Mechanisms of Shock Wave Action for Improved SWL

项目2计划采用一种机械方法来制定实际的治疗策略， 结果和减少SWL的不良反应。1)我们将进一步了解SW的机制， 使用光纤水听器（FOPH）确定结石破裂和组织损伤的作用， SW在肾盂和近端输尿管中作用部位的特征。2)音质差 与干头碎石机结合降低了治疗效率，导致输送的SW多于 是用来打碎石头的我们将找到消除耦合缺陷和开发成像的方法 允许泌尿科医生在整个治疗过程中监测偶联的方法。3)肥胖患者 通常具有SWL的不良结局，并且通常在高水平下接受过多数量的SW治疗。 压力我们将确定限制成功治疗的因素，并探索如何改善 当患者的皮肤-结石距离预测结果不佳时，可以输送SW。4)泌尿科医生 越来越意识到SWL可能产生不利影响，但几乎没有实用信息来关联SWL 剂量的潜在伤害。我们将使用基于超声的系统来确定SW编号 常规治疗条件下和方案下肾脏空化相关损伤的阈值 旨在保护组织免受损伤。我们的目标是监测条件成熟的伤害， 可以采取措施将组织损伤降至最低5)新一代的碎石机已经推出 临床实践。这些机器产生低声压传递到一个广泛的焦点区。 初步研究表明，这些机器可以提供一个显着的优势，改善石头破碎 不良影响最小，但需要进行彻底的独立评估，以确定 这一新技术的优势和局限性。6)碎石机在慢SW速率下碎石效果优于 在快速的速度。我们已经表明，在负压下，快速的SW显著减少， 空化是造成这种效应的原因。我们现在建议使用高速成像和FOPH来 确定SW率对结石破碎的作用机制。 相关性（参见说明）： 冲击波碎石术（SWL）是最常用的治疗方法，用于去除肾结石。然而，SWL 已经发现会对肾脏和周围器官造成急性创伤， 严重的慢性不良反应。这项拟议中的研究将找到使SWL更安全， 有效

Project 2 plans a mechanistic approach to the development of practical treatment strategies that will Improve outcomes and reduce adverse effects in SWL. 1) We will advance understanding of the mechanisms of SW action in stone breakage and tissue injury using a fiberoptic hydrophone (FOPH) to determine the characteristics of SWs at their site of action in the renal pelvis and proximal ureter. 2) Poor acoustic coupling with dry-head lithotripters reduces the efficiency of treatment, leading to delivery of more SWs than are needed to break stones. We will find methods to eliminate coupling defects and develop imaging methods that allow urologists to monitor coupling throughout the treatment session. 3) Obese patients typically have poor outcomes with SWL and are often treated with excessive numbers of SWs at high pressures. We will detemiine the factors that limit successful treatment and explore ways to improve how SWs can be delivered when the patient's skin-to-stone distance predicts a poor result. 4) Urologists are increasingly aware that SWL can generate adverse effects but have little practical information to relate SW dose to the potential for injury. We will use an ultrasound-based system to determine the SW number threshold for cavitation-related injury in the kidney under routine treatment conditions and with protocols designed to protect against tissue damage. The goal is to monitor for conditions that are ripe for injury so that steps can be taken to minimize tissue damage. 5) A new generation of lithotripter has been introduced to clinical practice. These machines produce low acoustic pressures delivered to a wide focal zone. Preliminary studies suggest these machines may offer a significant advantage for improved stone breakage with minimal adverse effects, but a thorough independent assessment is needed to determine the advantages and limitations of this new technology. 6) Lithotripters break stones better at slow SW-rate than at fast rate. We have shown that SWs at fast rate are dramatically reduced in negative pressure and that cavitation is responsible for this effect. We now propose to use high-speed imaging and the FOPH to determine the mechanism of action of SW-rate on stone breakage. RELEVANCE (See instructions): Shock wave lithotripsy (SWL) is the most common treatment used to remove renal stones. However, SWL has been found to cause acute trauma to the kidney and sunrounding organs that is linked to potentially very serious chronic adverse effects. The proposed research will find ways to make SWL safer and more effective.