A Novel Instant 3-Dimensional Printing System for Postoperative Fracture Patients: A Comparative Cohort Study.

BACKGROUND Traditional plaster (TP) is a widely used auxiliary fixation (AF) approach for postoperative fracture patients. However, patient discomfort and inconvenience to clinicians has limited its application. We introduce a novel instant 3-dimensional printing appliance system (3D-AS) to address such issues. MATERIAL AND METHODS Twenty-seven postoperative fracture patients were divided randomly between a TP group and a 3D-AS group, and analyzed retrospectively. Radiographic images during follow-up were evaluated for fracture healing and fracture reduction quality. The range of motion (ROM) was recorded to assess motor performance. Patient pain was assessed using the Visual Analogue Scale (VAS). Complications were also compared between the 2 groups. RESULTS The patients comprised 17 men and 10 women with ages ranging from 21 to 69 years (mean age: 47.35). All patients completed a follow-up visit (range: 14-19 months, mean: 13.59 months). Although no significant difference was found between general characteristics (P>0.05) and the time of fracture union (P>0.05), significant differences between groups were seen in complications (P<0.05), VAS (P<0.01), patient satisfaction (P<0.05), and ROM for the upper joints (P<0.05). CONCLUSIONS Our study suggests that 3D-AS provides better upper-limb ROM and more comfortable healing for postoperative fracture patients, indicating that it can be recommended for use in such patients.

Customized 3D printed bioreactors for decellularization-High efficiency and quality on a budget.

Decellularization (DC) of biomaterials with bioreactors is widely used to produce scaffolds for tissue engineering. This study uses 3D printing to develop efficient but low-cost DC bioreactors. Two bioreactors were developed to decellularize pericardial patches and vascular grafts. Flow profiles and pressure distribution inside the bioreactors were optimized by steady-state computational fluid dynamics (CFD) analysis. Printing materials were evaluated by cytotoxicity assessment. Following evaluation, all parts of the bioreactors were 3D printed in a commercial fused deposition modeling printer. Samples of bovine pericardia and porcine aortae were decellularized using established protocols. An immersion and agitation setup was used as a control. With histological assessment, DNA quantification and biomechanical testing treatment effects were evaluated. CFD analysis of the pericardial bioreactor revealed even flow and pressure distribution in between all pericardia. The CFD analysis of the vessel bioreactor showed increased intraluminal flow rate and pressure compared to the vessel's outside. Cytotoxicity assessment of the used printing material revealed no adverse effect on the tissue. Complete DC was achieved for all samples using the 3D printed bioreactors while DAPI staining revealed residual cells in aortic vessels of the control group. Histological analysis showed no structural changes in the decellularized samples. Additionally, biomechanical properties exhibited no significant change compared to native samples. This study presents a novel approach to manufacturing highly efficient and low budget 3D printed bioreactors for the DC of biomaterials. When compared to standard protocols, the bioreactors offer a cost effective, fast, and reproducible approach, which vastly improves the DC results.

Investigation of a three-dimensional printed dynamic cervical spine model for anatomy and physiology education.

INTRODUCTION: Three-dimensional (3D) printing of anatomical structures is a growing method of education for students and medical trainees. These models are generally produced as static representations of gross surface anatomy. In order to create a model that provides educators with a tool for demonstration of kinematic and physiologic concepts in addition to surface anatomy, a high-resolution segmentation and 3D-printingtechnique was investigated for the creation of a dynamic educational model. METHODS: An anonymized computed tomography scan of the cervical spine with a diagnosis of ossification of the posterior longitudinal ligament was acquired. Using a high-resolution thresholding technique, the individual facet and intervertebral spaces were separated, and models of the C3-7 vertebrae were 3D-printed. The models were placed on a myelography simulator and subjected to flexion and extension under fluoroscopy, and measurements of the spinal canal diameter were recorded and compared to in-vivo measurements. The flexible 3D-printed model was then compared to a static 3D-printed model to determine the educational benefit of demonstrating physiologic concepts. RESULTS: The canal diameter changes on the flexible 3D-printed model accurately reflected in-vivo measurements during dynamic positioning. The flexible model also was also more successful in teaching the physiologic concepts of spinal canal changes during flexion and extension than the static 3D-printed model to a cohort of learners. CONCLUSIONS: Dynamic 3D-printed models can provide educators with a cost-effective and novel educational tool for not just instruction of surface anatomy, but also physiologic concepts through 3D ex-vivo modeling of case-specific physiologic and pathologic conditions.

