Digital light 3D printing of customized bioresorbable airway stents with elastomeric properties

High-Resolution Additive Manufacturing of a Biodegradable Elastomer with A Low-Cost LCD 3D Printer

Artificial organs and organs-on-a-chip (OoC) are of great clinical and scientific interest and have recently been made by additive manufacturing, but depend on, and benefit from, biocompatible, biodegradable, and soft materials. Poly(octamethylene maleate (anhydride) citrate (POMaC) meets these criteria and has gained popularity, and as in principle, it can be photocured and is amenable to vat-photopolymerization (VP) 3D printing, but only low-resolution structures have been produced so far. Here, a VP-POMaC ink is introduced and 3D printing of 80 µm positive features and complex 3D structures is demonstrated using low-cost (≈US$300) liquid-crystal display (LCD) printers. The ink includes POMaC, a diluent and porogen additive to reduce viscosity within the range of VP, and a crosslinker to speed up reaction kinetics. The mechanical properties of the cured ink are tuned to match the elastic moduli of different tissues simply by varying the porogen concentration. The biocompatibility is assessed by cell culture which yielded 80% viability and the potential for tissue engineering illustrated with a 3D-printed gyroid seeded with cells. VP-POMaC and low-cost LCD printers make the additive manufacturing of high resolution, elastomeric, and biodegradable constructs widely accessible, paving the way for a myriad of applications in tissue engineering and 3D cell culture as demonstrated here, and possibly in OoC, implants, wearables, and soft robotics.

Digital light 4D printing of bioresorbable shape memory elastomers for personalized biomedical implantation

Four-dimensional (4D) printing unlocks new potentials for personalized biomedical implantation, but still with hurdles of lacking suitable materials. Herein, we demonstrate a bioresorbable shape memory elastomer (SME) with high elasticity at both below and above its phase transition temperature (Ttrans). This SME can be digital light 3D printed by co-polymerizing glycerol dodecanoate acrylate prepolymer (pre-PGDA) with acrylic acid monomer to form crosslinked Poly(glycerol dodecanoate acrylate) (PGDA)-Polyacrylic acid (PAA), or PGDA-PAA network. The printed complex, free-standing 3D structures with high-resolution features exhibit shape programming properties at a physiological temperature. By tuning the pre-PGDA weight ratios between 55 wt% and 70 wt%, Ttrans varies between 39.2 and 47.2 ℃ while Young's moduli (E) range 40-170 MPa below Ttrans with fractural strain (εf) of 170 %-200 %. Above Ttrans, E drops to 1-1.82 MPa which is close to those of soft tissue. Strikingly, εf of 130-180 % is still maintained. In vitro biocompatibility test on the material shows > 90 % cell proliferation and great cell attachment. In vivo vascular grafting trials underline the geometrical and mechanical adaptability of these 4D printed constructs in regenerating the aorta tissue. Biodegradation of the implants shows the possibility of their full replacement by natural tissue over time. To highlight its potential for personalized medicine, a patient-specific left atrial appendage (LAA) occluder was printed and implanted endovascularly into an in vitro heart model. STATEMENT OF SIGNIFICANCE: 4D printed shape-memory elastomer (SME) implants particularly designed and manufactured for a patient are greatly sought-after in minimally invasive surgery (MIS). Traditional shape-memory polymers used in these implants often suffer from issues like unsuitable transition temperatures, poor biocompatibility, limited 3D design complexity, and low toughness, making them unsuitable for MIS. Our new SME, with an adjustable transition temperature and enhanced toughness, is both biocompatible and naturally degradable, particularly in cardiovascular contexts. This allows implants, like biomedical scaffolds, to be programmed at room temperature and then adapt to the body's physiological conditions post-implantation. Our studies, including in vivo vascular grafts and in vitro device implantation, highlight the SME's effectiveness in aortic tissue regeneration and its promising applications in MIS.

Opposite Mechanical Preference of Bone/Nerve Regeneration in 3D-Printed Bioelastomeric Scaffolds/Conduits Consistently Correlated with YAP-Mediated Stem Cell Osteo/Neuro-Genesis

To systematically unveil how substrate stiffness, a critical factor in directing cell fate through mechanotransduction, correlates with tissue regeneration, novel biodegradable and photo-curable poly(trimethylene carbonate) fumarates (PTMCFs) for fabricating elastomeric 2D substrates and 3D bone scaffolds/nerve conduits, are presented. These substrates and structures with adjustable stiffness serve as a unique platform to evaluate how this mechanical cue affects the fate of human umbilical cord mesenchymal stem cells (hMSCs) and hard/soft tissue regeneration in rat femur bone defect and sciatic nerve transection models; whilst, decoupling from topographical and chemical cues. In addition to a positive relationship between substrate stiffness (tensile modulus: 90-990 kPa) and hMSC adhesion, spreading, and proliferation mediated through Yes-associated protein (YAP), opposite mechanical preference is revealed in the osteogenesis and neurogenesis of hMSCs as they are significantly enhanced on the stiff and compliant substrates, respectively. In vivo tissue regeneration demonstrates the same trend: bone regeneration prefers the stiffer scaffolds; while, nerve regeneration prefers the more compliant conduits. Whole-transcriptome analysis further shows that upregulation of Rho GTPase activity and the downstream genes in the compliant group promote nerve repair, providing critical insight into the design strategies of biomaterials for stem cell regulation and hard/soft tissue regeneration through mechanotransduction.

