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In this paper, it is proposed wavelet neural network using the fuzzy concept with the fuzzy and the multi-resolution analysis(MRA) of wavelet transform. Also, it wishes to improve any nonlinear function learning approximation using this system. Here, the fuzzy concept is used the bell type fuzzy membership function. And the composition of wavelet has a unit size. It is used the backpropagation algorithm for learning of wavelet neural network using the fuzzy concept. It is used the multi-resolution analysis of wavelet transform, the bell type fuzzy membership function and the backpropagation algorithm for learning. This structure is confirmed to be improved approximation performance than the conventional algorithms from one dimension and two dimensions function through simulation.

In this paper, we propose a Fuzzy Cellular Neural Network(FCNN) that is based on a-Least Trimmed Square Hausdorff distance(a-LTSHD) which applies Hausdorff distance(HD) to the FCNN structure in order to remove the impulse noise of images effectively and also improve the speed of operation. FCNN incorporates Fuzzy set theory to Cellular Neural Network(CNN) structure and HD is used as a scale which computes the distance between set or two pixels in binary images without confrontation of the feature object. This method has been widely used with the adjustment of the object. For performance evaluation, our proposed method is analyzed in comparison with the conventional FCNN, with the Opening-Closing(OC) method, and the LTSHD based FCNN by using Mean Square Error(MSE) and Signal to Noise Ratio(SNR). As a result, the performance of our proposed network structure is found to be superior to the other algorithms in the removal of impulse noise.

Purpose: To evaluate the efficacy of taurolidine instillation on postoperative air leak by clini-cal study and to investigate the mechanism of action by animal experiments.Methods: Outcomes of taurolidine instillation in patients with postoperative air leak were retrospectively reviewed. 100 ml of 1% taurolidine solution was instilled through a chest tube in patients with postoperative air leak lasting 4days or more. Success was defined as cessation of air leak within 24 hours with full expansion of lung on chest radiograph and subsequent removal of chest tube within another 24 hours. The effect of taurolidine instillation was esti -mated by development of adhesion and thickening of the visceral pleura in rabbits. The study group was compared with a control group and a talc poudrage group.Results: Out of 75 patients, the success rate was 66.7%. Out of 96 total attempts, taurolidine instillation was successful in 55%. In animal experiments, pleural adhesion was minimal in the taurolidine and control groups, whereas the talc group showed more adhesions. The tau -rolidine group showed a moderate visceral pleural thickening. The talc group showed severe visceral pleural thickening, whereas the control group showed mild thickening. Conclusion: Taurolidine is an effective alternative agent for the management of air leak. A chemical sclerosing effect is suggested as the mechanism of air leak cessationKeywords

Introduction: Clinical outcomes and prognosis of recurrent thymoma are not well known because of its rarity and indolent clinical course. This study was designed to determine the clinical outcomes and prognosis of recurrent thymoma. Methods: Between 1986 and 2009, 41 of 305 patients who underwent resection for thymoma had recurrence. We reviewed those patients retrospectively. Results: Of 15 patients who underwent re-resection for recurrent thymoma, 13 patients (87%) achieved complete re-resection. Of 26 patients who did not undergo re-resection, 11 patients received chemotherapy, five received chemoradiotherapy, one received another treatment, and nine patients did not receive any treatment. World Health Organization histological types AB or B1 and complete re-resection were positive prognostic factors. The complete re-resection group had better survival after recurrence than the non/incomplete re-resection group (5-year survival rate: 90.9% versus 44.7%, p = 0.014). The complete re-resection group had comparable survival after initial resection of thymoma to the patients without recurrence (5-year, 10-year survival: 91.7%, 91.7% versus 90.7%, 86.5%, p = 0.618) and better survival compared with the non/incomplete re-resection group (5-year, 10-year survival: 91.7%, 91.7% versus 81.6%, 56.7%, p = 0.018). Conclusions: World Health Organization histologic types AB or B1 and complete re-resection are favorable prognostic factors of recurrent thymoma. In particular, complete re-resection of recurrent thymoma contributes to better survival than other management. Therefore, we suggest that long-term surveillance extended at least 20 years may be essential for early detection of recurrence to increase the chance of complete re-resection of recurrent thymoma.

