[
  {
    "index": 0,
    "original_id": null,
    "input_data": {
      "source_text": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
      "source_subclaims": [
        "The patient is a 20-year-old woman.",
        "She was followed up since the age of eight.",
        "She had idiopathic nephrotic syndrome.",
        "The idiopathic nephrotic syndrome was inaugurated by cerebral venous thrombosis.",
        "The cerebral venous thrombosis extended to the right jugular vein.",
        "She had a massive pulmonary embolism.",
        "She did not have any sequelae.",
        "She had no other medical or surgical history.",
        "A family history of thrombosis has not been reported.",
        "She was not biopsied.",
        "She had no kidney failure at first presentation.",
        "She had no gross hematuria at first presentation.",
        "She had no hypertension at first presentation.",
        "She had no extra renal signs suggestive of a secondary nephrotic syndrome.",
        "She was put on anticoagulant therapy.",
        "She was put on oral corticosteroid therapy.",
        "She had good evolution.",
        "She received several cures of high-dose corticosteroids.",
        "She was put on mycophenolate mofetil as background therapy.",
        "An exhaustive assessment of thrombophilia was performed.",
        "The assessment did not show any abnormality.",
        "The anticoagulant treatment was stopped after nine years.",
        "The evolution was enameled by several relapses.",
        "The relapses were controlled by oral corticosteroid therapy.",
        "Remission of nephrotic syndrome was noted since 2017.",
        "Mycophenolate mofetil was gradually stopped in 2019.",
        "The patient remained asymptomatic.",
        "The patient had no relapse.",
        "The patient came to the emergency department for acute intense diffuse abdominal pain.",
        "The pain was associated with postprandial vomiting.",
        "The pain was associated with bilateral lower limb edema.",
        "The physical examination revealed intense epigastric tenderness.",
        "The urinalysis showed proteinuria.",
        "The hemogasanalysis showed metabolic acidosis with respiratory compensation.",
        "The patient had hypoalbuminemia.",
        "The patient had hypercholesterolemia.",
        "The prothrombin time was at 90%.",
        "The D-dimer levels were high.",
        "The lactate dehydrogenase levels were high.",
        "The creatine phosphokinase levels were high.",
        "The CRP was 37 mg/L.",
        "The patient had leucocytosis at 26.4 x 103/µL.",
        "The patient was hospitalized in an intensive care unit.",
        "An abdominal ultrasound showed an intra-abdominal effusion.",
        "An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery.",
        "The CT scan showed acute mesenteric ischemia.",
        "The patient was routed to the operating room.",
        "Intraoperative exploration confirmed mesenteric ischemia.",
        "There was extensive necrosis of almost the entire small bowel.",
        "The resections were incompatible with life.",
        "The patient died after 48 hours."
      ],
      "gold_summary": "We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.",
      "gold_subclaims": [
        "The patient was a 20-year-old woman.",
        "She had a 12-year history of idiopathic nephrotic syndrome.",
        "She was diagnosed after extensive cerebral venous thrombosis with pulmonary embolism.",
        "She received anticoagulation therapy.",
        "She received oral corticosteroid therapy.",
        "She was treated with mycophenolate mofetil.",
        "Thrombophilia assessment did not show any abnormalities.",
        "She had several nephrotic syndrome relapses controlled by oral corticosteroid therapy until 2017.",
        "She did not have a relapse after 2017.",
        "Anticoagulant treatment was stopped.",
        "Mycophenolate mofetil was stopped.",
        "One year later, she presented with severe diffuse acute abdominal pain.",
        "She had postprandial vomiting.",
        "She had bilateral lower limb edema.",
        "Laboratory results confirmed a nephrotic syndrome relapse.",
        "An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery.",
        "The CT scan showed acute mesenteric ischemia.",
        "Intraoperative exploration showed mesenteric ischemia.",
        "There was extensive necrosis of the small intestine.",
        "Resection of the small intestine was incompatible with life.",
        "The patient died after 48 hours."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "She had a 12-year history of idiopathic nephrotic syndrome."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "She was diagnosed after extensive cerebral venous thrombosis with pulmonary embolism."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "She received anticoagulation therapy."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "She received oral corticosteroid therapy."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "She was treated with mycophenolate mofetil."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "Thrombophilia assessment did not show any abnormalities."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "She had several nephrotic syndrome relapses controlled by oral corticosteroid therapy until 2017."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "She did not have a relapse after 2017."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "Anticoagulant treatment was stopped."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "Mycophenolate mofetil was stopped."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "One year later, she presented with severe diffuse acute abdominal pain."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "Laboratory results confirmed a nephrotic syndrome relapse."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery."
        },
        {
          "gold_subclaim_id": "GS-17",
          "subclaim_text": "The CT scan showed acute mesenteric ischemia."
        },
        {
          "gold_subclaim_id": "GS-18",
          "subclaim_text": "Intraoperative exploration showed mesenteric ischemia."
        },
        {
          "gold_subclaim_id": "GS-19",
          "subclaim_text": "There was extensive necrosis of the small intestine."
        },
        {
          "gold_subclaim_id": "GS-20",
          "subclaim_text": "Resection of the small intestine was incompatible with life."
        },
        {
          "gold_subclaim_id": "GS-21",
          "subclaim_text": "The patient died after 48 hours."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "She had idiopathic nephrotic syndrome."
        },
        {
          "source_subclaim_id": "ST-4",
          "subclaim_text": "The idiopathic nephrotic syndrome was inaugurated by cerebral venous thrombosis."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "She had a massive pulmonary embolism."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "She was put on anticoagulant therapy."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "She was put on oral corticosteroid therapy."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "She was put on mycophenolate mofetil as a background therapy."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "An exhaustive assessment of thrombophilia was performed."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "The assessment did not show any abnormality."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "The anticoagulant treatment was stopped after nine years."
        },
        {
          "source_subclaim_id": "ST-23",
          "subclaim_text": "The evolution was enameled by several relapses."
        },
        {
          "source_subclaim_id": "ST-24",
          "subclaim_text": "The relapses were controlled by oral corticosteroid therapy."
        },
        {
          "source_subclaim_id": "ST-25",
          "subclaim_text": "Remission of nephrotic syndrome was noted since 2017."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "Mycophenolate mofetil was gradually stopped in 2019."
        },
        {
          "source_subclaim_id": "ST-28",
          "subclaim_text": "The patient had no relapse."
        },
        {
          "source_subclaim_id": "ST-29",
          "subclaim_text": "The patient came to the emergency department for acute intense diffuse abdominal pain."
        },
        {
          "source_subclaim_id": "ST-30",
          "subclaim_text": "The pain was associated with postprandial vomiting."
        },
        {
          "source_subclaim_id": "ST-31",
          "subclaim_text": "The pain was associated with bilateral lower limb edema."
        },
        {
          "source_subclaim_id": "ST-33",
          "subclaim_text": "The urinalysis showed proteinuria."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "The patient had hypoalbuminemia."
        },
        {
          "source_subclaim_id": "ST-36",
          "subclaim_text": "The patient had hypercholesterolemia."
        },
        {
          "source_subclaim_id": "ST-45",
          "subclaim_text": "An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery."
        },
        {
          "source_subclaim_id": "ST-46",
          "subclaim_text": "The CT scan showed acute mesenteric ischemia."
        },
        {
          "source_subclaim_id": "ST-48",
          "subclaim_text": "Intraoperative exploration confirmed mesenteric ischemia."
        },
        {
          "source_subclaim_id": "ST-49",
          "subclaim_text": "There was extensive necrosis of almost the entire small bowel."
        },
        {
          "source_subclaim_id": "ST-50",
          "subclaim_text": "The resections were incompatible with life."
        },
        {
          "source_subclaim_id": "ST-51",
          "subclaim_text": "The patient died after 48 hours."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-16",
          "source_subclaim_id": "ST-45",
          "subclaim_text": "An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-17",
          "source_subclaim_id": "ST-46",
          "subclaim_text": "The CT scan showed acute mesenteric ischemia.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-21",
          "source_subclaim_id": "ST-51",
          "subclaim_text": "The patient died after 48 hours.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 1,
    "original_id": null,
    "input_data": {
      "source_text": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
      "source_subclaims": [
        "The patient is a 34-year-old woman.",
        "She is eight weeks pregnant.",
        "She presented to the emergency department with generalized convulsions.",
        "The convulsions resolved progressively in less than two hours.",
        "On physical examination, she was conscious and oriented.",
        "There were no language, motor, or sensory deficits.",
        "Signs of a right lateral tongue bite were observed.",
        "Blood tests and electrocardiogram were normal.",
        "An urgent magnetic resonance of the skull was requested.",
        "The MRI identified multiple venous cortico-medullary vascular structures.",
        "The MRI findings formed the classic 'Medusa head' sign.",
        "The drainage vein showed increased signal on T1 sequences with central hypointensity after contrast.",
        "The surrounding brain tissue was hyperintense on T2 and FLAIR sequences.",
        "The findings are suggestive of a venous developmental anomaly.",
        "The patient was started on clexane 60 mg every 12 hours.",
        "The patient was started on levetiracetam 500 mg every 12 hours.",
        "The patient showed improvement and symptomatic stability after one week."
      ],
      "gold_summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
      "gold_subclaims": [
        "The patient is a 34-year-old pregnant woman.",
        "She presented with seizures.",
        "She presented with dysarthria.",
        "She was urgently referred for a cranial MRI.",
        "The classic ‘Medusa head’ sign was seen on imaging.",
        "The diagnosis was a venous anomaly of development.",
        "The venous anomaly was associated with peripheral partial thrombosis.",
        "The venous anomaly was associated with proximal slow flow."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "She presented with seizures."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "She presented with dysarthria."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "She was urgently referred for a cranial MRI."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The classic ‘Medusa head’ sign was seen on imaging."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The diagnosis was a venous anomaly of development."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The venous anomaly was associated with peripheral partial thrombosis."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "The venous anomaly was associated with proximal slow flow."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "She is eight weeks pregnant."
        },
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "She presented to the emergency department with generalized convulsions."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "An urgent magnetic resonance of the skull was requested."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "The MRI identified multiple venous cortico-medullary vascular structures."
        },
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "The MRI findings formed the classic 'Medusa head' sign."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "The drainage vein showed increased signal on T1 sequences with central hypointensity after contrast."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "The surrounding brain tissue was hyperintense on T2 and FLAIR sequences."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "The findings are suggestive of a venous developmental anomaly."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "The patient was started on clexane 60 mg every 12 hours."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "The patient was started on levetiracetam 500 mg every 12 hours."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "The patient showed improvement and symptomatic stability after one week."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-5",
          "source_subclaim_id": "ST-11",
          "subclaim_text": "The classic ‘Medusa head’ sign was seen on imaging.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 2,
    "original_id": null,
    "input_data": {
      "source_text": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
      "source_subclaims": [
        "The patient is a 22-year-old woman.",
        "She came to the Department of Oral Medicine with complaints of mouth ulcers.",
        "The mouth ulcers caused pain and difficulty eating and drinking.",
        "The symptoms persisted for one month.",
        "The condition began with a fever.",
        "The lesions appeared like pimples on the lips.",
        "She had been using pod-type vapes for about a year.",
        "She had never smoked traditional cigarettes.",
        "She tried different types of e-liquid with different flavors.",
        "She vapes almost every day, but not all day.",
        "She had no history of taking medications before the condition appeared.",
        "She had no history of drug or food allergies.",
        "She had unhealthy eating habits, including irregular eating and not consuming vegetables and fruit.",
        "Extraoral examination showed no lesions on other parts of the body.",
        "The lips had serosanguineous crusts and an erosive area at the corner of the mouth.",
        "Intraoral examination revealed white ulcers with yellowish edges.",
        "The ulcers were irregular, varied in size, and painful.",
        "The diagnosis was vaping-related oral erythema multiforme.",
        "The condition was classified as minor erythema multiforme.",
        "The treatment included 0.9% NaCl moistened in gauze placed on the lips three times a day.",
        "She was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day.",
        "She was given 2% miconazole cream applied to the wound twice a day.",
        "She was advised to stop vaping.",
        "She was instructed to avoid foods containing monosodium glutamate.",
        "Control after a week showed improvement in the oral condition.",
        "Written informed consent for the publication of details was obtained from the patient.",
        "The case report conformed with the Helsinki Declaration.",
        "The publication of the case report was approved by the institution."
      ],
      "gold_summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
      "gold_subclaims": [
        "The patient is a 22-year-old woman.",
        "She presented with stomatitis causing pain, eating, and drinking difficulty.",
        "The symptoms started with fever and pimple-like lesions on the lips.",
        "She was an active vape user for one year.",
        "Extraoral examination revealed no lesions on other body parts.",
        "Serosanguinolent crusts were present on the lips.",
        "An erosive area was noted on the labial commissures.",
        "Intraoral examination revealed white ulcers with yellowish edges.",
        "The ulcers were of irregular, varying sizes.",
        "The anti-HSV-1 IgG laboratory results were non-reactive.",
        "The diagnosis was oral erythema multiforme.",
        "Management included 0.9% NaCl compress.",
        "Dexamethasone mouthwash was used.",
        "Hyaluronic acid was applied.",
        "2% miconazole cream was applied on the labial commissures.",
        "Vaseline album cream was applied on dry lips.",
        "Vaping was stopped.",
        "The oral condition improved in a week of therapy."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "She presented with stomatitis causing pain, eating, and drinking difficulty."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The symptoms started with fever and pimple-like lesions on the lips."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "She was an active vape user for one year."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "Extraoral examination revealed no lesions on other body parts."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "Serosanguinolent crusts were present on the lips."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "An erosive area was noted on the labial commissures."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "Intraoral examination revealed white ulcers with yellowish edges."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "The ulcers were of irregular, varying sizes."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The anti-HSV-1 IgG laboratory results were non-reactive."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "The diagnosis was oral erythema multiforme."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "Management included 0.9% NaCl compress."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "Dexamethasone mouthwash was used."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "Hyaluronic acid was applied."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "2% miconazole cream was applied on the labial commissures."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "Vaseline album cream was applied on dry lips."
        },
        {
          "gold_subclaim_id": "GS-17",
          "subclaim_text": "Vaping was stopped."
        },
        {
          "gold_subclaim_id": "GS-18",
          "subclaim_text": "The oral condition improved in a week of therapy."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "She came to the Department of Oral Medicine with complaints of mouth ulcers."
        },
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "The mouth ulcers caused pain and difficulty eating and drinking."
        },
        {
          "source_subclaim_id": "ST-5",
          "subclaim_text": "The condition began with a fever."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The lesions appeared like pimples on the lips."
        },
        {
          "source_subclaim_id": "ST-7",
          "subclaim_text": "She had been using pod-type vapes for about a year."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "Extraoral examination showed no lesions on other parts of the body."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "The lips had serosanguineous crusts and an erosive area at the corner of the mouth."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Intraoral examination revealed white ulcers with yellowish edges."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "The ulcers were irregular, varied in size, and painful."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "The diagnosis was vaping-related oral erythema multiforme."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "The condition was classified as minor erythema multiforme."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The treatment included 0.9% NaCl moistened in gauze placed on the lips three times a day."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "She was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "She was given 2% miconazole cream applied to the wound twice a day."
        },
        {
          "source_subclaim_id": "ST-23",
          "subclaim_text": "She was advised to stop vaping."
