th week of pregnancy, an elective cesarean section on maternal choice was carried out and a male baby of 3180 g was delivered. Epidural anesthesia was chosen with nasal oxygen throughout. No adverse neonatal outcomes and no congenital anomalies were registered. An uneventful recovery period was observed and the patient was discharged on the 4th postoperative day. No postoperative complications were observed after delivery. X-ray examination after delivery revealed no bone abnormalities and finally no further increase in the size of the patient's spleen was observed. The patient decided not to breastfeed.
+This study was approved by the local departmental ethics committee and written informed consent was obtained from the patient for the case report to be published.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2948_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2948_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eda2fefb259af5aa790d1fdf41816f71f8a373d2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2948_en.txt
@@ -0,0 +1,3 @@
+The patient was a 69-year-old man referred to our department after a simple computed tomography (CT) scan revealed enlarged gastric lesser curvature lymph nodes and a mass lesion in the pancreatic head. A subsequent contrast-enhanced CT revealed wall thickening of the lower gastric body, multiple enlarged gastric lesser curvature lymph nodes, and an anterior superior common hepatic artery (CHA) lymph node involving the pancreatic head and CHA . Tumor markers showed elevated levels of carcinoembryonic antigen (CEA, 33.9 ng/ml) and carbohydrate antigen (CA19-9, 108.1 U/ml). Esophagogastroduodenoscopy (EGD) revealed a tumor with an ulcer on the lesser curvature of the lower body of the stomach . Histopathological examination of the biopsied specimen indicated moderately differentiated adenocarcinoma, which was HER2-negative, and MSI-high status was determined using an MSI test kit (FALCO biosystems, Kyoto, Japan). Based on these findings, a diagnosis of advanced gastric cancer of stage III (T3N2M0) was made (8th edition of the Union for International Cancer Control). The anterior superior lymph node of the CHA was considered unresectable due to its involvement with the pancreatic head and CHA, and chemotherapy was decided as the treatment plan. The patient had difficulty swallowing at the time of examination; therefore, he was treated with mFOLFOX6 therapy (leucovorin 200 mg/m2, oxaliplatin 85 mg/m2 in a 2-h infusion, bolus fluorouracil 400 mg/m2 on day 1, and a 46-h infusion of fluorouracil 2400 mg/m2 every 2 weeks). At the end of three courses, tumor markers were elevated (CEA, 35.3 ng/ml and CA19-9, 136.9 U/ml), and contrast-enhanced CT showed enlargement of the primary tumor, and lymph node of the lesser curvature and anterior superior CHA .
+The patient was diagnosed with the progressive disease based on the Response Evaluation Criteria in Solid Tumors (RECIST) and was treated with ramucirumab plus paclitaxel as a second-line therapy. After a 4-week course of paclitaxel (80 mg/m2) intravenously on days 1, 8, and 15, with ramucirumab (8 mg/kg) intravenously on days 1 and 15, the patient developed a grade 3 fatigue, which necessitated a change of the therapeutic drugs. Hence, his second-line therapy was switched to pembrolizumab monotherapy (pembrolizumab 200 mg once every 3 weeks). Tumor markers decreased markedly to CEA 7.2 ng/ml and CA19-9 35.9 U/ml at the end of three courses, and contrast-enhanced CT showed that both the primary tumor and the lesser curvature lymph node had shrunk, and the anterior superior lymph nodes of the CHA showed improved findings of invasion into the pancreatic head and CHA . A diagnosis of partial response was made based on RECIST guidelines. EGD revealed a tumor in the primary lesion that almost disappeared after six courses of pembrolizumab . Tumor markers remained low with CEA 7.5 mg/ml and CA19-9 33.7 U/ml , and contrast-enhanced CT revealed that R0 resection was possible; therefore, a distal gastrectomy with D2 lymph node dissection was performed. Surgical findings showed no obvious liver metastasis or peritoneal dissemination, and the cytology was negative. The anterior superior lymph node of the CHA was safely dissected after resection of the primary tumor, as intraoperative ultrasonography confirmed that there was no invasion into the pancreatic head or CHA . Gastrectomy specimens showed an ulcerated scar on gross examination . The histopathological findings showed that the superficial layer of the gastric mucosa was covered by regenerating epithelium and that there was only mucus accumulation from the submucosa to the serosa with no residual tumor cells that could be considered viable, determined to be histological grade 3 . The histopathological findings of the resected lymph node revealed mucus accumulation only in the anterior superior lymph node of the CHA, which was diagnosed as metastasis of adenocarcinoma, although there were no residual tumor cells that could be classified as viable . The patient was discharged from the hospital 23 days after surgery without complications.
+The patient commenced 6 months of adjuvant chemotherapy with pembrolizumab 3 months after surgery. Twenty months after surgery, the patient is alive and recurrence-free.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2949_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2949_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9c1adfa7db1b23520c386e2fd350db6dfc442672
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2949_en.txt
@@ -0,0 +1,2 @@
+A 31-year-old pregnant woman gravida two abortion 1 admitted in our institution (HAZRAT ZEYNAB Hospital of Shiraz University of medical science) at gestational age (GA) of 27 + 3 weeks with the chief complaint of vaginal leakage and diagnosis of premature rupture of amniotic membrane (PROM). In her first obstetric sonography at GA of 19+2 weeks, the MCDA pattern was confirmed with adequate amniotic fluid, and no congenital anomalies were detected. On the first physical examination, no tachycardia, fever, and uterine tenderness were observed. The patient’s speculum examination revealed fern-positive vaginal leakage without malodor discharge, with a closed cervix and no uterine contraction. Ultrasound examination showed two alive fetuses, and the posterior placenta and amniotic fluid of both fetuses were adequate (5cm and 7.5cm). Strip NST of both fetuses was reactive with an FHR base of 150. Based on these examinations, the patient admitted and received IV antibiotics at first for two days, continued with oral antibiotics for seven days, and two doses of corticosteroids for lung maturation administered during 48hrs.
+The patient was under observation in the hospital with weekly WBC and CRP (c-reactive protein) and twice-weekly NST and maternal pulse rate (PR) and temperature monitoring for early detection of chorioamnionitis signs. In-hospital course after two weeks of admission, the biometry and colorflowmetry of the umbilical artery revealed fetal weight discrepancy of 31% and IUGR stage I for one of the fetuses and the other fetus was relatively small for gestational age (SGA). Ultrasonography also reported that no intertwin membrane was seen most probably because of the rupture of the membrane since the patient had not experienced any invasive procedure during pregnancy. Fetal heart rate monitoring was acceptable for gestational age. Also, no sign of chorioamnionitis presented until the 3rd week of admission. At the 30th week of gestation, the patient developed maternal tachycardia (PR: 110-120), fever (t: 38-38.5), a rise in WBC count up to 14000, and persistent tachycardia of the IUGR fetus (170-180). Therefore after hydration and administration of broad-spectrum antibiotics, the emergency cesarean section was performed due to chorioamnionitis diagnosis. At the time of cesarean section two female newborns delivered by breech and vertex presentation, the first one cried immediately after birth with an APGAR score of 6, weighing 1430gr and the second one born with mild respiratory depression and poor APGAR score of 1 and birth weight of 1020gr. APGAR score re-evaluation five minutes after the delivery showed the scores of 8 and 6 for the first and the second newborn, respectively. Two times nuchal cord was observed around the neck of one of the fetuses. Furthermore, two umbilical cords were twisted and formed a complex of true knots and tight loops as it is shown in . Umbilical artery blood gas examinations showed PH: 7.4, pCo2: 35, HCO3: 21.3, base excess: -2.6, for the first fetus, and PH: 7.35, pCo2: 32, HCO3: 17.1 and base excess: -7, for the second one (the depressed baby). Both neonates were admitted in the NICU ward because of prematurity and also respiratory distress syndrome in the second twin. No significant neonatal complication occurred, except mild hyperbilirubinemia. All cultures and gram stain of throat, nose, blood, eye discharge, and CSF were negative. Brain sonography revealed grade-I IVH in the second twin. The first and the second babies were respectively discharged from NICU ward 20 and 24 days after their birth, and no complications have been observed yet in the afterbirth follow-ups. After consultation with the mother and upon her request, the placenta and umbilical cord were sent for histological examination. The anatomical pathology findings (macroscopic) confirmed the MCDA as the type of chorionicity with no specific pathological changes except cholangitis of the placenta.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2990_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2990_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6de4765a645dcc13321d3e7ec7e4e70e176336f9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2990_en.txt
@@ -0,0 +1,6 @@
+A 66-year-old female patient with a history of dilated cardiomyopathy, first diagnosed 4 years ago, who had undergone surgical tricuspid valve repair with an incomplete three-dimensional-shaped rigid AR due to severe secondary TR 3 years ago presented with pronounced right heart decompensation including ascites, pitting pretibial oedema, bilateral pleural effusion, chronic kidney disease but without signs of liver dysfunction.
+The transthoracic echocardiogram performed after 5 days of intensive diuretic therapy showed a severely impaired systolic left ventricular ejection fraction of 30% with dilation of all heart chambers and a resulting moderate secondary mitral regurgitation and severe TR. The basal diameter of the right heart was 50 mm and right heart function was severely impaired . A transoesophageal echocardiogram (TOE) confirmed severe TR as a consequence of severe leaflet tethering but showed no signs of dehiscence of the AR. Right heart catheterization revealed moderate post-capillary pulmonary hypertension filling pressures of the right heart were significantly elevated. Right ventricular stroke work index was 1.0 g/m2/beat and central venous pressure-to-pulmonary capillary wedge pressure-ratio 0.9.
+Based on the severity of right ventricular disease a right ventricular assist device (RVAD) was considered but this option was eventually discarded as it was declined by the patient at least as primary treatment option. Redo tricuspid surgery was—in line with the literature—felt to be associated with a too high perioperative risk because of renal insufficiency and poor clinical condition of the patient., Due to massive tethering with restrictive motion of the anterior leaflet and complete lack of coaptation particularly in the antero-septal area of the valve percutaneous edge-to-edge repair was also regarded as unfavourable. Our Heart Team finally decided to perform a percutaneous valve-in-ring-implantation with the option of RVAD implantation as a bail-out strategy in case of acute rHF following elimination of TR.
+The procedure was performed in general anaesthesia under angiographic and TOE-guidance. A soft-tip Amplatz extra-stiff wire was placed from the femoral vein in the right pulmonary artery via a 7-Fr balloon-tipped pulmonary artery catheter. SP3 was inserted via a 16-Fr eSheath, with the company label facing towards the patient to allow for flexing of the catheter towards the tricuspid valve. Subsequently, the balloon was retracted under the valve, the valve was advanced to the tricuspid annular plane, the pusher was pulled back a couple of centimetres beyond the designated markers to allow flexible alignment of the valve and the position of the prosthesis was optimized aiming at a 15/85 right atrium to right ventricle position. The balloon was then inflated slowly, while carefully checking for correct positioning without pacing of the heart. The prosthesis could be implanted in an optimal position under an intentional overinflation of the balloon of 2 mL .
+Echocardiographic control, also after complete removal of the wire revealed a massive transvalvular regurgitation, which was found to be caused by complete immobility of the cusp adjacent to the ventricular septum resulting in a large coaptation gap , most likely caused by an asymmetric bulging of the valve stent in the area of the opening of AR . As there was only mild paravalvular leakage (PVL) , the decision was taken to implant a second SP3, which could be implanted uneventfully and lead to complete elimination of TR with only minimal septal PVL . Haemodynamics remained stable throughout the whole course of the procedure. The patient was extubated in the hybrid operating room and transferred to the general ward after one night in the intensive care unit. Her creatinine levels dropped from 1.8 mg/dL prior to the procedure to 1.3 g/dL on the first post-interventional day. After mobilization, the patient was discharged in good general condition to a follow-up treatment in a rehabilitation centre.
+At follow-up after 2 months, the patient showed slightly improved right and left heart function and an improved general condition without signs for right heart and liver failure, ascites or oedemas .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2994_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2994_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1aee0108b98ce6431fd908911bcf9a4aaf705056
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2994_en.txt
@@ -0,0 +1,49 @@
+Our patient was a six-year-old girl who had presented at the age of eight months to
+our hospital with persistent symptoms of cough, dyspnea and hypoxaemia since she was
+two months old. She had an unremarkable neonatal history, which was the result of a
+full-term pregnancy, and had a birth weight of 2.4 kg. Her symptoms led to an
+initial diagnosis of viral bronchiolitis. However, her dyspnea persisted, and her
+condition further deteriorated during successive viral infections. Her parent
+complained that she suffered from recurrent vomiting, choking and symptoms
+suggestive of aspiration. The parents were first-degree consanguineous cousins, but
+there was no family history suggestive of chronic respiratory diseases.
+On clinical examination, she was in respiratory distress, was failing to thrive and
+had a weight below the third percentile. Her height and head circumference were
+normal. No dysmorphism was noted, and clubbing was not initially present. Her vital
+signs showed tachypnea and hypoxaemia, and clear chest auscultation was observed. On
+cardiovascular examination, there was no murmur and no initial finding suggestive of
+pulmonary hypertension.
+Her initial basic laboratory workup was normal apart from a nasopharyngeal polymerase
+chain reaction that was positive for rhinovirus. Chest X-rays showed diffuse
+bilateral ground glass opacity . An echocardiography was unremarkable. Her immunological work
+up was normal, and a bronchoscopy showed a normal airway structure. A workup for
+gastroesophageal reflux disease revealed moderate gastroesophageal reflux disease in
+pH probe studies. She was managed accordingly, and because the patient did not
+respond to optimal medical therapy, we proceeded with fundoplication and gastrostomy
+tube insertion.
+Nevertheless, within the following year, she continued to exhibit dyspnea without
+exertion and hypoxaemia. Thus, a diagnosis of childhood interstitial lung disease
+was suspected. A chest computed tomographic scan showed diffuse inhomogeneous
+bilateral ground glass opacity with scattered small, thin-walled cysts in the
+superior segments of both lower lobes and the lateral segments of the middle lobe
+.
+A wedge lung biopsy was obtained, which showed prominent large, irregular and cystic
+parenchymal distortion with marked thickening and fibrotic expansion of the
+interstitial spaces . The alveolar spaces showed moderate epithelial hyperplasia with
+abundant foamy histiocytes, lymphocytic infiltrate and some areas with cholesterol
+clefts .
+Histiocytes also showed dense eosinophilic granules and occasionally globules of
+periodic acid–Schiff stain-positive proteinosis material . The airways showed mild epithelial
+hyperplasia and focal mild subepithelial fibrosis. These histological features are
+typical of genetic disorders of surfactant metabolism, and this morphological
+pattern at this age is most commonly associated with mutation in SFTPC. This
+diagnosis was confirmed by genetic testing, which showed a p.I73T pathogenic
+mutation located in coding exon 3 of the SFTPC gene, and no
+abnormalities were detected in the ABCA3 or NKX2.1
+genes.
+Currently, our patient is six years old. She was managed with six doses of monthly
+pulse therapy with hydroxychloroquine and azithromycin, which led to subsequent
+improvement in her respiratory status, as demonstrated by a decrease in her home
+oxygen requirement from 2 l/min to 0.5 l/min. She is also managed with supportive
+care, including nutritional, psychosocial and home care therapy. She was referred
+for the evaluation of lung transplantation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2998_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2998_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c39f36c51c26695526a386b17427593323b07483
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_2998_en.txt
@@ -0,0 +1,6 @@
+The patient was a 67-year-old Middle-Eastern man who came to the emergency ward with progressive bilateral lower extremity muscle weakness and myalgia. The patient had no drug history and no significant past medical history or history of contact with toxins. Fifteen days prior to the onset of muscle weakness, the patient had presented with fever, rhinorrhea, and mild shortness of breath, and with a positive nasal swab PCR test, had a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, for which he was treated as an outpatient, with desirable recovery after 15 days. However, following the resolution of COVID-19 symptoms, the patient started to develop myalgia and bilateral lower extremity proximal weakness. Due to augmentation of his lower extremity weakness and development of upper extremity proximal weakness, he was admitted to the hospital for further evaluation. In the physical examination, proximal muscle weakness was noted in the upper and lower extremities (power grade 4/5 and 3/5, respectively), with normal tone and deep tendon reflexes. The patient had no skin lesions or rashes. The patient also reported no muscle tenderness in our examination. The rest of the examination was normal.
+The initial laboratory tests detected elevated muscle enzymes including creatine phosphokinase (CPK): 12,000 (normal: 38–174 U/L); lactate dehydrogenase (LDH): 757 (normal: 130–240 U/L)]; and aldolase: 11 (normal: 8.5 U/L). Procalcitonin was in the normal range. Also, 25-hydroxy vitamin D test levels were normal, at 40 ng/mL. Other laboratory data included a white blood count (WBC) of 8.83 × 103 µl), hemoglobin of 14.2 g/dL, erythrocyte sedimentation rate (ESR) of 9 mm/hour (normal: < 20 mm/hour), C-reactive protein of < 2 mg/L (normal: ≤ 6 mg/L), creatinine of 1 mg/dL, blood urea of 32 mg/dL, sodium (Na) 140 mEq/L, potassium (K) 4.4 mEq/L, aspartate aminotransferase (AST) of 25 IU/L (normal: 15–40 IU/L), alanine transaminase (ALT) 26 IU/L (normal: ≤ 41 IU/L), and alkaline phosphatase 121 IU/L (normal 120–450 IU/L). Bilateral thigh magnetic resonance imaging (MRI) axial and coronal view (T1 and T2; Short Tau Inversion Recovery) showed diffuse edema within all muscle compartments of the thigh with notable intra- and perimuscular edema, suggestive of myositis. .
+Electromyography (EMG) and nerve conduction velocity (NCV) findings were suggestive of irritable myopathy in several proximal muscles, including rectus femoris, iliopsoas, and deltoid. Additionally, in a left deltoid muscle biopsy, muscle necrosis was reported in the absence of inflammation, in favor of necrotizing autoimmune myositis . In cryopreserved biopsy from deltoid muscle, variation in fiber size was evident, with presence of some pale necrotic fibers with evidence of myophagocytosis associated with some regenerating fibers. Inflammation was absent. On trichrome stain, no apparent fibrosis was seen. Based on the overall histomorphology and clinical and laboratory findings, the diagnosis of immune-mediated necrotizing myopathy was established. .
+Among all myositis-related autoantibodies such as anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), anti-signal recognition particle (SRP), anti-Jo-1, and anti-NXP2, only anti-NXP2 autoantibodies were positive, which prompted us to search for underlying malignant processes. The patient underwent a malignancy workup by abdomen and pelvis ultrasound, chest CT scan, endoscopy and colonoscopy, prostate-specific antigen (PSA), and ear, nose, and throat (ENT) examination, which were all unremarkable. Based on the positive results of NXP2 and to rule out malignancy, a fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan was performed, which demonstrated a 35 × 28 mm left thyroidal lobe nodule . A thyroid biopsy confirmed its unmalignant nature and thyroid-stimulating hormone (TSH) levels were also normal. Cardiac echocardiography, electrocardiography, and lung spirometry were also normal. Chest high-resolution computed tomography (HRCT) also showed bilateral multifocal patchy ground-glass opacities with dominant peripheral distribution, which were attributable to previous COVID-19 pneumonia. .
+Since myositis could emerge in the context of some connective tissue disorders, testing for some other laboratory markers, including antinuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA), perinuclear antineutrophil cytoplasmic antibodies (p-ANCA), cytoplasmic antineutrophil cytoplasmic autoantibody (C-ANCA), anticyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), anti-double-stranded DNA (anti-ds DNA), complement component 3 (C3), complement component 4 (C4), and anti-Ro were done, which were all in the normal range. Thus, a diagnosis of necrotizing autoimmune myositis, possibly complicating COVID-19, was made after ruling out other causes for NAM by appropriate tests.
+For treatment, prednisolone 1 mg/kg orally was administered. CPK levels started to fall after the initiation of steroids and were 107 IU/mL at the time of discharge. Resolution of ground-glass opacity of the lungs was observed after three months from his discharge. The prednisolone dose was decreased gradually to 10 mg, 1 year after diagnosis, and azathioprine was continued with an initial dose of 150 mg/day, which was decreased to 100 mg/day. The patient’s muscle force was resolved to normal after 1 year of follow-up. After confirming no inflammation, we reduced the prednisolone dose to an eventual 5 mg daily, along with 50 mg/day azathioprine. The patient is still relatively well after 15 months follow-up with improved laboratory examinations and muscle power in all extremities. The latest laboratory data were as follows: CPK: 115 U/L; LDH: 478 U/L; WBC: 9.02 × 103/µl); hemoglobin: 13.9 g/dL; AST: 25 IU/L; ALT: 23 IU/L; alkaline phosphatase (ALK): 134 IU/L; K: 4.1 mEq/L; ESR: 5 mm/hr; CRP < 2; vitamin D: 30 ng/mL; creatinine: 1.19 mg/dL; blood urea: 42 mg/dL; and Na: 139 mEq/L.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3015_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3015_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d098ffc8605c2cb49109995f27c01e588f40fd4c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3015_en.txt
@@ -0,0 +1,37 @@
+A 33-year-old male presented to the outpatient clinic with a one-month history of moderate haemoptysis, bright red in colour, associated with recurrent fever, chest infections, and shortness of breath. He has no past medical history and denies any substance abuse or chronic medication use. He is a non-smoker and non-alcoholic. There is no family history of autoimmune disease or premature deaths.
+
+Upon detailed history-taking, it is revealed that he has had a history of persistent and recurrent oral ulcers for more than 10 years. Additionally, he experienced one episode of genital ulceration three years ago, and uveitis leading to blindness in the right eye occurred one year ago.
+
+On examination, he is an average-built male in distress with pale conjunctiva and palmar creases. There are no signs of jaundice, lymphadenopathy, clubbing, or oedema. Respiratory, abdominal, and cardiac examinations were unremarkable. Ophthalmology examination of the right eye revealed phthisis bulbi (lost eye), while examination of the left eye showed a decrease in vision, cataract, and retinal vascular attenuation. Oropharyngeal examination revealed oral aphthous ulcer.
+
+No genital ulcer was observed at the time of examination. His vital signs were as follows: blood pressure 123/83 mmHg, respiratory rate 24 cycles/min, temperature 37.3 degrees Celsius, and oxygen saturation at 95% on room air.
+
+The top diagnosis considered as an emergency was pulmonary embolism, which needed to be excluded. We proceeded with a chest X-ray and an ECG, both labelled as normal.
+
+Chest infection was considered as one of the differential diagnoses. Given the high prevalence of tuberculosis in Iraq, three sputum samples were sent for Acid Fast Bacilli (AFB) test, all of which returned negative results. Blood samples were collected for a complete blood count, renal and liver function tests, inflammatory markers, and immune screening.
+
+His history, examination, and laboratory test results raised a high suspicion of autoimmune disease, specifically Behcet’s disease.
+
+We proceeded further with a pathergy test, and the result was the development of an inflammatory papule 4 cm in size within 24 h, which constitutes a positive result. Therefore, a computed tomography pulmonary angiography was ordered.
+
+Echocardiography was ordered and revealed a normal ejection fraction without valvular abnormalities or regional wall motion anomalies, neither pericardial effusion.
+
+His diagnosis was established as a case of Behcet’s disease complicated by pulmonary artery aneurysm according to the criteria published by the International Study Group for Behcet’s Disease.
+
+We started him on intravenous methylprednisolone (1 g/day) for 3 days, then oral prednisone 60 mg once daily, which was subsequently tapered to 10 mg twice daily after one month. Intravenous cyclophosphamide at a dose of 1 g (15 mg/kg) was also given every 4 weeks for a total of 6 cycles, followed by oral azathioprine 100 mg once daily.
+
+Regarding oral ulcers, we treated him with triamcinolone cream three times per day and colchicine 1 mg once daily for arthritis.
+
+Two months following the initiation of treatment, the patient showed remarkable improvement in clinical symptoms and laboratory markers. Regular follow-ups were conducted to monitor his progress closely.
+
+During the follow-up visits for one year, the patient reported a significant reduction in the frequency and severity of oral ulcers. The oral aphthous ulcer on the buccal mucosa and tongue showed signs of healing, with reduced inflammation and pain. Additionally, there were no new episodes of genital ulcers reported.
+
+Laboratory investigations revealed a gradual normalization of inflammatory markers. The C-reactive protein (CRP) levels decreased steadily to 11. Similarly, the erythrocyte sedimentation rate (ESR) showed a downward trend at 9, reflecting decreased inflammatory activity in the body.
+
+Imaging studies, including repeat chest X-rays and CT pulmonary angiography at 6 months after treatment, were performed to assess the status of the pulmonary artery aneurysm. Demonstrated stability in the size of the aneurysm, without any signs of progression or complications such as thrombosis or rupture.
+
+Echocardiography examinations were conducted to monitor cardiac function and assess for any signs of cardiac involvement related to Behcet’s disease. Throughout the follow-up period, echocardiograms showed preserved ejection fraction and no evidence of valvular abnormalities or pericardial effusion.
+
+The patient tolerated the treatment regimen well with no significant adverse effects reported. Regular monitoring of liver and renal function tests ensured the safety of medications such as cyclophosphamide and azathioprine.
+
+Psychosocial support and counselling were provided to address any concerns or anxieties related to the chronic nature of Behcet’s disease and its treatment. The patient was encouraged to adhere to the prescribed medication regimen and advised on lifestyle modifications to optimize overall health and well-being.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_301_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_301_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ddf4dfef2dfee86a153778c9b597f48eadf0cea4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_301_en.txt
@@ -0,0 +1,3 @@
+A 65-year-old woman was admitted to our hospital with a complaint of a mass in her left lumbar area. She had a previous history of appendectomy at the age of 19 and had diabetes, hypertension, angina and hyperlipidemia as comorbidities. On physical examination, reducible soft mass was located in the left lumbar area. Computed tomography showed a defect of transverse fascia in the left lumbar area with the perirenal fat protruding through the defect. The size of hernia orifice was 20 × 14 mm . Under a diagnosis of superior lumbar hernia, the patient underwent single-incision retroperitoneal laparoscopic repair.
+Under general anesthesia, the patient was placed in the right lateral decubitus position. A single, 2-cm-long incision was made 1 cm ventral from the middle point between the 12th rib and superior anterior iliac spine on the middle axillary line . External oblique muscle, internal oblique muscle and transverse abdominal muscle were each split to reach retroperitoneal space. After placing a Lap-Protector Mini (Hakko Co., Nagano, Japan) in the retroperitoneal space, three 5-mm trocars (one for a 5-mm flexible scope and two for surgical devices) were inserted through a single-port access device (EZ Access; Hakko). The EZ access with three trocars was attached to the Lap-Protector Mini to maintain the inflation of the preperitoneal space with carbon dioxide (CO2) gas, and the retroperitoneal space was gradually dissected, using laparoscopic instruments without a dissection balloon. The hernia orifice was recognized and hernia sac was slipped from the hernia orifice. The collateral branch of subcostal nerve and iliohypogastric nerve were recognized . ProGrip™ laparoscopic self-fixating mesh of 15 × 10 cm (Medtronic, Dublin, Ireland) was placed to cover the hernia orifice without mesh fixation . The retroperitoneal space was carefully deflated to avoid displacing the mesh. The sheaths of transverse abdominal muscle and external oblique muscle were each closed with 2–0 absorbable suture, and the skin was closed with 4–0 absorbable suture.
+The operative time was 50 min, and the bleeding volume was minimal. The postoperative course was uneventful. Food intake and normal activities restarted the next day after surgery, and she was discharged five days after surgery. At the 9-month follow-up, she remained well, with no signs of recurrence.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3038_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3038_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f8e590b3dc450d555aa2d4b7fd5b785a9756fc3c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3038_en.txt
@@ -0,0 +1 @@
+A 15-year-old patient presented with horizontal diplopia for 2 years. He noticed that he initially had double vision at distance and subsequently developed diplopia at near. His refractive status was myopia of −2.00 diopters (D) in both eyes. He wore spectacles only for distance vision. He had a history of smartphone usage of more than 6 hours per day. He denied any history of stress, trauma, or underlying disease. A photograph of when he was 6 years old showed that he was orthophoric at this age. On examination, his unaided visual acuity (VA) was 20/50 in both eyes and the best-corrected VA with −2.00 D was 20/20 in both eyes. A similar refractive error was found using cycloplegic refraction. Examination of the anterior and posterior segments was unremarkable. Orthoptic examination revealed esotropia of 35 prism diopters (PD) at distance and 30 PD at near by the alternated prism cover test. The deviation difference was less than 5 PD in all gazes. Esotropia at near worsened with spectacles, at which point the patient also developed diplopia. Ductions and versions were full in both eyes. The Worth 4-dot test demonstrated diplopia at both distance and near. The result of the Bagolini striated glasses test showed unsuppressed esotropia. The accommodative convergence to accommodation ratio was 4:1 as determined by the lens gradient method. Computed tomography (CT) of the brain and orbits was unremarkable. The patient underwent a bilateral medial rectus recession of 5.5 mm. The distance between the medial rectus insertion site and the limbus was 5.3 mm in the right eye and 5.2 mm in the left eye. There was no complication after treatment. He was orthophoric at both distance and near with stereoacuity Timus test of 40 sec of arc. The Bagolini striated glasses test at 3 months post-surgery showed normal binocular single vision. The follow-up time was 8 months, and there was no recurrence of esotropia.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3042_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3042_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1904bc685f2791467393eb11e8840cbfa6bac14c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3042_en.txt
@@ -0,0 +1,13 @@
+7-year-old male patient with a diagnosis of acute lymphoid leukemia of T precursors, who was finishing the cycle of induction chemotherapy with the PETHEMA 2013 protocol (which includes L asparaginase, Vincristine and Daunorrubicin + continuous prednisone for more than a month). During hospital stay, he developed a clinical picture of 12 days of epigastric abdominal pain and occasional vomiting. The segmental physical examination described exquisite pain to the palpation of epigastric, with peristalsis present, without data of obstruction. The laboratory examinations showed moderate neutropenia, with increased c reactive protein (CRP).
+
+Acute pancreatitis was initially suspected but ruled out as pancreatic enzymes and abdominal computed tomography were normal. Steroid acid-peptic disease was then suspected and medical treatment with proton pump inhibitors, prokinetic and oral tolerance was continued.
+
+The next day, he presented with increasing abdominal pain at night, associated with emetic episodes on multiple occasions, evolving with haematemesis, electrolyte imbalance (severe hypokalaemia), hyperglycaemia, severe neutropenia and signs of shock, which required transfer to the paediatric intensive care unit (PICU). Emergency esophagogastroduodenoscopy (EGD) was performed, in which an acute erosive haemorrhagic pangastritis was reported, consistent with necrotizing gastritis, confirmed by biopsy.
+
+Management was initiated with fasting, potassium replacement, fluid replacement, omeprazole in continuous infusion, ondansetron. Laboratory tests and blood cultures were negative with no bacterial isolation. The patient progressed to catecholamine refractory shock, requiring mechanical ventilation, antibiotic management, multiple vasoactive support with norepinephrine, epinephrine and vasopressin.
+
+The critical condition was overcome and parenteral nutrition was indicated on the second day due to prolonged intestinal rest. The EGD on the sixth day showed persistence of necrotizing gastritis. Therefore, intestinal rest, proton pump inhibitors and sucralfate were maintained. A control EGD was performed 30 days after intestinal rest, showing significant improvement of extensive necrosis of the body, fundus and gastric antrum, however, with persistence of necrosis area that compromised 20% of the greater curvature of the gastric body. Tolerance of the start of enteral nutrition (polymeric diet) was evaluated and, depending on tolerance, progressed to bland diet without irritants or lactose.
+
+It was initiated orally, with adequate intrahospital tolerance for 72 hours, for which hospital discharge was indicated with double dose of proton pump inhibitors and sucralfate and attention to warning signs. On control at 2 months of discharge, it was found hemodynamically stable, in the control EGD complete improvement of the necrotizing gastritis was observed, remaining areas of fibrosis at the level of the corpus antrum region.
+
+The chemotherapy treatment was postponed for a month and a half after the resolution of the critical condition associated with the necrotizing gastritis, and the same high-risk PETHEMA protocol was initiated, but in the intensification stage the doses were reduced to 50% of the cytostatic. In the next stage, the protocol was continued with the usual dose. The end of treatment studies were done and the patient is in complete remission, without complications associated with the underlying pathology; for two years to date.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3043_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3043_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..edb41b59b4dc10da8fff50679ed9d97fd43c67f7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3043_en.txt
@@ -0,0 +1,27 @@
+We present the case of a 40-year-old Caucasian female nurse who presented with complaints of blurred vision that had developed over the preceding two weeks. The patient denied experiencing other symptoms, including pain, ocular redness or scotoma. Notably, she reported flu-like illness one week prior to the onset of her visual symptoms, during which she self-initiated treatment with oral prednisolone (20 mg/day, during 3 days) and bilastine (10 mg/day, during 3 days).
+
+Her medical history is significant for vitiligo and hypertension, which has been well-controlled with telmisartan (40mg/day) since diagnosis, 3 years earlier. The patient has no known allergies and no relevant family medical history. Her visual acuity was assessed at 20/20 with a refractive error of −0.25 in both eyes at baseline.
+
+Biomicroscopy of the anterior segment was unremarkable, and intraocular pressure (IOP) was recorded at 14 mmHg in the right eye (OD) and left eye (OS). Pupillary reflexes were normal, with equal and reactive pupils. Extraocular movements were intact.
+
+Fundoscopic examination under mydriasis revealed the absence of the foveal reflex, along with a suspected subfoveal serous retinal detachment and multiple small serous retinal detachments in the posterior pole, but no other abnormalities. The retinal vessels appeared normal without signs of vasculitis, and no vitreous opacities or chorioretinal lesions were identified.
+
+Infrared and spectral-domain optical coherence tomography (SD-OCT) in OD and OS revealed bilateral, multiple, bleb-like small serous retinal detachments in the macula and along the vascular arcades, with varying sizes. A large confluent detachment was present in both eyes, temporal to the fovea. Fundus autofluorescence (FAF) appeared normal, showing no significant alterations at this stage. Fluorescein angiography (FA) and indocyanine green angiography (ICG) presented a normal aspect without any leakage or pooling.
+
+A survey for possible infectious causes was carried out and the patient lived in an apartment in an urban area with good sanitary conditions but had contact with a dog and cows/goats once a week, cleaning them. There is no history of international travel within the past five years, nor any recent hair coloring. There was no recent tick bite, no contact with patients with known pulmonary tuberculosis, nor any recent work accident, such as a needle stick. No recent or past consumption of intravenous drugs and no recent or previous use of topiramate or any MEK inhibitor. No recent or past risky sexual relations and no consumption of unpasteurized milk and its derivatives or consumption of undercooked meat.
+
+Regarding vaccination, the patient’s immunization status is in accordance with the national vaccination schedule, including the COVID-19 vaccination. Two initial doses of the Pfizer-BioNTech COVID-19 vaccine were administered at the beginning of 2021, followed by a booster dose later in the same year. An annual booster has been received since then, with the most recent dose administered 6 months prior to the onset of symptoms.
+
+A comprehensive laboratory workup was conducted to investigate potential infectious, autoimmune, and systemic etiologies for the serous retinal detachments. Hematological evaluation, including a complete blood count and platelet levels, returned within normal limits. Liver function tests, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT), as well as kidney function markers (creatinine and urea), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were all normal. Electrolyte levels were also within normal ranges, and thyroid function tests, including thyroid-stimulating hormone (TSH) and free thyroxine (T4), revealed no abnormalities. Angiotensin-converting enzyme (ACE) levels and ionized calcium were likewise normal.
+
+To explore autoimmune causes, tests for antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA), anti-double-stranded DNA (anti-dsDNA), anti-extractable nuclear antigen (anti-ENA), anti–Sjögren’s-syndrome-related antigens A and B (anti-SSA and anti-SSB) and anti-Smith antibodies (anti-SM) were all negative. Rheumatoid factor testing was also negative. Syphilis serology (TPPA) was unremarkable.
+
+Infectious serologies showed that IgG antibodies for cytomegalovirus (CMV), herpes simplex virus 1 (HSV1), Epstein-Barr virus (EBV), and parvovirus were positive, while IgM antibodies for these infections were negative, suggesting past infections. Serologies for herpes simplex virus 2 (HSV2), varicella-zoster virus, Toxoplasma gondii, Borrelia, Coxsackie B virus, Coxiella burnetii, and Rickettsia were negative for both IgG and IgM antibodies. Bartonella DNA/PCR testing was negative, as was the Wright reaction for brucellosis. Serological tests for HIV, hepatitis B, and hepatitis C were also negative. Tuberculosis screening with an interferon-gamma release assay (IGRA) and a Mantoux test yielded negative results, with 0 mm of induration. Urine test revealed no hematuria or proteinuria.
+
+Additional imaging and systemic evaluations were conducted. A brain and orbit magnetic resonance imaging (MRI) and thoraco-abdominopelvic computerized tomography (CT) scan were both normal. Further assessments, including upper gastrointestinal endoscopy, colonoscopy, breast CT, breast ultrasound, cervical cytology, transvaginal ultrasound, and dermatological screening, revealed no significant abnormalities.
+
+Three months after the onset of the visual symptoms, in a follow-up consultation, her best corrected visual acuity (BCVA) remained 20/20 in OD but decreased to 20/25 in OS. Biomicroscopy of the anterior segment was unremarkable, and IOP was 14 mmHg in both eyes. Fundoscopic examination revealed multifocal yellowish subretinal polymorphous material scattered throughout the macula and seemed to gravitate along the lower margin of the serous retinal detachment, forming a curvilinear meniscus along temporal inferior vascular arcade. The previously observed bilateral multiple small serous retinal detachments have coalesced into a single larger detachment, while an accumulation of hyperreflective material in the subretinal space is observed, which translates the fundoscopic vitelliform deposits, as seen on SD-OCT. Additionally, FAF demonstrated the characteristic hyperautofluorescence of the polymorphous deposits, that corresponded to the yellow spots observed during fundoscopic examination. The same lesions showed hyperfluorescence on FA in all phases of the angiogram and ICG showed mild hypofluorescence in all phases of the angiogram.
+
+In both eyes, full field electroretinogram was normal, as electrooculogram (Arden ratio was 2.39 in OD and 2.51 in OS) and pattern visually evoked potentials. Pattern Electroretinogram was normal in OD but showed a mild macular dysfunction in OS (reduction of P50-wave amplitude).
+
+Based on the clinical presentation, multimodal imaging findings, evolving retinal changes, and comprehensive systemic screening to rule out autoimmune, infectious, and neoplastic etiologies, a diagnosis of idiopathic AEPVM was established. The patient is being monitored for visual recovery and the potential need for further interventions.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3075_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3075_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..cdc74bcc1bf6602e4d5852ff3ffdd6daa34add4b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3075_en.txt
@@ -0,0 +1,7 @@
+The 15-year-old boy’s parents are both healthy. His main manifestations are epilepsy, autism, and dystonia, which progressively worsens. His family has no similar illnesses, half a month past the due date, cesarean section, weighed 9 pounds at birth, weak sucking ability, no history of asphyxia.
+
+The boy reached the peak of his morbidity before the age of 15. He was diagnosed with epilepsy at birth. The main manifestation is has involuntary upper limb jerks and hand clumsiness, treatment with phenobarbital, sodium valproate, and levetiracetam. He learned to walk at the age of 2 and less verbal, but can say duplicate word, diagnosed with autism, rehabilitation was given with poor results. Involuntary jerks of both upper limbs disappears at about 9 years of age, discontinuation of “phenobarbital, sodium valproate, and levetiracetam.” At the age of 12, who appeared myoclonic jerks of the limbs, involuntary lifting of both upper limbs and stick out one’s lips, weakness of both lower limbs, the right lower limb is obvious, with abnormal posture of hands, feet and left shoulder, manifested by involuntary lifting of the hands, flexion of the fingers and toes of both hands, symptoms progressively worsen until they become unsteady and prone to falls. Completely unable to walk at age 14. Symptoms worsened again at about 14.5 years of age, accompanied by involuntary tilt back of the neck, have difficulty chewing, aggravated by external stimuli and/or stress, symptoms are worse at night, difficulty sleeping, occasional fecal incontinence. He was treated with oral baclofen tablets 3 times a day, but the results were not satisfactory, so he came to our hospital.
+
+Physical examination of the nervous system shows, loss of speech, bilateral pupils are equal in size and circumference about 3 mm in diameter, sensitive to light reflection, limb flexion, involuntary limb movement, hypertonia of both hands and feet, inside left shoulder, the bilateral pathological signs were not elicited, and the physical examination of the residual nervous system did not cooperate.
+
+Return of test results, blood routine: hemoglobin 115 g/L. Six items of blood coagulation: fibrinogen 1.39 g/L, thrombin time 21.5 s; thyroid function 3 items: thyrotropin 10.7 uIU/mL, the rest is normal; liver function: total protein 57.8 g/L, albumin 38 g/L; blood lipids: low density lipoprotein cholesterol 1.83 mmol/L; electrolytes: potassium 3.69 mmol/L, sodium 146 mmo1/L; no obvious abnormality was found in Hs-CRP, SAA, vitamin B12, folic acid, blood homocysteine, vitamin B1, and blood ammonia. Brain magnetic resonance imaging (MRI) showed mild brain atrophy-like changes. Two-hour video electroencephalogram (EEG) showed that during the awakening period of abnormal adolescents, the background fast wave activity increased, and the family members identified the event without seizure pattern. Genetic testing showed that NM_024496.4 (IRF2BPL): c.379C > T (p.Q127*) may be pathogenic, and the frequency of this variant in the gnomAD database is 0. This variant is nonsense and is predicted to result in the possible premature appearance of the termination codon, with multiple losses of function reported downstream of this locus, the patient’s father, mother, and sister did not carry the variant, considering the clinical relevance of this variant in the context of the patient’s clinical presentation, as a result he has been diagnosed with NEDAMSS, autism. Sodium valproate oral solution 15 mL twice/day, levetiracetam tablets 0.125 g twice/day, clonazepam tablets 0.5 mg twice/day, baclofen tablets 15 mg in the morning, 10 mg in the afternoon and 10 mg at night were given. The patient did not have any further seizures and the dystonia improved over the previous period.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3081_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3081_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4b3d29d3f3303f55f5137ad751ef99fb49b5fed1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3081_en.txt
@@ -0,0 +1,55 @@
+The patient is a 65-year-old male who presented with progressive lower back pain accompanied by complete bilateral lower limb paralysis and was urgently admitted to Hunan Provincial People’s Hospital for treatment under the diagnosis of “intraspinal mass”. The patient reported waking up in the morning with unexplained lower back pain, which progressed steadily, culminating in complete paralysis of both lower limbs after 36 hours, with a complete loss of sensation and motor function. At the onset, there were no complaints of headache, dizziness, nausea, vomiting, chest or lumbar pain, and normal urinary and bowel habits.
+
+Physical Examination
+Vital signs: normal, blood pressure: 18.7/12.0 kPa (140/90 mmHg).
+
+Conscious and oriented with normal heart and lung function.
+
+No palpable splenomegaly.
+
+Normal sensation and motor function in both upper limbs.
+
+Tenderness and percussion pain over the T12-L3 spinous processes.
+
+Diminished sensation in the thighs bilaterally.
+
+Complete loss of deep and superficial sensation below both knees and in both lower limbs.
+
+Reduced muscle tone, muscle strength graded as 0.
+
+Absent anal reflex, bilateral absent knee and ankle reflexes.
+
+Normal biceps and triceps reflexes, negative Hoffmann and Babinski signs.
+
+Negative meningeal signs.
+
+Laboratory Results on Admission
+WBC: 37.52 x 10^9 g/l.
+
+HGB: 176 g/l.
+
+Platelet count: 1694 x 10^9/l.
+
+PCT: 1.77.
+
+Normal red blood cell and platelet distribution width, coagulation function, and blood glucose.
+
+Emergency Lumbar Spine Interlaminar CT Findings
+L2-4 intraspinal wedge-shaped high-density lesion.
+
+Treatment
+After fluid resuscitation and symptomatic treatment, and completion of preoperative examinations, the patient underwent decompressive surgery under general anesthesia. Intraoperatively, a mass consistent with an epidural hematoma was identified, extending from the posterior aspect of the L1 vertebra to the lower border of the L3 vertebra. The hematoma was situated on the right side of the spinal cord, causing compression and flattening. The intraoperative diagnosis was confirmed as spontaneous spinal epidural hematoma. Microscopic exploration after hematoma evacuation did not reveal vascular rupture or significant bleeding within the spinal canal. The compressed spinal cord was irrigated with ice saline solution, and after confirming the absence of intraspinal vascular bleeding, posterior spinal fusion with pedicle screw fixation and bilateral bone grafting was performed. A negative-pressure drainage tube was placed, and the wound was closed after careful inspection, indicating normal bone quality in the thoracic and lumbar spine with mild soft tissue edema in the surgical area.
+
+Owing to early application of hyperbaric oxygen therapy (HBOT) can reduce spinal cord hemorrhage, edema and hypoxia, and is beneficial to the recovery of spinal cord function. After surgery, the patient underwent hyperbaric oxygen therapy (HBOT) and emerged from the hyperbaric oxygen chamber two weeks later. Subsequent blood routine examinations revealed a persistent elevation of platelet count, significantly exceeding the normal range. Bone marrow aspiration and peripheral blood smears were performed, along with JAK2, CALR, and MPL gene testing. The results indicated active bone marrow proliferation with a clustered distribution of platelets. The JAK2V617F mutation was identified as positive, while CALR and MPL gene mutations were negative. Comprehensive analysis could not definitively distinguish between primary thrombocythemia and early-stage primary myelofibrosis. Hydroxyurea therapy was initiated, resulting in a gradual normalization of platelet levels.
+
+Upon discharge, the patient still had motor dysfunction and was unable to walk unaided, and reported sensory deficits extending from the left lateral surface of the leg to the outer side of the calf and from the right lateral surface of the thigh to the middle of the outer side. Muscle strength assessments revealed:
+
+Left lower limb: Iliopsoas muscle at grade III, Extensor hallucis longus muscle at grade I–II.
+
+Left thigh: Quadriceps femoris muscle at grade II–III.
+
+Right thigh: Quadriceps femoris muscle at grade I.
+
+Howbeit at the 12-month follow-up post-discharge, routine blood examinations and other assessments returned to normal. Bladder and bowel functions were restored, and muscle strength in both lower limbs had reached grade 4. The patient was able to walk normally but with a slight limp and had a history of overall good health, with no trauma, hypertension, diabetes, family hereditary diseases, or infectious disease history.
+
+This study adhered to ethical standards established by the ethics committee, and the subject was well-informed and provided consent for participation in the research.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3085_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3085_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eb71c669f6f28fd9dea71df8ba541d6c4d8e3262
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3085_en.txt
@@ -0,0 +1,8 @@
+We report a case of 52-year-old white woman living in southwest Pennsylvania with a medical history significant for well-controlled hypertension (HTN), chronic obstructive pulmonary disease (COPD) without oxygen supplementation, and chronic back pain following multiple surgical interventions, currently managed with a spinal pain pump, presenting to an outside facility with exertional dyspnea. The patient reported subjective fever, chills, generalized fatigue, and polyarthralgia. She also reported persistent dizziness and occasional pre-syncope. Notably, she denied palpitations, chest pain, or skin rash, and she did not recall recent tick bites, but mentioned her dog’s diagnosis of Lyme disease following deer tick infestation a few months prior. Her vital signs revealed tachypnea and hypoxemia necessitating the initiation of 2 L of oxygen via nasal cannula.
+
+Clinical Course
+An electrocardiogram (EKG) displayed T-wave flattening in the anterolateral pre-cordial leads. Initial investigations included a chest X-ray, indicating pulmonary edema and inter-stitial infiltrates. Laboratory analysis revealed a significantly elevated B-type natriuretic peptide (BNP) of around 2800 pg/mL, along with mildly elevated troponins (128 ng/L). Consequently, the patient received ceftriaxone and doxycycline for presumed pneumonia, as well as intravenous furosemide therapy for acute heart failure exacerbation. Additionally, a 48-hour heparin infusion was initiated due to concerns regarding underlying acute coronary syndrome (NSTEMI). Subsequently, she was transferred to our hospital for further management.
+
+Upon arrival, her condition had stabilized, with the resolution of supplemental oxygen requirement and improvement in exertional dyspnea following diuretic therapy. However, she exhibited gradually worsening sinus bradycardia, with a heart rate in the 50s and significant hypotension (systolic blood pressure consistently below 90 mmHg). Telemetry monitoring and EKGs throughout the hospitalization revealed absence of AV block. Importantly, she continued to deny chest pain, shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She did not show signs of end-organ dysfunction evidenced by normal mental status, lactate levels, urine output, renal, and liver functions. Her thyroid-stimulating hormone and 8 a.m. cortisol profiles were also normal (0.039 uIU/ml and 17.1 ug/dL, respectively). The respiratory viral panel result was unremarkable. Point-of-care ultrasound (POCUS) of the heart revealed a hypokinetic anterior left ventricular (LV) wall and mildly reduced ejection fraction by visual estimation, while the inferior vena cava (IVC) parameters were within the normal range and showed respiratory variation. Of note, her prior EKGs and echocardiograms were normal. Lyme serologies were ordered a few days after presentation due to the unclear etiology of new heart failure and in the setting of this persistent bradycardia.
+
+Due to persistent hypotension, reaching a nadir of 76/50 mmHg (MAP of 59), she was transferred to the Cardiovascular Intensive Care Unit (CVICU) for monitoring and potential pressor support. Lyme IgM and IgG titers followed by Western blot returned positive, leading to the continuation of ceftriaxone therapy for Lyme carditis. Formal echocardiography demonstrated mildly depressed LV systolic function with an ejection fraction of 50% and akinetic anteroseptal, anterolateral, and anterior LV walls. A coronary computed tomography angiogram (CTA) ruled out an ischemic etiology and coronary artery disease, revealing a coronary calcium score of 0. Over the following days, the patient’s condition gradually improved, with stabilization of blood pressure and heart rate, leading to her discharge on an extended course of intravenous ceftriaxone therapy (28 days) for the treatment of Lyme cardiac disease, manifested as myocarditis and cardiomyopathy. Cardiac MRI or endomyocardial biopsy were not pursued given the patient’s remarkably good clinical response to treatment. She was discharged on 14-day Holter monitor, showing absence of AV block.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3099_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3099_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..939b6858cc456282832d54213b997103d064372e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3099_en.txt
@@ -0,0 +1,7 @@
+A 34-year-old man of Asian ethnicity was referred to the Department of Oral Medicine (OM) from the Department of Internal Medicine. The patient complained of very dry mouth, tongue stiffness, burning making it difficult to open the mouth, and white patches on the throat that made it difficult to swallow. A few days earlier, the patient had felt nauseous, vomited, had a sore throat, and looked like he had canker sores in his mouth. To relieve his symptoms, the patient went to the clinic and was given medication. The sore throat was getting worse, so he was referred to Hasan Sadikin Hospital and diagnosed with type 2 diabetes mellitus (DM). Patients are unaware and do not know the signs or symptoms of DM. This patient has a poor lifestyle, always eating fast food, drinking sugary every day, rarely drinking water, and never exercising. In the last few months, he has been experiencing stress at work.There are no allergies to any food or medication. There was no history of alcohol use or smoking. The habit of brushing teeth three times a day was healthy, but the patient’s family never cleaned the mouth and teeth while he was in the hospital. The patient had a history of chickenpox, but he forgot when exactly he got it. The patient also has a habit of wetting his lips with his tongue when he has oral complaints. This patient’s complaint is only in the oral cavity. The diagnosis from the internal medicine department was type 2 diabetes mellitus with mild diabetic ketoacidosis, acute kidney injury, mild dehydration, and hyperemia. The diagnosis of type 2 DM was made in this patient by examining the random blood sugar (784 mg/dL) and HbA1c (13.9%).