Light-Based 3D Multi-Material Printing of Micro-Structured Bio-Shaped, Conducting and Dry Adhesive Electrodes for Bioelectronics

In this work, a new method of multi-material printing in one-go using a commercially available 3D printer is presented. The approach is simple and versatile, allowing the manufacturing of multi-material layered or multi-material printing in the same layer. To the best of the knowledge, it is the first time that 3D printed Poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) micro-patterns combining different materials are reported, overcoming mechanical stability issues. Moreover, the conducting ink is engineered to obtain stable in-time materials while retaining sub-100 µm resolution. Micro-structured bio-shaped protuberances are designed and 3D printed as electrodes for electrophysiology. Moreover, these microstructures are combined with polymerizable deep eutectic solvents (polyDES) as functional additives, gaining adhesion and ionic conductivity. As a result of the novel electrodes, low skin impedance values showed suitable performance for electromyography recording on the forearm. Finally, this concluded that the use of polyDES conferred stability over time, allowing the usability of the electrode 90 days after fabrication without losing its performance. All in all, this demonstrated a very easy-to-make procedure that allows printing PEDOT:PSS on soft, hard, and/or flexible functional substrates, opening up a new paradigm in the manufacturing of conducting multi-functional materials for the field of bioelectronics and wearables.

A Tunable Soft Silicone Bioadhesive for Secure Anchoring of Diverse Medical Devices to Wet Biological Tissue

Silicone is utilized widely in medical devices for its compatibility with tissues and bodily fluids, making it a versatile material for implants and wearables. To effectively bond silicone devices to biological tissues, a reliable adhesive is required to create a long-lasting interface. BioAdheSil, a silicone-based bioadhesive designed to provide robust adhesion on both sides of the interface is introduced here, facilitating bonding between dissimilar substrates, namely silicone devices and tissues. The adhesive's design focuses on two key aspects: wet tissue adhesion capability and tissue-infiltration-based long-term integration. BioAdheSil is formulated by mixing soft silicone oligomers with siloxane coupling agents and absorbents for bonding the hydrophobic silicone device to hydrophilic tissues. Incorporation of biodegradable absorbents eliminates surface water and controls porosity, while silane crosslinkers provide interfacial strength. Over time, BioAdheSil transitions from nonpermeable to permeable through enzyme degradation, creating a porous structure that facilitates cell migration and tissue integration, potentially enabling long-lasting adhesion. Experimental results demonstrate that BioAdheSil outperforms commercial adhesives and elicits no adverse response in rats. BioAdheSil offers practical utility for adhering silicone devices to wet tissues, including long-term implants and transcutaneous devices. Here, its functionality is demonstrated through applications such as tracheal stents and left ventricular assist device lines.

Adhesive, Flexible, and Fast Degradable 3D-Printed Wound Dressings with a Simple Composition

3D printing technology has revolutionized the field of wound dressings, offering tailored solutions with mechanical support to facilitate wound closure. In addition to personalization, the intricate nature of the wound healing process requires wound dressing materials with diverse properties, such as moisturization, flexibility, adhesion, anti-oxidation and degradability. Unfortunately, current materials used in digital light processing (DLP) 3D printing have been inadequate in meeting these crucial criteria. This study introduces a novel DLP resin that is biocompatible and consists of only three commonly employed non-toxic compounds in biomaterials, that is, dopamine, poly(ethylene glycol) diacrylate, and N-vinylpyrrolidone. Simple as it is, this material system fulfills all essential functions for effective wound healing. Unlike most DLP resins that are non-degradable and rigid, this material exhibits tunable and rapid degradation kinetics, allowing for complete hydrolysis within a few hours. Furthermore, the high flexibility enables conformal application of complex dressings in challenging areas such as finger joints. Using a difficult-to-heal wound model, the manifold positive effects on wound healing in vivo, including granulation tissue formation, inflammation regulation, and vascularization are substantiated. The simplicity and versatility of this material make it a promising option for personalized wound care, holding significant potential for future translation.

Fluorescence-readout as a powerful macromolecular characterisation tool

The last few decades have witnessed significant progress in synthetic macromolecular chemistry, which can provide access to diverse macromolecules with varying structural complexities, topology and functionalities, bringing us closer to the aim of controlling soft matter material properties with molecular precision. To reach this goal, the development of advanced analytical techniques, allowing for micro-, molecular level and real-time investigation, is essential. Due to their appealing features, including high sensitivity, large contrast, fast and real-time response, as well as non-invasive characteristics, fluorescence-based techniques have emerged as a powerful tool for macromolecular characterisation to provide detailed information and give new and deep insights beyond those offered by commonly applied analytical methods. Herein, we critically examine how fluorescence phenomena, principles and techniques can be effectively exploited to characterise macromolecules and soft matter materials and to further unravel their constitution, by highlighting representative examples of recent advances across major areas of polymer and materials science, ranging from polymer molecular weight and conversion, architecture, conformation to polymer self-assembly to surfaces, gels and 3D printing. Finally, we discuss the opportunities for fluorescence-readout to further advance the development of macromolecules, leading to the design of polymers and soft matter materials with pre-determined and adaptable properties.

