Objective: Our goals were to validate stone comminution with an investigational burst wave lithotripsy (BWL) system in patient-relevant conditions and to evaluate the use of ultrasonic propulsion to move a stone or fragments to aid in observing the treatment endpoint. Materials and Methods: The Propulse-1 system, used in clinical trials of ultrasonic propulsion and upgraded for BWL trials, was used to fragment 46 human stones (5-7 mm) in either a 15-mm or 4-mm diameter calix phantom in water at either 50% or 75% dissolved oxygen level. Stones were paired by size and composition, and exposed to 20-cycle, 390-kHz bursts at 6-MPa peak negative pressure (PNP) and 13-Hz pulse repetition frequency (PRF) or 7-MPa PNP and 6.5-Hz PRF. Stones were exposed in 5-minute increments and sieved, with fragments >2 mm weighed and returned for additional treatment. Effectiveness for pairs of conditions was compared statistically within a framework of survival data analysis for interval censored data. Three reviewers blinded to the experimental conditions scored ultrasound imaging videos for degree of fragmentation based on stone response to ultrasonic propulsion. Results: Overall, 89% (41/46) and 70% (32/46) of human stones were fully comminuted within 30 and 10 minutes, respectively. Fragments remained after 30 minutes in 4% (1/28) of calcium oxalate monohydrate stones and 40% (4/10) of brushite stones. There were no statistically significant differences in comminution time between the two output settings ( p = 0.44), the two dissolved oxygen levels ( p = 0.65), or the two calyx diameters ( p = 0.58). Inter-rater correlation on endpoint detection was substantial (Fleiss' kappa = 0.638, p < 0.0001), with individual reviewer sensitivities of 95%, 86%, and 100%. Conclusions: Eighty-nine percent of human stones were comminuted with a clinical BWL system within 30 minutes under conditions intended to reflect conditions in vivo. The results demonstrate the advantage of using ultrasonic propulsion to disperse fragments when making a visual determination of breakage endpoint from the real-time ultrasound image.
Self-healing concrete is described as the capability of material to repair their cracks independently. Cracks in concrete are well-known circumstance because of their short tensile strength. Many researchers carried out their research on self-healing concrete using different classification and clustering methods. But the temperature variation and pH variation were not minimized. In order to address these problems, a Multivariate Logistic Regressed Chi-Square Deep Recurrent Neural Network based Self-Healing (MLRCSDRNN-SH) Method is introduced. The main aim of MLRCSDRNN-SH method is to improve building structures strength through inducing the micro-bacteria in concrete. Multiple Logistic Regressed Chi-Square Deep Recurrent Neural Network (MLRCSDRNN) is used to revise bacteria’s stress-strain behaviour towards enhanced material strength in the MLRCSDRNN-SH approach. Initially, the bacteria selection is carried out in alkaline environment like Bacillus subtilis, E. coli and Pseudomonas sps. The data sample is given to the input layer. The input layer transmits sample to the hidden layer 1. The regression analysis is carried out between the multiple independent variables (i.e., parameters) using multivariate logistic function for improving the building structure strength. The regressed value is transmitted to the hidden layer 2. The pearson chi-squared independence hypothesis is performed to identify the probability of crack self-healing property for increasing the building structure strength. When probability value is higher, then the building structure strength is high. Otherwise, the output of second hidden layer is feedback to the input of hidden layer 1. The mixture with higher strength of building structure is sent to the output layer. Several specimens have different sizes used by various researchers for bacterial material study in comparison with the concrete. Depending on experimental results, compressive strength restoration proved higher self-healing ability of the concrete.
It is hypothesized a 2.6-mm stone was too small to break with 390-kHz burst wave lithotripsy (BWL). In clinical trial NCT03873259, a 2.6-mm stone failed to break after 10 min of 390-kHz BWL and was removed intact. Ex vivo, the stone failed to break after another 30 min at 390 kHz but broke into four pieces in 4 min at 650 kHz. A linear elastic model was used to calculate the stress created inside stones of different sizes, shapes, and compositions by shock wave lithotripsy (SWL) and different BWL frequencies. The model predicts above a threshold frequency proportionate to wave speed over stone length, the maximum principal stress inside a stone increases to more than five times the acoustic pressure applied. Thus, smaller stones may fragment at higher but not lower frequency. Amplification remains with irregularly shaped stones but is not seen with an SWL waveform. Ex vivo, stones smaller than 3 mm broke fastest at 830 kHz while larger stones broke fastest with 390 kHz followed by 830 kHz. For small stones and fragments, increasing BWL frequency many produce, amplified stress in the stone causing the stone to break to smaller fragments to pass. [Work supported by NIH-P01-DK04331 and NIH-K01-DK104854.]
Continuous hands-on training on SWL technique was found to be able to keep the treatment success rate high. Appropriate case selection and compliance with HOT technique can dramatically improve SWL success rate.
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