+
+Extraoral examination revealed exfoliation, with desquamation and erosion of the lips, multiple, not tend to bleed, but painful. Intraoral examination of the labial mucosa, upper and lower gingiva, right and left buccal mucosa, and dorsum of the tongue showed multiple white plaques that could be scraped off, leaving an erythematous, painful, and the mirror stick to the buccal mucosa. The hard palate appears as vesicles filled with clear fluid, multiple, accompanied by erosion with an erythematous base, extending to the soft palate, painful with dry saliva. The dorsum of the tongue appears as depapilation with a mirror stick. There is no saliva pooling on the floor of the mouth. Additional examinations show the results of a complete blood test and others listed in Table 1, the results of the examination of fungal preparations in Table 2, and the examination of Depression Anxiety and Stress Scale-21 score (DASS-21) with results of normal depression (score 0), anxiety mild (score 4), and moderate stress (score 10) and body mass index (BMI) 38.91. The definitive diagnosis in this case based on history, clinical, and additional examination was established as RIH in the hard palate region extending to the soft palate, accompanied by pseudomembranous candidiasis on the right and left buccal mucosa, mandibular anterior gingiva, dorsal tongue, and oropharynx. There was also severe xerostomia Challacombe scale and exfoliative cheilitis of the upper and lower. The differential diagnosis for this case is Herpes Associated Erythema Multiforme (HAEM). Treatment for this patient consists of pharmacological therapy in the form of systemic and topical medication. Systemic medication with Fluconazole 150 mg injection once a day for seven days and Acyclovir 200 mg per oral five times a day (given after the IgG test results a positive value). Topical medications include 0.9% NaCl to compress the lips, clean the teeth and the tongue at least twice a day after breakfast and at night before going to bed, chlorine dioxide mouthwash to compress the oral cavity three times a day, and 100% petroleum jelly applied to the upper and lower lips after compressing. Non-pharmacological therapy includes oral hygiene instructions and education on how to compress the lips and oral cavity with NaCl 0.9% and chlorine dioxide, refer to the internal medicine clinic for DM management. The management of stress in this patient was to refer him to a professional and instruct him to take a few days off from work. The first follow-up or second visit was performed three days later, and the condition of the oral cavity has improved, the right and left lateral areas of the tongue and the ventral tongue could be evaluated. Pseudomembranous candidiasis resolved, RIH and exfoliative cheilitis improved, severe xerostomia improved to moderate xerostomia, and keratotic lesions appeared on the right and left lateral sides of the tongue (around the radix of teeth 36 and 46), and atrophy (glossitis) occurred on the dorsum of the tongue. Acyclovir 200 mg was given five times a day for seven days. Lip compresses with NaCl and oral cavities with chlorine dioxide were discontinued. The patient rinsed with chlorine dioxide mouthwash. Acyclovir 200 mg therapy was given on day two of the initial visit for seven days, five times a day. Fluconazole injection is continued, and multivitamins are added once a day. Brush teeth and tongue with a soft- bristled toothbrush twice a day, in the morning after breakfast and the evening before bed. The result of the random blood sugar test was 475 mg/dL.
+
+The third visit (Days +7), the condition of the patient’s oral cavity experienced significant improvement. RIH has resolved, xerostomia is still moderate, exfoliative cheilitis is still improving, and keratotic lesions at regio teeth 36 and 46 are still present. The patient has not been able to remove he remaining radix 36 and 46 and remove calculus because the patient’s blood sugar was still high 275 mg/dL. The injectable fluconazole drug was stopped, the use of acyclovir 200 mg, multivitamins, and chlorine dioxide mouthwash as well as oral hygiene instructions continued, and after hospitalization, the patient was allowed to go home by the internal medicine department.
+
+The fourth visit (Days +14) was made at the oral medicine outpatient clinic. The condition of the patient’s oral cavity had recovered optimally. The xerostomia became mild on the Challacombe scale, and the keratotic lesions on teeth 36 and 46 were still present. The dorsum of the tongue did not appear atrophic, and there was white plaque on 2/3 of the dorsum of the tongue, which could be scraped off without leaving an erythematous area. The patient was referred to the internal medicine department before scaling and extraction of radixes of teeth 36 and 46. The mouthwash was changed to 1% povidone-iodine 10 mL three times a day, acyclovir therapy was stopped, multivitamins and oral hygiene instructions were continued by brushing teeth and tongue at least twice a day after breakfast and at night before bed with a soft-bristled brush, and the patient was educated to be able to exercise. This case is important because the oral complaints occurred in an adult who was unaware of the symptoms of DM and under high occupational stress and differentiated from the differential diagnosis, which is herpes-associated erythema multiforme. The limitation of this case report is that the reported case is limited to only one patient. However, knowledge about the relationship between systemic diseases, triggering factors, clinical features, and appropriate supporting examinations to establish a rapid and appropriate diagnosis according to the patient’s oral complaints can be additional knowledge for dental practitioner colleagues The patient has approved and written informed consent for the case details to be published included publication of the image, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki. The publication of this case report has also been approved by the institution.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3105_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3105_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b07e466327ad68bc0da56679fcf9bbf74115fcf5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3105_en.txt
@@ -0,0 +1,57 @@
+In January 2011, a 40-year-old woman was presented at our emergency department with a six-day history of fever up to 38.1 degrees Celsius every evening and with exertional retrosternal chest pain. She reported no other symptoms like dyspnea, abdominal pain, urinary, or stool abnormalities. Past medical history revealed an appendectomy at the age of 12, a caesarean section in 1993 and a thyroidectomy in November 2010 due to Graves’ disease. Approximately 5 months prior to presentation (August 2010), the patient had been on holiday in Hurghada, Egypt. Her long-term medication included levothyroxin, esomeprazole, and tizanidin. Her primary care physician had prescribed amoxicillin/clavulanic acid the day before presentation at our department. The patient worked as a nurse in a nursing home for the elderly. She smoked 15 cigarettes per day (15 pack years), occasionally drank alcohol, and had an allergy to house dust mites. Her cardiovascular risk factors were smoking, hypercholesterolemia, and a family history of myocardial infarction.
+
+The patient was in a good general condition. On arrival, temperature was 36.9° Celsius, blood pressure 150 over 90 mmHg, heart rate 130 beats per minute, and oxygen saturation 97% with ambient air. Auscultation and percussion of lung and heart were unremarkable. The abdomen showed no resistance or tenderness. No peripheral edema was observed. Results of a basic neurological examination were unremarkable and the skin was normal.
+
+An electrocardiogram (ECG) revealed sinus tachycardia with a heart rate of 120 beats per minute, normal axis, and slight T-wave inversion in leads V3-V6. The white blood cell count was 13.2 G/l with 4% (0.5 G/l) eosinophils, hemoglobin 13.6 g/dl, platelet count 176 G/l. Levels of serum creatinine, blood urea nitrogen and electrolytes were normal. The concentrations of gamma glutamyltransferase (54 U/l) and alkaline phosphatase (122 U/l) were slightly elevated. C-reactive protein (CRP, 6.11 mg/dl), high sensitive Troponin-T (hs TnT, 67 pg/ml) and D-Dimer (2.06 mg/l) were also elevated (Table 1). Chest x-ray was unremarkable and computed tomography angiography showed no signs of pulmonary embolism. Transthoracic echocardiogram was without pathological findings. In particular, it revealed normal right and left ventricular function, no wall motion abnormalities and no evidence of valve disease or pericardial effusion. Based on the history, laboratory result and imaging findings, (peri-) myocarditis was suspected and the patient was admitted for observation and symptomatic treatment with aminosalicylic acid and ibuprofen.
+
+On day two of hospitalization, the patient had no more complaints, cardiac enzymes and CRP decreased, and on day three the patient was discharged. Further diagnostic procedures included blood culture, immunology (anti-nuclear antibodies with subsets, anti-neutrophil cytoplasmic antibodies, [ANCA]), virus serology for typical cardiotropic viruses, antibodies (complement-fixation test) against mycoplasma, coxiella burnetii (Q-fever), chlamydia psittaci (ornithosis) and interferon-γ release assays were negative, except for perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) which were elevated to 47 U/ml (0–20).
+
+Eight months later, in September 2011, the patient was re-hospitalized with chest pain for 1 week, dyspnea on minimal exertion (New York Heart Association [NYHA] functional class IV), which had developed within 4 days, and a new echocardiographic finding of severe mitral regurgitation. Medication comprised levothyroxin, bisoprolol and simvastatin. On examination, the temperature was 36.9° Celsius, blood pressure 100 over 75 mmHg, heart rate 99 beats per minute and oxygen saturation 97% (pulse oximetry) with ambient air. Auscultation and percussion of lung and heart were unremarkable and the abdomen showed no resistance or tenderness. No peripheral edema was observed. Laboratory results showed elevated white blood-cell count 14.7 G/l with 6% (0.8 G/l) eosinophilic, NT-proBNP (3697 pg/ml), LDH (375 U/l) and CRP (1.47 mg/dl). Hs-TnT and creatine kinase were normal.
+
+On ECG a new P-mitrale was detected (see Additional file 1). Transthoracic and transesophageal echocardiogram showed a hyperdynamic left ventricle with preserved left ventricular ejection fraction without any regional wall motion abnormalities and dilated left and right atria. The left ventricular apical and lateral wall were thickened while the interventricular septum was normal. Doppler recordings of mitral valve inflow showed a restrictive filling pattern with severe mitral regurgitation (see Additional file 2). Further aortic and tricuspid regurgitation as well as significant elevated systolic pulmonary artery pressure were observed in the absence of pericardial effusion.
+
+Coronary angiography was unremarkable but invasive hemodynamic evaluation showed postcapillary pulmonary hypertension (mean pulmonary artery pressure 42 mmHg) with markedly elevated left ventricular filling pressures (LV end-diastolic pressure 39 mmHg) and reduced cardiac index (1.74 L/min/m2). Left ventriculography showed apical contrast dye sparing.
+
+CMR imaging confirmed severe mitral regurgitation and revealed a mildly dilated left ventricle with a left ventricular ejection fraction of 45% and an apical thrombus. Extended semicircumferential subendocardial late enhancement with partial involvement of the papillary muscles was compatible with EMF.
+
+Enalapril and anticoagulation with enoxaparin followed by phenprocoumon were started for heart failure and the apical thrombus, respectively, and the patient was discharged in stable condition. For a second opinion and the development of a management plan, the patient was referred to a university heart failure unit with a focus on rare cardiomyopathies in November 2011. Endomyocardial biopsy was planned from the right ventricle - to avoid left ventricular thrombus mobilization – but was hampered by the dense consistency of the fibrotic endocardium. After several attempts the right ventricular free wall was perforated resulting in pericardial tamponade, which was immediately treated successfully by pericardiocentesis and drainage. In synopsis of all findings, the patient was given the diagnosis of EMF without another attempt for histological confirmation.
+
+Further workup revealed no evidence of infection, systemic immunologic, hematological, or solid malignant disease. Microscopy on helminthic eggs or intestinal protozoa was negative. The patient progressively deteriorated with decreasing walking distances of < 100 m, semiorthopnoea, and increasing signs of congestion so that a rapid therapeutic decision was necessary. The interdisciplinary heart team, consisting of cardiologists and cardiac surgeons, discussed several therapeutic options and decided to evaluate and list the patient for heart transplantation.
+
+While on the waiting list, the patient’s condition initially stabilized with enalapril, bisoprolol, and furosemide. Due to continuous progression of heart failure starting in June 2012 she underwent high urgency heart transplantation in August 2012. Macroscopic and microscopic findings of the explanted heart confirmed the diagnosis of EMF. Both ventricles revealed severe fibrosis of the endocardium with apical predominance. The neighboring myocardium was characterized by hypervascularization, fibroblasts, chronic inflammatory infiltration with few mast cells and eosinophils as well as interstitial fibrosis in subendocardial layers. Six years after heart transplantation the patient was in an excellent clinical condition.
+
+Macroscopic image of explanted heart. Image shows severe fibrosis of the endocardium involving both ventricles.
+
+
+Timeline of patient’s history from first presentation until end of follow-up
+
+Year	Month	History
+2010	August	• Holiday in Hurghada, Egypt
+2011	January	
+• First presentation at emergency department with fever and exertional retrosternal chest pain
+
+• Discharge after 3 days without complaints
+
+• Suspected (Peri-)myocarditis
+
+September	
+• Re-hospitalization with chest pain for 1 week, dyspnea on minimal exertion (NYHA IV)
+
+• Comprehensive diagnostic work-up
+
+• Medical treatment for heart failure and anticoagulation for apical thrombus were started
+
+• Discharge in stable condition
+
+• Suspected EMF
+
+November	
+• Referred to a university heart failure unit with a focus on rare cardiomyopathies for second opinion
+
+• Unsuccessful endomyocardial biopsy
+
+• Diagnosis of EMF without another attempt for histological confirmation
+
+2012	June	• Continuous progression of heart failure
+August	• High urgency heart transplantation
+2018		• Excellent outcome after heart transplantation
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3110_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3110_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..186bdaa5c0cc5c89decaacb1c1cad54a7c4f3b5c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3110_en.txt
@@ -0,0 +1,7 @@
+12-year-old male patient from the community of Santa Clotilde in the Napo River located 1113 km from the city of Iquitos in the district of Napo, Province of Maynas, region of Loreto. With no relevant infectious history, on day one (05/10/2022) he was bitten by a Bothrops (Jergón) snake while walking along the banks of the Napo River. According to the mother, the snake was about 50 cm long, with a triangular head, brown color, dark spots, and yellow tail. Three hours after the bite, he developed intense pain and bleeding in the area of the bite, lateral face of the right leg, for which he received home remedies (a glass of water and salt and a second glass of water and sugar). The next day (06/10/2022), the pain persisted, accompanied by inflammation in the leg, for which he was given intramuscular penicillin. On the third day (07/10/2022), the pain persisted in the area of the bite and the patient presented edema in the face, for which he was transferred to a health center where he was given four vials of anti-venom serum made by the National Institute of Health of Peru, dexamethasone and chlorpheniramine. On the fourth day (08/10/2022), he developed increased edema, and due to persistence of the clinical picture he was transferred by air to the city of Iquitos, arriving at the Regional Hospital of Loreto on the fifth day (09/10/2022), in the evaluation the patient was hemodynamically stable, with vital signs within the normal ranges. In the physical examination, cutaneous pallor, facial and cervical edema, as well as ecchymosis in the lateral face of the right leg were observed.
+
+The parotid glands in the face were markedly swollen, suggesting a likely complication secondary to the Bothrops envenomation.
+
+The initial blood count revealed mild anaemia with a haemoglobin level of 9.9 g/dL (normal value ≥ 12.0 g/dL). The rest of the complementary studies, including the coagulation profile, were within the normal parameters. He was given treatment with intravenous hydration of 0.9% sodium chloride and an antibiotic regimen with ceftriaxone (1.5 g every 12 hours) and clindamycin (385 mg every 8 hours), supplemented with the administration of four vials of anti-venom serum (National Institute of Health) and metamizol (950 mg) for the control of pain.
+
+After 7 days of treatment, the patient showed a significant improvement, remaining hemodynamically stable with a notable decrease in edema and pain. Finally, he was discharged on (13/10/2022) with medical indications to continue the outpatient follow-up.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3117_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3117_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3fa35ec38685aaf4ab001a957f2b36bd614ad8e4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3117_en.txt
@@ -0,0 +1,43 @@
+This was a 29-year-old mother of five who presented to the Kampala International University Teaching Hospital accident and emergency department with history of difficulty swallowing, trismus and painful neck swelling for over a week. The condition had begun shortly after a tooth extraction performed by a traditional healer in the community. She had reportedly experienced progressive symptoms including fever, sharp pain, submandibular swelling, and difficulty swallowing. For which she had received two ampoules of penicillin from a nearby clinic with no improvement. She had no known chronic diseases or drug allergies.
+
+Physical Examination
+The patient appeared ill but not in respiratory distress. Her vital signs were: temperature: 38°C, heart rate: 85 beats/minute, blood pressure: 120/70 mmHg, respiratory rate: 15 breaths/minute and oxygen saturation at 94% on room air.
+
+Head and neck examination revealed redness and tender swelling involving the sublingual, submental, and submandibular spaces bilaterally. She exhibited trismus and could only open her mouth up to about 1.5 cm. The floor of the mouth was inflamed and elevated, and the tongue was also inflamed and swollen but did not push back far enough to obstruct the airway.
+
+Diagnostic Intervention
+Diagnostic tests revealed critical findings indicative of systemic infection. A pus culture isolated Escherichia coli and Enterococcus faecalis, with antibiotic sensitivity testing showing resistance to ceftriaxone, cefoxitin, rifampicin, amoxiclav, chloramphenicol, and azithromycin. The isolates were sensitive to ciprofloxacin, imipenem, and amikacin. Laboratory results highlighted elevated white blood cell and granulocyte counts, anemia, and thrombocytosis, reflecting the body’s response to severe infection. A contrasted CT scan was recommended, but was not done due to the patient’s financial limitations. A chest X-ray revealed cardiomegaly and features of a secondary lung infection (Pneumonia).
+
+Therapeutic Intervention
+Initial management included:
+
+Antibiotics:
+- IV Ceftriaxone 2g twice daily
+- IV Metronidazole 500mg three times daily
+- IV Gentamicin 80mg twice daily
+Rehydration - Intravenous Normal Saline and Dextrose every 6 hours
+
+Intravenous paracetamol 1g three times daily for pain management
+
+Steroid Therapy – Intravenous dexamethasone 4mg TDS for 3 days.
+
+Adjusted Antibiotic regimen (post-culture sensitivity results)
+
+- IV Ciprofloxacin 400mg three times daily.
+
+- IV Metronidazole 500mg three times daily.
+
+- IV Amikacin 500mg once daily.
+
+- Imipenem was indicated as sensitive but could not be administered due to its prohibitive cost.
+
+Surgical Intervention
+Multiple incisions for drainage were performed under sedation to manage the extensive abscesses. Specifically; two incisions were made in both submandibular spaces. One incision was made in the submental area. Another incision was made in the left zygomatic area, as the swelling had extended to the left temporal area. The final incision was placed between the suitable submandibular and submental spaces. A sublingual incision was not required.
+
+The following day, the patient reported to be feeling better, with her tongue returning to its normal position. However, we observed necrosis on her left cheek upon removing the dressing. We immediately took the patient to the operating theater and performed debridement, which revealed that the necrosis had extended to the floor of mouth, buccal mucosa, and parotid area near the division of the facial nerve. Additionally, there was a discharge from the left temporal region. Throughout these days, the patient’s vital signs remained stable, and she did not experience any respiratory distress until her final day.
+
+Necrosis Management
+The patient developed necrosis on the left facial side, involving the submandibular space, anteromedial floor of the mouth, buccal mucosa, and posterior angle of the mandible near the facial nerve division. Debridement was performed until the necrotic tissue was cleaned. The infection seemed to extend to other deep neck spaces, evidenced by foul-smelling pus and trismus, preventing oropharynx visualization.
+
+Outcome
+The patient’s condition deteriorated despite these interventions. On the morning of her death, there was significant bleeding from the injury site, mouth, and nose. We administered tranexamic acid (1g) in response to the bleeding, and a sample was taken to confirm DIC. She also subsequently developed respiratory distress, necessitating oxygen therapy, and a cross-matched blood transfusion was started. Preparations were made for an urgent tracheostomy in the operating theater for the possibility of difficult intubation because of the trismus. However, the patient experienced cardiorespiratory arrest on the table, and despite extensive resuscitation efforts, she succumbed to her condition.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3126_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3126_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f56fd05adfe9444c97fe283cc7ea4ddc700f573b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3126_en.txt
@@ -0,0 +1,31 @@
+Patient: A 59-year-old man.
+
+Chief complaint: dyspnea.
+
+History of the present illness: at the age of 54 years, hypertension was diagnosed during hospitalization for intestinal obstruction.
+
+Treatment was started with a calcium channel blocker and an angiotensin II receptor antagonist, and thereafter his BP was well controlled.
+
+At the age of 59 years, his systolic blood pressure (SBP) increased to about 170 mmHg and BP was poorly controlled for several months. His serum creatinine increased from 0.8 mg/dl to 1.6 mg/dl during a 3-month period. The patient developed exertional dyspnea, which gradually became worse.
+
+He was transported to our hospital by ambulance due to the onset of respiratory distress at rest. Echocardiography indicated that left ventricular systolic function was maintained, but a chest X-ray film demonstrated cardiac enlargement and pulmonary congestion. A diagnosis of pulmonary edema due to heart failure with preserved ejection fraction (HFpEF) was made and he was urgently admitted to the hospital.
+
+His past medical history included pulmonary embolism and pericarditis in his 30s. There was no special mention of his family history. His social history showed that he smoked 20 cigarettes a day for 40 years and had consumed 44 g of alcohol a day.
+
+Physical examination on admission revealed height 163 cm and weight 49 kg, blood pressure was 174/124 mmHg, and heart rate was regular and 89/min. His heart sound showed no murmur. A lung examination showed an increased respiratory rate (28/min) and wheezes at the end of exhalation in both lungs. No peripheral edema or hepatomegaly were observed.
+
+Immediately after admission, he was treated with intravenous furosemide, as well as carperitide (0.025 γ) and noninvasive positive pressure ventilation. Diuresis was rapid and his respiratory condition became stable. Since the patient had hypertension and circumferential cardiac enlargement on echocardiography, hypertensive heart disease was suspected. After admission, he received multiple antihypertensive agents (nifedipine CR at 60 mg/day, telmisartan at 20 mg/day, furosemide at 40 mg/day, and spironolactone at 50 mg/day), but his BP remained around 150/90 mmHg and was not sufficiently controlled.
+
+The patient had renal dysfunction and hypokalemia (2.5 mmol/L). Further tests on admission demonstrated secondary aldosteronism associated with high plasma renin activity (PRA). Consequently, renovascular hypertension was suspected due to uncontrolled hypertension, hypokalemia, high PRA and aldosterone, progressive renal dysfunction, and heart failure. Ultrasound and plain computed tomography (CT) (Siemens, Munich, Germany) were performed, detecting unilateral renal atrophy. Due to the patient’s renal dysfunction, unenhanced magnetic resonance imaging (MRI) (Philips, Amsterdam. Netherlands) was performed to evaluate the renal arteries rather than contrast CT, revealing severe stenosis or occlusion at the origin of the right renal artery and the right renal atrophy.
+
+On hospital day 17, selective renal angiography was conducted via the left radial artery, confirming total occlusion at the origin of the right renal artery. The location of the right renal artery was identified by CT and MRI relative to the position of the left renal artery, and a stump was detected at the occlusion site. Accordingly, it was considered that blood flow could be restored and PTRA was performed.
+
+
+A 6F guiding catheter (JR4.0; Medikit Co., Tokyo, Japan) was positioned at the ostial part of the right artery. A 0.014-inch guide wire (Aguru™ floppy; Boston Scientific Corporation, Marlborough, USA) and a microcatheter (Prominent, Tokai Medical Products Inc., Kasugai, Japan) were used to cross the occlusion, after which the microcatheter was advanced to the distal part of the renal artery and back flow of blood was verified. Then, tip imaging was conducted, and it was confirmed that the wire was in the lumen of the main trunk of the renal artery. To treat the lesion, a 2.0×20 mm balloon (Shiden; Kaneka Medical Products, Osaka, Japan) was inflated and then exchanged for a larger balloon. Subsequently, a 4.0×15 mm cutting balloon (Peripheral Cutting Balloon, Boston Scientific) was used to achieve additional dilation. Finally, a 5.0×19 mm stent (Express™ Vascular SD; Boston Scientific) was placed to fully cover the lesion from the entry site. The occlusion improved to 0% stenosis and there was no distal embolism or renal artery perforation. Selective collection of renal vein blood for measurement of PRA was done before and after release of renal artery occlusion during PTRA. Before PTRA, PRA was significantly higher in the right renal vein compared with the left renal vein, while the right-left difference disappeared 15 min after the procedure.
+
+To protect the kidney, intravenous fluid infusion was conducted from 1 day before PTRA to postoperative day 4, and continuous hemodiafiltration was performed for 2 days after PTRA. Good diuresis (4000 ml/day) was achieved after PTRA, with no deterioration of renal function, and proteinuria also decreased.
+
+
+Immediately after PTRA, the dose of nifedipine was decreased from 60 mg/day to 20 mg/day, while furosemide and spironolactone were discontinued on day 8 after the procedure. Control of the patient’s BP was markedly improved by the procedure. At 1 week after PTRA (1 week after completion of fluid infusion), mean SBP was significantly lower than at 1 week before PTRA, with morning SBP decreasing from 145/93 mmHg to130/78 mmHg and evening SBP decreasing from 140/83 mmHg to 120/72 mmHg (both p<0.05).
+
+PRA and the plasma aldosterone concentration decreased dramatically after PTRA. After discontinuation of the aldosterone antagonist, the potassium level remained within normal range. The patient was discharged from hospital on hospital day 30. Both home and office BP have been controlled at around 130/80 mmHg for approximately 6 months since discharge.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3132_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3132_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..546fdec396b73f28b2105bca0911fd9bff6ec644
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3132_en.txt
@@ -0,0 +1,3 @@
+A 60-year old female was admitted to our hospital with a low-grade fever and purulent secretion from the incision at the right lower abdomen. She had suffered from the symptoms for about 1 year and underwent an antibiotic therapy in the local hospital but showed little effect. Six years ago, the patient came to our hospital with the right low extremity intermittent claudication and rest pain and then received a conventional aortofemoral dacron graft bypass because the pre-operation computed tomographic angiography (CTA) showed obstruction of the right external iliac artery. She recovered well after the surgery and was discharged without claudication. It is noteworthy that 6 months after the operation, she was involved in an accident which triggered a rectal hematoma and recovered under conservative treatment.
+
+The laboratory tests showed elevated peripheral white blood cell count (9.74 × 109/L), neutrophil (7.2 × 109/L), C-reactive protein (over 200 mg/L), erythrocyte sedimentation rate (24 mm/hour) and procalcitonin (2.71 ng/mL). The purulent secretion was positive for Escherichia coli. Colonoscopy revealed a rectal fistula the same place where the rectal hematoma was spotted 5 years ago due to the accident, and an air test and a methylene blue test confirmed a sinus between the rectum and the abdominal wall. A CTA examination showed the right iliac prosthesis was occlusive with perivascular infection and a sinus formation in right anterior lower abdomen. Therefore, we suspect a rectal fistula induced AVGI. After peri-operative preparation, the patient was treated with graft excision and debridement, but without artery reconstruction. Intraoperative, a peri-graft intestinal adhesion was evident and segments of intestinal wall participate in a composition of the sinus formation. The infected vascular graft was found and removed. About 2 months after the operation, the patient’s value of C-reactive protein, erythrocyte sedimentation rate and procalcitonin dropped to normal ranges. She recovered well with no signs of right extremity lower ischemia and continued to receive postoperative anti-infective treatment.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3146_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3146_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e4354eaaadbacb2eeb7e07ebbcd835863e644185
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3146_en.txt
@@ -0,0 +1,16 @@
+A previously healthy 6-year-old girl with no relevant family or consanguineous history presented with a history of hyporexia for 24 months, increased abdominal circumference and recurrent vomiting; in the last 2 months with chest pain and progressive decrease in functional class. She was found with hepatomegaly approximately 6 cm below the costal margin. The initial echocardiogram revealed marked dilatation of the suprahepatic veins and inferior vena cava, with marked biatrial dilatation, diastolic dysfunction with restrictive pattern and indirect signs of pulmonary hypertension. CMR was suspected and treatment with diuretics, carvedilol and enalapril was initiated, with improvement of the functional class.
+
+Studies were requested to clarify the etiology of CMR, cardiac magnetic resonance reported left ventricular hypertracheal with respect to non-compacted region/compacted region of 4:1, systolic dysfunction, significant ventricular cavity hypertracheal, right ventricular dilation with deterioration of systolic function. In addition, a 24-hour Holter ECG described right and left atrial changes and repolarization disorder in precordial leads. Based on the above, the patient was discussed in a cardiology meeting, considering the coexistence of restrictive cardiomyopathy and hypertracheal.
+
+Anti-insufficiency medical treatment was initiated and there was an improvement in the New York Heart Association (NYHA) functional classification from III to II. However, after a few months, the patient presented clinical worsening, requiring admission to an intensive care unit for refractory heart failure, and a diagnosis of cardiac tamponade was made, requiring a pericardial window, support with extracorporeal mechanical oxygenation and subsequent massive cerebral hemorrhage leading to her death.
+
+Written informed consent was obtained from the minor's legal guardian/next of kin to publish any potentially identifiable images or data in this article. The ethics committee approved the conduct of the study.
+
+Genomics-based assessment
+Due to the diagnosis of early onset CMR, the genetic medical team was consulted. Physical examination was normal and there was no family history of cardiomyopathies or sudden cardiac death. After a careful review of the case, a full exome sequencing (WES) was performed.
+
+A new heterozygous missense variant in the FLNC gene (NM_001458.5) was identified: c.7559C>A, p.Thr2520Asn and confirmed by Sanger sequencing. This substitution converts the codon threonine at position 2520 to asparagine, located in the ROD2 domain in which there is a cluster of variants mainly associated with hypertrophic cardiomyopathy. This variant has not been reported in population databases or in the current medical literature and is classified as probably pathogenic.
+
+Other genetic variants identified in this case were: a heterozygous frameshift variant in the AGK gene (NM_018238.4): c.675delG, p.Trp225CysfsTer6, classified as pathogenic according to ACMG guidelines; and a heterozygous missense variant in the PKP2 gene (NM_004572.4): c.1163G>A, p.Arg388Gln, classified as a variant of uncertain significance (VSI).
+
+No other genetic variants were identified in this case. The patient's mother (34 years old), father (38 years old), and paternal grandparents (55 and 62 years old) consented to genetic testing, and the father was found to carry the FLNC and AGK variants. He has a normal echocardiogram and is being evaluated by the cardiology team.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_316_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_316_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c09d31a434bd1df9b815c87e22a14b3da5e1b16a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_316_en.txt
@@ -0,0 +1,4 @@
+A 53-year-old female presented to the ED with six days of nausea and vomiting. She also noted feeling progressively weak with xerostomia and lower abdominal pain for several days prior to presentation. Further history revealed that she was a previous vegetarian who over the prior 22 days was attempting to lose weight by eating solely meat and eggs. She reported a 17-pound weight loss over the time period and noted that she was consuming only minimal carbohydrates. She took no medications and denied chronic alcohol use.
+Her vitals upon arrival were as follows: temperature 97.1 degrees Fahrenheit, heart rate 77 beats per minute, respiratory rate 16 breaths per minute, blood pressure 160/106 millimeters of mercury, and oxygen saturation 97% on room air. She weighed 73 kilograms with her stated height of 5 feet 6 inches and had a body mass index of 26. The physical exam revealed dry mucous membranes and a benign abdominal exam.
+The patient was given two liters (L) of normal saline intravenously (IV) and four milligrams of ondansetron IV for nausea. Labs were drawn due to a concern for abnormal electrolytes as well as her change in diet. Labs revealed an anion gap acidosis with ketosis .
+In the ED she received antiemetics, two L of normal saline and an infusion of D5NS at 150 cubic centimeters (cc) an hour, and her symptoms greatly improved. By the time she was admitted to the hospital, her gap had closed to a level of 12. She continued to receive an infusion of 5% dextrose in normal saline (D5NS) at 150 cc an hour as well as insulin subcutaneously on a sliding scale after admittance to the hospital. Her anion gap remained within the normal limits while in the hospital and her insulin was discontinued. After returning to a normal diet, her glucose remained stable and she was discharged after three days with only potassium supplement prescriptions. Since discharge, she established a balanced diet and symptoms ceased.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3173_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3173_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c7cb6ebdec11cdf7603cc29f7b5485ee53e049cd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3173_en.txt
@@ -0,0 +1,9 @@
+A 32 year old woman in her first pregnancy had an anomaly scan at 23 weeks of gestation, at which the fetus was diagnosed to have a right sided CDH. The pregnancy was also complicated by polyhydramnios. There was a normal fetal echocardiogram. The initial observed to expected (O/E) lung area to head circumference ratio (LHR) was 41 %, which reduced to 17 % at 26 weeks of gestation. The mother was then referred at 26 weeks of gestation to our Fetal Medicine Unit where a fetal endoluminal tracheal occlusion (FETO) procedure was performed. FETO was performed by placing a thin walled flexible Teflon cannula loaded with a custom designed pyramidal trocar into the amniotic cavity through the abdominal and uterine walls and directed towards the fetal mouth. The trocar was then withdrawn and fetoscopic instruments, including an endoscope, inserted. The endoscope was introduced into the fetal mouth, pharynx and epiglottis and advanced through the vocal cords to identify the carina. The catheter was positioned to deliver the balloon just above the carina. The procedure was performed under local anaesthetic. Post-FETO, the observed to expected LHR O/E increased to 90 %. At 26 and 31 weeks of gestation, amnio drainage was undertaken because of the polyhydramnios (1700 and 2,700 mLs respectively were removed). No chromosomal anomalies were detected on genetic testing undertaken by microarray analysis. At 31+3 weeks of gestation, there was preterm, premature rupture of the membranes. An in-utero transfer was undertaken to our tertiary perinatal medical and surgical unit. The FETO balloon was punctured in-utero. The mother was given a complete corticosteroid course (two doses of betamethasone 24 h apart). She subsequently went into spontaneous preterm labour at 35+6 weeks of gestation. The O/E LHR immediately prior to delivery was 55 %.
+
+The female infant was born by a forceps assisted vaginal delivery. The infant’s birthweight was 2.37 kg and the Apgar scores were five at one minute and six at five minutes respectively. A nasogastric tube was inserted and the baby was electively intubated at two minutes of age. She was initially ventilated on conventional mechanical ventilation (CMV) with a fraction of inspired oxygen concentration of 0.60, but due to a rising pressure requirement due to hypercarbia she was transferred to high-frequency oscillatory ventilation (HFOV) until day three. In total, she was ventilated for 25 days and remained oxygen dependent up till discharge to her local hospital at two months of age.
+
+A postnatal echocardiography showed a small intra-atrial communication and a PDA with bidirectional flow. Inhaled nitric oxide (iNO) was started on day one after birth due to a moderate pre-and post-ductal SpO2 difference of 5 %, but was able to be weaned after 48 h.
+
+The chest radiograph demonstrated elevation of both hemidiaphragms with clear small lung fields. The appearance on the chest ultrasound (USS) and CT Chest suggested a CDH and a contralateral eventration, but with the possibility that there could be bilateral CDH. The abdominal radiograph demonstrated a double bubble and no gas in the distal bowel loops and hence duodenal atresia (DA) was suspected. DA was confirmed by barium follow-through. Surgical repair was undertaken on day six. Bilateral, type C posterolateral CDHs were noted with herniation of the liver on the right and the spleen, stomach, colon, and left lobe of liver on the left. Surgical repair included bilateral patch repair of the CDHs using ‘domed’ Goretex patches, as primary repair was not possible due to the size of the defects. Type one duodenal atresia (DA), with no malrotation, was identified and repaired with enterotomy and diamond duodenoduodenostomy. In order to prevent abdominal compartment syndrome, the abdomen was kept open using a Goretex patch. The patch was reduced on day 12 and the abdomen was closed on day 15.
+
+The infant no longer required respiratory support by two months of age. At an outpatient follow-up appointment at four months of age, she continued to require no respiratory support. The infant was gaining weight along the second per centile for age having a combination of breast feeding and bolus nasogastric feeds (Infatrini) via a pump.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3180_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3180_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..20d72c3cbe03448316f25e995a9949eb489691ef
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3180_en.txt
@@ -0,0 +1,14 @@
+Female patient, 43 years old, with uterine diffuse large B-cell lymphoma, stage IIIB, undergoing hysterectomy followed by chemotherapy (QT) and radiotherapy (RT). As a background, she had a diagnosis of chronic renal disease in renal replacement therapy (TSR), due to bilateral ureterohydronephrosis by uterine primary disease. Pre-QT echocardiogram with concentric left ventricular hypertrophy (HVE) and preserved left ventricular ejection fraction (FEVE) (66%).
+
+The patient underwent eight cycles of the R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine) treatment schedule. Due to refractoriness to the primary treatment, she underwent rescue therapy with the R-ICE (Mesna, Ifosfamide, Etoposide, Carboplatin) schedule for four cycles, but she was intolerant to Carboplatin. The treatment was switched to GEMOX (Oxaliplatin, Gencitabine) and was completed after four cycles. She then underwent 28 sessions of RT and has not shown signs of oncological recurrence since then.
+
+Two years after the start of the QT, she was admitted with a picture of heart failure (IC). A new echocardiogram showed a FEVE of 35%. Myocardial perfusion scintigraphy showed a reduction in the FEVE (37%) by gated SPECT and transient hypoperfusion in the apical and inferoseptal walls of the left ventricle (LV). A cineangiocoronariography did not show epicardial coronary artery disease.
+
+Since then, there have been four hospitalizations for decompensated HF, the last one a year ago. Cardiac MRI (CMR) showed a LVEF of 39% and non-ischaemic late enhancement in the inferior left wall of the LV.
+
+The patient is currently stable on Carvedilol 25 mg/day, Losartan 100 mg/day and Furosemide 40 mg/day. The diagnosis of cardiotoxicity (CTX) was considered the most likely etiology of the HF with reduced LVEF (HFrEF).
+
+Evolution of Cardiological Imaging Exams
+Due to the evolution of the case, the cardiac imaging exams were allocated chronologically, for a better understanding. A decrease in the LVEF was observed in the echocardiogram performed at the time of the diagnosis of HF. This LVEF had a recovery in 2019, with new decreases in the following echocardiograms, as well as in the MUGA.
+
+In a retrospective evaluation of myocardial uptake of fluorodeoxyglucose-fluorine-18 (18F-FDG) by positron emission tomography, coupled with computed tomography (PET/CT), an increase in uptake was observed from the first examination, performed after the initiation of QT. The standard uptake value (SUV) remained elevated in subsequent examinations, reaching its highest value in the last examination.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3183_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3183_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ffeee5c1297b7aae04eaca52914565b951000afd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3183_en.txt
@@ -0,0 +1,7 @@
+33-year-old woman with a history of essential hypertension who is attending a dermatology evaluation for her 15-day-old newborn son due to the recent appearance of non-scaling, erythematous, raised-border, round plaques that began in the retroauricular region 5 days after birth and then spread to the abdomen, posterior trunk and both newborn's inguinal folds. The newborn, born in winter, did not receive phototherapy at any time.
+
+The mother, who had a normal pregnancy with no relevant perinatal history, had no personal or family history of connective tissue disorders.
+
+Due to the high suspicion of neonatal lupus, both the mother and the newborn were examined. The mother presented positive antinuclear antibodies with a titer of 1/1280, a spotted pattern, positive anti-double-stranded DNA antibodies with a titer of 1/20 and positive anti-RO and anti-LA antibodies with values greater than 200 U/ ml. She was evaluated in rheumatology and in a directed questioning she reported a history of fatigue, alopecia, xeroftalmia, acrocyanosis and recurrent non-painful ulcers at the level of the labial mucosa. Physical examination showed malar erythema and reticular livedo outlined on both upper extremities. The diagnosis of systemic lupus erythematosus with associated Sjogren's syndrome was raised, supported by a Schirmer's test consistent with severe dry eye due to hypolacrimia. Steroidal therapy was initiated with prednisone 20 mg daily for 30 days, then decreasing doses for 8 weeks until discontinuation associated with hydroxychloroquine at doses of 200 and 400 mg on alternate days, with good response and improvement of the general condition. The mother remains stable with her underlying disease and is under rheumatology control to date.
+
+In the newborn examination, an initial electrocardiogram was within normal limits, then a Holter rhythm monitor showed normal atrio-ventricular and intra-ventricular conduction and an echocardiogram showed a patent foramen ovale. In the blood tests, moderate neutropenia (ANC = 620), altered liver tests with mild elevation of transaminases (GOT 95 IU/L and GPT 130 IU/L) and the presence of anti-Ro and anti-La antibodies were noted. Photoprotection was indicated and follow-up was performed with examinations at 2 and 5 months of life that showed recovery of neutropenia, normalization of liver tests and decrease of the anti-Ro and anti-La antibodies. In the dermatological controls, complete regression of the skin lesions was observed at 2 months of follow-up.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3198_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3198_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c412425d0a4782de9431de1b185477cf21f5e527
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3198_en.txt
@@ -0,0 +1,7 @@
+A 21-year-old girl complaining of a six-month history of progressive dyspnoea and chest pain was transferred to our centre because of heart failure, without a history of any cardiovascular diseases, injuries or operations.
+
+On examination, there was a grade 3/6 continuous machinery murmur that was maximal between the right 2nd and 3rd intercostal region and radiated to the right infraclavicular fossa. The patient had a normal saturation value at rest in ambient air (SPO2 95%) with non-cyanotic skin colour. Chest-X-ray revealed cardiomegaly. The electrocardiogram showed sinus rhythm with a heart rate of 95 bpm and a complete right bundle branch block and right ventricular hypertrophy. The respiratory tests were not abnormal.
+
+Transthoracic echocardiography showed a dilated right subclavian artery with an 8-mm fistula to the SVC and obvious stenosis at the proximal initial site of the fistula, in addition to a markedly dilated right ventricle and right atrium and mild tricuspid regurgitation. Continuous wave Doppler showed a flow signal at 2.3 m/s that was continuously moving from the RSA to the SVC with a gradient of 22 mmHg, while the highest flow rate was 3.9 m/s at the stenosis site of the fistula with a gradient of 59 mmHg. Computed tomography angiography further delineated the anatomy of the arteriovenous fistula from the RSA to the SVC and stenosis of the fistula.
+
+The patient underwent transcatheter occlusion for the fistula under local anaesthesia. Briefly, a 10/12 mm Amplatzer ductal occluder was delivered and deployed from the SVC side using a 5-F H1 catheter by angiogram guidance, and an 8F sheath was used to send the occluder to occlude the abnormal fistulous connection. The post-procedure angiogram revealed a completely occluded lumen of the fistula, and the echocardiogram showed no residual shunt. The patient had an uneventful course and a significant improvement in symptoms at the 3-month follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3203_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3203_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7dc2b7a5b3df3bd43bde22f94a3a19afecf6b6ce
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3203_en.txt
@@ -0,0 +1 @@
+A 60-year-old male with an unremarkable prior medical history presented to our institution with progressively worsening dyspnea on exertion and paroxysmal nocturnal dyspnea for a duration of 20 days. The physical examination was within normal limits, apart from a finding of bilateral crackles of the lung bases. His complete blood count at presentation showed a normal white blood cell count (7280/mL), with 30% neutrophils, 13% lymphocytes, and 5% eosinophils, but demonstrated hypereosinophilia (absolute eosinophil counts 3610/mL, normal 20–520/mL), and severely elevated pro-B-type natriuretic peptides of 3710 pg/mL. Echocardiography revealed an apical left ventricular infiltration with a 14 × 7 mm thrombus that was associated with leaflet restriction and moderate mitral and tricuspid valve regurgitation. Both atriums were enlarged and a restrictive left ventricle (LV) filling pattern was noted. Both ventricles displayed normal dimensions in the absence of regional wall motion abnormalities, and both ventricular systolic functions were preserved (left ventricular ejection fraction 64%). The estimated systolic pulmonary artery pressure was 71 mm Hg. Electrocardiography (ECG) showed a right axis deviation and T waves changes. Cardiac magnetic resonance imaging (MRI) was performed to aid in the diagnosis. The cardiac MRI showed intense, linear, delayed gadolinium enhancement of the endocardium of the lateral wall of the LV, and obliteration of the LV apex. A bone marrow smear and biopsy revealed a markedly elevated eosinophil count (>36%), but was absent dysplasia and a number of blasts, and there was no evidence of myeloproliferative disorder. The FIP1L1-PDGFRA fusion gene was positive in 82% of segmented nucleated cells, based on fluorescence in situ hybridization (FISH) analysis. An additional, extensive workup of secondary causes of eosinophilia proved negative and excluded other causes, leading to the final diagnosis of idiopathic HES with heart involvement. Treatment was started immediately with warfarin and a high dose of prednisone (1 mg/kg/d). Over the next few months, the patient began to feel much better, demonstrating marked improvement in his symptoms, with no complaints of shortness of breath or dyspnea on exertion. Eosinophil counts also normalized.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3207_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3207_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..54ae59b7399fd7f19b6f9dce57c75a186da12679
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3207_en.txt
@@ -0,0 +1,11 @@
+Computed tomography (CT) was performed at a peripheral hospital in a 24-year-old female who had complained of persisting chest and back pain and been treated with analgesics for nearly 2 weeks after an event of acute thoracic pain. She was finally diagnosed with AAD that had led to compromise of the left coronary ostium. Echocardiography demonstrated a poor left ventricular (LV) ejection fraction that was in keeping with the finding of severely compromised coronary perfusion. She was transferred to our hospital for surgery, and a staged approach anticipating need for postoperative mechanical circulatory support was agreed upon.
+
+Intraoperative inspection of the dissected aorta and the LV myocardium yielded findings perfectly compatible with a process that had been ongoing since the patient had experienced the initial event of thoracic pain. After transection and direct true lumen cannulation of the ascending aorta, the left coronary ostium was found to have collapsed without, however, being irreversibly occluded. Therefore, antegrade cardioplegia was administered via the coronary ostia.
+
+Subsequently, supracoronary replacement of the ascending aorta was implemented in deep hypothermic circulatory arrest. When it was found that repair of the left coronary ostium had failed, the left internal thoracic artery was grafted to the patient’s extremely narrow left anterior descending artery. Grafting of the circumflex artery turned out to be unfeasible due to the extremely narrow caliber of the circumflex system. When weaning from cardiopulmonary bypass (CPB) turned out to be impossible, the patient was put on ECLS using a sidegraft (6 mm Dacron prosthesis) sewn to the aortic prosthesis for central cannulation (Nova Port Single Lumen Cannula, Novalung GmbH). The venous cannula (BioMedicus Multi-Stage Femoral Venous Cannula, Medtronic Inc.) was placed in the right femoral vein.
+
+The ECLS system provided adequate circulatory support and the patient remained hemodynamically stable. Upon discontinuation of sedatives, her neurologic status was found normal. Considering that coronary malperfusion had been ongoing for some time preceding the surgical repair, and given the devastating LV damage seen intraoperatively and evidenced by CK and CK-MB levels of 8816 and 884 U/L and a troponin level of 488 899 pg/ml, respectively, sufficient recovery of the LV myocardium in the short run appeared unlikely. To prevent complications associated with prolonged ECLS, left ventricular assist device (LVAD) implantation as a bridge to recovery/transplantation was scheduled for the second day after the aortic procedure.
+
+After re-sternotomy, the arterial cannula was moved from the aorta to the femoral artery and the patient was switched back from ECLS to CPB. After implantation of the pump (HVAD, HeartWare Inc., Framingham, MA, USA), the aortic prosthesis was side-clamped, the sidegraft attached to the aorta was removed, and the LVAD outflow graft was joined to the aortic prosthesis. When chest closure turned out to be impossible due to massive edematous swelling of the heart, the patient was transferred back to the intensive care unit (ICU) with the sternotomy wound temporarily covered.
+
+After regredience of her massive cardiac edema and chest closure 2 days later, the patient took an unremarkable further course. She was transferred to the ward after 16 days in the ICU and discharged to a rehabilitation facility after a total hospital stay of 27 days.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3213_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3213_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..421e6ed8cb38566df209b728e8da18db559d83e1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3213_en.txt
@@ -0,0 +1 @@
+66-year-old woman referred to the endocrinology department in 2001 for polynodular goiter and osteopenia, with increased sweating in the last year and mild, nonspecific polyarthralgia. She presented a subtle acromegaloid face (enlarged nose, thick lips and prominent superciliary arches) on physical examination. She reported that she had been wearing rings with a larger diameter in the last few years, but did not have an increase in the number of shoes. The biochemical profile showed a calcium level of 9.1 mg/dL (normal value: 8.5-10.5), phosphate level of 4.8 ng/dL (normal value: 2.5-4.5), 236 mg/24h calcium excretion (normal value: < 250) and 95% renal tubular reabsorption of phosphate (normal value: 85-94). Based on the clinical presentation, hyperphosphatemia with renal tubular reabsorption of phosphate at the upper limit of normal was suspected to be acromegaly. A measurement of plasma IGF-1 was requested and found within the normal range. PTOG/GH did not show suppression of the same: basal GH: 4.4 ng/mL, 30 minutes: 3.6, 60 minutes: 5, 90 minutes: 7.1 and 120 minutes: 5.5 (normal value: < 1 at all times of the test); confirming a hypersecretion of GH. The blood glucose levels were normal throughout the test: 97 and 139 mg/dL (basal and 120 minutes, respectively). The MRI of the hypophysis was normal, so the possible source of ectopic secretion of GH was sought. The MRI of the thorax and abdomen did not show a GH-producing tumour. Based on these results and with a patient who was oligosymptomatic for acromegaly, clinical and biochemical monitoring of the same was decided. In her clinical evolution there were no changes: she persists with hyperphosphatemia between 4.6 and 5.5 ng/dL, IGF-1 levels were slightly elevated to 2.3 (normal value: 2) and with annual PTOG/GH curves that were pathological (without suppression of GH). The oscillations in the serum phosphate and IGF-1 levels in the monitoring were modified in parallel. Annual MRI of the hypophysis was performed until 3 years of monitoring when a picture compatible with a 4 mm pituitary microadenoma was found, and an endoscopic transsphenoidal resection of the same was performed with good surgical resolution and without complications. The histopathological report reported somatotrophic adenoma of densely granulated cells, with immunohistochemical positivity for GH and with Ki67 labelling of 1.5%. Remission of acromegaly was achieved, maintaining IGF-1 levels within the normal range and PTOG/GH curve with suppression of GH. Clinical improvement was observed, normalisation of phosphatemia in parallel to normalisation of IGF-1 dosages. The patient remains in control and clinical monitoring in the institution for 18 years without recurrence of acromegaly. Informed consent of the patient and approval of the institution's ethics committee for the publication of the case was obtained.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3217_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3217_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b68a32f3a265713502bb75a936679445d2ee1657
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3217_en.txt
@@ -0,0 +1,17 @@
+A 49-year-old man with a history of acromegaly was admitted to our hospital with the concern of recurrent shortness of breath and dyspnea on exertion during the previous 2 years, and he had experienced an episode of presyncope 2 weeks prior without any further evaluation. He was a chef in a local restaurant for almost 30 years. He had no family history of any diseases and no past history of hypertension, diabetes mellitus, sleep apnea, or sudden cardiac death. He did not smoke or consume alcohol. The patient provided a history of stereotactic radiosurgeries twice in a decade or so and adherence to treatment with a somatostatin analog (octreotide given 40 mg once per month through intramuscular injection) at the time of diagnosis 20 years before. The patient was overweight and moderately nourished. He was 1.85 m (73 inches) tall, weighed 134 kg, and had a body mass index of 39 kg/m2. His blood pressure was 110/60 mmHg, and his heart rate was 92 beats/min with sinus rhythm. He had distinct skeletal features that included prominent superciliary arches and nose bridge, enlargement of the tongue and lip, and large hands and feet. Cardiac auscultation revealed irregular premature beats and pathological third heart sound, and a systolic murmur was discovered over the apex and aortic area. Bilateral extensive borders of cardiac dullness were noted. His physiological reflexes were present without any pathology. An electrocardiogram demonstrated sinus rhythm with wide (160 ms) QRS duration of left bundle branch block (LBBB). The patient’s condition was classified as New York Heart Association (NYHA) stage III–IV.
+
+On admission, magnetic resonance imaging showed pituitary macroadenoma. Given the symptoms described, we arranged blood testing of myocardial injury markers showing an elevated brain natriuretic peptide level of 740 pg/ml indicating cardiac failure (Table 1). Hormone laboratory tests performed subsequently demonstrated excessive secretion of GH and IGF-1, twofold greater than the reference normal upper limit, which was consistent with pituitary macroadenoma (Table 2). Other routine analyses of liver and renal function were roughly normal.
+
+A Holter monitor was ordered for underlying arrhythmias to explain the patient’s dyspnea, chest discomfort, and presyncope. It demonstrated sinus rhythm with an average heart rate of 68 beats/min, frequent ventricular premature beats, and nonsustained ventricular tachycardia (up to 2200 ms).