Microinjection Molded Biopolymeric Airway Stent with Antibacterial and Anti-Hyperplastic Properties

Central airway stenosis is a condition that the diameter of the trachea or main bronchus shrinkage is caused by external compression or internal tissue hyperplasia, which can cause difficulty breathing, asphyxia, and even death. Airway stenting is an easy way to restore the patency of the central airway, but airway stents commonly used in clinical practice can lead to complications such as mucus plugging, bacterial infection, and granulation tissue hyperplasia. Moreover, the non-degradable characteristic makes it requires a second operation to remove, which has the potential to cause tissue damage. In this study, a biodegradable airway stent is fabricated by microinjection molding using the bioelastomer of poly (L-lactide-co-ε-caprolactone) as the matrix material. The airway stent has excellent mechanical properties and an appropriate degradation rate. The hydrophilic surface of the airway stent can inhibit mucus plugging. The loading of silver nanoparticles and cisplatin endows the stent with antibacterial and anti-hyperplastic functions. In vitro and in vivo experiments demonstrate that this study provides an antibacterial and anti-hyperplastic biodegradable airway stent with elastic properties to avoid secondary removal operation and reduce complications associated with mucus plugging, bacterial infection, and granulation tissue hyperplasia.

Biosynthetic Plastics as Tunable Elastic and Visible Stent with Shape-Memory to Treat Biliary Stricture

Common biliary tract is ≈4 mm in diameter to deliver bile from liver to small intestine to help digestion. The abnormal narrowing leads to severe symptoms such as pain and nausea. Stents are an effective treatment. Compared with non-degradable stents which require repeated removal, biodegradable stents have the advantage of reducing secondary injury related to endoscopic operation and patient burden. However, current biodegradable materials may cause tissue hyperplasia and the treatment method does not target etiology of stricture. So recurrence rates after biodegradable stent implantation are still high. Here, a biodegradable helical stent fabricated from biosynthetic P(3HB-co-4HB) is reported. Tunable properties can be acquired through altering culture substrates. Stent shows shape memory in various solvents. The stent has an optimized design with helical structure and outer track. The self-expanding of helical structure and double drainage realized by outer track greatly improve drainage of bile. Importantly, stent-loading triamcinolone acetonide can inhibit proliferation of fibroblasts and reduce incidence of restricture. Therapeutic effect is also demonstrated in minipigs with biliary stricture. The results of minipig experiments show that biliary duct in treatment group is unobstructed and tissue hyperplasia is effectively inhibited.

Boosting systemic absorption of peptides with a bioinspired buccal-stretching patch

Biopharmaceuticals, including proteins and peptides, have revolutionized the treatment of a wide range of diseases, from diabetes and cardiovascular disorders to virus infections and cancer. Despite their efficacy, most of these macromolecular drugs require parenteral administration because of their high molecular weight and relative instability. Over the past 40 years, only a few oral peptide drugs have entered clinical trials, even when formulated with substantial amounts of permeation enhancers. To overcome the epithelial barrier, devices that inject drugs directly into the gastrointestinal mucosa have been proposed recently. However, the robustness and safety of those complex systems are yet to be assessed. In this study, we introduced an innovative technology to boost drug absorption by synergistically combining noninvasive stretching of the buccal mucosa with permeation enhancers. Inspired by the unique structural features of octopus suckers, a self-applicable suction patch was engineered, enabling strong adhesion to and effective mechanical deformation of the mucosal tissue. In dogs, this suction patch achieved bioavailability up to two orders of magnitude higher than those of the commercial tablet formulation of desmopressin, a peptide drug known for its poor oral absorption. Moreover, systemic exposure comparable to that of the approved oral semaglutide tablet was achieved without further optimization. Last, a first-in-human study involving 40 healthy participants confirmed the dosage form's acceptability, thereby supporting the clinical translatability of this simple yet effective platform technology.

Application of Advanced Technologies-Nanotechnology, Genomics Technology, and 3D Printing Technology-In Precision Anesthesia: A Comprehensive Narrative Review

There has been increasing interest and rapid developments in precision medicine, which is a new medical concept and model based on individualized medicine with the joint application of genomics, bioinformatics engineering, and big data science. By applying numerous emerging medical frontier technologies, precision medicine could allow individualized and precise treatment for specific diseases and patients. This article reviews the application and progress of advanced technologies in the anesthesiology field, in which nanotechnology and genomics can provide more personalized anesthesia protocols, while 3D printing can yield more patient-friendly anesthesia supplies and technical training materials to improve the accuracy and efficiency of decision-making in anesthesiology. The objective of this manuscript is to analyze the recent scientific evidence on the application of nanotechnology in anesthesiology. It specifically focuses on nanomedicine, precision medicine, and clinical anesthesia. In addition, it also includes genomics and 3D printing. By studying the current research and advancements in these advanced technologies, this review aims to provide a deeper understanding of the potential impact of these advanced technologies on improving anesthesia techniques, personalized pain management, and advancing precision medicine in the field of anesthesia.