        },
        {
          "source_subclaim_id": "ST-25",
          "subclaim_text": "Control after a week showed improvement in the oral condition."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-8",
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Intraoral examination revealed white ulcers with yellowish edges.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 3,
    "original_id": null,
    "input_data": {
      "source_text": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
      "source_subclaims": [
        "The patient is a 29-year-old woman.",
        "She is gravida V par IV.",
        "All four of her previous children are alive.",
        "She had three spontaneous vaginal deliveries.",
        "Her last child was delivered by cesarean section.",
        "The last cesarean section was for failed induction.",
        "The last cesarean section was 4 years prior to the current pregnancy.",
        "She came for ANC follow-up at 32 weeks gestational age.",
        "All four of her children are healthy.",
        "All four of her children are doing well in school.",
        "The children have no known history of genetic disorders.",
        "The children have no known history of seizure disorders.",
        "VDRL was negative.",
        "Hepatitis B surface antigen was negative.",
        "Urine analysis was negative.",
        "All cell lines in the CBC were normal.",
        "Her blood group is A.",
        "Her Rh is positive.",
        "Obstetric ultrasound showed normal anatomical scan of the fetus except the heart.",
        "Fetal echocardiography showed both atria have comparable size.",
        "Fetal echocardiography showed normal situs.",
        "Both atrioventricular and semilunar valves are normally positioned.",
        "Both ventricles are comparable in size.",
        "The left ventricle forms the apex of the heart.",
        "There is no ventricular septal defect.",
        "There were two circumscribed, round, echogenic masses on the papillary muscles of the left ventricle.",
        "The masses measured 18.2 mm by 8.3 mm and 13.5 mm by 8.3 mm.",
        "The LVOT and RVOT have normal anatomy.",
        "The LVOT and RVOT have normal function.",
        "A diagnosis of cardiac rhabdomyoma was made.",
        "There is a high chance of tuberous sclerosis in cardiac rhabdomyoma.",
        "Detailed neurosonography was done.",
        "Other system exams were done.",
        "No other signs of tuberous sclerosis were found.",
        "She had regular ANC follow-up from 32 weeks to 39 weeks.",
        "She underwent a cesarean section at 39 weeks plus 1 day.",
        "The cesarean section was for full-term pregnancy.",
        "The cesarean section was for the request for a repeat cesarean section.",
        "The neonate weighed 3200 grams.",
        "The APGAR score was 10 at 1 minute.",
        "The APGAR score was 10 at 5 minutes.",
        "The mother and neonate had a smooth post-operative period.",
        "The mother and neonate were discharged on the third day.",
        "The neonate was evaluated on the 1st, 7th, and 30th days.",
        "All physical examination results were normal.",
        "The mass size was similar to the antepartal evaluation.",
        "At 7 months, the child was evaluated.",
        "The child was growing appropriately for her age.",
        "An echocardiography study revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles.",
        "The masses measured 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm.",
        "The masses created no left ventricular inflow obstruction.",
        "The child was developing normally.",
        "All systems examined were unremarkable.",
        "Echocardiography showed no size increment of the masses.",
        "Echocardiography showed no left ventricular inflow obstruction."
      ],
      "gold_summary": "We are reporting an isolated, asymptomatic fetal intra-cardiac mass (rhabdomyoma) that was discovered at 32 weeks of gestation and was followed as an outpatient until 39 weeks plus one day, at which point a cesarean section was performed. After delivery, the child underwent evaluations at the 1st day, 7th day, 30th day, 7th month, and 12th month of age. Following a checkup, the child's anthropometric and neurobehavioral growth were both healthy. Except for the tumor, which was neither growing nor shrinking in size, none of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year.",
      "gold_subclaims": [
        "An isolated, asymptomatic fetal intra-cardiac mass was discovered at 32 weeks of gestation.",
        "The mass was followed as an outpatient until 39 weeks plus one day.",
        "A cesarean section was performed at 39 weeks plus one day.",
        "The child underwent evaluations at the 1st day, 7th day, 30th day, 7th month, and 12th month of age.",
        "The child's anthropometric growth was healthy.",
        "The child's neurobehavioral growth was healthy.",
        "The intra-cardiac mass was neither growing nor shrinking in size.",
        "None of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "subclaim_text": "An isolated, asymptomatic fetal intra-cardiac mass was discovered at 32 weeks of gestation."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "A cesarean section was performed at 39 weeks plus one day."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The child's anthropometric growth was healthy."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The child's neurobehavioral growth was healthy."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The intra-cardiac mass was neither growing nor shrinking in size."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "None of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "Obstetric ultrasound showed normal anatomical scan of the fetus except the heart."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "There were two circumscribed, round, echogenic masses on the papillary muscles of the left ventricle."
        },
        {
          "source_subclaim_id": "ST-30",
          "subclaim_text": "A diagnosis of cardiac rhabdomyoma was made."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "No other signs of tuberous sclerosis were found."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "She had regular ANC follow-up from 32 weeks to 39 weeks."
        },
        {
          "source_subclaim_id": "ST-36",
          "subclaim_text": "She underwent a cesarean section at 39 weeks plus 1 day."
        },
        {
          "source_subclaim_id": "ST-44",
          "subclaim_text": "The neonate was evaluated on the 1st, 7th, and 30th days."
        },
        {
          "source_subclaim_id": "ST-46",
          "subclaim_text": "The mass size was similar to the antepartal evaluation."
        },
        {
          "source_subclaim_id": "ST-47",
          "subclaim_text": "At 7 months, the child was evaluated."
        },
        {
          "source_subclaim_id": "ST-48",
          "subclaim_text": "The child was growing appropriately for her age."
        },
        {
          "source_subclaim_id": "ST-49",
          "subclaim_text": "An echocardiography study revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles."
        },
        {
          "source_subclaim_id": "ST-52",
          "subclaim_text": "The child was developing normally."
        },
        {
          "source_subclaim_id": "ST-54",
          "subclaim_text": "Echocardiography showed no size increment of the masses."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "source_subclaim_id": "ST-36",
          "subclaim_text": "A cesarean section was performed at 39 weeks plus one day.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 4,
    "original_id": null,
    "input_data": {
      "source_text": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n",
      "source_subclaims": [
        "The patient is a 13-year-old boy.",
        "The patient is from Cusco.",
        "The patient has a history of laryngeal papillomatosis since the age of two.",
        "At the age of three, the patient required a tracheostomy.",
        "The patient's mother has a history of genital papilloma.",
        "The patient was admitted to the San Borja National Institute of Child Health in Lima.",
        "The patient had a 16-day illness characterised by respiratory difficulties predominantly at night.",
        "The patient had inspiratory laryngeal stridor.",
        "The patient had moderate dysphonia.",
        "The patient previously received azithromycin.",
        "The patient previously received oxygen support.",
        "The patient's oxygen support did not improve symptoms.",
        "The physical examination revealed mild subcostal retraction.",
        "The physical examination revealed decreased vesicular murmurs in the left hemithorax.",
        "The physical examination revealed scanty wheezy breath sounds with predominance in the right hemithorax.",
        "The patient required oxygen support with a binasal cannula at 4 liters.",
        "The laboratory found leukocytes at 8.03 × 103/u.",
        "The laboratory found platelets at 209 × 103/u.",
        "The laboratory found hemoglobin at 13.2 g/dL.",
        "The laboratory found C-reactive protein at 36.6 mg/L.",
        "A chest radiograph was performed.",
        "A head and neck tomography was performed.",
        "48 hours after admission, the patient presented with increased stridor.",
        "48 hours after admission, the patient presented with increased respiratory difficulty.",
        "The patient was admitted to the emergency operating room for tracheostomy.",
        "The patient underwent microsurgery.",
        "The patient underwent excision of papillomatosis lesions.",
        "An appendicular tumour of papillomatose appearance was evident.",
        "Ventricular bands were evident in the epiglottis.",
        "Ventricular bands were evident in the glottic face.",
        "Ventricular bands were evident in the vocal cords.",
        "Ventricular bands were evident in the subglottis.",
        "Ventricular bands were evident in the trachea up to ring 5.",
        "The anatomopathological report reported coilocitic atypia due to HPV.",
        "The anatomopathological report reported mild focal dysplasia.",
        "In the immediate postoperative period, the patient was transferred to the paediatric intensive care unit.",
        "The patient received a single dose of bevacizumab 400 mg intravenous.",
        "The patient improved clinically.",
        "The patient remained hospitalised for seven days.",
        "The patient achieved clinical stability.",
        "The patient's oxygen saturation levels normalised.",
        "The patient had progressive weaning from oxygen.",
        "The patient was referred to the hospital in Breña to continue management.",
        "Telemonitoring was carried out after eight months.",
        "The family indicated no evidence of relapse.",
        "The family indicated no other intercurrences."
      ],
      "gold_summary": "A 13-year-old boy with a history of laryngeal papillomatosis since the age of two years was presented. The patient presented respiratory distress and multiple stenosing nodules in the larynx and trachea, and several pulmonary cysts were visualized on a chest tomography. The patient underwent exeresis of the papillomatosis lesions and tracheostomy. He received a single dose of 400 mg bevacizumab intravenous and respiratory therapy with a favorable evolution, without recurrence in the follow-up.\n",
      "gold_subclaims": [
        "The patient is a 13-year-old boy.",
        "He has a history of laryngeal papillomatosis since the age of two years.",
        "He presented with respiratory distress.",
        "Multiple stenosing nodules were found in the larynx and trachea.",
        "Chest tomography showed several pulmonary cysts.",
        "The patient underwent exeresis of the papillomatosis lesions.",
        "The patient underwent tracheostomy.",
        "He received a single dose of 400 mg bevacizumab intravenously.",
        "He received respiratory therapy.",
        "He had a favorable clinical evolution.",
        "There was no recurrence in the follow-up."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "subclaim_text": "The patient is a 13-year-old boy."
        },
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "He has a history of laryngeal papillomatosis since the age of two years."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "He presented with respiratory distress."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "Multiple stenosing nodules were found in the larynx and trachea."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "Chest tomography showed several pulmonary cysts."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The patient underwent exeresis of the papillomatosis lesions."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The patient underwent tracheostomy."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "He received a single dose of 400 mg bevacizumab intravenously."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "He had a favorable clinical evolution."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "There was no recurrence in the follow-up."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a 13-year-old boy."
        },
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "The patient has a history of laryngeal papillomatosis since the age of two."
        },
        {
          "source_subclaim_id": "ST-7",
          "subclaim_text": "The patient had a 16-day illness characterised by respiratory difficulties predominantly at night."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "The patient had inspiratory laryngeal stridor."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "The patient had moderate dysphonia."
        },
        {
          "source_subclaim_id": "ST-23",
          "subclaim_text": "48 hours after admission, the patient presented with increased stridor."
        },
        {
          "source_subclaim_id": "ST-24",
          "subclaim_text": "48 hours after admission, the patient presented with increased respiratory difficulty."
        },
        {
          "source_subclaim_id": "ST-25",
          "subclaim_text": "The patient was admitted to the emergency operating room for tracheostomy."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "The patient underwent microsurgery."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "The patient underwent excision of papillomatosis lesions."
        },
        {
          "source_subclaim_id": "ST-28",
          "subclaim_text": "An appendicular tumour of papillomatose appearance was evident."
        },
        {
          "source_subclaim_id": "ST-29",
          "subclaim_text": "Ventricular bands were evident in the epiglottis."
        },
        {
          "source_subclaim_id": "ST-30",
          "subclaim_text": "Ventricular bands were evident in the glottic face."
        },
        {
          "source_subclaim_id": "ST-31",
          "subclaim_text": "Ventricular bands were evident in the vocal cords."
        },
        {
          "source_subclaim_id": "ST-32",
          "subclaim_text": "Ventricular bands were evident in the subglottis."
        },
        {
          "source_subclaim_id": "ST-33",
          "subclaim_text": "Ventricular bands were evident in the trachea up to ring 5."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "The anatomopathological report reported coilocitic atypia due to HPV."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "The anatomopathological report reported mild focal dysplasia."
        },
        {
          "source_subclaim_id": "ST-37",
          "subclaim_text": "The patient received a single dose of bevacizumab 400 mg intravenous."
        },
        {
          "source_subclaim_id": "ST-38",
          "subclaim_text": "The patient improved clinically."
        },
        {
          "source_subclaim_id": "ST-44",
          "subclaim_text": "Telemonitoring was carried out after eight months."
        },
        {
          "source_subclaim_id": "ST-45",
          "subclaim_text": "The family indicated no evidence of relapse."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a 13-year-old boy.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-2",
          "source_subclaim_id": "ST-3",
          "subclaim_text": "He has a history of laryngeal papillomatosis since the age of two years.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-8",
          "source_subclaim_id": "ST-37",
          "subclaim_text": "He received a single dose of 400 mg bevacizumab intravenously.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-10",
          "source_subclaim_id": "ST-38",
          "subclaim_text": "He had a favorable clinical evolution.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 5,
    "original_id": null,
    "input_data": {
      "source_text": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
      "source_subclaims": [
        "The patient was a 54-year-old male.",
        "The patient had a medical history of membranous nephropathy II.",
        "The patient had nephrotic syndrome.",
        "The patient was administered long-term oral glucocorticoids.",
        "The patient had a 20 pack-year history of smoking.",
        "Chest x-ray demonstrated normal findings one month before admission.",
        "The patient was hospitalized on August 8, 2016.",
        "The patient had fever, progressive dyspnea, cough, and expectoration for 5 days before admission.",
        "On admission, the patient's body temperature was 39.0°C.",
        "The patient had severe hypoxemia with SaO2 86%.",
        "Chest CT scan revealed multiple ground-glass opacities.",
        "Laboratory tests showed elevated neutrophil count.",
        "The patient was diagnosed with RSV infection on the fourth day of hospitalization.",
        "The patient was given moxifloxacin for 4 days.",
        "The patient was given voriconazole for 10 days.",
        "The patient's condition worsened after 10 days of treatment.",
        "The patient was transferred to the Emergency Intensive Care Unit.",
        "The patient received noninvasive mechanical ventilation.",
        "The patient received methylprednisolone 40 mg bid iv.",
        "The patient received meropenem, moxifloxacin, and cotrimoxazole.",
        "The patient received micafungin.",
        "The patient received ganciclovir.",
        "Five days after ICU admission, the patient's condition was further aggravated.",
        "The patient received invasive ventilator-assisted ventilation therapy.",
        "The patient received methylprednisolone 80 mg bid.",
        "The patient received cefoperazone sulbactam, tigecycline, and cotrimoxazole.",
        "The patient eventually died after 2 days."
      ],
      "gold_summary": "Patient concerns:\nA 54-year-old male patient with chronic nephropathy, who received long-term immunosuppressants, was admitted to the Department of Respiratory Medicine due to the symptoms of fever, cough, expectoration, and dyspnea.\n\nDiagnoses:\nPulmonary radiology revealed multiple bilateral ground-glass opacity. Laboratory tests revealed elevated inflammation indicators, implying infection with bacteria, viruses, and/or fungi. Furthermore, the patient was positive for RSV antibodies, without positive results for other pathogens. Moreover, the patient was immunocompromised due to the long-term use of corticosteroids and immunosuppressants, as evidenced by decreased total IgG levels and reduced CD4 and CD8 T-lymphocyte counts.\n\nInterventions and outcome:\nDespite the intensive anti-infection treatment and respiratory support, the patient developed rapid progression, and subsequently died of respiratory failure.",
      "gold_subclaims": [
        "The patient is a 54-year-old male.",
        "The patient has chronic nephropathy.",
        "The patient received long-term immunosuppressants.",
        "The patient was admitted to the Department of Respiratory Medicine.",
        "The patient had symptoms of fever, cough, expectoration, and dyspnea.",
        "Pulmonary radiology revealed multiple bilateral ground-glass opacity.",
        "Laboratory tests showed elevated inflammation indicators.",
        "The patient was positive for RSV antibodies.",
        "The patient was negative for other pathogens.",
        "The patient was immunocompromised due to long-term corticosteroids and immunosuppressants.",
        "The patient had decreased total IgG levels.",
        "The patient had reduced CD4 and CD8 T-lymphocyte counts.",
        "The patient received intensive anti-infection treatment.",
        "The patient received respiratory support.",
        "The patient died of respiratory failure."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The patient had symptoms of fever, cough, expectoration, and dyspnea."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "Pulmonary radiology revealed multiple bilateral ground-glass opacity."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "Laboratory tests showed elevated inflammation indicators."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "The patient was positive for RSV antibodies."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "The patient was negative for other pathogens."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The patient was immunocompromised due to long-term corticosteroids and immunosuppressants."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "The patient received intensive anti-infection treatment."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "The patient received respiratory support."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "The patient died of respiratory failure."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-4",
          "subclaim_text": "The patient was administered long-term oral glucocorticoids."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "The patient had fever, progressive dyspnea, cough, and expectoration for 5 days before admission."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "The patient had severe hypoxemia with SaO2 86%."
        },
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "Chest CT scan revealed multiple ground-glass opacities."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "Laboratory tests showed elevated neutrophil count."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "The patient was diagnosed with RSV infection on the fourth day of hospitalization."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "The patient's condition worsened after 10 days of treatment."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "The patient was transferred to the Emergency Intensive Care Unit."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "The patient received noninvasive mechanical ventilation."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The patient received meropenem, moxifloxacin, and cotrimoxazole."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "The patient received micafungin."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "The patient received ganciclovir."
        },
        {
          "source_subclaim_id": "ST-24",
          "subclaim_text": "The patient received invasive ventilator-assisted ventilation therapy."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "The patient eventually died after 2 days."
