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Original Title: A Study Using a Wavelet Detection Algorithm to Determine Arteriovenous Fistula Stenosis

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Manuscript

Received:

16, June, 2011

Revised:

1, July, 2011

Accepted:

25, July, 2011

Published:

10, August, 2011

Keywords

hemodialysis,

wavelet

transform,

arteriovenous

fistula.

Abstract According to the annual

statistics report of the United States Renal

Data System (USRDS) in 2009, the number

of patients with end-stage renal disease has

increased yearly, especially those patients

undergoing hemodialysis. As they require

long-term vascular punctures, and stenosis

easily occurs at puncture sites or vascular

junctions. The objective of help

hemodialysis patients to remove the noises

and to retain important features as much as

possible by identifying the features of

changes in blood flow frequency, and utilize

a digital signal processing technique and

wavelet transform algorithm in order to

determine arteriovenous fistula stenosis for

patients, with the goal of preventing, rather

than treating the disease. The proposed

method is using wavelets transform

algorithm of vessels sounds utilizing

characteristics extraction. The proposed

hard threshold wavelet decomposition at

multiple levels is a simple and facilitates

identification. Results suggested that this

technique can be useful.

1. Introduction

According to the statistical report of the United States

Renal Data System (USRDS), the number of end-stage renal

patients in Taiwan ranked first in the world in 2008.

Moreover, the incidence and prevalence rates are number

one in the world, higher than those of the US and Japan.

Clinically, there are three methods to treat renal disease,

namely, hemodialysis, peritoneal dialysis, and kidney

transplantation. Hemodialysis, which is the most common

treatment for patients with renal disease, uses a hemodialysis

machine to scavenge for waste in body, and thereby,

discharges excessive salt and potassium ion. According to

the statistics of the Taiwan Kidney Foundation, the number

of hemodialysis patients increases every year. A total of

57,844 patients with chronic renal failure receive long-term

dialysis, among which, 52,538 are hemodialysis patients

(90.83%), and 5,306 are peritoneal dialysis patients (9.17%).

As seen, hemodialysis patients account for an extremely high

percentage.

An arteriovenous fistula site must be first surgically

Yen-Nien Wang and Shi-Jun Chou are with Lunghwa University of

Science and Technology, Department of Electronic Engineering

(ynwang@mail.lhu.edu.tw; G972321012@ms.lhu.edu.tw)

Chih-Yang Chan is with National Taiwan University Hospital,

Department of Surgery(chanchihyang@hotmail.com)

created on the arms of hemodialysis patients, and can be

either an autogenous arteriovenous fistula or an artificial

fistula. Autogenous arteriovenous fistula is created by

vascular anastomoses when the patients arteries and veins

are in good condition; while artificial fistula applies to

patients with poor vascular condition, and an artificial blood

vessel serves as a bridge between the patients arm arteries

and veins. For long-term hemodialysis patient, it is very

important to maintain permanent vascular access patency in

order to achieve optimal dialysis effects. More than 80% of

hemodialysis patients have arteriovenous fistula embolism

due to blood stenosis at the puncture site. In particular,

patients using artificial vessels often have stenosis at

vascular junctions or puncture openings. Vascular stenosis

easily causes insufficient blood flow, which renders toxin

and water difficult to discharge, and may undermine or even

nullify hemodialysis.

Vascular stenosis is a kind of vascular disease, usually

due to trauma, high blood fat, or cholesterol. When blood

passes through the vascular stenosis site, vascular fat or

blood clots in the vessel reduce blood flow dynamics, thus,

leading to high venous pressure in hemodialysis, machine

out of range during treatments, insufficient blood flow, and

incomplete urine toxin removal. Severe stenosis leads to

embolism; where embolitic blood clots are likely to flow to

the heart, lungs, or brain. The situation may induce a

myocardial infarction, a pulmonary embolism, or a

cerebrovascular embolism, which could result in coma or

death. Conventional diagnosis of arteriovenous fistula

stenosis includes angiography and ultrasonic detection.

Angiography is a type of invasive precision examination,

where a contrast medium must be injected into a blood

vessel, which has high side effects. Ultrasonic detection is a

non-invasive technique with low side effects, and is used to

check for blood stream changes and size of vessel in order

to determine if the blood vessel has narrowed or is blocked.

Clinically, upon encountering vascular stenosis, a high tone

ejection murmur equal in diastolic and systolic periods will

occur, known as the Sea-gull Murmur, as its sound is mostly

a high-frequency signal, and sounds when the blood flow

meets with a resistance, which is presumably a feature of

vascular stenosis.

