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The Clinical Application and Results of Palliative Damus-Kaye-Stansel Procedure (고식적 Damus-Kaye-Stansel 술식의 임상적 적용 및 결과)

  • Lim, Hong-Gook;Kim, Soo-Jin;Kim, Woong-Han;Hwang, Seong-Wook;Lee, Cheul;Shinn, Sung-Ho;Yie, Kil-Soo;Lee, Jae-Woong;Lee, Chang-Ha
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.1-11
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    • 2008
  • Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

Mid-term results of IntracardiacLateral Tunnel Fontan Procedure in the Treatment of Patients with a Functional Single Ventricle (기능적 단심실 환자에 대한 심장내 외측통로 폰탄술식의 중기 수술성적)

  • 이정렬;김용진;노준량
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.472-480
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    • 1998
  • We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.

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KNU Korean Sentiment Lexicon: Bi-LSTM-based Method for Building a Korean Sentiment Lexicon (Bi-LSTM 기반의 한국어 감성사전 구축 방안)

  • Park, Sang-Min;Na, Chul-Won;Choi, Min-Seong;Lee, Da-Hee;On, Byung-Won
    • Journal of Intelligence and Information Systems
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    • v.24 no.4
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    • pp.219-240
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    • 2018
  • Sentiment analysis, which is one of the text mining techniques, is a method for extracting subjective content embedded in text documents. Recently, the sentiment analysis methods have been widely used in many fields. As good examples, data-driven surveys are based on analyzing the subjectivity of text data posted by users and market researches are conducted by analyzing users' review posts to quantify users' reputation on a target product. The basic method of sentiment analysis is to use sentiment dictionary (or lexicon), a list of sentiment vocabularies with positive, neutral, or negative semantics. In general, the meaning of many sentiment words is likely to be different across domains. For example, a sentiment word, 'sad' indicates negative meaning in many fields but a movie. In order to perform accurate sentiment analysis, we need to build the sentiment dictionary for a given domain. However, such a method of building the sentiment lexicon is time-consuming and various sentiment vocabularies are not included without the use of general-purpose sentiment lexicon. In order to address this problem, several studies have been carried out to construct the sentiment lexicon suitable for a specific domain based on 'OPEN HANGUL' and 'SentiWordNet', which are general-purpose sentiment lexicons. However, OPEN HANGUL is no longer being serviced and SentiWordNet does not work well because of language difference in the process of converting Korean word into English word. There are restrictions on the use of such general-purpose sentiment lexicons as seed data for building the sentiment lexicon for a specific domain. In this article, we construct 'KNU Korean Sentiment Lexicon (KNU-KSL)', a new general-purpose Korean sentiment dictionary that is more advanced than existing general-purpose lexicons. The proposed dictionary, which is a list of domain-independent sentiment words such as 'thank you', 'worthy', and 'impressed', is built to quickly construct the sentiment dictionary for a target domain. Especially, it constructs sentiment vocabularies by analyzing the glosses contained in Standard Korean Language Dictionary (SKLD) by the following procedures: First, we propose a sentiment classification model based on Bidirectional Long Short-Term Memory (Bi-LSTM). Second, the proposed deep learning model automatically classifies each of glosses to either positive or negative meaning. Third, positive words and phrases are extracted from the glosses classified as positive meaning, while negative words and phrases are extracted from the glosses classified as negative meaning. Our experimental results show that the average accuracy of the proposed sentiment classification model is up to 89.45%. In addition, the sentiment dictionary is more extended using various external sources including SentiWordNet, SenticNet, Emotional Verbs, and Sentiment Lexicon 0603. Furthermore, we add sentiment information about frequently used coined words and emoticons that are used mainly on the Web. The KNU-KSL contains a total of 14,843 sentiment vocabularies, each of which is one of 1-grams, 2-grams, phrases, and sentence patterns. Unlike existing sentiment dictionaries, it is composed of words that are not affected by particular domains. The recent trend on sentiment analysis is to use deep learning technique without sentiment dictionaries. The importance of developing sentiment dictionaries is declined gradually. However, one of recent studies shows that the words in the sentiment dictionary can be used as features of deep learning models, resulting in the sentiment analysis performed with higher accuracy (Teng, Z., 2016). This result indicates that the sentiment dictionary is used not only for sentiment analysis but also as features of deep learning models for improving accuracy. The proposed dictionary can be used as a basic data for constructing the sentiment lexicon of a particular domain and as features of deep learning models. It is also useful to automatically and quickly build large training sets for deep learning models.