4D printing of biodegradable elastomers with tailorable thermal response at physiological temperature

4D printing has a great potential for the manufacturing of soft robotics and medical devices. The alliance of digital light processing (DLP) 3D printing and novel shape-memory photopolymers allows for the fabrication of smart 4D-printed medical devices in high resolution and with tailorable functionalities. However, most of the reported 4D-printed materials are nondegradable, which limits their clinical applications. On the other hand, 4D printing of biodegradable shape-memory elastomers is highly challenging, especially when transition points close to physiological temperature and shape fixation under ambient conditions are required. Here, we report the 4D printing of biodegradable shape-memory elastomers with tailorable transition points covering physiological temperature, by using poly(D,L-lactide-co-trimethylene carbonate) methacrylates at various monomer feed ratios. After the programming step, the high-resolution DLP printed stents preserved their folded shape at room temperature, and showed efficient shape recovery at 37 °C. The materials were cytocompatible and readily degradable under physiological conditions. Furthermore, drug-loaded devices with tuneable release kinetics were realized by DLP-printing with resins containing polymers and levofloxacin or nintedanib. This study offers a new perspective for the development of next-generation 4D-printed medical devices.

Patient-specific airway stent using three-dimensional printing: a review

The primary function of an airway stent is to reestablish patency, impeding restenosis, supporting the tracheobronchial wall, or occluding fistulas. But stent-related complications are prevalent and can have devastating consequences. For this reason, stents are considered a last resort when there are no alternatives in treatment. Additionally, commercially available airway stents often poorly fit patients with complex airways, and they can cause various complications. At the end of the 20th century, three-dimensional (3D) printing technology was created. It has been transformative in healthcare and has been used in several applications. One of its first utilizations was the anatomical modeling of body structures that helps preoperative planning. In respiratory medicine, this technology has been essentially used in central airway diseases to produce 3D airway models and to create airway splints and prostheses. In the last decade, it has led to a transformation and allowed progress in personalized medicine, making patient-specific stents for individuals with complex airway problems. A patient-specific stent using 3D printing may minimize complications, improve quality of life, and reduce the need for repeated procedures. This review describes the recent advances in 3D printing technology, its use for developing airway prostheses to treat complex airway diseases, and the current evidence that supports its use.

A Regression Approach to Model Refractive Index Measurements of Novel 3D Printable Photocurable Resins for Micro-Optofluidic Applications

In this work, a quadratic polynomial regression model was developed to aid practitioners in the determination of the refractive index value of transparent 3D printable photocurable resins usable for micro-optofluidic applications. The model was experimentally determined by correlating empirical optical transmission measurements (the dependent variable) to known refractive index values (the independent variable) of photocurable materials used in optics, thus obtaining a related regression equation. In detail, a novel, simple, and cost-effective experimental setup is proposed in this study for the first time for collecting the transmission measurements of smooth 3D printed samples (roughness ranging between 0.04 and 2 μm). The model was further used to determine the unknown refractive index value of novel photocurable resins applicable in vat photopolymerization (VP) 3D printing techniques for manufacturing micro-optofluidic (MoF) devices. In the end, this study proved how knowledge of this parameter allowed us to compare and interpret collected empirical optical data from microfluidic devices made of more traditional materials, i.e., Poly(dimethylsiloxane) (PDMS), up to novel 3D printable photocurable resins suitable for biological and biomedical applications. Thus, the developed model also provides a quick method to evaluate the suitability of novel 3D printable resins for MoF device fabrication within a well-defined range of refractive index values (1.56; 1.70).

Current Status and Future Outlook of Additive Manufacturing Technologies for the Reconstruction of the Trachea

Tracheal stenosis and defects occur congenitally and in patients who have undergone tracheal intubation and tracheostomy due to long-term intensive care. Such issues may also be observed during tracheal removal during malignant head and neck tumor resection. However, to date, no treatment method has been identified that can simultaneously restore the appearance of the tracheal skeleton while maintaining respiratory function in patients with tracheal defects. Therefore, there is an urgent need to develop a method that can maintain tracheal function while simultaneously reconstructing the skeletal structure of the trachea. Under such circumstances, the advent of additive manufacturing technology that can create customized structures using patient medical image data provides new possibilities for tracheal reconstruction surgery. In this study, the three-dimensional (3D) printing and bioprinting technologies used in tracheal reconstruction are summarized, and various research results related to the reconstruction of mucous membranes, cartilage, blood vessels, and muscle tissue, which are tissues required for tracheal reconstruction, are classified. The prospects for 3D-printed tracheas in clinical studies are also described. This review serves as a guide for the development of artificial tracheas and clinical trials using 3D printing and bioprinting.

Digital light processing-based multi-material bioprinting: Processes, applications, and perspectives

In the past decade, three-dimensional (3D) printing technology based on digital light processing (DLP) has developed rapidly and shown application prospects in several fields such as pneumatic robotics, flexible electronics, and tissue engineering. In particular, DLP-based multi-material printing has been capable of constructing heterogeneous 3D structures with characteristic gradients. DLP 3D printing technology has a wide range of applications in the field of bioprinting due to its high precision and mild printing conditions, including functionalized artificial tissues, medical models, and bioreactors. This paper focuses on the development of DLP-based multi-material 3D printing technology and its applications in the field of bioprinting, followed by giving an outlook on future efforts on overcoming the challenges and obstacles of this promising technique.

A single-tube-braided stent for various airway structures

Background: Airway stent has been widely used in airway procedures. However, the metallic and silicone tubular stents are not customized designed for individual patients and cannot adapt to complicated obstruction structures. Other customized stents could not adapt to complex airway structures with easy and standardized manufacturing methods.