        }
      ],
      "minimum_shared_key_subclaims": []
    }
  },
  {
    "index": 6,
    "original_id": null,
    "input_data": {
      "source_text": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
      "source_subclaims": [
        "The patient is a 34-year-old woman.",
        "She had a cesarean section in the 37th week of pregnancy two months before the current presentation.",
        "She had persistent bleeding from the surgical wound after the cesarean section.",
        "She denied a history of bleeding in childhood or adolescence.",
        "Three years earlier, she had a cesarean section for her first child, who died due to a chromosome disorder.",
        "She is allergic to tramadol.",
        "The clinical picture began with lower back pain due to bilateral renal lithiasis.",
        "She expelled a stone and then presented with haematuria for three days.",
        "She received tranexamic acid every 12 hours.",
        "Three weeks later, she presented with pain in the lower region of the left thigh that increased in intensity.",
        "She had hardening of the area on the left thigh.",
        "She was given diclofenac intramuscularly.",
        "The diclofenac caused ecchymosis and bleeding in the gluteal area.",
        "The bleeding persisted despite compression with gauze.",
        "A Doppler ultrasound revealed deep venous thrombosis of the left lower limb.",
        "She was given enoxaparin 30 mg subcutaneously every 24 hours.",
        "She was hospitalized.",
        "The next day, she presented with epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg, and saturation of 93%.",
        "Enoxaparin was discontinued.",
        "The blood count revealed a hemoglobin of 6.4 g/dl.",
        "The hemoglobin was 10.4 g/dl one day before admission.",
        "Two blood transfusions were given.",
        "Methylprednisolone was indicated due to suspicion of vasculitis.",
        "She was referred to a hospital for further study.",
        "On admission, the physical examination revealed severe pallor.",
        "There was extensive ecchymosis on the left thigh and lateral knee.",
        "There was a haematoma on the right thigh.",
        "The haemogram showed moderate anaemia with hemoglobin of 9.8 g/dl.",
        "The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 seconds.",
        "The ultrasound of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue.",
        "The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis.",
        "Blood and urine cultures were negative.",
        "Factor VIII activity was found to be decreased (<1.0 U/dl).",
        "The presence of a factor VIII inhibitor was demonstrated at 8.64 Bethesda units/ml.",
        "The diagnosis of acquired haemophilia was confirmed.",
        "The acquired haemophilia was related to the postpartum period.",
        "Prednisone 50 mg orally at breakfast and 10 mg orally at lunch was initiated.",
        "Cyclophosphamide 50 mg twice daily was initiated.",
        "Anti-inhibitor coagulant complex for haemophilia (FEIBA) was initiated.",
        "FEIBA was discontinued after five days due to chest tightness, dyspnoea, and nausea.",
        "Activated recombinant factor VII (NovoSeven) was initiated.",
        "The patient's clinical evolution was favorable.",
        "There was a decrease in ecchymosis.",
        "She was discharged from the hospital."
      ],
      "gold_summary": "A 34-year-old female patient presented with lower back pain, haematuria and a haematoma in the right gluteal region, with no previous history of bleeding. Due to the extent of the haemorrhagic manifestations, she was transferred to the emergency department. The coagulation profile, mixing test and measurement of the factor VIII inhibitor titres confirmed the diagnosis.\n",
      "gold_subclaims": [
        "The patient is a 34-year-old female.",
        "The patient presented with lower back pain.",
        "The patient had haematuria.",
        "The patient had a haematoma in the right gluteal region.",
        "The patient had no previous history of bleeding.",
        "She was transferred to the emergency department.",
        "The coagulation profile was performed.",
        "A mixing test was performed.",
        "Factor VIII inhibitor titres were measured.",
        "The diagnosis was confirmed."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The patient had haematuria."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "The patient had a haematoma in the right gluteal region."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The patient had no previous history of bleeding."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The coagulation profile was performed."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "A mixing test was performed."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "Factor VIII inhibitor titres were measured."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The diagnosis was confirmed."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "She had persistent bleeding from the surgical wound after the cesarean section."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "She expelled a stone and then presented with haematuria for three days."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "The diclofenac caused ecchymosis and bleeding in the gluteal area."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "The bleeding persisted despite compression with gauze."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The blood count revealed a hemoglobin of 6.4 g/dl."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "Two blood transfusions were given."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "There was extensive ecchymosis on the left thigh and lateral knee."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "There was a haematoma on the right thigh."
        },
        {
          "source_subclaim_id": "ST-29",
          "subclaim_text": "The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 seconds."
        },
        {
          "source_subclaim_id": "ST-33",
          "subclaim_text": "Factor VIII activity was found to be decreased (<1.0 U/dl)."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "The presence of a factor VIII inhibitor was demonstrated at 8.64 Bethesda units/ml."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "The diagnosis of acquired haemophilia was confirmed."
        },
        {
          "source_subclaim_id": "ST-36",
          "subclaim_text": "The acquired haemophilia was related to the postpartum period."
        },
        {
          "source_subclaim_id": "ST-37",
          "subclaim_text": "Prednisone 50 mg orally at breakfast and 10 mg orally at lunch was initiated."
        },
        {
          "source_subclaim_id": "ST-38",
          "subclaim_text": "Cyclophosphamide 50 mg twice daily was initiated."
        },
        {
          "source_subclaim_id": "ST-39",
          "subclaim_text": "Anti-inhibitor coagulant complex for haemophilia (FEIBA) was initiated."
        },
        {
          "source_subclaim_id": "ST-40",
          "subclaim_text": "FEIBA was discontinued after five days due to chest tightness, dyspnoea, and nausea."
        },
        {
          "source_subclaim_id": "ST-41",
          "subclaim_text": "Activated recombinant factor VII (NovoSeven) was initiated."
        },
        {
          "source_subclaim_id": "ST-42",
          "subclaim_text": "The patient's clinical evolution was favorable."
        },
        {
          "source_subclaim_id": "ST-44",
          "subclaim_text": "She was discharged from the hospital."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "source_subclaim_id": "ST-8",
          "subclaim_text": "The patient had haematuria.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-7",
          "source_subclaim_id": "ST-29",
          "subclaim_text": "The coagulation profile was performed.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-9",
          "source_subclaim_id": "ST-34",
          "subclaim_text": "Factor VIII inhibitor titres were measured.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-10",
          "source_subclaim_id": "ST-35",
          "subclaim_text": "The diagnosis was confirmed.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 7,
    "original_id": null,
    "input_data": {
      "source_text": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
      "source_subclaims": [
        "The patient is a two-day old neonate.",
        "The neonate had a right scrotal swelling.",
        "The neonate was born at term via cesarean section.",
        "The neonate was kept in the nursery for one day.",
        "The examining doctor referred them for urgent surgical care.",
        "It took one day to arrive at the hospital.",
        "Upon arrival, the neonate was well hydrated.",
        "The right testis was enlarged, tense, non-tender, and visibly reddish.",
        "Trans-illumination was negative in the right testis.",
        "Trans-illumination was positive in the left testis.",
        "The right testis was enlarged (15.6*9.4 mm) on ultrasound.",
        "The right testis showed heterogeneous hypoechoic texture on ultrasound.",
        "There was no flow on color Doppler analysis of the right testis.",
        "The left testis appeared normal in size, shape, and echotexture.",
        "An urgent scrotal exploration was undertaken.",
        "Intra-operatively, there was frank necrotic right testis.",
        "There was intravaginal torsion of the right testis.",
        "A right orchidectomy was performed.",
        "A contralateral orchidopexy was performed."
      ],
      "gold_summary": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.",
      "gold_subclaims": [
        "The patient is a two-day old neonate.",
        "The neonate had a right scrotal swelling.",
        "The neonate was born at term via cesarean section.",
        "The right testis was enlarged, tense, non-tender, and visibly reddish.",
        "Trans-illumination was negative in the right testis.",
        "Trans-illumination was positive in the contralateral testis.",
        "Doppler ultrasound showed the right testis to be enlarged (15.6*9.4 mm).",
        "Doppler ultrasound showed no flow on color doppler analysis of the right testis.",
        "An urgent scrotal exploration was performed.",
        "Intra-operatively, there was frank necrotic right testis.",
        "A right orchidectomy was performed.",
        "A contralateral orchidopexy was performed."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "subclaim_text": "The patient is a two-day old neonate."
        },
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "The neonate had a right scrotal swelling."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "The right testis was enlarged, tense, non-tender, and visibly reddish."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "Trans-illumination was negative in the right testis."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "Trans-illumination was positive in the contralateral testis."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "Doppler ultrasound showed the right testis to be enlarged (15.6*9.4 mm)."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "Doppler ultrasound showed no flow on color doppler analysis of the right testis."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "An urgent scrotal exploration was performed."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "Intra-operatively, there was frank necrotic right testis."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "A right orchidectomy was performed."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "A contralateral orchidopexy was performed."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a two-day old neonate."
        },
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "The neonate had a right scrotal swelling."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "The right testis was enlarged, tense, non-tender, and visibly reddish."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "Trans-illumination was negative in the right testis."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "Trans-illumination was positive in the left testis."
        },
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "The right testis was enlarged (15.6*9.4 mm) on ultrasound."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "There was no flow on color Doppler analysis of the right testis."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "An urgent scrotal exploration was undertaken."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Intra-operatively, there was frank necrotic right testis."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "There was intravaginal torsion of the right testis."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "A right orchidectomy was performed."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "A contralateral orchidopexy was performed."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a two-day old neonate.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-2",
          "source_subclaim_id": "ST-2",
          "subclaim_text": "The neonate had a right scrotal swelling.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-4",
          "source_subclaim_id": "ST-8",
          "subclaim_text": "The right testis was enlarged, tense, non-tender, and visibly reddish.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-10",
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Intra-operatively, there was frank necrotic right testis.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-11",
          "source_subclaim_id": "ST-18",
          "subclaim_text": "A right orchidectomy was performed.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-12",
          "source_subclaim_id": "ST-19",
          "subclaim_text": "A contralateral orchidopexy was performed.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 8,
    "original_id": null,
    "input_data": {
      "source_text": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
      "source_subclaims": [
        "The patient is a 4-year-old male.",
        "The patient had a history of nasal impetigo two weeks before admission.",
        "The nasal impetigo was treated with topical mupirocin and oral cefadroxil.",
        "The patient had no other morbid history.",
        "The patient presented with macroscopic glomerular haematuria.",
        "The patient had oedema of the lower extremities for 5 days.",
        "The patient had headaches, nausea, and vomiting for the last 12 hours before consultation.",
        "The patient had a convulsive status at the time of ED presentation.",
        "The convulsive status was generalised tonic-clonic.",
        "The convulsive status lasted 20 minutes.",
        "The patient was intubated in the ED.",
        "Phenobarbital (10 mg/kg) was administered to manage the convulsive status.",
        "On ICU admission, blood pressure was 134/94 mmHg.",
        "The initial urine test showed haematuria (>100 erythrocytes per field).",
        "The initial urine test showed proteinuria 3+.",
        "The initial urine test showed leucocyturia 10-25 per field.",
        "The initial creatinine was 0.3 mg/dL.",
        "The initial haematocrit was 21%.",
        "The initial haemoglobin was 7 g/dL.",
        "The initial white blood cell count was 23,900 cells/mm3.",
        "The initial platelet count was 756,000/mm3.",
        "The initial C3 complement level was 25 mg/dL.",
        "The rapid antigen test for Streptococcus pyogenes was positive.",
        "The Anti-streptolysin O test was positive.",
        "The non-contrast brain CT showed no acute changes.",
        "The renal ultrasound showed bilateral nephromegaly.",
        "The renal ultrasound showed increased cortical echogenicity.",
        "The renal ultrasound showed decreased corticomedullary differentiation.",
        "The diagnosis was nephritic syndrome due to complicated GNAPE with hypertensive emergency and convulsive status.",
        "The patient required mechanical ventilation within the first 24 hours.",
        "The patient received phenobarbital as anticonvulsant therapy.",
        "The patient had a normal EEG on the day following admission.",
        "The cerebrospinal fluid study was normal.",
        "Antibiotic therapy with cefotaxime was initiated.",
        "Diuretic therapy with furosemide was initiated.",
        "The next day, creatinine increased to 0.99 mg/dL.",
        "The next day, 24-hour proteinuria was 36.6 mg/m2/h.",
        "Antihypertensive therapy with amlodipine and labetalol was initiated.",
        "Extubation was performed at 48 hours.",
        "After 24 hours of extubation, the patient's consciousness deteriorated.",
        "The Glasgow Coma Scale was 8.",
        "Blood pressure exceeded the p95+12 percentile.",
        "Mechanical ventilation was reintroduced.",
        "Sodium nitroprusside infusion was started.",
        "MRI of the brain showed subcortical signal increase in the bilateral occipital region.",
        "The MRI findings were compatible with PRES.",
        "Enalapril was added to the treatment.",
        "Normalization of blood pressure was achieved after 10 days.",
        "The control MRI showed regression of the PRES findings.",
        "Successful extubation was achieved after 5 days.",
        "Hemoglobin dropped to 5 g/dL.",
        "Hemolytic anemia was suspected.",
        "The direct Coombs test was positive.",
        "Red blood cell transfusions were given twice.",
        "Steroid therapy with methylprednisolone was initiated.",
        "All cultures were negative.",
        "ANA was positive at 1/160.",
        "The patient improved with blood pressure normalization.",
        "The urine test showed no proteinuria or hematuria.",
        "The direct Coombs test remained positive on day 9.",
        "The patient was discharged on day 31.",
        "The patient was normotensive at discharge.",
        "The patient had no anemia at discharge.",
        "The patient had preserved renal function at discharge.",
        "The patient had no proteinuria or hematuria at discharge.",
        "C3 levels were normalized at discharge.",
        "The patient was asymptomatic neurologically at discharge.",
        "The patient did not present recurrence 6 months after discharge."
      ],
      "gold_summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
      "gold_subclaims": [
        "The patient is a 4-year-old male.",
        "The patient had 5 days of haematuria.",
        "The patient had oedema.",
        "The patient had headaches.",
        "The patient had nausea and vomiting.",
        "The patient entered a convulsive state.",
        "The patient had a hypertensive crisis.",
        "Laboratory tests showed hypocomplementemia C3.",
        "Laboratory tests showed elevated Anti-Streptolysin O titers.",
        "The diagnosis was interpreted as GNAPE.",
        "The patient developed encephalopathy.",
        "There was suspicion of secondary PRES due to hypertensive emergency.",
        "Magnetic resonance of the brain confirmed PRES.",
        "The patient developed autoimmune haemolytic anaemia.",
        "The patient's haemoglobin was up to 5 g/dL.",
        "Treatment included antihypertensive therapy.",
        "Treatment included neuroprotection measures.",
        "Treatment included steroid treatment.",
        "The patient was discharged after 31 days of hospitalisation.",
        "The patient was asymptomatic 6 months after discharge."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The patient entered a convulsive state."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The patient had a hypertensive crisis."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "Laboratory tests showed hypocomplementemia C3."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "Laboratory tests showed elevated Anti-Streptolysin O titers."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The diagnosis was interpreted as GNAPE."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "The patient developed encephalopathy."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "There was suspicion of secondary PRES due to hypertensive emergency."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "Magnetic resonance of the brain confirmed PRES."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "The patient developed autoimmune haemolytic anaemia."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "The patient's haemoglobin was up to 5 g/dL."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "Treatment included antihypertensive therapy."
        },
        {
          "gold_subclaim_id": "GS-17",
          "subclaim_text": "Treatment included neuroprotection measures."
        },
        {
          "gold_subclaim_id": "GS-18",
          "subclaim_text": "Treatment included steroid treatment."
        },
        {
          "gold_subclaim_id": "GS-19",
          "subclaim_text": "The patient was discharged after 31 days of hospitalisation."
        },
        {
          "gold_subclaim_id": "GS-20",
          "subclaim_text": "The patient was asymptomatic 6 months after discharge."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-5",
          "subclaim_text": "The patient presented with macroscopic glomerular haematuria."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The patient had oedema of the lower extremities for 5 days."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "The patient had a convulsive status at the time of ED presentation."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "The initial C3 complement level was 25 mg/dL."
        },
        {
          "source_subclaim_id": "ST-24",
          "subclaim_text": "The Anti-streptolysin O test was positive."
        },
        {
          "source_subclaim_id": "ST-29",
          "subclaim_text": "The diagnosis was nephritic syndrome due to complicated GNAPE with hypertensive emergency and convulsive status."
