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published_or_final_version / Biochemistry / Doctoral / Doctor of Philosophy

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Bibliography: leaves 278-289. / xi, 324 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / This thesis reports on experimental investigation of the growth and aggregation of calcium oxalate mono-dydrate in metastable saline solutions using batch and continuous systems. The physical chemistry of calcium oxalate mono-hydrate in aqueous solutions is considered. A tubular crystalliser to be used as an in vitro system is described. / Thesis (Ph.D.)--University of Adelaide, Dept. of Chemical Engineering, 1996?

A brief investigation was made of various enzymes such as urease in conjunction with a wetting agent, ficin, steapsin, and hyaluronidase as aides in the :in vitro" dissolution of calculi in "G"⁷ solution. This investigation indicated that a more effective solvent was needed. / Master of Science

A brief investigation was made of various organic and inorganic solvents for the dissolution of urinary calculi in vitro and Albright’s (1) citric acid buffer and a solvent designated in this investigation simply as “G” (33) were shown to be the most efficient solvents. Further investigation showed that something was necessary to increase the efficiency of these solvents, as the dissolution would proceed to a certain point where the solvent ceased to act. It was at this point that the investigation changed its course and the attack was centered on the organic colloidal matrix in the structure of the stone. It is a well known fact that this organic matrix is resistant to weak acids and bases (30) and therefore the course of the investigation pointed to those most remarkable agents, “the enzymes”, which due to their enormous amount of surface energy are capable of producing astonishing results. The enzymes investigated were not selected for their specific action, but they were selected for the purpose of studying the effect of their surface energy on the colloidal matrix of urinary calculi. The investigation indicates that a calculus pretreated with urease for fifteen minutes, followed by a 6 hour irrigation with “G” (33) solution is sufficient to cause dissolution and disintegration in nearly all of the one hundred calculi selected at random. (See Table 5) The ability of urease to hasten disintegration may be due to its activity on the colloidal matrix, causing it to swell, thereby giving back the former hydrotropic properties mentioned by Snapper (52). Colloidal material was isolated from a large calculus and was subjected to the action of urease. After 6 hours the colloids from the calculus had swollen approximately five hundred times their original volume, and changed from a dark brown-colored material to a white translucent gel. These organic colloidal matrices of urinary calculi are apparently of a reversible nature and irreversible as investigators have assumed in the past (30). Investigations were made and reported in various sections of this paper on the ability of other enzymes, peroxide, and acids to act as dissolution agents or as aids to dissolution. An efficient in vitro irrigator Fig. 1 is described and its merit in the irrigation of urinary calculi lies in the facts that its construction is simple, its rate of flow can be accurately regulated by a slight manipulation, and the calculus can be treated in various ways without removing it from the original crucible. It now remains for the urologist to investigate the possibility of in vitro dissolution, using the above auxiliary agent. It is suggested that the urease might be used simultaneously with the irrigation solvent. / Ph. D.

