Improving Mechanistic Understanding and Treatment Efficiency of Laser Lithotripsy

总体：摘要 肾结石（或俗称泌尿系结石病）是一种良性但严重疼痛的泌尿生殖系统疾病， 这种疾病正在上升，是美国第二大泌尿系统疾病，每年超过20亿美元。 肾结石的治疗正从冲击波碎石术转向腔内激光碎石术 输尿管镜碎石术（LL），但激光-结石-组织相互作用和LL的基础知识 技术并没有随着其在临床护理中的日益增长的使用而发展。目前，有一个紧迫的 需要对现有的LL技术和不同的 与各种LL模式相关的作用机制。这样的努力将是及时和关键的优化 LL用于改善以患者为导向的结局和结石病的长期手术管理。因此 该P20应用程序的首要目标是在杜克建立泌尿科激光技术中心（CULT） 大学，将协同联合收割机在工程和泌尿科的专业知识，以更好地了解 不同的激光技术和临床上用于结石管理的技术。该中心将集中在一个 研究项目。该中心的团队将由具有泌尿学，生物光子学，热 转移，计算力学和材料科学，以解决在推进激光所面临的挑战， 治疗结石病的技术。该中心的研究项目有两个具体目标，重点是（1） 全面表征肾脏和人工肾脏的光学、热学、声学和机械特性， 不同组成的石头，并研究不同的机制，石头损坏产生的 各种模式的LL;和（2）进行深入的分析激光诱导空泡动力学在 与不同LL装置产生的结石后移和治疗效率的相关性。该中心的 行政核心将提供管理CULT研究的科学监督所需的基础设施 项目研究和监督组织、预算、报告、外联、通信和教育 邪教的目标。CULT的EEP将提供一个新的工程设计培训经验， 企业家精神的下一代生物工程师与临床医生密切合作，有兴趣在良性 泌尿生殖系统研究CULT创造的协同效应和知识有望推动技术进步。 与领先的LL制造商Dornier合作，推动LL系统的创新和发展 MedTech和其他医疗器械公司，使全球数百万结石患者受益。

OVERALL: SUMMARY ABSTRACT Nephrolithiasis (or commonly known as urinary stone disease) is a benign but severely painful genitourinary disease that is on the rise and is the second most costly urologic condition in the US at over $2 billion per year. The treatment of nephrolithiasis is shifting away from shock wave lithotripsy (SWL) to intracorporeal laser lithotripsy (LL) via ureteroscopy, but the foundational knowledge of laser-stone-tissue interaction and LL technology has not advanced commensurably with its growing use in clinical care. At present, there is a pressing need for a fundamental and comprehensive investigation of the existing LL technologies and the dissimilar mechanisms of action associated with various modes of LL. Such an effort will be timely and crucial to optimize LL for improved patient-oriented outcomes and long-term surgical management of stone disease. Therefore, the overarching goal of this P20 application is to develop a Center for Urological Laser Technologies (CULT) at Duke University that will synergistically combine the expertise in engineering and urology to better understand the dissimilar laser technologies and techniques used clinically for stone management. This center will focus on a Research Project. The center's team will consist of investigators with expertise in urology, biophotonics, heat transfer, computational mechanics, and materials science to address the challenges faced in advancing laser technologies to treat stone disease. The center's Research Project has two Specific Aims focusing on (1) Characterizing comprehensively the optical, thermal, acoustic, and mechanical properties of kidney and artificial stones of different compositions and investigate the dissimilar mechanisms of stone damage produced by various modes of LL; and (2) Performing an in-depth analysis of laser-induced cavitation bubble dynamics in correlation with stone retropulsion and treatment efficiency produced by different LL devices. The center's Administrative Core will provide infrastructure required to manage the scientific oversight of CULT's Research Project studies and oversee the organizational, budgeting, reporting, outreach, communications, and educational goals of the CULT. CULT's EEP will provide a novel training experience in engineering design and entrepreneurship to the next generation of bioengineers in close collaboration with clinicians interested in benign genitourinary research. Synergies and knowledge created by CULT are expected to propel technological innovation and development in LL systems forward, in collaboration with a leading LL manufacturer Dornier MedTech and other medical device companies, benefitting millions of stone patients worldwide.