Object: This study aimed to design a series of novel stents with different shapes which can adapt to various airway structures, such as the “Y” shape structure at the tracheal carina, and to propose a standardized fabrication method to manufacture these customized stents in the same way.

Methods: We proposed a design strategy for the stents with different shapes and introduced a braiding method to prototype six types of single-tube-braided stents. Theoretical model was established to investigate the radial stiffness of the stents and deformation upon compression. We also characterized their mechanical properties by conducting compression tests and water tank tests. Finally, a series of benchtop experiments and ex vivo experiments were conducted to evaluate the functions of the stents.

Results: The theoretical model predicted similar results to the experimental results, and the proposed stents could bear a compression force of 5.79N. The results of water tank tests showed the stent was still functioning even if suffering from continuous water pressure at body temperature for a period of 30 days. The phantoms and ex-vivo experiments demonstrated that the proposed stents adapt well to different airway structures.

Conclusion: Our study offers a new perspective on the design of customized, adaptive, and easy-to-fabricate stents for airway stents which could meet the requirements of various airway illnesses.

3D printing of a controlled urea delivery device for the prevention of tooth decay

Dental caries is one of the most widespread chronic infectious diseases in the world. It is mainly caused by the production of acid in the biofilm from the bacterial metabolism of carbohydrates. Nowadays, the prevention of caries is mainly based on the use of topical formulations containing fluoride. However, effective fluoride supplementation may not be sufficient in high-risk individuals, leading to the exploration of alternative strategies such as the neutralization of acid in the oral cavity. Urea is hydrolyzed into ammonia by oral bacteria, leading to a local alkalization that may counteract tooth decay. Herein, we report the fabrication of 3D printed personalized dental trays with a local and prolonged release of urea. Composite filaments with tunable urea release kinetics were produced by hot melt extrusion of poly(ε-caprolactone) and poly(vinyl alcohol) or poly(ethylene glycol) blends mixed with urea. The filaments were further used to 3D print by fused deposition modeling objects capable of releasing urea in a sustained and spatially controlled manner. In vitro studies performed in the presence of Streptococcus salivarius demonstrated the ability of urea released from a 3D printed model toothguards to reduce the pH drop induced by carbohydrates. This study showed the potential of urea-loaded devices to reduce cariogenic acidification of the environment surrounding the enamel by delivering urea directly to the tooth surface.

Block Copolymers in 3D/4D Printing: Advances and Applications as Biomaterials

3D printing is a manufacturing technique in constant evolution. Day by day, new materials and methods are discovered, making 3D printing continually develop. 3D printers are also evolving, giving us objects with better resolution, faster, and in mass production. One of the areas in 3D printing that has excellent potential is 4D printing. It is a technique involving materials that can react to an environmental stimulus (pH, heat, magnetism, humidity, electricity, and light), causing an alteration in their physical or chemical state and performing another function. Lately, 3D/4D printing has been increasingly used for fabricating materials aiming at drug delivery, scaffolds, bioinks, tissue engineering (soft and hard), synthetic organs, and even printed cells. The majority of the materials used in 3D printing are polymeric. These materials can be of natural origin or synthetic ones of different architectures and combinations. The use of block copolymers can combine the exemplary properties of both blocks to have better mechanics, processability, biocompatibility, and possible stimulus behavior via tunable structures. This review has gathered fundamental aspects of 3D/4D printing for biomaterials, and it shows the advances and applications of block copolymers in the field of biomaterials over the last years.

Three-dimensional printing and 3D slicer powerful tools in understanding and treating neurosurgical diseases

With the development of the 3D printing industry, clinicians can research 3D printing in preoperative planning, individualized implantable materials manufacturing, and biomedical tissue modeling. Although the increased applications of 3D printing in many surgical disciplines, numerous doctors do not have the specialized range of abilities to utilize this exciting and valuable innovation. Additionally, as the applications of 3D printing technology have increased within the medical field, so have the number of printable materials and 3D printers. Therefore, clinicians need to stay up-to-date on this emerging technology for benefit. However, 3D printing technology relies heavily on 3D design. 3D Slicer can transform medical images into digital models to prepare for 3D printing. Due to most doctors lacking the technical skills to use 3D design and modeling software, we introduced the 3D Slicer to solve this problem. Our goal is to review the history of 3D printing and medical applications in this review. In addition, we summarized 3D Slicer technologies in neurosurgery. We hope this article will enable many clinicians to leverage the power of 3D printing and 3D Slicer.

Digital Light 3D Printed Bioresorbable and NIR-Responsive Devices with Photothermal and Shape-Memory Functions

Digital light processing (DLP) 3D printing is a promising technique for the rapid manufacturing of customized medical devices with high precision. To be successfully translated to a clinical setting, challenges in the development of suitable photopolymerizable materials have yet to be overcome. Besides biocompatibility, it is often desirable for the printed devices to be biodegradable, elastic, and with a therapeutic function. Here, a multifunctional DLP printed material system based on the composite of gold nanorods and polyester copolymer is reported. The material demonstrates robust near-infrared (NIR) responsiveness, allowing rapid and stable photothermal effect leading to the time-dependent cell death. NIR light-triggerable shape transformation is demonstrated, resulting in a facilitated insertion and expansion of DLP printed stent ex vivo. The proposed strategy opens a promising avenue for the design of multifunctional therapeutic devices based on nanoparticle-polymer composites.