Conclusion This series of investigations demonstrated how we can apply our knowledge to improve the treatment outcome of ESWL. Based on clinical information, such as age, suitable candidates for ESWL can be identified, and hence better application of ESWL can be achieved. With an understanding of the benefits and limitations of imaging (NCCT and intravenous urography), treatment success can be predicted, and better treatment plans for patients can be formulated. A policy of more liberal use of analgesia during ESWL can also help to improve the treatment outcomes of patients. Finally, with the use of different assessment methods, the true impact of various new technologies or treatment protocols can be assessed, and the results can lead to better understanding of ESWL and also improvement in the treatment outcomes. / Materials and Methods In a retrospective review of treatment information of 2192 patients, the effect of age on stone-free rates after ESWL was assessed. Next, in a prospective study, the role of stone parameter, measured using non-contrast computerized tomography (NCCT), in predicting the treatment outcomes of upper ureteric stones was examined. The general applicability of caliceal pelvic height (CPH) in determining the treatment outcomes for lower caliceal stones for three different lithotriptors was assessed in the third study. In another retrospective comparative study, the effect on treatment outcomes of additional usage of intravenous analgesic during ESWL, as compared to oral analgesic premedication alone, was analyzed. Finally, the feasibility of the use of two statistical methods, logistic regression and matched-pair analysis, in comparing the treatment results of different lithotriptors was investigated. / Objectives Despite the initial success of extracorporeal shock wave lithotripsy (ESWL), the performance of the contemporary machines has never been as good as that of the first-generation machine. Therefore, a series of studies was conducted to advance the current knowledge of ESWL and investigate possible ways to further optimize the treatment outcomes. / Results We found that the stone-free rate after ESWL for older patients with renal stones, but not for those with ureteric stones, was significantly lower than that of younger patients. Stone parameters measured using NCCT, namely, mean stone density, stone volume, and skin-to-stone distance, were significant predictive factors for successful ESWL for upper ureteric stones. However, caliceal pelvic height, measured by intravenous urography, was a significant predictor of treatment outcomes of lower caliceal stones for only the Piezolith 2300 lithotriptor, and not the other two types of lithotriptors. The additional usage of intravenous analgesic improved the effectiveness quotient and hence treatment outcomes of ESWL. Finally, both logistic regression and matched-pair analysis were found to be feasible approaches for the comparison of the performance of different lithotriptors. / Chi-Fai Ng. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 224-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

Bibliography :leaves 149-172. / vii, 172,[60] leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / The investigations centre on the use of [beta]-aminothiols (cysteine, cysteamine and penicillamine) to decrease endogenous oxalate production by forming adducts with glyoxylate, the immediate precursor of oxalate. They indicate that cysteine delivery drugs like OTC have the potential to aid in management of calcium oxalate stone disease, thereby reducing endogenous oxalate production and urinary oxalate excretion. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 1995?

The purposes of this research are (1) to bridge this gap of deficiency by developing a simple, precise and reproducible routine analytical technique by using attenuated total reflectance, and (2) to serve as an atlas for identification of renal calculi.

