Engineered microbubbles to augment laser lithotripsy of urinary stones

工程微泡增强尿路结石激光碎石术

• 批准号: 10255749
• 负责人: Yuri A. Pishchalnikov
• 金额: $ 25.65万
• 依托单位: APPLAUD MEDICAL, INC.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2023-05-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10255749
• 关键词: Affect; American; Chemicals; Clinical; Data; Devices; Disease; Distal; Dust; Effectiveness; Emergency department visit; Engineering; Environment; Feasibility Studies; Fiber; Frequencies; Goals; Healthcare Systems; Injury; Intervention; Irrigation; Knowledge; Laser Lithotripsy; Lasers; Lead; Left; Life; Light; Lipids; Longevity; Mechanics; Microbubbles; Operative Surgical Procedures; Optics; Outcome; Pain; Patients; Pattern; Penetration; Phase; Physiologic pulse; Postoperative Period; Procedures; Pulse Rates; Recurrence; Research; Residual state; Risk; Shock; Site; Small Business Innovation Research Grant; Specific qualifier value; Speed; Surface; Techniques; Time; Treatment Cost; Treatment Protocols; Ureteroscopes; Urinary Calculi; Urinary system; Urine; Video Microscopy; Violence; Water; Work; X-Ray Computed Tomography; aqueous; base; biomineralization; care costs; common treatment; cost; detector; energy density; improved; innovation; insight; minimally invasive; patient safety; pressure; product development; public health relevance; sensor; therapy development; vapor; vaporization

Abstract Significance: Ureteroscopic laser lithotripsy is currently the most common surgical treatment for urinary stones—a painful disease affecting 1 in 11 people and imposing a significant burden on the U.S. healthcare system, with the cost of care exceeding $10 billion annually. Although laser lithotripsy breaks all types of stones, an emergent concern is that a large fraction of patients (around one in two) is left with residual stone fragments when evaluated with computed tomography that are too small to laser efficiently but too large to pass spontaneously with urine flow. While the residual fragments are small in comparison with the pre-treatment stone, the residual fragments nonetheless lead to high rates of post- operative emergency department visits, additional interventions, and recurrence of stones. Preliminary studies suggest that specially engineered microbubbles augment laser lithotripsy, producing smaller residual fragments, which should lead to improved clinical outcomes. We hypothesize that engineered microbubbles augment laser lithotripsy by focusing energy into stones and stone fragments via two main mechanisms: optical and mechanical. This is consistent with the mechanisms by which conventional laser lithotripsy ablates urinary stones, via direct laser light interactions with the stone surface as well as mechanical effects due to the rapid vaporization and subsequent violent collapse of the aqueous environment concomitant with each laser pulse. The objective of this Phase I SBIR is to determine the feasibility of using specially engineered microbubbles to significantly reduce residual stone fragments and improve laser lithotripsy. In Aim 1, we will identify mechanisms and sites of action of engineered microbubbles in laser lithotripsy. In Aim 2, we will develop strategies to improve the effectiveness of laser lithotripsy with engineered microbubbles. The innovation of the proposed approach is the use of engineered microbubbles that accumulate on urinary stones to augment stone fragmentation and reduce residual stone fragments in laser lithotripsy. This approach has the potential to significantly improve the treatment for urinary stones by reducing the risk of injury, procedural complications, and additional procedures, as well as result in a significant reduction in procedural time and cost. In addition, the knowledge gained from this feasibility study will aid our understanding of the mechanisms by which conventional laser lithotripsy operates, and produce further insights into the treatment of biomineralization-related diseases.

抽象的 意义：输尿管激光碎石疗法目前是尿中最常见的手术治疗 石头 - 一种痛苦的疾病，影响11人中有1人，并对美国施加大量烧伤 医疗保健系统，每年的护理费用超过100亿美元。虽然激光碎石疗法断裂 所有类型的石头，紧急关注的问题是，一小部分患者（大约二分之一）留下 用剩余的石材碎片用计算机断层扫描评估，该片段太小而无法激光 有效但太大，无法随着尿液的流动而发挥。而残差碎片很小 与治疗结石的比较，残余碎片仍然导致高率 手术急诊室就诊，其他干预措施和石头的复发。 初步研究表明，专门设计的微泡增强激光碎石疗法，产生 较小的残留片段，应导致改善临床结果。我们假设这一点 通过将能量聚焦于石头和石材碎片，工程化的微泡增强激光碎石疗法 通过两个主要机制：光学和机械。这与该机制一致 传统的激光岩石疗法通过与石头直接激光相互作用消融尿石 由于迅速分散和随后的暴力崩溃，表面以及机械效应 每个激光脉冲伴有水性环境。 I阶段I SBIR的目的是确定使用特殊工程的可行性 微泡可显着减少残留的石材碎片并改善激光碎石疗法。在AIM 1中， 我们将确定在激光碎石疗法中工程微泡的机制和作用位置。在AIM 2中， 我们将制定策略，以使用工程的微泡提高激光碎石疗法的有效性。 拟议方法的创新是使用累积的工程微泡 尿石以增强石材碎片化并减少激光碎石疗法中的残留石材碎片。 这种方法有可能通过减少尿石的处理显着改善治疗 受伤的风险，程序并发症和其他程序，并导致重大 减少程序时间和成本。此外，从这项可行性研究中获得的知识将 帮助我们理解常规激光碎石操作员的机制，并生产 进一步了解与生物矿化相关疾病的治疗。

项目成果

Plasma formation in holmium:YAG laser lithotripsy.

钬：YAG 激光碎石术中的等离子体形成。

• DOI: 10.1002/lsm.23659
• 发表时间: 2023
• 期刊: Lasers in surgery and medicine
• 影响因子: 2.4
• 作者: Pishchalnikov,YuriA;Behnke-Parks,WilliamM;Stoller,MarshallL
• 通讯作者: Stoller,MarshallL