+
+A chest x-ray showed a cardiothoracic ratio (CTR) of 78%. Echocardiography showed diffuse impairment of left ventricular (LV) systolic motion, reaching an LVEF of 16%. We noted hypertrophy of the ventricular septum at 18 mm, ventricular dilation, with LV diameter of 72 mm. The right ventricle and atrium and the left atrium were also dilated with moderate mitral regurgitation and mild tricuspid regurgitation. There was no associated systolic anterior motion (SAM) of the mitral valve. Dyssynchrony of the biventricular systolic motion was apparent.
+
+Given an exertional component to the symptoms together with echo presentations in order to better exclude ischemic cardiomyopathy, coronary angiography was performed, which showed normal coronary arteries without stenosis, and left ventriculography applied simultaneously revealed an EF of 20% with diffuse LV hypokinesis.
+
+Given the patient’s previous medical history of acromegaly, the absence of obstructive coronary artery imaging findings or segmental dyskinesia, family history of hypertrophic cardiomyopathy (HCM), symmetric hypertrophy, as well as absence of SAM of the mitral valve, acromegaly-induced cardiomyopathy was confirmed, which was absolutely opposed to coronary heart disease (CHD) and HCM.
+
+These results indicated that it was probably not a case of hereditary cardiomyopathy; therefore, we diagnosed the patient as having secondary dilated cardiomyopathy due to acromegaly, even taking it a step further progressing to congestive heart failure secondary to acromegaly-induced dilated cardiomyopathy.
+
+Chronic excess of GH and IGF-I secretion affects cardiac morphology and performance [5], so etiological treatment for acromegaly-induced cardiomyopathy is crucial to suppressing GH secretion or blocking GH action for the sake of reversing acromegaly-induced cardiomyopathy. The mainstay of treatment acknowledged globally is surgical resection of the pituitary adenoma [6], which was unfortunately considered high-risk given our patient’s cardiac condition (NYHA stage III–IV). Although stereotactic radiosurgery combined with somatostatin analogs and GH antagonists administrated previously were effective in suppressing hormones, they could not help his cardiac function. Therefore, we carefully administered diuretics, vasodilators, angiotensin-converting enzyme inhibitor (ACEI), β-blockers, and spironolactone for management of heart failure following the current guidelines [7]; in the meantime, octreotide (200 μg/day) was administered for the control of GH excess. After good compliance of pharmacotherapy and a regular medical examination regimen for nearly half a year, the serum GH and IGF-1 concentrations decreased from 32.50 ng/ml to 1.98 ng/ml and 627.00 ng/ml to 229.10 ng/ml, respectively, but the patient was hospitalized again because of uncontrollable cardiac failure. Accompanied by the normalization of GH and IGF-1 levels, the patient’s cardiac function did not seem to take a favorable turn upon readmission. Though echocardiography showed a recovered EF value from 16% to 28%, a significant ventricular mechanical dyssynchrony was detected as formerly. Electrophysiological study was performed using a nonaggressive stimulation protocol, which revealed a nonsustained ventricular monomorphic tachycardia. In the presence of overt ventricular dyssynchrony, complete LBBB, LVEF< 35%, inducible ventricular tachycardia, and symptomatic heart failure despite guideline-directed medical therapy, surgical indication was rarely assessed by neurosurgeons, and stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects. Therefore, we boldly recommended cardiac resynchronization therapy with defibrillator (CRT-D) implantation based on device implantation official guidelines. The patient underwent CRT insertion finally and was discharged to home 5 days later, pharmacotherapy continued as usual.
+
+Telephone follow-up was arranged, and the patient claimed symptom improvement following the device insertion 1 month later and was basically back to normal life. We required that he return for follow-up at 1 month, 3 months, and 6 months after the interventional therapy. The patient has been followed in our outpatient clinic for nearly half a year now. During his last visit, echocardiography identified improved LVEF of 54%, and a chest x-ray showed reduced CTR of 60%. The patient was in NYHA functional class II.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3225_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3225_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a382bd356fba5258e1211fccf90653d36ef5f596
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3225_en.txt
@@ -0,0 +1,9 @@
+Five-year-old male patient from the district of Independencia in Lima, Peru, referred to the Instituto Nacional de Salud del Niño San Borja with a diagnosis of very severe myelopenia, clonal nocturnal paroxysmal hemoglobinuria (HPN), no response to immunosuppressive therapy (TIS) and no HLA-matched donor. In addition, he had a history of receiving polytransfusions and did not report allergies or adverse reactions to medicines.
+
+The patient underwent a first haploidentical T-cell receptor (TCR) α/β - CD19 - conditioning regimen with fludarabine, rabbit antithymocyte globulin, cyclophosphamide and total body irradiation. However, the transplant failed and subsequently he developed persistent febrile neutropenia requiring broad spectrum antimicrobial treatment and even required surgery for acute appendicitis. The patient recovered and three months after the first T-cell receptor (TCR) haploidentical transplant, a second haploidentical transplant was performed which also failed due to failure of engraftment and developed profound neutropenia (absolute neutrophil count (ANC) = 0 cells/µL), with intermittent fever episodes and partial response to broad spectrum antimicrobial treatment regimens for neutropenic colitis, central venous catheter-associated infection and probable invasive pulmonary aspergillosis, serum galactomannan positive, 2.1 optical density (OD).
+
+On day 110, after the TPH, following episodes of persistent fever and with elevated C-reactive protein values, the patient was afebrile for several days and reached the lowest C-reactive protein value in weeks of antimicrobial therapy (C-reactive protein = 30 mg/L, normal value = < 5mg/L), receiving meropenem, ciprofloxacin, linezolid and voriconazole for prolonged time.
+
+Subsequently, the progressive withdrawal of antimicrobials was decided, but he again presented fever, the values of C-reactive protein increased progressively and, from day 140, the deterioration of renal function (creatinine: 3.17 mg/dL; urea: 117 mg/dL; urea nitrogen: 54.64 mg/dL) was exacerbated, with bilateral eyelid oedema and oral mucositis. Despite the reintroduction of antimicrobials, on day 146 post-TPH, intense abdominal pain with a predominance of epigastrium, disseminated maculo-papular lesions of reddish skin, and pain in the right knee without evidence of signs of phlogosis, but which increased when performing extension movements, appeared. Due to the abdominal compromise, the patient did not continue receiving oral prophylaxis with posaconazole and, due to the clinical deterioration, caspofungin was initiated empirically (day 147) at a dose of 70 mg/SC/day (loading dose), then 50 mg/SC/day. According to the laboratory results, the patient persisted with ANC=0 cells/µL, C-reactive protein increased to 180 mg/dL, the galactomannan study was negative (0.08 DO), the viral loads for cytomegalovirus (CMV), adenovirus (ADV), and Epstein-Barr virus (EBV) were undetectable.
+
+Four sets of blood cultures were taken (including peripheral blood, proximal and distal lumen transcatheter), the first three were negative and the last one (taken from transcatheter blood only) on day 147, three days after the sample was taken, was identified as abundant pseudohifes in blood from the proximal and distal lumen catheters, with identification of Saprochaete capitata/Magnusiomyces capitatus. It should be noted that the central venous catheter did not show signs of inflammation in the insertion area, but that it was prolonged (57 days) and was not removed. Other laboratory examinations at the time of diagnosis are shown in Table 1. The patient died of septic shock (day 150), the same day that the identification of the causative agent of invasive fungal infection was reported.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3235_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3235_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f87158172db8f92e26350ef373bedc1d0b531370
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3235_en.txt
@@ -0,0 +1,7 @@
+A 64-year-old woman was examined at a local clinic because of reduced vision in her right eye of three days duration. Her best-corrected visual acuity (BCVA) in the right eye was hand motion at 30 cm and she had no history of trauma. Her intraocular pressure (IOP) was 12 mmHg and the axial length was 23.52 mm in the right eye. Ophthalmoscopy revealed a dense vitreous hemorrhage (VH), and she underwent successful pars plana vitrectomy (PPV) combined with cataract surgery the following day. A retinal tear that caused the hemorrhage was detected during vitrectomy and was treated with photocoagulation and gas tamponade. The decimal BCVA in the right eye had improved to 1.2 one week later.
+
+Eight months later, a MH developed in the vitrectomized right eye. OCT showed cyst-like changes in the retina and a thin hyperreflective membrane on the retinal surface. The patient complained of distorted vision even though her decimal BCVA was 1.2. PPV was planned, but was canceled 2 weeks later due to the spontaneous closure of the MH.
+
+Four months later, OCT showed a slight elevation of the ellipsoid zone and the interdigitation zone at the fovea but the patient reported that the distorted vision of her right eye was not present. Eleven months after the spontaneous closure of the MH, a LMH with EP was detected in the vitrectomized right eye. Nevertheless, her decimal BCVA was still 1.2. Two months later, the BCVA had decreased to 0.7, and OCT revealed a recurrence of the FTMH with cyst-like changes in the retina.
+
+A second PPV combined with the insertion of the peeled internal limiting membrane (ILM) flap into the MH was performed. The yellowish tissue was not large and was able to be inserted into the MH without trimming. The retina was then tamponaded with 20% SF6 gas. The MH was closed, and the decimal BCVA was restored to 1.2. No recurrence was found at the last visit 5 months after the second vitrectomy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3260_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3260_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a28bae7f52c159ff364aa030f96657335b0f6b4d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3260_en.txt
@@ -0,0 +1,13 @@
+A sixteen-year-old female patient presented with a complaint of intermittent upper and central abdominal cramps associated with abdominal distension of 12-hour duration. She later developed vomiting of ingested matter and obstipation. The abdominal pain worsened later and became persistent and agonizing in type. She has no fever, chills, or rigor. She also had no vaginal discharge or bleeding; her last normal menstrual period was a week back from her presentation. Her past medical and surgical history was absent for previous abdominal surgery. She was neither an alcoholic nor a smoker.
+
+Physical examination revealed an acutely sick-looking patient in pain. Her vital signs were a pulse rate of 110 beats per minute, blood pressure of 110/70 mmHg, respiratory rate of 22 breaths per minute, and temperature of 37.1°C. The pertinent physical findings were on abdominal examination, where a grossly distended central abdomen with hyperactive bowel sounds and mild upper abdominal tenderness were identified. A digital rectal examination revealed an empty rectum. As a result, possible differential diagnoses of intestinal obstruction, primary peritonitis, dyspepsia, cholecystitis, acute pancreatitis, pelvic inflammatory disease, and other gynecologic conditions were considered.
+
+Baseline laboratory examinations showed a white cell count of 11.9*103/µL, hemoglobin of 12.2 g/dl, and platelet count of 248k. Urine B-HCG was negative and other blood chemistry results were unremarkable.
+
+Imaging study with abdominal computed tomography (CT) was requested since the presentation was not typical and with myriads of differential diagnoses. Cross-sectional image indicates a significantly dilated sigmoid colon measuring 8.9 cm with air fluid levels seen in the sigmoid colon. It also depicts twisting and wrapping of the ileum along the base of the sigmoid colon and a characteristic whirlpool sign of mesenteric vessels. The diagnosis of intestinal obstruction secondary to ileosigmoid knotting was entertained, and the decision to emergency surgical exploration was made.
+
+The patient was then kept nil by mouth and resuscitated with intravenous crystalloids; an NG tube was inserted; an indwelling Foley catheter was inserted; and the patient was prepared for surgical exploration after informed written consent was obtained.
+
+We took the patient to the operating room, placing her in the supine position on the operating table General anesthesia was given and the airway secured with an endotracheal tube. The surgical site was prepared and draped in a sterile manner. The abdomen was entered through a vertical midline abdominal incision, and the intraoperative findings were around 100 mL of serosanguinous reactive fluid, a significantly distended, elongated, and redundant sigmoid colon that has twisted 360° CCW (counter clockwise) along its mesentery and is wrapped by a loop of terminal ileum and cecum. Both the ileocecum and the sigmoid colon appear normal. The knot was untied, the rotated sigmoid colon was derotated CW (clockwise), and the distension was decompressed with rectal tube.
+
+The patient had an uneventful postoperative course, and oral feeding was resumed on the second postoperative day and discharged home on the fourth postoperative day. Subsequently, resection of the redundant sigmoid colon was performed as an elective procedure after adequate bowel preparation after two months of the initial emergency exploration. Currently, she is being followed in our outpatient department.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3289_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3289_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..be9873138ba309afc61e31a219051d6cf5cb2241
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3289_en.txt
@@ -0,0 +1,19 @@
+31-year-old female patient (C.) referred to the rehabilitation center after suffering an ischemic stroke with hemorrhagic transformation, the result of an aneurysm in the right middle cerebral artery. She was admitted to the institution with a month of evolution of the brain damage and was referred to the occupational therapy service.
+
+The Functional Independence Measure (FIM) was administered during the initial evaluation to assess the level of assistance required in basic activities of daily living (ADL). The patient was fed by nasogastric tube, required maximum assistance in minor grooming and communication. She also received full assistance in dressing, bathing, using the toilet, transfers, functional mobility and continence.
+
+From the observation of occupational performance, alterations in motor skills related to obtaining and holding objects, the position of the body in relation to space and objects and maintaining execution were detected. An important apraxic component of movement was observed, which impacted the functional use of objects in daily tasks, so the Tulia Apraxia Test (AST) was administered, which rated the performance as severe apraxia. C. retained the processing skills related to the ability to keep up with an activity and the temporal organization of the same; not so the skills related to the organization of space and objects. As for the social interaction skills, she managed to look at the interlocutor and respond to their questions, although she was not able to initiate or end a conversation, produce language, keep up with the interaction or verbally support it. According to the evaluation of the speech therapy service, the patient had global aphasia.
+
+C. participated in an interdisciplinary treatment (TO, kinesiology, phonoaudiology, music therapy, cognitive rehabilitation) and intensive (5 hours daily of therapy, specifically 1 hour of TO) in an inpatient setting.
+
+In line with the reported baseline level, the objectives were defined together with the patient: (1) That the patient can increase her collaboration in basic ADLs, gradually decreasing the assistance required. (2) That the patient can incorporate her right upper limb (MSD) in functional activities. (3) That the patient can participate in instrumental ADLs with supervision.
+
+C. was admitted to the rehabilitation center for 5 months. The intervention from OT during the first month of admission focused on training in strategies to increase participation in basic ADLs, indicating the family the corresponding level of assistance. Due to the subluxation presented, she entered an 8-week protocol in which the use of rigid shoulder bandage and functional electrical stimulation in the shoulder musculature is combined, which is carried out together with kinesiology.
+
+Intervention during the second month focused on increasing motor and processing skills to continue training in basic ADL. Thickened handles were made for cutlery, which helped to hold them, and the bathroom environment was modified to facilitate the reach of the toiletries. We also worked together with a speech therapist to train the patient in accessing an augmentative alternative communication (AAC) application on her cell phone and the functional use of it.
+
+During the third month, sensory-motor reeducation of the MSD was performed to favor its incorporation into the ADLs. The protocol of movement therapy induced by restriction of the healthy limb was performed for 14 consecutive days. The Motor Activity Log (MAL) evaluation was administered in order to have an objective assessment of the use of the affected upper limb in daily activities before and after the protocol.
+
+During the fourth month, the treatment focused on increasing C.'s processing skills during instrumental ADL participation. Temporal, spatial and object organization were worked on in activities such as food preparation and handling of desk tools, and the spontaneous incorporation of the MSD in these activities.
+
+In the final evaluation, the patient was able to increase her level of independence in all basic ADLs, requiring more time in the activities of minor grooming, bathing, dressing, use of the toilet and social interaction. In terms of communication, C. was able to understand abstract ideas and complex conversations with minimal difficulty and was able to express herself orally, relying on the use of the CAA application. In addition, she incorporated the MSD spontaneously in basic and instrumental ADLs with a slight decrease in the efficiency of movement. Finally, she was able to participate in instrumental ADLs such as household chores, shopping, and preparing food with supervision. When comparing the evaluations administered at admission and discharge, an improvement in performance in all skills was observed.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_328_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_328_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..068ab5ebbc766849200e61333fb73e0f91f914ed
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_328_en.txt
@@ -0,0 +1,15 @@
+A 27-year-old man was admitted to our hospital with a thyroid tumor of the middle and lower poles of the right thyroid, which was found 1 wk previously.
+The patient was admitted to the hospital for routine physical examination 1 wk ago. Through thyroid color Doppler ultrasound, a thyroid tumor in the middle and lower poles of the right thyroid was found. The patient denied any symptoms such as dyspnea, fear of heat and lethargy.
+The patient had no other diseases or surgical history.
+The patient did not smoke or drink and denied a family history of genetic disease.
+The patient’s trachea was in the center, breath sounds in both lungs were clear and symmetrical, and there was no murmur on heart auscultation.
+The results of preoperative blood examinations, blood biochemistry tests, coagulation function tests, thyroid function tests, urinalysis and stool analysis were normal.
+Preoperative color Doppler ultrasound of the thyroid revealed a 1.9 cm × 2.6 cm nodule in the middle and lower poles of the right thyroid. The results of preoperative chest roentgenogram, electrocardiography and echocardiography were normal.
+On admission to the operating room, the patient’s heart rate, blood pressure, oxygen saturation and electrocardiography were monitored. Propofol, vecuronium and sufentanil were administered intravenously for induction of general anesthesia and sevoflurane, propofol and remifentanil for maintenance anesthesia. ETCO2 and body temperature were continuously monitored throughout general anesthesia.
+The patient was placed in the supine position, and the neck was extended with a shoulder pillow. In brief, after sterilization and draping, one 1.2-cm horizontal incision was made from 5 mm anterior the lower oral frenulum, and another two 5-mm horizontal incisions were made on either side of the first incision. Then 20 mL of 0.9% saline solution, containing 0.375% ropivacaine and epinephrine (1:40000), was injected subcutaneously into the submental and anterior neck area. A blunt-tipped 12 mm trocar was inserted into the space for insertion of a 10 mm 30-degree rigid endoscope (KARL STORZ-ENDOSKOPE, STORZ, Indonesia). The pressure of CO2 insufflation was 6 mmHg, and then two 5 mm trocars were inserted into the oral vestibule on both sides of the endoscope. Under endoscopy, grasping forceps and an ultrasonic knife were used to dissect the skin flap in the plane of the subplatysmal layer. The flap ranged from the level of the sternal notch and the anterior border of the sternocleidomastoid muscle.
+During dissection of the anterior cervical area, the anterior jugular vein was inadvertently injured, and obvious bleeding in the surgical area was observed. The ultrasonic scalpel was used to staunch the bleeding . At this time, the patient’s ETCO2 had increased from 46 mmHg to 68 mmHg and continued to reach a maximum of 84 mmHg 1 min later . His heart rate, blood pressure, oxygen saturation, heart rhythm and airway pressure were similar throughout the procedure. A CDE was initially considered, and CO2 insufflation was immediately ceased, the sevoflurane vaporizer was turned off, and the patient was placed in the Steep-head down, left-lateral decubitus (Durant’s) position. Loud coarse systolic and diastolic murmurs were heard over the precordium using a stethoscope, and breath sounds were normal on both sides. The patient’s ETCO2 began to drop to 82 mmHg at the third min, then gradually decreased to the preoperative baseline level of 40 mmHg within approximately 10 min. Surgery was continued using a gasless facelift approach. After the operation, the patient was transferred to the post anesthesia care unit. Bedside chest roentgenogram was immediately performed in the post anesthesia care unit and showed no abnormalities .
+To further examine the characteristics of CDE, such as the clinical manifestations, diagnosis, treatment and prognosis, in endoscopic thyroidectomy, we identified similar cases reported in the past decade. We first performed an electronic search of several databases including PubMed, Cochrane Library, EMBASE and Web of Science from January 2010 to November 2020. The search words included “embolism,” “hypercapnia,” “end-tidal carbon dioxide” and “thyroidectomy” and were adopted for all search strings according to the unique characteristics of each database. After the electronic search, we confirmed the included studies using the following entry criteria: the types of the published articles were case reports, prospective studies or retrospective studies, and the papers that reported hypercapnia or CDE occurring after CO2 insufflation during endoscopic thyroidectomy were included. Meta-analyses and non-English language studies were excluded.
+Finally, 5 cases in four articles were obtained[-]. Data on age, weight, tumor size, surgical approach, insufflation pressure, intraoperative anesthesia, embolization time, possible causes, clinical manifestations, diagnostic tools, treatment and prognosis were extracted and are shown in Table . Surgical approaches included the bilateral axilla and nipple areola approach, transoral robotic approach, axillo-bilateral-breast approach and the transoral approach. Insufflation pressure was set to 20 mmHg in one study, 8 mmHg in one study and 6 mmHg in two studies. Gas embolism developed in 2 cases when CO2 was insufflated, and the other cases developed CDE during the process of tissue dissection. Only one report suggested a possible anterior jugular vein tear, and the other three reports did not specify the cause.
+The clinical manifestations after embolism mainly included a sudden and severe drop in ETCO2, a drop in oxygen saturation, hypotension, sinus bradycardia, sinus tachycardia, atrial premature contraction and paradoxical embolism. Three cases developed cardiac arrest. Three reports mentioned ETCO2, one of which used transesophageal echocardiography (TEE) combined with ETCO2, and another reported the use of transthoracic Doppler ultrasound for diagnosis. The treatment methods for CDE included discontinuation of insufflation, adjustment of the patient’s position to Durant’s position, 100% oxygen hyperventilation, the administration of vasopressors and inotropic agents, aggressive volume expansion, positive end-expiratory pressure for ventilation and cardiopulmonary resuscitation for cardiac arrest.
+From the prospective study of a small sample of 81 patients by Fu et al, 2 patients were identified as having CDE. We calculated that the incidence of CDE in transoral endoscopic thyroidectomy was approximately 2.4%. The prognosis of these 5 patients was good. However, we believe that a long term, high-volume, prospective study is required to accurately quantify the incidence of CDE in endoscopic thyroidectomy (using reference standard monitoring) and its consequences.
+We found that CDE during endoscopic thyroidectomy is rare, and it can develop at any time during surgery. Although CDE may occur under various insufflation pressures, low pressures below 6 mmHg are generally recommended. If necessary, gasless endoscopic thyroidectomy can be considered as an alternative, which can significantly reduce or even avoid the occurrence of CDE[-].
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3298_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3298_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d5ff7924152eebfc04231df9473ee01c477581c7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3298_en.txt
@@ -0,0 +1,15 @@
+A 25-year-old Saudi male with a known medical history of juvenile myoclonic epilepsy, for which he takes valproic acid, presented to the emergency room with a 1-week history of left leg pain that suddenly worsened to severe anterior leg pain and swelling.
+
+The patient had been in his usual state of health until 1 week prior when he rapidly climbed multiple stairs at his university, triggering bilateral leg pain. Three days later, the pain was localized to the left leg, specifically over the shins, and rated a severity of 10/10. The pain was associated with notable swelling and inability to bear weight. There was no history of pain in other parts of the body, fever, change in urine volume or color, cough, runny nose, sore throat, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, chest pain, recent seizure episodes, trauma, or recent travel. The patient denied drug use.
+
+On examination, the patient appeared well, with a thinly built body, but in severe pain. Vital signs were within normal limits. Inspection of the left leg revealed swelling over the leg and foot along with an erythematous rash compared with the right leg. Palpation of the left leg and foot revealed severe tenderness. Pitting edema was present over the left leg up to the midshaft. Sensation and vascularity were intact, confirmed by Doppler ultrasonography. There was no evidence of pallor, extensive erythema, swelling, blisters, calf swelling, tenderness over the deep vein territories, or joint effusion in the knee or ankle. While the range of motion was normal, pain was noted during dorsiflexion. Weight-bearing was possible but painful.
+
+Laboratory investigations revealed elevated inflammatory markers with an elevated erythrocyte sedimentation rate (ESR) of 32 mm/hour (normal range: 0–13 mm/hour) and a C-reactive protein (CRP) level of 242.8 mg/L (normal range: 0–5 mg/L). Creatine kinase (CK) levels were elevated at 15,384 U/L (normal range: 26–174 U/L). Other laboratory results, including complete blood count, electrolyte levels, renal function, and coagulation profile, were within normal limits.
+
+A bedside deep vein thrombosis ultrasound study of the lower limbs yielded negative results. Radiography of the left leg revealed no acute osseous abnormalities. The soft tissues were unremarkable, and alignment and joint spaces were maintained. Contrast-enhanced computed tomography (CT) of the left leg showed changes suggestive of underlying edematous alterations in the anterior compartment. No definite gas foci, vascular stenosis, or thrombosis was detected.
+
+Initially, the patient was treated for rhabdomyolysis with intravenous fluids and strong analgesia. Despite the intravenous administration of multiple doses of morphine, the pain continued to increase. Given the complexity and unclear etiology of the patient’s symptoms, an orthopedic surgeon was consulted to facilitate a comprehensive evaluation and establish a diagnosis. The impression was left leg compartment syndrome, and an immediate fasciotomy was performed. Under general anesthesia, a 40-cm lateral longitudinal incision was made 3 cm posterior to the lateral edge of the tibia. All muscles in the anterior compartment were dusky, dark in color, not contracting, with no bleeding, and firm in consistency, indicating muscle necrosis. The tibialis posterior, extensor digitorum longus, and extensor hallucis longus muscles were debrided and nearly completely removed. The wound was closed primarily without tension after 1 day, and the patient was discharged 2 days after the initial surgery.
+
+After the procedure, the patient remained conscious with stable vital signs. He was able to walk with the assistance of a walker frame and was partially able to bear weight on the leg. Neurovascular status was normal and intact. The patient was referred for physical therapy and follow-up appointments for wound care and drainage.
+
+One week after the fasciotomy closure, the wound on the left leg was examined and found to be clean and dry. The patient was able to walk with a cast boot and tolerably bear full weight on the leg. The neurovascular status of the leg was normal and intact. One month after the procedure, the patient was instructed to continue daily home exercises. Unfortunately, the patient did not continue follow-up, and no further information could be obtained.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3336_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3336_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a778c73d4e0f7fe4dcb60563d1cee3f0032994a7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3336_en.txt
@@ -0,0 +1,9 @@
+A 35-year-old male presented to the ocular emergency room two days after sustaining a wire-related trauma while working in an industrial setting. He complained of redness, blurred vision, a sensation of a foreign body in his eye, and photophobia. The initial assessment revealed visual acuity of 20/50 in the right eye and 20/20 in the left eye, with a negative Marcus Gunn's reflex in both eyes. The patient had no previous history of ophthalmologic diseases or surgeries and was not on medication.
+
+Detailed ocular examination with a slit lamp showed conjunctival hyperemia, a 3 mm self-sealed corneal laceration in the temporal-corneal area at zone 1, with no signs of active corneal infiltration, an irregular pupil, and the presence of two eyelashes in the anterior chamber, with a 3 plus anterior chamber reaction but without fibrin or hypopyon formation. The Seidel test was negative. Vitreous and retinal appearance appeared normal, and intraocular pressure on the Goldmann Applanation Tonometer was within normal limits at 14 mmHg. The X-ray orbit showed no evidence of additional IOFB. All other eye examinations were normal.
+
+We performed surgical removal of the eyelashes and repaired the cornea. During the procedure, an intracameral antibiotic regimen (ceftazidime/vancomycin) was administered to reduce the risk of endophthalmitis. The patient received topical ciprofloxacin and betamethasone drops post-operatively and underwent 24-h monitoring. The immediate postoperative period was uneventful, with no signs of intraocular infection.
+
+After two days, the patient was discharged, and the visual acuity of the operated eye improved to 20/30. At a follow-up visit one month later, the corrected visual acuity reached 20/20, and the anterior chamber reaction had significantly decreased, indicating a successful intervention and recovery.
+
+This figure illustrates the rare occurrence of eyelashes inside the anterior chamber of a 35-year-old male patient following a wire-induced trauma. A close-up of the slit lamp examination shows two eyelashes in the anterior chamber, along with an irregular pupil and iridocorneal adhesion. The pre-operative image captures the self-sealing corneal laceration and conjunctival hyperemia.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_333_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_333_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..198d81a8c39e02e23e401a4e333a57b771b57aa0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_333_en.txt
@@ -0,0 +1,3 @@
+A 27-year-old man went to the local hospital because of exertional dyspnoea for the past 6 months. Oral diuretics were given. He had a history of recurrent oral and genital ulceration for 5 years. Imaging examination showed aortic regurgitation and aortic root aneurysm. He underwent aortic root replacement with a 20 mm Medtronic ATS mechanical valve and a 26 mm graft. During the operation, the thickened aortic cusps were perforated and changes of arteritis were obvious. There was no obvious annulus at the attachment of non-coronary cusp, so the suture was placed on the left ventricular outflow tract. Post-operative electrocardiogram showed a complete atrioventricular block. His heart rate was about 40 b.p.m., without dizziness or syncope, so a permanent pacemaker was not implanted. The histopathology of resected tissue showed fibromyxoid valvulopathy with leucocyte infiltration. Behcet’s disease was diagnosed, and oral prednisone (10 mg/day) was administrated after surgery. After 6 months, the cardiovascular examination was normal, and the patient stopped prednisone by himself.
+One year after the operation, the patient was admitted to the local hospital due to sudden chest pain. Computed tomography revealed a pseudoaneurysm at the distal anastomosis of the ascending aorta. He underwent percutaneous temporary pacemaker implantation and endovascular stent graft exclusion. Two 36 mm tube grafts were deployed. The patient had fever 4 days after endovascular intervention. Blood cultures were positive for Streptococcus viridis and Streptococcus oralis. The temporary pacemaker was removed. Targeted antibiotic therapy according to drug sensitivity results was initiated. During the next 4 months, the patient’s temperature fluctuated between 36°C and 38°C. Laboratory examination showed a white blood cell count of 1.06–8.58 ∗ 109/L (reference range: 4–10 ∗ 109/L), a haemoglobin of 90–111 g/L (reference range: 120–160 g/L), a B-type natriuretic peptide of 1400–1900 pg/mL (reference range: 0–150 pg/mL), a C-reactive protein (CRP) of 47–63 mg/L (reference range: 0–8 mg/L), and erythrocyte sedimentation rate (ESR) of 12–36 mm/h (reference range: 0–15 mm/h). Subsequent blood cultures were negative. Transoesophageal echocardiography showed paravalvular leakage and dysfunction of one mechanical valve leaflet. Computed tomography showed pseudoaneurysm recurrence and type I endoleak. Then, the patient was referred to our hospital.
+For cardiopulmonary bypass, femoral arterial cannulation and atrial cannulation were used. The pseudoaneurysm was 6 cm ∗ 4 cm, and the adhesion around the aorta was severe. After cross-clamping of the aorta, the aneurysm was incised, and the malfunctional valved conduit was removed. The aortic root replacement with a flanged composite valved conduit (flanged Bentall; ) was performed. A 22 mm supra-annular mechanical valve Medtronic AP360 and a 26 mm vascular graft Maquet were used. The flange of the conduit (5 mm in length) was implanted to the aortic annulus with interrupted pledgeted sutures. The Cabrol technique with an 8 mm graft was preferred due to tension on the left coronary anastomosis. The right coronary button was anastomosed end-to-side to the composite graft. The distal anastomosis of the graft to the transected aorta was performed using a continuous 4–0 polypropylene suture. After surgery, a permanent pacemaker was implanted. Immunosuppressants included oral prednisone (1 mg/kg/day) and cyclophosphamide (100 mg/day). Cultures of aortic tissues and grafts were negative. Antibiotic treatment (ceftriaxone) lasted for 8 weeks. After 3 months, the cardiovascular examination was normal, and the patient was in New York Heart Association functional class I. Computed tomography during follow-up was normal .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3352_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3352_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..30de5f5a1fbe46bc67f689d5a5a5ad19c1fc11c3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3352_en.txt
@@ -0,0 +1,19 @@
+This is a healthy 22-year-old gentleman who presented with chronic hematospermia for 5 years. This has been a consistent problem, present with every ejaculation. It has severely and negatively affected his sexual life. He has no chronic medical issues apart from major depressive disorder for which he takes Trazodone and Escitalopram. He has had no previous surgeries. Interestingly, he has a congenitally absent left kidney. He denies previous sexually transmitted illnesses (STIs). The patient has denied urinary symptoms or urethral discharge at any point, and he has adequate erections for sexual intercourse without any concern for erectile dysfunction. General physical examination and genital/prostate examination are within the normal limits without any notable findings.
+
+In attempts to address his hematospermia, the patient has received multiple courses of antibiotics (Doxycycline, Trimethoprim/Sulfamethoxazole, and Fluoroquinolones) without benefit over the past several years. A trial of Finasteride was offered but the patient declined this due to concern of possible sexual side effects at his young age.
+
+Other aspects of his work-up after presentation including labs and imaging. Serum creatinine was normal. Urinalysis, urine culture, Chlamydia/gonorrhea, and other STI tests came back negative. An ultrasound of the scrotum was performed which was unremarkable. Given the plethora of negative tests and persistent symptoms, it was agreed upon to perform a cystoscopy which was also unremarkable. At this point, Magnetic Resonance Imaging (MRI) of the pelvis was ordered and showed no evidence of tumors, cysts, or vascular abnormalities; and revealed distension of the left SV with blood. The right SV was normal.
+
+
+The options of treatment were discussed with the patient and given the chronicity of the condition and its negative effect on his sexual life. Several treatment options were discussed with the patient. TRUS-guided SV puncture with drug instillation, TRUS-guided cyst aspiration and transurethral resection with deroofing were discussed as less morbid interventions but associated with higher failure rate. He opted for surgical removal of the left SV, despite potential for higher morbidity and potential impotence or ejaculatory dysfunction, due to his many year struggle with the condition. This was performed as a robotic-assisted laparoscopic left seminal vesiculectomy.
+
+Technique of the primary procedure
+The patient underwent standard induction, position preparation and draping. He was placed in the 30-degree Trendelenburg position. An Xi DaVinci robot was utilized with port placement identical to that of a robotic prostatectomy. After access was obtained and we had visualization, the small bowel was mobilized cranially. The sigmoid colon was then mobilized, exposing the cul-de-sac. The left SV was exposed and mobilized using blunt dissection and bipolar cautery to avoid neurovascular injury. The SV was traced back and dissected to the base of seminal vesicle duct. The duct of the SV was then ligated using 2-0 Monocryl suture. Transection was completed sharply, and the SV was then sent for pathologic examination. Additional examination and hemostasis using bipolar cautery and hemostatic agents. The peritoneum was then closed over the operative field once packed with SURGIFLO ® Hemostatic Matrix mixed with thrombin.
+
+Outcome and follow up
+The patient was discharged home in good condition the next morning. He presented with abdominal pain 2 days after the procedure with abdominal pain and no fever or urinary symptoms. Unfortunately, CT scan of the abdomen & pelvis revealed pelvic hematoma. On the 3rd day post-operatively, he was brought back to the operative room and underwent robotic-assisted laparoscopic exploration.
+
+Technique for robotic exploration
+Following induction, positioning and draping, the port sites of the prior operation were opened and canula inserted. Intermediate Trendelenburg (15–20-degree) was used. Insufflation then proceeded normally. The hematoma was evacuated with the Stryker® large 10 mm suction device. The peritoneum in the Cul-de-Sac was reopened and additional hematoma was evacuated upon which, a small bleeding vessel was identified in the surgical field. This was controlled safely with bipolar cautery and a drain was placed in immediate vicinity. The field was then repacked with SURGIFLO® Hemostatic Matrix mixed with thrombin to limit any further bleeding. The peritoneum was again reconstituted, and the operation was concluded uneventfully following port closure.
+
+Following the procedure, the patient was feeling well and was discharged home the next day in good condition. At 6 months follow-up, the patient has no pain or urinary symptoms. He still maintains normal erections with maintenance of baseline ejaculatory volume and force without hematospermia. The patient was satisfied with the results of the procedure. Pathological examination revealed left SV with congestion and focal mild chronic inflammation but was negative for malignancy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3396_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3396_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2f7b2dbb539ee5ef9bc4de321757b87da5c055bb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_3396_en.txt
@@ -0,0 +1,23 @@
+A 30-year-old female hospitalized patient was referred from the Internal Medicine clinic with chief complaints of multiple oral ulcers, a sore palate, and difficulty opening her mouth ten days prior. Initially, the ulcers appeared on the buccal mucosa and palate, progressing rapidly throughout the oral cavity. Doctors from the hospital beforehand have prescribed medication to relieve the pain complaints, but there has been no improvement. Since being hospitalized, the patient has had difficulty cleaning her mouth and can only consume milk through a straw. The patient has a habit of peeling off the scabs on the lips.
+
+The patient experienced a body fever three days before being hospitalized. There were no complaints of coughing, runny noses, or altered taste. The patient has also complained of swollen legs and abdomen, pain in all joints, hair loss, and reddish skin once exposed to sunlight three months prior. Following a previous hospital diagnosis of nephrotic syndrome, the patient was prescribed furosemide 80 mg, albumin, and methylprednisolone 32 mg. The patient stopped the drugs after taking them for two weeks without consulting a doctor because she felt her condition was improving.
+
+Extra-oral examination at the first visit showed multiple hemorrhagic crusts and erosions in the bilateral frontal and zygoma regions passed through the bridge of the nose, an irregular shape with distinct borders, and hemorrhagic crusts on the upper and lower lips that bleed easily. Intra-oral examination revealed erythema throughout oral mucosa and multiple irregular white plaques with diffuse borders that vary in size, which can be partially scraped off to reveal patches of erythema on the palate. Based on the history and clinical findings, the suspected diagnosis in the first visit was oral lesions associated with SLE and acute pseudomembranous candidiasis, with the differential diagnoses were pemphigus vulgaris (PV), erythema major and Steven Johnson syndrome (SJS).
+
+The internal medicine specialist made a provisional diagnosis of suspected SLE with mucocutaneous, musculoskeletal, renal, and serositis involvement. Suspected chronic cutaneous lupus erythematosus (CCLE) and suspected toxic epidermal necrolysis-like acute cutaneous lupus erythematosus (TEN-like ACLE) were established as differential diagnoses. An antinuclear-antibodies (ANA) test was performed in the second visit (third day) and showed reactive results with a homogeneous pattern (titer 1:3200). Complete blood cell count and other parameters in laboratory examination were performed to assess the patient’s general health status.
+
+Disease activity assessment was performed using the Mexican-Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and revealed a score of 7. Based on these examination results, the internal medicine specialist diagnosed SLE, and the oral medicine specialist diagnosed lupus cheilitis and palatal erythematous ulcer. Evaluation from the oral medicine department at the second visit showed no improvement in the oral lesions.
+
+The patient complained of increasing crusts on her lips at her follow-up on the third visit (sixth day), while the pain in the oral cavity remained. Extra-oral examination reveals an improvement in the crust of the frontal region, bilateral zygomas, and nose bridge, but the hemorrhagic crust on the lips develops into the serosanguinolenta crust. Intra-oral examination showed multiple ulcers surrounded by diffusely bounded erythema areas on the buccal mucosa and palate. An anti-HSV-1 IgG examination was carried out, and positive results were obtained at a ratio of 1.57 times. Diagnosis of lupus cheilitis associated with HSV-1 infection, oral discoid lupus erythematosus (DLE), and palatal erythematous ulcer was established.
+
+The patient felt that the complaints in the oral cavity had begun to improve on the fourth visit (thirteenth day), but there was still a slight stinging sensation on the lips, buccal mucosa, and palate. Extra-oral examination showed that the crusts on the lips had improved but still bled easily. Intra-oral examination revealed improvement, as indicated by a decrease in lesion size.
+
+On the fifth visit (40th day), the patient no longer felt sore in the oral cavity, and all lesions had disappeared. The patient has been able to eat normally for the last 10 days, following a three-meal-A-day diet accompanied by routine consumption of vegetables and fruits. The patient was instructed to continue maintaining oral hygiene.
+
+
+Case Management
+Comprehensive management, including pharmacological and non-pharmacological therapy, was given to the patient with a multidisciplinary approach from various fields, such as internal medicine, dermatology venereology, and oral medicine.
+
+Pharmacological therapy from internal medicine was methylprednisolone 500 mg intravenously administered for three days and continued orally at a dose of 48 mg per day, while dermatology and venereology prescribed SPF 45 sunscreen and mometasone furoate 0.1% cream. These drugs were continued alongside therapy from the oral medicine clinic, such as 0.9% NaCl solution, 0.025% hyaluronic acid mouthwash, nystatin oral suspension 100.000 IU/mL, and a mixture of ointments containing dexamethasone. Acyclovir 200 mg as an antiviral agent was added on the sixth day after the anti-HSV-1 IgG test showed a positive result. Chlorhexidine gluconate 0.2% mouthwash was given on the thirteenth day to replace hyaluronic acid mouthwash, and nystatin oral suspension was stopped.
+
+Non-pharmacological therapy includes instructions for applying moist gauze moistened with 0.9% NaCl solution to compress lips at least three times daily. Education is given to the patient to stop the habit of peeling scabs on the lips, encouraging a healthy lifestyle and adequate hydration at least two liters per day. All lesions healed within 40 days, and the patient was still educated on maintaining oral hygiene.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_350_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_350_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..61feb48c734ae162947f230a815c8635daa8349e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_350_en.txt
@@ -0,0 +1,7 @@
+A 63-year-old woman with chronic hepatitis B virus infection was referred to our clinic due to incidental detection of a hepatic mass. Alpha-fetoprotein and protein induced by vitamin K absence or antagonist II (PIVKA II) levels were 25.24 ng/mL and 3021 mAU/mL, respectively. The patient was diagnosed with HCC in December 2014. Thereafter, she underwent hand-assisted laparoscopic partial hepatectomy for a solitary tumor with 5 cm in diameter in the right posterior sector. Pathological findings showed that the lesion was 40 mm in size, moderately differentiated, solitary HCC without any macroscopic vascular invasion (T1bN0M0 and stage IB, based on the 8th Union for International Cancer Control staging of HCC). Liver fibrosis was evident during initial surgery (METVIR F2-3).
+Six months after initial surgery, multiple recurrent lesions in the liver were observed. Consequently, the patient was treated with lipiodol-transcatheter arterial chemoembolization (TACE). After this successful TACE, sorafenib (400 mg per day) was administered. Six months later, she underwent laparoscopic left adrenalectomy for adrenal metastasis (pathology revealed metastatic, moderately differentiated HCC). Eight months after the adrenalectomy, the patient underwent laparoscopic partial hepatectomy for a solitary recurrence in the lateral sector (pathology revealed moderately differentiated HCC, background liver condition; METAVIR F3). Eight months after the second hepatectomy, the patient was treated with sorafenib (400 mg per day, followed by 600 mg per day) for increased PIVKA II levels. Despite 9-mo treatment with sorafenib, she was found to have a 43-mm mass in the spleen and portal vein tumor thrombosis (PVTT) that involved both the right and left portal branches down to the main trunk (Vp4) on computed tomography (CT) .
+Hepatitis B infection.
+Her personal and family history was unremarkable.
+Her vital signs were normal. There were no remarkable findings other than abdominal distention.
+PIVKA II levels increased tremendously up to 46.291 mAU/mL. The BCLC staging system classified the patient into stage C. Aspartate aminotransferase, alanine aminotransferase, and platelet count were 49 IU/L, 40 IU/L, and 14.7 × 104/μL, respectively. The FIB-4 index was calculated as 3.71, suggesting that she was likely to be cirrhotic. Her cirrhosis was classified into Child-Pugh B (8) and modified albumin-bilirubin grade 1.
+CT findings revealed moderate ascites, which indicated portal hypertension due to tumor thrombosis. This also demonstrated irregularity of the external contour of the left lobe of the liver, suggesting cirrhosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_355_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_355_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ed5039121ca42e6dd773400b5a0bb11b0a722a1d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_355_en.txt
@@ -0,0 +1 @@
+A 39- years old multiparous woman has suffered from mild MS for 10 years, as a result of childhood bacterial tonsilopharyngitis (rheumatic MS). The first attacks of symptoms appeared in her last year of second decade, during her second pregnancy. Her chief complaint was exertional dyspnea. Two - dimensional echocardiography (2D-ECG) revealed a decreased mitral valve area (1.5 cm2). She had no other medical conditions and her past medical history included nothing else of note. Recently the symptoms worsened and she began to experience dyspnea in ordinary activities, AF and hemoptesia (hemoptysis). 2D-ECG positive findings were: critical diminished mitral valve area (0.8 cm2), left atrial enlargement without any organized clot attachment, thickened leaflets, commissural and subvalvular fussions and mean diastolic pressure gradient across valve =12 mmHg. She was scheduled for MVR with mechanical prosthesis. Open cardiac surgery with CPB using bicaval connulation was carried out. Early post-operative course was uneventful and she was discharged to home on POD = 7 with warfarin prescription without any prohibition about taking it, since she had completed her family members. She felt face tenderness and hearing problems besides stuffy and clogged nose on POD = 20. She underwent ENT consultation and based on the clinical and paraclinical finding, met ARS diagnosis . As soon as an antihistamine, anticongestion and macrolide antibiotic was initiated. She came back to ENT service with persistent ARS as well as relapsing preoperative couphs and dyspnea besides lower extremities edema and toenails discoloration . After some modulations of therapeutic drugs, she was referred to pulmonary clinic on POD = 30. CXR confirmed a significant left pleural effusion and she was readmitted in our service while taking lasix and SABAs (albuterol inhaler) in addition to aforementioned medicines on POD = 33. Immediately a pigtail catheter was secured with the purpose of both assessment and management. At first the fluid was bloody then became milky. Finally we attained 1850 cc frankly white fluid. Bedside ether test revealed the presence of fat which was confirmed by lab study (triglycerides = 1750 mg/dl chylomicron). We encountered with a patient who had different signs such as chylothorax, lymphedema and yellow discoloration of toenails. After dermatologist consultation we arrived at Yellow Nail Syndrome on POD = 35. Immediately conservative treatment was taken place such as bed rest, massage and compression therapy of legs using garments, restricted diet consist of high protein low fat with medium chain triglycerides and octreotide. Since the decline of chylous drainage was unsatisfied (330 cc/d), we exchanged the pigtail catheter with an appropriate size chest tube and TPN was initiated. Then talc and doxycycline pleurodesis was carried out besides Vitamine E supplement on POD = 41. Fortunately chest tube output substantially decreased, allowing transition to low fat oral intake diet on POD =45. Chest tube was removed and the patient was discharged on POD = 47. At 4 weeks follow ups, CXR was clear without effusion and nails discoloration and legs lymphedema resolved.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_358_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_358_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..08aa9b76a48fc7651d3b39a37610f3686b23c9a8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_358_en.txt
@@ -0,0 +1 @@
+A 65-year old woman was hospitalized after reporting abdominal pain and faecal impaction. Blood samples were normal and a chest X-ray revealed hypoplasia of the right lung with severe thoracic scoliosis. A colonoscopy and gastrografin enema were performed with diagnosis of adenocarcinoma of the rectosigmoid junction. Pre-operative staging was performed with a CT scan that highlighted a right diaphragmatic hernia with involvement of the right kidney and subsequent migration of the right liver into the thorax. This herniation led to torsion of the caval axis and occlusion of the right and middle hepatic veins with modification of liver outflow, thus creating a right to left hepatic vein shunt passing anteriorly to the umbilical recess . An alteration of the retrohepatic cava vein was also demonstrated with suspected double caval system. The right lung presented absence of the inferior segment with bronchial ending without atelectasis. The patient underwent combined hernia repair and rectosigmoid resection. Intraoperative findings revealed a large right posterior diaphragmatic hernia without a sac opened in the thorax. Exclusively the left lobe remained inside the abdominal cavity with traction of the hepatic hilum under the right diaphragm with the round and falciform ligament overlying the diaphragm sustaining the liver . The liver was rotated in the abdominal cavity intraoperatively: this retraction revealed a ligament between the diaphragm and the liver determining compression of the inferior vena cava . The ligament was therefore, dissected in order to restore the vena cava’s normal diameter. Also the right kidney was reduced in the abdominal cavity and hernia repair was performed with dual mash sutured with non-absorbable separated stitches to the diaphragm. A shift of the liver outflow was seen with a natural by-pass inverting flow from the right and middle hepatic veins to a large accessory hepatic vein in the parenchymal bridge in front of the umbilical recess and then to the left hepatic vein . Sigmoid resection with mechanical colorectal anastomosis was performed at the same time. The postoperative course was uneventful and the patient was discharged eight days after surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_35_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_35_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..04f76cd6bff335711e215ed072bdfd0cbdc21b27
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_35_en.txt
@@ -0,0 +1,2 @@
+A 79-year-old man with advanced CKD, Stage 4, a baseline serum creatinine level of 2.04 mg/dL (normal range 0.65–1.09) and an estimated glomerular filtration rate (eGFR) of 25.5 mL/min/1.73 m2 (normal range > 90), presented with claudication. Other medical history included diabetes mellitus and hypertension. Bilateral claudication appeared 24 months prior and later worsened, on walking 10 m (Rutherford Category 3). The patient’s ankle brachial index (ABI) was 0.75 and 0.56 on the right side and left side, respectively. To avoid contrast medium administration, non-contrast MRA and vascular ultrasound were chosen for the diagnosis.
+Severe stenosis was detected at the bilateral common iliac artery (CIA) to the external iliac artery (EIA) on MRA . Doppler echo on vascular ultrasound indicated that the culprit lesion was on the CIA and/or EIA on both sides . Endovascular therapy was recommended in our multidisciplinary cardiovascular team. After discussion, the patient opted to proceed with zero-contrast EVT, with the concurrent preparation for contrast administration.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_369_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_369_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..56d52d6a85a532367aa7e07f1f6f1ff859e79b19
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_369_en.txt
@@ -0,0 +1,6 @@
+A 36-year-old Asian woman was admitted to our hospital on April 25, 2016 with localized pain in the left anterior tibial region for 15 years.
+The patient had visited several hospitals in the past 15 years but was diagnosed with venous thrombosis, which did not improve with conservative treatment such as analgetics. Over the past three years, the patient's pain had progressively worsened, and was exacerbated by touch, temperature changes and mood swings. In addition, the patient often had a poor sleep at night because of the pain.
+No special history of past illness.
+There was no personal history of GT or any other family medical history.
+Physical examination revealed mildly localized swelling on the on left leg along with tenderness in a 50 mm × 30 mm area of skin on the anterior medial aspect of her left lower extremity, with no ulceration or warmth.
+No obvious abnormality was found in laboratory examination.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_411_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_411_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..262c922ca5a406888b73f0b87dfdfdb14efa3e96
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_411_en.txt
@@ -0,0 +1,2 @@
+A 56-year-old woman presented to the emergency department with headache and right hemiparesis. Blood screening did not indicate any signs of infection, but she had the history of ovarian tumor resection. A computed tomography (CT) scan revealed a hyperdense mass in the right frontal lobe . MRI showed a nodular mass, with maximum diameter of 11 mm that was hypointense on FLAIR with perifocal edema. After gadolinium administration, the mass showed a ring enhancement [-]. Magnetic resonance angiography showed regular blood flow in the intracranial arteries. Because of the ring enhancement and surrounding FLAIR high signal, there was a significant probability of a metastatic brain tumor. We performed right temporal craniotomy with neuronavigation (BrainLab AG, Germany). Dissection was performed through the inferior frontal gyrus down to the level of the lesion. The preparation showed a hard spherical lesion with vasa vasorum at the lesion wall. Further, the lesion wall was grayish black and was found to be a thrombosed aneurysm originating from the distal temporal branch of the right MCA (M3 segment). Distal vessels exiting the aneurysm were seen, which were draped under the surface of the aneurysm, these were freed from the aneurysm dome . It was observed that they were not supplying the distal territory of MCA. At this time, a 4 mm permanent clip was placed across the distal vessel of the aneurysm. The proximal portion of the aneurysm and the parent vessel were identified and coagulated. We also clipped the proximal vessel . The aneurysm was fusiform in appearance. The aneurysm was then resected using micro scissors, cutting the proximal portion away from the permanent aneurysm clips, and then removing the distal portion of the aneurysm . The intraoperativeindocyanine green angiography demonstrated absence of blood flow in the aneurysm . It was observed that they were not supplying the distal territory of MCA. Histopathologicalfindings confirmed the thrombosed aneurysm and reveals remarkable angiogenesis of vasa vasorum .