Mathematical surface function-based design and 3D printing of airway stents

BACKGROUND

Three-dimensional (3D) printing is a method applied to build a 3D object of any shape from a digital model, and it provides crucial advantages especially for transferring patient-specific designs to clinical settings. The main purpose of this study is to introduce the newly designed complex airway stent models that are created through mathematical functions and manufactured with 3D printing for implementation in real life.

METHODS

A mathematical modeling software (MathMod) was used to design five different airway stents. The highly porous structures with designated scales were fabricated by utilizing a stereolithography-based 3D printing technology. The fine details in the microstructure of 3D printed parts were observed by a scanning electron microscope (SEM). The mechanical properties of airway stents with various designs and porosity were compared by compression test.

RESULTS

The outputs of the mathematical modeling software were successfully converted into 3D printable files and airway stents with a porosity of more than 85% were 3D printed. SEM images revealed the layered topography of high-resolution 3D printed parts. Compression tests have shown that the mathematical function-based design offers the opportunity to adjust the mechanical strength of airway stents without changing the material or manufacturing method.

CONCLUSIONS

A novel approach, which includes mathematical function-based design and 3D printing technology, is proposed in this study for the fabrication of airway stents as a promising tool for future treatments of central airway pathologies.

Light-Based Printing of Leachable Salt Molds for Facile Shaping of Complex Structures

3D printing is a powerful manufacturing technology for shaping materials into complex structures. While the palette of printable materials continues to expand, the rheological and chemical requisites for printing are not always easy to fulfill. Here, a universal manufacturing platform is reported for shaping materials into intricate geometries without the need for their printability, but instead using light-based printed salt structures as leachable molds. The salt structures are printed using photocurable resins loaded with NaCl particles. The printing, debinding, and sintering steps involved in the process are systematically investigated to identify ink formulations enabling the preparation of crack-free salt templates. The experiments reveal that the formation of a load-bearing network of salt particles is essential to prevent cracking of the mold during the process. By infiltrating the sintered salt molds and leaching the template in water, complex-shaped architectures are created from diverse compositions such as biomedical silicone, chocolate, light metals, degradable elastomers, and fiber composites, thus demonstrating the universal, cost-effective, and sustainable nature of this new manufacturing platform.

Digital Light Processing 3D Printing of Tough Supramolecular Hydrogels with Sophisticated Architectures as Impact-Absorption Elements

Processing tough hydrogels into sophisticated architectures is crucial for their applications as structural elements. However, Digital Light Processing (DLP) printing of tough hydrogels is challenging because of the low-speed gelation and toughening process. Described here is a simple yet versatile system suitable for DLP printing to form tough hydrogel architectures. The aqueous precursor consists of commercial photoinitiator, acrylic acid, and zirconium ion (Zr⁴⁺ ), readily forming tough metallo-supramolecular hydrogel under digital light because of in situ formation of carboxyl-Zr⁴⁺ coordination complexes. The high-stiffness and antiswelling properties of as-printed gel enable high-efficiency printing to form high-fidelity constructs. Furthermore, swelling-induced morphing of the gel is also achieved by encoding structure gradients during the printing with grayscale digital light. Mechanical properties of the printed hydrogels are further improved after incubation in water due to the variation of local pH and rearrangement of coordination complex. The swelling-enhanced stiffness affords the printed hydrogel with shape fixation ability after manual deformations, and thereby provides an additional avenue to form more complex configurations. These printed hydrogels are used to devise an impact-absorption element or a high-sensitivity pressure sensor as proof-of-concept examples. This work should merit engineering of other tough gels and extend their scope of applications in diverse fields.

3D printing of a controlled fluoride delivery device for the prevention and treatment of tooth decay

Dental decay is a highly prevalent chronic disease affecting people from all ages. Clinically, fluoride supplementation is the primary strategy in the prevention of dental decay. However, the current existing self-application formulations such as gels or mouthwashes are rapidly cleared after administration, resulting in modest efficacy even after repeated applications. Therefore, a user-friendly formulation that can provide sustained fluoride release in the oral cavity is of great interest for dental decay prevention. Herein, we report the utilization of fused deposition modelling to fabricate personalised mouthguards, which allow local and prolonged fluoride elution. Composite filaments comprising sodium fluoride and polymers with tuneable hydrophobicity were produced using blends of poly(ε-caprolactone) (PCL) and poly(vinyl alcohol) or poly(ethylene glycol) (PEG). The materials exhibited suitable mechanical properties for dental devices as well as different release kinetics depending on their composition. Ex vivo studies were performed on decayed human teeth using the 3D printed tooth caps that precisely fit the complex geometries of each specimen. A significant elevation of fluoride content in the lesion mineral in contact with the PCL/PEG tooth caps was achieved compared to the ones in contact with solutions mimicking dental care products. In conclusion, this study suggested that a sustained localized drug release of fluoride from personalised 3D printed mouthguards at the device-enamel interface can improve the incorporation of fluoride in the tooth matrix and prevent lesion progression.