        },
        {
          "source_subclaim_id": "ST-38",
          "subclaim_text": "Antihypertensive therapy with amlodipine and labetalol was initiated."
        },
        {
          "source_subclaim_id": "ST-46",
          "subclaim_text": "The MRI findings were compatible with PRES."
        },
        {
          "source_subclaim_id": "ST-51",
          "subclaim_text": "Hemoglobin dropped to 5 g/dL."
        },
        {
          "source_subclaim_id": "ST-52",
          "subclaim_text": "Hemolytic anemia was suspected."
        },
        {
          "source_subclaim_id": "ST-55",
          "subclaim_text": "Steroid therapy with methylprednisolone was initiated."
        },
        {
          "source_subclaim_id": "ST-61",
          "subclaim_text": "The patient was discharged on day 31."
        },
        {
          "source_subclaim_id": "ST-68",
          "subclaim_text": "The patient did not present recurrence 6 months after discharge."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-16",
          "source_subclaim_id": "ST-38",
          "subclaim_text": "Treatment included antihypertensive therapy.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-18",
          "source_subclaim_id": "ST-55",
          "subclaim_text": "Treatment included steroid treatment.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-19",
          "source_subclaim_id": "ST-61",
          "subclaim_text": "The patient was discharged after 31 days of hospitalisation.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-15",
          "source_subclaim_id": "ST-51",
          "subclaim_text": "The patient's haemoglobin was up to 5 g/dL.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 9,
    "original_id": null,
    "input_data": {
      "source_text": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
      "source_subclaims": [
        "The patient is a 69-year-old male.",
        "The patient had prior CABG.",
        "The patient had an inferior ST-segment-elevation myocardial infarction in 2009.",
        "The patient had severe 3-vessel disease in 2009.",
        "The patient underwent CABG with LIMA to LAD and sequential SVG to OM1, OM2, and PL in 2009.",
        "The patient presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.",
        "The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6.",
        "Blood examination revealed plasma N-terminal pro-B-type natriuretic peptide levels of 2640 pg/mL.",
        "Echocardiogram showed left ventricular systolic dysfunction.",
        "Echocardiogram showed a left ventricular ejection fraction of 30%.",
        "Coronary angiography demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits.",
        "Coronary angiography showed a complete occlusion of the sequential SVG to PL conduit.",
        "Native left main coronary artery was occluded in the ostium.",
        "Native RCA was occluded in the mid portion with bridging collaterals.",
        "The team decided to treat the native RCA CTO.",
        "An antegrade approach via the left radial artery was attempted.",
        "The antegrade approach failed to reach the true lumen in the distal RCA.",
        "A retrograde approach using a septal channel from LAD through the occluded left coronary artery was used.",
        "A Gaia 3 wire crossed the occluded left main and LAD, reaching the true lumen in the distal LAD.",
        "A Sion wire was exchanged into the distal LAD.",
        "Dilation of the left main and proximal LAD with a 2.0 × 15 mm balloon was performed.",
        "The septal surfing technique was used for septal crossing.",
        "A Sion wire was delivered retrogradely through a distal septal branch into the distal RCA.",
        "A Gaia 3 wire crossed the CTO lesion retrogradely into the true lumen in the proximal RCA.",
        "The CTO was predilated by a 2.0 × 15 mm balloon.",
        "The CTO was stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm).",
        "The angiographic result was excellent with TIMI3 flow in all distal branches.",
        "Dyspnea was relieved at discharge.",
        "At 6-month follow-up, the patient had no recurrence of dyspnea."
      ],
      "gold_summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
      "gold_subclaims": [
        "The patient is a 69-year-old male.",
        "The patient has a prior history of coronary artery bypass grafting.",
        "The patient presented with severe dyspnea at mild exertion.",
        "The dyspnea had been present for 2 months.",
        "The dyspnea was classified as NYHA class III.",
        "The patient was diagnosed with heart failure.",
        "The heart failure was caused by ischemia.",
        "The ischemia was due to SVG failure.",
        "The SVG was to the right coronary artery.",
        "The diagnosis was based on electrocardiogram findings.",
        "The diagnosis was based on plasma N-terminal pro-B-type natriuretic peptide levels.",
        "The diagnosis was based on coronary angiogram findings.",
        "The native right coronary artery chronic total occlusion was recanalized.",
        "The recanalization was performed using a retrograde approach.",
        "The retrograde approach used septal collaterals.",
        "The surfing technique was used during the procedure.",
        "The totally occluded left coronary artery was recanalized.",
        "Dyspnea was relieved at discharge.",
        "At 6-month follow-up, the patient had no recurrence of dyspnea."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "The patient has a prior history of coronary artery bypass grafting."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The patient presented with severe dyspnea at mild exertion."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "The dyspnea had been present for 2 months."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The dyspnea was classified as NYHA class III."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The patient was diagnosed with heart failure."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The heart failure was caused by ischemia."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "The ischemia was due to SVG failure."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "The SVG was to the right coronary artery."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "The native right coronary artery chronic total occlusion was recanalized."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "The recanalization was performed using a retrograde approach."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "The retrograde approach used septal collaterals."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "The surfing technique was used during the procedure."
        },
        {
          "gold_subclaim_id": "GS-17",
          "subclaim_text": "The totally occluded left coronary artery was recanalized."
        },
        {
          "gold_subclaim_id": "GS-18",
          "subclaim_text": "Dyspnea was relieved at discharge."
        },
        {
          "gold_subclaim_id": "GS-19",
          "subclaim_text": "At 6-month follow-up, the patient had no recurrence of dyspnea."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "The patient had prior CABG."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The patient presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration."
        },
        {
          "source_subclaim_id": "ST-7",
          "subclaim_text": "The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "Blood examination revealed plasma N-terminal pro-B-type natriuretic peptide levels of 2640 pg/mL."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "Echocardiogram showed left ventricular systolic dysfunction."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "Echocardiogram showed a left ventricular ejection fraction of 30%."
        },
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "Coronary angiography demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "Coronary angiography showed a complete occlusion of the sequential SVG to PL conduit."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "Native left main coronary artery was occluded in the ostium."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "Native RCA was occluded in the mid portion with bridging collaterals."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "The team decided to treat the native RCA CTO."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "An antegrade approach via the left radial artery was attempted."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "The antegrade approach failed to reach the true lumen in the distal RCA."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "A retrograde approach using a septal channel from LAD through the occluded left coronary artery was used."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "The septal surfing technique was used for septal crossing."
        },
        {
          "source_subclaim_id": "ST-24",
          "subclaim_text": "A Gaia 3 wire crossed the CTO lesion retrogradely into the true lumen in the proximal RCA."
        },
        {
          "source_subclaim_id": "ST-25",
          "subclaim_text": "The CTO was predilated by a 2.0 × 15 mm balloon."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "The CTO was stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm)."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "The angiographic result was excellent with TIMI3 flow in all distal branches."
        },
        {
          "source_subclaim_id": "ST-28",
          "subclaim_text": "Dyspnea was relieved at discharge."
        },
        {
          "source_subclaim_id": "ST-29",
          "subclaim_text": "At 6-month follow-up, the patient had no recurrence of dyspnea."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The patient presented with severe dyspnea at mild exertion.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-4",
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The dyspnea had been present for 2 months.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-5",
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The dyspnea was classified as NYHA class III.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-18",
          "source_subclaim_id": "ST-28",
          "subclaim_text": "Dyspnea was relieved at discharge.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-19",
          "source_subclaim_id": "ST-29",
          "subclaim_text": "At 6-month follow-up, the patient had no recurrence of dyspnea.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 10,
    "original_id": null,
    "input_data": {
      "source_text": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
      "source_subclaims": [
        "The patient is a 51-year-old male.",
        "He presented with acute painful visual loss of the left eye.",
        "The visual loss had been present for 3 days.",
        "The best-corrected distance visual acuity was 20/20.",
        "Hand motion detection was noted for the right eye.",
        "Hand motion detection was noted for the left eye.",
        "Ocular movement was normal in both eyes.",
        "The anterior segment examination was unremarkable for both eyes.",
        "The left eye fundus showed optic nerve head swelling.",
        "The left eye fundus showed choroidal bulging.",
        "The left eye fundus showed multiple patches of subretinal fluid accumulation.",
        "The left eye fundus showed retinal pigment epithelial corrugations.",
        "The right eye fundus was unremarkable.",
        "Multimodal imaging was used for further evaluation.",
        "Optical coherence tomography showed mild retinal pigment epithelial and choroidal bulging.",
        "Optical coherence tomography showed subretinal and intraretinal fluid accumulation.",
        "Optical coherence tomography showed mild retinal thickening.",
        "Indocyanin green angiography showed a geographic area of macular hypocyanescence in the left eye.",
        "Fundus blue-autofluorescence showed a geographic area with a speckled autofluorescence pattern at the macula.",
        "B-scan ultrasonography showed optic nerve enlargement.",
        "Fluorescein angiography showed vascular leakage at the optic nerve head.",
        "Fluorescein angiography showed a geographic patchy hypofluorescent area with speckled hyperfluorescent margins.",
        "The hypofluorescent area was three disc diameters in size.",
        "Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement.",
        "The mass was located at the junction of the optic nerve and sclera.",
        "An oncology consultation was done with no remarkable findings.",
        "The patient underwent transconjunctival lateral orbitotomy one week after presentation.",
        "A pink localized scleral nodule with edematous tenon was found.",
        "Sub-tenon triamcinolone acetonide was injected.",
        "The clinical diagnosis was nodular posterior scleritis.",
        "The patient refused admission and intravenous corticosteroid injection.",
        "Oral prednisolone 50 mg/Kg was started.",
        "Rheumatology consultation was obtained.",
        "PPD test was unremarkable.",
        "Chest X-ray was unremarkable.",
        "Serum ACE level was unremarkable.",
        "C-ANCA level was unremarkable.",
        "At the last follow-up, the best-corrected distance visual acuity was 20/20.",
        "At the last follow-up, counting fingers at 2 meters was noted for both eyes.",
        "Subretinal fluid was absorbed.",
        "The macula became atrophic.",
        "Oral prednisolone was tapered off slowly over three months."
      ],
      "gold_summary": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started.",
      "gold_subclaims": [
        "The patient is a 51-year-old male.",
        "He presented with acute painful visual loss of the left eye.",
        "The visual loss started 3 days before presentation.",
        "The best-corrected distance visual acuity of the right eye was 20/20.",
        "The best-corrected distance visual acuity of the left eye was hand motion.",
        "Fundus examination of the left eye showed optic nerve head swelling.",
        "Fundus examination of the left eye showed choroidal bulging.",
        "Fundus examination of the left eye showed multiple patches of subretinal fluid accumulation.",
        "Fundus examination of the left eye showed retinal pigment epithelial corrugations.",
        "Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement.",
        "The mass was located at the optic nerve and sclera junction.",
        "Oncology and rheumatology work-ups were unremarkable.",
        "The clinical diagnosis was nodular posterior scleritis.",
        "Oral prednisolone 50 mg/Kg was started."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "He presented with acute painful visual loss of the left eye."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The visual loss started 3 days before presentation."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "Fundus examination of the left eye showed optic nerve head swelling."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "Fundus examination of the left eye showed choroidal bulging."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "Fundus examination of the left eye showed multiple patches of subretinal fluid accumulation."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "Fundus examination of the left eye showed retinal pigment epithelial corrugations."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "The mass was located at the optic nerve and sclera junction."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "Oncology and rheumatology work-ups were unremarkable."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "The clinical diagnosis was nodular posterior scleritis."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "Oral prednisolone 50 mg/Kg was started."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "He presented with acute painful visual loss of the left eye."
        },
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "The visual loss had been present for 3 days."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "The left eye fundus showed optic nerve head swelling."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "The left eye fundus showed choroidal bulging."
        },
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "The left eye fundus showed multiple patches of subretinal fluid accumulation."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "The left eye fundus showed retinal pigment epithelial corrugations."
        },
        {
          "source_subclaim_id": "ST-24",
          "subclaim_text": "Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement."
        },
        {
          "source_subclaim_id": "ST-25",
          "subclaim_text": "The mass was located at the junction of the optic nerve and sclera."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "An oncology consultation was done with no remarkable findings."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "PPD test was unremarkable."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "Chest X-ray was unremarkable."
        },
        {
          "source_subclaim_id": "ST-36",
          "subclaim_text": "Serum ACE level was unremarkable."
        },
        {
          "source_subclaim_id": "ST-37",
          "subclaim_text": "C-ANCA level was unremarkable."
        },
        {
          "source_subclaim_id": "ST-30",
          "subclaim_text": "The clinical diagnosis was nodular posterior scleritis."
        },
        {
          "source_subclaim_id": "ST-32",
          "subclaim_text": "Oral prednisolone 50 mg/Kg was started."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "source_subclaim_id": "ST-2",
          "subclaim_text": "He presented with acute painful visual loss of the left eye.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-3",
          "source_subclaim_id": "ST-3",
          "subclaim_text": "The visual loss started 3 days before presentation.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-6",
          "source_subclaim_id": "ST-9",
          "subclaim_text": "Fundus examination of the left eye showed optic nerve head swelling.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-7",
          "source_subclaim_id": "ST-10",
          "subclaim_text": "Fundus examination of the left eye showed choroidal bulging.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-8",
          "source_subclaim_id": "ST-11",
          "subclaim_text": "Fundus examination of the left eye showed multiple patches of subretinal fluid accumulation.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-9",
          "source_subclaim_id": "ST-12",
          "subclaim_text": "Fundus examination of the left eye showed retinal pigment epithelial corrugations.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-10",
          "source_subclaim_id": "ST-24",
          "subclaim_text": "Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-11",
          "source_subclaim_id": "ST-25",
          "subclaim_text": "The mass was located at the optic nerve and sclera junction.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-13",
          "source_subclaim_id": "ST-30",
          "subclaim_text": "The clinical diagnosis was nodular posterior scleritis.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-14",
          "source_subclaim_id": "ST-32",
          "subclaim_text": "Oral prednisolone 50 mg/Kg was started.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 11,
    "original_id": null,
    "input_data": {
      "source_text": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
      "source_subclaims": [
        "The patient is a 78-year-old man from the Amhara region of Ethiopia.",
        "The patient has had a permanent cardiac pacemaker for 7 years.",
        "The patient was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia.",
        "The patient had a transurethral resection of the prostate 3 months earlier.",
        "The patient had a history of hypertension for 16 years.",
        "The patient was taking amlodipine 5 mg orally daily.",
        "The patient was taking enalapril 10 mg orally twice daily.",
        "The patient had type II diabetes mellitus for 25 years.",
        "The patient was taking metformin 500 mg orally twice daily.",
        "The patient was taking neutral protamine Hagedorn insulin 20 IU and 10 IU.",
        "An electrocardiogram detected complete bundle branch block.",
        "The patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease.",
        "The patient had an ejection fraction of 62%.",
        "Abdominal ultrasound revealed an enlarged prostate size of 82 ml.",
        "The chest X-ray showed a normal chest region with a left-side pacemaker in situ.",
        "The patient had a frailty score of 5.5.",
        "The patient had a poor functional cardiopulmonary reserve of metabolic equivalent = 3.4.",
        "The patient had a Revised Cardiac Risk Index class III.",
        "The patient had a 10.1% risk of major cardiac adverse events within 30 days of surgery.",
        "The patient was unable to afford health coverage for pacemaker reprogramming.",
        "The patient chose to proceed with the surgery, accepting the potential risks.",
        "Continuous cardiac monitoring was advocated during the intraoperative period.",
        "The patient did not experience cardiorespiratory failure.",
        "The patient continued on medication until the day of surgery.",
        "The patient took a lower dose of two-thirds of the NPH on the morning of surgery.",
        "The patient took 5 mg of diazepam orally for anxiolytics at midnight before surgery.",
        "Combined epidural–spinal anesthesia was administered.",
        "The block achieved anesthesia up to the umbilicus.",
        "The surgery involved a midline incision below the umbilicus.",
        "Monopolar cautery was used at low voltage (20 mA).",
        "The patient’s vital signs remained stable during the procedure.",
        "The patient was transferred to the postanesthesia care unit.",
        "The patient was observed in the PACU for 12 hours.",
        "The patient was later transferred to the ward in stable condition.",
        "The patient was discharged 88 days after surgery.",
        "The patient was advised to have regular checkups for the pacemaker’s in situ status."