by Lo, Kin Yin Anthony. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 168-195). / Abstracts in English and Chinese. / Abstract --- p.i / Declaration --- p.V / Publications and Conference Presentations --- p.vi / Scholarships and Awards --- p.vii / Acknowledgements --- p.viii / Table of contents --- p.X / Abbreviations --- p.xiv / List of Figures --- p.xvi / List of Tables --- p.xvii / Chapter 1. --- General Introduction --- p.1 / Chapter 2. --- Literature Review --- p.7 / Chapter 2.1 --- Introduction of nephrolithasis and surgical management --- p.9 / Chapter 2.1.1 --- Epidemology and physiochemistry --- p.9 / Chapter 2.1.2 --- Surgical management of nephrolithasis parallel with stone factors --- p.15 / Chapter 2.2 --- Extracorpoeral Shock Wave Lithotripsy in present study --- p.17 / Chapter 2.2.1 --- The 4th generation - Sonolith Vision electroconductive lithotripter --- p.18 / Chapter 2.2.2 --- The role of shock wave delivery rate in treatment outcome and its prediction --- p.23 / Chapter 2.2.3 --- Patient-controlled analgesia during Shock Wave Lithotripsy treatment and its pain management --- p.29 / Chapter 2.2.4 --- Shock wave induced renal injury & the use of urinary biomarker --- p.35 / Chapter 3. --- Materials and Methods --- p.62 / Chapter 3.1 --- Study Design --- p.63 / Chapter 3.2 --- Patient Selection --- p.64 / Chapter 3.3 --- Treatment Protocol --- p.63 / Chapter 3.4 --- Sample size calculation --- p.68 / Chapter 3.5 --- Statistical analysis --- p.68 / Chapter 4. --- The effect of shock wave delivery rate on treatment outcome and its prediction --- p.69 / Chapter 4.1 --- Introduction --- p.70 / Chapter 4.2 --- Materials and Methods --- p.72 / Chapter 4.2.1 --- ESWL treatment protocol --- p.72 / Chapter 4.2.2 --- Outcome Assessment --- p.73 / Chapter 4.2.3 --- Mathematical model development --- p.75 / Chapter 4.2.4 --- Statistical analysis --- p.76 / Chapter 4.3 --- Results --- p.77 / Chapter 4.3.1 --- Baseline characteristics and treatment modalities --- p.78 / Chapter 4.3.2 --- ESWL treatment outcome --- p.79 / Chapter 4.3.3 --- Mathematical model --- p.81 / Chapter 4.4 --- Discussion --- p.82 / Chapter 4.4.1 --- Overall treatment outcome improved by the use of slower rate --- p.82 / Chapter 4.4.2 --- When should we use fast/slow rate? --- p.86 / Chapter 4.4.3 --- Mathematical model to predict ESWL outcome --- p.88 / Chapter 4.5 --- Conclusion --- p.91 / Chapter 5. --- The role of shock wave delivery rate and patient-controlled analgesia in pain --- p.101 / Chapter 5.1 --- Introduction --- p.102 / Chapter 5.2 --- Materials and Methods --- p.104 / Chapter 5.2.1 --- ESWL treatment protocol and PCA settings --- p.104 / Chapter 5.2.2 --- Outcome Assessment --- p.105 / Chapter 5.2.3 --- Statistical analysis --- p.107 / Chapter 5.3 --- Results --- p.108 / Chapter 5.3.1 --- Baseline characteristics and treatment modalities --- p.108 / Chapter 5.3.2 --- Pain experience and satisfaction with PCA at different shock wave delivery rates --- p.108 / Chapter 5.3.3 --- Correlation between rate pain --- p.110 / Chapter 5.3.4 --- Vital signs --- p.110 / Chapter 5.4 --- Discussion --- p.111 / Chapter 5.4.1 --- Adverse complication was mild with PCA using alfentanil --- p.111 / Chapter 5.4.2 --- Less pain experience with 60 SWs/min --- p.112 / Chapter 5.4.3 --- Why PCA usage was the same in both groups? --- p.112 / Chapter 5.4.4 --- No correlation with treatment outcome --- p.114 / Chapter 5.5 --- Conclusion --- p.115 / Chapter 6. --- "The relations among rate of shock wave delivery, induced renal injury and acute complications" --- p.128 / Chapter 6.1 --- Introduction --- p.129 / Chapter 6.2 --- Materials and Methods --- p.130 / Chapter 6.2.1 --- ESWL treatment protocol --- p.130 / Chapter 6.2.2 --- Outcome Assessment --- p.131 / Chapter 6.2.3 --- Statistical analysis --- p.136 / Chapter 6.3 --- Results --- p.137 / Chapter 6.3.1 --- Baseline characteristics and treatment modalities --- p.137 / Chapter 6.3.2 --- Quality control of creatinine and NAG --- p.137 / Chapter 6.3.3 --- Standard curves ofIL-18 and NGAL --- p.137 / Chapter 6.3.4 --- Higher levels of urinary NAG and IL-18 in 60 SWs/min group --- p.138 / Chapter 6.3.5 --- Similar levels of urinary NGAL in both groups --- p.138 / Chapter 6.3.6 --- Unplanned hospital visits were similar in both groups --- p.139 / Chapter 6.4 --- Discussion --- p.140 / Chapter 6.4.1 --- More tubular damages caused by slower rate --- p.140 / Chapter 6.4.2 --- Escalated inflammatory activities in 60 SWs/min --- p.141 / Chapter 6.4.3 --- Vascular damage and ischemic insults were the same in both groups? --- p.142 / Chapter 6.4.4 --- Post-operative complications are similar in both groups --- p.142 / Chapter 6.4.5 --- 60 SWs/min vs. 120 SWs/min - What makes the difference in renal injury? --- p.143 / Chapter 6.5 --- Conclusion --- p.145 / Chapter 7. --- Discussion --- p.154 / Chapter 7.1 --- General discussion --- p.155 / Chapter 8. --- Conclusion --- p.158 / Chapter 8.1 --- General conclusion --- p.159 / Appendix --- p.160 / Appendix I --- p.161 / Appendix II --- p.163 / References --- p.167