Recent Trends in Advanced Photoinitiators for Vat Photopolymerization 3D Printing

3D printing has revolutionized the way of manufacturing with a huge impact on various fields, in particular biomedicine. Vat photopolymerization-based 3D printing techniques such as stereolithography (SLA) and digital light processing (DLP) attracted considerable attention owing to their superior print resolution, relatively high speed, low cost and flexibility in resin material design. As one key element of the SLA/DLP resin, photoinitiators or photoinitiating systems have experienced significant development in recent years, in parallel with the exploration of 3D printing (macro)monomers. The design of new photoinitiating systems can not only offer faster 3D printing speed and enable low-energy visible light fabrication, but also can bring new functions to the 3D printed products and even generate new printing methods in combination with advanced optics. This review evaluates recent trends in the development and application of advanced photoinitiators and photoinitiating systems for vat photopolymerization 3D printing, with a wide range of small molecules, polymers and nanoassemblies involved. Personal perspectives on the current limitations and future directions are eventually provided. This article is protected by copyright. All rights reserved.

Simple low-cost 3D metal printing via plastic skeleton burning

Additive manufacturing of complex volumetric structures opened new frontiers in many technological fields, turning previously inconceivable designs into a practical reality. Electromagnetic components, including antenna and waveguiding elements, can benefit from exploring the third dimension. While fused deposition modeling (FDM) polymer printers become widely accessible, they manufacture structures with moderately low electromagnetic permittivities, compared to metals. However, metal 3D printers, being capable of producing complex volumetric constructions, remain extremely expensive and hard to maintain apparatus, suitable for high-end market applications. Here we develop a new metal printing technique, based on a low-cost and simple FDM device and subsequent electrochemical deposition. For testing the new method, we fabricated several antenna devices and compared their performances to standard printed FeCl₃ etched board-based counterparts, demonstrating clear advantages of the new technique. Our new metal printing can be applied to manufacture electromagnetic devices as well as metallic structures for other applications.

3D Printed, Solid-State Conductive Ionoelastomer as a Generic Building Block for Tactile Applications

Shaping soft and conductive materials into preferential architectures via 3D printing is highly attractive for numerous applications ranging from tactile devices to bioelectronics. A landmark type of soft and conductive materials is hydrogels/ionogels. However, 3D-printed hydrogels/ionogels still suffer from a fundamental bottleneck: limited stability in their electrical-mechanical properties caused by the evaporation and leakage of liquid within hydrogels/ionogels. Although photocurable liquid-free ion-conducting elastomers can circumvent these limitations, the associated photocurable process is cumbersome and hence the printing quality is relatively poor. Herein, a fast photocurable, solid-state conductive ionoelastomer (SCIE) is developed that enables high-resolution 3D printing of arbitrary architectures. The printed building blocks possess many promising features over the conventional ion-conducting materials, including high resolution architectures (even ≈50 µm overhanging lattices), good Young's modulus (up to ≈6.2 MPa), and stretchability (fracture strain of ≈292%), excellent conductivity tolerance in a wide range of temperatures (from -30 to 80 °C), as well as fine elasticity and antifatigue ability even after 10 000 loading-unloading cycles. It is further demonstrated that the printed building blocks can be programmed into 3D flexible tactile sensors such as gyroid-based piezoresistive sensor and gap-based capacitive sensor, both of which exhibit several times higher in sensitivity than their bulky counterparts.

3D Printed Elastomers with Sylgard‐184‐like Mechanical Properties and Tuneable Degradability

The 3D printing of biodegradable elastomers with high mechanical strength is of great interest for personalized medicine, but rather challenging. In this study, we propose a dual-polymer resin formulation for digital light processing of biodegradable elastomers with tailorable mechanical properties comparable to those of Sylgard-184.

Digital light 3D printing of biodegradable elastomers with mechanical properties comparable to the ones of Sylgard-184 via dual-polymer resins.

Recent Progress in Active Mechanical Metamaterials and Construction Principles

Active mechanical metamaterials (AMMs) (or smart mechanical metamaterials) that combine the configurations of mechanical metamaterials and the active control of stimuli-responsive materials have been widely investigated in recent decades. The elaborate artificial microstructures of mechanical metamaterials and the stimulus response characteristics of smart materials both contribute to AMMs, making them achieve excellent properties beyond the conventional metamaterials. The micro and macro structures of the AMMs are designed based on structural construction principles such as, phase transition, strain mismatch, and mechanical instability. Considering the controllability and efficiency of the stimuli-responsive materials, physical fields such as, the temperature, chemicals, light, electric current, magnetic field, and pressure have been adopted as the external stimuli in practice. In this paper, the frontier works and the latest progress in AMMs from the aspects of the mechanics and materials are reviewed. The functions and engineering applications of the AMMs are also discussed. Finally, existing issues and future perspectives in this field are briefly described. This review is expected to provide the basis and inspiration for the follow-up research on AMMs.