Background This study was designed to analyze the predictive factors for survival in second primary lung cancer patients following operation. Methods A total of 1852 patients who underwent resection for primary lung cancer between January 1990 and December 2008 were reviewed, retrospectively. Results Nineteen patients were treated for synchronous second primary lung cancer and 23 patients were treated for metachronous cancer. The overall 5-year survival rate for patients with synchronous second primary lung cancer was comparable to that of patients with single-lung cancer (51.4 vs. 48.7%, p = 0.755). The overall 5-year survival rate after the first tumor resection in patients with metachronous second primary lung cancer was significantly better than that of patients with single-lung cancer (85.4 vs. 48.7%, p = 0.003), but was not significantly different after the second tumor resection (77.0 vs. 48.7%, p = 0.057). Conclusion Surgically resected second primary lung cancer had a survival comparable with single-lung cancer. Histologic concordance between the first and second tumors, and the pathological stage were important prognostic factors in second primary lung cancer.

Background We retrospectively reviewed the clinical features and surgical outcomes of patients with a surgically resected NSCLC invading chest wall in order to identify prognostic factors that impact long term survival. Methods Between January 1990 and December 2009, 107 patients who underwent surgical resection for chest wall invading NSCLC were reviewed. Tumors invading only the parietal pleura were defined as superficial invasions, and those involving the soft tissue or ribs were defined as deep invasions. Results There were 91 men and 16 women; median age was 64 years (range 30 to 80 years). Overall 5 year survival rate was 26.3%. The univariate prognostic factors for survival included gender, extent of resection (pneumonectomy vs lobectomy), tumor size(> 5 cm vs ≤ 5 cm), nodal status (N0 or N1 vs N2), completeness of resection (complete vs incomplete) and completeness of adjuvant chemotherapy. At multivariate analysis, five independent prognostic factors were shown; depth of invasion (superficial vs deep), tumor size, nodal status, completeness of resection, and completeness of adjuvant chemotherapy. In patients with completely resected T3N0 NSCLC, completion of chemotherapy is the only prognostic factor for long term survival. Conclusions Completeness of resection, nodal status, depth of invasion, tumor size, and adjuvant chemotherapy were prognostic factors for long-term survival in NSCLC patients with chest wall invasion. Because of poor prognosis in cases with chest wall invasion that have N2 positive LN, that is difficult to achieve complete resection and that need pneumonectomy, definite chemoradiotherapy or neoadjuvant chemoradiotherapy should be considered first in these cases.

Purpose To investigate the incidence of bilateral discoid lateral meniscus (DLM) and to evaluate the arthroscopic features of lateral meniscus in asymptomatic contralateral knees in an Asian population who presented with symptomatic DLMs. Methods This study prospectively enrolled 52 consecutive patients who underwent arthroscopic procedures for symptomatic DLMs (31 complete and 21 incomplete) and who consented to the examination of the contralateral knee at the time of arthroscopy. Types of DLMs and of meniscus tears were assessed by use of arthroscopic findings. Preoperative and postoperative functional outcomes were evaluated with Lysholm and Tegner activity scores. Results Arthroscopic examinations showed 21 complete DLMs, 19 incomplete DLMs, 11 normal lateral menisci, and 1 ring-shaped lateral meniscus in contralateral knees. The incidence of bilateral DLM in our study population was 79% (41 of 52 contralateral knees). Furthermore, 65% of patients (34 pairs of knees) had the same DLM types. In addition, 3 pairs of knees with complete DLMs had menisci of different thicknesses. DLM tears were observed in 2 contralateral knees (1 radial and 1 longitudinal) and were treated by partial central meniscectomy. Conclusions This study provides evidence of the high prevalence of bilateral DLM in an Asian population. Level of Evidence Level I, testing of previously developed diagnostic criteria in a series of consecutive patients.