+Postoperatively, the patient was stable and had no neurological deficits. A collateral circulation from the MCA and posterior circulation was detected. After 1-month of follow-up, the patient recovered from the surgery and could walk without assistance.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_413_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_413_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c920b494c46b9864f87546c94f770b8aaed73669
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_413_en.txt
@@ -0,0 +1,4 @@
+Patient 1 The proband , a 6.6-year-old girl, was admitted to our hospital because of short stature. As the first child of nonconsanguineous parents, she was born at 41 weeks of gestation via vaginal delivery, whose birth weight and length were 1800 g (<P3rd) and 47 cm (<P3rd), respectively. She showed significant growth retardation since the newborn stage, and now her height, weight and body mass index (BMI) were 90.5 m (− 6.3 SD), 11 kg (− 4.9 SD) and 13.4 kg/m2 (P10-25th), respectively. Her ratios of arm span/height and sitting height/height were 0.92 (− 2 SD) and 0.58 (+ 3 SD) according to the standard reference values . Her psychomotor development was mildly delayed.
+Physical examination: She showed the following typical features of Noonan syndrome : hypertelorism; downslanting palpebral fissures; epicanthal folds; low-set, oval-shaped, posteriorly rotated ears with a thick helix; a short broad nose with a depressed root and full tip; a deeply grooved and long philtrum; high and wide peaks of the vermilion; a highly arched palate; micrognathia; a short neck; cubitus valgus; scoliosis; café au lait spots; and mild hypertrichosis. She also presented with squinting, refractive errors and nystagmus.
+Auxiliary examination: The IGF-1 level was 61 μg/L (− 1.9 SD) and growth hormone (GH) stimulation test (insulin and levodopa stimulation test) showed that GH peak was 5.54 ng/mL (cut-off value: < 7 ng/mL). The electrocardiogram test showed frequent premature ventricular beats (the second and third rhythms), X-rays and MRI of the spine showed hemivertebral deformity of the third thoracic vertebra and scoliosis (Cobb’s angle = 28°), and her bone age was 5.5 years old. In addition, hormone levels of the adrenal gland, thyroid gland and gonad were normal; the tumor markers (includes AFP, HCG and CEA) were also negative. No abnormalities were found during the ultrasound examination of the heart, liver, kidneys, uterus or ovaries, so did the MRI of the craniocerebrum. Besides, her karyotype was 46, XX.
+According to the clinical manifestation and laboratory tests, she was diagnosed as Noonan syndrome with GH deficiency clinically . Due to her serious scoliosis and hemivertebral deformity, recombined human GH treatment was not recommended.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_426_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_426_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0dfb36eec664f30c35b3b3b2300da23b095fea40
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_426_en.txt
@@ -0,0 +1 @@
+A 64-year-old male presented as an intoxicated pedestrian who was involved in a hit-and-run incident. Initial trauma workup demonstrated that the patient had sustained a type II odontoid fracture . He subsequently underwent AOSF for this fracture, without any intraoperative complications. He tolerated the procedure well and postoperative imaging demonstrated near anatomic correction of the fracture with satisfactory placement of the lag screw [ and ]. Postoperatively, the patient was to attend physical therapy. Unfortunately, the patient was subsequently lost to follow up and he presented 7 months later for a routine outpatient CT of the cervical spine, which demonstrated upward migration of the screw into the intracranial cavity abutting the medulla , with CT angiography of the neck also demonstrating the screw lying between the two vertebral arteries . The patient had also obtained a magnetic resonance imaging of the cervical spine which demonstrated the odontoid screw lying within close proximity to the ventral cervicomedullary junction, marginating the left vertebral artery [ and ]. Although he did not exhibit any neurological symptoms at this time, given the migration of the screw, there was nonunion of the patient’s fracture with increased risk of poor recovery and neurological deterioration. He was subsequently taken for an anterior removal of the odontoid screw with posterior open treatment and reduction, C1-4 posterolateral arthrodesis and instrumented fusion, and Brooks sublaminar wire placement of C1-2 posterior instrumentation . He tolerated the procedure well and remained intact neurologically postoperatively.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_429_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_429_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..af2f4be05b3676b483f80010c67027c185368eeb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_429_en.txt
@@ -0,0 +1,7 @@
+The patient was a 42-year-old female, with one previous pregnancy, with a history of cesarean section seven years previously and resection of endometriosis of the cephalic scar (Pfannenstiel) two years previously at another service, for which a histopathological diagnosis of abdominal wall endometriosis was made.
+Her condition evolved with progressive expansion in the region previously resected, for eight months, leading to presence of a bulging mass in the right side of the anterior abdominal wall, with cyclical local pain. During the investigation period, the patient said that she did not have any genitourinary or gastrointestinal symptoms, or any presence of lymph nodes or systemic symptoms.
+Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen bordering the pubis. It extended inferiorly to the umbilical scar and laterally to the upper border of the iliac crest. At the time of the physical examination, there was no lymph node swelling in the inguinal region.
+Laboratory tests and tumor marker investigations (CA 125, CA 19-9, CEA and alpha-fetoprotein) were requested and these were found to be within normal limits. Computed tomography (CT) of the abdomen and pelvis revealed a heterogeneous expansive formation that was predominantly hypoattenuating, with images suggestive of internal septation. It measured around 10.6 cm x 4.7 cm x 8.3 cm along the major transverse, anteroposterior and longitudinal axes, respectively, and was located in the anterior pelvic wall, with the largest axis to the right of the midline, involving the rectus abdominis muscle .
+The patient underwent exploratory laparotomy by means of a Pfannenstiel incision, followed by block resection of the abdominal mass with margins to the peritoneum, along with lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed to reconstitute the defect caused by resection of the tumor, using a semi-absorbable tissue-separating screen composed of a polypropylene parietal face and a visceral face coated with carboxymethyl cellulose. This rectangular sodium hyaluronate mesh measured 20.3 cm x 30.5 cm (Sempramesh IP Composite Bard Davol Inc.).
+Histological analysis on the abdominal mass revealed infiltration by malignant epithelioid neoplasia into soft tissues, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components . The antigens investigated in the immunohistochemical evaluation are listed in . Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node (1/8), and that other lymph nodes of the iliac and inguinal chains presented lymphoid hyperplasia (0/11).
+Our patient is in her second postoperative month, without having presented any clinical or surgical intercurrence to date. She is being followed up by the oncology sector and an adjuvant chemotherapy scheme has been indicated.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_456_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_456_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d5d35ef48e5d2982c69b6dfe0b449c407bd1789e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_456_en.txt
@@ -0,0 +1,4 @@
+A 31-year old Caucasian, Turkish male patient was admitted to our emergency department with the complaints of nausea and vomiting occurring few hours. It was learned that these complaints were repeating after meals for a week, episodically. On admission he looked severely ill and dehydrated. Abdominal examination revealed distension and clanging intestinal sounds. Laboratory investigation showed that leukocytosis (13400/mm3), sodium: 134 mmol/L, potassium: 3.2 mmol/L. Plain films of abdomen disclosed multiple intestinal air-fluid levels. Contrast enhanced computed tomography showed intestinal obstruction without an obvious cause.
+Upon appropriate fluid resuscitation the patient underwent diagnostic laparatomy. In this process, it was seen that an approximately 10-cm of invaginated mid-jejunal segment . The pathologic segment was resected and end-to-end anastomosis was performed. The patient was discharged in a well condition 6 days after the surgery.
+Macroscopic examination of surgical specimen demonstrated a hard polypoid tumor approximately 3-cm in diameter, originating from submucosa and making ulceration by extending mucosa .
+Histopathologic examination showed proliferated vessel formations in fibrotic stroma, dense inflammatory mononuclear cell infiltration and polypoid tissue with patchy necrotic areas. The connective tissue of polyp was rich in fibroblasts and eosinophils. Vessel congestions were observed at submucosa and mucosa as well. With these findings polypoid lesion was classified as inflammatory fibroid polyp (IFP) .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_465_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_465_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3474d6df65982f52ffd1bf45f5b615baf4ab576a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_465_en.txt
@@ -0,0 +1,3 @@
+A 33-year-old healthy female patient presented with fever, myalgia, and skin rash lasting 3 days before visiting Korea University Guro Hospital . The patient had a history of trip to Thailand, and she came back to Koreaeight days ago. Except for conjunctiva hemorrhage and mild splenomegaly, the physical findings were unremarkable.
+Initial laboratory tests showed mild neutropenia (1251/μL), thrombocytopenia (75,000/μL), elevated level of lactate dehydrogenase (LDH, 1775 IU/L), and elevated levels of alanine aminotransferase (ALT, 116 IU/L) and aspartate transaminase (AST,74 IU/L). Prothrombin time (PT, 13.1 sec) and activated partial thromboplastin time (aPTT, 33.3 sec) were within the normal range. Despite conservative treatment, sustained high fever was observed.
+On hospital day 3, the patient appeared lethargic and fever persisted. With suspicion for secondary HLH after dengue infection, diagnostic tests were performed. Although bone marrow examination did not show typical findings of hemophagocytosis, diagnostic criteria of HLH were met: fever, splenomegaly, cytopenia, hypertriglyceridaemia (fasting TG 308 mg/dL), and hyperferritinaemia (ferritin 25,107 ng/mL) . Intravenous dexamethasone (10 mg/m2) was initiated on day 3 . Dengue virus PCR was positive and reported as a serotype 3 on hospital day 8. The dose of dexamethasone was tapered down after 2 weeks of treatment, and all results of blood tests were normalized . The patient was discharged from the hospital on hospital day 18 without any sequelae.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_477_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_477_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..28a7378ac9c954a16dda7ab778a1d584e9744154
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_477_en.txt
@@ -0,0 +1 @@
+A 21-year-old woman presented to the allergology clinic because of nausea, vomiting, abdominal pain, and itching of the skin each time after she ingested a chicken egg; symptoms had been present for 1 year. She also reported that two months before her visit there was an episode when 10 min after eating a raw chicken egg (in steak tartare) she started to experience severe abdominal pain, nausea, and severe itching of the skin all over her body; and she noticed hives with itchy wheals on her abdomen, chest, and lower limbs accompanied by facial redness as well as feeling of weakness and anxiety. The patient provoked vomiting and took an antihistamine drug in the form of a tablet, the name of which she could not remember. Within an hour, the symptoms resolved completely. Since then, the patient has eliminated chicken eggs from her diet. Her history revealed that she is a second-year psychology student, has an active lifestyle, practices yoga, does not use stimulants, and is interested in healthy nutrition. There is no history of allergic disease in the patient’s family. The patient had no history of chronic diseases and did not take any medications chronically. She had a history of diarrhea and spitting in infancy; at the age of 3 months she was diagnosed with cow's milk protein allergy, and thus was given milk replacer with a high degree of protein hydrolysis up to the age of 12 months. Currently, the patient fully tolerates dairy products. Due to her mother’s concerns, the diet was extended to other foods quite late, after the age of 12 months. In the 12th month of life, chicken egg yolk was introduced, which was well-tolerated; however, introduction of chicken egg white caused redness of the skin around the mouth accompanied by diarrhea. Until the age of 5, the patient did not consume any egg protein, and in the following years its consumption was heavily limited. Only at the age of 20, due to the patient’s belief about the high nutritional and health value of chicken eggs, she introduced this product into her diet in a large amount. It should be noted that initially the patient did not link her complaints with the consumption of eggs, and because of recurrent diarrhea and abdominal pain, she underwent full gastroenterological workup (including gastroscopy and colonoscopy), which ruled out gastrointestinal disorders.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_488_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_488_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4a73a6b60edbd2fb41efa1efdbb675ea03d2b3b9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_488_en.txt
@@ -0,0 +1,7 @@
+The 44-year-old male acute myeloid leukemia (AML) patient received an unmanipulated graft from an unrelated donor (CMV D−/R+) after conditioning with the FLAMSA protocol. The patient received acyclovir (ACV, 400 mg twice per day) continuously, except between days + 43 to + 70 and day + 110 to + 145 (summarized in Fig. ). For maintenance of immunosuppression, the patient received cyclosporine A per os (measured blood concentrations 180–220 μg/L), mycophenolate (360 mg twice daily), and prednisolone.
+It was planned to start LMV prophylaxis directly after the transplantation. However, due to a delay in delivery, administration of LMV could only be initiated at day + 34, under the assumption that CMV viral load was still below detection limit (50 IU/ml in serum). The compound was given at 240 mg once per day per os, along with cyclosporine. In retrospect, it turned out that the virus DNA load at the last check on day + 28 was 190 IU/ml in serum. Over the next 8 days, increasing CMV loads were measured up to 39.600 IU/ml. Therefore, letermovir treatment was discontinued and the patient was switched to valganciclovir (valGCV, 900 mg twice per day) at day + 42. Treatment was maintained for 4 weeks until CMV DNA was negative. At this time, the patient suffered from an intestinal graft-versus-host disease (GvHD) and a mucositis. Therefore, prednisolone was administered at day + 46 for 7 days with 10 mg and then was reduced to 1 mg until discontinuation at day + 82.
+As neutropenia occurred during valGCV therapy, stimulation with G-CSF was necessary. After discontinuation of valGCV, neutropenia was resolved and LMV secondary prophylaxis was started at day + 70 with 240 mg once per day. At this time point CMV DNA was not detectable. At day + 80, mycophenolate was discontinued. For 4 weeks, CMV DNA remained undetectable or at the limit of quantitation of 125 IU/ml. At day + 97, tapering of cyclosporine A was initiated. However, several days later, the patient failed to maintain virologic suppression. CMV viral loads rapidly increased to 236.400 IU/ml in serum samples, between days + 104 and + 110. In order to avoid neutropenia, valGCV treatment with a reduced dosage of 450 mg twice per day was initiated at day + 110. Concomitantly, LMV dosage was increased to 480 mg per day. During the next 4 weeks, CMV viral loads decreased to 1.200 IU/ml. ValGCV treatment, which meanwhile necessitated daily stimulation with G-CSF, was discontinued.
+However, CMV DNA levels increased up to 33.000 IU/ml during the following 2 weeks. Therefore, genotyping of the CMV terminase UL56 as well as the other relevant genes (UL97 kinase, viral polymerase UL54, and UL89) was initiated. Thereby, a mutation corresponding to amino acid 325 (C325Y, cytosine at amino acid 325 to tyrosine) of UL56 was detected (see Fig. ). This mutation is associated with a high resistance to LMV in vitro . Therefore, LMV was discontinued at day + 167.
+No further mutation was detected. Retrospective analysis revealed that the UL56 mutation C325Y was already present at day + 117, within 6 weeks after the start of the second letermovir administration. Unfortunately, no other patient specimens were available in order to further elucidate the time point of emergence of the mutation.
+Since then CMV DNA loads remained at a low level of 1300 to 2500 IU/ml. Due to the lack of clinical symptoms and increasing CD4 T-cells since day + 145, no further anti-CMV therapy was carried out.
+Until today, the patient is clinically stable and participates in a professional reintegration.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_510_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_510_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b47ba7b016541517852c4f74c2a5d21fe77b4b97
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_510_en.txt
@@ -0,0 +1 @@
+A 79-year-old woman has presented with advanced rectal cancer located on the dentate line. Computed tomography (CT) detected no metastasis. Laparoscopic APR for low rectal cancer was performed, and a sigmoid colostomy was created via the intraperitoneal route during laparoscopic APR. The histopathology of the resected tumor revealed a well-differentiated adenocarcinoma. The patient was therefore classified as T2N0M0 and Stage IIA . Six months after surgery, the patient experienced vomiting, abdominal distension, and abdominal pain and visited our hospital. Contrast-enhanced CT showed the body of the stomach positioned in the lateral space between the lifted sigmoid colon and the lateral abdominal wall. In addition, the stomach was observed to be markedly dilated . The patient was diagnosed with internal hernia of the stomach resulting from colostomy. Initially, a nasogastric tube was inserted into the dilated stomach for drainage of gastric juice and decompression of the stomach. Then, emergency laparoscopic exploration was performed. Laparoscopy revealed that a part of the stomach had passed through a defect between the lifted sigmoid colon and left lateral abdominal wall in a cranial-to-caudal direction . The herniated stomach was already decompressed without ischemic changes. This dislocated stomach was restored to the normal position laparoscopically. The lateral defect was closed with the lateral peritoneum and the lifted sigmoid colon to avoid postoperative recurrence of IHAC . The internal hernia was repaired by interrupted suture using non-absorbable thread. There was no recurrence of IHAC after surgery .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_513_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_513_en.txt
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index 0000000000000000000000000000000000000000..3f71279da1a393eec6dcea545d181675fe20ccb8
--- /dev/null
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@@ -0,0 +1,2 @@
+We present the case of 32-year-old female patient who presented to the urologist with fever lasting for the previous two months, usually 37°C to 38°C, with occasional temperature leaps to 40°. Laboratory blood tests showed leukocytosis with cell counts up to 19,000. The patient did not complain of lumbar pain. Urinalysis showed leukocyturia, erythrocyturia, and slight positivity for protein. The patient was treated with a combination of amoxicillin, clavulonic acid, and cefuroxime. Abdominal ultrasound and multiphase CT depicted a large, expansive, heterogenous mass in the lower pole of the left kidney measuring 92 × 59 × 76 mm. CT scans showed a renal neoplastic mass with increased peripheral inhibition and poor central inhibition, possibly due to central necrosis. The tumor was unsharply demarcated from the surrounding parenchyma and pelvic system . Regional lymphadenopathy was present, but there were no signs of propagation in the main renal vein or perinephric fat tissue, and there were no signs of liver or bone metastasis. Chest CT showed no signs of lungs metastasis or mediastinal lymphadenopathy. In order to determine the final histopathological diagnosis, histopathological and immunohistochemical analyses were performed, complemented by reverse transcryptase-polymerase change reaction (RT-PCR). Gross examination of the slitted specimen showed a sharply circumscribed tumor measuring 9 × 6 × 6 cm and replacing a large part of the kidney. The renal tumor displayed infiltrated parenchyma but no expansion into the pelvic system and ureter or signs of spreading into the main renal vein. Gross appearance of the tumor was white-yellow with large necrotic areas. The microscopic analysis of perinephric fat tissue, regional lymph nodes, and the left adrenal gland revealed no signs of metastasis. Microscopic analysis showed that the tumor was composed of solid nests and stripes of tumor cells with small oval and round nuclei, and some of the nuclei contained small nucleoli . The tumor cell cytoplasm was scanty and pink with coarser appearance of chromatin. Mitotic figures were also found. Immunohistochemical analysis included MIC2 gene product/CD 99 , neuron-specific enolase (NSE) , CD3, CD 20, chromogranin, synaptophysin, vimentin, and neurofilament. Immunohistochemical staining revealed positive expression of CD99 and NSE in all tumor cells. The tumor cells did not stain with CD3, CD 20, chromogranin, synaptophysin, vimentin, or neurofilament. RT-PCR analysis for EWS-FLI1 fusion proteins was positive for type II 191 pb and negative for type I 125 pb. Diagnosis of rPNET set on the basis of characteristic morphological characteristics and results of immunohistochemical analysis was confirmed by RT-PCR. After nephrectomy, the patient received 14 cycles of a VAC/IE regiment adjuvant chemotherapy comprised of vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide. Our patient was disease-free for nine years and eight months. Blood and urine laboratory test values were in the normal range.
+The study was approved by the institutional ethical committee and conducted according to the principles of the declaration of Helsinki of the world medical association. The authors declare that they have no conflicts of interest. The authors did not receive any grants for writing this article.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_532_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_532_en.txt
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index 0000000000000000000000000000000000000000..fd0328632d1e31152da9a0d92c0a54cc11eaefa1
--- /dev/null
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+Our patient is a 48-year-old female who has a history of localized early stage right renal cell carcinoma and had undergone an open right radical nephrectomy in 2002 via a right flank incision. She is in remission currently.
+During her surveillance, an MRI done in August 2010 detected an incidental lesion in her spleen measuring 3.9 cm. A follow up MRI done 3 months later showed the lesion to have increased in size to 4.5 cm. Interventional radiology performed a CT guided biopsy and the pathology showed it to be a possible spindle cell tumor or an inflammatory myofibroblastic tumor. A PET CT done showed low level activity in the splenic lesion. She denied any other local or constitutional symptoms.
+She had previously undergone a left oophorectomy and salphingectomy for an ectopic pregnancy, both via a Pfannenstiel incision. She has 3 children, all vaginal delivery.
+Due to her menorrhagia for the past couple of months, an ultrasound of her pelvis was done which showed large uterine fibroids. She was scheduled for a laparoscopic hysterectomy in 3 weeks.
+Physical examination was unremarkable except for her previous Pfannenstiel and right flank incisions.
+Due to the indeterminate nature of her splenic lesion with concerns for malignancy, patient was agreeable to undergoing a splenectomy. Discussion with her gynecologist then yielded the possibility doing both surgeries on the same day, possibly doing the laparoscopic splenectomy first, then the laparoscopic hysterectomy. After a careful review of the literature, we also pursued the idea of transvaginally extracting the spleen after the hysterectomy was performed. Pneumococcal and Hib vaccines were given 2 weeks prior to surgery.
+She underwent surgery in February 2011. Pre-operatively, the left ureter was stented to protect the left ureter in view of her single remaining kidney. The laparoscopic splenectomy was conducted with the patient in the supine position. One 12 mm port and 3 other 5 mm ports were placed in a diamond configuration in the left upper quadrant.
+The splenectomy was performed with standard laparoscopic dissection techniques. Hem-O-Lok clips (Weck Closure Systems, Research Triangle Park, NC) were applied to the splenic vessels. No complications were encountered.
+The remaining attachments were taken down and the spleen was passed into a 15 mm Endo Catch bag (Covidien, Dublin, Ireland). The splenic hilum was hemostatic and the bag containing the spleen was parked above the liver. The case was then turned over to the gynecologist for the hysterectomy.
+The vagina was cleansed and a Rumi II (Cooper Surgical Inc®, Trumbull, CT) uterine manipulator was introduced. The left lateral umbilical, sub-xiphoid and left anterior axillary line ports were reused for placement of the robotic instrument trocars. Laparoscopic transvaginal hysterectomy was performed in the standard fashion with no complications. The right adnexae were conserved. The colpotomy incision was extended till complete and the uterus was flipped forwards and amputated. The uterus was then removed via an Endo Catch bag placed through the vagina and a septal bulb on a sponge stick was placed to tent up the vaginal cuff to maintain pneumoperitoneum .
+Total operative time was 245 min and estimated blood loss was 50 mls.
+Patient had an uneventful post-operative course and was discharged home on post-operative day 2.
+Pathology showed a benign fibrous lesion in the spleen measuring 4.7 cm × 4.0 cm × 3.1 cm and this was called to represent either a sclerotic splenic hamartoma or a burned out inflammatory pseudotumor. The spleen weighed 175gms and measured 10.5 cm × 7.8 cm × 5.1 cm. The uterus weighed 210 gm with multifocal adenomyosis as well as intramural leiomyoma.
+Her first post-operative clinic visit was in March and she was doing well, back to her regular physical activities. Abdominal incisions were well healed. She resumed sexual activity at 6 weeks post procedure and noted no dyspareunia or any abnormal change in sensation. She was seen in June where she noted an episode of post-coital bleeding. Physical exam revealed some raw granulation tissue at the colpotomy incision site which was managed with topical creams and postponement of sexual activity for 2 weeks. Since then, no recurrence of her vaginal bleeding was noted after resumption of coitus. To date, she remains well with no symptoms related to her surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_543_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_543_en.txt
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index 0000000000000000000000000000000000000000..5da290afe0e268227425a921acb75e781c6bf3e9
--- /dev/null
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+A 74-year-old woman experienced parotid gland enlargement and swelling of the eyelid margins on the left side. Following a biopsy, the patient was diagnosed with IgG4-related Mikulicz’s disease. Her symptoms improved spontaneously. Three years later, she presented with swelling of the eyelid margins on both sides accompanied by a visual disorder. The patient was referred to the departments of ophthalmology, rheumatology and, connective tissue disorders. CT which revealed extensive abnormalities in the trachea and both bronchi, was subsequently referred to our department.
+The patient’s vital signs were as follows: body temperature, 36.8 ℃; heart rate, 66 beats/min; blood pressure, 163/73 mmHg; and SpO2, 97% (on room air). Breath sounds were within the normal range. Routine blood investigation results were normal. Immunological examination results revealed the following: IgG, 3028 mg/dL (normal range: 861–1747); IgG4, 1994 mg/dL (normal range: 11–121); IgA, 220 mg/dL (normal range: 93–393); IgM, 39 mg/dL (normal range: 50–269); and IgE, 2143 IU/mL (normal range: 28–138). The angiotensin-converting enzyme level was 12.8 U/L, and IL-2R was 960 U/mL. Chest CT revealed extensive multiple nodules and mucosal oedema of the trachea and both bronchi; however, no ground-glass nodules or lung masses were observed (shown in Figs. and ). Pulmonary function tests revealed that the vital capacity (VC) was 2.02 L/min, %VC was 90.6%, forced expiratory volume in one second (FEV1) was 1.25 L, and FEV1% was 67.57%, peak expiratory flow volumes (PEF) was 2.13 L/s, suggesting an obstructive disorder. On flexible bronchoscopy under sedation, extensive lesions were observed from the middle of the trachea to the carina and further on both segmental bronchi. The nodules were continuous with the normal respiratory tract mucosa, and the surfaces were smooth with little neovascularisation. It was difficult to pass an Olympus BF-1TQ290 through the left carina 1 and the right carina 2 (shown in Fig. ) because of the severe mucosal oedema. We tried to perform a biopsy using standard forceps, but the lesion was too solid to obtain an adequate amount of specimen . Subsequently, we used a 1.9 mm cryoprobe (ERBE; Medizintechnik, Tübingen, Germany) under intubation. Minimal bleeding was observed during the procedure. Following cryobiopsy , hematoxylin and eosin staining revealed a dense, non-monotonous lymphoplasmacytic infiltrate with focal interstitial fibrosis in the tracheal mucosa (shown in Fig. c). Immunostaining for IgG4 and IgG revealed abundant IgG4 + plasma cells, with > 40 IgG4 + plasma cells per high power field and an IgG4/IgG ratio of > 40% (shown in Fig. d, e); thus, these findings satisfied the diagnostic criteria for IgG4-RD. No malignant cells or areas were positive on Congo red staining. Consequently, the patient was diagnosed with IgG4-RLD. Treatment commenced with oral prednisolone at 30 mg/day (0.5 mg/kg/day). Subsequently, the symptoms of bilateral swelling of the lid margin and visual disorder rapidly improved. We continued prednisone at 30 mg/day for 4 weeks and then tapered it by 2.5-5 mg every 2–4 weeks [, ]. The symptoms did not relapse. The radiological findings on chest CT after 6 months of treatment are shown in Fig. . Bronchoscopy revealed only a few nodules (shown in Fig. ). The pulmonary function test results also improved as follows: VC, 2.43 L; %VC, 110.0%; FEV1, 1.79 L; FEV1%, 69.38%; and PEF 4.16 L/s.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_54_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_54_en.txt
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index 0000000000000000000000000000000000000000..1b983a3c23d2d10ce0079ddaefb61240178eb44b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_54_en.txt
@@ -0,0 +1,7 @@
+A 60-year-old man was admitted to our hospital with complaints of difficulty in swallowing and left chest pain.
+The patient had a 6-month history of persistent, worsening difficulty in swallowing since December 2023.
+The patient had no significant history.
+Mother of the patient had the history of uterine cancer.
+The patient showed a poor general condition, with Eastern Comprehensive Oncology Group Performance Status (ECOG PS 3).
+Blood tests showed preserved bone marrow, liver, and kidney functions, without coagulation abnormalities. Serum levels of tumor markers (carcinoembryonic antigen, SCC) were not increased.
+Upper gastrointestinal endoscopy showed a submucosal tumor-like protruding lesion, occupying nearly the entire lumen from the mid to lower thoracic esophagus, causing stenosis . Contrast-enhanced computed tomography (CT) showed esophageal tumor invasion into the left atrium, multiple liver and lung metastases, and a left pleural effusion . The biopsy specimen of the esophageal tumor showed spindle cells, positive for the mesenchymal marker vimentin and negative for epithelial markers including AE1/AE3, CAM5.2, p40, and cytokeratin 7, leading to a suspicion of esophageal sarcoma, and the patient was referred to our hospital for treatment. Cardiac ultrasonography showed a tumorous lesion on the posterior side of the left atrium, however, no invasion into the heart or intramyocardial tumor was observed. Chest X-ray and ultrasonography showed a pleural effusion, and thoracentesis was performed to alleviate symptoms and make a diagnosis, draining 1000 mL of slightly turbid, bloody pleural fluid. However, chest X-ray the next day showed re-accumulation of pleural fluid to the same degree as before drainage. Upper gastrointestinal endoscopy allowed passage of a slim scope, and biopsy of the primary lesion was performed. Histopathologically, atypical spindle cells and polymorphic cells, however, no epithelial components, were observed and immunohistological staining was negative for AE1/AE3, CAM5.2, cytokeratin 5/6, and p63, similar to the previous pathological report; thus, an epithelial malignant tumor could not be confirmed. The programmed death-ligand 1 Combined Positive Score (CPS) was ≥ 10. Pleural fluid cytology showed malignant cells, and cell block immunostaining showed similar findings to those of the primary lesion. Cancer stem cell markers including ZEB1 and TWIST were positive in both the primary and metastatic cardiac lesions .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_610_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_610_en.txt
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index 0000000000000000000000000000000000000000..d00fabb485bfc3c6cf20bfa1ab7ea866ae4a4e94
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+A 35-year-old Caucasian female patient was referred to our hospital because of an incidental finding of a large right ventricular mass during sonography of her upper abdominal organs performed for the evaluation of transient and moderate abdominal pain. Our patient did not have any specific cardiac symptoms like chest pain, dizziness, nausea, palpitations, syncope, or signs of congestive heart failure. Cardiovascular risk factors involved current smoking and obesity (body mass index 32.8 kg/m2). Her medical history included bronchial asthma, previous gestational diabetes, and minor depression. She was taking beclometasondipropionat, fluticason-17-propionat and formoterol-fumarate-dihydrate for the bronchial asthma, and fluoxetine for the depression. A cardiac murmur was not detected during a routine physical examination. Laboratory parameters were unremarkable, with no elevation in her levels of high-sensitive cardiac troponin T (7 pg/ml, reference <14 pg/ml), n-terminal pro-brain natriuretic peptide (75 ng/l, reference <125 ng/l), or C-reactive protein (4.5 mg/l, reference <5 mg/l). A 12-lead electrocardiogram showed T-wave inversion in the inferior and precordial leads . Holter monitoring showed a normofrequent sinus rhythm without any supraventricular or ventricular ectopic beat. An exercise test revealed a good exercise capacity without chest pain, shortness of breath, or any other symptoms upon reaching a maximal heart rate of 163 beats per minute (93 % of the target heart rate). Her blood pressure and heart rate profile during exercise testing were normal and no ectopic beats were detected. Transthoracic echocardiography revealed a large homogenous mass in her slightly dilated right ventricle, suggesting the involvement of her intraventricular septum and left ventricular apex. Her cardiac valves were normal without stenosis or regurgitation, and the size and function of her left ventricle were normal. A small, not significant pericardial effusion was also detected . Our patient then underwent cardiovascular magnetic resonance (CMR) imaging, which revealed a 104 × 62 mm right ventricular mass infiltrating her intraventricular septum and left ventricular apex. T1-weighted images showed isointensity and T2-weighted images showed clear hyperintensity of the relatively homogenous tumor . Late gadolinium enhancement depicted the dimensions of the tumor . Online supplemental video files show good systolic left ventricular function, slightly reduced right ventricular longitudinal function, and an intensive perfusion of the tumor (Additional files , and ).
+A transvenous right ventricular biopsy was performed to gain tissue material for histological analysis; however, the obtained material was insufficient for a definitive diagnosis. Our patient was then referred for an open myocardial biopsy via a partial inferior sternotomy . Previously, a coronary angiography was performed to identify the feeding arteries of the large tumor. Coronary angiography revealed ectatic coronary arteries without any stenosis. A biventricular tumor was visualized on angiography with connection to both her right coronary artery and her left circumflex artery, showing a characteristic tumor blush . Histopathological analysis led to the diagnosis of a benign vascular tumor. Examination of the tumor revealed numerous capillaries, arterioles, and venules embedded in a collagen-rich matrix . Some vital heart muscle cells within the tumor mass could also be observed . Cells showed strong positive staining with antibodies against CD31 and CD34, which supported the vascular origin of this tumor . Histological findings were consistent with a benign intracardiac angioma. The first imaging follow-up was performed 2 weeks later by CMR, and showed an unchanged result. Because our patient was asymptomatic without signs of heart failure or arrhythmia, and the large tumor proved to be surgically unresectable, we decided on conservative management with regular clinical and imaging controls. Nine months later our patient presented to our department for her regular follow-up appointment without any major complications. Echocardiography showed no significant progress of the tumor.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_619_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_619_en.txt
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index 0000000000000000000000000000000000000000..490ce81894fe643a6a36d0152ac79117fa14e216
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_619_en.txt
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+A 27-year-old, Caucasian female with a past medical history of tachycardia and ethanol dependence presented to the emergency department (ED) for possible psychosis in the setting of ethanol withdrawal. Two days previously, the patient was admitted to an outside hospital for management of ethanol withdrawal and was treated with intravenous fluids but not BNZs. She removed her IV and left the hospital before being formally discharged, but the family brought her to our hospital with a report of paranoia and believing people outside her home were trying to kill her. Her last known ethanol consumption was 4 days prior, and alcohol, BNZs, and barbiturates were not detected in her serum or urine. She reported at least five “heavy pours” of vodka every day, and had consumed this amount for a few years. Examination was significant for tachycardia (127–132 beats per minute), high blood pressure (ranging from 143 to 149/102 to 103 mmHg), and mild tenderness to palpation to bilateral upper abdominal quadrants. She was calm, fully oriented, and with organized thought process, but endorsed paranoia regarding family members being out to get her and hearing voices outside her head talking about her. A medical workup for delirium revealed normal complete blood count, a comprehensive metabolic panel with mildly elevated transaminases [aspartate aminotransferase (AST) 94 U/L; alanine transaminase (ALT) 72 U/L], and a noncontrast computed tomogram of the brain with mild diffuse volume loss greater than expected for her age. These abnormalities were consistent with her drinking history and not indicative of a separate process. No substances were present in urine or serum toxicology. She was negative for coronavirus (COVID), human immunodeficiency virus (HIV), and hepatitis panel. She expressed interest in achieving sobriety from ethanol. She was first given lorazepam 2 mg orally and started on chlordiazepoxide 25 mg twice daily because her pulse and blood pressure remained elevated. Within 2 hours of every chlordiazepoxide dose, she became acutely confused and agitated, reporting visual and auditory hallucinations and stating that there were people on the other side of the door who were coming after her. After two doses of chlordiazepoxide (total of 50 mg, which is equivalent to 2 mg lorazepam), it was discontinued and she was treated with 2 mg of intramuscular lorazepam and a subsequent dose of oral lorazepam 2 mg, which were associated with improvement of her agitation. All BNZs were subsequently held. The next day, the patient was calm, coherent, with organized thought, and no hallucinations or paranoia. She remained that way over an extended observation period of over 10 hours. She was then referred to a substance treatment program where she did not exhibit any psychosis, and did not require additional BNZ medication.
+Our institutional human subjects protection program allowed submission of this case presentation (IRB number 22.1081). Additionally, written informed consent was obtained from the patient for publication of this case report.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_645_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_645_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f968b3795fb51a660797ae70527e36e013da6ba1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_645_en.txt
@@ -0,0 +1,2 @@
+A 54-year-old female with dyslipidemia presented with acute right hemianesthesia with headache in the left temporal area. The physical examination revealed impaired sensation of the left side of the face (ophthalmic branch of the trigeminal nerve). The patient was sent for an magnetic resonance imaging (MRI) scan of the brain (May 26, 2022). The brain MRI showed a small outpouching lesion arising from the medial wall of the proximal A2 of the left ACA, pointing in the superomedial direction and measuring about 2 mm in neck width and height, and presenting as a suspected saccular aneurysm . One month later, the patient underwent cerebral angiography for evaluation of the suspected cerebral aneurysm enabling planning for further management.
+A four vessels cerebral angiogram was performed on July 6, 2022 and revealed a funnel-shaped dilatation of the anterior communicating artery with a single perforating branch arising from a dome sized 1.4 × 1.1 mm. The images from the three-dimension angiography are shown in . The findings were compatible with infundibular perforating branch of an anterior communicating artery. Follow-up of the neurological symptoms at the outpatient department was planned.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_64_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_64_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..efd802fb2df4014f4e81b3f916cd38cd29edc741
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_64_en.txt
@@ -0,0 +1 @@
+A 68-year-old man was admitted to our department with chief complaint of a scrotal mass, which had enlarged gradually over a 6 month duration. Physical examination revealed a round, nontender mass, approximate to the size of a tennis ball, occupying the whole left scrotum . Scrotal USG showed a heterogenous lesion in the left hemiscrotum arising from layer of tunica albuginea. The level of serum tumor markers, including alpha-fetoprotein, human chorionic gonadotropin and lactic acid dehydrogenase, were within the normal range. CT scans of the chest, abdomen did not reveal any lymphadenopathy or mass lesion. There was no evidence of lymph node enlargement or ascites. The patient underwent a high inguinal orchidectomy which was further send for HPE examination (, , ).
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_650_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_650_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4b4888072542dee22f745f7567c2e137c9178a16
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_650_en.txt
@@ -0,0 +1,6 @@
+A 56-year-old woman reported to our orthopedic hospital with a complaint of severe pain in the left hip and inability to stand or walk. The family reported that the patient had a fall on the same day. Routine investigation revealed a fracture in the neck region of the left femur. There was no history of any comorbid condition. The patient was taken up for a surgical intervention following standard of care compression fixation. The patient’s condition on day 3 post-surgery was satisfactory and the patient was discharged, with recommendation for regular follow-up.
+After about 8-month post-discharge, the patient visited our unit complaining of recurring severe pain in the left hip. Radiological investigation revealed a non-union of the previous fracture.
+Treatment using a novel bone cell therapy product (OSSGROW®) that is available in the India was considered given the age and lifestyle of the patient. The patient and her family were counseled about the cell therapy option and an appropriate consent was taken.
+Osteoblast cell therapy is a two-step process. The first step involves bone marrow harvest and the second step involves implantation of the ex vivo cultured autologous osteoblast cells from the bone marrow. First, an adequate quantity (4–5 ml) of bone marrow from the patient’s iliac crest was aspirated and collected in transport media containing an anticoagulant. The collection kit was transported under temperature-monitored conditions and the collected bone marrow was processed at the GMP-certified cell processing facility (Regrow Biosciences Pvt. Ltd.). Mesenchymal progenitor cells were isolated from the bone marrow of the patient. These progenitor cells were differentiated into bone forming cells or osteoblasts . Immunophenotypic characterization was done to ensure that the cultured cells test positive for osteoblast biomarkers. Osteoblasts were expanded for approximately 4 weeks under stringent laboratory conditions and multiplied to more than 50 million osteoblasts. The personalized autologous osteoblast product OSSGROW® was made available by the 5th week and the cell implantation was planned. In a short surgery, a small incision was made on the lateral cortex of femur shaft to expose the non-union region and the cultured osteoblast cells mixed with a gel (Tisseel kit from Baxter) was injected into the region of non-union.
+The patient was advised a rehabilitation protocol to be followed for about 6 weeks. With initial 48 h of immobilization, the patient started with non-weight-bearing exercises; with gradual partial weight-bearing followed by full weight-bearing exercises.
+At week 10 post-OSSGROW® treatment, radiological evaluation of the patient showed completely united femoral neck. shows radiological evidence of non-union of the fracture in the left hip and shows post-operative at 10 weeks with united bone at the femoral neck. The patient had no pain and other symptoms. At 10 months post-implantation, the patient can perform all routine chores, walks without support, and is experiencing very good quality of life.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_670_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_670_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ab14813d419d710f9455cb6f038f209c28ec5f24
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_670_en.txt
@@ -0,0 +1,7 @@
+A 79-year-old Japanese woman visited our hospital because of lower abdominal discomfort. She was endoscopically diagnosed with type 0–IIa + IIc cancer of the cecum, and biopsy of the lesion showed signet-ring cell carcinoma. Abdominal computed tomography showed no serous involvement, peritoneal dissemination, abdominal lymph node metastasis, or distant metastasis from the colon cancer. Based on all these findings, we determined that the preoperative clinical staging of the cancer was cStage I (cT2, cN0, cM0).
+The patient underwent laparoscopic ileocecal resection with D3 lymphadenectomy . No residual tumors were macroscopically found in the radial margin during the surgery. Histopathological examination of the resected specimens showed signet-ring cell carcinoma [type 4, pT4a, pN3 (No. 203), M0, pRM1, stage IIIc, R1] with severe lymphatic involvement, many lymph node metastases, and radial margin positivity. We suggested resection of the residual tumor to the patient, but she refused it.
+KRAS mutation test of the colon cancer revealed that the patient had wild-type KRAS. This result indicated that she was a candidate for anti-epidermal growth factor receptor (EGFR) therapy. However, she refused the therapy because of its potential adverse effects, such as acne-like rash. She also refused vascular endothelial growth factor (VEGF) inhibitors. She chose and began to receive oral chemotherapy using tegafur and uracil.
+One year after surgery, the patient lost her appetite, and the blood carcinoembryonic antigen concentration elevated to 23.8 ng/mL. Colonoscopy revealed anastomotic recurrence, and biopsy of the lesion showed signet-ring cell carcinoma. Conventional upper gastrointestinal endoscopy with white light showed multiple longitudinal submucosal tumors with erosions on their surfaces in the middle to lower esophagus . Narrow-band imaging endoscopy of the esophagus showed that the elevated margins of the tumors were covered with non-neoplastic epithelia .
+Biopsy of the esophageal tumors histologically showed that they were located predominantly in the submucosal layer, were continuous with the esophageal epithelium, and contained signet-ring cell carcinoma . The histological type of the esophageal tumors was the same as that of the resected ileocecal specimens. Based on all these findings, we diagnosed the esophageal tumors with metastatic esophageal cancer originating from signet-ring cell carcinoma of the cecum.
+Immunohistochemical examination showed that both the primary cancer and its metastatic lesions were negative for cytokeratin (CK) 7 and were positive for CK20 and caudal-type homeobox (CDX) 2 . These results correspond to the staining pattern of colorectal signet-ring cell carcinoma. Therefore, we diagnosed the patient’s condition with anastomotic recurrence and metastatic esophageal cancer after the resection of colon signet-ring cell carcinoma.
+The patient did not respond to 1-year oral chemotherapy using tegafur and uracil, resulting in anastomotic recurrence and esophageal metastasis of colon cancer. She hoped to receive a VEGF inhibitor, and her chemotherapy regimen was replaced with FOLFOX plus bevacizumab (FOLFOX/BV). Subsequently, she broke her femoral neck in a fall, and underwent bipolar hip hemiarthroplasty. She started physical therapy, but her performance status declined. After 2 cycles of FOLFOX/BV therapy was finished, her chemotherapy was discontinued. Two months later (i.e., 1 year and 5 months after ileocecal resection), she died of cancer progression.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_713_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_713_en.txt
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index 0000000000000000000000000000000000000000..72c0388e60470e820909f0761ecfe9ebef6d2ca2
--- /dev/null
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+A 71-year-old woman visited our hospital with a complaint of left ophthalmalgia, left ptosis, and diplopia. Around six weeks before the first admission, she suddenly noticed left ophthalmalgia. A few days later, she noticed diplopia in all directions when she drove a car. Left ophthalmalgia had been gradually waned, but she noticed left ptosis . She had a history of chronic sinusitis, and a nasal voice had been persisted for several years. Alteration in visual field was not presented. On the first visit, neurological findings revealed left oculomotor, trochlear and abducent nerve palsies. Her pupils were round, not anisocoric, and prompt consensual and direct light reflexes. Pupillary reflexes were bilaterally normal. Basal laboratory test suggested the central hypothyroidism (TSH 1.37 μIU/ml (reference range, 0.61–4.23 μIU/ml), Free T3 (FT3) 1.10 pg/ml (reference range, 2.52–4.06 pg/ml), Free T4 (FT4) 0.33 ng/dl (reference range, 0.75–1.45 ng/dl). Two weeks later, she was admitted to our hospital. In the physical examination, her body mass index was 21.2 kg/m2 and blood pressure was 121/62 mmHg. Neither swelling nor of lymph node pain was founded. Slight left ptosis and diplopia (horizontal) remained, but the symptoms were improved compared with those at the first visit. The nasal voices persisted, but no other definite abnormalities were detected in physiological or neurological examination.
+Initial laboratory test results were within the normal range of ACE, sIL-2R and IgG4, suggesting no obvious evidence of infiltrative disease such as sarcoidosis, lymphoma or IgG4-related disease . Biochemistry results were otherwise unremarkable, as shown in Table . Basal endocrine test showed a decrease in FT3, FT4, and LH . Low levels of FT3 and FT4 with anti-Tg antibody positivity suggested the presence of Hashimoto's disease. However, sustained TSH level for low FT3 and FT4 levels suggested the co-presence of central hypothyroidism. To investigate the pituitary function further, CRH (100 μg) /TRH (200 μg) /GnRH (100 μg) and GHRP-2 (100 μg) load tests were performed . ACTH and cortisol showed normal reactions after CRH load. TSH had a peak value of more than 6 μIU/ml, but a delayed response to the peak value after TRH load, suggesting central hypothyroidism. Both LH and FSH had a delayed response to the peak value after GnRH load, suggesting central hypogonadism. GHRP-2 load test revealed a low peak value of GH (less than 9 ng/ml), suggesting severe adult GH deficiency. Together, pituitary endocrine test revealed partial hypopituitarism. Oral administration of 25 μg levothyroxine per day was initiated.
+Initial magnetic resonance imaging (MRI) of the hypothalamus and pituitary gland indicated a heterogeneous enhancement of supra-sellar regions with a mass on the left sphenoid sinus wall and involvement of the left cavernous sinus . The pituitary gland was homogeneously enhanced, and slightly compressed by the infiltrated mass from the sphenoidal sinus. The stalk was median and not enlarged . Hyperintensity of posterior pituitary on T1 weighted intensity was preserved . Purulent reservoir and polyp-like mass were detected in the left sphenoidal and frontal sinuses. CT also showed the purulent reservoir in left sphenoidal and frontal sinuses, as shown in MRI. Furthermore, the osteolytic lesion of the sphenoid bone was observed as shown in Fig. E. These images suggested the presence of the infiltrative neoplastic lesion. However, because all the symptoms related to cranial nerve palsies were gradually waned, biopsy of the mass at the sphenoidal sinus was not performed based on the discussion with the patient with specialists of the otorhinolaryngology and neurosurgery. At around four weeks after the first admission, most of the symptoms had disappeared, except very slight left ptosis .
+Around seven weeks later, she noticed the worsening of the left ptosis and had high fever, cervical lymph node (CLN) swellings, and night sweats. She was secondary admitted to our hospital . Laboratory tests revealed elevated serum sIL-2R (781 U/ml, reference range, 122–496 U/ml) and LDH (467 U/l, reference range, 124–222 U/l) levels. Since hematological or otorhinolaryngological disease was strongly suspected, CLN biopsy was performed. Immunohistological examination of CLN revealed the presence of CD20, BCL-6, focal CD5 positive but CD23 and cyclin D negative B-cells. Cell proliferation index Ki-67 was about 90%. Based on the pathophysiological findings, she was diagnosed as having DLBCL. In cerebrospinal fluid analyses, cytology examination revealed no evidence of malignant cells. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) revealed elevated uptake in systemic lymph nodes, including the left sphenoidal and cervical lesions, which corresponded with the osteolytic lesion of the sphenoid bone and CLN swelling lesions, respectively, but not in the pituitary gland. After diagnosis of DLBCL, she was treated with cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and dexamethasone plus rituximab (R-CHOP) for six courses in total. After initiation of chemotherapy, there was improvement of all the symptoms associated with systemic lymphoma except hypopituitarism. Elevated serum sIL-2R and LDH levels were decreased to within the normal range .
+Ten months after the initiation of chemotherapy, endocrine function test was re-examined and revealed sustained severe GH deficiency and central hypogonadism, but improvement of central hypothyroidism. After cessation of levothyroxine, her thyroid function remained within normal range (TSH 3.19 μIU/ml (reference range, 0.61–4.23 μIU/ml), free T4 0.98 ng/dl (reference range, 0.75–1.45 ng/dl)). MRI showed intact pituitary and nasopharyngeal site. PET/CT showed almost complete remission of elevated uptake at the left sphenoidal lesion . One year after the treatment, there has been no recurrence of DLBCL nor cranial nerve palsies.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_725_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_725_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d1cf231eb95c67f6171d9b5999379f2fff9661ef
--- /dev/null
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@@ -0,0 +1,3 @@
+A 44-year-old healthy Japanese female experienced pain in her left eye when she was relaxed and watching television. She massaged her eyes with strong pressure several times with her fingers. Subsequently, she noticed a sudden loss in the left central vision. The next day, she visited our hospital. When questioned, she could not remember having done anything that might induce Valsalva retinopathy.
+Upon examination, her left eye had a best-corrected visual acuity of 0.01, intraocular pressure (IOP) was 17 mm Hg, and the cornea and lens were clear. A left fundus examination showed a dense preretinal hemorrhage at the posterior pole . The preretinal hemorrhage appeared to be located under the internal limiting membrane (ILM) due to the reflection of the surface of the preretinal hemorrhage, and this was confirmed by optical coherence tomography . A mild vitreous hemorrhage was also observed. Fluorescein and indocyanine green angiography showed no retinal vascular abnormality, although the posterior pole was veiled by the preretinal hemorrhage . In her right eye, no abnormality was found. The blood examination including complete blood counts and clotting parameters were within normal limits.
+During her first visit to our hospital, we could not perform a neodymium-doped yttrium-aluminium-garnet laser membranotomy to perforate the ILM due to interference by the vitreous hemorrhage. Five days after the first visit, the vitreous hemorrhage had decreased and we successfully performed the neodymium-doped yttrium-aluminium-garnet laser membranotomy (power setting, 5.4 mJ) using Goldmann's three-mirror contact lens. The preretinal hemorrhage immediately moved to the vitreous cavity through the open hole in the ILM. Two days after the treatment, the best-corrected visual acuity improved to 1.0, but a small amount of the vitreous hemorrhage and residual preretinal hemorrhage were observed at the posterior pole . The optical coherence tomography image showed remaining ILM elevation . One month after the treatment, we performed another fluorescein and indocyanine green angiography, and it demonstrated no retinal vascular abnormalities in the macular area .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_735_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_735_en.txt
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index 0000000000000000000000000000000000000000..1a0ee829651b7f64a1d88079a81437fe23831bea
--- /dev/null
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+A 25-year-old Asian man presented to our department 2 days after a penile trauma with perineal pain and erectile dysfunction. The patient was injured during rolling over in bed and heard a “snap” sound just before pain. Physical examination showed swelling of the perineum with subcutaneous bleeding and tenderness. However, the appearance of the penis was normal. His laboratory data were within the normal limits, and hematuria was not detected on urinalysis. Ultrasonography revealed a hematoma in the perineum without any testicular injury. MRI showed a subcutaneous perineal hematoma and a 6-mm tear to the ventral tunica albuginea of the left crus penis near the bulbospongiosus muscle . He was diagnosed with PF associated with a penile crus injury. Six days after injury, repair of the tear at the left penile crus was performed. The transperineal approach was selected because the injured area was near the bulbospongiosus muscle. Subcutaneous bleeding expanded into his hip. However, a penis deformity was not found . Just before surgery, we were able to insert a 14-Fr Foley’s catheter smoothly through his urethra and no urethral injury was observed. We made a 4-cm incision in his perineum and identified the bulbospongiosus muscle after removing the hematoma. After dissecting the bulbospongiosus muscle, the corpus spongiosum of the penis was pulled to the right side using an 8-Fr flexible catheter. The trauma site of the left crus penis was revealed and repaired by interrupted sutures using 3-0 absorbable sutures . The day after surgery, Foley’s catheter was removed without complications. The patient had a good recovery and was discharged 6 days after surgery without postoperative complications. At the follow-up period of approximately 50 days, he did not face perineal pain, dysuria, or erectile dysfunction.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_746_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_746_en.txt
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index 0000000000000000000000000000000000000000..c4c0b5708eb750f51b92423bc60be1e2f3399a11
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+A 26-year-old male presented with severe dyspnea, palpitation, orthopnea, and paroxysmal nocturnal dyspnea. He had hypertension, medical history of ischemic stroke 5 months ago, and repeated hospitalization caused by congestive heart failure. His blood pressure in the right arm was 180/64 mmHg. The heart rate was irregular with 150 beats/min. The jugular venous pulse was elevated to 9 cm of water. There was murmur systolic on intercostal space (ICS) 5 anterior axilla line (AAL) sinistra and murmur diastolic on ICS 2 parasternal line (PSL) dextra. Respiratory rate of 28 breaths/min, oxygen saturation at the right arm was 92% without supplemental oxygen, and body mass index of 19,5 kg/m2.