      ],
      "gold_summary": "A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.",
      "gold_subclaims": [
        "The patient is a 78-year-old male.",
        "The patient is from the Amhara region of Ethiopia.",
        "The patient has a permanent pacemaker.",
        "The pacemaker was implanted for complete heart block.",
        "The patient was scheduled for retropubic prostatectomy.",
        "Preoperative assessments were conducted by the anesthetist and cardiologist.",
        "The team recommended reprogramming the pacemaker to asynchronous mode.",
        "The recommendation was to reduce risks related to the dual-chamber, rate-modulated mode.",
        "The patient could not afford pacemaker reprogramming.",
        "The patient opted to proceed with the existing perioperative plan.",
        "Informed consent was obtained.",
        "Permission to publish the case report was obtained after the operation.",
        "The patient received combined epidural-spinal anesthesia.",
        "The epidural-spinal anesthesia included 2.50 ml of 0.5% isobaric bupivacaine.",
        "The epidural-spinal anesthesia included 50 µg fentanyl.",
        "The epidural-spinal anesthesia was administered at the L3-L4 interspace.",
        "Standard American Society of Anesthesiology monitoring was applied.",
        "The patient remained stable with minimal vital sign fluctuations.",
        "Adequate blood pressure was maintained using isotonic saline.",
        "The patient was transferred to the postanesthesia care unit after surgery.",
        "Analgesia was provided after 4 hours postoperatively.",
        "An epidural top-up was administered.",
        "The patient was transferred to the ward after 6 hours.",
        "Epidural analgesia was continued for 72 hours.",
        "The patient was discharged on the 88th postoperative hour.",
        "The patient was discharged in stable condition."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The patient has a permanent pacemaker."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The patient was scheduled for retropubic prostatectomy."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The team recommended reprogramming the pacemaker to asynchronous mode."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "The patient could not afford pacemaker reprogramming."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The patient opted to proceed with the existing perioperative plan."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "The patient received combined epidural-spinal anesthesia."
        },
        {
          "gold_subclaim_id": "GS-18",
          "subclaim_text": "The patient remained stable with minimal vital sign fluctuations."
        },
        {
          "gold_subclaim_id": "GS-20",
          "subclaim_text": "The patient was transferred to the postanesthesia care unit after surgery."
        },
        {
          "gold_subclaim_id": "GS-26",
          "subclaim_text": "The patient was discharged in stable condition."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "The patient has had a permanent cardiac pacemaker for 7 years."
        },
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "The patient was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia."
        },
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "An electrocardiogram detected complete bundle branch block."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "The patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "The patient had an ejection fraction of 62%."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "The patient had a frailty score of 5.5."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "The patient had a poor functional cardiopulmonary reserve of metabolic equivalent = 3.4."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "The patient had a Revised Cardiac Risk Index class III."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "The patient had a 10.1% risk of major cardiac adverse events within 30 days of surgery."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The patient was unable to afford health coverage for pacemaker reprogramming."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "The patient chose to proceed with the surgery, accepting the potential risks."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "Continuous cardiac monitoring was advocated during the intraoperative period."
        },
        {
          "source_subclaim_id": "ST-23",
          "subclaim_text": "The patient did not experience cardiorespiratory failure."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "Combined epidural–spinal anesthesia was administered."
        },
        {
          "source_subclaim_id": "ST-31",
          "subclaim_text": "The patient’s vital signs remained stable during the procedure."
        },
        {
          "source_subclaim_id": "ST-32",
          "subclaim_text": "The patient was transferred to the postanesthesia care unit."
        },
        {
          "source_subclaim_id": "ST-33",
          "subclaim_text": "The patient was observed in the PACU for 12 hours."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "The patient was later transferred to the ward in stable condition."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "The patient was discharged 88 days after surgery."
        },
        {
          "source_subclaim_id": "ST-36",
          "subclaim_text": "The patient was advised to have regular checkups for the pacemaker’s in situ status."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "source_subclaim_id": "ST-2",
          "subclaim_text": "The patient has a permanent pacemaker.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-5",
          "source_subclaim_id": "ST-3",
          "subclaim_text": "The patient was scheduled for retropubic prostatectomy.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-9",
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The patient could not afford pacemaker reprogramming.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-10",
          "source_subclaim_id": "ST-21",
          "subclaim_text": "The patient opted to proceed with the existing perioperative plan.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-13",
          "source_subclaim_id": "ST-27",
          "subclaim_text": "The patient received combined epidural-spinal anesthesia.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-18",
          "source_subclaim_id": "ST-31",
          "subclaim_text": "The patient remained stable with minimal vital sign fluctuations.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 12,
    "original_id": null,
    "input_data": {
      "source_text": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
      "source_subclaims": [
        "The patient is a 52-year-old woman.",
        "She was referred to the urology clinic with urinary complaints.",
        "Her symptoms began three years ago.",
        "She experienced frequency, dysuria, and dribbling.",
        "She passed red and black thread-like substances in her urine.",
        "She had headache, fever, and chills during these discharges.",
        "She had intermittent periurethral and genital itching.",
        "She had been treated for recurrent urinary tract infections with no improvement.",
        "She denied recent travel, camping, hiking, farming, swimming, and insect bites.",
        "She had a history of pilonidal sinus surgery 8 years earlier.",
        "She had a history of hysterectomy 7 years earlier.",
        "She had been hospitalized two years prior for assessment.",
        "On physical examination, she was well-appearing with normal vital signs.",
        "All laboratory tests, including CBC, urine analysis, and biochemistries, were normal.",
        "Abdominopelvic CT scan revealed no abnormalities.",
        "Cystoscopy showed erythema and hyperemia of the bladder mucosa.",
        "Cystoscopy showed suspended debris and dilation of the left ureteral orifice.",
        "Schistosomiasis was suspected by an infectious diseases specialist.",
        "She was treated with Praziquantel with appropriate dose and duration.",
        "Her symptoms did not subside after Praziquantel.",
        "She was prescribed ivermectin due to suspicion of urinary myiasis.",
        "No improvement was observed after ivermectin.",
        "She underwent bladder irrigation with polyethylene glycol.",
        "The bladder wash fluid did not contain visible larvae.",
        "This procedure was followed by two days of hematuria with spontaneous cessation.",
        "A 24-hour urine sample was sent to the laboratory.",
        "A live larva was demonstrated under light microscope.",
        "The larva was identified as belonging to the species Sarcophaga.",
        "The patient was advised to take personal hygiene measures.",
        "The patient was advised to consume at least 3 L of water daily."
      ],
      "gold_summary": "We report a 52-year-old woman with persistent dysuria, frequency despite multiple treatments for suspected infections. Cystoscopy revealed erythema and debris, but imaging and laboratory tests were unremarkable. A live larva was identified in urine analysis, confirming the diagnosis. Treatment involved improved hygiene and hydration.",
      "gold_subclaims": [
        "The patient is a 52-year-old woman.",
        "She had persistent dysuria.",
        "She had urinary frequency.",
        "She had multiple treatments for suspected infections.",
        "Cystoscopy showed erythema.",
        "Cystoscopy showed debris.",
        "Imaging tests were unremarkable.",
        "Laboratory tests were unremarkable.",
        "A live larva was identified in urine analysis.",
        "The diagnosis was confirmed by identifying a live larva in urine.",
        "Treatment included improved hygiene.",
        "Treatment included increased hydration."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "She had persistent dysuria."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "She had urinary frequency."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "She had multiple treatments for suspected infections."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "Cystoscopy showed erythema."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "Cystoscopy showed debris."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "Imaging tests were unremarkable."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "Laboratory tests were unremarkable."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "A live larva was identified in urine analysis."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The diagnosis was confirmed by identifying a live larva in urine."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "Treatment included improved hygiene."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "Treatment included increased hydration."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-4",
          "subclaim_text": "She experienced frequency, dysuria, and dribbling."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "She had been treated for recurrent urinary tract infections with no improvement."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "All laboratory tests, including CBC, urine analysis, and biochemistries, were in normal ranges."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "Abdominopelvic CT scan revealed no abnormalities."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Cystoscopy showed erythema and hyperemia of the bladder mucosa."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "Cystoscopy showed suspended debris and dilation of the left ureteral orifice."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "Schistosomiasis was suspected by an infectious diseases specialist."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "She was treated with Praziquantel with appropriate dose and duration."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "Her symptoms did not subside after Praziquantel."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "She was prescribed ivermectin due to suspicion of urinary myiasis."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "No improvement was observed after ivermectin."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "A 24-hour urine sample was sent to the laboratory."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "A live larva was demonstrated under light microscope."
        },
        {
          "source_subclaim_id": "ST-28",
          "subclaim_text": "The larva was identified as belonging to the species Sarcophaga."
        },
        {
          "source_subclaim_id": "ST-29",
          "subclaim_text": "The patient was advised to take personal hygiene measures."
        },
        {
          "source_subclaim_id": "ST-30",
          "subclaim_text": "The patient was advised to consume at least 3 L of water daily."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-5",
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Cystoscopy showed erythema.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-6",
          "source_subclaim_id": "ST-17",
          "subclaim_text": "Cystoscopy showed debris.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-8",
          "source_subclaim_id": "ST-14",
          "subclaim_text": "Laboratory tests were unremarkable.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-11",
          "source_subclaim_id": "ST-29",
          "subclaim_text": "Treatment included improved hygiene.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-12",
          "source_subclaim_id": "ST-30",
          "subclaim_text": "Treatment included increased hydration.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 13,
    "original_id": null,
    "input_data": {
      "source_text": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
      "source_subclaims": [
        "The patient is a 36-year-old female.",
        "She has a history of ulcerative colitis.",
        "She is on sulfasalazine.",
        "She is on ferrous fumarate.",
        "She uses intermittent prednisone for flare-ups.",
        "She had a 1-week history of progressive oppressive precordial pain.",
        "The electrocardiogram showed supradesnivel of the ST segment in the lower wall.",
        "The electrocardiogram was in sinus rhythm.",
        "The patient reported a 6-month history of general disorders.",
        "The patient reported a 6-month history of fatigue.",
        "The patient reported a 6-month history of night sweats.",
        "She had previously had episodes of precordial pain related to effort.",
        "The episodes of precordial pain progressed to rest.",
        "The physical examination was without murmurs.",
        "The physical examination showed no alterations of the peripheral pulses.",
        "An emergency coronary angiography was performed.",
        "The coronary angiography revealed severe 2-vessel disease.",
        "There was a 90% ostial lesion in the left coronary trunk.",
        "There was a 99-100% subocclusive lesion at the ostial level in the right coronary artery.",
        "Primary angioplasty of the right coronary artery was performed.",
        "A medicated stent was successfully installed.",
        "The hemodynamicist suggested an etiological study oriented to inflammatory disease.",
        "The hemodynamicist suggested the study prior to surgical resolution of the left coronary trunk lesion.",
        "The laboratory tests showed mild anemia with hemoglobin of 11.6 g/dL.",
        "The laboratory tests showed mild leukocytosis with 13,800/mm3.",
        "The erythrocyte sedimentation rate was 42 mm/h.",
        "The C-reactive protein was 4.9 mg/L.",
        "The ultrasensitive troponin was elevated.",
        "The autoimmunity study showed normal levels of complement C3 and C4.",
        "The autoimmunity study showed negative anti-nuclear antibodies.",
        "The autoimmunity study showed negative anti-DNA.",
        "The autoimmunity study showed a negative extracellular nuclear antigen profile.",
        "The VDRL was non-reactive.",
        "The cardiac MRI showed acute infarction of the left ventricular inferior wall.",
        "The cardiac MRI showed subendocardial ischemia in the anteroseptoapical region.",
        "The cardiac MRI showed mild aortic and mitral insufficiency.",
        "The cardiac MRI showed preserved biventricular systolic function.",
        "The CTA showed periaortic fibrotic wall thickening involving the root, aortic arch, and abdominal aorta.",
        "The CTA showed severe left coronary trunk stenosis.",
        "The CTA showed mild left subclavian artery stenosis.",
        "The CTA showed mild left vertebral artery stenosis.",
        "The CTA showed severe lower mesenteric artery stenosis.",
        "IgG4 deposition disease or Takayasu's arteritis was suggested.",
        "IgG levels were 1,600 mg/dl.",
        "IgG1 levels were 1,024 mg/dl.",
        "Takayasu arteritis was diagnosed clinically and by imaging.",
        "Treatment was initiated with prednisone 60 mg daily.",
        "Treatment was initiated with methotrexate 20 mg weekly by injection.",
        "Treatment was initiated with folic acid 1 mg daily.",
        "After 3 weeks of treatment, she underwent myocardial revascularization surgery.",
        "The surgery used the left internal mammary artery as a graft to the descending anterior artery.",
        "The surgery included an aortocoronary bypass to the circumflex artery.",
        "Intraoperatively, the root of the aorta and the ascending aorta were noted to have a healthy appearance.",
        "The patient is currently at home in good general condition.",
        "The patient is under ambulatory follow-up."
      ],
      "gold_summary": "A 36-year-old woman with ulcerative colitis presented with progressive precordial pain and neurovegetative symptoms. The electrocardiogram showed a ST segment elevation in the inferior wall. The patient had a history of fatigue and night sweats. She underwent a coronary angiography that revealed severe disease in two coronary arteries, with successful primary angioplasty of the culprit artery. Aortitis was suspected, which led to additional studies, including a mild elevation of inflammatory activity indices and a computed tomographic angiography with periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu arteritis. She was treated with prednisone, methotrexate, and underwent delayed myocardial revascularization surgery with good results.\n",
      "gold_subclaims": [
        "The patient is a 36-year-old woman.",
        "She has ulcerative colitis.",
        "She presented with progressive precordial pain.",
        "She had neurovegetative symptoms.",
        "The electrocardiogram showed ST segment elevation in the inferior wall.",
        "She had a history of fatigue.",
        "She had a history of night sweats.",
        "She underwent coronary angiography.",
        "The coronary angiography revealed severe disease in two coronary arteries.",
        "Primary angioplasty of the culprit artery was successful.",
        "Aortitis was suspected.",
        "Computed tomographic angiography showed periaortic fibrotic thickening.",
        "Computed tomographic angiography showed significant stenosis in multiple arteries.",
        "Takayasu arteritis was suggested.",
        "She was treated with prednisone.",
        "She was treated with methotrexate.",
        "She underwent delayed myocardial revascularization surgery.",
        "The surgery had good results."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "She presented with progressive precordial pain."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The electrocardiogram showed ST segment elevation in the inferior wall."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "She underwent coronary angiography."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "The coronary angiography revealed severe disease in two coronary arteries."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "Primary angioplasty of the culprit artery was successful."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "Aortitis was suspected."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "Computed tomographic angiography showed periaortic fibrotic thickening."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "Computed tomographic angiography showed significant stenosis in multiple arteries."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "Takayasu arteritis was suggested."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "She was treated with prednisone."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "She was treated with methotrexate."
        },
        {
          "gold_subclaim_id": "GS-17",
          "subclaim_text": "She underwent delayed myocardial revascularization surgery."
        },
        {
          "gold_subclaim_id": "GS-18",
          "subclaim_text": "The surgery had good results."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "She had a 1-week history of progressive oppressive precordial pain."
        },
        {
          "source_subclaim_id": "ST-7",
          "subclaim_text": "The electrocardiogram showed supradesnivel of the ST segment in the lower wall."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "An emergency coronary angiography was performed."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "The coronary angiography revealed severe 2-vessel disease."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "Primary angioplasty of the right coronary artery was performed."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "A medicated stent was successfully installed."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "The hemodynamicist suggested an etiological study oriented to inflammatory disease."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "The erythrocyte sedimentation rate was 42 mm/h."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "The C-reactive protein was 4.9 mg/L."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "The cardiac MRI showed acute infarction of the left ventricular inferior wall."
        },
        {
          "source_subclaim_id": "ST-38",
          "subclaim_text": "The CTA showed periaortic fibrotic wall thickening involving the root, aortic arch, and abdominal aorta."
        },
        {
          "source_subclaim_id": "ST-39",
          "subclaim_text": "The CTA showed severe left coronary trunk stenosis."
        },
        {
          "source_subclaim_id": "ST-42",
          "subclaim_text": "The CTA showed severe lower mesenteric artery stenosis."
        },
        {
          "source_subclaim_id": "ST-43",
          "subclaim_text": "IgG4 deposition disease or Takayasu's arteritis was suggested."
        },
        {
          "source_subclaim_id": "ST-46",
          "subclaim_text": "Takayasu arteritis was diagnosed clinically and by imaging."