Vesquez proposed using the eigenvalue method to

determine signal differences. He found that anomalies occur

at 300~500 Hz, 200~800 Hz, and 250~1000 Hz [1], which

is a frequency with a wide range. This study significantly

shortens the range for stenosis to between 700 Hz~800 Hz

after signal processing. The proposed method is a

non-invasive, safe, rapid, and low cost technique, which

uses an electronic stethoscope to measure the blood flow

The Detection of Arteriovenous Fistula Stenosis for

Hemodialysis Based on Wavelet Transform

Yen-Nien Wang, Chih-Yang Chan, & Shi-Jun Chou

Wang et al.: The Detection of Arteriovenous Fistula Stenosis for Hemodialysis Based on Wavelet Transform

International Journal Publishers Group (IJPG)

17

sound signal, and utilizes a wavelet algorithm to analyze

vascular stenosis [2].

Conventional biomedical signal analysis is generally

composed of time domain and frequency domain analyses.

The time domain uses waveform width, height, and interval,

where the high-frequency signal analysis is applicable to a

small time interval, but is subjected to a pulse, and thus,

could only be used on a non-stationary signal. The

frequency domain adopts the Fourier Transform in order to

transform a time signal into a frequency domain, and then

observes the spectral signal, in order to determine the

significance of the physical signal [3]. The Fourier

Transform causes a linear superposition of the Harmonic

Function in the signal. In regard to a periodic signal, which

does not abruptly change with time, its signal characteristic

can be well exhibited from the spectra. However, the

periodic signal is not the most important in most cases; thus,

the non-periodic signal (e.g., signal feature point) is the key

focus of this study, specifically, when the Fourier

Transform shows its limitation and weak point by failing to

provide time dependent information [4]. Therefore, both

frequency and amplitude must be functions of time before

being able to demonstrate signal characteristics. Fourier

Transform adopts the square-integrable real function space,

to any function in space, Fourier Transform definition is:

( ) ( )

j t

F f t e dt

e

e

+

=

}

(Equ. 1)

1

( ) ( )

2

j t

f t F e d

e

e e

t

+

=

}

(Equ. 2)

where

j t

e

e

is the base value of square-integrable real

function space ) (

2

R L , when frequencye adopts discrete

integer n e = , here is Fourier series base value,

jnt

e .

Although

j t

e

e

is a frequency-dependent continuous form

of

jnt

e , they differ greatly. First, the function space

) (

2

R L differs completely from ) 2 , 0 (

2

t L ; second,

) (

2

R L must attenuate to zero when each function is

infinitely great. Unlike the continuous and discrete forms of

a wavelet transform, the Fourier Transform cannot provide

uniform descriptions. The Fourier Transform discrete form

is:

( ) ( )

jn t

F n f t e dt

+

A

A =

}

(Equ. 3)

where discrete the Fourier Transform is a function with

period of 2 / t A , and can be seen beyond function

space ) (

2

R L . The best way to search an ) (

2

R L wave, in

order to generate the entire function space ) (

2

R L , is to

retain waveform and move along R, such a wave is called a

wavelet. The wavelet theory is an analytical method

developed over the past decade, and was first used to

analyze electromagnetic waves, seismic waves, and

quantum physics. At present, wavelet analysis has been

successfully applied in many biomedical research

techniques, as it can be used to measure data noise, data

correctness, and reliability. Since a biomedical signal has a

weak signal and high noise, its analysis is very difficult, and

the application of the wavelet analysis theory to biomedical

techniques remains as an issue to be addressed.

A high-frequency sound occurs when the blood stream

flow meets with a resistance, and thus, is a non-stationary

signal. Such a high-frequency sound may be a feature

signaling the occurrence of a vascular stenosis. With its

good time-frequency analysis characteristics, wavelet

analysis has excellent performance in lowering noise and

singular point detection. To effectively find the singular

point in a signal, this study employs the wavelet algorithm

to analyze pulse wave data, using the wavelet

time/frequency domain analysis concept to resolve

time-dependent changes in a signal spectrum, in order to

analyze singular points in a signal. Wavelet transform can

be used to conduct simultaneous signal analysis in both time

and frequency domains, thus, overcoming the disadvantage

of the Fourier Transform in singular point processing.