Evaluation of the Usability of a Low-Cost 3D Printer in a Tissue Engineering Approach for External Ear Reconstruction.

The use of alloplastic materials instead of autologous cartilage grafts offers a new perspective in craniofacial reconstructive surgery. Particularly for regenerative approaches, customized implants enable the surgeon to restore the cartilaginous framework of the ear without donor site morbidity. However, high development and production costs of commercially available implants impede clinical translation. For this reason, the usability of a low-cost 3D printer (Ultimaker 2+) as an inhouse-production tool for cheap surgical implants was investigated. The open software architecture of the 3D printer was modified in order to enable printing of biocompatible and biologically degradable polycaprolactone (PCL). Firstly, the printing accuracy and limitations of a PCL implant were compared to reference materials acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA). Then the self-made PCL-scaffold was seeded with adipose-tissue derived stem cells (ASCs), and biocompatibility was compared to a commercially available PCL-scaffold using a cell viability staining (FDA/PI) and a dsDNA quantification assay (PicoGreen). Secondly, porous and solid patient-customized ear constructs were manufactured from mirrored CT-imagining data using a computer-assisted design (CAD) and computer-assisted manufacturing (CAM) approach to evaluate printing accuracy and reproducibility. The results show that printing of a porous PCL scaffolds was possible, with an accuracy equivalent to the reference materials at an edge length of 10 mm and a pore size of 0.67 mm. Cell viability, adhesion, and proliferation of the ASCs were equivalent on self-made and the commercially available PCL-scaffolds. Patient-customized ear constructs could be produced well in solid form and with limited accuracy in porous form from all three thermoplastic materials. Printing dimensions and quality of the modified low-cost 3D printer are sufficient for selected tissue engineering applications, and the manufacturing of personalized ear models for surgical simulation at manufacturing costs of EUR 0.04 per cell culture scaffold and EUR 0.90 (0.56) per solid (porous) ear construct made from PCL. Therefore, in-house production of PCL-based tissue engineering scaffolds and surgical implants should be further investigated to facilitate the use of new materials and 3D printing in daily clinical routine.

Polymethylmethacrylate cranioplasty using low-cost customised 3D printed moulds for cranial defects - a single Centre experience: technical note.

We report our experience with 3D customised cranioplasties for large cranial defects. They were made by casting bone cement in custom made moulds at the time of surgery. Between October 2015 and January 2018, 29 patients underwent the procedure; 25 underwent elective cranioplasties for large cranial defects and four were bone tumour resection and reconstruction cases. The majority of patients (96.5%) reported a satisfactory aesthetic outcome. No infections related to the surgical procedure were observed in the follow-up period. The method proved to be effective and affordable.

Cost-Effective Technique of Fabrication of Polymethyl Methacrylate Based Cranial Implant Using Three-Dimensional Printed Moulds and Wax Elimination Technique.