        },
        {
          "source_subclaim_id": "ST-47",
          "subclaim_text": "Treatment was initiated with prednisone 60 mg daily."
        },
        {
          "source_subclaim_id": "ST-48",
          "subclaim_text": "Treatment was initiated with methotrexate 20 mg weekly by injection."
        },
        {
          "source_subclaim_id": "ST-50",
          "subclaim_text": "After 3 weeks of treatment, she underwent myocardial revascularization surgery."
        },
        {
          "source_subclaim_id": "ST-54",
          "subclaim_text": "The patient is currently at home in good general condition."
        }
      ],
      "minimum_shared_key_subclaims": []
    }
  },
  {
    "index": 14,
    "original_id": null,
    "input_data": {
      "source_text": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
      "source_subclaims": [
        "The patient is a 36-year-old female.",
        "The patient complained of dysphagia.",
        "The patient had longstanding cervical and upper thoracic pain.",
        "The patient had a multinodular goiter.",
        "An esophagogastroduodenal transit was performed.",
        "The transit showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte.",
        "The impression extended 3.5 cm cephalocaudal.",
        "A maximum esophageal stenosis of 60% was estimated.",
        "A CT scan revealed a congenital anomaly of the aortic arch.",
        "The aortic arch is a mirror image of the right aortic arch.",
        "The aortic arch originates from the root of the aorta.",
        "The aortic arch runs above the right stem bronchus.",
        "The aortic arch gives rise to three supra-aortic trunks.",
        "The first trunk is the left brachiocephalic artery.",
        "The left brachiocephalic artery gives rise to the left common carotid artery.",
        "The left brachiocephalic artery gives rise to the left subclavian artery.",
        "The second trunk is the right common carotid artery.",
        "The third trunk is the right subclavian artery.",
        "The aortic arch enters posteriorly to the esophagus.",
        "The aortic arch gives rise to a Kommerell diverticulum.",
        "The Kommerell diverticulum is 1.3 cm in size.",
        "The configuration forms a ring around the tracheo-esophageal pair.",
        "The ring is formed posterior-lateral to the right by the aortic arch.",
        "The ring is formed posterior-lateral to the left by the Kommerell diverticulum.",
        "The ring is formed lateral to the left by the arteriosum ligamentum.",
        "The ring is formed anteriorly by the left brachiocephalic artery.",
        "A gastroscopy confirmed the endoluminal impact of extrinsic compression.",
        "No surgical cure was performed.",
        "The patient had minimal clinical repercussions.",
        "The patient had no nutritional disorders.",
        "The patient reported a spontaneous amelioration of symptoms."
      ],
      "gold_summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
      "gold_subclaims": [
        "The patient was a 36-year-old female.",
        "The patient had dysphagia.",
        "The patient had a congenital anomaly of the thoracic aorta.",
        "The anomaly was a right aortic arch with mirror image.",
        "A right aortic arch with mirror image is a rare anomaly of embryonic development.",
        "In this anomaly, the aorta winds around the right stem bronchus.",
        "The supra-aortic trunks emerge from the crown in the reverse and opposite order to normal.",
        "The vast majority of patients are asymptomatic unless there is compression of mediastinal structures.",
        "Major compression of the esophagus or trachea may warrant surgical intervention.",
        "Thoracic aortic dissection may warrant surgical intervention.",
        "The presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention.",
        "There is no standard treatment for this condition.",
        "Treatment must be adapted to the clinical presentation and anatomical configuration of the patient.",
        "The patient did not receive any treatment for her condition."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "subclaim_text": "The patient was a 36-year-old female."
        },
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "The patient had dysphagia."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The patient had a congenital anomaly of the thoracic aorta."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "The anomaly was a right aortic arch with mirror image."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "The patient did not receive any treatment for her condition."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a 36-year-old female."
        },
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "The patient complained of dysphagia."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "The transit showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "A maximum esophageal stenosis of 60% was estimated."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "A CT scan revealed a congenital anomaly of the aortic arch."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "The aortic arch is a mirror image of the right aortic arch."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The aortic arch gives rise to a Kommerell diverticulum."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "The Kommerell diverticulum is 1.3 cm in size."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "The configuration forms a ring around the tracheo-esophageal pair."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "A gastroscopy confirmed the endoluminal impact of extrinsic compression."
        },
        {
          "source_subclaim_id": "ST-28",
          "subclaim_text": "No surgical cure was performed."
        },
        {
          "source_subclaim_id": "ST-31",
          "subclaim_text": "The patient reported a spontaneous amelioration of symptoms."
        }
      ],
      "minimum_shared_key_subclaims": []
    }
  },
  {
    "index": 15,
    "original_id": null,
    "input_data": {
      "source_text": "A 62-year-old Tunisian Arab postmenopausal female diagnosed with Von Hippel–Lindau disease in 2021 presented with various manifestations related to the disease. She had a history of multiple surgeries, primarily for renal, adrenal, and pancreatic tumors, with incidental findings of ovarian masses.\n\nThe patient was asymptomatic from a gynecological standpoint, but primarily complained of headaches before undergoing brain surgery. She had no significant family or psychosocial history.\n\nHer surgical history included\n2021: A non-operable tumor (6 cm) of the left petrous bone endolymphatic sac, managed with radiotherapy.\n\n2021: Left adrenalectomy for a 6 cm pheochromocytoma. Pathological examination revealed pheochromocytoma.\n\n2021: Left nephrectomy for a ruptured left renal tumor. Microscopy showed multifocal clear-cell renal carcinoma of nuclear grade 2.\n\n2022: Cephalic duodenopancreatectomy for a mass in the pancreas. Histological examination confirmed three serous cystadenomas and two well-differentiated neuroendocrine tumors.\n\nIn January 2021, during postoperative surveillance with an abdominal–pelvic computed tomography (CT) scan, a 4 cm solid cystic left adnexal mass was incidentally discovered, which raised suspicion of malignancy. The mass was confirmed by transvaginal ultrasound and pelvic MRI, classified as Ovarian-Adnexal Reporting and Data System (O-RADS) 5 (high suspicion for malignancy).\n\nGynecological examination and surgical history\nPhysical examination: No abdominal–pelvic mass detected.\n\nSpeculum examination: Healthy cervix observed.\n\nSurgical scars from previous left nephrectomy and cephalic duodenopancreatectomy were noted.\n\nA multidisciplinary staff meeting concluded that surgery was necessary. A laparotomy was performed via a midline incision below the umbilicus, revealing a well-defined solid cystic mass in the left adnexa. No ascites or signs of peritoneal carcinomatosis were present, and the right adnexa appeared normal, with no macroscopic signs of malignancy observed intraoperatively, including the absence of exocystic vegetations.\n\nCytology was performed along with left adnexectomy, and the specimen was sent for frozen section examination. The results were inconclusive, raising the possibility of borderline tumors or tumors specific to Von Hippel–Lindau syndrome. Considering the patient’s postmenopausal status, a right adnexectomy and total hysterectomy were performed.\n\nHistological examination later revealed bilateral clear-cell papillary cystadenomas of the Fallopian Tubes and broad ligament, characteristic of Von Hippel–Lindau disease (0.5 cm on the right side and 4 cm on the left side).The tumors consisted of tightly packed papillae with fibrous cores, covered by monolayered epithelium.\n\nThe immediate postoperative period was uneventful, and at the 1-month follow-up, no abnormalities were detected. The patient has since been followed up with every 4 months with normal pelvic ultrasounds. During these 2 years of follow-up, no complications have arisen, but the patient was recently readmitted to the neurosurgery department for recurrence of a brain tumor.",
      "source_subclaims": [
        "The patient is a 62-year-old Tunisian Arab postmenopausal female.",
        "She was diagnosed with Von Hippel–Lindau disease in 2021.",
        "She had multiple surgeries for renal, adrenal, and pancreatic tumors.",
        "In 2021, she had a non-operable tumor of the left petrous bone endolymphatic sac, managed with radiotherapy.",
        "In 2021, she had a left adrenalectomy for a 6 cm pheochromocytoma.",
        "In 2021, she had a left nephrectomy for a ruptured left renal tumor.",
        "In 2022, she had a cephalic duodenopancreatectomy for a mass in the pancreas.",
        "In January 2021, a 4 cm solid cystic left adnexal mass was incidentally discovered on CT scan.",
        "The mass was classified as O-RADS 5, indicating high suspicion for malignancy.",
        "A multidisciplinary staff meeting concluded that surgery was necessary.",
        "A laparotomy was performed via a midline incision below the umbilicus.",
        "A well-defined solid cystic mass was found in the left adnexa.",
        "No ascites or signs of peritoneal carcinomatosis were present.",
        "The right adnexa appeared normal.",
        "Cytology was performed along with left adnexectomy.",
        "Frozen section examination was inconclusive.",
        "A right adnexectomy and total hysterectomy were performed.",
        "Histological examination revealed bilateral clear-cell papillary cystadenomas of the Fallopian Tubes and broad ligament.",
        "The tumors were characteristic of Von Hippel–Lindau disease.",
        "The tumors were 0.5 cm on the right side and 4 cm on the left side.",
        "The immediate postoperative period was uneventful.",
        "At the 1-month follow-up, no abnormalities were detected.",
        "The patient has been followed up with every 4 months with normal pelvic ultrasounds.",
        "During 2 years of follow-up, no complications have arisen.",
        "The patient was recently readmitted to the neurosurgery department for recurrence of a brain tumor."
      ],
      "gold_summary": "A 62-year-old white North African woman diagnosed with Von Hippel-Lindau disease in 2021 presented with multiple manifestations, including a left petrous bone tumor, left pheochromocytoma, left renal cell carcinoma, multi-cystic right kidney, and pancreatic masses. She underwent various treatments, including radiotherapy, adrenalectomy, nephrectomy, and cephalic duodenopancreatectomy. Ultrasonographic and magnetic resonance imaging examinations revealed a solid cystic mass in the left adnexal region. Laparoscopy identified cystic tumors in the right and left mesosalpinx. Following a hysterectomy with bilateral adnexectomy, histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, consistent with Von Hippel-Lindau disease.",
      "gold_subclaims": [
        "The patient is a 62-year-old white North African woman.",
        "She was diagnosed with Von Hippel-Lindau disease in 2021.",
        "She had a left petrous bone tumor.",
        "She had a left pheochromocytoma.",
        "She had left renal cell carcinoma.",
        "She had a multi-cystic right kidney.",
        "She had pancreatic masses.",
        "She underwent radiotherapy.",
        "She underwent adrenalectomy.",
        "She underwent nephrectomy.",
        "She underwent cephalic duodenopancreatectomy.",
        "Ultrasonographic and magnetic resonance imaging showed a solid cystic mass in the left adnexal region.",
        "Laparoscopy identified cystic tumors in the right and left mesosalpinx.",
        "She had a hysterectomy with bilateral adnexectomy.",
        "Histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx.",
        "The tumors were consistent with Von Hippel-Lindau disease."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "She was diagnosed with Von Hippel-Lindau disease in 2021."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "Ultrasonographic and magnetic resonance imaging showed a solid cystic mass in the left adnexal region."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "She had a hysterectomy with bilateral adnexectomy."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "Histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "The tumors were consistent with Von Hippel-Lindau disease."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "She was diagnosed with Von Hippel–Lindau disease in 2021."
        },
        {
          "source_subclaim_id": "ST-4",
          "subclaim_text": "In 2021, she had a non-operable tumor of the left petrous bone endolymphatic sac, managed with radiotherapy."
        },
        {
          "source_subclaim_id": "ST-5",
          "subclaim_text": "In 2021, she had a left adrenalectomy for a 6 cm pheochromocytoma."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "In 2021, she had a left nephrectomy for a ruptured left renal tumor."
        },
        {
          "source_subclaim_id": "ST-7",
          "subclaim_text": "In 2022, she had a cephalic duodenopancreatectomy for a mass in the pancreas."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "In January 2021, a 4 cm solid cystic left adnexal mass was incidentally discovered on CT scan."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "The mass was classified as O-RADS 5, indicating high suspicion for malignancy."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "A well-defined solid cystic mass was found in the left adnexa."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "Cytology was performed along with left adnexectomy."
        },
        {
          "source_subclaim_id": "ST-16",
          "subclaim_text": "Frozen section examination was inconclusive."
        },
        {
          "source_subclaim_id": "ST-17",
          "subclaim_text": "A right adnexectomy and total hysterectomy were performed."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "Histological examination revealed bilateral clear-cell papillary cystadenomas of the Fallopian Tubes and broad ligament."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "The tumors were characteristic of Von Hippel–Lindau disease."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "source_subclaim_id": "ST-2",
          "subclaim_text": "She was diagnosed with Von Hippel-Lindau disease in 2021.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 16,
    "original_id": null,
    "input_data": {
      "source_text": "The patient was a 59-year-old Japanese man with a 28-year history of type 1 diabetes. He visited our hospital monthly for management of diabetes with intensive therapy employing multiple-dose insulin injections. His height and body weight were 168 cm and 52 kg (body mass index: 18.4 kg/m2), respectively. He showed depleted insulin secretion (serum C-peptide level was below the limit of detection), such that his blood glucose levels fluctuated severely, and his hemoglobin A1c (HbA1c) level was around 9.0% despite intensive insulin therapy. He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation (AR) 16 years before the current presentation but had declined follow-up for the AR. He had never undergone surgery nor the implantation of any prosthetic devices.\n\nEight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃. Until that day, he had not noticed any fever, chills, weakness, or any other symptoms. His blood pressure and pulse rate were 192/82 mmHg and 118/min, respectively. He showed orthopnea, and his oxygen saturation (SpO2) was 80%. He was transported to the emergency department of our hospital. A physical examination revealed a Levine 3/6 systolic murmur, although his cardiac murmur had not been checked at regular hospital visits. No physical findings suggesting IE, such as Osler nodes, Janeway lesions, or conjunctival petechiae, were recognized. His white blood cell (WBC) count was markedly increased to 20,800 /μL, and his C-reactive protein (CRP) was elevated to 6.06 mg/dL. Serum creatine phosphokinase MB was within the normal range, at 6.0 IU/L, and troponin T was negative. Chest X-ray showed pulmonary congestion with cardiac enlargement (cardiothoracic ratio: 55%). Electrocardiography revealed ST elevation on V1-V4, but emergency echocardiography showed no dysfunction of cardiac contractility. He was diagnosed with acute heart failure due to valvular disease, and treatment with non-invasive positive pressure ventilation and nitrates was initiated.\n\nAfter hospital admission, a detailed examination by transthoracic echocardiography showed severe aortic regurgitation, severe mitral regurgitation, and a mobile vegetation on the mitral valve. Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve. These findings raised strong suspicion of NVE. In this case, head computed tomography (CT) and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging, although a mobile vegetation was detected.\n\nOn reviewing the clinical course until hospitalization, we noted that at the visit four months before admission, his WBC count had been slightly elevated. The following month, his albumin (Alb) level decreased to 3.0 g/dL, and his hemoglobin (Hb) level had shown a gradual decline over the 2 months prior to admission. During this period, he had experienced a 4-kg weight loss. Esophagogastroduodenoscopy and whole-body CT were performed, but no abnormalities were detected. One month later, he had regained some weight, and the laboratory findings had nearly normalized, except for a slightly elevated CRP level (0.54 mg/dL). At the last visit (8 days before admission), his WBC count had again risen to 9,300 /μL, while his Hb and Alb levels had again decreased to 13.1 g/dL and 3.0 g/dL, respectively. Furthermore, his CRP level had increased to 4.18 mg/dL. At that time, his diastolic blood pressure has shown an obvious decrease. Thus far, he had not experienced a fever or any symptoms other than weight loss. We suspected diseases of infectious and/or malignant origin and initiated comprehensive examinations to identify the source of his clinical findings.\n\nAfter heart failure treatment had been started, his clinical symptoms showed rapid improvement, and his hemodynamic stability was maintained during the first six hours. He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam (ABPC/S) and 120 mg/day of gentamycin (GM). Three blood culture sets were obtained on the admission, and all were positive for S. warneri [minimum inhibitory concentration (MIC) to ABPC/S ≤8 μg/mL; MIC to GM ≤1 μg/mL; MIC to cefazolin (CEZ) ≤2 μg/mL]. Thus, IE caused by this organism was diagnosed.\n\nAccording to the clinical guideline established by the Japanese Circulation Society, emergency surgery is generally recommended for heart failure of NYHA III to IV or urgent surgery for NVE mobile vegetation exceeding 10 mm and severe valve dysfunction. In this case, however, his heart failure was successfully improved. Based on the guideline, the risk of embolism was considered to have been reduced by the administration of appropriate antibiotic therapy. In addition, the patient had type 1 diabetes, and his glycemic control was so poor that we were concerned that double-valve surgery would be a high-risk procedure. Therefore, we planned elective surgery after sufficient control of both infection and diabetes.\n\nBased on the blood culture results, the antibiotic regimen was switched to 6 g/day of CEZ. A detailed dental examination revealed no abnormalities, such as periodontitis. After four weeks of antibiotic therapy, he underwent surgical therapy. His aortic valve was found to be bicuspid, and the aortic and mitral annuli were intact without abscess formation. Large vegetations were exenterated, and the mitral and aortic valves were both replaced with mechanical valves. He experienced no postoperative complications and was discharged on the 22nd day after the operation without apparent embolism. He has not had any recurrence in over two years since the operation.",
      "source_subclaims": [
        "The patient was a 59-year-old Japanese man.",
        "He had a 28-year history of type 1 diabetes.",
        "He was managed with multiple-dose insulin injections.",
        "His body mass index was 18.4 kg/m2.",
        "His serum C-peptide level was below the limit of detection.",
        "His hemoglobin A1c level was around 9.0%.",
        "He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation 16 years before the current presentation.",
        "He had never undergone surgery nor the implantation of any prosthetic devices.",
        "Eight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃.",
        "His oxygen saturation was 80%.",
        "He was transported to the emergency department of the hospital.",
        "A physical examination revealed a Levine 3/6 systolic murmur.",
        "His white blood cell count was 20,800 /μL.",
        "His C-reactive protein was 6.06 mg/dL.",
        "Chest X-ray showed pulmonary congestion with cardiac enlargement.",
        "Electrocardiography revealed ST elevation on V1-V4.",
        "Emergency echocardiography showed no dysfunction of cardiac contractility.",
        "He was diagnosed with acute heart failure due to valvular disease.",
        "Transthoracic echocardiography showed severe aortic regurgitation.",
        "Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve.",
        "Transesophageal echocardiography revealed an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve.",
        "These findings raised strong suspicion of native valve endocarditis.",
        "Head computed tomography and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging.",
        "At the visit four months before admission, his WBC count had been slightly elevated.",
        "His albumin level decreased to 3.0 g/dL the following month.",
        "He had experienced a 4-kg weight loss.",
        "One month later, he had regained some weight.",
        "At the last visit (8 days before admission), his WBC count had risen to 9,300 /μL.",
        "His CRP level had increased to 4.18 mg/dL.",
        "He had not experienced a fever or any symptoms other than weight loss.",
        "He was suspected to have diseases of infectious and/or malignant origin.",
        "He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam and 120 mg/day of gentamycin.",
        "Three blood culture sets were obtained on admission.",
        "All blood cultures were positive for S. warneri.",
        "Infective endocarditis caused by S. warneri was diagnosed.",
        "Emergency surgery is generally recommended for heart failure of NYHA III to IV.",
        "Emergency surgery is generally recommended for native valve endocarditis mobile vegetation exceeding 10 mm.",
        "The patient's heart failure was successfully improved.",
        "The risk of embolism was considered to have been reduced by appropriate antibiotic therapy.",
        "The patient had type 1 diabetes.",
        "His glycemic control was poor.",
        "Double-valve surgery was considered a high-risk procedure.",
        "Elective surgery was planned after sufficient control of both infection and diabetes.",
        "The antibiotic regimen was switched to 6 g/day of cefazolin.",
        "After four weeks of antibiotic therapy, he underwent surgical therapy.",
        "His aortic valve was found to be bicuspid.",
        "Large vegetations were exenterated.",
        "The mitral and aortic valves were both replaced with mechanical valves.",
        "He was discharged on the 22nd day after the operation.",
        "He has not had any recurrence in over two years since the operation."