According to the differences between singular point and

wavelet coefficients, when a singular signal is detected, the

detected data are further compared with an ultrasonic

detection graph; if accurate, then they are consistent,

otherwise, they are inconsistent.

2. Wavelet transform

A wavelet ( ) (t ) is a small interval wave [5], with a

limited length and a rapidly-attenuating waveform, with a

zero mean. There are various wavelet function spaces. This

study adopts the one square-integrable real function space

) (

2

R L , or:

) ( ) (

2

R L t = (Equ. 4)

A wavelet differs from the Fourier Transform in the

relationship of bandwidth e A versus central frequencye ,

where bandwidth e A is not related with the central

frequencye of the Fourier Transform, but is in proportion

to the wavelet transform, as expressed by Equ.(5),

C

e

e

A

= (Equ. 5)

where C is a constant, e A is the bandwidth, and e is

the central frequency.

When wavelet analysis is adopted, then the wavelet

generating function ) (t is a square-integrable real

function space, and the substituted transform must satisfy

the following equation:

2

( )

R

C d

e

e

e

= <

}

(Equ. 6)

Translate and dilate the wavelet generating function

) (t in order to obtain function ) (

,

t

a t

; where a is

International Journal of Advanced Computer Science, Vol. 1, No. 1, Pp. 16-22, Jul. 2011.

International Journal Publishers Group (IJPG)

18

distance, t is time; and t is displacement. The

representation is:

) (

1

) (

,

a

t

a

t

a

t

t

= (Equ. 7)

A continuous wavelet transform is defined as the

convolution of an unanalyzed signal ) (t x of the wavelet

generating function ) (t , at time t, and various distance

a [6], as shown below:

dt

a

t

t f a a WR

R

f

}

=

) ( * ) ( | | ) , (

2

1

t

t (Equ. 8)

) , ( t a WR

f

is the wavelet transform coefficient; if

rewriting time t to e , then a frequency domain

representation can be obtained [14].

The first step of wavelet analysis is to decompose the

original signal, and then extract the high-frequency and

low-frequency coefficients, as if entering highpass and

lowpass filters, as shown in Fig 1 (a). If a three-level

analysis is to be conducted, then a second decomposition of

the low-frequency coefficient must be performed, which

process is to first extract the high-frequency and

low-frequency coefficients, and then, run the third

decomposition of the low-frequency coefficient in order to

extract high-frequency coefficients, H1, H2, and H3, as well

as the low-frequency coefficient L3, as shown in Fig 1 (b).

Fig 1 (c) shows a representation reconstruction, where HF

and LF coefficients are obtained in decomposition, and H1,

H2, H3, and L3 must be reconstructed to a resolvable signal.

Upon completion of the above steps, the discrete wavelet is

inversely transformed as a reversing decomposition. The

reconstruction analysis signal is obtained as shown in Fig 1

(d), the reconstruction equation is as follows:

= ) ( ) (

, ,

t C C t f

a a t t

(Equ. 9)

This study adopts a bandpass filter to locate a signal within

a frequency range of 500 Hz~1,000 Hz, and conducts

wavelet three-level decomposition. Level 1 is reconstruction

in 1,000 Hz~750 Hz and 750 Hz~500 Hz, Level 2 is

reconstruction in 1,000 Hz~750 Hz, 750 Hz~625 Hz, and

625 Hz~500 Hz, and finally, Level 3 reconstruction is

performed in 1,000 Hz~750 Hz, 750 Hz~625 Hz, 625

Hz~575.5 Hz, and 575.5 Hz~500 Hz (Fig 2).

Fig. 1. Wavelet decomposition & reconstruction diagrams: (a)

Flow chart of wavelet decomposition at Level 1; (b) Three-level

wavelet decomposition diagram; (c) Three-level wavelet

reconstruction diagram; (d) Flow chart of wavelet reconstruction at

Level 1.

Fig. 2 Three-level wavelet reconstruction graph.

