Ultrasound Imaging and Treatment of Hernia Mesh

迫切需要开发一种新的设备，在不切除网眼感染的情况下进行非侵入性治疗 网状。在没有这种设备的情况下，许多网状感染的治疗仍将是高度侵入性的和 代价不菲。这项研究的目的是发展基于空化的组织摩擦学来治疗外科网眼感染。 组织摩擦学在组织中产生/激发一团微米大小的气泡，这些气泡机械地撕碎目标 细胞。微泡坍塌的物理学促进了附着在植入物上的细菌的溶解，从而增强了 破坏引起感染的细菌生物膜。 具体目标#1：改进脉冲方案以减少空化记忆的影响。我们假设 在我们的应用中，添加较低幅度的脉冲将减少空化记忆，也会显著减少 治疗次数。曝光对网格属性的影响也将针对不同的 曝光条件。 具体目标2：提高网格对比度。我们假设，如果我们 结合横波和脉冲回波成像和/或通过添加玻璃微球来增加网格对比度 丙纶纤维。增加对比度也可能通过提供 网格的较强反射增加了网格附近的压力场。 具体目标#3：在动物模型中测试治疗的安全性和有效性。我们假设我们的 在动物模型中，治疗将能够安全有效地治疗疝气网片上的细菌生物膜。这 假说将通过在猪模型中在不同的植入位置植入受感染的网状样本来评估 和深度，同时仔细评估组织是否有任何意外损害。 这个项目意义重大，因为一旦开发出来，每年数千名患者将有另一种选择 到治疗网眼感染的侵入性手术。此外，改善网格对比度可以改善患者护理 即使在没有感染的情况下。一旦网状感染的可行性被证明，许多其他的 植入的装置可能是我们同样以组织摩擦学为基础的治疗的候选对象。

There is a critical need to develop a new device to noninvasively treat mesh infections without removing the mesh. In the absence of such a device, the treatment of many mesh infections will remain highly invasive and costly. This study's objective is to develop cavitation-based histotripsy to treat surgical mesh infections. Histotripsy generates/excites a cloud of micron sized bubbles in the tissue which mechanically shred the targeted cells. The physics of microbubble collapse promotes lysis of bacteria attached to the implant enhancing the destruction of the bacteria biofilm causing the infection. Specific Aim #1: Improve pulsing scheme to reduce the impact of cavitation memory. We hypothesize that adding lower amplitude pulses will reduce cavitation memory in our application as well drastically reducing treatment times. The impact of the exposures on mesh properties will also be determined for the different exposure conditions. Specific Aim #2: Improve mesh Contrast. We hypothesize that it will be easier to visualize the mesh if we combine shear-wave and pulse echo imaging and/or increase mesh contrast by adding glass microspheres to the polypropylene fibers. Increasing the contrast may also increase the effectiveness of our therapy by providing a stronger reflection off the mesh increasing the pressure fields in the immediate vicinity of the mesh. Specific Aim #3: Test therapies safety and effectiveness in an animal model. We hypothesize that our therapy will be able to treat bacteria biofilms on hernia mesh safely and effectively in an animal model. This hypothesis will be evaluated by implanting infected mesh samples in a swine model at varying implant locations and depths while also carefully assessing the tissue for any unintended damage. This project is significant because once developed thousands of patients each year would have an alternative to invasive surgery for treating mesh infections. In addition, improving mesh contrast could improve patient care even when no infection develops. Once feasibility has been shown for mesh infections, numerous other implanted devices may be candidates for our same histotripsy-based treatment.