+An electrocardiogram showed atrial fibrillation (AF) with a rapid ventricular response. A routine laboratory examination did not show any abnormality. Chest X-ray showed cardiomegaly with calcification aortic arch and pulmonary edema. Echocardiography found that left ventricular ejection fraction (LVEF) was decreased (48,5%) with left atrial and ventricular dilatation. Echocardiography also found severe aortic and mitral valve regurgitation . He was diagnosed with congestive heart failure with mildly reduced ejection fraction (HFmrEF) and classified in New York Heart Association (NYHA) class IV.
+After one day of hospitalization, the patient also complained of intermittent claudication in the left arm. Clinical examination found an absence of the left brachial pulse and the left carotid artery bruit. Four limbs blood pressure discrepancy was present (right arm 163/50 mmHg, left arm 96/55 mmHg, right leg 90/60 mmHg, left leg 95/55 mmHg). Computed tomography angiography (CTA) showed calcification in the left common carotid artery leading to stenosis and total occlusion of the left subclavian artery with the collateral artery branch from the left common carotid artery that supplies vascularization of the left arm. There was vascular thickness and calcification from the peri-aortic valve, ascending aorta, aortic arch, and thoracic descending aorta until abdominal aorta with high-grade stenosis on the inferior side of the renal artery branching accompanied by a post-stenotic dilatation . Inflammatory markers evaluation that needed notable are elevation C-reactive protein (CRP) level (45,1 mg/L) and erythrocyte sedimentation rate (ESR) level (25 mm/h). Other laboratory evaluations were antinuclear antibody (ANA) titer, antistreptolysin O (ASO) titer, and interferon-gamma release assay (IGRA) showed negative results. He has subsequently diagnosed with Takayasu arteritis according to the American College of Rheumatology criteria.
+For treatment of hypertension and HFmrEF, beta-blocker bisoprolol 2,5 mg/day, angiotensin-converting enzyme inhibitor (ACE-I) ramipril 5 mg/day, and mineralocorticoid receptor antagonists (MRA) spironolactone 25 mg/day therapy were initiated. Loop diuretic furosemide 40 mg/day is given to treat congestive symptoms of heart failure and glycoside digoxin 0,25 mg/day is given as rate control of atrial fibrillation. Anticoagulant warfarin 2 mg/day was given to prevent thromboembolism. A combination of methotrexate 7,5 mg/week and high-dose methylprednisolone at 48 mg/day with subsequent tapering was given for induction of remission to inhibition vasculitis of TA. After 3 months of high-dose steroid and methotrexate therapy, the patient showed a decrease in symptoms of NYHA class II for heart failure and a decrease in the frequency of rehospitalization. The patient also did not complain of claudication in the left arm. On physical examination, the patient's right arm blood pressure was 146/55 mmHg and the left arm was 105/50 mmHg. Follow-up evaluation of inflammatory markers CRP and ESR showed normal results.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_752_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_752_en.txt
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index 0000000000000000000000000000000000000000..e39b8fc0476a70abd2f02f6f39aa8e49727e65aa
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_752_en.txt
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+The patient is a 65-year-old Chinese woman with a 4-year history of hypertension, and a 14 months history of proteinuria and microscopic hematuria. The patient had been in her baseline renal condition until January 9, 2020. As shown in Table , her baseline estimated glomerular filtration rate (eGFR) in the past year range from 64.2 ml/min/1.73m2 to 72.6 ml/min/1.73m2. Baseline urine sediment examination showed 36.61 cells/μl − 74.43 cells/μl in erythrocyte count and baseline proteinuria excretion was up to 510 mg/day. Three days prior to her admission, she got flu-like symptoms including headache, myalgia and fatigue, which were resolved in 1 to 2 days. However, she developed dark-colored urine and flank pain a day later and presented to the out-patient clinic. Urine sediment investigation showed significant worsening in urine erythrocyte count (2518.03/μL) and she was admitted to the hospital on January 10, 2020. On admission, vital signs were normal with a body temperature of 36.8 °C, blood pressure of 149/104 mmHg, heart rate of 80 beats per minute, and a respiratory rate of 16 breaths per minute. Both lungs were clear to auscultation. The rest of the physical examination was also unremarkable.
+Laboratory results from the time of admission are summarized in Table . She got decreased eGFR (53.6 ml/min/1.73m2) and deteriorated proteinuria (1.07 g/day, of which, albuminuria was 839 mg/day) when compared to her baseline level. Notably, the patient had mild lymphopenia of 0.86*109/L and increased C reaction protein (CRP) level of 19.6 mg/L. Serologic examinations for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) were negative. Anti-nuclear antibody, anti-extractable nuclear antigen antibodies, anti-neutrophil cytoplasm antibodies and anti-glomerular basement membrane antibody were negative. Serum immunoglobulin (Ig) A level was slightly increased at 4.71 g/L (reference range: 0.82 g/L-4.53 g/L), whereas IgG, IgM, complement C3 and C4 levels were within the normal range. An ultrasound and a Computed Tomography (CT) examinations for the urinary system were unremarkable. A chest CT scan revealed scattered ground glass opacity (GGO) .
+On admission day 5, a renal biopsy was performed. A total of 16 glomeruli were identified in the tissue submitted for evaluation, 5 of which were completely sclerosed. One glomerulus showed segmental sclerosis and one showed a fibrocellular crescent . Focal mild mesangial hypercellularity was identified in rare glomeruli. There was no evidence of significant glomerular inflammation or necrosis. The tubular parenchyma showed moderate interstitial fibrosis associated with nonspecific mononuclear cell inflammatory. Intact tubules showed focal acute tubular injurious changes characterized by attenuation of the brush borders and cytoplasmic vacuolization as well as luminal cellular debris . By immunofluorescence microscopy, the glomeruli showed 2+ granular mesangial staining for IgA , C3, kappa and lambda light chains. IgG, IgM and C1q were negative. Electron microscopy (EM) examination revealed mesangial electron dense immune-type deposits. There was no evidence of definitive viral particles . A diagnosis of IgA nephropathy with an Oxford score of M0E0S1T1C1 was rendered.
+With the diagnosis of IgA nephropathy, she received valsartan, an angiotensin II receptor blocker (ARB), with an initial dosage of 20 mg per day. She experienced dry cough without fever, dyspnea, diarrhea, myalgia or sore throat on admission day 12. Consequently, we repeated a chest CT scan for her out of caution due to COVID-19. The CT images showed a significant interval progression with a viral pneumonia pattern . She had progressive chest imaging, however, she had only mild symptoms and her oxygen saturation maintained between 97 and 99%. Her CRP level increased to 36.6 mg/L. A panel of infectious disease screening was initiated including IgM antibodies against nine respiratory pathogens: influenza virus A, influenza virus B, parainfluenza virus, adenovirus, respiratory syncytial virus, pneumonophagous legionella, Q fever rickettsia, mycoplasma pneumoniae and chlamydia pneumoniae, which were all negative. A throat swab specimen tested positive for SARS-CoV-2 later. The frozen renal tissue from biopsy specimens was submitted for reverse transcription-polymerase chain reaction, however, which was tested negative for SARS-CoV-2. Immunohistochemical (IHC) evaluation for the spike protein (40150-R007, Sino Biological, Beijing, China) of SARS-CoV-2 in the kidney was negative as well . According to the guideline for COVID-19 issued by the National Health Commission of China , she received methylprednisolone (40 mg per day for 3 days) to alleviate her pulmonary inflammation and empirical anti-virus medication (oseltamivir at 75 mg, twice a day for 5 days).
+On admission day 17, a follow-up chest CT scan showed a significant improvement . Laboratory investigations showed stable renal function , restored lymphocyte count (1.05*109/L) and decreased CRP level (4.6 mg/L). A repeated throat swab specimen tested negative for SARS-CoV-2. The patient was discharged.
+Three months later, the patient remains asymptomatic clinically. A follow-up investigation revealed positive IgG and the IgM antibody against SARS-CoV-2. Her eGFR and UACR were 74.69 ml/min/1.73m2 and 33.61 mg/g respectively; her urine erythrocyte was 28.3 cells/μl (her baseline level). The valsartan dosage was titrated to 40 mg OD for optimizing her blood pressure control.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_772_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_772_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dbdc775493405747e4016f5fba1ecbc4e6f339ec
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_772_en.txt
@@ -0,0 +1 @@
+A 58-year-old man, who had hypertension, hyperlipidemia and the past history of cerebral infarction and had past smoking and drinking history, visited his nearby hospital, complaining of hematemesis and tarry stools. As a family history, his mother had treated for colon cancer. Endoscopic examination showed a hemorrhagic esophageal tumor. Additionally, a contrast computed tomography (CT) scan showed a large hypervascular tumor of 4.8 cm in diameter in the left kidney. He came to our institution for further examination and treatment of the esophageal and kidney lesions. On blood examination, mild anemia of serum hemoglobin (12.7 mg/dl) was observed. SCC, carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA) were within normal range. Serum human chorionic gonadotropin (hCG) was not measured. Upper gastrointestinal endoscopy showed an easy bleeding elevated tumor of 2 cm in diameter at the left wall of the middle thoracic esophagus . Histopathological diagnosis from biopsied specimens was a poorly differentiated carcinoma. However, a precise diagnosis could not be obtained from the biopsy specimen. Long segment Barrett’s esophagus (LSBE) of about 4 cm in length was observed at the anal side of the tumor . Endoscopic ultrasonography showed a tumor with a combination of isoechoic and low echoic components infiltrating into the submucosal layer . Upper gastrointestinal contrast examination showed an elevated lesion of 2.2 cm in diameter in the middle thoracic esophagus . Contrast-enhanced CT examination showed the tumorous lesion occupying the esophageal lumen of the middle thoracic esophagus . Swollen mediastinal or abdominal lymph nodes and distant metastases were not observed. Additionally, a solid tumor of 4.8 cm in diameter was found in the left kidney medulla with hyperenhancement in the early phase and washout of contrast in the delayed phase . 2-[18F] fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography (PET) examination showed abnormal FDG accumulation in the esophageal tumor. The maximum standardized uptake values (SUVmax) in early and delay phases were 12.7 and 15.7, respectively. There was no suspected metastatic accumulation in the mediastinal or abdominal lymph nodes and other organs. Another abnormal FDG accumulation was observed in the left kidney lesion which was diagnosed as a primary renal cancer by its typical image findings . He was diagnosed with esophageal cancer [MtLt 2.2 cm Type 0-Ip cT1b N0 M0 cStage I] combined with a left renal cancer. His general condition was poor (ECOG-Physical Status 2) because of a left hemi-paralysis caused by cerebral infarction and was given anticoagulating agent. We preferentially performed esophagectomy to control bleeding from esophageal tumor prior to renal cancer treatment. Therefore, mediastinoscopic transhiatal esophagectomy and posterior mediastinal gastric tube reconstruction was performed as a first surgery.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_776_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_776_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4b711c0674ed0ab6c268e6055321e94641196b5b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_776_en.txt
@@ -0,0 +1,8 @@
+A 66-year-old woman, with a WHO performance status of 0, history of chronic smoking, high blood pressure and atrial fibrillation, was diagnosed with a stage IVa locally advanced laryngeal squamous-cell carcinoma (cT3N2M0). She had neither history of headache nor previous allergic drug reactions. She received neoadjuvant chemotherapy by docetaxel, cisplatin and fluorouracil, with a marked tumor regression following three courses. She was then offered definitive external beam radiotherapy with concurrent weekly cetuximab. On her first cycle, she received routine premedication with dexchlorpheniramine 5 mg I.V. followed by a loading dose of 400 mg/m2 cetuximab I.V. over 2 h (5 mg/min) without developing any infusion reaction. Her usual medicines were rilmenidine, pantoprazole, fenofibrate, and acetaminophen. However, 4 h after completing cetuximab infusion, she was admitted to hospital with sudden headaches, photophobia, neck stiffness and vomiting without fever.
+Cerebrospinal fluid (CSF) analysis showed a cloudy liquid with elevated protein (1.5 g/L; normal range: 0.2–0.4 g/L), a red blood cell count of 6/μL, and a leukocyte count of 4100/μL (normal range: 0–4/μL), 90 % of them were neutrophils, 9 % were lymphocytes, and 1 % were monocytes. The glucose level in CSF was 3.16 mM (normal range: 2.7–4.2 mM) with a glucose level in blood of 7.3 mM (ratio 0.43). The white blood cell count was 7900/μL with 7000/μL neutrophils, and a C-reactive protein at 5.9 mg/L (normal range <6.0 mg/L). The patient was treated with empiric antibiotic therapy (ceftriaxone I.V.) for 7 days without corticosteroids and recovered neurologically within 8 days. Bacterial cultures remained negative. Viral analysis including a viral encephalitis panel was performed by polymerase chain reaction and remained negative. Repeat CSF analysis was initially planned 8 days after admission to the hospital but the lumbar puncture failed and was not repeated as the patient was well.
+Symptoms resolution was reported by day 2. Radiation therapy was started 3 weeks after for 8 weeks and cetuximab was reintroduced 28 days after with a lower dose of 250 mg/m2. Methylprednisolone 80 mg I.V. was added to dexchlorpheniramine 5 mg I.V. and the infusion flow rate of cetuximab was decreased to 2 mg/min. She tolerated it well and no side effects were reported all along the other additional infusions up to 10 weeks. At a follow-up of 18 months the patient is well with no evidence of tumor recurrence.
+The temporal association, clinical and laboratory findings strongly support the diagnosis of cetuximab-induced aseptic meningitis. As for our patient, most patients with aseptic meningitis are treated with antibiotics, pending identification of infectious agent and recover within 2 weeks, without any long-term neurological sequelae.
+Distinction on clinical grounds alone is not possible, and the CSF pattern with neutrophilic pleocytosis may cause confusion with infectious meningitis. Resolution occurs several days after drug discontinuation. Diagnosis of aseptic meningitis is based on viral and bacterial CSF profiles remaining sterile.
+Nonsteroidal anti-inflammatory drugs, antibiotics, intravenous immunoglobulins, antiepileptic drugs, and monoclonal antibodies (mainly tumor necrosis factor inhibitors) are the most frequent cause of drug-induced meningitis. History of drug intake is crucial because there are no specific characteristics associated with a specific drug .
+In order to try to understand the pathophysiology of aseptic meningitis due to cetuximab, we can draw similarities with aseptic meningitis occurring with I.V. immunoglobulin (IVIG) infusion [–]. The factors, which may predispose to the development of the meningitis, include fast infusion rates and a history of headaches. The symptoms of aseptic meningitis generally occur within 24 h of starting treatment. Theories of aseptic meningitis with IVIG have included an allergic hypersensitivity reaction or serum immunoglobulin crossing the blood brain barrier. Hence, this entry of serum immunoglobulin into the cerebrospinal fluid would be responsible for the inflammatory reaction. It has also been suggested that releasing histamine, serotonin, and prostaglandins could affect the meningeal microvasculature, such as in migraine mechanism .
+The first occurrence of drug-induced aseptic meningitis related to cetuximab was reported in 2000 by Baselga et al. in a phase I clinical trial . Since then, 7 other cases of cetuximab-induced aseptic meningitis have been described. Cetuximab was reintroduced successfully for three of them with an appropriate premedication and a slower infusion rate, one patient had a positive rechallenge without corticosteroid premedication [, ]. Characteristics of the reported patients from the literature were compiled recently and are now completed with a new one and our present report in Table . Note that these adverse reactions always occurred during the first administration which may suggest a dose-related response, even though an idiosyncratic response in patients with risk factors is also possible. Surprisingly, there are no cases described in colorectal cancer whereas cetuximab is commonly being dosed at 500 mg/m2 (higher dose) every 2 weeks for a larger number of patients.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_786_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_786_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..97a746484ef883bc8729b806a19e13533e94d805
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_786_en.txt
@@ -0,0 +1,5 @@
+Mr. X is a 55-year-old Caucasian male living in a small village in the Inner South of Portugal. He is an only child and lived with his parents his entire life in this village where everyone knows one another. More recently, after his father’s death, he continued living alone with his mother. He graduated from high-school, and afterwards he worked with his parents in a coffee house that they owned. They sold the establishment some years ago, and now he has no employment nor occupation, and sustains himself with the profits of rented properties, having a low socioeconomical status. He spends his days frequenting another coffee house with a very small group of two friends, having no other friends nor social contact.
+Mr. X always had a very close relationship with his mother, describing her as his best friend. He had a troublesome relationship with his father. He describes himself as having very low self-esteem and considers himself an unattractive man. He is very vague when asked about previous relationships, mentioning he never had any lasting or significant previous relationships, and he hesitantly reports his first sexual intercourse at the age of 18. He also states that he has a strong desire of having a wife and children, and fears this will never happen because he feels he has no luck with women.
+When Mr. X was 51 years old, he started believing that a married lady that frequented the same coffee house that he did, Mrs. A, was in love with him. He was certain of this because of the way that she looked at him and by her gestures, sending him signals, and he returned her love. He approached Mrs. A and had very brief interactions with her, and he found in their short innocent conversations further evidence that she was in love with him. He believed that they were deeply in love, that her marriage was doomed and that she would only be truly happy with him. He was very insistent in approaching her, and Mrs. A rejected further interaction. He started sending her text messages and going to the coffee house at the specific times that he knew she would be there to watch her from afar. Then he started stalking her around the village. His infatuation ceased when Mrs. A confronted and physically assaulted him, and so Mr. X. stopped stalking her. He was certain that this relationship didn’t work because another divorced lady, the owner of the coffee house he spent his days in, Mrs. B, was also in love with him, and was jealous of Mrs. A. He believed that Mrs. B conspired to end his relationship with Mrs. A by saying bad things about him to other people in the coffee house. He found certainty of Mrs. B’s infatuation and jealousy in an episode in which he had followed Mrs. A to another coffee house, and later that evening, when he tried to return to Mrs. B’s coffee house, she closed the door of the establishment earlier specifically to keep him outside, out of spite, letting other people in as usual. Mr. X stated that he considered having a relationship with Mrs. B, had he not been deeply in love with Mrs. A. After this episode, Mr. X continued spending his days in Mrs. B’s coffee house, having little interaction with her. He holds a grudge against Mrs. A, resenting her for not being strong enough to end her marriage and for believing the gossip about him.
+Some years later, at the age of 55, shortly after his mother went to live in a nursing home, Mr. X started believing that another married lady that went to the coffee house, Mrs. C, was also in love with him. He believed that everyone in the coffee house was talking about this, conspiring and scheming behind his back to get them together because Mrs. C asked them to. Mr. X. returned Mrs. C’s love, and then he started stalking her around the village. First, he followed her from a distance, but he eventually went to her workplace to ask her out on a date. Mrs. C declined the invitation, and Mr. X believed this was because she was married and was ashamed of admitting she was in love with him in front of her co-workers. Meanwhile, Mr. X started having complaints of insomnia and anxiety. He believed that Mrs. C that was provoking these symptoms using witchcraft, and he also believed she had shrunk his genitals. Mr. X kept on stalking Mrs. C, and 1 week after the new complaints began, he threatened her with a knife, demanding that she undo the spell. He was apprehended by the authorities and was brought to the emergency unit for psychiatric evaluation. He was admitted as an inpatient in the psychiatry service. He was medicated with risperidone 3 mg per day and diazepam 3 mg per day, with no adverse effects, and his persecutory delusion remitted 4 days later. Physical examination, including neurological, was unremarkable and there were no analytical nor imaging relevant findings (normal blood count, renal and liver function, inflammatory markers, normal vitamin B12 and folic acid levels, normal thyroid function, normal parathyroid hormone levels, normal ceruloplasmin levels, negative drug screening, negative serology for HIV, syphilis, hepatitis B and C, normal EKG and no alterations in CT-scan nor MRI). The was no family history of psychiatric illness or of any remarkable medical condition. He did not present any other psychopathology nor history of other symptoms or disorders, so other psychiatric and organic diagnoses were excluded, and the patient was diagnosed with a Persistent Delusional Disorder. He gained insight to his persecutory delusion, but maintained the erotic delusions, and was discharged to follow-up as an outpatient.
+Throughout follow-up, the same pharmacological treatment was continued, with good adherence and no observed nor reported adverse effects upon clinical observation and interview. He has not presented further aggressive behavior, he feels better and is satisfied with the medication. He retains the delusional belief that all three ladies are in love with him and are extremely unhappy without him, but these beliefs are less intense. Mr. X is not in love with Mrs. B nor Mrs. C anymore, but remains in love with Mrs. A, and he considers having had the only significant relationship of his life with her. The timeline of this case is summarized in Table .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_808_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_808_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..05b829fff8b9bc9776c95347de6e1a67bd72a51b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_808_en.txt
@@ -0,0 +1,2 @@
+A 38-year-old-gentleman presented with complains of acute-onset progressive breathlessness with dry cough and fever for 7 days. He was a never smoker and had no previous known comorbidities. On initial assessment, the patient was tachypneic (respiratory rate: 30/minute) and hypoxic (SpO2: 76% at room air which increased to 85% with oxygen supplementation). His heart rate was 132 per minute. His respiratory system examination revealed bilateral crepitations in mammary, infra-axillary, and infrascapular regions. Clinical evaluation of his other systems (cardiovascular system, central nervous system, and per abdomen) was not showing any significant abnormality. Among blood investigations, complete blood count was largely unremarkable (hemoglobin: 13.6 g/dL, total leukocyte count: 9,200/mm3, platelet count: 3.5 lakh/mm3). Similarly, the liver function test (total bilirubin: 1 mg/DL), the renal function test (urea and creatinine were 46 and 1 mg/dL, respectively), and the coagulation profile were also within normal limits except for mild transaminitis (alanine transaminase: 65 IU/L, aspartate transaminase: 59 IU/L). Chest radiograph was showing bilateral middle- and lower-zone infiltrates , and the arterial blood gas (ABG) analysis was showing hypoxia (PaO2: 68 mm Hg with FiO2 nearly 100%). A provisional diagnosis of severe ARDS was made, given the PaO2/FiO2 less than 100, and the patient was intubated. He was ventilated with low tidal volume and high positive end-expiratory pressure (PEEP) strategy as per the ARDS-Net protocol. On evaluation for the etiology of ARDS, his nasopharyngeal swab was sent for H1N1 testing (reverse transcription polymerase chain reaction), which came out to be positive and he was started on oseltamivir (75 mg twice daily for 5 days) apart from ceftriaxone and azithromycin (empiric institutional protocol for ARDS). The patient was persistently hypoxic despite high PEEP, recruitment maneuvers, and 100% FiO2 . Subsequently, he was put on the prone position for 16 hours/day for 4 consecutive days. The patient improved clinically, and 10 days later, he was weaned off from mechanical ventilation.
+Despite ameliorated chest condition and extubation , the patient continued to be tachypneic and hypoxic. During invasive mechanical ventilation, various endotracheal aspirates to look for ventilator-associated pneumonia were done, which all came out to be sterile. He was initiated on HFNC with flow of 45 L/minute at a FiO2 of 45%. On HFNC, he was comfortable and maintaining a SpO2 of 91%. His PaO2/FiO2 ratio was 143 on ABG. At this point of time, the study by Lin Ding et al. was discussed in our departmental journal club, and it was planned to attempt PP in our index case while being on HFNC. As he was quite cooperative, he was asked to lie in a prone position if he felt comfortable . He tolerated prone position well, and 1 hour later of PP when ABG was repeated, his SpO2 had increased to 98% and PaO2 was 136 mm Hg on same settings (PaO2/FiO2: 302) . In the following course of his ICU stay, he himself was inclined to stay in the prone position for prolonged periods. Over the next 48 hours, his FiO2 was tapered off, and he was shifted to the ward. After a stay of 2 days in ward, he was off oxygen supplementation and mobilizing. All parenteral medicines were stopped and he was discharged on 5th day of ward stay.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_809_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_809_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5f3505ff0665fb58ddcd1de6348c9b5feadf928f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_809_en.txt
@@ -0,0 +1 @@
+A 39-year-old healthy male complained of pain in his left chest and back, the pain persisted for 11 days, with ring-shaped radiations to the precordial area, and numbness in both the lower extremities continued for 9 days. The skin sensation below the costal margin was weakened, and there was only a sense of banding. After a long walk, the patient could feel a sense of disharmony in both lower limbs. The most prevalent signs were patellar clonus, ankle clonus, and Babinski sign, which were significantly positive. MRI of thoracic vertebrae showed a strip-like structure equal to T1 signals in the spinal canal at the level of T1–T3 vertebrae, low and equal T2 signals, and high signals in the fat-suppression sequence. The contrast-enhanced T1 weighted phase showed a uniform enhancement, with clear borders and wide base attachments close to the dural membrane. The meningioma was located on the left posterolateral side of the spinal cord, and dumbbell-type growth was outward at the level of the T2–T3 intervertebral foramen . Computerized tomography (CT) with a value of 67HU showed a soft tissue mass in the spinal canal at the level of the T1–T3 vertebral body. A spot-like calcification density was observed, and the spinal cord was compressed and moved to the right. The enhanced scan showed moderately uneven enhancement. The CT-mediated biopsy of the T2–T3 intervertebral foramina lesion showed meningioma . Immunohistochemistry showed that Vim, E-cad, S-100, D2-40, PR, and EMA were (+), whereas, Ki67 (5%) and CK were (−). The left thoracic hemilaminectomy was performed under general anesthesia. The operation was extended to the maximum possibility to increase the exposure field and ensure the minimum displacement of the spinal cord during the operation. At the same time, the left intervertebral joint bone of T2/T3 was resected, and the resected bone was preserved; later, the bone graft was prepared by calcining and trimming. The tumor was gray-colored, appeared fish-like structure, rich in blood vessels, located on the left posterolateral side of the dura mater, and grew to the anterolateral side of the spinal cord but did not exceed the midline of the ventral side. The tumor penetrated deep in and grew outwards, located in the ventral side of the left nerve root of T1 and surrounded by the left nerve root of T2. With a nerve stripper exploration, the tumor could completely strip from the T1 root and dura mater and get separated from the T2 nerve root, which was unclear. To remove the tumor completely, the T2 nerve root was severed, the sleeve was burned, and a sufficient hemostatic was applied that was covered with a gelatin sponge to autologous with the bone grafted. Postoperative pathology showed meningioma, immunohistochemical EMA, PR, S-100 (+), Ki-67 (1%), and E-Cadherin (+). The patient’s sense of banding disappeared immediately after the surgery, and there was no uncoordinated walking even after attempting a long walk. Cerebrospinal fluid leakage occurred on the 3rd day postoperatively, but there were no symptoms of hypotensive cranial pressure such as headache, nausea, and vomiting. He was encouraged to walk daily, suggested to lie on his right side, and change his dressing daily. The cerebrospinal fluid leakage recovered on the 10th day of the postoperative procedure, and the patient was discharged on the 13th day of the postoperative procedure. The patient was advised to come for the follow-up on the 3rd, 6th, and 12th months postoperatively, and there were no further complaints observed. MRI showed no recurrence of the mass, no compression of the spinal cord, and no instability of the thoracic spine.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_837_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_837_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6477f7a77f7c069dec26e1c869fd80eeb9851fd3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_837_en.txt
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+The proband was a 1-year and 11-month old boy at the time of admission. He is the third child with two healthy elder brothers of a non-consanguineous marriage, born after full-term by normal delivery, with a birth weight of 3000 g and allergy history of cephalosporin. No other members in the family have seizures. Nothing abnormal was observed in the perinatal period. Motor development and language development were mildly delayed before the onset of seizures, with an unbalanced gait and dual tone. The first two seizure episodes occurred within half a day when the temperature reached 39 °C at 1-year and 10-month old, which presented with generalized tonic-clonic, lasting for about 2 min per episode. Subsequently, the convulsion occurred twice during the following week without fever or other inducements. Twenty days later, the convulsion occurred again and presented as tonic of four limbs. Then the convulsion occurred more frequently (10–20/day) with varied epileptic seizure types such as myoclonic, atypical absence, atonic seizures a week before admission into our clinical center.
+His height, body weight, and head circumference were 85.0 cm, 11.8 kg, and 48.0 cm respectively at the admission. He had no obvious craniofacial dysmorphisms with fontanel closure. No other positive signs were found upon physical examination except slight gait instability. Results from routine examination including urine/blood/cerebrospinal fluid, blood/cerebrospinal fluid biochemistry, blood electrolytes examination, blood glucose, cerebrospinal fluid pathogens, metabolic screening and brain magnetic resonance imagery were normal. Video-EEG monitoring was performed for 3 h which showed slow background activity accompanied by a 2 ~ 3 Hz slow activity major in anterior area , interictal EEG showed a large number of generalized high amplitude 2 ~ 2.5 Hz slow spike-and–wave complexes . Two atypical absence seizures with generalized high amplitude 2.5 ~ 3 Hz spike-and–wave complexes lasting 7 s ; two atonic seizures with 1-2 Hz polyspikes-and-wave complexes and electromyography flat ; and several myoclonic seizures with 1-2 Hz polyspikes-and-wave complexes and electromyography burst were recorded . The myoclonic seizures disappeared and atypical absence and atonic seizures improved with combined treatment of sodium valproate and nitrazepam. Then focal and general tonic-clonic seizures were seen during sleep occasionally. Follow-up EEG showed a large number of generalized high amplitude 1.5 ~ 2.5 Hz slow spike-and–wave complexes in the slow background . Lamotrigine then was added as the third drug for combination therapy, and after which the focal and general tonic-clonic seizures were well controlled and atypical absence, atonic seizures reduced. However, subsequently epileptic spasms emerged more than 10 times a day especially when he was quiet or shortly after waking up. During the two-month follow-up, the child exhibited gait instability and cognition regression, the Gesell scale scored 55, including gross motor 54, fine motor 47, language 70, cognition 50, social development 54. Based on the aforementioned clinical manifestations, the patient was diagnosed with Lennox-Gastaut syndrome (LGS). He was seizure-free with ketogenic diet combined with antiepileptic drugs forementioned finally. The blood Ketogen level was maintained at about 3 mmol/L.
+To identify the potential pathogenic mutations, the proband and the parents’ genomic DNA was extracted from peripheral blood lymphocytes using the QIAamp® Blood Mini Kit (Qiagen, Hilden, Germany) and subjected to whole-exome sequencing (WES) on Illumina NovaSeq6000 (Illumina, San Diego, CA, USA). The read mapping, variant calling, genome annotation, and variant prioritization were performed as described previously , the variant was classified according to standards and guidelines of the American College of Medical Genetics and Genomics (ACMG) . The results were also confirmed by Sanger sequencing. WES showed only one de novo heterozygous mutation c.4321C > T (p.Gln1441Ter) in TANC2 gene (NM_025185.4) in the proband . No other rare variants in any other genes associated with LGS reported previously were found in the patient. This nonsense mutation would lead to premature translation termination and has no allele frequency in several commonly used databases (i.e., dbSNP, gnomAD, ClinVar, HGMD). The in silico prediction score of GERP (Genomic Evolutionary Rate Profiling), LRT (Likelihood ratio test) and Mutation Taster is 5.29, 0 and 1 respectively which indicate pathogenicity. According to the ACMG clinical variant interpretation guidelines, the pathogenic evaluation of this variant was “PVS1 + PS2 + PM2”, which classified as “Pathogenic”. The genetic characteristics and pathogenetic analysis of the variant in TANC2 were displayed in Table .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_906_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_906_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f056f5c6bc096705d7211f257eb2f0e1dc9057b4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_906_en.txt
@@ -0,0 +1,4 @@
+The patient was a 36-year-old female who presented with the complaint of a right-sided facial mass. She had noticed this painless mass two years before referral. On examination, there was a soft, round, and mobile mass in the right mandibular angle. The overlying skin was erythematous and adhered to the mass. Facial nerve function was normal, no lymphadenopathy was found, and a cystic lesion was reported on ultrasonography. Following that, the patient underwent mass resection surgery with a pre-operative diagnosis of lymphangioma and WT. Inflammation and infection in the cystic component cause the lesion to adhere to the skin. Therefore, adhesion did not necessarily mean a malignant lesion. In addition, in the classical approach, parotidectomy can be performed even in malignant lesions. Finally, due to financial problems, the patient refused to have a CT scan or fine needle biopsy. After general anesthesia, superficial parotidectomy was performed with the preservation of the facial nerve, and the lymph nodes of zone II were removed. The specimen was submitted for histopathological evaluation.
+On gross examination, the excised tissue included the superficial lobe of the parotid gland and overlying skin measuring 6×5.5×5 cm. The cut surface showed a 1.5-cm soft gray-white area with partial circumscription and cystic spaces. In the microscopic view, the sections revealed salivary gland tissue with neoplastic lesions consisting of cystic structures covered by two layers of cells with nuclei of no significant atypia and eosinophilic cytoplasm. The underlying stroma contained lymphomononuclear cells with lymphoid follicle formation .
+On the periphery of the neoplasm, another neoplastic lesion was observed with infiltrative borders composed of mucous-secreting glands with extensive cystic areas and few solid sheets of squamoid and intermediate cells with clear cytoplasms, mild to moderate nuclear atypia, low mitotic rate, perineural invasion, and no necrosis .
+Accordingly, the diagnosis of MEC in the background of WT was established. Dermal and deep margin involvement was observed in some foci, and the lymph nodes showed reactive features. After surgery, the patient underwent radiation therapy, and in the 5-year follow-up, the patient was in good general condition and reported no problems with the physical examination; however, she refused to take further diagnostic procedures.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_925_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_925_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5c2c2daf2fe23e177536ca341f46e70017ce33ef
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_925_en.txt
@@ -0,0 +1,6 @@
+The patient, a 38-year-old Chinese female, presented to the general surgical outpatients clinic with a 18-month history of intermittent right upper abdominal pain, back pain, nausea and vomiting. The examination of the patient's medical history revealed good general health, absence of systemic diseases, and smoking habit. The physical examination was normal. These symptoms were not decreased in patient treated with oral acid-inhibitory drug and cholagogue at the local hospital.
+Ultrasound of the abdomen showed a retroperitoneal tumor measuring 4.8 × 2.3 cm . To further confirm the diagnosis, Abdominal contrast enhanced computed tomography (CT) revealed a retroperitoneal mass 34 mm × 27 mm in size, near right renal veins extending to inferior vena cava, and it was pushing the pancreas forward . Abdominal contrast enhanced CT did not reveal any evidence of retroperitoneal enlarged lymph nodes. The border between the tumor and IVC was indistinct at the arterial phase, the venous phase and the delayed phase . To determine the primary site of the tumor and whether metastasis had occurred, The patients' complete examination included head magnetic resonance imaging (MRI), chest CT and cardiac ultrasound. The patient refused to undergo PET-CT due to financial constraints. The cardiac ultrasound and brain MRI were normal. The CT scan of the chest showed a tumor in the lingual segment of the upper lobe of the left lung, consisting of ground-glass nodules with unclear boundaries; The tumor was approximately 1.3 cm × 1.1 cm in size and multiple short burls can be seen around the edges of the tumor. There were no enlarged lymph nodes in the mediastinum . Bronchoscopy was performed to clarify the nature of the tumor, showing acute inflammation of the bronchial mucosa. Pulmonary tumor may be metastases of inferior vena cava tumors, primary lung cancer or benign pulmonary nodules. Therefore, the patient was discussed in the multidisciplinary tumor board meeting to determine the best treatment strategy. Discussion the results suggest surgery as the only effective treatment for inferior vena cava tumors and pulmonary tumor. The patient first underwent resection of IVC sarcoma. And 1 month later, the patient underwent wedge resection of pulmonary by thoracoscope without preoperative pulmonary biopsy.
+The patient underwent resection of IVC sarcoma, which was located at the confluence of the renal vein into the inferior vena cava. After the proximal and distal clamp, the tumor and the involved IVC were completely removed from the infrahepatic IVC to just above the right renal vein. In order to save operation time, the inferior vena cava was reconstructed with artificial blood vessels. Blood loss was around 400 ml during the operation. Post operatively, patient made a good recovery without serious complications.
+The postoperative pathological specimens showed that the size of the tumor was 6 × 4 × 3 cm, which was lobulated, the capsule was intact, and there was no metastasis in the surrounding lymph nodes. The histopathological examination showed a well-circumscribed mass composed of spindle cells arranged in interlaced and bundles . The tumor cells are fusiform, slender and rich in cytoplasm. The nucleus is deeply stained, the end is blunt, located in the center, with a certain degree of heteromorphism and pleomorphism . A few fused nuclei were also seen. Immunohistochemistry analysis revealed the tumor to be positive for smooth muscle actin (SMA), myoglobin, desmin, Epithelial Membrane Antigen (EMA), Transducin-Like Enhancer of split 1 (TLE-1), h-caldesmon, vimentin, CD99 and Ki-67:40%, and negative for CD 117, CKp, CK7, Bcl-2, S100, CD31, CD34, Dog-1 and STAT-6. These findings support the diagnosis of IVC sarcoma.
+After 1 month, the patient underwent thoracoscopic wedge resection of the upper lobe of left lung. The lung tissues 20 mm from the edge of the nodule, including the nodule, was removed with a linear cutting closure device. There were no obvious blood loss and complications during or after the operation. Blood loss was around 50 ml during the operation. Post operatively, patient made a good recovery without serious complications.
+Grossly, the resected lung tissue was approximately 6 × 4 × 3 cm in size with an solid mass measuring 0.8 × 0.8 cm in the central area. Patient underwent pathologically confirmed complete anatomical resection of the primary tumor, therefore the surgical margin was >2 cm. There were no enlarged or suspected lymph nodes in the mediastinum during the operation, so mediastinal lymph node dissection was not performed. The histopathological examination of the excised mass showed lung adenocarcinoma . Immunohistochemical staining of the tumor cells revealed positive expression for CK7, napsin A, TTF-1 and Ki-67:20%, and negative expression for CK5/6, p63, p40, Syn, CgA, CD56 and LCA. Cells from a squamous cell carcinoma are generally CK5/6, p40 and P63 positive and TTF-1 and Napsin A negative whereas adenocarcinoma cells are generally CK7, Napsin A and TTF-1 positive while being negative for p40 and CK5/6 . In addition, the patient's lung tissue specimens were consulted by pathologists in Fudan University Cancer Hospital and Gansu Cancer Hospital, and the pathologists of the two hospitals agreed on the diagnosis of lung adenocarcinoma. The patient received gefitinib tablets (250 mg per day) as a maintenance therapy during the perioperative period. Follow-up based on patient's recent medical history, chest and abdominal physical examination, complete blood count, liver function tests, tumor markers monitoring, ultrasound scan of the abdomen every 3 months, CT scans of the lung, abdomen and head every 6 months. 20 months after resection of inferior vena cava leiomyosarcoma, the contrast-enhanced CT images show two lump about 1.2 and 0.7 cm in diameter in upper lobe and lower lobe of the right lung . According to the examination results, it may be metastasis of inferior vena cava sarcoma or recurrence of lung adenocarcinoma. Thoracoscopic wedge resection was performed in patient after the discussion by thoracic surgery department. The immunohistochemical results of postoperative specimens were consistent with the metastasis of inferior vena cava leiomyosarcoma . Immunohistochemical staining of the tumor cells revealed positive expression for SMA, desmin, vimentin and h-caldesmon and Ki-67:70%, and negative expression for CD117, S100, CD34, and Dog-1. Histopathological examination of the right lung mass confirmed the diagnosis of the inferior vena cava leiomyosarcoma metastasis. The patient received oral anlotinib treatment (12 mg once daily) after the last operation. The follow-up items are the same as before. During on-going regular follow-up visits no evidence of recurrence or metastasis was observed from December 2020 to October 2021 .
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_934_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_934_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8d608ff94438ec94c3b73c232cffa8b6c6454f90
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_934_en.txt
@@ -0,0 +1,3 @@
+A 39-year-old woman contacted the ambulance service stating that she was choking. On assessment by the attending paramedic, she was sat upright on the sofa, appeared systemically well but was distressed. She had a patent airway, although her uvula was deviated to the left. She had a hoarse voice and was unable to talk properly. She confirmed that she had a sensation of choking, but had good bilateral air entry on examination with no additional sounds. Her physiological observations were all normal and a 3-lead electrocardiogram showed a sinus rhythm of 70 beats per minute.
+On further assessment, an implanted device under the patient’s left clavicle was discovered, which turned out to be a VNS. As the patient’s condition spontaneously improved, she explained that she had experienced a ‘tingling’ sensation in her throat. She had interpreted this as the onset of a seizure, so had swiped her ring magnet to activate the VNS. However, the ‘tingling’ sensation had become worse, leading to a cycle of further VNS activations with the magnet and worsening of symptoms until she was unable to speak and felt as though she was choking.
+The paramedic provided reassurance and advice, and on learning that the patient did not feel confident about using her device, advised her to contact her specialist neurology team the next day for follow-up and further advice. Now understanding that the choking sensation was a common side effect and nothing to worry about, the patient was content with the management plan. The patient was not transported to hospital, so the treating paramedic added that she or anyone around her should still call for help if she had a seizure leading to injury, a seizure lasting more than five minutes or repeat seizures without recovery in between .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_937_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_937_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..988d493a98de34a3e27cac41c3a6293a763cc94f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_937_en.txt
@@ -0,0 +1 @@
+A 9-year-old Han Chinese boy presented with both lower extremity weakness of 6-month duration. Neurophysical examination revealed weakness of the lower extremities (power grade IV/V) and decreased sensation below the T10 dermatome with bilateral knee tendon hyperreflexia and Babinski sign positive. Magnetic resonance imaging (MRI) showed an well-demarcated intramedullary lesion located at the level of T8 vertebra with isointensity on T2WI and hypointensity on T1WI, which was homogeneous enhanced after gadolinium injection . There was associated syringomyelia extending from T7 down to the level of T10. A right thoracolumbar scoliosis with a Cobb angle of 28° was also observed . The patient underwent a T7–8 laminectomy. Opening the dura mater revealed a well-demarcated, soft, greyish-red tumor . The lesion was totally resected with the help of microsurgical techniques. T7–8 laminoplasty was performed to keep the integrity of spinal structural. Histopathological findings were consistent with fibrillary schwannoma. Postoperative MRI did not reveal the presence of a residual tumor with syringomyelia reduced. By 2 weeks after treatment, the patient had experienced nearly complete recovery. Management with external bracing was performed on this patient for 3 months after surgery to prevent spinal deformity. However, a thoracic kyphotic deformity with a Cobb angle of 30° occurred 5 months after surgery , and a progressive postoperative spinal kyphosis with a Cobb angle of 60° was observed 3 years after surgery . Continued conservative management with observation was performed as there is no association with functional decline and impairment in health-related quality-of-life measures.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_956_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_956_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4c1d03eb3901c63f41ad9977309f86dee35c2547
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_956_en.txt
@@ -0,0 +1,3 @@
+A 65 year old female with a background of hypertension and osteoporosis presented to the orthopedic department complaining of pain and reduced range of motion after slipping and falling directly onto her left shoulder. Initial assessment showed mild bruising and tenderness, while neurovascular status was intact with no open wounds. Subsequent imaging showed a displaced two-part proximal humerus fracture . A joint decision was made to undergo open reduction and internal fixation using a proximal humerus locking plate (Philos plate®).
+The patient was prepared supine under general anesthesia. The fracture was accessed uneventfully via a delto-pectoral approach. Open reduction was achieved and a short proximal humeral locking plate was fixed preliminarily with K-wires. Next, one cortical screw was inserted distally and three proximal locking screws were inserted under power, with the last few turns performed manually .
+During insertion of the fourth proximal locking screw under power, maximum screw purchase was obtained prematurely. This resulted in a violent sudden flexion of the humerus with the screw as a pivot, followed by an ominous snap . Fluoroscopy confirmed a significantly displaced fracture of the humeral shaft along the entry of the distal cortical screw. The metal was subsequently removed, reduction obtained and a longer proximal locking plate, resulting in a lengthened and more complex surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_957_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_957_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1212d879d8e75161bdf26bfa35ecdae6c19da152
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_957_en.txt
@@ -0,0 +1,5 @@
+A 50-year-old Mediterranean woman presented with 1-year history of involuntary movement of the toes of her right foot. Our patient was not known to have diabetes or hypertension. Initially, the patient started to have an odd but painless feeling in her foot; she described the feeling as something moving inside her foot. This had gradually progressed to visible movement of the toes of her right foot; she did not describe any aggravating or relieving factors to the movement. However, the severity of movement varied during the day. There was no history of lower limb trauma or psychological problems. There was no history of neuroleptics use or symptoms of thyroid disease [, ]. Our patient reported that she had a history of low back pain 15 years ago. She had been told that surgery was required for her lower back pain but she did not recall the reason for the surgery; unfortunately, her previous MRI scan was not available.
+On clinical examination, our patient appeared healthy with no signs of anxiety or psychological problems. She had a normal gait with normal tandem gait and a negative Romberg’s sign. The movement did not affect her gait and she could walk on her toes and her heels . Her upper and lower limb power and reflexes were normal. There was normal coordination of the upper and lower limbs with no evidence of cerebellar signs, nystagmus or ophthalmoplegia. Her peripheral pulses were intact but there was mild swelling of her feet and legs due to mild varicose veins.
+The movement was a continuous semirhythmic movement involving the right first, second, third and fourth toes. It was a constant, flexion/relaxation movement with a variable frequency between 0.5 and 1 Hz. There was no associated visible movement of her ankle or calf muscles. The patient was able to temporarily suppress the movement by powerful extension of her toes and dorsiflexion of her ankle.
+Laboratory investigations did not show any remarkable abnormalities. Her vitamin B12 level was normal and she was already on vitamin D3 treatment. A nerve conduction study of her right lower limb showed no evidence of demyelination or axonal loss. There was no neurophysiological evidence of peroneal nerve compression at the fibular head or tarsal tunnel syndrome. F wave examination and electromyography (EMG) did not show any evidence of denervation.
+A lumbar MRI scan demonstrated a mild disc protrusion between L4 and L5. There was a much smaller disc protrusion between L5 and S1. Both discs did not show spinal cord or nerve root compression on axial view. A Tarlov cyst was seen at the sacral area .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_963_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_963_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..166c7b2ab8e343520d42bd3b59971b038de52d24
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_963_en.txt
@@ -0,0 +1 @@
+A 45-year-old male patient gazed at the sun several times during a baseball game that took place on a sunny day at 7 weeks prior to his first visit to our clinic. Immediately after gazing at the sun, the subject reported having bilateral central scotoma and decreased vision. At the time of the incident, the patient was taking etizolam for a psychiatric condition (panic disorder). At the first visit, his decimal best corrected visual acuity was 0.8 (logMAR conversion: 0.10) (with -3.00 diopters, cylinder -1.00 diopters axis 5°) in the right eye and 0.7 (logMAR conversion: 0.15) (with -3.00 diopters, cylinder -1.00 diopters axis 180°) in the left eye. Slit lamp examinations showed no abnormalities in the anterior segments and media of both eyes. Fundus examinations showed a tiny, yellowish spot in the fovea bilaterally . FAF (Spectralis HRA; Heidelberg Engineering, Heidelberg, Germany) , fluorescein angiography, and indocyanine green angiography all indicated that there were no remarkable abnormalities in either of the eyes. OCT (Cirrus HD-OCT; Carl Zeiss Meditec AG, Dublin, CA, USA) images showed an elevated and blurred ellipsoid zone along with loss of the interdigitation zone at the foveal area bilaterally . There was also no vitreomacular adhesion or traction seen in either of the eyes . When the findings were taken together, the patient was diagnosed with solar retinopathy due to the characteristic symptoms and bilateral findings present after an episode of sun gazing. Treatment was started at the first visit, with the patient given a posterior sub-Tenon triamcinolone injection in his right eye followed by being placed on oral prednisolone therapy (30 mg per day) on the same day. The prednisolone therapy was decreased over a 12-week tapering period. There were no changes noted in the decimal best corrected visual acuity at 2, 4, and 6 weeks after starting the medication. However, at 9 weeks, there was improvement to 1.2 in the right eye and 1.0 in the left eye, with this good visual acuity sustained and observed at the examinations at 12 and 21 weeks. Fundus examinations performed at 12 weeks after the initial treatment showed the tiny, yellowish spots were diminished in both eyes. Sequential OCT images obtained during the follow-up examinations showed that the blurred ellipsoid zone that was visible in both eyes at 2 weeks after initiation of the therapy along with the elevated ellipsoid zone both improved to nearly normal at 4 weeks in the right eye and at 21 weeks in the left eye. However, loss of the interdigitation zone was observed after 12 weeks in the right eye and after 21 weeks in the left eye .
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_966_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_966_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2bac3e6eeec4a0d286499f89d6f1a6e34780d159
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_966_en.txt
@@ -0,0 +1,3 @@
+A 74-year-old Japanese woman presented with a 6-month history of gradually worsening dyspnea on exertion, a 10-year history of bronchiectasis, a 4-year history of infection with Mycobacterium avium complex, and pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma in remission that had been treated by surgical resection of the right lower lobe and subsequent chemotherapy with single-agent rituximab. She had no history of recurrent epistaxis, and her family history did not include hereditary hemorrhagic telangiectasia (HHT) or PAVMs. She was admitted with pneumonia, symptoms of which were only partially resolved by antibiotic therapy as dyspnea on exertion persisted.
+Overall, physical examination findings were unremarkable. Her lungs were clear to auscultation, and clubbing or evidence of telangiectatic lesions on the nasal mucosa or skin was absent. Blood findings revealed C-reactive protein of 0.32 mg/dL and an erythrocyte sedimentation rate of 50 mm/hour. Arterial blood gas analysis showed slight hypoxemia (PaO2 of 65.9 mmHg on ambient air). Chest radiography showed increased density in the lower lung. Chest computed tomography (CT) showed bronchiectasis and increased density in the right middle lobe and the lingular segment of the left lung. Contrast-enhanced chest CT showed no evidence of pulmonary thromboembolism, but the pulmonary veins of the right middle lobe and left lingular segment were enhanced in the arterial phase. Reconstructed 3D-CECT images revealed abnormal intrapulmonary shunts in the right and left pulmonary arteries and veins. Echocardiography findings did not indicate vascular heart disease. Measuring PaO2 and SaO2 after breathing 100% oxygen for 20 minutes revealed a shunt fraction of 22%. Whole-body 99mTc-macroaggregated albumin (MAA) perfusion lung imaging revealed a shunt fraction of 21.3%. Head magnetic resonance imaging (MRI) findings were normal.
+Pulmonary angiography revealed irregular staining of the pulmonary arteries in the right middle lobe and the pulmonary vein during the early phase . Although the typical sac and nidus of PAVMs were not evident, an abnormal shunt was suspected and treated by transcatheter coil embolization. Thereafter, the vein in the early phase was undetectable . The shunt fraction decreased to 12.4%, on 99mTc-MAA lung perfusion images, and the dyspnea on exertion was ameliorated, so the patient was discharged. However, pneumonia reoccurred 3 months later and was improved with antibiotics, but hypoxemia persisted. The shunt fraction on 99mTc-MAA lung perfusion images was elevated to 16%, indicating recanalization of the embolized shunts. Pulmonary angiography did not reveal evidence of recanalization, but new abnormal shunt lesions were found in the periphery of another area of the right middle lobe and in the left lingular segment . The hypoxemia and dyspnea improved after coil embolization of these new lesions, and the patient was discharged. She has remained free of shunt recurrence and is presently under follow-up as an outpatient.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_967_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_967_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b52017fe88525f2a2a73f037579902a786151237
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_967_en.txt
@@ -0,0 +1,2 @@
+A 13-year-old female with previously diagnosed T1D, was admitted to the emergency department presenting incoercible vomiting since the previous day, oligo-anuria and deteriorating state of consciousness. The girl had been diagnosed with autoimmune T1D at the age of 9 years (no DKA at onset). Past medical history was unremarkable. Sensor-augmented pump therapy (SAP) was started, and her follow-up was characterized by suboptimal glucose control (latest HbA1c of 60 mmol/mol).