Low

coefficient

L3

High

coefficient

H3

High

coefficient

H2

High

coefficient

H1

Low

coefficient

L3

High

coefficient

H3

High

coefficient

H2

High

coefficient

H1

(a)

(b)

(c)

(d)

Wang et al.: The Detection of Arteriovenous Fistula Stenosis for Hemodialysis Based on Wavelet Transform

International Journal Publishers Group (IJPG)

19

3. Experimental

Clinically, vascular stasis easily occurs at four points,

namely, the fistula-vessel junction or puncture site, puncture

site arterial end (blood is pumped to dialysis machine),

puncture site venous end (blood is sent from dialysis

machine back to blood vessel), and artery/vein fistula

junctions. As patients arteriovenous fistulae are hidden

under the derma, the signal is weak. Most transplanted

fistulae are under the skin, where signal collection is clearer,

thus, measurements are mainly performed on an artificial

transplanted fistula. An artificial fistula (artificial vessel) is

created in two ways, a linear type (Fig 3 (a)), and a U type

(Fig 3 (b)). Clinically, ultrasonic detection of stenosis has

two criteria: 1) when the blood flow ratio at the arterial end

is over 3 (Fig 3), and over 2 at the venous end (Fig 3), then

there is vascular stenosis; and 2) when the measurement

point flow rate is above 400cm/sec, valid even if the flow

ratio does not reach criterion 1, it is still determined as a

vascular stenosis. An inherent characteristic of a continuous

vascular stenosis is that a majority of the vessels have

become smaller, thus, the bloodstream continuously passes,

which results in a faster blood flow. This study determines

stenosis from ultrasonic blood flow data, compares

measurement computation results with ultrasonic detection

results (Fig 4), and then, utilizes their relation to validate the

algorithm of this study.

Fig. 3 Ultrasonic test points schematic: (a) U-type transplanted

fistula; (b) linear transplanted fistula.

Fig. 4 Ultrasonic measurement and collection data schematic (The

highlighted number at the bottom left is the measured blood flow

rate).

In ultrasonic measurement, vascular shape, position

and pulse are clearly visible to identify and measure the

vessels. This study has two test points, and one is

arteriovenous fistula surgical mark (Fig 5). In Fig 5 (a), only

one surgical mark serves for the convenience of surgery and

patient skin recovery. The internal arterial fistula and

venous fistula junctions are very close, and one surgical

mark is visible at the surface, thus only one point is to be

measured. The other point is the junction of an arterial end

and a venous end at the puncture site, which normally has

an eschared mark on the surface (Fig 5).

Fig. 5 Stethoscope test point schematic: (a) U-type transplanted

fistula; (b) linear transplanted fistula.

A ten-second signal is sampled, and the maximum value is

extracted for every second. Every 10 signals are sequenced

in order to choose the maximum median, which is

synthesized into an analysis signal. This study uses two

methods to determine data availability: 1) frequency domain

analysis 3D and 2D graphs, and 2) time domain wavelet

three-level reconstruction. Frequencies are shrunk into one

block, time-frequency analysis is conducted, redundant

noise is checked (voltage noise, artificial noise) and

compared against the time domain and frequency domain

analysis results. Wavelet transform is performed on

consistent signals, then, the three-level signal is analyzed,

and the first level signal is converted to a power spectrum

by Hilbert transform [7]. The threshold is obtained to

increase visibility, and if there is a significant feature, it is

stenosis, otherwise, there is no stenosis (Fig 6).

Fig. 6 Algorithm flow chart.

(a) (b)

(a) (b)

International Journal of Advanced Computer Science, Vol. 1, No. 1, Pp. 16-22, Jul. 2011.

International Journal Publishers Group (IJPG)

20

Fig. 7 Hardware schematic.

In data collection recording begins when a patient

receives ultrasonic detection, and a condenser microphone

is placed into the stethoscopes chestpiece. The signal is

amplified through an audio amplifying circuit, and passes

through the designed analog bandpass filter [8]. The

required bandwidth is captured and saved to a computer for

further analysis (Fig 7).

The recorded signal is an audio signal, where the

normal audible sound ranges between 50~20 kHz. The

statistic analysis finds that, the blood flow signal consists of

a fundamental frequency signal and carrier wave, which

bandwidth depends on the extent of the vascular stasis [9].

Through examining the information of the

bandwidth-dependent carrier wave, vascular stenosis, and

its degree, can be determined [10].

4. Experimental Results

In singular point detection, when a signal is interrupted

or discontinued, the signal has singularity. When a signal

changes, the slight change will be within a certain range,

which differs from noise. Singular point detection

recognizes singular points among the signals, and is defined

as the basis of the stenosis, and is analyzed.

After sampling the 10s signals from the original signal,

this study employs a time-frequency comparison in order to

enhance data accuracy. When using Matlab software and

plotting in 2D time domain, the problem cannot be shown

accurately; however, if transformed into a frequency domain

for recognition, the difference can be directly found. The 3D

graph, as below, is plotted after transforming into a time

domain; where the light color is intense, and the dark color

is tranquil, as too light a color affects judgments, and a 2D

graph is added for comparison. Fig 8 shows a stenosis-free

case, and Fig 9 shows a stenosis case.