      ],
      "gold_summary": "A 59-year-old man with type 1 diabetes presented with heart failure. Echocardiography showed large vegetations on the mitral and aortic valves. Blood bacterial culture was positive for Staphylococcus warneri, a coagulase-negative staphylococcus (CoNS) family member. He was diagnosed with native valve endocarditis (NVE) induced by the resident bacteria and ultimately underwent double valve replacement. Retrospectively, slight laboratory data abnormalities and weight loss beginning four months before may have been signs of NVE. He had no history of immunosuppressive therapies or medical device implantation. ",
      "gold_subclaims": [
        "The patient is a 59-year-old man.",
        "The patient has type 1 diabetes.",
        "The patient presented with heart failure.",
        "Echocardiography showed large vegetations on the mitral and aortic valves.",
        "Blood bacterial culture was positive for Staphylococcus warneri.",
        "Staphylococcus warneri is a coagulase-negative staphylococcus.",
        "The patient was diagnosed with native valve endocarditis.",
        "The patient underwent double valve replacement.",
        "The patient had no history of immunosuppressive therapies.",
        "The patient had no history of medical device implantation."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "The patient presented with heart failure."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "Echocardiography showed large vegetations on the mitral and aortic valves."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "Blood bacterial culture was positive for Staphylococcus warneri."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The patient was diagnosed with native valve endocarditis."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "The patient underwent double valve replacement."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "He had never undergone surgery nor the implantation of any prosthetic devices."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "He was diagnosed with acute heart failure due to valvular disease."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "Transthoracic echocardiography showed severe aortic regurgitation."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "Transesophageal echocardiography revealed an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "All blood cultures were positive for S. warneri."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "Infective endocarditis caused by S. warneri was diagnosed."
        },
        {
          "source_subclaim_id": "ST-40",
          "subclaim_text": "The patient had type 1 diabetes."
        },
        {
          "source_subclaim_id": "ST-45",
          "subclaim_text": "After four weeks of antibiotic therapy, he underwent surgical therapy."
        },
        {
          "source_subclaim_id": "ST-48",
          "subclaim_text": "The mitral and aortic valves were both replaced with mechanical valves."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-5",
          "source_subclaim_id": "ST-34",
          "subclaim_text": "Blood bacterial culture was positive for Staphylococcus warneri.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-8",
          "source_subclaim_id": "ST-48",
          "subclaim_text": "The patient underwent double valve replacement.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 17,
    "original_id": null,
    "input_data": {
      "source_text": "A 27-year-old woman with multiple colorectal cancers on a background of FAP was presented to our department. Notably, a large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum, and pathological examination confirmed some of them as adenocarcinoma. Preoperative computed tomography revealed multiple lymph node swellings along the inferior mesenteric artery (IMA) and middle colic artery, without any evidence of distant metastases. After a comprehensive evaluation by a multidisciplinary cancer board, we decided to perform TPC with lymph node dissection of the entire colorectal region, using the Hugo RAS system as a surgical device.\n\nRobot-assisted TPC using the Hugo RAS system was approved by the Evaluating Committee for Highly Difficult New Medical Technologies (approval number H-0051) and the Institutional Review Board at Kyoto University.\n\nUnder general anesthesia, the patient was placed in a lithotomy position with the arms tucked. After a 5-cm vertical skin incision was made at the umbilicus, a wound-protecting device was applied. After pneumoperitoneum, 4 robotic trocars and 2 assistant trocars were placed. The instruments used in robot-assisted TPC with Hugo were a camera, monopolar curved shears for the right hand, bipolar fenestrated forceps for the left hand, and Cadiere/double fenestrated forceps for the reserve arm. Robot-assisted TPC with Hugo consists of 3 distinct steps, followed by transanal specimen extraction, ileal pouch construction through a small laparotomy, and ileal pouch-anus anastomosis (IPAA). Two table positions, Trendelenburg and flat, were required, each with specific docking tilts but the same angles of the arm carts throughout the robotic procedure. The detailed operative procedure is presented in Supplementary Videos.\n\nStep 1: Ascending colon complete mesocolic excision (CME)\n\nThe ascending colon CME from the caudal approach proceeded until the completion of the hepatic flexure mobilization (Supplementary Video S1).\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)\n\nAfter CVL of the IMA, descending colon CME proceeded until the completion of splenic flexure mobilization, followed by TME until the intersphincteric space was fully exposed (Supplementary Video S2).\n\nStep 3: CVL along the superior mesenteric artery (SMA)\n\nAfter undocking all the robotic arms, the patient was placed in a flat position. Then, CVL along the SMA was performed to ligate the ileocolic, right colic, and middle colic vessels (Supplementary Video S3). The final step of this procedure was the ligation of the inferior mesenteric vein (IMV) at its root, which was exposed in Step 2.\n\nTransanal and small laparotomy procedures\nAfter transection of the terminal ileum, we extracted the specimen transanally by excising the rectal mucosa entirely from just below the dentate line because of multiple adenomas in the anal canal. After constructing the ileal pouch through the small umbilical incision and confirming that the ileal pouch could reach the bottom of the anal canal for anastomosis, transanal hand-sewn IPAA was performed. A diverting ileostomy was not performed.\n\nAll 3 steps were completed without conversion to open surgery. After undocking Hugo when we finished Step 3, we performed a laparoscopy to confirm hemostasis, specimen extraction, and appropriate anastomosis. The operative time was 632 min (36 min for Step 1, 160 min for Step 2, 188 min for Step 3, and 248 min for other procedures such as positioning, docking, specimen extraction, and anastomosis), with a minimal intraoperative estimated blood loss of 20 mL. The patient exhibited an uneventful postoperative recovery, with gas passage and initiation of liquid nutrition on postoperative day 1 (POD 1) and a solid diet on POD 3 with a functional ileal pouch and satisfactory anal function. Pathological examination revealed 2 sigmoid colon cancers (S1, Type 0-Ip, 55 × 50 mm, tub1, T1b, ly0, v0; S2, Type 0-Isp, 55 × 50 mm, tub1, Tis, ly0, v0) and 1 rectal cancer (R1, Type 0-Ip, 40 × 35 mm, tub1, Tis, ly0, v0). It also revealed 18 out of 89 positive lymph nodes, all of which belonged to the sigmoid colon and rectosigmoid lesions (stations #241, 242, and 251), resulting in UICC pT1bN2b stage.",
      "source_subclaims": [
        "The patient is a 27-year-old woman.",
        "She has multiple colorectal cancers.",
        "She has a background of familial adenomatous polyposis (FAP).",
        "A large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum.",
        "Pathological examination confirmed some lesions as adenocarcinoma.",
        "Preoperative computed tomography showed multiple lymph node swellings along the inferior mesenteric artery.",
        "There was no evidence of distant metastases.",
        "A multidisciplinary cancer board decided to perform total proctocolectomy (TPC) with lymph node dissection.",
        "The Hugo RAS system was used as a surgical device.",
        "The procedure was approved by the Evaluating Committee for Highly Difficult New Medical Technologies.",
        "The procedure was also approved by the Institutional Review Board at Kyoto University.",
        "The patient was placed in a lithotomy position with the arms tucked.",
        "A 5-cm vertical skin incision was made at the umbilicus.",
        "A wound-protecting device was applied.",
        "Pneumoperitoneum was established.",
        "Four robotic trocars and two assistant trocars were placed.",
        "The instruments used included a camera, monopolar curved shears, bipolar fenestrated forceps, and Cadiere/double fenestrated forceps.",
        "The robot-assisted TPC with Hugo consisted of three distinct steps.",
        "Transanal specimen extraction was performed.",
        "Ileal pouch construction was done through a small laparotomy.",
        "Ileal pouch-anus anastomosis (IPAA) was performed.",
        "Two table positions, Trendelenburg and flat, were used.",
        "The docking tilts varied with each table position.",
        "The angles of the arm carts remained the same throughout the robotic procedure.",
        "The first step was ascending colon complete mesocolic excision (CME).",
        "The second step included central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME).",
        "The third step was CVL along the superior mesenteric artery (SMA).",
        "The inferior mesenteric vein (IMV) was ligated at its root.",
        "The specimen was extracted transanally after excising the rectal mucosa.",
        "The ileal pouch was constructed through a small umbilical incision.",
        "Transanal hand-sewn IPAA was performed.",
        "A diverting ileostomy was not performed.",
        "All three steps were completed without conversion to open surgery.",
        "The operative time was 632 minutes.",
        "The intraoperative estimated blood loss was 20 mL.",
        "The patient passed gas and started liquid nutrition on postoperative day 1.",
        "She began a solid diet on postoperative day 3.",
        "Pathological examination revealed two sigmoid colon cancers.",
        "Pathological examination also revealed one rectal cancer.",
        "Eighteen out of 89 lymph nodes were positive.",
        "The positive lymph nodes belonged to the sigmoid colon and rectosigmoid lesions.",
        "The UICC stage was pT1bN2b."
      ],
      "gold_summary": "A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.",
      "gold_subclaims": [
        "The patient is a 27-year-old woman.",
        "She has multiple colorectal cancers.",
        "She has a background of familial adenomatous polyposis.",
        "She underwent robot-assisted total proctocolectomy (TPC).",
        "The procedure included lymph node dissection of the entire colorectal region.",
        "The Hugo RAS system was used.",
        "The robotic procedure was divided into 3 steps.",
        "The first step was Trendelenburg position to perform ascending colon complete mesocolic excision to the hepatic flexure.",
        "The second step was descending colon complete mesocolic excision and total mesorectal excision with D3 lymph node dissection.",
        "The third step was central vessel ligation along the superior mesenteric artery in the flat position.",
        "The specimen was extracted transanally after undocking.",
        "An ileal pouch was constructed from a small laparotomy at the umbilical incision.",
        "An ileal pouch-anal anastomosis was performed.",
        "The operative time was 632 minutes.",
        "The estimated blood loss was minimal.",
        "The postoperative period was uneventful."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "subclaim_text": "The patient is a 27-year-old woman."
        },
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "She has multiple colorectal cancers."
        },
        {
          "gold_subclaim_id": "GS-3",
          "subclaim_text": "She has a background of familial adenomatous polyposis."
        },
        {
          "gold_subclaim_id": "GS-4",
          "subclaim_text": "She underwent robot-assisted total proctocolectomy (TPC)."
        },
        {
          "gold_subclaim_id": "GS-5",
          "subclaim_text": "The procedure included lymph node dissection of the entire colorectal region."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The Hugo RAS system was used."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The robotic procedure was divided into 3 steps."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "The first step was Trendelenburg position to perform ascending colon complete mesocolic excision to the hepatic flexure."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "The second step was descending colon complete mesocolic excision and total mesorectal excision with D3 lymph node dissection."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The third step was central vessel ligation along the superior mesenteric artery in the flat position."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "The specimen was extracted transanally after undocking."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "An ileal pouch was constructed from a small laparotomy at the umbilical incision."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "An ileal pouch-anal anastomosis was performed."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "The operative time was 632 minutes."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "The estimated blood loss was minimal."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "The postoperative period was uneventful."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a 27-year-old woman."
        },
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "She has multiple colorectal cancers."
        },
        {
          "source_subclaim_id": "ST-3",
          "subclaim_text": "She has a background of familial adenomatous polyposis (FAP)."
        },
        {
          "source_subclaim_id": "ST-5",
          "subclaim_text": "Pathological examination confirmed some lesions as adenocarcinoma."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "Preoperative computed tomography showed multiple lymph node swellings along the inferior mesenteric artery."
        },
        {
          "source_subclaim_id": "ST-7",
          "subclaim_text": "There was no evidence of distant metastases."
        },
        {
          "source_subclaim_id": "ST-8",
          "subclaim_text": "A multidisciplinary cancer board decided to perform total proctocolectomy (TPC) with lymph node dissection."
        },
        {
          "source_subclaim_id": "ST-9",
          "subclaim_text": "The Hugo RAS system was used as a surgical device."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "The robot-assisted TPC with Hugo consisted of three distinct steps."
        },
        {
          "source_subclaim_id": "ST-19",
          "subclaim_text": "Transanal specimen extraction was performed."
        },
        {
          "source_subclaim_id": "ST-21",
          "subclaim_text": "Ileal pouch-anus anastomosis (IPAA) was performed."
        },
        {
          "source_subclaim_id": "ST-22",
          "subclaim_text": "Two table positions, Trendelenburg and flat, were used."
        },
        {
          "source_subclaim_id": "ST-25",
          "subclaim_text": "The first step was ascending colon complete mesocolic excision (CME)."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "The second step included central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)."
        },
        {
          "source_subclaim_id": "ST-27",
          "subclaim_text": "The third step was CVL along the superior mesenteric artery (SMA)."
