1. Presenter: Wei-Liang Hong Advisor: Dr. Chun-Ju Hou

2. Problems and Rationale Incidence of renal failure and dialysis Incidence in 2004Incidence in 2005 number of people (millions) Source: USRDS

3. Problems and Rationale Prevalence rates of renal failure and dialysis Prevalence rates in 2004Prevalence rates in 2005 Source: USRDS number of people (millions)

4. Problems and Rationale Treatments for renal failure Kidney transplantation Dialysis Peritoneal dialysis: 9.17% Hemodialysis: 90.83% Native arteriovenous (AV) fistula Synthetic AV shunt (Graft) U-type transplanted fistula Linear transplanted fistula 4

5. Problems and Rationale 5 Native AV fistula AV graft

6. Problems and Rationale Complications of arteriovenous fistula (AVF) Infection Bleeding Vascular access dysfunction Stenosis Embolism Steal syndrome Venous hypertension …..

7. Problems and Rationale Assessments for AVF function Palpated with the fingers Strength of pulse, thrill Auscultation Appear high-pitched bruit or sea-gull murmur (200 ~ 800 Hz) when stenosis occurs Angiography Ultrasound CT

8. Problems and Rationale Problems in AVF care Insufficient auscultation skill Subjective Depend on individual experience Insufficient manpower Lack of objectively computerized sound analysis

9. Purpose and Specific Aims Establishment of an auscultation system for the evaluation of arteriovenous fistula stenosis Hardware and software design Experimental testing

10. Analog circuits Wavelet transform STFT FFT Hilbert transform 10 Yen-Nien Wang, Chih-Yang Chan, & Shi-Jun Chou, “The Detection of Arteriovenous Fistula Stenosis for Hemodialysis Based on Wavelet Transform”, International Journal of Advanced Computer Science, Vol. 1, Pp. 16-22, Jul. 2011. (Impact Factor 0.740) Background & Literatures Review

11. (a) Stenosis-free representation; (b) Stenosis representation. 11 Background & Literatures Review

12. 12 Stenosis-free Stenosis Background & Literatures Review

13. 13 Stenosis-free Stenosis Background & Literatures Review

14. Equipment (BIOPAC, Inc.) 0.05~5k(Hz) Matlab Analysis method Empirical Mode Decomposition (EMD) Pablo V´asquez, Marco Mungu´ıa M., Members IEEEE,lisabeth Mattsson, and Bengt Mandersson, “Application of the Empirical Mode Decomposition in the study of murmurs from Arteriovenous Fistula Stenosis”, 32nd Annual International Conference of the IEEE EMBSBuenos Aires, Argentina, August 31 - September 4, 2010 Background & Literatures Review

16. References 行政院衛生署， “ 醫療統計年報 ” ，民國 99 年。 http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=12336&class_no=440&level_ no=4 行政院衛生署， “ 年全民健康保險動向 ” ，民國 99 年。 http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=12073&l evel_no=2&doc_no=83223 ，行政院衛生署 2009 年全民健康保險動向 Yen-Nien Wang, Chih-Yang Chan, & Shi-Jun Chou, “The Detection of Arteriovenous Fistula Stenosis for Hemodialysis Based on Wavelet Transform,” (Jul. 2011.) International Journal of Advanced Computer Science, Vol. 1, No. 1, pp. 16-22 黃敏祥、盧明智， “OP Amp 應用 + 實驗模擬 ” ，全華科技圖書股份有限公司， 2004 。 醫學百科 ， http://big5.wiki8.com/katuopuli_32669/ Microphone ~ Vintage Mike Mic Sound Recording Stickers ， http://www.google.com/imgres?hl=zh- TW&tbm=isch&tbnid=qZgN2qsILuggoM:&imgrefurl=http://www.zazzle.com/microphone_vintage_ mike_mic_sound_recording_sticker-217046618120618483&docid=nlvmY- v9C_6ZOM&imgurl=http://rlv.zcache.com/microphone_vintage_mike_mic_sound_recording_sticker - p217046618120618483b2o35_400.jpg&w=400&h=400&ei=ueBzUKqMIuP2mAWho4CIBw&zoom =1&iact=rc&dur=303&sig=103467883864509983712&page=3&tbnh=141&tbnw=139&start=53&n dsp=30&ved=1t:429,r:11,s:53,i:275&tx=115&ty=92&biw=1366&bih=615 H. A. Mansy, S. J. Hoxie, N. H. Patel and R. H. Sandler, “Computerized analysis of auscultatory sounds associated with vascular patency of haemodialysis access,” Medical ＆ Biological Engineering ＆ Computing, Vol 43, pp. 56-62, 2005. http://www.eefocus.com/article/10-02/14308027070239Jllc.html, 與非網 侯春茹, 梁正,”Design of a Multi-channel Lung Sound Measuring System” 財團法人台灣醫療改革基金會, http://www.thrf.org.tw/Page_Show.asp?Page_ID=674

17. Thank You For Your Attention