Fig. 8 Stenosis-free representation: (a) 3D representation; (b) 2D

representation.

Fig. 9 Stenosis representation: (a) 3D representation; (b) 2D

representation.

A bloodstream signal consists of a fundamental

frequency signal and carrier wave, which bandwidth

depends on the vascular stasis. As shown in Figs 8 and 9, as

there is no embolism, the stenosis-free case manifests as a

regular blood flow signal (Fig 8), while the stenosis case is

affected by a carrier wave, which bandwidth depends on

vascular stasis (Fig 9).

Fig. 10 Wavelet three-level reconstruction representation: (a)

Stenosis-free representation; (b) Stenosis representation.

Fig 10 (a) shows a regular stenosis-free waveform in

wavelet analysis. In Fig 10 (b), the stenosis wave is mixed

with a carrier wave, which bandwidth depends on the

vascular stasis, and results in an irregular waveform.

Figs 11 and 12 present the power spectra, after Hilbert

transformation of a Level 1 signal, which is reconstructed

after wavelet decomposition. Obvious features occur at

700~800 Hz. Fig 11 shows a stenosis-free case, and Fig 12

shows a stenosis case. Whether the blood vessel is narrowed

can be seen from the threshold judgment. In this study, if

the signal is above the threshold, then the threshold is

subtracted in order to facilitate identification, this detection

threshold is shown as follows:

f

W threshold max 15 1 = (Equ. 8)

(a)

(b)

(a) (b)

(a) (b)

Wang et al.: The Detection of Arteriovenous Fistula Stenosis for Hemodialysis Based on Wavelet Transform

International Journal Publishers Group (IJPG)

21

Fig. 11 Stenosis-free Hilbert transform: (a) power spectrum; (b)

threshold judgment.

In Fig 11(a) there is neither a significant feature, nor a

singularity. In Fig 12(a), the significant feature is in

700~800 Hz, which is the stenosis criterion in this study.

Thus, Fig 12(a) is supposed as having stenosis. Fig 11(b)

and Fig 12(b) show a greater visible threshold judgment

result than do Figs 11(a) and 12(a).

In this study, if the signal is above the threshold, then

the threshold is subtracted. Fig 11(b) is obtained after a

threshold judgment, as the signal does not exceed the

threshold and 0~100 kHz interval is due to a fundamental

frequency effect; and therefore, it will be neglected. In Fig

12(b), there is significant rise in 700~800 Hz, which

suggests that a stenosis has occurred. It can be assumed that

the carrier wave at the stenosis falls within 700~800Hz.

This study has 83 groups of valid data, and after

comparing the Hilbert transformed power spectrum with the

ultrasonic detection results, 71 groups of data are correct

(consistent with ultrasonic detection results), accounting for

85.54% of the total data; and 12 groups of data are

misjudged (inconsistent with ultrasonic detection results),

accounting for 14.45% of the total data (Table 1).

Fig. 12 Hilbert transform in case of stenosis: (a) power spectrum;

(b) threshold judgment.

5. Conclusions

This study developed an algorithm to determine if

hemodialysis patients have arteriovenous fistula stenosis.

According to the statistics of all patient data, vascular

stenosis affects the high-frequency component in a

bloodstream signal. It is preliminarily judged that

singularity occurs in 700~800 Hz; and when transformed

into a frequency domain, it is also clearly recognizable.

High-frequency sound occurs when the bloodstream is

subjected to resistance. Such a non-stationary signal is a

probability feature of vascular stenosis. This study

employed a wavelet algorithm to analyze pulse wave data,

and used the wavelet frequency domain analysis concept to

(a)

(b)

(a)

(b)

Table 1 Simulation results

Sequence

Comparison with

ultrasonic detection

results

Number

of data

groups

Percentage of

total data

A Not consistent 12 14.45%

B Consistent 71 85.54%

International Journal of Advanced Computer Science, Vol. 1, No. 1, Pp. 16-22, Jul. 2011.

International Journal Publishers Group (IJPG)

22

resolve time-dependent signal spectral changes in order to

analyze singular points in a signal. A singular signal can be

detected from the difference between an abrupt singular

point signal and wavelet coefficients. If a signal is broken or

discontinued, then this signal is singular at that point. When

a signal changes, it would be slightly over a certain range,

and thus, would be different from noise. Hence, singular

point detection is to recognize a singular point within a

signal, and is defined as stenosis criterion before analysis.