+On admission, the child presented in hypovolemic shock with an altered state of consciousness (GCS 12) without evident focal neurological signs, pale skin and Kussmaul respiration. Her physical examination was unremarkable except for decreased and tachycardic distal pulses, cool extremities, prolonged capillary refill (> 2 sec). Venous blood gas analysis and lab tests showed severe DKA, hyperosmolar state, and acute kidney injury (AKI) with hyperkaliemia, confirmed at ECG analysis . Two boluses of normal saline were infused (10 mL/kg each) with improvement in vital parameters. No bicarbonates were administered. The patient was then transferred to the intensive care unit (ICU) and DKA correction was carried out according to the most recent guidelines with progressive resolution of the DKA, hyperosmolar state, AKI, and electrolyte imbalances. A brain CT excluded cerebral edema. On arrival the patient’s pump controller showed that the patch pump had expired. Of note, the patch pump is designed to shut-off automatically after 72h, after sounding alarms to alert the user to change the pump when approaching expiration. The child later admitted to not having changed the expiring patch pump while at her grandparents’ due to her not having any replacements and in fear of her mother’s anger. When DKA resolved, the patient was transferred to the pediatrics department and her SAP was reinstated. Since admission she referred modest abdominal pain that had persisted throughout DKA treatment. No other signs or symptoms were present apart from slightly loose stools which were collected for microbiological testing. An abdominal ultrasound only showed slight thickening of the ileal wall. On day 2 since DKA resolution, Clostridium difficile toxin tested positive and oral vancomycin treatment was started. On day 4, follow-up US only confirmed signs of enterocolitis. On day 5, abdominal symptoms and signs worsened alongside onset of fever and elevation of inflammatory indices (CRP 145 mg/L, normal range <6 mg/L). Thus, abdominal ultrasound was repeated, documenting an uneven multi-chambered area of 8x3 cm with a small aerial component . Treatment with metronidazole was started and the patient was transferred to the city’s center of reference for pediatric surgery. Abdominal magnetic resonance imaging revealed a large, fluid-filled pelvic abscess with air bubbles suspect for bowel perforation, with parietal contrast enhancement . Therefore, an urgent ileal resection (44 cm) was performed, and NOMI was diagnosed intraoperatively. Antibiotic treatment with piperacillin-tazobactam and gentamicin was administered for 7 days, and treatment with metronidazole and vancomycin was continued for 10 days. The patient was discharged after 3 weeks of transition from parenteral to enteral feeding. Pre-discharge abdominal ultrasound resulted normal without signs of inflammation or free abdominal fluid.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_977_en.txt b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_977_en.txt
new file mode 100644
index 0000000000000000000000000000000000000000..25f039b12664939e52c2af18b709a00b607be448
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/fulltext/multiclinsum_test_977_en.txt
@@ -0,0 +1,6 @@
+A 57-year-old South Asian man presented with a painless, nodular lesion (1 cm × 0.5 cm) on his left knee. He had had a renal transplant eight months earlier for autosomal dominant polycystic kidney-related renal failure. He received two doses (20 mg) of interleukin receptor-2 antibodies (Simulect®, Novartis Pharmaceuticals, Surrey, UK) at induction and on the fourth postoperative day. This was followed by tacrolimus, mycophenolate mofetil and prednisolone for immunosuppression. During the follow-up period, his tacrolimus level was kept within the therapeutic range (5 to 8 ng/ml). He was cytomegalovirus (CMV) negative and had received a kidney from a CMV-negative deceased donor. He had immigrated to the United Kingdom from Bangladesh twenty-five years ago and had last visited there eight years ago. There was no past history of trauma to the knee.
+He was started on flucloxacillin and the course was extended for a period of 14 days. In spite of antibiotic therapy, the lesion progressed significantly and reached 5 cm × 5 cm and became cystic in nature. The lesion was confined to the skin and subcutaneous tissue with no deep extension to bone or lymph node involvement. The surface of the lesion had multiple small sinuses showing a dark-brown discharge, which was sent for microscopy.
+During this period, he did not show any systemic symptoms and inflammatory markers (C-reactive protein) and his white cell count were both normal. Because of the failure of antibiotic therapy and the fast growing nature of the lesion an incisional biopsy was performed.
+Histological examination of the specimen showed marked epidermal hyperplasia and abundant fungal spores with hyphae. The microscopy of the discharge also confirmed the fungal spores and hyphae (fungal grains).
+The patient was started provisionally on voriconazole while awaiting confirmation of the causative organism. The large size of the lesion on his knee significantly reduced his quality of life so an excision biopsy was done. The specimen showed marked epidermal hyperplasia with microabscess formation. Within the microabscess, there were PAS (Periodic acid-Schiff) positive branching and septate hyphae . No bacteria were found. The excision margins were clear, and no evidence of the neoplastic process was found.
+Nuclear ribosomal repeat-region sequencing confirmed that the causative organism was P. romeroi (Mycology Reference Laboratory, Bristol, UK). An in vitro antifungal susceptibility test demonstrated that P. romeroi was sensitive to voriconazole. Following a successful surgical removal, voriconazole was continued orally for two months under the care of the infectious-disease team. No recurrence was seen during the following six months.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1015_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1015_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3e5e036be44a66b16e6c829992777e607d3b2b61
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1015_en_sum.txt
@@ -0,0 +1 @@
+A 9-year-old Japanese girl with Alagille syndrome was admitted to our institution with marked hyperbilirubinemia and a pathological fracture of the femur. She had been diagnosed with biliary atresia at the age of 1 month and treated with surgical bile duct reconstruction, vitamins D and K, and ursodeoxycholic acid. However, her liver dysfunction and hyperbilirubinemia worsened. The pathological fracture of the femur was treated with low-intensity pulsed ultrasound stimulation (LIPUS) and an Ilizarov ring fixator. Seventy-four days after surgery, the patient had anatomically and functionally recovered. There was no leg-length discrepancy and no angular malalignment of the lower extremities as measured clinically and radiographically. The range of motion of the hip, knee, and ankle of the patient's operative leg matched the range of motion in the nonoperative leg.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1017_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1017_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1522831dfa9a995c7f398b68adfa7d701e95c366
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1017_en_sum.txt
@@ -0,0 +1 @@
+A 6-year-old boy, white Kosovar ethnicity, presented with right groin pain, swelling and redness. Two days before admission the patient was injured by football during a children game in the right lower abdomen and the next day he complained of pain in the right inguinal area.On admission patient had a painful non-reducible mass in the right inguinal region and cellulitis. Plain abdominal x-ray showed no fluid-air levels, but a metallic foreign body (pin) under right superior pubic ramus was apparent. With preoperative diagnosis of suspect incarcerated inguinal hernia with cellulitis the patient was operated on under general anaesthesia in December 2, 2006. Intraoperatively we found the inflamed vermiform appendix perforated by a pin in the hernial sac. Appendectomy and herniotomy were performed. The wound was primary closed, without any post-operative complications and follow up for the patient is three years long.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1027_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1027_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e105c2554a29cfdde627d220ac0656ba7614d21a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1027_en_sum.txt
@@ -0,0 +1 @@
+A 71-year-old man was referred to our clinic for management of an iatrogenic total iridodialysis. The totally dialyzed iris tissue was immediately preserved in sterile cold balanced salt solution and packed in a sterile biopsy bottle that was surrounded with ice cubes. Under general anesthesia, a pars plana vitrectomy was performed to remove the remaining lens cortex and vitreous fiber anterior to the equator. A sulcus-positioned intraocular lens (IOL) was repositioned and fixed by ab externo scleral sutures. Preserved iris tissue was inserted and ironed using both iris spatula and ocular viscoelastic devices. Five-point ab interno scleral sutures were made 1.0 mm posterior to the limbus.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1028_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1028_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6445e26e42fc2d147f8e097526b018c284002082
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1028_en_sum.txt
@@ -0,0 +1 @@
+The ultrasound-guided right lung mass biopsy showed mucosa-associated lymphoid tissue (MALT), and the patient was diagnosed with Sjögren's syndrome (SS). The patient's symptoms were partially relieved with chemotherapy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_102_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_102_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3b7e7035bc7fdee74cd88b9f7438c089ab13214a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_102_en_sum.txt
@@ -0,0 +1 @@
+One of our aHUS cases with a novel complement factor H mutation, who developed unusual laboratory findings (thrombocytopenia and mild creatinine elevation without other features of TMA) following discontinuation of eculizumab was presented. Literature and case reports relevant to discontinuation of eculizumab in aHUS patients were reviewed.
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diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1050_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1050_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9d5837431a0187fa3390e00f5feda61e602c2435
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1050_en_sum.txt
@@ -0,0 +1 @@
+A 6-year-old medically and surgically free boy presented to the Emergency Department with severe shortness of breath. The patient was initially saturating well, but then suddenly worsened and was rushed for intubation. The patient was taken to the operating room for direct laryngobronchoscopy to retrieve the foreign body obstructing the airway. The foreign body was successfully retrieved, and the presence of a tracheal bronchus was confirmed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1064_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1064_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..23c13a80fa2ea4b513836bb5569c38b5bc973607
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1064_en_sum.txt
@@ -0,0 +1 @@
+Product of a full term uneventful pregnancy, delivered to non-consanguineous apparently healthy parents. At birth was noted to gradually develop swelling on the right leg, worse at the right foot. There was crossed hemi-hypertrophy with right leg bigger than the left. As child grew symptoms worsened, parents separated and eventually he was abandoned to the streets. He presented at University of Calabar Teaching Hospital for medical care at the age of fifteen years with lymphatic obstruction, persistent foul smelling drainage, lipodermatosclerosis of right foot as well psycho-social and financial constraints. The diagnosis was made with x-rays and Doppler studies of the lower limb vessels. He is currently being managed conservatively with compression dressings on the affected limbs, Antibiotics for the infection and analgesics. De-bulking surgery is being anticipated at this time.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1080_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1080_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e7be3cfcb69f52de9a3ce2841bd1324d87a12e41
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1080_en_sum.txt
@@ -0,0 +1 @@
+We present a family carrying an interstitial deletion and its reciprocal duplication within the 6p25.1p24.3 region. The deletion is 5.6 Mb in size and was detected by array comparative genomic hybridization (aCGH) in a 26-month-old female proband who presented speech delay and mild growth delay, bilateral conductive hearing loss and dysmorphic features. Array CGH studies of her family members detected an apparently mosaic deletion of the same region in the proband's mildly affected mother, but a reciprocal interstitial duplication in her phenotypically normal brother. Further chromosomal and fluorescence in situ hybridization (FISH) analyses revealed that instead of a simple mosaic deletion of 6p25.1p24.3, the mother actually carries three cell populations in her peripheral blood, including a deletion (~70 %), a duplication (~8 %) and a normal (~22 %) populations. Therefore, both the deletion and duplication seen in the siblings were apparently inherited from the mother.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1097_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1097_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2d697835c346b128377344588e4f903ef61975ff
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1097_en_sum.txt
@@ -0,0 +1 @@
+We describe a 20-year-old girl who was initially misdiagnosed with juvenile idiopathic arthritis (JIA) almost 15 years prior. In October 2019, she developed renal arteritis at the age of 17 years and was eventually diagnosed with Blau syndrome. A de-novo M513T mutation was found in her gene testing. A review of the literature on patients with Blau syndrome and vasculitis showed that a total of 18 cases were reported in the past 40 years. The vast majority of them were predominantly involved medium and large vessel arteritis. Of the 18 patients included in our literature review, 14 patients had aorto-arteritis, and 4 of them had renal artery involvement. Two patients presented with renal artery stenosis, 1with a sinus of Valsalva aneurysm, and 1 with retinal vasculitis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1099_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1099_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fd666e0df9772aef3e6e10c4958b90b795e515eb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1099_en_sum.txt
@@ -0,0 +1 @@
+A 42-year-old female with history of uterine fibroids was admitted with abdominal pain and intraperitoneal fluid of unknown etiology. She was initially managed nonoperatively and empirically treated with broad spectrum antibiotics. Blood and urine cultures were unrevealing. Increasing abdominal pain and peritoneal fluid prompted diagnostic laparoscopy which revealed a dense fibrinous exudate covering the entire peritoneal cavity. Peritoneal fluid and biopsies were sent for cytology and culture. The peritoneal fluid was eventually sent for 16 s ribosomal analysis, which discovered Mycoplasma hominis RNA. Her antibiotics were narrowed, and she eventually made a full recovery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1115_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1115_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9e30193d5699b9d3d8a84c463ef2f926bd963115
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1115_en_sum.txt
@@ -0,0 +1 @@
+A 61-year-old woman was admitted to a hospital for obstructive jaundice, and extra-hepatic cholangiocarcinoma was found. Seven years prior, she underwent poly-surgery, which included cholecystectomy, gastrectomy, and colectomy, for advanced gall bladder carcinoma. Although she did not receive adjuvant chemotherapy, she had no tumor relapse. She was recommended chemo-radiation therapy to treat the cholangiocarcinoma; however, she visited our hospital to inquire the possibility of receiving radical operation. Enhanced computed tomography showed extensive cholangiocarcinoma without distant metastases, which was confirmed by endoscopic biopsy. Since the transected bile duct was without cancer-invasion, which was confirmed by a negative biopsy result, we were able to perform radical left hepatectomy and pancreaticoduodenectomy (HPD). The patient was discharged without any complications. Careful preoperative examination allowed for a complex operation to be successfully completed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1118_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1118_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..79e9bf92fbb43e35dfed5615e0cae885013de668
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1118_en_sum.txt
@@ -0,0 +1 @@
+Here we report a 69-year-old patient with minimal cardiovascular risk factors who developed a rupture of a splenic arterial aneurysm after more than 5 years of effective treatment with pazopanib for metastatic renal cell carcinoma.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1131_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1131_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5a593deb9bcc903a8061bb5534413b975aa9e527
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1131_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP) bone single-photon emission-computed tomography (SPECT) was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1149_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1149_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fc53fdc23956de0dbb803269b2bb8408c8c126a2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1149_en_sum.txt
@@ -0,0 +1 @@
+We present a case of a 43-year-old male implanted with a dual-chamber primary prevention implantable cardioverter-defibrillator (AUTOGEN EL, Boston Scientific) for sudden cardiac death. At the time of implant, the patient had hypertrophic cardiomyopathy with mild left ventricular (LV) systolic impairment, and sinus rhythm with intact atrioventricular (AV) conduction. The patient developed progression of his disease with symptoms (dyspnoea) and LV impairment. This led to a decision to activate the minimal RV pacing algorithm (RYTHMIQ™). A deterioration in AV conduction caused intrinsic ventricular beats to fall in the atrial blanking period, and subsequent VVI backup pacing resulted in R on T pacing. This induced ventricular arrhythmia. RYTHMIQ™ was subsequently deactivated, and the patient has had no further device-induced arrhythmias.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_116_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_116_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..09d476148050dfebe76705bbcf7199d78c1bd406
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_116_en_sum.txt
@@ -0,0 +1 @@
+We report a case of two sisters with clinically epidermodysplasia verruciformis specific lesions on the face, neck, trunk, and extremities. PCR analysis indicated the presence of human papillomavirus type 5 in the lesions. Electron microscopic examination showed viral-like particles in keratinocyte nuclei and the stratum corneum of the epidermodysplasia verruciformis lesions. In addition, we examined the EVER1 and EVER2 genes using eight different primer pairs without finding any nonsense or frameshift mutations in the gDNA from lymphocytes of the elder sister.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1218_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1218_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..748789547e89f95610b97153011231206eca6e69
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1218_en_sum.txt
@@ -0,0 +1 @@
+The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned. Anesthesia was induced, and tracheal intubation was performed successfully with a video laryngoscope. About 2 min after tracheal intubation, the airway peak pressure increased to 50 cm H2O and the oxygen saturation dropped to 70%. According to the BLUE protocol, a recommended area of the chest was scanned by ultrasound. The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung. The boundary of pneumothorax (lung points) were rapidly confirmed by ultrasound. To avoid lung injury, a closed thoracic drainage tube was placed in the involved area. On day 9 after surgery, the patient was discharged from the hospital without any complications.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1219_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1219_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5409d48dd79ec0184921e6796ac5ceaacac925e0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1219_en_sum.txt
@@ -0,0 +1 @@
+A 25-year-old woman underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma. After tumor resection, sellar floor reconstruction was performed by mucosal graft and Glubran®2 glue. The early post-operative period was uneventful. However, 2 months after surgery, the patient complained of headache, facial pain and greenish foul-smelling nasal discharge with solid particles dripping from the nose. Medical treatment was unsuccessful. Brain MRI showed inflammation and thickening of the sphenoidal and para-sphenoidal mucosa. The patient underwent endoscopic endonasal surgery and a solid glass-like mass surrounded by inflamed infected mucosa was seen in the inferior and lateral aspects of the sphenoid sinus. Efforts were made to erupt and de-crust the solid mass until total resection was achieved. Early post-operative period was uneventful, and a course of antibiotics was continued until total disappearance of the discharge.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1234_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1234_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8c7eff34d0d8b76757566ce5ac8d984729dcdf37
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1234_en_sum.txt
@@ -0,0 +1 @@
+A 63-year-old Caucasian woman with past medical history significant for hypertension, hypothyroidism, right breast ductal cell carcinoma treated with mastectomy and breast implant, platelet granule disorder, asthma requiring chronic intermittent prednisone use, presented to the outpatient cardiology office with recent onset exertional dyspnea, palpitations, weight gain and weakness. Initial workup with electrocardiogram and holter monitor did not reveal significant findings. During the subsequent hospitalization for community acquired pneumonia, the patient developed symptomatic paroxysmal atrial fibrillation. Transthoracic echocardiogram showed a right ventricular mass. A biopsy was not pursued given the high risk of bleeding due to platelet granule disorder. Cardiac MRI showed characteristic features consistent with cardiac lipoma and LHIS. Prednisone was discontinued. Genetic testing for arrhythmogenic right ventricular dysplasia and 24-h urine cortisol test was negative. As multiple attempts at rhythm control failed with sotalol and flecainide, pulmonary vein isolation and right atrial isthmus radiofrequency ablation were done. She is in follow-up with symptomatic relief and no recurrence of atrial fibrillation for 10 mo.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_123_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_123_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e82bb9eb10c69567ce74dd8d4c598c584b249e33
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_123_en_sum.txt
@@ -0,0 +1 @@
+A 60-year-old male patient presented with pain in the left knee with difficulty in walking since 3 months. The patient had road traffic accident 3 months back and sustained trauma to left knee. On clinical examination, there was palpable gap of more than 5 cm between the fracture fragments, anterior surface of femur and condyles was palpated through fracture site and knee range of motion was between 30° and 90° of flexion, and X-ray suggests of patella fracture. Midline 15 cm longitudinal incision was taken. The insertion of the quadriceps tendon over proximal pole of patella was exposed and pie crusting was done on medial and lateral side and V-Y plasty was done. SS wire was used to hold the reduction of the fragments by encirclage wiring and anterior tension band wiring done. Retinaculum was repaired and wound closed in layers. Postoperatively, long rigid knee brace was given for 2 weeks and walking with partial weight-bearing started. After suture removal at 2 weeks, full weight-bearing initiated. At 3 weeks, knee range of motion started and continued till 8 weeks. At 3 months post-operative, the patient is able to do flexion up to 90° and no extension lag is present.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1246_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1246_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..43719e5fa881dae60a49a553e54a62343de73005
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1246_en_sum.txt
@@ -0,0 +1 @@
+A bilateral spontaneous cICADs with hypoperfusion-related AIS after 72 h from the onset was presented herein. The patient responded well to primary Solitaire stent detachment at the critical flow-limiting site.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1258_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1258_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b51d19104f19b896e9667628ab2e64ceaf86d8b7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1258_en_sum.txt
@@ -0,0 +1 @@
+We present here a case of BRBNS involving a 4-year-old female, whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam. Skin lesions, typical for BRBNS, appeared on the 8th d of the child's life and their number increased over the next several months. The child also experienced episodes of critical decrease in hemoglobin level (by as much as 52 g/L) for several years, requiring iron supplementation and several blood transfusions. Video capsule endoscopy revealed numerous vascular formations in the small bowel. The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis. Single-balloon enteroscopy was used to perform sclerotherapy, with aethoxysklerol foam. A positive effect was observed within 19 mo of follow-up. We continue to monitor the patient's hemoglobin level, every 2 wk, and it has remained satisfactory (> 120 g/L).
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1266_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1266_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3a084bbdd725e19c998a5c6be8580d270c6cb061
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1266_en_sum.txt
@@ -0,0 +1 @@
+A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3-4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1297_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1297_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ab55b4257e1766190cfc9ebbdcb1731472fcc642
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1297_en_sum.txt
@@ -0,0 +1 @@
+We describe here the first case of primary hepatic leiomyosarcoma successfully treated by transcatheter arterial chemoembolization (TACE). The patient was a 68-year-old woman who presented with right upper quadrant pain and weight loss over the past 5 wk before admission. Abdominal computed tomography (commonly known as CT) and ultrasonography showed a mixed echoic mass measuring about 10 cm × 7 cm occupying the right lobe of the liver. Exploratory laparotomy was performed 1 wk after admission. The tumor was unresectable and biopsy was performed. Based on rapid frozen-section and histopathological examination, a final diagnosis of primary hepatic leiomyosarcoma was established. TACE was performed 2 wk later. The postoperative course was uneventful and the patient was discharged on day 7 after the operation. Contrast-enhanced CT showed that the tumor significantly shrunk with satisfactory lipiodol deposition. The patient has been followed up for 82 mo until now, and no progressive enlargement of the tumor or distal metastasis was observed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_130_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_130_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..af353c8b9f98f3da9e1af66b0000a2a7a926c3c0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_130_en_sum.txt
@@ -0,0 +1 @@
+We encountered a 3-year-old girl with IgA PIGN presenting with acute renal failure, oedema, hypertension, and heavy proteinuria of 7955 mg/g creatinine. Renal biopsy specimens showed diffuse glomerular endocapillary hypercellularity with prominent neutrophil and monocyte infiltration on light microscopy. Strong deposits of IgA and C3 were observed along the glomerular basement membranes and the mesangium by immunofluorescence microscopy, and electron microscopy revealed the presence of subepithelial humps. The patient was managed with steroid (and probatory antibiotic) therapy and is now undergoing follow-up, with a significant improvement 6 months after the initial presentation (glomerular filtration rate (GFR) and cystatin C clearance rate of 165 ml/min/1.73m2 and 106 ml/min/1.73m2, respectively). No signs of bacterial infection were detectable.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1385_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1385_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e7618fe88280333bb024657ac8601db153c65699
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1385_en_sum.txt
@@ -0,0 +1 @@
+We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1417_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1417_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..89f5eb9b58fc8f5f3832192147d6e5c850c1b23c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1417_en_sum.txt
@@ -0,0 +1 @@
+We here report a 75-year-old male patient with arch saccular aneurysm. Because of his liver cirrhosis, 2 debranching TEVAR has chosen as a treatment using Najuta. After extrathoracic bypass was performed, a CTAG stent graft was implanted distal to the LSCA in order to deliver Najuta stent graft steadily. Najuta stent graft was successfully positioned in zone 0. However, he was suffered from stent-graft collapse. After additional TEVAR to salvage stent-graft collapse to zone 0, he complicated type A dissection, which was treated by ascending aorta replacement. After salvage operation complicated multiorgan failure and he died.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1428_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1428_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fa89737dfb69d7c12a668ca37d7790306c5beede
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1428_en_sum.txt
@@ -0,0 +1 @@
+A 25-year-old man who experienced glans necrosis following paraphimosis was not treated promptly with circumcision. The patient underwent conservative treatment with debridement of necrotic tissue and cystostomy for urethral meatal necrosis. We were able to prevent partial penectomy. His penile glans was covered with healthy epithelium and retained its natural shape and voiding and erectile functions were normal 2 years after the treatment.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1466_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1466_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d6bbe08e922b4ad72dd267d263a63453eb5ed0a6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1466_en_sum.txt
@@ -0,0 +1 @@
+A handmade bovine three-portion pericardial patch was used to reconstruct the AMC in a patient with severe endocarditis requiring double valve replacement; the technique allowed for steady anchorage of prosthetic valves without additional incisions other than conventional aortotomy and atriotomy. Postoperative echocardiography revealed normal cardiac function and no significant perivalvular leakage. The patient displayed complete recovery and was discharged on postoperative day 33. The patient was symptom-free at his 1-year follow-up and displayed normal laboratory and echocardiographic findings.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1474_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1474_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eb97d12db357fa62e9c99d78cbde39afc14e26ce
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1474_en_sum.txt
@@ -0,0 +1 @@
+A 76-year-old man, injured from a fall while walking, presented to another hospital with right shoulder pain and a limited range of motion (ROM) 3 days after the injury. Given a diagnosis of right shoulder dislocation, he received manual reduction followed by immobilization with a sling. He continued to experience difficulty in performing active ROM exercises of the shoulder and underwent magnetic resonance imaging, which revealed an irreparable extensive rotator cuff tear involving the supraspinatus and infraspinatus muscles. He was then referred to our hospital 2 months after the injury. Examination revealed atrophy of the supraspinatus and infraspinatus muscles, atrophy of the deltoid muscle and hypoesthesia, likely due to axillary nerve palsy, and a marked limitation of active ROM with flexion, abduction and lateral rotation angles of 10°each. ASCR was considered for treating the irreparable rotator cuff tear. Since the technique is not indicated for patients with deltoid paralysis, the operation was delayed until signs of improved axillary nerve palsy were observed at 6 months after the injury. The patient started passive ROM training the day after the operation while wearing a shoulder abduction orthosis for 3 weeks, followed by immobilization with a sling for 2 weeks. Thereafter, he started active exercise. The axillary nerve palsy was almost completely resolved 3 months after the operation. He achieved a ROM comparable to that of the unaffected side at 1 year after operation. He has had an uneventful post-operative course for 2 years after operation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1477_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1477_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..48955ff3555164235197823c257197dc16ac8612
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1477_en_sum.txt
@@ -0,0 +1 @@
+A 47-year-old man with a family history of HCC was found to have hepatitis B virus (HBV) infection 25 years ago. In 2000, he was administered lamivudine for 2 years, and entecavir (ETV 0.5 mg) was administered in 2006. In October 2016, magnetic resonance imaging revealed a tumor in the liver (5.3 cm × 5 cm × 5 cm); no intraoperative hepatic and portal vein and bile duct tumor thrombi were found; and postoperative pathological examination confirmed a grade II HCC with no nodular cirrhosis (G1S3). ETV was continued, and no significant changes were observed on imaging. After receiving pegylated interferon alfa-2b (PEG IFNα-2b) (180 μg) + ETV in February 2019, the HBsAg titer decreased significantly within 12 wk. After receiving hepatitis B vaccine (60 μg) in 12 wk, HBsAg serological conversion was realized at 48 wk. During the treatment, no obvious adverse reactions were observed, except for early alanine aminotransferase flares. The reexamination results of liver pathology were G2S1, and reversal of liver fibrosis was achieved.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_14_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_14_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..433a324dddb577fe4e0d0428bad1c40246ca2f9b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_14_en_sum.txt
@@ -0,0 +1 @@
+The patient, a female, had extremely low physical development, neonatal progeroid appearance, lipodystrophy, thin skin, partial alopecia, cyanosis of the face, triangular face, microgenia, arachnodactyly, delayed bone age, hepatomegaly, hypoplasia of the labia majora, and hypertrophy of the clitoris in addition to known clinical signs. Differential diagnosis was performed with chromosomal abnormalities and Hutchinson-Gilford progeria. According to the results of sequencing of the clinical exome, the patient had two previously undescribed variants in the CDC6 gene, c.230A>G (p.(Lys77Arg)) and c.232C>T (p.(Gln78Ter)), NM_001254.3, in a compound heterozygous state.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1526_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1526_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5a4cb1c4a2f76263bce53a40618028f76812ebf4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1526_en_sum.txt
@@ -0,0 +1 @@
+Here we describe a 22-year-old man who was admitted to our hospital because of diffuse abdominal distention. A VPS was placed 21 years earlier to treat hydrocephalus secondary to spina bifida. Abdominal computed tomography (CT) revealed a homogeneous low-density fluid collection adjacent to the VPS catheter tip, causing stomach obstruction. Thus a peritoneal pseudocyst around VPS was suspected and emergency laparotomy was performed. The large mass was localized in the left upper abdomen between the stomach and mesentery of the transverse colon, exactly at the omental bursa. The cystic mass was opened and 1500 ml of clear fluid was drained; the distal end of the VPS was repositioned outside the mass. Thus, an abdominal cerebrospinal fluid pseudocyst as a complication of VPS was diagnosed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1527_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1527_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9cf27724eea8092ee23e32c0fd1813dfc68412d3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1527_en_sum.txt
@@ -0,0 +1 @@
+A man in his 50s who was diagnosed as having two foci of HCC and advanced liver cirrhosis was referred to our hospital for further examination and treatment. Both foci of HCC were located in segment 8 of the liver and measured 39 and 9 mm. Endoscopy showed esophageal varices that had a high risk of bleeding. After endoscopic ligation of the esophageal varices, he underwent transcatheter arterial chemoembolization (TACE) for downstaging of the advanced HCCs. No further liver deterioration was observed after TACE, and HCC staging was successfully downstaged to within the Milan criteria. One hundred ten days after TACE, he underwent liver transplantation; at 2.5 years after transplantation, he remains alive without HCC recurrence.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1529_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1529_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b8ab486f9d438d9e44ac6284e59c4d5b5b4d6357
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1529_en_sum.txt
@@ -0,0 +1 @@
+A 28-year-old female with a history of Ebstein anomaly of the tricuspid valve status post-Fontan presented with chest pain and acute hypoxia. Computed tomographic angiography (CTA) reported a submassive pulmonary embolism (PE). She was initiated on a heparin drip. Catheterization demonstrated elevated Fontan pressures and a large thrombus in the right lower pulmonary artery that was removed with an aspiration device. The patient was transitioned to a direct oral anticoagulant (DOAC) following the procedure.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1536_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1536_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8ddb232d90cb87af74cb612aeafbcde8121150f4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1536_en_sum.txt
@@ -0,0 +1 @@
+A 28-year-old man had positive urinary protein and elevated serum creatinine (Scr) results and was diagnosed with IgAN 2-3 years prior to the outpatient department visit at our hospital in 2017. Professor Zou used the following methods to treat the patient: Invigorating the spleen and tonifying the kidney, removing dampness and clearing turbidity, quickening the blood and transforming stasis, and freeing vessels and regulating collaterals. She adjusted the prescription in accordance with the patient's symptoms. After 6 mo of treatment, the symptoms had resolved and serological indexes were also decreased
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1545_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1545_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..99df1e58b253c89efe813bd11502e2086f2373de
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1545_en_sum.txt
@@ -0,0 +1 @@
+A chest computed tomography scan of a 51-year-old Japanese woman showed multiple nodular ground-glass opacities that were not seen on chest X-ray. Video-assisted thoracoscopic surgery was performed. A histological examination demonstrated type II pneumocyte hyperplasia with thickened fibrotic alveolar septa, which was consistent with multifocal micronodular pneumocyte hyperplasia. Brain magnetic resonance imaging displayed multiple cortical tubers, and abdominal computed tomography showed bilateral renal angiomyolipoma. Our patient was finally diagnosed as having tuberous sclerosis complex with multifocal micronodular pneumocyte hyperplasia, although she had no episodes of epilepsy, no skin lesions, and no family history.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1558_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1558_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ff9605c1babbdd508198450508bdc56f3fcbbebc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1558_en_sum.txt
@@ -0,0 +1 @@
+A 66-year-old man affected by DME, with glycated hemoglobin (HbA1c) at 6.9%, refractory to laser grid treatment and intravitreal injections of triamcinolone, was selected to receive a cycle of three subtenon injections/week of IFNα (1×106 IU/ml). BCVA and CMT, using spectral domain ocular coherence tomography (SD-OCT), were evaluated preoperatively and at 1 week, 1 month, 4 months, and 1 year postoperatively. BCVA and CMT were significantly improved at 1 week after the three injections (20/200 vs. 20/40 and 498 μm vs. 237 μm, respectively). BCVA remained stable during the 1-year follow-up. CMT was slightly increased, but was still lower than the baseline value (215 μm, 255 μm, and 299 μm during the follow-up visits). No adverse events were recorded, with the exception of mild subconjunctival hemorrhage at the injection site.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1613_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1613_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5281a7cd0a53529c3310d99ccccb5bcbace06395
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1613_en_sum.txt
@@ -0,0 +1 @@
+We present a case of a cellular angiofibroma arising from the spermatic cord of a 74-year-old Caucasian man. Initially, the lesion was confused with a scrotal hernia, but imaging revealed a subcutaneous, inhomogeneous, but well-circumscribed lesion to the surrounding tissues with rich vasculature. Surgical resection of the lesion was performed. Histology revealed a benign tumor of vascular origin rich in fibroblasts.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1623_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1623_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d7e41f8c5a4e84ab4af99ce01fd10d0be7b1a97a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1623_en_sum.txt
@@ -0,0 +1 @@
+A 46-year-old male patient with previously normal thyroid function was diagnosed with a renal carcinoma with rhabdoid differentiation. He was treated with sunitinib, followed by the immune checkpoint inhibitors ipilimumab and nivolumab, and he developed primary hypothyroidism secondary to thyroiditis. Substitution with unusually high doses of levothyroxine as high as 4.3 µg/kg/day did not normalize his thyroid function. Poor compliance was refuted because there was no improvement after observed administration. He had no malabsorption. Although tyrosine kinase inhibitors can increase the expression of D3, this effect tends to be modest. Therefore, the suspicion of tumor-related consumptive hypothyroidism was raised and supported by low free T3 and elevated rT3 levels. The therapy could not be further modified because the patient opted for palliative care and passed away 12 days later. Immunohistochemistry of the tumor from a sample obtained prior to systemic therapy documented abundant expression of D3, corroborating the diagnosis of consumptive hypothyroidism.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1628_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1628_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b1a52c01f1b0d6de2a5f43f21dc72e9e4b60d32e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1628_en_sum.txt
@@ -0,0 +1 @@
+A young woman with a recurrent, right ovarian teratoma had previously undergone surgical removal 2 times. After the second surgery, she underwent regular out-patient follow-up, and no residual tumor was observed. However, 3 years after the second surgery, she developed recurrent, bilateral ovarian teratomas, in conjunction with elevated carbohydrate antigen-125 levels.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1630_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1630_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..29442bc252c89c300cbafdf64f837d481754ba6a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1630_en_sum.txt
@@ -0,0 +1 @@
+This report describes an 11-year-old girl presenting with hoarseness as the first symptom of PSF. Hoarseness occurred 2 days prior to admission. On admission, she had fever, hoarseness, and an elastic soft mass on her left anterior neck. Contrast-enhanced computed tomography of the cervical region demonstrated an abscess partially infiltrating the thyroid gland and an air pocket near the pyriform sinus. Pharyngoscopy revealed swelling of the left arytenoid region, with purulent retention. The left vocal cord was swollen but not paralyzed. Additionally, the laboratory data indicated thyrotoxicosis. Suspecting a PSF infection, parenteral treatment with cefotaxime and dexamethasone was initiated. On the following day, the hoarseness disappeared, and the fever resolved. Four weeks after onset, the thyroid hormone levels returned to the normal range, and a barium esophagogram revealed residual contrast in the left pyriform sinus, leading to a diagnosis of PSF.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1640_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1640_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f2d296d66b64b974e336a9c43e8c8904633d4ac9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1640_en_sum.txt
@@ -0,0 +1 @@
+We present a case of a Tajik, Afghan patient with chronic myeloid leukemia with del(6)(q23.3q27), t(9;22)(q34;q11.2), monosomy 11, monosomy 12, and marker chromosome who, despite having typical clinical and hematological disease with initial response to therapy, progressed to blast crisis very early and thus required special interventions.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1642_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1642_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ad13fd1a7c44c6eeaa7cb332903cc877a9513442
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1642_en_sum.txt
@@ -0,0 +1 @@
+A 52-year-old female patient was scheduled for laparoscopic operation of uterine adnexa under general anesthesia. The patient preoperative evaluation showed only 1 finger width of mouth opening, and the computed tomography scan showed bilateral temporomandibular arthritis, which was evident on the right side. Intraoperatively, the expected airway difficulties occurred, and the anesthesiologist opted to use lightwand intubation, which was ultimately successful in 1 pass without any complications.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1644_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1644_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4746b9a1c8a00417ff576a4126d8713a5f16ce20
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1644_en_sum.txt
@@ -0,0 +1 @@
+A 55-year-old postmenopausal woman had intermittent chest pain following emotionally stressful events three times in the past 3 years. Cardiac troponin levels increased after each instance of symptom onset. A transthoracic echocardiogram showed reversible left ventricular dysfunction. The patient underwent three coronary angiograms without evidence of coronary artery disease. A left ventriculogram was first performed at the third hospitalization and revealed apical akinesia with ballooning of the apical region and consistent hypercontractile basal segments. The diagnosis of TCM was confirmed. The patient was treated with an angiotensin-converting-enzyme inhibitor (perindopril) and a β-blocker (metoprolol). No complications occurred during the patient's hospitalization. The patient was told to avoid stressful events. During the 9-mo follow-up visit, the patient was asymptomatic with an ejection fraction of 55%.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1662_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1662_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..bfe9a3b128072f81c124d3cf9c9b8beb8f070f58
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1662_en_sum.txt
@@ -0,0 +1 @@
+A 66-year-old man with lower extremity pain and claudication visited the outpatient spine clinic. He complained of a tingling sensation in the L5 dermatome of the right leg and L4 dermatome of the left leg. Magnetic resonance imaging showed central stenosis in at the L4-5 and L5-S1 levels, and lateral recess stenosis at the L5-S1 level. The patient's symptoms were ambiguous with mixed neurological claudication and vascular claudication. Computed tomography of the lower extremity artery showed complete occlusion in the right external iliac artery. Conservative treatment with clopidogrel and beraprost sodium was performed. After treatment, his symptoms gradually improved. Clopidogrel and beraprost sodium were continued for 4 years. Follow-up computed tomography at 4 years showed recanalization of the right external iliac artery occlusion.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1674_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1674_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..13870dc966071fbd693bb45145e8774067783228
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1674_en_sum.txt
@@ -0,0 +1 @@
+An 18-year-old male presented with hemoptysis and respiratory distress requiring orotracheal intubation. Laboratory tests showed positive anti-nuclear antibody and anti-dsDNA and low C3 and C4. Bronchoalveolar lavage became progressively hemorrhagic after each aliquot. He was treated with pulse methylprednisolone, cyclophosphamide, and plasma exchanges.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1684_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1684_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..47425304eb7e74c20ea986b86cb389a02ef9a365
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1684_en_sum.txt
@@ -0,0 +1 @@
+In this report, a 33-year-old female diagnosed with a TSH PitNET co-secreting GH presented no obvious clinical symptoms. The main characteristics were elevated thyroid-stimulating hormone (TSH), free tri-iodothyronine (FT3), and free thyroxine (FT4) levels accompanied by slightly elevated GH and insulin-like growth factor-1 (IGF-1) levels. Magnetic resonance imaging (MRI) detected a pituitary macroadenoma (18 × 16 × 16 mm) with cavernous sinus and suprasellar invasion. Immunohistochemistry revealed diffuse positivity for TSH, strong immunoreactivity for GH, and sporadic positivity for PRL. The electron microscope and double immunofluorescence staining confirmed a plurimorphous plurihormonal adenoma producing TSH, GH, and PRL. After preoperative somatostatin receptor ligand (SRL) treatment and transsphenoidal surgery, the patient achieved temporary clinical and biochemical remission. However, 3 months after surgery, the patient was suspected of having Hashimoto's thyroiditis due to higher thyroglobulin antibody (TGAb), thyroid peroxidase antibody (TPOAb), and thyroid receptor antibody (TRAb) and an enlarged thyroid nodule. During follow-up, thyroid function and TSH slowly transformed from transient hyperthyroidism to hypothyroidism. They were maintained in the normal range by L-T4.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1687_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1687_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7f188b301b610e97fc0b60ab397854721a853be8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1687_en_sum.txt
@@ -0,0 +1 @@
+A 21-year-old female presented with 3 months of severe left L5 distribution radicular leg pain and sensory loss. The MR revealed a dumbbell-shaped, heterogenously enhancing lesion centered on the left L5/S1 foramen; the intracanalicular component displaced the thecal sac to the right, while the extraforaminal portion of tumor extended anteriorly into the retroperitoneal space. Gross total resection was performed after a L5/S1 facetectomy. In the immediate postoperative period there were no complications, and the patient had full lower limb power. Four months later, the patient experienced generalized seizures, headache, and multiple cranial nerve palsies due to local and diffuse CNS dissemination. The MRI of the brain and whole spine revealed diffuse leptomeningeal enhancement along the full length of the spinal cord into the brainstem and cerebrum along with a focally recurrent epidural soft-tissue lesion located posterolaterally on the left at the L4/5 level (i.e., measuring 12 mm × 10 mm). An external ventricular drain and subsequent ventriculoperitoneal shunt were inserted, followed by craniospinal irradiation. She was discharged 3 months later with residual distal lower limb weakness.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1725_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1725_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..52a97c822394b315138ecc836f69292f48569f10
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1725_en_sum.txt
@@ -0,0 +1 @@
+A 39-year-old man had no significant improvement in symptoms due to frequent urination and urgency for 1 month following the treatment of prostatitis for 2 weeks. Ultrasound and computed tomography (CT) showed a mass in the left side wall of the bladder (size approximately 2.0 × 1.9 cm) that had clear boundaries and protruded outward from the bladder. After the extraperitoneal space was dilated with a balloon, a minimally invasive laparoscopic partial cystectomy was performed in this space to remove the tumour. The pathological diagnosis was bladder schwannoma. Immunohistochemical staining showed that it was strongly S100 protein positive. There was no recurrence after 2 years follow-up by cystoscopy and CT.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1742_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1742_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fee7688ef6865fdf4c5c1deda4450516bda22737
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1742_en_sum.txt
@@ -0,0 +1 @@
+Here, we present a case of nemaline myopathy in a young woman who was newly diagnosed with systemic lupus erythematosus (SLE) and Sjögren's overlap syndrome complicated by macrophage activation syndrome (MAS). She had no personal or family history of myopathy and was reporting progressive thigh weakness. A muscle biopsy revealed type 1 myofiber predominance with granular material in atrophic myocytes consistent with nemaline myopathy. Her symptoms markedly improved with immunotherapy for her SLE and MAS supporting the diagnosis of sporadic late-onset nemaline myopathy (SLONM) associated with her autoimmune disease.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1746_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1746_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ef4ee0511993997d0bb74179c211cbf40975f41a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1746_en_sum.txt
@@ -0,0 +1 @@
+We report a case with severe osteoporosis who sustained a subtrochanteric fracture and was managed with a Dynamic condylar screw DCS. Three years after the surgery the patient is pain free and has a full range of motion.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1750_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1750_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0e6cef33138b7b056bb729a60c2f3b08a3f42828
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1750_en_sum.txt
@@ -0,0 +1 @@
+We describe the clinical presentation and periodontal findings in a 20-year-old Japanese man with previously diagnosed Prader-Willi syndrome. Clinical and radiographic findings confirmed the diagnosis of periodontitis. The most striking oral findings were anterior open bite, and crowding and attrition of the lower first molars. Periodontal treatment consisted of tooth-brushing instruction and scaling. Home care involved recommended use of adjunctive chlorhexidine gel for tooth brushing twice a week and chlorhexidine mouthwash twice daily. Gingival swelling improved, but further treatment will be required and our patient's oral hygiene remains poor. The present treatment of tooth-brushing instruction and scaling every three weeks therefore only represents a temporary solution.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1752_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1752_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..42651b60fcbe01f504b4e50f73ccaafdf0b8fc3d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1752_en_sum.txt
@@ -0,0 +1 @@
+We present a case of DNH with intracranial hypertension and CNS hemorrhagic lesions on the mesencephalic aqueduct, resulting in triventricular hydrocephalus, treated with endoscopic ventriculocisternostomy (ETV) and medical therapy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1774_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1774_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9a7ff2c134004b5ea5e999f879b94fd490f0d882
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1774_en_sum.txt
@@ -0,0 +1 @@
+A 54-year-old man underwent laparoscopic distal gastrectomy, D2 lymph node dissection, and Roux en-Y reconstruction for duodenal neuroendocrine tumors. Drainage was performed for a postoperative pancreatic fistula and abdominal abscess. On the 28th postoperative day, he passed a large amount of bloody stool; therefore, emergency esophagogastroduodenoscopy (EGD) and angiography were performed. However, neither examination demonstrated any bleeding foci or pseudoaneurysm. He was conservatively observed and discharged on the 50th postoperative day. Approximately 1 year after the surgery, he passed a bloody stool and experienced hemorrhagic shock. An EGD revealed exposed blood vessels at the duodenal blind end. His condition was diagnosed as a pseudoaneurysm arising from gastroduodenal artery, which ruptured into the duodenum, based on abdominal contrast-enhanced computed tomography findings. Emergency angiography was performed, and the pseudoaneurysm and artery were successfully embolized.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1776_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1776_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eb62fd39aaf0644b9f65dc19b0cbc20e29197cf5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1776_en_sum.txt
@@ -0,0 +1 @@
+A previously healthy 49-year-old female patient was admitted to Northern Jiangsu People's Hospital owing to chest tightness, cough, and breathing difficulty that persisted for 3 days. Following admission, a computed tomography (CT) pulmonary angiography revealed an embolism in the main pulmonary artery, upper and lower pulmonary artery branch. The patient was treated with alteplase, warfarin, and antibiotics. Over the following year, she experienced recurrent chest pain and tightness and breathing difficulty, with multiple CT pulmonary angiography revealing thrombosis in the right and left main pulmonary artery. No abnormalities were observed in surrogate markers of autoimmune diseases, tumor antigen testing, or ultrasonography; thus, the cause of recurrent PE was not identified. Subsequently, a positron emission tomography-computed tomography (PET-CT) examination revealed diffuse heterogeneous thickening of the right pleura and substantially increased glucose metabolism. A CT-guided pleural biopsy was performed, and histopathological examination of the pleura eventually revealed a diagnosis of PPSCC.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1779_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1779_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e656b4f5417e92d4a35d338675e43af75a79cbb8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1779_en_sum.txt
@@ -0,0 +1 @@
+We present a case of persistent non-union after high tibial osteotomy treated with autologous iliac crest bone grafting and revision plating. At 1 year post-operative interval, successful union was achieved after revision internal fixation. In addition, a good functional outcome was achieved.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1795_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1795_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..58668077d48ff862126c1d711159afbcf354c1cc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1795_en_sum.txt
@@ -0,0 +1 @@
+Here, we reported a case of a 17-year-old Han Chinese female who developed symptomatic hypothyroidism, sinus bradycardia, and sinus arrest while being treated with lithium and paliperidone for bipolar disorder with psychotic features including auditory hallucinations. Her workup suggested that these adverse effects might be related to the combined lithium and paliperidone treatment, although other causes could not be ruled out. After discontinuing both medications, her thyroid function and heart rhythm normalized over 20 days.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1856_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1856_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..959f9c688a05ba09240d032fa1bcaad7a254b32d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1856_en_sum.txt
@@ -0,0 +1 @@
+Here, we report the conversion of a highly sensitized renal transplant recipient with pretransplant donor-specific antibodies from tacrolimus to belatacept within 1 week of transplantation. This substitution was necessitated by the diagnosis of CNI-induced de novo post-transplant hemolytic uremic syndrome.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1866_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1866_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e8a3fdb8111772e71fddf8aa679cb81282025642
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1866_en_sum.txt
@@ -0,0 +1 @@
+A 55-year-old male was diagnosed with an anastomotic recurrence of rectal cancer 15 months after undergoing anterior resection. Computed tomography (CT) suggested that the lesion was at an anastomosis site and broadly adherent to the upper sacrum, and colonoscopy confirmed the diagnosis of LRRC. Histopathological examination of the biopsy specimens revealed adenocarcinoma cells and that lesion was genetically RAS-wild. Induction chemotherapy with mFOLFOX6 and panitumumab was used as the first treatment. The recurrent lesion shrank and no signs of distant metastasis were observed after 11 cycles, although the range of the lesions attached to the sacrum remained unchanged. Therefore, we provided CIRT for this inoperable lesion and prophylactically removed the radiation-exposed bowel including the recurrent lesion, because radiation-induced ulcers can cause bleeding and perforation. Despite the presence of considerable fibrosis in the irradiated region, the operation was successful and the postoperative course had no untoward incidents. He is still recurrence-free 24 months following surgery, despite the lack of adjuvant chemotherapy. This is the first report of CIRT followed by CIRT-irradiated bowel removal for an unresectable anastomosis recurrent lesion.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1886_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1886_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5c4674b621396827e79b947822794c8403907f4b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1886_en_sum.txt
@@ -0,0 +1 @@
+A 63-year-old male patient affected by primary open angle glaucoma (IOP = 25 mmHg) and a full thickness macular hole in his right eye, underwent ab-interno Xen gel stent implantation and, 1 month later, a 25 G vitrectomy surgery. Despite a significant IOP reduction after stent implant, 6 days after vitrectomy, IOP increased (25 mmHg) and the conjunctival bleb flattened following occlusion of stent internal ostium by a clot of presumed fibrinous material. The Nd:YAG laser failed to remove the clot, so that we decided to snip a small bit of the proximal end of the Xen tube (about 0,5 mm length) with a 25 G vitreous scissors, using a bimanual technique. In the postoperative day 1 and month 1, the IOP was 8 mmHg and 12 mmHg, respectively. The Anterior Segment OCT confirmed a functional, layered, filtering bleb, and the normal appearance and patency of the XEN proximal segment. No side effects from the intervention were observed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1887_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1887_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6a081688385b64eaef5735590d341e7c788c7a86
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1887_en_sum.txt
@@ -0,0 +1 @@
+The current study presented the case of a patient with SYS and a novel de novo truncating mutation of MAGEL2 and phenotypic characteristics typical of this Prader-Willi-like syndrome and also including partial hypopituitarism, hypothyroidism, growth hormone deficiency, and hyperprolactinemia.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1900_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1900_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..718ab5ca84fe16cc05399b7ea91a4f89f1d0bfdc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1900_en_sum.txt
@@ -0,0 +1 @@