        },
        {
          "source_subclaim_id": "ST-30",
          "subclaim_text": "The ileal pouch was constructed through a small umbilical incision."
        },
        {
          "source_subclaim_id": "ST-33",
          "subclaim_text": "All three steps were completed without conversion to open surgery."
        },
        {
          "source_subclaim_id": "ST-34",
          "subclaim_text": "The operative time was 632 minutes."
        },
        {
          "source_subclaim_id": "ST-35",
          "subclaim_text": "The intraoperative estimated blood loss was 20 mL."
        },
        {
          "source_subclaim_id": "ST-38",
          "subclaim_text": "Pathological examination revealed two sigmoid colon cancers."
        },
        {
          "source_subclaim_id": "ST-39",
          "subclaim_text": "Pathological examination also revealed one rectal cancer."
        },
        {
          "source_subclaim_id": "ST-40",
          "subclaim_text": "Eighteen out of 89 lymph nodes were positive."
        },
        {
          "source_subclaim_id": "ST-41",
          "subclaim_text": "The positive lymph nodes belonged to the sigmoid colon and rectosigmoid lesions."
        },
        {
          "source_subclaim_id": "ST-42",
          "subclaim_text": "The UICC stage was pT1bN2b."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-1",
          "source_subclaim_id": "ST-1",
          "subclaim_text": "The patient is a 27-year-old woman.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-2",
          "source_subclaim_id": "ST-2",
          "subclaim_text": "She has multiple colorectal cancers.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-3",
          "source_subclaim_id": "ST-3",
          "subclaim_text": "She has a background of familial adenomatous polyposis.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-6",
          "source_subclaim_id": "ST-9",
          "subclaim_text": "The Hugo RAS system was used.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-7",
          "source_subclaim_id": "ST-18",
          "subclaim_text": "The robotic procedure was divided into 3 steps.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-13",
          "source_subclaim_id": "ST-21",
          "subclaim_text": "An ileal pouch-anal anastomosis was performed.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 18,
    "original_id": null,
    "input_data": {
      "source_text": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
      "source_subclaims": [
        "The patient is a 65-year-old male.",
        "He had swelling and boutonniere deformity on the right middle finger for six months.",
        "The injury occurred after a motorcycle accident on January 1st, 2023.",
        "Initially, he managed the injury with painkillers and did not seek medical attention.",
        "After six months of persistent symptoms, he sought treatment.",
        "He had an inability to fully extend the right middle finger.",
        "He had noticeable edema on the right middle finger.",
        "The inspection of the right hand showed the presence of deformity with edema.",
        "The active range of motion (ROM) was impaired in the PIP joint of the right middle finger.",
        "The active ROM of the PIP joint of the right middle finger was 45–110 degrees.",
        "The passive ROM of the PIP joint of the right middle finger was within normal.",
        "X-ray of the right hand showed no abnormality in the bone.",
        "The deformity was diagnosed as from soft tissue, specifically a central slip injury.",
        "A central slip defect reconstruction was performed.",
        "The reconstruction utilized the partial ulnar side of the flexor digitorum superficial tendon.",
        "The patient was positioned supine with a tourniquet applied to the upper arm.",
        "A midlateral incision was made on the ulnar aspect of the right middle phalanx.",
        "The incision extended dorsally in an oblique manner.",
        "A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley.",
        "The ulnar digital neurovascular bundle was identified and protected.",
        "The central slip and extensor tendon to the PIPJ were exposed.",
        "Full-thickness dorsal flaps were elevated.",
        "Scar tissue and pseudotendinous tissue were identified and excised.",
        "The central slip could not be repaired primarily.",
        "The ulnar slip of the FDS tendon was used for reconstruction.",
        "The ulnar neurovascular bundle was mobilized to visualize the periosteal insertion of the A3 pulley.",
        "The extensor tendon was mobilized and tenolyzed.",
        "The dorsal capsule of the PIP joint was incised and interposed tissue was removed.",
        "The A3 pulley's periosteal insertion was incised longitudinally.",
        "The PIP joint's volar capsule was incised longitudinally.",
        "The ulnar slip of the FDS tendon was identified.",
        "A 2–0 non-absorbable, monofilament suture was placed around the ulnar slip.",
        "A transverse incision was made at the MCP joint flexion crease, proximal to the A1 pulley.",
        "The tendon sheath and A1 pulley were incised longitudinally.",
        "The FDS tendon was identified.",
        "The ulnar slip of the FDS tendon was isolated and transected.",
        "A 2.8-mm drill was used to create a vertically oriented bone tunnel dorsal to volar.",
        "An elevator was placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx.",
        "The FDS tendon slip passed through the tunnel while maintaining the PIP joint in extension and reduced position.",
        "The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon.",
        "A tendon weaver completed a Pulvertaft weave.",
        "The appropriate tension was confirmed with the PIPJ in the reduced, full extension position.",
        "A 3–0 non-absorbable suture secured the Pulvertaft weave.",
        "The margins of the capsule and central slip reconstruction were approximated across the PIP joint.",
        "Adhesions were released and the lateral bands mobilized.",
        "The overall posture, stability, and motion with tenodesis were assessed.",
        "All incisions were copiously irrigated.",
        "The tourniquet was deflated and hemostasis was obtained.",
        "Capillary refill of all fingers was assessed.",
        "The skin was closed using horizontal mattress stitches.",
        "A sterile dressing was applied with an appropriately padded PIP joint extension splint.",
        "The first follow-up was done 4 days after the surgery for wound treatment.",
        "The patient was given oral meloxicam 7.5 mg twice a day.",
        "The patient was given doxycycline 100 mg twice a day for 3 days.",
        "The second follow-up was done 3 days after the first follow-up for wound treatment.",
        "After 2 weeks, the back slab was removed.",
        "After 2 weeks, the external suture was removed.",
        "After 2 weeks, active and passive ROM exercises were begun.",
        "After 3 weeks, the wound was healed.",
        "After 3 weeks, the ROM of the PIP joint was 0 to 90 degrees.",
        "After a month, the ROM of the PIP joint improved to 0 to 100 degrees.",
        "After a month, the functional outcome improved.",
        "After 7 weeks of physical rehabilitation, the patient returned to work.",
        "After 7 weeks, the ROM of the PIP joint improved to 0 to 110 degrees.",
        "The function of the patient's right hand was evaluated with the DASH score.",
        "The DASH score improved significantly from 50 to 4.2."
      ],
      "gold_summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
      "gold_subclaims": [
        "The patient is a 65-year-old male.",
        "The patient presented with swelling and boutonniere deformity on the right middle finger.",
        "The boutonniere deformity was on the right hand.",
        "The patient had previously fallen from a motorcycle.",
        "The patient's right middle finger was injured six months ago.",
        "The patient's right middle finger could not be fully extended after the injury.",
        "The right hand showed edema.",
        "The interphalangeal (PIP) joint was flexed.",
        "The distal interphalangeal (DIP) joint was hyperextended.",
        "The range of motion of the PIP joint of the right middle finger was 45-110 degrees.",
        "The X-ray of the right hand showed no bone involvement in the deformity.",
        "The patient underwent central slip defect reconstruction.",
        "The reconstruction used the partial ulnar side of the flexor digitorum superficial tendon.",
        "A PIP joint extension splint was applied for 2 weeks.",
        "Active and passive exercise of the PIP joint range of motion began after 2 weeks of splinting.",
        "The patient's PIP joint range of motion improved to 0-90 degrees 1 month after surgery.",
        "The patient's PIP joint range of motion returned to normal 2 months after surgery.",
        "The patient's right hand function was evaluated with the DASH score.",
        "The DASH score improved significantly from 50 to 4.2."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-2",
          "subclaim_text": "The patient presented with swelling and boutonniere deformity on the right middle finger."
        },
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "The patient's right middle finger could not be fully extended after the injury."
        },
        {
          "gold_subclaim_id": "GS-10",
          "subclaim_text": "The range of motion of the PIP joint of the right middle finger was 45-110 degrees."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "The X-ray of the right hand showed no bone involvement in the deformity."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "The patient underwent central slip defect reconstruction."
        },
        {
          "gold_subclaim_id": "GS-13",
          "subclaim_text": "The reconstruction used the partial ulnar side of the flexor digitorum superficial tendon."
        },
        {
          "gold_subclaim_id": "GS-14",
          "subclaim_text": "A PIP joint extension splint was applied for 2 weeks."
        },
        {
          "gold_subclaim_id": "GS-15",
          "subclaim_text": "Active and passive exercise of the PIP joint range of motion began after 2 weeks of splinting."
        },
        {
          "gold_subclaim_id": "GS-16",
          "subclaim_text": "The patient's PIP joint range of motion improved to 0-90 degrees 1 month after surgery."
        },
        {
          "gold_subclaim_id": "GS-17",
          "subclaim_text": "The patient's PIP joint range of motion returned to normal 2 months after surgery."
        },
        {
          "gold_subclaim_id": "GS-19",
          "subclaim_text": "The DASH score improved significantly from 50 to 4.2."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-2",
          "subclaim_text": "He had swelling and boutonniere deformity on the right middle finger for six months."
        },
        {
          "source_subclaim_id": "ST-6",
          "subclaim_text": "He had an inability to fully extend the right middle finger."
        },
        {
          "source_subclaim_id": "ST-10",
          "subclaim_text": "The active ROM of the PIP joint of the right middle finger was 45–110 degrees."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "X-ray of the right hand showed no abnormality in the bone."
        },
        {
          "source_subclaim_id": "ST-13",
          "subclaim_text": "The deformity was diagnosed as from soft tissue, specifically a central slip injury."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "A central slip defect reconstruction was performed."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "The reconstruction utilized the partial ulnar side of the flexor digitorum superficial tendon."
        },
        {
          "source_subclaim_id": "ST-51",
          "subclaim_text": "A sterile dressing was applied with an appropriately padded PIP joint extension splint."
        },
        {
          "source_subclaim_id": "ST-56",
          "subclaim_text": "After 2 weeks, the back slab was removed."
        },
        {
          "source_subclaim_id": "ST-58",
          "subclaim_text": "After 2 weeks, active and passive ROM exercises were begun."
        },
        {
          "source_subclaim_id": "ST-60",
          "subclaim_text": "After 3 weeks, the ROM of the PIP joint was 0 to 90 degrees."
        },
        {
          "source_subclaim_id": "ST-61",
          "subclaim_text": "After a month, the ROM of the PIP joint improved to 0 to 100 degrees."
        },
        {
          "source_subclaim_id": "ST-64",
          "subclaim_text": "After 7 weeks, the ROM of the PIP joint improved to 0 to 110 degrees."
        },
        {
          "source_subclaim_id": "ST-65",
          "subclaim_text": "The function of the patient's right hand was evaluated with the DASH score."
        },
        {
          "source_subclaim_id": "ST-66",
          "subclaim_text": "The DASH score improved significantly from 50 to 4.2."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-12",
          "source_subclaim_id": "ST-14",
          "subclaim_text": "The patient underwent central slip defect reconstruction.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-13",
          "source_subclaim_id": "ST-15",
          "subclaim_text": "The reconstruction used the partial ulnar side of the flexor digitorum superficial tendon.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-19",
          "source_subclaim_id": "ST-66",
          "subclaim_text": "The DASH score improved significantly from 50 to 4.2.",
          "required_for_all_labels": true
        }
      ]
    }
  },
  {
    "index": 19,
    "original_id": null,
    "input_data": {
      "source_text": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
      "source_subclaims": [
        "The patient is a 23-year-old male.",
        "He presented with a sudden onset of severe frontal headache lasting 2 hours.",
        "He had associated symptoms of nausea, vomiting, and chest heaviness.",
        "He has a unremarkable medical record.",
        "He is a smoker with a history of 23 pack-years.",
        "He does not consume alcohol.",
        "On physical examination, he appeared distressed but was fully conscious and oriented.",
        "Neurological examination demonstrated neck stiffness.",
        "His blood pressure was 178/103 mmHg.",
        "His temperature was 38.9°C.",
        "An ECG revealed ST segment elevation >2 mm in leads V2-V5.",
        "The top differential diagnosis was STEMI.",
        "Troponin levels were significantly elevated at 1.48 mg/dl.",
        "Percutaneous coronary intervention was performed via the femoral artery.",
        "The coronary angiography showed normal coronary arteries with TIMI flow grade 3.",
        "The ECG after coronary angiography showed normal sinus rhythm with left ventricular hypertrophy.",
        "The echocardiogram revealed normal ventricular function with no regional wall motion abnormalities.",
        "A CT brain showed cisternal subarachnoid haemorrhage with extension anterior to the right temporal lobe.",
        "Nimodipine 60 mg every 4 hours was initiated.",
        "On the second day, the patient's condition suddenly deteriorated, culminating in cardiac arrest.",
        "Cardiopulmonary resuscitation was performed, resulting in a Glasgow Coma Scale score of 6.",
        "The patient was intubated and placed on mechanical ventilation in the ICU.",
        "A nasogastric tube was inserted for feeding and fluid replacement.",
        "On the 8th day, the patient developed ventricular fibrillation.",
        "Despite CPR with more than five defibrillations, the patient could not be revived.",
        "The final outcome was death."
      ],
      "gold_summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
      "gold_subclaims": [
        "The patient was a 23-year-old male.",
        "He presented with a sudden severe headache.",
        "He had nausea and vomiting.",
        "He reported chest heaviness.",
        "Initial evaluation showed elevated blood pressure.",
        "An emergency ECG indicated ST-segment elevation myocardial infarction.",
        "The patient was referred for percutaneous coronary intervention.",
        "Percutaneous coronary intervention revealed normal coronary arteries.",
        "A CT brain scan identified a cisternal subarachnoid haemorrhage.",
        "The patient's condition rapidly deteriorated.",
        "The patient experienced cardiac arrest.",
        "The patient died."
      ]
    },
    "llm_output": {
      "key_gold_summary_subclaims": [
        {
          "gold_subclaim_id": "GS-6",
          "subclaim_text": "An emergency ECG indicated ST-segment elevation myocardial infarction."
        },
        {
          "gold_subclaim_id": "GS-7",
          "subclaim_text": "The patient was referred for percutaneous coronary intervention."
        },
        {
          "gold_subclaim_id": "GS-8",
          "subclaim_text": "Percutaneous coronary intervention revealed normal coronary arteries."
        },
        {
          "gold_subclaim_id": "GS-9",
          "subclaim_text": "A CT brain scan identified a cisternal subarachnoid haemorrhage."
        },
        {
          "gold_subclaim_id": "GS-11",
          "subclaim_text": "The patient experienced cardiac arrest."
        },
        {
          "gold_subclaim_id": "GS-12",
          "subclaim_text": "The patient died."
        }
      ],
      "key_source_text_subclaims": [
        {
          "source_subclaim_id": "ST-11",
          "subclaim_text": "An ECG revealed ST segment elevation >2 mm in leads V2-V5."
        },
        {
          "source_subclaim_id": "ST-12",
          "subclaim_text": "The top differential diagnosis was STEMI."
        },
        {
          "source_subclaim_id": "ST-14",
          "subclaim_text": "Percutaneous coronary intervention was performed via the femoral artery."
        },
        {
          "source_subclaim_id": "ST-15",
          "subclaim_text": "The coronary angiography showed normal coronary arteries with TIMI flow grade 3."
        },
        {
          "source_subclaim_id": "ST-18",
          "subclaim_text": "A CT brain showed cisternal subarachnoid haemorrhage with extension anterior to the right temporal lobe."
        },
        {
          "source_subclaim_id": "ST-20",
          "subclaim_text": "On the second day, the patient's condition suddenly deteriorated, culminating in cardiac arrest."
        },
        {
          "source_subclaim_id": "ST-26",
          "subclaim_text": "The final outcome was death."
        }
      ],
      "minimum_shared_key_subclaims": [
        {
          "gold_subclaim_id": "GS-8",
          "source_subclaim_id": "ST-15",
          "subclaim_text": "Percutaneous coronary intervention revealed normal coronary arteries.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-9",
          "source_subclaim_id": "ST-18",
          "subclaim_text": "A CT brain scan identified a cisternal subarachnoid haemorrhage.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-11",
          "source_subclaim_id": "ST-20",
          "subclaim_text": "The patient experienced cardiac arrest.",
          "required_for_all_labels": true
        },
        {
          "gold_subclaim_id": "GS-12",
          "source_subclaim_id": "ST-26",
          "subclaim_text": "The patient died.",
          "required_for_all_labels": true
        }
      ]
    }
  }
]