Moreover, detected data are compared with ultrasonic

detection results; if accurate, then they are consistent,

otherwise, they are inconsistent.

After processing the signal and wavelet transform, there

is a stenosis feature in 700 Hz~800 Hz, indicating that

vascular stenosis affects the high-frequency component in a

bloodstream signal. Threshold judgment and statistical

analysis are conducted on the data of all patients. The

success rate is 85.54%, and the misjudgment rate is 14.46%.

References

[1] P.O. Vesquez, M.M. Macro, & B. Mandersson,

Arteriovenous Fistula Stenosis Detection using Wavelets

and Support Vector Machines, (2009) Annual International

Conference of the IEEE EMBS, pp. 1298-1301.

[2] H.A. Mansy, S.J. Hoxie, N.H. Patel, & R.H. Sandier,

Computerized Analysis of Auscultatory Sounds Associated

with Vascular Patency of Hemodialysis Access, (2005)

Medical & Biological Engineering & Computing, vol. 43,

pp. 56-62.

[3] Yalin Zhang, Qinyu Zhang, & Shaohua Wu,

Biomedical Signal Detection Based on Fractional Fourier

Transform, (2008) International Conference on

Information Technology and Application in Biomedicine, pp.

349-352.

[4] S. Kadambe & Boudreaux-bartels GF, An Application

of the Wavelet Ttransform for Pitch Detection of Speech

Signals, (1992) IEEE Trans. on Information Theory, vol.

38, pp. 917-924.

[5] D.A. Sherman, An Introduction to Wavelets with

Electrocardiology Applications, (1998) Herzschr

Elektrophys, vol. 9, pp. 42-52.

[6] A. Graps, An Introduction to Wavelet, (1995) IEEE

Computational Science and Engineering, vol. 2, pp. 50-61.

[7] N.E. Huang, Z. Shen, & S.R. Long, A new View of

Nonlinear Water Waves: The Hilbert Spectrum, (1999)

Annu. Rev. Fluid Mech., vol. 31, pp. 417-457.

[8] H.C. Deepa, R.P. Valentini, & E.S. Kamil,

Hemodialysis Vascular Access Options in Pediatrics:

Considerations for Patients and Practitioners, (2006)

Medical & Biological Engineering & Computing, vol. 36,

pp. 386-397.

[9] Z. Sharg, M.S. Zainal, A.Z. Sha'ameri, & S.H.S. Salleh,

Analysis and Classification of Heart Sounds and Murmetrs

Based on Tee Instantaneous Energy and Frequency

Estimations, (2000) IEEE Porceedings TENCON, vol. 2,

pp.130-134.

[10] J.E. Earis & B.M.G. Cheetham, Current Methods

Used for Computerized Respiratory Sound Analysis, (2000)

Eur. Respir. Rev. vol. 10: 77, pp586-590.

Yen-Nien Wang was born in Taipei,

Taiwan in 1968. He received his B. S.

degree from the Dept. of Automatic

Control Engineering, Feng Chia

University in 1991, M. S. degree from

the Dept. of Electrical Engineering,

National Taiwan Institute of Technology

in 1993 and Ph.D. degree from the Dept. of Electrical

Engineering, National Taiwan University of Science and

Technology in 2000. He is currently an assistant professor of

Electronic Engineering at the LungHwa University of

Science and Technology. His research interests include the

digital signal processing, digital communication, artificial

intelligence, and bioengineering.

Chih-Yang Chan was born in Taipei,

Taiwan in 1965. He received his M.D.

degree from the Dept. of Medicine,

China Medical College in 1994 and

Ph.D. degree from the Graduate Institute

of Physiology, National Taiwan

University in 2007. He is currently an

Attending Surgeon of the Department of

Surgery, National Taiwan University Hospital and an

Associate Professor of the Medical School, National Taiwan

University. His research interests include the Vascular

Pathophysiology and bioengineering.

Shi-Jun Chou was born in Taipei,

Taiwan in 1985. He received his B.S.

and M.S. degree from the Dept. of

Electronic Engineering, LungHwa

University of Science and Technology

in 2008 and 2011, He is currently an

assistant professor of Electronic

Engineering at the LungHwa University of Science and

Technology. His research interests include the digital signal

processing and artificial intelligence.

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