Vancomycin-Loaded Polycaprolactone Electrospinning Nanofibers Modulate the Airway Interfaces to Restrain Tracheal Stenosis

Site-specific release of therapeutics at the infected trachea remains a great challenge in clinic. This work aimed to develop a series of vancomycin (VA)-loaded polycaprolactone (PCL) composite nanofiber films (PVNF-n, n = 0, 1, and 5, respectively) via the electrospinning technique. The physiochemical and biological properties of PVNF-n were evaluated by a series of tests, such as FT-IR, XRD, SEM-EDS, and antibacterial assay. The PVNF-n samples displayed a typical network structure of fibers with random directions. VA was successfully introduced into the PCL nanofibers and could be sustained and released. More importantly, PVNF-5 showed relatively good antibacterial activity against both methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae (SPn). Thus, PVNF-5 was covered onto the self-expandable metallic stent and then implanted into a New Zealand rabbit model to repair tracheal stenosis. Compared to a metallic stent, a commercial pellosil matrix–covered stent, and a PVNF-0–covered metallic stent, the PVNF-5–covered airway stent showed reduced granulation tissue thickness, collagen density, α-SMA, CD68, TNF-α, IL-1, and IL-6 expression. In conclusion, this work provides an anti-infection film–covered airway stent that in site restrains tracheal stenosis.

Virtual Surgical Planning: Modeling from the Present to the Future

Virtual surgery planning is a non-invasive procedure, which uses digital clinical data for diagnostic, procedure selection and treatment planning purposes, including the forecast of potential outcomes. The technique begins with 3D data acquisition, using various methods, which may or may not utilize ionizing radiation, such as 3D stereophotogrammetry, 3D cone-beam CT scans, etc. Regardless of the imaging technique selected, landmark selection, whether it is manual or automated, is the key to transforming clinical data into objects that can be interrogated in virtual space. As a prerequisite, the data require alignment and correspondence such that pre- and post-operative configurations can be compared in real and statistical shape space. In addition, these data permit predictive modeling, using either model-based, data-based or hybrid modeling. These approaches provide perspectives for the development of customized surgical procedures and medical devices with accuracy, precision and intelligence. Therefore, this review briefly summarizes the current state of virtual surgery planning.

Selective Detection of an Infection Biomarker by an Osteo-Friend Scaffold: Development of a Multifunctional Artificial Bone Substitute

Developments in three-dimensional (3D) printing technologies have led to many potential applications in various biomedical fields, especially artificial bone substitutes (ABSs). However, due to the characteristics of artificial materials, biocompatibility and infection remain issues. Here, multifunctional ABSs have been designed to overcome these issues by the inclusion of a biochemical modality that allows simultaneous detection of an infection biomarker by osteo-friend 3D scaffolds. The developed multifunctional scaffolds consist of calcium-deficient hydroxyapatite (CDHA), which has a similar geometric structure and chemical composition to human bone, and gold nanoparticles (Au NPs), which assists osteogenesis and modulates the fluorescence of labels in their microenvironment. The Au NPs were subsequently conjugated with fluorescent dye-labeled probe DNA, which allowed selective interaction with a specific target biomarker, and the fluorescent signal of the dye was temporally quenched by the Au NP-derived Förster resonance energy transfer (FRET). When the probe DNA unfolded to bind to the target biomarker, the fluorescence signal was recovered due to the increased distance between the dye and Au NPs. To demonstrate this sensing mechanism, a microbial oligonucleotide was selected as a target biomarker. Consequently, the multifunctional scaffold simultaneously facilitated osteogenic proliferation and the detection of the infection biomarker.

Smartphone-enabled 3D printing of medicines

3D printing is a manufacturing technique that is transforming numerous industrial sectors, particularly where it is key tool in the development and fabrication of medicinees that are personalised to the individual needs of patients. Most 3D printers are relatively large, require trained operators and must be located in a pharmaceutical setting to manufacture dosage forms. In order to realise fully the potential of point-of-care manufacturing of medicines, portable printers that are easy to operate are required. Here, we report the development of a 3D printer that operates using a mobile smartphone. The printer, operating on stereolithographic principles, uses the light from the smartphone's screen to photopolymerise liquid resins and create solid structures. The shape of the printed dosage form is determined using a custom app on the smartphone. Warfarin-loaded Printlets (3D printed tablets) of various sizes and patient-centred shapes (caplet, triangle, diamond, square, pentagon, torus, and gyroid lattices) were successfully printed to a high resolution and with excellent dimensional precision using different photosensitive resins. The drug was present in an amorphous form, and the Printlets displayed sustained release characterises. The promising proof-of-concept results support the future potential of this compact, user-friendly and interconnected smartphone-based system for point-of-care manufacturing of personalised medications.

Controlling Molecular Aggregation-Induced Emission by Controlled Polymerization

In last twenty years, the significant development of AIE materials has been witnessed. A number of small molecules, polymers and composites with AIE activity have been synthesized, with some of these exhibiting great potential in optoelectronics and biomedical applications. Compared to AIE small molecules, macromolecular systems-especially well-defined AIE polymers-have been studied relatively less. Controlled polymerization methods provide the efficient synthesis of well-defined AIE polymers with varied monomers, tunable chain lengths and narrow dispersity. In particular, the preparation of single-fluorophore polymers through AIE molecule-initiated polymerization enables the systematic investigation of the structure-property relationships of AIE polymeric systems. Here, the main polymerization techniques involved in these polymers are summarized and the key parameters that affect their photophysical properties are analyzed. The author endeavored to collect meaningful information from the descriptions of AIE polymer systems in the literature, to find connections by comparing different representative examples, and hopes eventually to provide a set of general guidelines for AIE polymer design, along with personal perspectives on the direction of future research.