OBJECTIVE: Cranioplasty is one of the oldest known neurosurgical procedure performed. Many materials have been used for cranioplasty since ages. Polymethyl methacrylate (PMMA) has become the workhorse for fabrication of cranial implants since World War II in cases where autologous bone is not available or cannot be harvested. The aim of the present study is to present author's experience in the management of cranioplasty using acrylic implants fabricated using 2 different techniques. METHODS: The author conducted a retrospective analysis of patients with extensive skull defects undergoing acrylic cranioplasties between October 2016 and January 2018. The surgical results were classified based on surgical time, blood loss, and the 3 scales of patient satisfaction, improvement of facial symmetry, and need for additional surgery along with the rate of wound complications. RESULTS: Thirty patients underwent cranioplasty with PMMA-based implants, whether fabricated using alginate impression technique (56.67%) or fabricated using 3-dimensional (3D) printed patient-specific moulds (43.33%). Complications included infection (13.3%). The authors considered the craniofacial aesthetics based on patient satisfaction excellent (69%) with the degree of improvement of craniofacial symmetry satisfactory (92.3%), and 1 patient requiring resurgery in alginate impression technique fabricated implants. CONCLUSION: The author recommends a unique technique for fabrication of PMMA-based implants using 3D printed moulds to achieve a better fitting implant and highly cosmetic outcome for cranioplasty at affordable cost.

A Patient-Specific Hollow Three-Dimensional Model for Simulating Percutaneous Occlusion of Patent Ductus Arteriosus.

Percutaneous catheter closure of patent ductus arteriosus (PDA) is difficult when the ductus is large and long or shows calcification. We created a patient-specific 3-dimensional (3D) model for PDA, with which we simulated device deployment, thereby selecting the device/size in a patient-by-patient manner. We assessed whether this 3D model is effective for catheter PDA closure.The 3D model was created in this institute, requiring 3 days and 90 US dollars. After its introduction, 7 consecutive patients (the study group) with severe PDA underwent closure with the aid of the 3D model. The control group consisted of 4 patients before 3D-model introduction, with all having severe PDA: the requirement of computed tomography was considered a criterion of severe or difficult-procedure-requiring PDA.In all study group patients, the devices/sizes could be pre-selected based on the simulation, whereas devices were changed during the procedure in 2 of 4 in the control group. In the study group, compared with the control group, the fluoroscopic (median 31 [interquartile range of 16-42] versus 39 [19-71] minutes, respectively) and total procedural times (median 107 [interquartile range 67-114] versus 124 [78-184] minutes, respectively) were shorter. A questionnaire confirmed the doctors' understanding of the procedure.This 3D model may be effective for percutaneous catheter closure of PDA. This may be especially true in cases of severe or difficult-procedure-requiring PDA.

3D printing anatomical models of head bones.

PURPOSE: In many medical schools, the study of Anatomy is becoming increasingly theoretical owing to the difficulty of having human body parts available, rather than offering the students the possibility of a more realistic and practical approach. We developed a project where we use a 3D printer to produce models of the human skull bones, with high quality and quantity to satisfy the needs for Anatomy classes and to be available for request to study at home. METHODS: We selected regular and well-shaped bones of the head upon which we based the 3D models. These bones were scanned using a 64-channel Computed Tomography (high-resolution volumetric acquisition) and the resulting images were then processed with a segmentation software to isolate and reconstruct the structures of interest. The final digital three-dimensional objects were converted into a printable file that the 3D printer could read. We used two filament extrusion type 3D printers, the Prusa i3 and the Zortrax M200. RESULTS: We have printed successfully several models of the skull bones, such as the temporal, occipital, and sphenoid. All the models have obtained good anatomical detail, thus demonstrating the practicality of this technology. Key aspects of the CT image post-processing are discussed. The production process is cost-effective and technically accessible. CONCLUSIONS: These results confirm the potential of 3D printing to create more complex models (e.g. regional, vascular, nervous system structures) that would allow a similar experience compared with a dissection.

Drone inflight mixing of biochemical samples.

Autonomous systems for sample transport to the laboratory for analysis can be improved in terms of timeliness, cost and error mitigation in the pre-analytical testing phase. Drones have been reported for outdoor sample transport but incorporating devices on them to attain homogenous mixing of reagents during flight to enhance sample processing timeliness is limited by payload issues. It is shown here that flipping maneuvers conducted with quadcopters are able to facilitate complete and gentle mixing. This capability incorporated during automated sample transport serves to address an important factor contributing to pre-analytical variability which ultimately impacts on test result reliability.

Moving toward rapid and low-cost point-of-care molecular diagnostics with a repurposed 3D printer and RPA.

