Strategies for Improved Shock Wave Lithotripsy

总体描述（由申请人提供）：我们提出了四个项目和两个核心之间的协调、高度互动的多学科合作，主要目标是使冲击波碎石术（SWL）对所有患者安全有效。在这项工作中，我们将： * 确定SWL对肾脏的慢性影响-对肾脏的长期影响 在治疗期间诱导急性损伤后结构和功能 * 确定碎石术是否会诱发新发糖尿病 制定治疗方案， 保护患者免受SWL不良影响 * 确定SW在肾脏和近端输尿管中作用部位的特性 * 通过改善声耦合，提高SWL的效率 碎石机和病人 * 设计改善肥胖患者SWL结局的治疗方案 * 确定SWL损伤的治疗阈值并开发监测方法 损害肾脏的疾病的发作 * 低压宽焦区治疗新趋势的临床疗效和安全性评价 碎石技术 * 发展声学监测和反馈技术，以改进目标定位和射击 碎石机，以消除错过结石的SW输送，并确定 当石头 中断完成，会话可以结束 * 确定血管内空化导致出血的机制 * 开发数值模型，以了解空化和非空化的作用 机制 导致组织损伤

DESCRIPTION, OVERALL (provided by applicant): We propose a coordinated, highly interactive multidisciplinary collaboration between four Projects and two Cores with the main goal of making shock wave lithotripsy (SWL) safe and effective for all patients. In this work we will: * Determine the chronic effects of SWL on the kidney-the long-term effects on renal structure and function that follow induction of acute damage during a treatment session * Determine if lithotripsy induces new-onset diabetes Develop treatment protocols that protect patients from SWL adverse effects * Determine the properties of SWs at their site of action in the kidney and proximal ureter * Increase the efficiency of SWL by improving the acoustic coupling between the lithotripter and the patient * Devise treatment protocols that improve SWL outcomes for obese patients * Determine the treatment threshold for SWL injury and develop a method to monitor onset of conditions that are damaging to the kidney * Evaluate the efficacy and safety of a new trend-low-pressure wide-focal-zone-in clinical lithotripter technology * Develop acoustic monitoring and feedback techniques to improve the targeting and firing of lithotripters to eliminate the delivery of SWs that miss the stone, and to determine when the stone has broken to completion and the session can be ended * Determine the mechanism by which cavitation within a vessel causes hemorrhage * Develop numerical models to understand the role of cavitation and non-cavitational mechanisms in causing tissue damage