+A 69-year-old Japanese man underwent treatment for liver dysfunctions 3 years after aortic valve replacement. Computed tomography revealed an enhanced tumor within the hilar bile duct and dilatation of the left hepatic duct, typical of hilar cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography revealed tumor shadow in his bile duct, and the cytology confirmed malignant cells in the bile. We performed extended left hepatectomy with bile duct resection; his postoperative course remained good without acute complications. After 3 months postoperatively, he was readmitted for subacute cholangitis and obstructive jaundice. Immediately, percutaneous transhepatic cholangiography drainage was performed, followed by cholangiography that exhibited intrabiliary tumor growth in the remnant liver. On immunohistochemical examination, tumor cells were positive for cytokeratin 20 and CDX2 but negative for cytokeratin 7. Then, computed tomography revealed an enhanced tumor-like lesion at the descending colon. After 3 months, left hemicolectomy was performed. Meanwhile, the percutaneous transhepatic cholangiography drainage fluid turned bloody, which was considered to be bleeding from a residual bile duct tumor. Accordingly, radiotherapy was initiated to prevent tumor bleeding around the hilar bile duct, but, unfortunately, the effects were short-lived, and cholangitis rebooted after 1 month leading to our patient's death due to septic liver failure. Autopsy revealed a remnant tumor in the bile duct, but no noticeable nodular metastasis was observed, except for a single small metastasis in the lower lobe of the left lung.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1981_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1981_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7b31a78a35a53848a625e5b71d63e0192cc50da0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1981_en_sum.txt
@@ -0,0 +1 @@
+We present a unique case of an anaplastic cortical ependymoma in a 51-year-old female presenting as a butterfly lesion with involvement of both frontal lobes. The patient underwent gross total resection of her tumor with further adjuvant treatment. We present the findings in our case and review the literature surrounding supratentorial ependymomas and their treatment outcomes.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2000_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2000_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..50ab506aa6ad3a0b9ce4f1af9acf48fbd45a3656
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2000_en_sum.txt
@@ -0,0 +1 @@
+A 68-year-old Japanese male with sudden onset of abdominal pain was clinically diagnosed with gastrointestinal perforation, and an emergency abdominal operation was performed. A diverticulum with rupture was found in the sigmoid colon, but no apparent tumor was observed. Histological examination revealed bland spindle cells flatly proliferating and diffusely replacing the muscularis propria at the diverticular structure. The spindle cells were positive for KIT, DOG1, and CD34. Mutational analysis of the c-kit gene revealed that the lesion had a heterozygous deletion of 2 amino acids at codons 557 and 558 of exon 11. The mutation was not observed in the normal mucosa of the surrounding tissue.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_204_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_204_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9257a4e1c085cf04732bc538e4e256016c6bc2fe
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_204_en_sum.txt
@@ -0,0 +1 @@
+A 67-year-old man was referred to our hospital one day after starting oral antibiotic treatment for acute appendicitis. Physical examination revealed only slight spontaneous abdominal pain without tenderness and peritoneal irritation. Contrast-enhanced computed tomography demonstrated an enlarged appendix (10 mm in diameter) without fecalith, ascites, intraperitoneal free air, and abscess. There was no evidence of perforating appendicitis. Laboratory analysis revealed septic DIC. The patient was diagnosed with non-perforating acute appendicitis with septic DIC. The patient was distressed regarding whether he should be treated conservatively with an antibiotics-first strategy or undergo an appendectomy. Ultimately, a laparoscopic appendectomy was performed. Histopathological examination showed non-perforating gangrenous appendicitis. He required DIC therapy for 2 days postoperatively. He was discharged on postoperative day 9, and remained in good health 1 month after surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2061_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2061_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e59ad64f05b1c648a07dc914a1dea6d50801e3fd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2061_en_sum.txt
@@ -0,0 +1 @@
+A 31-year-old male patient presented to the hospital with a progressively growing mass in the right lower abdomen, accompanied by abdominal discomfort. Symptoms are discovered 1 week before admission. Enteroscopy revealed no evidence of colonic abnormalities, and blood tests did not indicate any abnormalities. Due to the indeterminate nature of the mass during surgery, a partial resection of the ileum and cecum was performed, followed by ileocolonic end-to-end anastomosis, with no postoperative complications. The final pathological diagnosis confirmed primary desmoid-type fibromatosis of the distal ileum (invasive fibromatosis). To effectively manage DF, we recommend a follow-up schedule for patients. This includes appointments every 3 months in the first year following surgery, followed by appointments every 6 months up to the fifth year, and then once a year thereafter. The follow-up examinations should include collection of the patient's medical history, physical examination, blood tests, ultrasounds, CT scans, and other relevant assessments. During the first year of the follow-up period, no further treatment was administered, and the patient remained disease-free.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2065_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2065_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dc244ec3bf57203cb8acfeb7d9fdf8d2580677c8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2065_en_sum.txt
@@ -0,0 +1 @@
+A 65-year-old woman with persistent atrial fibrillation was referred for LAAc. Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus; the LAA shape was tortuous and difficult to assess. A first LAAc procedure was unsuccessful given the unsuitable sheath position. Therefore, a soft three-dimensional (3D) model printing was performed by laser sintering and revealed excessive sheath kinking with an inferior approach, but successful deployment would be feasible using a superior approach. Successful trans-jugular implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved during the subsequent procedure. At 3-month follow-up, and after cessation of oral anticoagulation, the patient's symptoms improved. Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2074_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2074_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..cdaf8aace0a087e92e5f40b2da62e1d886682639
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2074_en_sum.txt
@@ -0,0 +1 @@
+This study reports a case of prosthetic joint infection in a patient who had a previous history of total knee replacement surgery. Cy. fabianii was recovered from intraoperative culture specimens identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and confirmed using molecular assays. It was, however, initially misidentified as Candida utilis by phenotypic identification.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2079_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2079_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6b8b7c59e0f3532acbe957c05af736512120b41f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2079_en_sum.txt
@@ -0,0 +1 @@
+Molecular profiling was performed using next generation DNA sequencing and (IHC) testing for MMR and PD-L1. A patient with sporadic, high grade urothelial carcinoma of the renal pelvis was found to have a hypermutator genotype with 73 mutations occurring amidst 62 known drivers of malignancy, and 340 VUS alterations. MMR deficiency phenotype was confirmed by the absence of MSH2 and MSH6 as well as deleterious mutations in these genes. IHC staining for programmed cell death ligand-1
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2107_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2107_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6f334f029fd7f5ca42a8e742bc9a2d5defa1a411
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2107_en_sum.txt
@@ -0,0 +1 @@
+We report a unique case of Rhopressa-induced corneal edema in a 79-year-old African-American woman, which resolved after discontinuation. She had a history of smoking one cigarette per day and did not consume alcohol. She had no history of corneal edema or uveitis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2110_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2110_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3397be8ecaa9d118b0b72c92b8f855b8196ed1b2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2110_en_sum.txt
@@ -0,0 +1 @@
+A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm×15 mm at the C1-C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1-C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2149_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2149_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e38a5fde660d9836f1e97cd6626099cdb3884c2e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2149_en_sum.txt
@@ -0,0 +1 @@
+This article reports a preschool boy with SLE who presented with renal tubular acidosis, accompanied by weakness in both lower limbs, delayed growth, and malnutrition. It was later found that the patient had the complication of Fanconi syndrome with renal tubular acidosis. Ultimately, renal biopsy confirmed lupus nephritis. The patient was treated with corticosteroid combined with mycophenolate mofetil, hydroxychloroquine, and belimumab. The symptoms of the child were relieved.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2150_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2150_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5c32397d81fcccfd0835542e56067cd6384b7197
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2150_en_sum.txt
@@ -0,0 +1 @@
+We report a case of a 28 years old woman, in 33 week of her first pregnancy who came to our hospital complaining of abdominal pain in the right hemiabdomen, associated with nausea and vomiting. The ultrasound and MRI (Magnetic resonance imaging) scan showed a 7 x 7 x 5 cm mass suggestive of angiomyolipoma in the right kidney, with evidence of retroperitoneal bleeding right perirenal and intrarenal haematoma. Given the size of the tumor, presence of symptoms and hemodynamic instability of the patient right nephrectomy was performed, following emergency caesarean delivery. The histological study of the resected mass revealed the presence of angiomyolipoma.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2160_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2160_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..09a03d654539c9b29e14a06d06de47400f4694d9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2160_en_sum.txt
@@ -0,0 +1 @@
+A 71-year-old female patient was diagnosed initially with early-stage right breast cancer (HR+/HER2-) and was treated with breast-conserving surgery followed by chemotherapy, radiotherapy, and hormonal therapy. A few years later, she developed metastatic disease to the hilar lymph nodes, and to multiple skeletal sites, including the left scapula, left shoulder, left iliac bone, and dorsal vertebrae, for which she was treated with ribociclib and letrozole. While on treatment, she developed hypopigmented lesions involving both hands, feet, and face, which were described as vitiligo-like lesions.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2161_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2161_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5451fc7d931427263fcb9b1e344e3ca99c30aafb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2161_en_sum.txt
@@ -0,0 +1 @@
+A 34-year-old G4P3 Caucasian woman was followed up antenatally because of a stillbirth in her previous pregnancy. At 36 weeks' gestation, a hypoechoic, 3.6 x 4.2 cm rounded mass was noted within the placenta on ultrasound examination. Histologically, the tumor was a benign leiomyoma and this finding was supported by immunohistochemistry. The newborn infant was male. Chromosomes of the neoplasm were studied by the fluorescence in situ hybridization technique and the tumor was found to carry XX chromosomes.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2214_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2214_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..78ec122db845ad43736de155705abd5f3ec52368
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2214_en_sum.txt
@@ -0,0 +1 @@
+A 33-year-old woman underwent S8 subsegmentectomy after clinical diagnosis of a mucinous cystic neoplasm of the liver. Histological analysis revealed a tumor composed of spindle-shaped cells with vascular proliferation in a myxoid stroma. Immunohistochemically, the tumor cells stained positively for CD34, estrogen receptor (ER), and progesterone receptor (PgR) and negatively for S-100, EMA, CK19, CD99, HMB45, and α-smooth muscle actin. The tumor was diagnosed as AAM originating from the liver. The patient received no adjuvant chemotherapy. No sign of recurrence or distant metastasis has been noted for 10 months after the surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2230_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2230_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8109794057d3c8e9990a31b12a39acd09ac3625c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2230_en_sum.txt
@@ -0,0 +1 @@
+This is a case of a 35-year-old male diagnosed with trigeminal neuralgia who presented with acute facial pain. His history and physical exam were consistent with an acute exacerbation of his trigeminal neuralgia. The patient was refractory to multiple doses of standard pain medication in the ED, and the decision was made to attempt IV fosphenytoin to relieve his pain. He was given 250 milligrams of fosphenytoin that was infused via IV over 10 minutes. By the end of the infusion, the patient had reported complete resolution of his pain.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2234_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2234_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0f405722e59979ba2377618d0a69f390aaadd622
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2234_en_sum.txt
@@ -0,0 +1 @@
+Herein we describe an 8-year-old male patient who presented to the emergency department with an appendicitis-like picture six weeks after a history of falling. Intraoperatively, the patient was found to have a normal appendix. However, a large intramural cecal hematoma contains black blood with many clots was found. The patient was treated by hematoma evacuation with preservation of the cecum and colon and he was discharged with uneventful recovery. During two years follow up there was no history of complications or recurrence.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2239_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2239_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4d764728e86f5ccf1c13a5cb20c86ef6da9127e1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2239_en_sum.txt
@@ -0,0 +1 @@
+The patient showed mildly progressive fatigue in the muscles of mastication over 3 years. Neurological examination showed facial muscle weakness and a wasting tongue with fasciculations, but the weakness, wasting, or fasciculations were not obvious in the limbs. 3-Hz RNS showed a decremental response in bilateral orbicularis oculi. The test of titin antibody was positive in the serum, and the electrocardiogram showed a WPW pattern ECG. Genetic analysis revealed an increased number (39 repeats) of tandem CAG repeats in the AR gene, which confirmed the diagnosis of SBMA. The fatigue symptom was significantly improved after oral pyridostigmine bromide treatment.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2256_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2256_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f87c0dda9f68909c702f97bf270e0c23b3f22fcc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2256_en_sum.txt
@@ -0,0 +1 @@
+An 85-year-old male presented with left CSDH, which recurred five times. The hematoma was irrigated and drained through a left frontal burr hole during the first to third surgery and through a left parietal burr hole during the fourth and fifth surgery. The hematoma had no septation and was well-evacuated during each surgery. Antiplatelet therapy for preventing ischemic heart disease was stopped after the second surgery, the hematoma cavity was irrigated with artificial cerebrospinal fluid at the third surgery, and the direction of the drainage tube was changed to reduce the postoperative subdural air collection at the fourth surgery. However, none of these interventions was effective. He was successfully treated by fibrin glue injection into the hematoma cavity after the fifth surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2259_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2259_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b46fdfe343948d818f08c2f13ca57867f820c50f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2259_en_sum.txt
@@ -0,0 +1 @@
+This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma, initially misdiagnosed as prostatic hyperplasia. This case's operative process, intraoperative findings and postoperative management are discussed in detail.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2267_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2267_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..50fe43157d3389775c756e5b256803c308746ffb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2267_en_sum.txt
@@ -0,0 +1 @@
+We report a critical case of COVID-19 in a young woman without any medical history. She was admitted to the hospital with a rare, but serious presentation of temporary complete heart block with a skin rash after three weeks of treatment with an antiviral agent and hydroxychloroquine. The result of cardiac monitoring, using a Holter monitor, was normal, and her sinus rhythm returned to normal without any interventions.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2276_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2276_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..095bd2e53e63d594efa8991a4559afcf88e35f50
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2276_en_sum.txt
@@ -0,0 +1 @@
+A left renal tumor measuring 22 mm was detected and a radical nephrectomy was performed on a 50-year-old man who had received hemodialysis for the past 6 years. A pathological diagnosis of pT1aNxMx, clear cell papillary renal cell carcinoma was made. We studied the expression of miR-155 in this case and compared it to the expression in nondialysis kidney tissue. The expression level of miR-155 was upregulated in tumor tissue compared with expression levels in the renal cortex for the present case. The expression level of miR-155 in the renal cortex was lower in the present case than in nondialysis kidney tissues.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2287_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2287_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..48332ba4d90fd01c2a4cada0af5a3ad3da7c3d2c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2287_en_sum.txt
@@ -0,0 +1 @@
+A 69-year-old man was referred to our hospital with severe abdominal pain, and serial imaging studies showed acute distally localized pancreatitis with a pseudocyst. Although he had successful conservative medical treatment followed by discharge from the hospital, he was re-admitted with severe abdominal pain for recurrent distal pancreatitis with splenic artery aneurysm followed by its rupture. No pancreas mass was detected by imaging studies including endoscopic ultrasound and cytologic studies of the pancreas juice did not show any malignant cells, although slight dilatation of distal pancreas duct was observed only in the initial computed tomography. Because of the episodes of repeated distally localized pancreatitis caused by possible pancreatic ductal neoplasm, we planned and performed laparoscopy-assisted distal pancreatectomy after full-informed consent. Pathological examination revealed pancreatic intraepithelial neoplasia (PanIN) with carcinoma in situ in the distal main pancreas duct. The post-surgical course of the patient was uneventful and he was discharged 10 days after surgery from recurrent disease for over a year.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2293_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2293_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b467c22c0fb0583fd62ef2c8ac64710b5ffd1607
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2293_en_sum.txt
@@ -0,0 +1 @@
+An anomalous single coronary artery with the left main coronary artery arising from the right coronary ostium was discovered in a 40-year old male evaluated for cardiac donation. After evaluation, this heart was successfully procured and utilized for orthotopic heart transplantation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2310_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2310_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dbbfd4a9f32c1e8f872273a8a57fe90f1e9b96c1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2310_en_sum.txt
@@ -0,0 +1 @@
+We report a case of severe skin and soft tissue infection of the left upper limb caused by Aeromonas veronii. A 50-year-old Chinese woman, who had a history of cardiac disease and type 2 diabetes mellitus, accidentally injured her left thumb while cutting a fish. Early antibiotic therapy and surgical debridement was performed before the result of bacterial culture came back. Whole-genome sequencing was further performed to confirm the pathogen and reveal the drug resistance and virulence genes. The wound was gradually repaired after 1 month of treatment, and the left hand recovered well in appearance and function after 3 months of rehabilitation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2317_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2317_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..41a87c28d602d50226f9b0289d7cf3ec4a14599f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2317_en_sum.txt
@@ -0,0 +1 @@
+A 52-year-old male with a history of heart transplant developed severe upper and lower lip edema. The patient had been on Lisinopril without any adverse events. However, sirolimus was recently added to his drug regimen. Sirolimus potentiated angioedema was suspected.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2335_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2335_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..06e3718cb2cb502d80c1278f6d635e7e5075049a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2335_en_sum.txt
@@ -0,0 +1 @@
+A 16-year-old female with a past medical history of type 1 diabetes presented to the emergency department with altered mental status, vomiting, and abdominal pain. She was diagnosed with euglycemic diabetic ketoacidosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2343_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2343_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..42eccf1d44c40833e90310fb881b2bd36be1f0f7
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2343_en_sum.txt
@@ -0,0 +1 @@
+An 8-year-old girl presented with a 2-month history of headaches. On occasions the headaches were associated with redness and watering of her left eye. She denied any visual loss or visual symptoms. Her visual acuity was reduced to 6/30 in her left eye. Fundal examination revealed a unilateral chorioretinitis. Investigation did not reveal a specific cause for the chorioretinitis. Over 15 months her visual acuity improved to 6/9 but the fundal appearance changed and a diagnosis of DUSN was made. She was treated with focal laser, systemic anti-helminthic and immunosuppressive treatments but continued to develop new, active areas of chorioretinitis, raising the possibility of multiple worms in the sub-retinal space. There is also a concern as to other central nervous system (CNS) involvement given her significant and ongoing headaches.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2352_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2352_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..93891d80735436433554d3da574f66fca10e9eb5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2352_en_sum.txt
@@ -0,0 +1 @@
+A 70-year-old female with retropharyngeal abscess developed features of Lemierre syndrome. The condition was managed with serial aspiration of the abscess and prolonged usage of intravenous antibiotics.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2382_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2382_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..95e482c070e0d6ca49bc8005814b429535acdee4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2382_en_sum.txt
@@ -0,0 +1 @@
+We present the case of a 66-year-old Macedonian man with synchronous rectal signet ring cell carcinoma and RCC with tumor to tumor metastasis feature. He underwent a left nephrectomy and anterior rectal resection after complaining of constipation for 3-4 months and the appearance of synchronous tumors on the imaging studies. Morphology and immunohistochemical analysis of specimens from the RCC revealed signet ring cells identical to the rectal signet ring cell carcinoma. The next-generation sequencing study revealed mutations in TP53 and ERBB2, and microsatellite stable signet ring cell carcinoma was determined by deoxyribonucleic acid (DNA) sequencing.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2426_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2426_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6a52d043a0103d4c903d99c538be730f98b6152c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2426_en_sum.txt
@@ -0,0 +1 @@
+A 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. She also had stenosis and aneurysmal dilatation of right subclavian artery. Takayasu arteritis was diagnosed subsequently. She was started on aspirin and high dose steroids.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2438_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2438_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7a7f9de2413b4474ab42786e8ec8e619a12ebd48
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2438_en_sum.txt
@@ -0,0 +1 @@
+A 52-year-old woman with primary Sjögren's syndrome developed membranous glomerulonephritis and Epstein-Barr virus-positive diffuse large B-cell lymphoma (DLBCL). She was diagnosed with Sjögren's syndrome based on the dry eyes, dry mouth, positive anti-nuclear antibody test, anti-Ro (SS-A) antibody, salivary gland biopsy, and salivary scintigraphy. Moreover, renal biopsy confirmed the diagnosis of membranous glomerulonephritis. Three months later, her small bowel was perforated with pneumoperitoneum, and the biopsy revealed Epstein-Barr virus-positive DLBCL.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2460_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2460_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b3709e44704ff131c60355cfde82a7adbb95546d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2460_en_sum.txt
@@ -0,0 +1 @@
+A 63-year-old man was admitted to our hospital for treatment of a liver tumor. After examination, he was diagnosed with hepatocellular carcinoma with a diameter of 40 mm in segment 8. Contrast-enhanced computed tomography scan showed a portal vein passing between the duodenum and pancreas, hence called PPPV. At the hepatic hilus, the portal vein branched off in a complicated course with some porto-portal communications. We determined that anatomical resection with manipulation of the hepatic hilum in this case resulted in major vascular injury. Therefore, we performed partial liver resection, and the patient was discharged uneventfully on postoperative day 14.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2489_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2489_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fa41e13eaea8fbaec2b4efa87541d4a35c424565
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2489_en_sum.txt
@@ -0,0 +1 @@
+A 26-year-old pregnant woman was admitted to our hospital for more than 2 months following the discovery of pancytopenia and increased creatinine. Ultrasonography detected an enlarged left liver lobe, widened hepatic portal vein, splenomegaly, and dilated splenic vein. In addition, both kidneys were obviously enlarged and sonolucent areas of varying sizes were visible, but color Doppler flow imaging revealed no abnormal blood flow signals. The gestational age was approximately 25 weeks, which was consistent with the actual fetal age. Polyhydramnios was detected but no other abnormalities were identified. Magnetic resonance imaging revealed that the liver was plump, and polycystic liver disease was observed near the top of the diaphragm. The T1 and T2 weighted images were the low and high signals, respectively. The bile duct was slightly dilated; the portal vein was widened; and the spleen volume was enlarged. Moreover, the volume of both kidneys had increased to an abnormal shape, with multiple, long, roundish T1 and T2 abnormal signals being observed. Magnetic resonance cholangiopancreatography revealed that intrahepatic cystic lesions were connected with intrahepatic bile ducts. The patient underwent a genetic testing, the result showed she carried two heterozygous mutations in PKHD1. The patient was finally diagnosed with CD with concomitant ARPKD. The baby underwent a genetic test three months after birth, the result showed that the patient carried one heterozygous mutations in PKHD1, which indicated the baby was a PKHD1 carrier.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2500_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2500_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..71bf9782e88a7fafc9f6085926aaf94369cee09a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2500_en_sum.txt
@@ -0,0 +1 @@
+We describe a 9-month-old boy with acute onset high fever and vomiting. The ultrasonography demonstrated micro-gas bubbles continuously floating in the intrahepatic portal vein. Contrast-enhanced CT, performed 1 h later from echography, revealed a whirlpool sign suggesting an intestinal malrotation with midgut volvulus, but with no signs of residual intrahepatic gas. Operative findings showed a mild volvulus with neither congestion nor ischemic change of the twisted bowel. Detorsion and Ladd's procedure were completed laparoscopically.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2502_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2502_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f0064d7ac56ead4ef4b9d2c98d0cccd8c0b6ce42
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2502_en_sum.txt
@@ -0,0 +1 @@
+A 57 year-old woman presented with sudden onset chest pain and ventricular fibrillation after hearing of her brother's death. The electrocardiography indicated "anterior wall ST segment elevation myocardial infarction". Coronary angiography ruled out obstructive lesion in the major coronary arteries, but revealed fibromuscular dysplasia of the distal left anterior descending artery. The ventriculography showed remarkable ventricular dilation, which affected much broader myocardium than the culprit vessel supplied. In a subsequent cardiac magnetic resonance study, delayed contrast (gadolinium) image revealed a focal left ventricular (LV) apical infarction. Her LV systolic function normalized within 1 week, except for a residual apical hypokinesis. She developed recurrent chest pain and LV dilation when she was laid off 9 months later. After supportive therapy, her symptoms improved and LV dysfunction normalized again.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2507_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2507_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a8d7e1613c7c9684818dfb262a47b9ea16cdf49a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2507_en_sum.txt
@@ -0,0 +1 @@
+A 68-year-old male with severe right internal carotid artery stenosis and left internal carotid artery occlusion underwent right stenosis stent implantation. Restlessness and left limb hemiplegia occurred within 24 h after the procedure, which was similar to hyperperfusion syndrome. However, postoperative computerized tomography perfusion (CTP) revealed abnormal hypoperfusion in the right hemisphere. Transcranial Doppler (TCD) also showed decreased flow velocity in the right middle cerebral artery, and increased flow velocity in the right anterior cerebral artery. We considered that intracerebral steal phenomenon might be the cause, then hypervolemic therapy was accepted and the symptoms completely resolved after 3 days.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2560_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2560_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..34207a7dae3b355115844450a2f9886437680f49
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2560_en_sum.txt
@@ -0,0 +1 @@
+We herein report a case of symptomatic bilateral severely calcified RAS, treated successfully with intravascular ultrasound (IVUS)-guided coronary and peripheral intravascular shockwave lithotripsy systems and stenting.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2584_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2584_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..314d0339f659faf53b2758f809c0edcd2fdd3e1f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2584_en_sum.txt
@@ -0,0 +1 @@
+A 56-year-old man was referred to our hospital with abdominal distension and discomfort. A computed tomography scan showed a huge mass located between the stomach and transverse colon. The preliminary differential diagnoses were sarcoma with a mucinous component, gastrointestinal stromal tumor, lymphangioma, and mesenteric cyst. Upper and lower endoscopy was not performed because the patient declined. The patient underwent surgical resection, and the tumor was completely removed. Macroscopic examination revealed a 39-×26-×20-cm tumor weighing 13,000g. On histological examination, the tumor was diagnosed as a myxoid liposarcoma in the gastric submucosa. The patient was still doing well 2 years postoperatively.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2603_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2603_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..737fd014ede63a33b9340cd9c193c7246f334be1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2603_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of Streptococcus salivarius bicuspid aortic and mitral valve endocarditis with concurrent spontaneous mycotic aneurysm rupture and acute subarachnoid haemorrhage (SAH). A 40-year-old man with history of intravenous drug abuse presented to our emergency department with altered mental status and dyspnoea. Echocardiography documented large vegetations on a bicuspid aortic valve and on the mitral valve, causing acute severe aortic and mitral regurgitation. Brain computed tomography imaging documented a ruptured fusiform aneurysm in a distal branch of the right middle cerebral artery causing acute SAH and acute obstructive hydrocephalus. An external ventricular drain was emergently placed and endovascular embolization of the aneurysm was achieved with deployment of six coils. Blood cultures grew S. salivarius and antibiotic therapy according to microbiological sensitivities was administered. Hospital stay was complicated by acute heart failure, ST-elevation myocardial infarction, conduction disturbances, cerebral vasospasm, recurrent mycotic aneurysm rupture, and death.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2609_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2609_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8209064f7f0e5d5203bd8e6274eaa91fd4bd93c8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2609_en_sum.txt
@@ -0,0 +1 @@
+A 57-year-old woman presented with a 19-year history of a giant right orbital mass. Orbital computed tomography (CT) revealed an inhomogeneously-enhancing mass compressing and engulfing the eyeball and optic nerve. She underwent lid-sparing orbital exenteration. Microscopic characteristics and immunohistochemistry (IHC) tests were indicative of a benign SFT. No recurrence was observed at the 4-year follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_260_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_260_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c4820fafaa7434307e6387ae35778611fde3a685
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_260_en_sum.txt
@@ -0,0 +1 @@
+We report the case of a 2-year-old girl diagnosed with dilated cardiomyopathy associated with homozygous mutation in the Myosin Light Chain 3 gene admitted for edema in lower extremities, muscle weakness, lethargy and vomiting, and she was found to be in cardiogenic shock. Chest x-ray showed cardiomegaly and EKG showed first degree atrioventricular block. Echocardiogram showed severe biventricular systolic and diastolic dysfunction. After 70 days of hospitalization, the patient went into cardiac arrest with cessation of electrical and mechanical activity of the heart, despite cardiopulmonary resuscitative efforts.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2631_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2631_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d949d1b42993e1251b4d34d5a260a5e2b23fd713
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2631_en_sum.txt
@@ -0,0 +1 @@
+A 73 year-old man presented with confusion and was found to have widely disseminated sebaceous carcinoma with metastases to brain, lungs, liver, bowel, lymph nodes, and bone. Following initial treatment of the brain metastases with surgery he received post-operative radiosurgery. He then began systemic immunotherapy with pembrolizumab. After 6 months, he developed a near complete response to therapy by irRECIST and RECIST v.1.1. The response was associated with circulating CD8+ T cells with central memory (CM) and effector memory (EM) phenotype and mature CD16 + CD57+ NK cells. During treatment the patient developed adrenal insufficiency requiring high-dose systemic corticosteroids and later adrenal replacement therapy. After 12-months of follow-up he showed imaging evidence of progression in liver, mediastinum, and abdominal lymph nodes. Given persistent, strong PD-L1 expression he resumed pembrolizumab therapy and showed radiographic evidence of an ongoing response to therapy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2645_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2645_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..accef84d6d4be3b2134d4749649da146c0bd7c65
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2645_en_sum.txt
@@ -0,0 +1 @@
+A 40-year-old woman presented with multiple uterine leiomyomas, one of which is a giant uterine leiomyomas (approximately 8 cm in diameter) that gradually shrinked after delivery. At over two months postpartum, the large myometrial leiomyoma had transformed into a submucosal leiomyoma, and over 3 years postpartum, both the submucosal leiomyoma and multiple intramural leiomyomas completely regressed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2648_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2648_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8e4d20fd5a02a96714eca07666ff6546e3bc70c6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2648_en_sum.txt
@@ -0,0 +1 @@
+The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2650_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2650_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..941b6b22d2cf420e4e40c7df0bef359b86c32896
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2650_en_sum.txt
@@ -0,0 +1 @@
+We report on a 14-year-old overweight White Italian boy who suffered headache, diplopia, and severe bilateral papilloedema after a Mycoplasma pneumoniae infection, exacerbated on levofloxacin intake. A spontaneous improvement in headache and a reduction in diplopia was seen during hospitalisation. Oral acetazolamide therapy led to the regression of papilloedema in about five months. No permanent eye damage has been observed in our patient to date.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2679_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2679_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d91e87e3d10eea0d93b0a8f37ea6e84fd854ce84
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2679_en_sum.txt
@@ -0,0 +1 @@
+A 72-year-old Asian (Indian) man presented with scleritis following cataract surgery at another facility. He had been treated elsewhere for suspected scleritis, primarily with steroids followed by empiric antibiotic and antifungal agents. At our institute he underwent a complete microbiological workup and a scleral patch graft. The scleral scraping revealed fungal filaments. He was treated postoperatively with topical and systemic antifungal agent along with topical cyclosporine. The follow-up examination at 5 months revealed that the scleral patch graft was successful in maintaining the integrity of his globe and restoring partial vision.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2682_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2682_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..770dd9b090cff14aabf9fdd941b0f0fbd3675d1e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2682_en_sum.txt
@@ -0,0 +1 @@
+We report on a 64-year-old Caucasian man who developed P. acnes endocarditis four years following a composite valve-graft conduit replacement of the aortic root. Bacterial growth in blood cultures was detected after an incubation period of 6 days. However, the antibody titer to P. acnes was 1:8 at the time of diagnosis and declined slowly thereafter over 2½ years. The patient's response to the antibiotic treatment was excellent, and no surgical re-intervention was necessary.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_26_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_26_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a60651fc749cbaf08bc58b670a8885196dad4c9d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_26_en_sum.txt
@@ -0,0 +1 @@
+A 67-year-old Caucasian woman presented with palpitations, fatigue and weight loss. She had a history of total thyroidectomy for nontoxic multinodular goiter at the age of 60 without any signs of malignancy on microscopic examination. She had been medicated with levothyroxine 100 μg/day since the surgery without follow-up. She was tachycardic, had no cervical mass or eye involvement. Her thyroid-stimulating hormone levels were suppressed (0.000 μU/mL) and her free thyroxine (3.22 ng/dL) and free triiodothyronine (8.46 pg/mL) levels increased. Neither mediastinal enlargement nor trachea deviation was found on chest roentgenogram. Levothyroxine treatment was stopped but our patient showed no improvement on free thyroxine or free triiodothyronine 10 days later. Thyroglobulin was increased to 294 mg/mL. A cervical ultrasound scan revealed no thyroid remnant. Her anti-thyroid-stimulating hormone receptor antibodies were high (19.7 U/L). Corporal scintigraphy demonstrated increased intrathoracic radioiodine uptake. A computed tomography scan confirmed a 60 × 40 mm mediastinal mass. Methimazole 10 mg/day was started. Three months later, her thyroid function was normal and she underwent surgical resection. Microscopic examination showed thyroid tissue with no signs of malignancy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_275_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_275_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..465872d0262086316c866fb30d0c9680322fbfe0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_275_en_sum.txt
@@ -0,0 +1 @@
+Here we report a case of 21-year-old female, diagnosed with a de novo AML-M1 according to WHO classification and a CK at diagnosis. Cytogenetic, molecular cytogenetic approaches (standard fluorescence in situ hybridization (FISH), array-proven multicolor banding (aMCB)) and high resolution array comparative genomic hybridization (aCGH) analyses revealed a unique complex but still near diploid karyotype involving eleven chromosomes was identified. It included pentasomy 4, three yet unreported chromosomal aberrations t(1;2)(p35;p22), t(1;3)(p36.2;p26.2), and t(10;12)(p15.2;q24.11), and a combination of two cytogenetic events, yet unreported to appear in together, i.e. a reciprocal translocation t(1;3)(p36.2;p26.2) leading to EVI1/PRDM16 gene fusion, and monoallelic loss of tumor suppressor gene TP53. After successful chemotherapeutic treatment the patient experienced a relapse to AML-M1, and she developed secondary AML-M6 with tetraploidy and HH. Unfortunately, the young woman died 8.5 months after initial diagnosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2764_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2764_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1149bf15f262fab6df6e2c395d422e4591529865
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2764_en_sum.txt
@@ -0,0 +1 @@
+A 21-year-old woman presented with left upper quadrant pain, the cause of which could not be diagnosed. She returned to our hospital, 2 days later, without any pain improvement. Enhanced computed tomography showed splenic infarction and polysplenia. Initially, we could not identify the cause of the infarction and started conservative therapy, which did not result in any improvement. Hence, we performed a splenectomy, after securing informed consent. Because the patient was a young woman, we opted for a laparoscopic approach. During surgery, we identified the cause of the infarction as spleen pedicle torsion; the infarcted spleen was excised using an automated suturing device. We completed the laparoscopic surgery without converting it to an open laparotomy, and the patient was discharged 4 days later. This was a rare case of polysplenia with splenic torsion.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2781_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2781_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9f3e8f148b9eca3debd3e5720a63a9ec054886e6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2781_en_sum.txt
@@ -0,0 +1 @@
+We present the case of a pregnant woman who was diagnosed with venous sinus thrombosis after she developed headache and hemiparesis. Polymerase chain reaction (PCR) positivity lasted for two weeks after COVID-19 had been diagnosed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_278_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_278_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3cb1f8e200e94a84e220f94b2e39c7b43e15de00
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_278_en_sum.txt
@@ -0,0 +1 @@
+A 43-year-old man underwent radical total gastrectomy for gastric cancer. He underwent adjuvant chemotherapy with oral 5-fluorouracil (5-FU) for 2 years and regular follow-up. Twenty-nine months after gastrectomy, computed tomography (CT) was performed and revealed a solitary localized mass measuring 43 mm in diameter among retroperitoneal lymph nodes of the posterior inferior vena cava. This finding indicated that the previous gastric cancer recurred either in the lymph node or retroperitoneum. Second-line chemotherapy, consisting of oxaliplatin and 5-FU (FOLFOX) was administered in four cycles. However, serial CT scans showed increased tumor size. Retroperitoneal tumor did not respond to treatment, surgical resection was performed. Pathological findings led to a diagnosis of pleomorphic and epithelioid leiomyosarcoma without metastatic adenocarcinoma of the stomach.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2791_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2791_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..03a19d4b40f8df262aeb4c6ea77643d35ad7f387
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2791_en_sum.txt
@@ -0,0 +1 @@
+A seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2797_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2797_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..15c0e0d61ada568dc1b3ca89fe9be43c10f3f647
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2797_en_sum.txt
@@ -0,0 +1 @@
+We present a case of a 70-year-old Japanese man with multiple hepatocellular carcinomas in whom the replaced left hepatic artery arising from the left gastric artery needed to be embolized. After several failed procedures, the replaced left hepatic artery was successfully catheterized and embolized with a microcatheter and microcoils via the right gastric artery through the anastomosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_280_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_280_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f3d8af69d08f42e41a7bbc2d4ace25ebd066150f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_280_en_sum.txt
@@ -0,0 +1 @@
+A 35-year-old man who was thrombolyzed for anterior wall myocardial infarction in another city, reported to our hospital four weeks later with persistent angina. Coronary angiography showed severe multivessel coronary artery disease. There was diffuse disease in LAD distal to potential site of LIMA insertion and needed patch-plasty. We carried out a hybrid procedure by performing DCB angioplasty of mid-to-distal LAD through the LAD arteriotomy site during CABG followed by LIMA insertion to the LAD. The patient remained asymptomatic post procedure with a 6-month follow-up computerized tomography scan showing patent LIMA and mid-to-distal LAD.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2820_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2820_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..68671cbe2ead6a4a7e70a88c1aa5aa9af1a9912c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2820_en_sum.txt
@@ -0,0 +1 @@
+A 4-year-old white girl of Greek origin, with a dog-bite related trauma was admitted to the University Hospital of Crete, Greece, for surgical repair and intravenous antibiotic therapy due to extensive lesions. Exposure to the traumatic event triggered the onset of an unusual psychological response, selective mutism and acute post-traumatic stress disorder.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2823_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2823_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1104cabe3743b53554ab412add1f3fc27e1dbb18
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2823_en_sum.txt
@@ -0,0 +1 @@
+This report presents a case of a 7-year-old male patient with a PBI resulting from a nail that penetrated the left mastoid region following a fall from a tree. On admission, the patient maintained consciousness, displayed stable vital signs, and showed no neurological deficits. Crucial radiological examinations, including skull X-rays and head computed tomography (CT) scans, revealed a 6.5 mm caliber nail penetrating 5.5 cm into the brain, with intraventricular hemorrhage filling the bilateral posterior horns of the lateral ventricles. In addition, the CT angiography (CTA) of the head provided a visual of the internal carotid arteries and the vertebrobasilar artery system, obscured by metal artifacts but showing no evidence of thrombus, aneurysm, or vascular malformation. The patient underwent an urgent mastoidectomy and retro sigmoid craniotomy to remove a foreign object, involving a multidisciplinary team. Subsequent to the intervention, the patient sustained full consciousness without neurological impairments and received intensive care.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_283_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_283_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3ca65fed8d04306763c9598086e1185b398cb01d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_283_en_sum.txt
@@ -0,0 +1 @@
+The Authors report two cases of EPC of the lower limbs occurred in two women. Patients were treated by wide surgical excision of the lesion and SNLB. 6 months follow-up was disease free for both patients.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2855_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2855_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a67fa3779b8ee6ea2d8c520cb0a0435006637918
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2855_en_sum.txt
@@ -0,0 +1 @@
+We present a case in which a 67-year-old Caucasian female developed fatal haemolytic uremic syndrome in the immediate postoperative period of uncomplicated day care surgery. The patient had suffered gastrointestinal symptoms followed by confusion approximately two weeks before surgery, but had been without any symptoms in the week before surgery. Haemolytic uremic syndrome with cerebral symptoms ranging from initial anxiety to subsequent seizures and coma developed within a few hours after the end of surgery. In addition, acute kidney failure and severe thrombocytopenia occurred about the same time. During intensive care, the patient was found to be positive for enterohaemorrhagic E. coli (EHEC) in faeces.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2869_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2869_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..82eb45e711bd6b6fcfda3fb49c42bf94016f68fc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2869_en_sum.txt
@@ -0,0 +1 @@
+A 29-year-old female with epilepsy developed dysphagia, dyspnea and impaired exercise tolerance. Obstruction caused by swollen lingual tonsil and edema in the epiglottis and arytenoid mucosa were found. Lingual tonsil and epiglottis biopsies displayed non-necrotizing granulomas. There was no evidence of viral, bacterial, mycobacterial or fungal infections. Chest X-ray, computerized tomography of chest and ultrasound of neck and abdomen remained unremarkable. Positron emission tomography/computed tomography (PET/CT) showed laryngeal enhancement. Empiric antimicrobials combined with prednisolone were insufficient to control her disease. In immunological evaluation, the patient had normal counts of B and T cells. Proportions of CD27+ memory B cells (30.3%) and IgD-IgM-CD27+ switched memory B cells (7.2%; normal range 6.5-29.2%) were normal. Percentage of activated CD21low B cells was high (6.6%; normal range 0.6-3.5%). IgG (3.5 g/L; normal range 6.77-15.0 g/l) and all IgG subclass concentrations were low. Anti-polysaccharide responses were impaired, with 3/10 serotypes reaching a level of 0.35 µg/ml after immunization with Pneumovax®. The findings were consistent with hypogammaglobulinemia resembling CVID, possibly secondary to antiepileptic medication. Her dyspnea and dysphagia responded favorably to subcutaneous IgG and rituximab.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2874_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2874_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b5e6e7d4fdb662cc054f3b094d45c849f051a081
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2874_en_sum.txt
@@ -0,0 +1 @@
+We report a case of a 78y.o female patient with left bipolar clavicular fracture on ipsilateral reverse shoulder prosthesis, associated with multiple ribs fracture, that was treated with open reduction and internal fixation using k-wires and endobutton for the lateral part, while as the medial part was fixed with plate and screws.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2875_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2875_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..374939ea3155a62dd843a8850177c82dd1c453a4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2875_en_sum.txt
@@ -0,0 +1 @@
+We present a patient suffering from debilitating blepharospasm treated with bilateral DBS of the GPi alongside 7 years of stimulation parameter manipulations and a literature review of comparable patients.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_287_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_287_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..18f577e11775a43d31bf5b00c9b5b0e3fa8d6850
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_287_en_sum.txt
@@ -0,0 +1 @@
+A 45-year-old Chinese man was referred to our hospital for the treatment of right lumbago and odynuria. Ultrasound examination indicated the low echo on the right portion wall and the neck of the bladder. Computed tomography showed a remarkable enhancing large mass that measured 5.0 cm × 2.3 cm located on the right portion of the bladder with undefined margin. For further treatment, diagnostic transurethral resection of the bladder was performed, the postoperative histopathological diagnosis was EC complicated with CG. After transurethral resection, antibiotics, glucocorticoids, and antihistamines were treated. The patient recovered uneventfully and was discharged on postoperative day 8 without evidence of recurrence followed-up for 6 months.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2880_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2880_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dc340f82806aace5d4acb90356be05ac2d45df23
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2880_en_sum.txt
@@ -0,0 +1 @@
+An 11-month-old female infant of type 2 Peters anomaly presented with bilateral corneal opacity with distinct demarcation, keratolenticular adhesion and cataract, which was first noted at the age of 3 months. By peeling off the adhesion from corneal endothelium combined with lensectomy and vitrectomy, there was a gradual reduction in corneal opacity and improvement in visual acuity after surgery over a 2-year period. Her visual acuity had improved from light perception preoperatively to 20/50 at the latest follow-up. No sight-threatening postoperative complications were noted.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_290_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_290_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..00a5e3d4d0092bb7bc317edb279273d46562b91e
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_290_en_sum.txt
@@ -0,0 +1 @@
+A 68-year-old man was referred to our institution with a diagnosis of rectal cancer. He had complained of anal fistula for 5 years. Based on a recent history of cerebral infarction, Hartmann's operation was performed to treat the rectal cancer after the administration of preoperative chemotherapy for 3 months. However, 1 month after Hartmann's operation, the anal fistula was found to have worsened. Pelvic magnetic resonance imaging (MRI) revealed tumor formation at the perianal lesion. Metastatic anal fistula cancer originating from the rectal cancer was diagnosed based on the examination of the biopsied tissue. We selected local excision because the anal tumor had not invaded the surrounding tissue. There has been no recurrence in the 31 months after the curative operation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2924_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2924_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..098c0336da05251091a281211ccca2deb0e657f3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2924_en_sum.txt
@@ -0,0 +1 @@
+A six-month-old boy from Pakistan was brought to our hospital with tachypnea and supraventricular tachycardia and, on the basis of echocardiography and multi-slice computed tomography, was diagnosed with an anomalous left coronary artery origin from the pulmonary artery. The presence of an anomalous left coronary artery origin from the pulmonary artery was not initially recognized, and left ventricular dysfunction was considered as a result of supraventricular tachycardia. He underwent direct re-implantation of the left coronary artery to the aorta using the trapdoor flap technique. Recurrent episodes of supraventricular tachycardia resistant to maximal pharmacological treatment occurred post-operatively. A left posterolateral accessory pathway was successfully ablated by using a trans-septal approach.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2962_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2962_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c7738509d321d18863b0edae97277af1a25ec332
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2962_en_sum.txt
@@ -0,0 +1 @@
+A 52-year-old female was referred to our ophthalmology clinic with decreased vision and increased tearing. She was diagnosed with stage III Alport syndrome two years prior. Upon examination she was found to have average keratometries of 48 D bilaterally with tomographic evidence of keratoconus.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2997_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2997_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..174bf18e58fda14b8b3303df4a5e95fd88c751b0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2997_en_sum.txt
@@ -0,0 +1 @@
+We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60-70 mmHg). Coronary angiography revealed no obstructive coronary lesions.She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3001_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3001_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c42a8bd31968164ea8af9d5eadccce42083cf394
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3001_en_sum.txt
@@ -0,0 +1 @@
+Male school-age child, 8 years old, no relevant history, presented with a 1-year history of conjugate horizontal rapid eye movement jerking and associated mild miosis, 5-10 seconds in duration, occurring 5-6 times daily, with some episodes with a questionable disconnection from the environment or impairment of consciousness, without other accompanying signs or symptoms. General examinations were normal. He was evaluated by ophthalmologists and otolaryngologists who ruled out pathology in those fields. The neurological examination between episodes was normal. The video-electroencephalogram demonstrated an electro-clinical correlate, with epileptiform activity in the left temporal and occipital region that later generalized during episodes. The brain MRI was normal. After initiation of treatment with carbamazepine, he had a good evolution, with no recurrence of episodes at 2 years of follow-up.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3017_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3017_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..86d0912069bee84ba7d1c2927bba5bdbe99bd452
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3017_en_sum.txt
@@ -0,0 +1 @@
+We report an unusual case of female genital fistula secondary to a lobular capillary hemangioma. A 35-year-old Congolese woman presented with urinary incontinence associated with a vaginal "tearing" sensation during micturition. A suburethral vascular bud and vesico-vaginal fistula were observed on examination. Over 2 weeks, the fistula enlarged to involve the trigone and bladder neck, resulting in a semi-circumferential urethro-vesico-vaginal fistula. Histology revealed a lobular capillary hemangioma. During fistula repair, the edges with vascular clusters were freshened, the genital fistula was closed and the woman became continent of urine.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3024_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3024_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..90b098595198adbe69a1239496d055db14b9e8bd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3024_en_sum.txt
@@ -0,0 +1 @@
+We present the diagnostic process of a 51-year-old patient with a clinical history of a cough with yellowish expectoration, without symptoms of infection or fever, of long evolution. In the computed axial tomography, bilateral pulmonary infiltrates of an alveolar type were observed. A bronchoalveolar lavage was performed in which a yellowish material of unknown origin was obtained, which did not allow any clear conclusion to be reached. The pulmonary cryobiopsy was the key test that led to the diagnosis of exogenous lipoid pneumonia, in probable relation to the anorexia with purging habit that the patient suffered chronically.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_303_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_303_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..bb8e7ee1adc42b21296d1d96b95057dfaa5cef7c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_303_en_sum.txt
@@ -0,0 +1 @@
+A 90-year-old female with atrial fibrillation on therapeutic apixaban and status-post TAVR presented with COVID-19 infection and was found to have severe bioprosthetic valvular regurgitation with features suggestive of valve thrombosis. She underwent valve-in-valve TAVR with resolution of valvular dysfunction.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3064_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3064_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..73da53f280ad5201f6f3d8d71da96d1fb4b2d4f4
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3064_en_sum.txt
@@ -0,0 +1 @@
+A pediatric patient with weight deficit who developed FGC after surgery (esophagocoloplasty with right colon). FGC was treated endoscopically with double J ureteral catheters (CUDJ) with one end in the gastric lumen and the other end coming out through the skin orifice through the fistula. Laminar drainage was used to evacuate the intraabdominal cavity. The patient received feeding through a gastro-jejunal probe, with the diameter of the CUDJ being progressively reduced. At 92 days of the initial endoscopic therapy, the gastric orifice was closed. No serious complications or recurrences were recorded.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3074_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3074_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0bd9cb9f220db90e2dd63bce2324a7f2704b3d5d
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3074_en_sum.txt
@@ -0,0 +1,3 @@
+A 58-year-old man with a history of vitreous syneresis in both eyes and glaucoma presented with an abnormal, painful sensation of the left eye and mild hyperemia. Physical examination revealed peripheral ulcerative keratitis superiorly and a salmon-colored lesion in the superior conjunctiva.
+
+Results: The differential diagnosis of superior corneal thinning includes collagen vascular disease, Terrien's marginal degeneration, infectious keratitis, and other forms of peripheral keratitis. Our patient was diagnosed with conjunctival MALT lymphoma by surgical excision of the mass, and the peripheral ulcerative keratitis may be related to this diagnosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3078_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3078_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ed8a0d3ff19f010069b2c6cb6bb62f9d70c300ba
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3078_en_sum.txt
@@ -0,0 +1,7 @@
+Patient concerns: Patients with lung tumors, which had been surgically removed in the past. This time, the tumor occurred again, and the patient could not tolerate another surgical treatment. Other targeted treatments are not available due to financial and body constraints.
+
+Diagnoses: The case was diagnosed as invasive adenocarcinoma of the upper lobe of the right lung.
+
+Interventions: The patient received early surgical treatment, and then changed to traditional Chinese medicine (TCM) decoction treatment. The treatment principle of Chinese medicine is mainly to tonify healthy Qi and blood, enhancing the immunity of the body.