Traditionally, the majority of nucleic acid amplification-based molecular diagnostic tests are done in centralized settings. In recent years, point-of-care tests have been developed for use in low-resource settings away from central laboratories. While most experts agree that point-of-care molecular tests are greatly needed, their availability as cost-effective and easy-to-operate tests remains an unmet goal. In this article, we discuss our efforts to develop a recombinase polymerase amplification reaction-based test that will meet these criteria. First, we describe our efforts in repurposing a low-cost 3D printer as a platform that can carry out medium-throughput, rapid, and high-performing nucleic acid extraction. Next, we address how these purified templates can be rapidly amplified and analyzed using the 3D printer's heated bed or the deconstructed, low-cost thermal cycler we have developed. In both approaches, real-time isothermal amplification and detection of template DNA or RNA can be accomplished using a low-cost portable detector or smartphone camera. Last, we demonstrate the capability of our technologies using foodborne pathogens and the Zika virus. Our low-cost approach does not employ complicated and high-cost components, making it suitable for resource-limited settings. When integrated and commercialized, it will offer simple sample-to-answer molecular diagnostics.

Open Labware: 3-D printing your own lab equipment.

The introduction of affordable, consumer-oriented 3-D printers is a milestone in the current "maker movement," which has been heralded as the next industrial revolution. Combined with free and open sharing of detailed design blueprints and accessible development tools, rapid prototypes of complex products can now be assembled in one's own garage--a game-changer reminiscent of the early days of personal computing. At the same time, 3-D printing has also allowed the scientific and engineering community to build the "little things" that help a lab get up and running much faster and easier than ever before.

An inexpensive open source 3D-printed membrane feeder for human malaria transmission studies.

BACKGROUND: The study of malaria transmission requires the experimental infection of mosquitoes with Plasmodium gametocytes. In the laboratory, this is achieved using artificial membrane feeding apparatus that simulate body temperature and skin of the host, and so permit mosquito feeding on reconstituted gametocyte-containing blood. Membrane feeders either use electric heating elements or complex glass chambers to warm the infected blood; both of which are expensive to purchase and can only be sourced from a handful of specialized companies. Presented and tested here is a membrane feeder that can be inexpensively printed using 3D-printing technology. RESULTS: Using the Plasmodium falciparum laboratory strain NF54, three independent standard membrane feeding assays (SMFAs) were performed comparing the 3D-printed feeder against a commercial glass feeder. Exflagellation rates did not differ between the two feeders. Furthermore, no statistically significant difference was found in the oocyst load nor oocyst intensity of Anopheles stephensi mosquitoes (mean oocyst range 1.3-6.2 per mosquito; infection prevalence range 41-79%). CONCLUSIONS: Open source provision of the design files of the 3D-printed feeder will facilitate a wider range of laboratories to perform SMFAs in laboratory and field settings, and enable them to freely customize the design to their own requirements.

Developing an In-house Interdisciplinary Three-Dimensional Service: Challenges, Benefits, and Innovative Health Care Solutions.

Three-dimensional printing (3DP) technologies have been employed in regular medical specialties. They span wide scope of uses, from creating 3D medical models to design and manufacture of Patient-specific implants and guidance devices which help to optimize medical treatments, patient education, and medical training. This article aims to provide an in-depth analysis of factors and aspects to consider when planning to setup a 3D service within a hospital serving various medical specialties. It will also describe challenges that might affect 3D service development and sustainability and describe representative cases that highlight some of the innovative approaches that are possible with 3D technology. Several companies can offer such 3DP service. They are often web based, time consuming, and requiring special call conference arrangements. Conversely, the establishment of in-house specialized hospital-based 3D services reduces the risks to personal information, while facilitating the development of local expertise in this technology. The establishment of a 3D facility requires careful consideration of multiple factors to enable the successful integration with existing services. These can be categorized under: planning, developing and sustaining 3D service; 3D service resources and networking workflow; resources and location; and 3D services quality and regulation management.