Query-based Answer Extraction using Korean Dependency Parsing (의존 구문 분석을 이용한 질의 기반 정답 추출)

  • Lee, Dokyoung;Kim, Mintae;Kim, Wooju
    • Journal of Intelligence and Information Systems
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    • v.25 no.3
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    • pp.161-177
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    • 2019
  • In this paper, we study the performance improvement of the answer extraction in Question-Answering system by using sentence dependency parsing result. The Question-Answering (QA) system consists of query analysis, which is a method of analyzing the user's query, and answer extraction, which is a method to extract appropriate answers in the document. And various studies have been conducted on two methods. In order to improve the performance of answer extraction, it is necessary to accurately reflect the grammatical information of sentences. In Korean, because word order structure is free and omission of sentence components is frequent, dependency parsing is a good way to analyze Korean syntax. Therefore, in this study, we improved the performance of the answer extraction by adding the features generated by dependency parsing analysis to the inputs of the answer extraction model (Bidirectional LSTM-CRF). The process of generating the dependency graph embedding consists of the steps of generating the dependency graph from the dependency parsing result and learning the embedding of the graph. In this study, we compared the performance of the answer extraction model when inputting basic word features generated without the dependency parsing and the performance of the model when inputting the addition of the Eojeol tag feature and dependency graph embedding feature. Since dependency parsing is performed on a basic unit of an Eojeol, which is a component of sentences separated by a space, the tag information of the Eojeol can be obtained as a result of the dependency parsing. The Eojeol tag feature means the tag information of the Eojeol. The process of generating the dependency graph embedding consists of the steps of generating the dependency graph from the dependency parsing result and learning the embedding of the graph. From the dependency parsing result, a graph is generated from the Eojeol to the node, the dependency between the Eojeol to the edge, and the Eojeol tag to the node label. In this process, an undirected graph is generated or a directed graph is generated according to whether or not the dependency relation direction is considered. To obtain the embedding of the graph, we used Graph2Vec, which is a method of finding the embedding of the graph by the subgraphs constituting a graph. We can specify the maximum path length between nodes in the process of finding subgraphs of a graph. If the maximum path length between nodes is 1, graph embedding is generated only by direct dependency between Eojeol, and graph embedding is generated including indirect dependencies as the maximum path length between nodes becomes larger. In the experiment, the maximum path length between nodes is adjusted differently from 1 to 3 depending on whether direction of dependency is considered or not, and the performance of answer extraction is measured. Experimental results show that both Eojeol tag feature and dependency graph embedding feature improve the performance of answer extraction. In particular, considering the direction of the dependency relation and extracting the dependency graph generated with the maximum path length of 1 in the subgraph extraction process in Graph2Vec as the input of the model, the highest answer extraction performance was shown. As a result of these experiments, we concluded that it is better to take into account the direction of dependence and to consider only the direct connection rather than the indirect dependence between the words. The significance of this study is as follows. First, we improved the performance of answer extraction by adding features using dependency parsing results, taking into account the characteristics of Korean, which is free of word order structure and omission of sentence components. Second, we generated feature of dependency parsing result by learning - based graph embedding method without defining the pattern of dependency between Eojeol. Future research directions are as follows. In this study, the features generated as a result of the dependency parsing are applied only to the answer extraction model in order to grasp the meaning. However, in the future, if the performance is confirmed by applying the features to various natural language processing models such as sentiment analysis or name entity recognition, the validity of the features can be verified more accurately.