Mechanisms of Shock Wave Action for Improved SWL

项目2计划采用机械化的方法来制定将改进的实际治疗策略。 减少SWL的不良反应。1)我们将加深对短波机制的理解 光纤水听器(FOPH)在结石破碎和组织损伤中的作用 肾盂和输尿管近端作用部位的SWS特征。2)音质差 与干头碎石机配合使用降低了治疗效率，导致比 是打碎石头所需要的。我们将找到消除耦合缺陷的方法，并开发成像 使泌尿科医生能够在整个治疗过程中监测耦合的方法。3)肥胖患者 通常SWL的结果不佳，并且经常在高海拔时接受过多的SWS治疗 压力。我们将确定限制成功治疗的因素，并探索如何改进 当患者的皮肤到结石的距离预测结果不佳时，可以提供SWS。4)泌尿科医生 越来越意识到SWL可能会产生不利影响，但几乎没有与SWL相关的实用信息 可能会造成伤害的剂量。我们将使用基于超声波的系统来确定软件编号 常规治疗条件下肾脏空洞相关损伤的阈值及治疗方案 设计用来保护组织免受损伤。目标是监测伤病时机成熟的情况，因此 可以采取措施将组织损害降至最低。5)引进了新一代碎石机 到临床实践。这些机器产生较低的声压，可传输到较宽的焦点区域。 初步研究表明，这些机器可能在改善碎石方面提供显著的优势。 不良反应最小，但需要进行彻底的独立评估以确定 这项新技术的优点和局限性。6)碎石机慢速碎石效果好于 以极快的速度。我们已经证明，快速的SWS在负压下显著减少，并且 空化作用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 确定了波速对碎石的作用机理。 相关性(请参阅说明)： 冲击波碎石术(SWL)是最常用的治疗肾结石的方法。然而，SWL 已被发现会对肾脏和日光器官造成急性创伤，这可能与 严重的慢性不良反应。拟议的研究将找到使SWL更安全和更多的方法 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.