Enhanced lithotripsy through coalescence and dispersion of cavitation bubbles

通过空化气泡的聚结和分散增强碎石术

• 批准号: 9924525
• 负责人: Timothy L Hall
• 金额: $ 35.68万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9924525
• 关键词: Acoustics; Acute; Adopted; Adoption; Adverse effects; American; Animals; Attenuated; Blood Tests; Caliber; Cell Nucleus; Clinical; Clinical Trials; Complex; Cystine; Data; Dose; Effectiveness; Electromagnetics; Environment; Extracorporeal Shockwave Lithotripsy; Failure; Family suidae; Goals; Grant; Human; Implant; In Situ; In Vitro; Injury; Injury to Kidney; Intervention; Kidney; Laboratories; Liquid substance; Lithotripsy; Location; Magnetic Resonance Imaging; Methods; Modeling; Operative Surgical Procedures; Outcome; Pain; Pathway interactions; Patients; Procedures; Process; Proliferating; Protocols documentation; Radiation; Recording of previous events; Research; Residual state; Risk; Role; Safety; Shock; Soft Tissue Injuries; System; Techniques; Testing; Time; Tissues; Transducers; Ultrasonic Transducer; Ultrasonography; Ureter; Urinary Calculi; Urine; Work; clinical translation; design; experimental study; follow-up; healing; improved; millisecond; operation; prevent; safety study; sound; statistics; success; tissue injury; tool

Abstract Extracorporeal shockwave lithotripsy (SWL) revolutionized the treatment of urinary stones when first introduced three decades ago. Instead of open stone surgery, acoustic energy could be applied from outside the body to fragment stones in situ. Although widely utilized for treatment of stones, SWL has not fully lived up to its potential. Incomplete fragmentation of stones can result in significant pain (when fragments migrate down the ureter and obstruct urine outflow) and a high rate of residual fragments that need subsequent additional therapy. SWL research has shown the complex role of acoustic cavitation in the stone comminution process. While cavitation has been demonstrated to be an essential component of the fragmentation process, the bubbles produced also interfere with subsequent shockwaves reducing their effectiveness and sometimes causing tissue injury. SWL treatments at extremely low rates (i.e. <30 shocks/min) have been shown in the laboratory to be substantially more efficient and cause less tissue injury because there is sufficient time for most of the cavitation bubbles to dissolve. However, ultra-low rates have not been adopted clinically because of the impractically long procedure times that would be required. We have previously demonstrated that unfocused low amplitude acoustic bursts can stimulate rapid coalescence and dispersion of cavitation bubbles during SWL clearing the pathway for subsequent shockwaves within tens of milliseconds. By this method we can recover the stone fragmentation efficiency and safety of very low shockwave rates at standard clinical rates. Initial studies outlined in this proposal are designed to optimize the bubble coalescence and dispersion process for use with a standard clinical electromagnetic shockwave lithotripsy system. The following studies will then demonstrate safety and improved efficacy on a porcine model such that a pilot clinical trial could be initiated following this work.

抽象的 体外冲击波碎石术 (SWL) 首次推出后彻底改变了尿路结石的治疗 三十年前。可以从体外应用声能来破碎碎石，而不是进行开放式碎石手术 石头就地。尽管 SWL 广泛用于治疗结石，但尚未完全发挥其潜力。不完整 结石碎裂会导致剧烈疼痛（当碎石沿着输尿管向下移动并阻塞尿液时） 流出）和需要后续额外治疗的高残留碎片率。 SWL 研究表明 声空化在石料粉碎过程中的复杂作用。虽然空化已被证明是一种 作为破碎过程的重要组成部分，产生的气泡也会干扰随后的冲击波 降低其有效性，有时还会导致组织损伤。 SWL 治疗率极低（即 <30 冲击/分钟）已在实验室中显示出显着提高效率并减少组织损伤，因为 大多数空化气泡有足够的时间溶解。但超低费率并未被采用 临床上由于需要不切实际的长手术时间。我们之前已经演示过 未聚焦的低振幅声爆发可以刺激空化气泡的快速聚结和分散 在 SWL 期间，可在数十毫秒内为后续冲击波清除通道。通过这个方法我们可以恢复 标准临床速率下极低冲击波速率的结石破碎效率和安全性。初步研究 该提案中概述的目的是优化气泡聚结和分散过程，以便与标准一起使用 临床电磁冲击波碎石系统。接下来的研究将证明安全性并得到改进 在猪模型上的功效，以便在这项工作之后可以启动试点临床试验。

项目成果

Enhanced High-Rate Shockwave Lithotripsy Stone Comminution in an In Vivo Porcine Model Using Acoustic Bubble Coalescence.

使用声学气泡聚结增强体内猪模型中的高速冲击波碎石碎石。

• 发表时间: 2016-12
• 影响因子: 2.7
• 作者: Alavi Tamaddoni, Hedieh;Roberts, William W;Duryea, Alexander P;Cain, Charles A;Hall, Timothy L
• 通讯作者: Hall, Timothy L

Removal of residual cavitation nuclei to enhance histotripsy fractionation of soft tissue.

去除残留的空化核以增强软组织的组织解剖分离。

• 发表时间: 2015-12
• 作者: Duryea, Alexander P;Cain, Charles A;Roberts, William W;Hall, Timothy L
• 通讯作者: Hall, Timothy L

Removal of residual cavitation nuclei to enhance histotripsy erosion of model urinary stones.

去除残余空化核以增强模型尿路结石的组织解剖侵蚀。

• 发表时间: 2015-05
• 作者: Duryea, Alexander P;Roberts, William W;Cain, Charles A;Hall, Timothy L
• 通讯作者: Hall, Timothy L

Removal of residual nuclei following a cavitation event: a parametric study.

空化事件后残留核的去除：参数研究。

• 发表时间: 2015-09
• 作者: Duryea AP;Tamaddoni HA;Cain CA;Roberts WW;Hall TL
• 通讯作者: Hall TL

Removal of residual nuclei following a cavitation event using low-amplitude ultrasound.

使用低振幅超声波去除空化事件后的残留核。

• 发表时间: 2014-10
• 作者: Duryea, Alexander P;Cain, Charles A;Tamaddoni, Hedieh A;Roberts, William W;Hall, Timothy L
• 通讯作者: Hall, Timothy L