Background This study was designed to assess the treatment of patients in whom a second primary lung cancer developed after the resection of primary lung cancer. Methods Between January 1990 and December 2008, 1852 patients underwent complete resection for primary lung cancer in our institution. Of these individuals, patients who had been identified as having a second primary lung cancer by December 2009 were selected for this study using the criteria proposed by Martini and Melamed. Results Of 1852 patients, a second primary lung cancer developed in 40 (2.2%) during the follow-up period. The overall 5-year and 10-year survival rates after the resection of the first tumor were 78.3% and 39.9%, respectively. The overall 5-year survival rate from the time of detection of the second primary lung cancer was 47.8%, and the 5-year survival rate of the patients who underwent resection of the second tumor was 77.0%. The patients who underwent sublobar resection had comparable overall survival and disease-free survival compared with the patients who underwent anatomic resection. Additionally, the patients who underwent sublobar resection had a better operative outcome. Conclusions Surgical resection is feasible and effective in the management of second primary lung cancer, and sublobar resection may be adequate. Long-term surveillance of more than 5 years is essential for early detection to increase the chance of resection of a second primary lung cancer.

Background: Aortic valve replacement (AVR) improves left ventricular (LV) systolic function in patients with chronic aortic regurgitation (AR). The objective of this study is to determine predictors for normalization of impaired LV systolic function after valve replacement for chronic AR. Methods and Results: Between 1997 and 2007, 171 patients underwent AVR for severe chronic AR. Of these patients, 79 patients with LV systolic dysfunction or severe LV dilatation preoperatively, who were evaluated by echocardiography at predischarge and early follow up (mean, 6 months) were examined. The mean preoperative ejection fraction was 49%. The mean LV end-systolic and end-diastolic dimensions were 52.32±8.35mm and 69.59±7.80mm, respectively. In the early follow up, 62 of 79 patients exhibited restored normal LV function. LV end-systolic dimension and LV end-diastolic dimension were significantly decreased early after AVR (52.32±8.35mm vs 37.82±6.88mm, and 69.59±7.80mm vs 51.55±6.40mm, respectively). Operative mortality was 3.7%. Multivariate stepwise regression analysis revealed that preoperative indexed LV end-systolic and end-diastolic dimensions were independent predictors of restored LV systolic function. The sensitivity and specicity in predicting normalization of LV function were 88% and 92% for indexed LVESD

Background: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths.A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju Severance Christian Hospital in Korea from January 2010 to December 2012.The mean age of patients was 35.2 years old. The most frequent trauma mechanism was blunt injury (90.8%), as well as slip-and-fall down injury, motor vehicle accidents, and others. Aside from 142 early trauma deaths, a total of 4673 patients were admitted for further treatment. The most common major trauma sites of admitted patients were on the extremities (38.4%), followed by craniocerebral, abdominopelvis, and thorax. With deaths of 126 patients during in-hospital treatment, the overall mortality (142 early and 126 late deaths) was 5.6% for admitted patients. Ages ≥55, injury severity score ≥16, major craniocerebral injury, cardiopulmonary resuscitation at arrival, probability of survival25% calculated from the trauma and injury severity score were independent predictors of trauma mortality in multivariate analysis.The epidemiology of the trauma patients studied was found to be mainly blunt trauma. This finding is similar to previous papers in terms of demographics and mechanism. Trauma patients who have risk factors of mortality require careful management in order to prevent trauma-related deaths.

The boundary of an object image in a digital image is distorted by noise or other elements of the system that mix with the image during transmission. In this paper, it is proposed that the object boundary be detected and exactly divided for optimal edge detection method. After bringing up the object boundary by applying adaptive morphology on the threshold of the input image, the optimal edge is detected using wavelet-cellular neural network (CNN). The proposed method is compared with the conventional Sobel method used as an edge detection algorithm. The proposed algorithm is confirmed to be superior than the conventional methods.