+
+Outcomes: After nearly 2 years of TCM decoction treatment, the recurrent tumor has shrunk significantly. No discomfort such as fatigue, fever or weight loss. During this period, the patient did not receive western medical treatment such as surgery and chemotherapy, which did not affect normal life. It also proves that Chinese medicine is effective.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3079_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3079_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..edbdf9821e1f1f7e19dd8c8069275f4472dce221
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3079_en_sum.txt
@@ -0,0 +1 @@
+We report the case of a 67-year-old man with a history of severe HS and major depressive disorder who came to our hospital complaining of dyspnea, fatigue upon exertion, and lower-extremity edema of 2 weeks’ evolution. Symptoms began after the re-initiation of adalimumab for his severe HS. During hospitalization, he was diagnosed with decompensated congestive heart failure (CHF). Extensive studies, looking for ischemic or infectious etiology, yielded negative results. Being aware of adalimumab’s potential adverse effects, the team discontinued the medication as a probable cause of his condition. Unfortunately, the patient died secondary to heart failure and septicemia.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3088_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3088_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..64d837f5e3860c6a6d7454ba24528f9e45a5f24b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3088_en_sum.txt
@@ -0,0 +1 @@
+We described a 38-year-old female patient with multiple sclerosis (MS) who was treated for three years with Natalizumab. Myalgia, fever, and erythematous plaques accompanied by painful lesions in both upper extremities manifested with the fifteenth dosage of NTZ. After comprehensive testing and a Magnetic Resonance Imaging (MRI) scan, we excluded other systemic diseases and a recurrence of multiple sclerosis, respectively. After consulting a dermatologist, a skin biopsy was performed, and pathology report confirmed PG. Eventually, the lesions began to heal after stopping NTZ injection without receiving any dermatological care.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3092_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3092_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..07e231dd2d6e339b521b8306a37072da676ee5c9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3092_en_sum.txt
@@ -0,0 +1 @@
+Male infant, 18 months old and the only child of a non-consanguineous couple. At birth, craniofacial dysmorphies (facial asymmetry, maxillary and mandibular hypoplasia, macrostomia, microtia grade 3 and appendage in the trago-oral line) were observed restricted to the right side of the face. Complementary examinations evidenced asymmetrical hypoplasia of the face and thoracic hemi-vertebrae. No cytogenetic or cytogenomic abnormalities were identified. The patient developed several episodes of respiratory discomfort, stridor and nausea, even though he had undergone gastrostomy and tracheostomy in the neonatal period. The investigation directed to the respiratory symptoms identified the compression of the esophagus and trachea by an aberrant right subclavian artery. After the surgical correction of this anomaly, the infant has not presented respiratory symptoms and maintains multidisciplinary follow-up seeking rehabilitation.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3097_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3097_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..55a1369e453d2e6bf3d3e2a864ee115e20f84670
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3097_en_sum.txt
@@ -0,0 +1 @@
+A 10-year-old child presented with chronic abdominal pain that started ten months ago. The patient had a family history of lymphoma in his brother. The computed tomography scan showed a sigmoid luminal mass measuring 10×3 cm with significant lumen narrowing and diffuse circumferential wall thickening of the sigmoid colon, hepatomegaly, and multiple perilesional, para-hepatic, and pulmonary lymph nodes enlargements. The mass was morphologically mimicked cancer and proved to be of bilharzial etiology (Schistosoma mansoni) after surgical excision.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3108_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3108_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2881b011e1e8518fd6d4d68e1d1796b353aeed00
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3108_en_sum.txt
@@ -0,0 +1 @@
+41-year-old multiparous, 23.6 weeks pregnant, admitted to a private high-complexity hospital for a significant decrease in bilateral visual acuity and headaches. A diagnosis of craniopharyngioma was made and expectant management was decided. The patient had a cesarean delivery without complications.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3116_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3116_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..db187a39214503c065aa4deee0b533a39bb5852a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3116_en_sum.txt
@@ -0,0 +1 @@
+A 60-year-old male with posttraumatic hydrocephalus underwent a ventriculo-peritoneal shunt. After initial clinical improvement, thirteen months later he developed gait deterioration and cognitive problems. Chest X-ray and computed tomography showed that the distal catheter of the shunt had migrated to the pulmonary artery. The catheter was removed surgically by reopening the pre-existing retroauricular incision and manual traction, without incident. A new peritoneal catheter was implanted with immediate clinical improvement. Two years later, the patient remains asymptomatic.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3166_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3166_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..57258da854cd8f5ab886637223a9917c4b6d228a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3166_en_sum.txt
@@ -0,0 +1 @@
+A 49-year-old man was admitted to the coronary care unit with a history of dilated cardiomyopathy, severely impaired left ventricular systolic function and severe bicuspid aortic stenosis, symptomatic for recently diagnosed syncope, angina and dyspnea. During the admission he developed cardiogenic shock that required double inotropic support. Due to his high surgical risk and high probability of rejection of a possible heart transplant, according to his histocompatibility studies, a transcatheter aortic valve replacement was performed with a favorable evolution.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_316_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_316_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6d15db0e3a186d38b656ad687b7351fa18b116fa
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_316_en_sum.txt
@@ -0,0 +1 @@
+A 53-year-old female presented after starting a low-carbohydrate ketogenic diet for weight loss. She reported xerostomia, nausea with abdominal pain and a 17-pound weight loss over the previous 22 days. Labs revealed an anion-gap metabolic acidosis with ketosis. She was treated with 5% dextrose in normal saline and a sliding scale insulin coverage. Her anion gap corrected during her hospital course and was discharged on hospital day three.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3174_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3174_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..72c2c0587f9d87a6f7c289029d611e22c52639d9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3174_en_sum.txt
@@ -0,0 +1 @@
+We report the case of a previously healthy 61-year-old male who sustained a sting from an Androctonus crassicauda scorpion to his right eye. The patient was admitted to the intensive care unit (ICU) in a comatose state immediately after the sting. A few days later, he suffered from tearing right-eye pain and loss of vision, which persisted despite initial treatment. The patient was subsequently diagnosed with keratitis and admitted to King Abdullah University Hospital (KAUH). He was prescribed various antibiotics, which initially improved his condition. However, the patient experienced subsequent deterioration and recurrent episodes of keratitis. The patient’s visual acuity improved after treatment with a combination of antifungal and antibiotic medications, suggesting a polymicrobial infection. Despite the improvement in his condition, the sting left a central corneal scar, necessitating corneal transplant surgery as a definitive treatment.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3181_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3181_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0e38cd8befe3d27e6a62186bdafb682597898ffd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3181_en_sum.txt
@@ -0,0 +1 @@
+34-year-old pregnant female patient presented to the emergency department with complaints of right iliac pain that had been worsening for the past 2 days with suspicion of acute appendicitis. Laboratory tests were requested, which were within the normal limits for infectious and inflammatory aspects. Imaging tests were also requested, with ultrasound being the method of choice, which revealed an ongoing pregnancy with no changes and a thickness of the appendix wall with no inflammatory signs. Still with suspicion of acute appendicitis, magnetic resonance imaging was performed, confirming the hypothesis of lipomatosis of the cecal appendix.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3216_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3216_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3c5039e2f1f17a5d464458158a46db014b850f80
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3216_en_sum.txt
@@ -0,0 +1,3 @@
+Carmi Syndrome is an extremely rare autosomal recessive genetic disorder characterized the coexistence of pyloric atresia and junctional epidermolysis bullosa, and with aplasia cutis congenita in approximately 28% patients. In this case, a full-term male neonate was born to a G4P2+1L1 multipara through cesarean section delivery in hospital in a non-consanguineous marriage with 4000mL of II°meconium-stained amniotic fluid. He was found extensive skin loss over lower legs and other parts, with scattered blisters and bilateral microtia. Plain abdominal X-ray revealed a large gastric air bubble with no gas distally. The mother had an intrauterine fetal loss previously for reasons unknown. The dermatologist diagnosed the newborn with Bart Syndrome, while the pediatric surgeon diagnosed congenital pyloric atresia(CPA). The parents refused further treatment and the neonate passed away about 30 hours after birth.
+
+Outcome: The neonate passed away about 30 hours after birth.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3237_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3237_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a38467547d9f7c4d6c52496318304a0e316a5c84
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3237_en_sum.txt
@@ -0,0 +1 @@
+A 49-year-old female reported to the clinical ophthalmic emergency room with complaints of decreased visual acuity, retrobulbar pain on eye movement and red color desaturation in her left eye. The ophthalmological examination revealed Snellen’s distance best-corrected visual acuity (DBCVA) of 1.0 in her right eye and 0.04 in her left eye, normal intraocular pressure in both eyes, left side relative afferent pupillary defect (RAPD), normal anterior segment of both eyes and normal fundus of the right eye. However, the optic disc was slightly elevated with marked borders in the left eye and optical coherence tomography (SD-OCT) confirmed increased peripapillary retinal nerve fiber layer thickness (RNFL) with a normal result for macular ganglion cell layer (GCL) thickness. Basic laboratory tests (sedimentation rate, c-reactive protein) were normal. Pattern visual evoked potentials (PVEPs, ISCEV Standard 2016) showed slightly increased latencies of P100 waves for a large (1° 4’) checkerboard in both eyes and a reduction of P100 amplitude for a large (1° 4’) and small (0° 16’) checkerboards in the left eye. The patient was referred for scheduled head and orbit imaging. The preliminary diagnosis was demyelinating ON for observation, no treatment was initiated. However, after two weeks, the patient was admitted to the hospital due to a visual acuity decrease to no light perception in the left eye and exotropia. Ocular examination showed an increase in left optic nerve disc edema, confirmed by examination of RNFL in SD-OCT. The magnetic resonance imaging (MRI) showed inflammatory thickening of the left optic nerve throughout its entire thickness involving the left side of the optic chiasm. The right optic nerve and the right side of the optic chiasm were normal. There were no specific changes in the brain and spinal cord imaging. The serological indirect immunofluorescence revealed a positive result for MOG-IgG. Treatment of 1 g per day of intravenous methylprednisolone for 3 days was initiated, followed by oral prednisone (1 mg per kg bw initially, with a reduction of 5 mg per week). Two weeks after treatment began, DBCVA of the left eye improved to counting fingers at 30 centimeters and the reduction of the optic nerve edema was visible, however, the eye was still in exotropia. A further two weeks later, DBCVA was 0.02, the angle of the exotropia decreased, there was no visible disc edema and RNFL was also within normal limits, but GCL reduction appeared. Kinetic perimetry performed at that time showed a narrowing of the visual field to central 10 degrees in the left eye. Three months after the beginning of the steroid treatment, DBCVA in the affected eye was 0.3 and only periodically did exotropia occur, no optic nerve disc edema was seen, however, a reduction of RNFL and GCL was observed in SD-OCT. To prevent the recurrence of ON, 20 mg of prednisone was planned to be maintained at least up to 6 months after the ON episode. However, the neurologist recommended maintaining treatment for up to one year and also added treatment with mycophenolate mofetil when the dose of 20 mg of prednisone was achieved. As there are currently no evidence-based guidelines for long-term follow-up in patients with MOGAD and some irreversible complications occurred in our case, treatment with mycophenolate mofetil will be continued till an undetermined point. At the examination of the patient’s left eye one year after the ON episode, DBCVA was 0.5, exotropia occurred only in moments of lack of concentration, and optic nerve neuropathy was visible at the fundus of the eye, which was confirmed by RNFL and GCL reduction in SD-OCT. In the PVEPs, the only abnormality was a prolongation of P100 latency for a small (0° 16’) checkerboard. The field of view has improved to 20 central degrees. All results from the patient’s right eye were normal and no episode of ON was observed during the one-year follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3239_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3239_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1970b4838ff31b83fdb9882c043e1494ab9b14a8
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3239_en_sum.txt
@@ -0,0 +1 @@
+This case report describes a 41-day-old full-term male infant who developed widespread annular, bullseye-shaped erythematous skin lesions one week after receiving the Bacillus Calmette-Guérin (BCG) vaccination. The infant, exclusively breastfed and without a significant past medical history, presented with these lesions but no associated systemic symptoms. Physical examination revealed characteristic targetoid lesions, sparing the face, palms, soles, and mucous membranes. Laboratory tests, including a complete blood count and infection markers, were within normal ranges except for a mildly elevated C-reactive protein. The differential diagnosis ruled out other conditions and EM diagnosis is confirmed. The infant was managed conservatively with supportive care, and the lesions resolved without the need for antibiotics or any additional therapy. The patient remained stable and was discharged with instructions for monitoring and follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3250_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3250_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..27af80414756e137d79f7370250595946c7c46d5
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3250_en_sum.txt
@@ -0,0 +1 @@
+A 67-year-old woman presented with a 2-month history of swelling of the centrofacial region, with an erythematous and edematous plaque; the episode was treated as facial erysipelas with antibiotics. In the absence of improvement, the diagnosis of cutaneous leishmaniasis in its erysipeloid form was suspected and then confirmed by a skin smear showing the presence of leishmania amastigotes. The patient was treated with metronidazole and clarithromycin for 30 days, with good progression.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3252_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3252_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..282c447415535a6b57895bd17843f9ffcb225c09
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3252_en_sum.txt
@@ -0,0 +1 @@
+A 57-year-old woman with a diagnosis of autosomal dominant polycystic kidney disease underwent deceased-donor liver transplantation for polycystic liver disease. She did not have any background lung disease, although her right lower lobe was mostly atelectatic due to a remarkably elevated diaphragm. The liver transplant itself was uneventful. A small hole was made in the right diaphragm during the dissection of the liver, but it was successfully repaired without any injury to the lung. On postoperative day 1, the chest radiograph revealed a round hypertranslucency on the right side, which was initially considered subphrenic air retention, and no further evaluation was made at that time. Given that the hypertranslucency persisted, follow-up computed tomography was performed on postoperative day 18, and revealed an air-fluid level above the diaphragm in the right thoracic cavity. Thoracoscopic investigation revealed an intrathoracic hematoma within a pneumatocele in the right lower lobe, which was not detected in the pretransplant computed tomography. The hematoma was removed, and the pneumatocele was resected.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_325_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_325_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..40d3ad004232338e7abcdfe8fa762587765d5b10
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_325_en_sum.txt
@@ -0,0 +1 @@
+An entire male dog was presented with a bloody discharge from its penis and tenesmus of 5 days' duration. A diagnosis of cystic uterus masculinus was made on the basis of the findings of abdominal ultrasonography and histopathology of tissues obtained during an exploratory laparotomy. In addition, a Sertoli cell tumour affecting both testes was diagnosed following scrotal castration. The cystic uterus masculinus was completely resected, after which the tenesmus and bloody discharge resolved. Thus, cystic uterus masculinus should be considered as a differential diagnosis for a paraprostatic cyst when such a lesion develops as part of the feminising effect of a Sertoli cell tumour.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3312_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3312_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d3d739a340bc983f72d1c2959130c1002d8c3496
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3312_en_sum.txt
@@ -0,0 +1 @@
+A 33-year-old male visited our clinic with complaints of progressive dysphonia and choking for two months. The patient did not experience dysphagia or dyspnea. There was no history of previous intubation, gastroesophageal reflux disease, or other chronic illnesses. Upon laryngoscopic examination, a polypoid lesion measuring 25×8 mm was found on the posterior commissure of the right vocal cord. No abnormalities were observed during the ear and nose examinations.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3316_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3316_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d78492461b1b8b8acf47d7066e00e4dfee7f1f3f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3316_en_sum.txt
@@ -0,0 +1 @@
+A 77-year-old female, known to have PD, presented with a head injury following a fall. Brain CT showed diffuse subarachnoid hemorrhage. The patient was started on Levetiracetam for seizure prophylaxis. Four days after, the patient dropped GCS from 15 to 9. She was having progressive exacerbation of Parkinson's disease symptoms. After ruling out all possible causes of PD exacerbation, Levetiracetam was gradually weaned until it was discontinued. Consequently, the patient had rapid significant clinical improvement after discontinuation of Levetiracetam.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_334_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_334_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9800904f9d4cc911a320d6be26f643a4c467591a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_334_en_sum.txt
@@ -0,0 +1 @@
+A 25-year-old G1P1 female with a past psychiatric history of a depressive episode in adolescence presented to the Emergency Department with her 5-month-old daughter, fiancée, and family 1 week after breastfeeding cessation. She endorsed sleep-deprived energy enhancement, unfulfilled goal-oriented productivity, hyper-talkativeness, hyper-sexuality and increased nicotine use. Concurrent depressive symptoms included hopelessness, worthlessness, poor concentration, lack of appetite, and ego-dystonic intrusive thoughts that she may kill herself or her child. She exhibited pressured speech, affective lability, expansiveness, distractibility, and tangential, grandiose, delusional self-referential content. Transient thoughts of self-harm and harm to her child were not associated with intent. Her family history was significant for a deceased mother who had bipolar I disorder. The patient was hospitalized for 5 days and diagnosed with bipolar disorder, type I, current episode manic with psychotic features with a mixed-feature specifier. Olanzapine and lithium were initiated and the patient's acute episode of mania resolved prior to discharge.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3364_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3364_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2a5f7f0b4d77a717428a61b37a9b261cd7ada721
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3364_en_sum.txt
@@ -0,0 +1 @@
+We present the case of an adult male patient with cerebral malaria by Plasmodium vivax, who starts with general discomfort and fever, then presents convulsions more than twice a day with loss of consciousness and motor functional limitation. He is given a thick drop where Plasmodium vivax trophozoites and depression of the three blood series are observed. He is given treatment with artesunate and clindamycin for five days, a blood transfusion and continues with primaquine for seven days. The patient shows clinical improvement with neurological sequelae in the left lower extremity.
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3378_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3378_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..91256512a7c911eef3db0e1f0d129495e69b6f79
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3378_en_sum.txt
@@ -0,0 +1,11 @@
+Patient: Male, 46
+
+Final Diagnosis: Yolk Sac tumor
+
+Symptoms: Shortness of breath
+
+Medication: —
+
+Clinical Procedure: Cardiac MRI • tumor resection
+
+The patient is a 46-year-old male with a history of testicular cancer that presented with dyspnea on exertion. He was found to have two large right sided intracardiac masses on echocardiography. Cardiac magnetic resonance imaging (MRI) was obtained to further investigate these masses. Right ventricular function was decreased and concern for right ventricular outflow tract (RVOT) obstruction was present. The patient was taken to the operating room (OR) for resection of the cardiac masses. Pathology revealed the masses to be yolk sac tumors. Despite urgent resection of the tumors, the patient deteriorated clinically, ultimately succumbing to heart failure.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3389_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3389_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5089c8d63af9b1e254a538be822aa71412b50660
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_3389_en_sum.txt
@@ -0,0 +1 @@
+A 53-year-old patient was admitted to the stroke unit with sudden onset of weakness on the left side and dysarthria. This patient had been diagnosed with symptomatic intracerebral artery stenosis two months previously and had been administered dual oral antiplatelet agents and an aggressive dose of atorvastatin. The patient underwent percutaneous transluminal angioplasty and stenting two weeks after admission. Interventional treatment was technically successful when a self-expandable Enterprise stent was used. She was followed up for 2 years after discharge, without any cerebrovascular incidents.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_338_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_338_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..75c67be9450a10e593aabc58dba92141f3dc45cb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_338_en_sum.txt
@@ -0,0 +1 @@
+Three cases of ophthalmic infections, including two cases of keratitis and one case of recurrent endophthalmitis caused by A. nidulans were diagnosed at the ocular microbiology section of a tertiary eye care center. One case of keratitis had a history of ophthalmic surgery and underlying diabetes mellitus. The case of recurrent endophthalmitis had undergone cataract surgery in the recent past. Diminution of vision was the most common presenting feature in all three cases. The microbiological diagnosis was made by conventional microscopy and culture techniques.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_339_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_339_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..79b0101baf2c3e754f9e027d695ec473176c29df
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_339_en_sum.txt
@@ -0,0 +1 @@
+We present a case of 49 years old male suffering from chronic lymphoedema of the left lower extremity who had developed a composite haemangioendothelioma with high grade angiosarcoma-like areas mimicking the Stewart-Treves syndrome. Given the multifocality of the disease, the only potentially curable surgical treatment would be hemipelvectomy, which was refused by the patient. The patient has been followed-up, with no signs of local progression of the remaining disease, nor a distant spread outside the involved extremity for two years.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_36_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_36_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dcb3155f1a71a2e71ddf860ea7b3abaa4d7eff21
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_36_en_sum.txt
@@ -0,0 +1 @@
+We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_391_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_391_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..173c8ff710de5b0de313a5386f517169e8454ba9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_391_en_sum.txt
@@ -0,0 +1 @@
+A 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud's phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_402_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_402_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6d80f695af28c98e267e1089c7557c4a26c1ff40
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_402_en_sum.txt
@@ -0,0 +1 @@
+A 71-year-old woman with cancer involving the pancreatic head, uncinate process, and SMV underwent pancreatoduodenectomy with SMV resection. Reconstruction used a portion of the right ovarian vein that was markedly dilated and had placed her at risk for pelvic congestion syndrome (PCS). Graft patency was confirmed 8 months after surgery. She now finished receiving adjuvant chemotherapy and has no symptoms of PCS.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_406_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_406_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7d03ab2f892c1ce75261b69dbb928a3e3b37bae9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_406_en_sum.txt
@@ -0,0 +1 @@
+A 62-year-old female presenting with sudden onset CP and infero-lateral ST-elevation in the electrocardiogram. The diagnosis of ST-elevation myocardial infarction was presumed and administered tenecteplase. The patient was immediately transported to a percutaneous coronary intervention centre. She complained of intermittent diplopia during transport and referred constitutional symptoms for the past 2 weeks. Coronary angiography showed normal arteries. The echocardiogram revealed moderate to severe left ventricular systolic dysfunction due to large areas of akinesia sparing most of the basal segments, and a mobile mass inside the left atrium attached to the septum. The cardiac magnetic resonance (CMR) suggested the diagnosis of myocarditis with concomitant left atrial myxoma. The patient underwent resection of the myxoma. Neurological evaluation was performed due to mild vertigo while walking and diplopia in extreme eye movements. The head magnetic resonance imaging identified multiple infracentimetric lesions throughout the cerebral parenchyma compatible with an embolization process caused by fragments of the tumour.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_421_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_421_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..adfbf9c224d2a55c7b1f49d4e3027b857675c860
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_421_en_sum.txt
@@ -0,0 +1 @@
+Here, we report the case of a 60-year-old female patient with a complaint of swelling in the left lower limb and pain for 5 days. Computed tomography angiography indicated MTS, and thrombus formation of left external iliac vein and femoral vein. The patient was diagnosed with deep venous thrombosis (DVT) and MTS. The patient underwent ascending venography from the lower extremity to inferior vena cava (IVC) and then to the pulmonary artery with IVC filter implantation, left iliac vein balloon plasty, and stent placement. The patient visited the hospital for the removal of IVC filter, 28 days after the operation. After the interventional therapy, the patient had no in-stent restenosis and had remission during the 2-year follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_430_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_430_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8ecfc6cf3e0b308495b0915af20e38fcb20042e9
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_430_en_sum.txt
@@ -0,0 +1 @@
+A 12-year-old boy presented with vision loss, headache and dizziness at our hospital. Magnetic resonance imaging (MRI) revealed a large (19.8 mm*18.5 mm*23.5 mm) irregular mass located in the suprasellar region. The mass was successfully removed after craniotomy and microsurgical treatment. The pathological diagnosis was left optic nerve HGB. Genetic analyses showed p.Pro86Leu (c. 257C>T) heterozygous missense mutations in the VHL gene.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_433_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_433_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..cf97064fb914998cd7f78e6796f391ee77ecf2bd
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_433_en_sum.txt
@@ -0,0 +1 @@
+A 43-year-old female diagnosed with metastatic leiomyosarcoma of unknown primary presented with a mild rash in sun-exposed areas of her face and upper chest, with no other neuromuscular symptoms. This rash resolved with systemic treatment with doxorubicin for metastatic leiomyosarcoma. Imaging assessment confirmed overall stable disease after chemotherapy completion. She presented acutely 2 months later with new onset rash in a shawl-like distribution, periorbital oedema and proximal muscle weakness. Based on the characteristic cutaneous signs and symmetrical proximal muscle weakness, abnormal electromyography and raised skeletal muscle enzymes with a positive anti-transcription intermediary factor-1 gamma antibody result, a diagnosis of paraneoplastic dermatomyositis was made. Re-evaluation of her metastatic leiomyosarcoma revealed disease progression. Second-line chemotherapy was commenced once the dermatomyositis was controlled on steroid therapy. Systemic anti-cancer therapy was again associated with mild improvement in dermatomyositis symptoms.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_452_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_452_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..83ec04669323d0379b950009d88bd36224f88d1f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_452_en_sum.txt
@@ -0,0 +1 @@
+A 37-year-old postpartum female was presented at a local hospital and was diagnosed with HER2-positive stage IIIB (cT4N1M0) invasive micropapillary adenocarcinoma in the left breast with left axillary metastatic lymph nodes. The patient failed to respond to two cycles of the doxorubicin plus cyclophosphamide (AC) regimen but achieved clinical partial response (cPR) after 4 cycles of the combination of pyrotinib, trastuzumab, paclitaxel and cisplatin (PTPC) regimen according to radiologic assessments. Then, she underwent left-side modified radical mastectomy (MRM) and achieved pathologic complete response (pCR), as confirmed by postoperative pathology. The patient held on receiving 2 cycles of the targeted therapy plus chemotherapy with trastuzumab, paclitaxel plus cisplatin (TPC) and adjuvant radiation therapy but continued to receive targeted therapy with trastuzumab and pertuzumab during the 1-year follow-up period. There has been no clinical evidence of disease progression so far.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_461_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_461_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9ae3e0a2abb01f6072221c16325cb9a637909d46
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_461_en_sum.txt
@@ -0,0 +1 @@
+We present the case of a 64 year-old Caucasian woman with a gigantic glomic tumor mass in the neck. Twenty years before the consultation, the patient had undergone an unsuccessful attempt to remove the mass. Over the last 3 years, the patient had felt enlargement of the mass at an increased rate, almost doubling the prior size. Angio magnetic resonance imaging showed a 9 cm paratracheal mass on the left cervical side that laterally displaced the sternocleidomastoid muscle and 2 c m of the trachea. Due to the change in the tumor behavior, the maxillofacial team at Ruber International Hospital decided to remove the tumor surgically after embolization. During the surgery the tumor was gently dissected from the carotid an removed from the carotid bifurcation uneventfully. Two small nodes adhering tightly to the internal carotid adventitia and the posterior torn hole were left in place to avoid any potentially life-threatening complications. The final biopsy confirmed the initial diagnosis of carotid body paraganglioma and showed a Ki-67 expression of 19%. Due to the aggressive growth behavior and high Ki-67 expression of the tumor, the patient was referred to the CyberKnife Unit of Ruber International Hospital for treatment of the remaining nodes.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_462_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_462_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..077fc6b530ef7ea3b6e572aa07c8cfebe0240976
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_462_en_sum.txt
@@ -0,0 +1 @@
+A 79-year-old male presents with acute-on-chronic back pain in the absence of risk factors or exposures, aside from age. On radiological imaging, spondylodiscitis of L3-L4 was diagnosed. Subsequently, a CT-guided biopsy was performed to aid in confirming microbiological aetiology. Listeria monocytogenes was grown in culture and patient received appropriate antibacterial therapy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_467_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_467_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eafd1e296e6893359c3702c5063733bb9bff6133
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_467_en_sum.txt
@@ -0,0 +1 @@
+A 70-year-old woman developed acute-onset lateral flexion of her trunk to the left side while standing, and she was admitted to our hospital. One month before, she had a mild head trauma with loss of consciousness. At 65 years of age, she noticed difficulty with walking and clumsiness with her hands. She was diagnosed as having PD (Hoehn and Yahr stage 2) and levodopa was initiated. Her symptoms were markedly improved. At 67 years of age, she developed orthostatic hypotension and was treated sequentially with fluids, compression stockings, and midodrine. Urgently performed brain computed tomography (CT) showed a CSDH in the right hemisphere resulting in a marked compression of the hemisphere. After surgical evacuation, her PS disappeared. She has fully recovered to her preoperative level of function.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_471_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_471_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..98f900dc61bc9319d55de0d3426404d9bc81791c
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_471_en_sum.txt
@@ -0,0 +1 @@
+Here we report a case involving a 72-year-old woman who experienced recurrent low back pain after undergoing two back surgeries. She was treated with erector spinae plane (ESP) block, which affected the dorsal rami of the spinal nerves from T12 to L5. Pain relief lasted for approximately 10 h after the initial block, and successful low back pain relief was achieved after a total of three trials.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_484_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_484_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b0801728667b5100907cc0f281a36241c572e4a0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_484_en_sum.txt
@@ -0,0 +1 @@
+A 78-year-old multiparous housewife was hospitalized at University Clinical Center because of painless, asymptomatic tumor of vaginal portion (posterior side). Tumor size was 7 millimeters in diameter. Internal genital organs did not present abnormalities. The patient underwent operative removal of the tumor and went to home at some day. At the histological examination the tumor presented as a angiomyofibroblastoma cervices uteri.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_488_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_488_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8345b424ce7abaf34f9ff728c5792a114cdb67bb
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_488_en_sum.txt
@@ -0,0 +1 @@
+A 44-year-old male patient with acute myeloid leukemia (AML) experienced a CMV-reactivation within the first 4 weeks of allogeneic hematopoietic-cell transplantation. Administration of LMV was initiated at day + 34. Due to increasing viral loads, LMV treatment was discontinued after 8 days. The patient was then administered with valganciclovir (valGCV) until viral DNA was undetectable. Due to neutropenia, valGCV treatment was switched to LMV secondary prophylaxis. For 4 weeks, the patient maintain virologic suppression. Then, CMV viral loads increased with a fast kinetic. Genotypic testing of the viral polymerase UL54, the kinase UL97 as well as the viral terminase UL56 and UL89 revealed the mutation C325Y in UL56, which is associated with the high level LMV resistance.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_490_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_490_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..024c3dd6af33c6856214e58cd7dfaff6ee35a89b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_490_en_sum.txt
@@ -0,0 +1 @@
+A 62-year-old woman presented with mental abnormality and forgetfulness for 3 months before she was admitted to our hospital. There were prodromal symptoms of fever before she had the mental disorder. Encephalitis was first suspected, and the patient underwent lumbar puncture and brain magnetic resonance imaging (MRI). A cerebrospinal fluid (CSF) examination indicated normal pressure, a normal white blood cell count, and slightly elevated protein and glucose levels. Coxsackie B virus, enterovirus, and cytomegalovirus tests showed normal results. Bacterial culture and Cryptococcus neoformans test results were negative. The contrast-enhanced MRI of the brain was normal. The brain diffusion-weighted imaging (DWI) showed a symmetrically distributed strip-shaped hyperintensity signal of the corticomedullary junction in the bilateral frontal, parietal, and temporal lobes. We considered the diagnosis of the NIID, and therefore, skin biopsy was performed. The electron microscopy revealed that intranuclear inclusions in the nucleus of fibrocytes existed and were composed of filaments.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_493_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_493_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..15a75d7f37b1cc14d37c2fb48278ee7aadd28aec
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_493_en_sum.txt
@@ -0,0 +1 @@
+We report the case of a prostate cancer patient presenting 5 years after robot-assisted laparoscopic prostatectomy with biochemical recurrence, no neurological symptoms, and in the absence of metastatic lesions in the body on conventional imaging. A solitary cerebral metastasis was detected using
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_49_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_49_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4e60a3305d8d56969398f455f304c91a59d2ee49
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_49_en_sum.txt
@@ -0,0 +1 @@
+We report the case of a 66-year-old white male who presented with painless jaundice. Clinical, laboratory and radiographic features demonstrated a cholestatic pattern of liver injury without significant abnormalities in the biliary tract. All workup for viral hepatitis and autoimmune diseases with liver involvement was negative. Liver biopsy showed acute necro-inflammatory changes suggestive of drug-induced liver injury. The patient had received 18 days of IV nafcillin for blood culture positive methicillin-susceptible Staphylococcus aureus (MSSA) four weeks prior to his presentation. He showed clinical and laboratory improvement of his liver functions with supportive care only.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_519_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_519_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..31f0f59041576ca683348efafd0ba83a3c207110
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_519_en_sum.txt
@@ -0,0 +1 @@
+Semi-emergent surgical ventricular restoration combined with ventricular septal rupture closure and coronary artery bypassing was performed in a 67-year-old male patient. Severe mitral regurgitation was detected after the weaning of cardiopulmonary bypass. Two key questions arose in the management of this condition: did the regurgitation exist previously and was dissimulated by significant left-to-right shunt, or it occurred secondarily to the Dor procedure? Which was the better management strategy, chordal-sparing mitral valve replacement or mitral plasty? We believed that severe mitral regurgitation was under-estimated pre-operatively and we performed an downsizing annuloplasty to treat mitral regurgitation. The outcomes were promising and the patient did well in follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_51_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_51_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a8f6ee7dc62c0fe669d1c32bc0643ba3a16b6b40
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_51_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of mixed adenoid cystic cancer of the breast with infiltrating ductal carcinoma in a 67-year-old Caucasian woman who underwent mastectomy with sentinel node biopsy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_527_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_527_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b16e61de060964c2061cf84656864019d84bd229
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_527_en_sum.txt
@@ -0,0 +1 @@
+We present a 51-years-old woman with relevant clinical history for breast cancer. The patient was admitted in the emergency department with jaundice, dark urine and pale stools. She was on the 10th day of hormonotherapy for recurrence of breast cancer, diagnosed 7 years previously. Usual causes of acute liver failure were excluded, all drugs were stopped and the imaging studies performed were positive only for steatosis. Nonetheless, ALF progressed and the patient died 4 days later. Autopsy demonstrated a massive intrasinusoidal infiltration of the liver by breast cancer cells.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_534_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_534_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..49dbff47a1be5293c81564c5009d354b213d26ac
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_534_en_sum.txt
@@ -0,0 +1 @@
+A 54-year-old male with dextrocardia situs inversus and ischemic left ventricular dysfunction developed ventricular tachycardia and fibrillation. Therefore, left- sided approach, dual chamber implantable cardioverter-defibrillator (ICD) was applied using a conventional method and standard equipment after complete evaluation of cardiac anatomy and vascular assessment.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_546_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_546_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..950a3e5fc6b63f1ef91a22ca4fdfe737dcd205e1
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_546_en_sum.txt
@@ -0,0 +1 @@
+This case study involves a middle-aged male patient with a history of drinking but no other liver diseases. A routine ultrasound examination showed a 6.0 × 5.5 cm inhomogeneous echo mass in the right lobe of the liver. The patient experienced no discomfort or other symptoms, and blood tests were normal. Imaging revealed a localized cystic-solid neoplasm in segment 6 of the liver that did not have the features of a malignant tumor. Surgical resection was performed. Based on imaging, macroscopic examination, and histological results, a final diagnosis of MCBH was made.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_550_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_550_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2fecc2ceffb52de14a3391ced2c8b5206ac94fe3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_550_en_sum.txt
@@ -0,0 +1 @@
+A 28-year-old Togolese woman was admitted for left hemibody sensory problems with ataxia. These problems were observed while the patient was hospitalized for a few days in the hepato-gastroenterology department for persistent vomiting, abdominal pain and hiccups lasting for about a month. The examination confirmed left hemibody ataxia with nystagmus when looking to the left, pronounced left osteotendinous reflexes, and left hemibody hypoesthesia up to the base of the neck. Encephalic magnetic resonance imaging (MRI) showed a hypersignal lesion in the bulbar more lateralized on the left in the fluid-attenuated inversion recovery sequence, not enhanced after a gadolinium injection. Biological assessment showed the presence of Mycobacterium tuberculosis deoxyribonucleic acid in the cerebrospinal fluid and a sedimentation rate of 120 mm in the 1st hour. The result of the anti-AQP4 antibody test was positive. Two months from the onset of digestive problems with Lhermitte's sign and hand and foot contracture access without vesico-sphincter problems were established. Cervical medullary MRI showed an additional intramedullary hypersignal lesion in the T2 sequence at the C2 level, not enhanced after a gadolinium injection. A second course of intravenous corticosteroids was administered, and anti-tuberculosis treatment was continued. The outcome was favorable. After 8 months of anti-tuberculosis treatment, the patient started immunosuppressive therapy (azathioprine 50 mg twice daily) to limit the risk of recurrence of NMOSD.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_59_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_59_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..090e71bd2bd8a8754330a8b65cecf4e81f549acf
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_59_en_sum.txt
@@ -0,0 +1 @@
+A 55-year-old man presented to our Respiratory Department because of mild morning hemoptysis for five weeks with occasional palpitations, having undergone futile antibiotic therapy for two weeks at his local hospital before admission. Symptoms of hemoptysis were alleviated with venous hemostatic drugs. 18F-FDG PET/CT was performed, showing a right atrial mass with multiple parenchymal nodules in lungs surrounded by ground-glass opacity, and indicated an intracardiac malignant tumor associated with pulmonary metastases, consistent with cardiothoracic CT and ultrasound. No evidence of infection or neoplasm was found using a fiberoptic bronchoscope. After multidisciplinary consultation and discussion, provisional diagnosis was established such that metastatic intrapulmonary hemorrhagic foci were secondary to intracardiac malignancy. A percutaneous biopsy from the left lung was carried out and but showed mild chronic inflammation of the lung. Therefore, urgent wedge resections for biopsy were performed from the right lung and the histopathology revealed angiosarcoma. The patient died of cardiorespiratory failure before anticancer therapy.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_631_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_631_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f6551401ec3b20612edd5f05f886dc24a84b09d0
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_631_en_sum.txt
@@ -0,0 +1 @@
+A 57-year-old woman 16 years of post-heart transplant with a previously unremarkable post-transplant course including protocol driven biopsies showing no rejection and a recent unremarkable screening nuclear stress test presented to our institution with clinical heart failure. Echocardiogram revealed graft dysfunction and endomyocardial biopsy showed no signs of cellular rejection, but evidence of AMR. The patient was treated with steroid and immunotherapy with clinical improvement but suffered several infectious complications and renal dysfunction requiring haemodialysis related to her immunotherapy treatment. Despite aggressive AMR management, donor-specific antibodies and symptoms persisted and CAV progressed.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_642_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_642_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7d270cb40e0e5429f14c4a19cd958b714e526ad3
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_642_en_sum.txt
@@ -0,0 +1 @@
+A 52 year-old diabetic woman collapsed at her home in front of an acquaintance. "Bloody vomit" was noted. Despite resuscitation efforts, the patient died. A complete autopsy was performed. The middle portion of the esophagus showed a 9 cm longitudinal ulcer situated 12 cm from the esophago-gastric junction. Microscopic examination showed complete sloughing of the esophageal epithelium with a striking subepithelial lichenoid lymphocytic infiltrate extending into the muscularis mucosae. The findings were considered compatible with lichenoid esophagitis. Laboratory studies also showed the presence of diabetic ketoacidosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_654_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_654_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..08f7e4a0d16f55920edbf3046597dd89511fd2a2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_654_en_sum.txt
@@ -0,0 +1 @@
+A 61-year-old woman presented to the emergency department after an intentional multiple drug overdose. Upon examination, she was somnolent with stable respiration and hemodynamics. Electrocardiography showed a prolonged QTc interval of 503 ms. The patient was admitted to the ICU for cardiopulmonary monitoring. During admission, the patient remained stable and showed improved neurologic function over time. After 22 h, a second ECG showed normalization of the QTc interval to 458 ms. However, 36 to 40 h after admission, our patient developed recurrent episodes of Torsades de Pointes (TdP) with loss of cardiac output, leading to cardiopulmonary resuscitation. Spontaneous circulation was restored after intravenous administration of magnesium sulphate. Retrospective serum analysis revealed fluoxetine concentrations of 2700 mcg/l.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_660_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_660_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e7a6ee1cb7d86f4b9289d5016fcc136b86d7037a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_660_en_sum.txt
@@ -0,0 +1 @@
+A 27-year-old Javanese man presented borderline intellectual functioning and striking dysmorphisms. A clinical diagnosis of Apert syndrome was previously made based on these clinical features. Furthermore, POSSUM software was used before molecular analysis and the result showed suspected Apert syndrome with a cut-off point of 14. Molecular genetic analysis of FGFR2, targeting exon 7, was performed by direct sequencing. In this patient, a missense mutation c.755C>G was detected, changing a serine into a tryptophan (p.Ser252Trp).
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_690_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_690_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f2bf7daafa360861ddd5f2724d22f626a7763fcc
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_690_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of disseminated sporotrichosis in a patient with poorly controlled human immunodeficiency virus infection. The patient was initially treated for bacterial skin infections. The differential diagnosis also included tuberculosis and syphilis. Only after appropriate specimens had been sent for microbiological and histopathological investigations was the diagnosis of disseminated sporotrichosis made and appropriate treatment started. The patient showed a good clinical response to itraconazole.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_698_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_698_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a3a211a1b143461d0d0f427604e6e17c07c76cf6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_698_en_sum.txt
@@ -0,0 +1 @@
+A 49-year-old woman with type 2 diabetes mellitus underwent PD for two years. Repeated exit-site infections led to subcutaneous pathway diversion two months ago. She was hospitalized with fever and abdominal pain as well as cloudy dialysis effluent. Laboratory data revealed increased serum C-reactive protein level and white blood cell (WBC) count in the effluent. Her exit site had no sign of infection, leading to the diagnosis of PD-related peritonitis. Initial therapy with intraperitoneal ceftazidime immediately ameliorated her symptoms, and the WBC count in the effluent normalized in five days. Culture test results of the dialysis effluent on admission were negative with no information regarding the infection route. However, mass spectrometry (MALDI Biotyper, Bruker Daltonics) successfully obtained the specific spectral pattern for C. canimorsus. She had four cats in her house and was advised not to allow the cats in the room where the bag exchange took place.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_712_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_712_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7ca882669d89b6f17f33a591ad27a57c7392240f
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_712_en_sum.txt
@@ -0,0 +1 @@
+We herein present the case of a 60-year-old man with slow response, behavioral changes, psychosis and sleep disorders. Laboratory test included serum hyponatremia, positive serum LGI1 and GABABR1 antibodies using transfected cell-based assays. Electroencephalogram exhibited moderate diffusion abnormality. The patient responded well to steroid impulse treatment and sodium supplement therapy, and did not recur during the follow-up.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_721_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_721_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dcdbbf12d21622b3c64b37eb44c18837ded90c01
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_721_en_sum.txt
@@ -0,0 +1 @@
+We report a case of a 71-year-old male suffering from pulmonary infection with severe coagulation disorder without bleeding symptoms. He also had a history of Parkinson's disease, Alzheimer's disease and cardiac insufficiency. Coagulation tests were normal at the time of admission, prothrombin time (PT) is 13.9 (normal, 9.5-13.1) seconds and the activated partial thromboplastin time (APTT) is 30.2 (normal, 25.1-36.5) seconds. But it turned severely abnormal after 20 days (PT: 136.1 s, APTT: 54.8 s). However, no anticoagulants such as warfarin was used and no bleeding symptoms were observed. Subsequent mixing studies with normal plasma showed a decrease in prothrombin times. Vitamin K deficiency was thought to be the cause of coagulation disorders considering long-term antibiotic therapy, especially cephalosporins, inadequate diet and abnormal liver function. After supplementation with 20 mg of vitamin K, coagulation dysfunction was rescued the next day and serious consequences were effectively prevented.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_738_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_738_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d750c84791022726ffe428243608419a445f6459
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_738_en_sum.txt
@@ -0,0 +1 @@
+We herein describe the steps of this technique and its successful performance in a 71-year-old man with end-stage renal disease.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_73_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_73_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5136fd8a9a9e543512d4b53714f480bc1e5507db
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_73_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of rectal adenoma with submucosal pseudoinvasion in a 48-year-old man. The patient was admitted to Jinhua People's Hospital due to a change in stool habit for 5 d. We performed colonoscopy, and the results suggested a submucosal bulge approximately 1.0 cm × 1.0 cm in size in the rectum 8 cm from the anal verge, with red surface erosion. Ultrasound colonoscopy was also performed and a homogeneous hypoechoic mass about 0.52 cm × 0.72 cm in size was seen at the lesion, protruding into the lumen with clear borders and invading the submucosa. Endoscopic surgery was then performed and the pathological specimen showed a tubular adenoma with high-grade intraepithelial neoplasia (intramucosal carcinoma) involving the adenolymphatic complex. In addition, we performed a literature review of rectal tubular adenoma with submucosal pseudoinvasion to obtain a deeper understanding of this disease.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_741_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_741_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2b78d816d9a0cb7bf4a89f8fe7f512a90a4edd71
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_741_en_sum.txt
@@ -0,0 +1 @@
+Undiagnosed foreign body aspiration mostly occurs in bronchial airway rather than larynx and can cause severe complications. In this article, we report a silent laryngeal foreign body aspiration to show that careful history taking and accurate evaluation of radiography are important factors for diagnosis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_758_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_758_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f96958cf1cbb1916b18c21a99321fde9e4ea20aa
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_758_en_sum.txt
@@ -0,0 +1 @@
+This work presents a 48-year-old patient, to whom an adenocarcinoma of the prostate has been proven by the pathohistological finding of transrectal biopsy, performed due to the elevated level of prostate-specific antigen (PSA). Nine years after the initial diagnosis, due to a gradual rise of PSA and tumorous enlargement of the left testis, left inguinal orchectomy and right orchectomy were performed. Metastatic dissemination of prostate adenocarcinoma into a testis was determined by a pathohistological analysis of the left testis.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_762_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_762_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1fc3ee9acb53a2c42fc7f7be84ab4efa9c76c9cf
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_762_en_sum.txt
@@ -0,0 +1 @@
+A 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA (T3N0M0) and underwent surgery in April 2014, followed by XELOX adjuvant chemotherapy. The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy. In May 2018, pancreatic metastasis was found and he underwent pancreaticoduodenectomy. After surgery, he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019. Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer. Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer (e.g., APC, TP53, KRAS and FBXW7). Blood circulating tumor (ct)DNA before adjuvant chemotherapy was undetectable with NGS, suggesting a favorable response to chemotherapy. The patient was alive and well at the latest follow-up visit, achieving a disease-free survival of 17 mo.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_784_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_784_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f1ad85989e635369b6c23f18587ce2a658f186ee
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_784_en_sum.txt
@@ -0,0 +1 @@
+A 20-year-old man with a 1-year history of diabetes mellitus was admitted to the Endocrinology Clinic. Physical examination revealed the dysmorphic facial features, and broad and foreshortened halluces. Laboratory examination indicated spherocytosis anemia, and hypogonadotropic hypogonadism. Bone mineral density analysis showed decreased bone density in the lumbar vertebrae. Brain CT showed calcification. Whole-exome sequencing revealed a 7.05-Mb deletion in 8p11 containing 43 OMIM genes, and a large in-frame deletion of exons 48-55 in the DMD gene. Metformin was given to the patient after which his blood glucose was well controlled. HCG was injected subcutaneously and was supplemented with calcium and vitamin D, which led to an improvement in the patient's quality of life.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_817_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_817_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2d9cda863a6c7ff7ffe8ab9470256cc5c9f6450a
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_817_en_sum.txt
@@ -0,0 +1 @@
+The patient was a 72-year-old man diagnosed with GC. Upper endoscopy revealed a type 3 tumor in the anterior wall of the stomach body. Multidetector computed tomography showed no obvious GC metastasis or inverted organs. The preoperative diagnosis was cStage IIB (i.e., cT3, cN0, and cM0) GC with SI. Although liver retracting and intracorporeal suturing required special attention, LDG with D2 LND and Billroth-I reconstruction were safely performed by reversing the usual procedure. The patient was discharged 10 days after the surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_836_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_836_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7275e277edc685d510a91b64a7d431440bc545c2
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_836_en_sum.txt
@@ -0,0 +1 @@
+This report describes the case of a 46-year-old Asian man who presented with fever, epigastric pain, and back pain for 1 month. A computed tomographic scan revealed ascites, mild lymphadenopathy, and left adrenal necrosis without hemorrhage. A blood test showed thrombocytopenia, anemia, and elevated C-reactive protein, alkaline phosphatase, and creatinine levels. Based on the edema, severe thrombocytopenia, fever, reticulin myelofibrosis shown by bone marrow biopsy, mild lymphadenopathy, and progressive renal insufficiency, we diagnosed this patient as having TAFRO syndrome. He was successfully treated by immediate administration of glucocorticoids and tocilizumab.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_855_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_855_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..36e39152f1a25e744bd7a22404c7898f4e3b31a6
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_855_en_sum.txt
@@ -0,0 +1 @@
+A 14-year-old patient who came to our clinic with a traumatic crown fracture of the permanent, right central incisor is described. The patient had preserved the fragment that had broken off into his mouth and it was rebonded to the tooth using lasers (LightWalker device; Fotona, Ljubljana, Slovenia) with the following parameters: Er:YAG, SSP mode; 200 mJ; 10 Hz; quasi-contact tipless handpiece; Nd:YAG, SP mode; 4 W; 40 Hz; 300 μm contact fiber. The whole procedure was performed without the need for anesthesia.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_872_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_872_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6847e2f539cff332ba2db9260e5c48e9103d8e5b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_872_en_sum.txt
@@ -0,0 +1 @@
+We present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_87_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_87_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..93917de3a9c002c143eaab1c609669c5bb045011
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_87_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of a 47-year-old male patient presenting with weakness, difficulty swallowing (mainly liquids) and dysarthria. He was discovered to have low cortisol and TSH levels with high T4 and T3. These findings lead to the suspicion of a more complex disease process and through a thorough research of literature we discovered an association between myasthenia gravis and autoimmune polyglandular syndrome specifically type 2 which fits with our patients' presentation.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_902_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_902_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..96d604a5e4400bc953d42f6017badd4c3b98b86b
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_902_en_sum.txt
@@ -0,0 +1 @@
+We present a case of severely ill SARS-COV-2 infected 46-year-old man with fever, coughing and chest tightness. We performed viral detection using his BALF samples and imaging method (CT) for confirmation. The patient received combination of interferonalfa-1b and ribavirin, lopinavir and ritonavir for antiviral treatment at different stages. Other medication was also given to him in combination for anti-inflammation, intestinal microbial regulation, phlegm elimination, liver protection and pulmonary fibrosis prevention purposes. We provided oxygen supply to him using BIPAP ventilator and high-flow humidification oxygen therapy instrument to facilitate respiration. The patient was cured and discharged.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_940_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_940_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..07964922ab728e237451abcb3636d3405e112156
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_940_en_sum.txt
@@ -0,0 +1 @@
+A 43 year-old Chinese man with a 13-year history of eosinophilia and shortness of breath for 7 d presented to our hospital. During the course of his illness, the patient variably presented with gastrointestinal symptoms, eczema, vitiligo, mastitis, joint symptoms, nephrotic syndrome, and interstitial pneumonia. The chronic mastitis proved burdensome, necessitating bilateral mastectomy. HE was diagnosed by repeat bone marrow biopsy, and a kidney biopsy showed focal segmental glomerulosclerosis. Intermittent steroidal therapy is typically initiated to relieve such symptoms, although relapse and organ involvement often ensue once treatment is withdrawn. We administered methylprednisolone sodium succinate (40 mg/d) intravenously for 3 d, followed by oral tablets at the same dose. Subsequent computed tomography (CT) of the chest CT showed relative improvement of the interstitial pneumonia. The patient is currently on a continuous regimen of oral steroid, and his condition is stable.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_955_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_955_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..17a039ee26681df5f23f53f5b953a2719b8301ee
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_955_en_sum.txt
@@ -0,0 +1 @@
+We present a case of successful repair of an isolated common iliac artery aneurysm associated with a congenital pelvic kidney treated by an endovascular technique. A 75-year-old man was referred for the treatment of an asymptomatic left common iliac artery aneurysm. A computed tomography angiography revealed an isolated left common iliac artery aneurysm and a left pelvic kidney. The maximum diameter of the aneurysm was 32 mm. The congenital pelvic kidney was supplied by three small superior polar arteries that emerged from the proximal non-aneurysmal portion of the common iliac artery and the main artery that arose from the left internal iliac artery. The aneurysm exclusion was accomplished by using an iliac branch device (Gore Excluder Iliac Branch, Flagstaff, AZ). The 1 and 6 months computed tomography angiography after the procedure demonstrated complete exclusion of the aneurysm and preservation of all renal arteries.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_968_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_968_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ee31dfccf53cc1919cdc2844895b29902efa6856
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_968_en_sum.txt
@@ -0,0 +1 @@
+A 70-year-old man presented with chest discomfort. An echocardiogram showed the presence of a right ventricular tumor. A positron emission tomogram showed multiple foci of abnormal activity in right cervical lymph nodes, cardiac wall, and stomach. A right cervical lymph node biopsy specimen revealed histological features of DLBCL. An esophagogastroduodenoscopy showed a large circumferential ulceration on the gastric body. Subsequent biopsy revealed adenocarcinoma cells surrounded by infiltrating lymphoma cells. On immunohistochemical staining, lymphoma cells were positive for CXCR4 and adenocarcinoma cells were positive for CXCL12/SDF-1. The patient was treated with six cycles of R-CHOP chemotherapy regimen, resulting in a complete remission.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_971_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_971_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..87ed5b15067d799af944030a4f6c3d500dd32945
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_971_en_sum.txt
@@ -0,0 +1 @@
+A 33-year-old previously healthy male with no history of atopic disease presented with abdominal pain, hematochezia, peripheral eosinophilia as high as 10,000 eos/µL, right and left portal vein, mesenteric, and splenic vein thrombi with ischemic colitis resulting in hemicolectomy and small bowel resection. Despite an extensive workup for primary and secondary etiologies of hypereosinophilia by hematology/oncology, infectious disease, rheumatology and allergy/immunology, no other clear causes were identified, and the patient was diagnosed with idiopathic HES. His eosinophilia was successfully treated with high-dose oral corticosteroids (OCS) and subsequently transitioned to anti-IL-5-receptor therapy with benralizumab. He has continued this treatment for over a year with no recurrence of eosinophilia or thrombosis while on benralizumab.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_984_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_984_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..62a47bd4c1eb6ff2c751f4a281f66bcdd623f124
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_984_en_sum.txt
@@ -0,0 +1 @@
+We describe a case of tuberculosis (TB) dactylitis in a patient with AIDS who originated from the Ivory Coast. The diagnosis was established by direct visualization of acid-fast bacilli on joint fluid and bone biopsy of the proximal phalanx. Imaging of the chest revealed multiple bilateral nodules. Confirmation of the diagnosis was made by isolation of Mycobacterium tuberculosis from sputum and bone cultures.
\ No newline at end of file
diff --git a/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_998_en_sum.txt b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_998_en_sum.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9a8eccd7e26d9dd3c26466d5bd09653488bbbe48
--- /dev/null
+++ b/data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_998_en_sum.txt
@@ -0,0 +1 @@
+A 43-year-old Japanese woman underwent 70 Gy heavy-particle radiotherapy for a right choroidal malignant melanoma. Positron emission tomography-computed tomography examination was performed 4 years after treatment, when contrast accumulation was observed on the posterior wall of the stomach. Endoscopic ultrasonography and computed tomography showed a mass with contrast enhancement in contact with the stomach wall. Based on the imaging findings, a gastrointestinal stromal tumor of the posterior wall of the lower gastric corpus with extramural growth was suspected. Laparoscopic surgery was performed under general anesthesia. A black-pigmented tumor originating from the pancreas was discovered. Following an intraoperative diagnosis of metastasis of malignant melanoma, a laparoscopic distal pancreatectomy was performed. The pathological diagnosis was pancreatic metastasis of malignant melanoma. The patient was treated with adjuvant immune checkpoint inhibitors and chemotherapy after surgery, which led to long-term survival.
\ No newline at end of file