In this paper, we propose the color fuzzy decision algorithm for face segmentation in a color image. Our algorithm can segment without the user's interaction by fuzzy decision marking. It removes small parts such as a noise using wavelet morphology in the image obtained by applying the fuzzy decision algorithm. Also, it merges and chooses the face region in each quantization image through rough sets. This video object division algorithm is shown to be superior to a conventional algorithm.

There has recently been increasing interest in the development of radioprobes that specifically target proteins transcribed from expression of reporter genes of interest. The purpose of this study was to develop a radioprobe that targets one of the most widely used reporter genes, the bacterial lacZ gene. We synthesised and purified radioiodine-labelled phenylethyl-beta- d-thiogalactopyranoside (PETG), a competitive inhibitor specific against Escherichia coli beta-galactosidase. We showed that [(125)I]iodo-PETG specifically binds to beta-galactosidase as verified by column chromatography and polyacrylamide gel electrophoresis after incubation of radiotracer with the protein. We also showed through enzyme kinetic studies that iodo-PETG retains inhibitory action against beta-galactosidase activity. COS-7 cells infected with a recombinant adenovirus expressing the lacZ gene had viral titre-dependent enhancements in [(125)I]iodo-PETG uptake ( r(2)=0.897; P=0.001), which reached up to 642.5%+/-16.7% of control levels ( P0.00001). Moreover, the level of uptake was highly correlated to luminescent measurements of beta-galactosidase activity ( r(2)=0.878; P0.0001). These results confirm that radioiodine-labelled PETG specifically targets beta-galactosidase and that its uptake rates faithfully reflect levels of expression of the lacZ reporter gene. Further investigations were performed in nude mice bearing human neuroblastoma tumours transferred with the lacZ gene. Compared with control tumours, lacZ-expressing tumours were slightly better visualised on [(123)I]iodo-PETG images and had a modest increase in tumour to muscle count ratio (2.6+/-0.2 vs 1.9+/-0.1, P0.05). The present results provide proof-of-principle for the potential of radiolabelled inhibitors as promising radiotracers to monitor lacZ gene expression levels. Future modifications to improve cell permeability should enhance in vivo contrast levels and may allow the use of radiolabelled beta-galactosidase inhibitors for non-invasive monitoring of lacZ gene expression.

Angiostatin (AS) is a potent antiangiogenic agent which inhibits tumor growth through specific action on proliferating endothelial cells. Imaging of radiolabeled AS would enhance our knowledge on the pharmacokinetics of AS and might provide useful information relating to tumor neovasculature. We therefore investigated the potential of radiolabeled AS as a novel tumor imaging agent. Human angiostatin was radioiodine labeled using the lactoperoxidase method. Competition binding studies showed a dose-dependent inhibition of (125)I-AS binding to endothelial cells by excess unlabeled AS, and a displacement curve demonstrated that specific binding was dose dependent and saturable, with a K(d) value of 169 n M. Gel analysis showed that (125)I-AS remained stable in serum for up to 24 h without significant degradation. Intravenously injected (125)I-AS in rats was cleared from the blood in an exponential fashion. Biodistribution data from human colon cancer-bearing Balb/C nude mice showed high uptake in the kidneys, stomach, liver, and lungs. Tumor uptake was 3.2+/-0.7, 2.6+/-0.2, and 1.7+/-0.2%ID/g at 2, 4, and 9 h after injection, respectively. Tumor to muscle count ratio increased from 3.1+/-0.5 at 2 h to 4.4+/-0.5 at 9 h. Serial scintigraphy from 1 to 5 h after (123)I-AS injection demonstrated high uptake in the kidneys and bladder, consistent with renal excretion. There was clear demarcation of tumor by 1 h, with gradual increase in contrast over time (4-h tumor to contralateral thigh ratio =4.7+/-1.1). Thus, radioiodine-labeled angiostatin binds specifically to endothelial cells and has potential as a novel tumor imaging agent.