Correction: Bisighini et al. Fabrication of Compliant and Transparent Hollow Cerebral Vascular Phantoms for In Vitro Studies Using 3D Printing and Spin-Dip Coating. Materials 2023, 16, 166.

In the original publication [...].

Patient-specific cranioplasty, by direct and indirect additive manufacturing of biopolymers and implantable materials.

BACKGROUND: Autologous bones are traditionally used in surgical reconstruction of skullcap. Since patients' bones are often unavailable or cause of infections, implantable synthetic materials emerged as promising alternative. These can be shaped by different technologies, while 3D printing offers remarkable chances in terms of flexibility, accuracy, cost-saving and customizability. METHODS: This study aims to evaluate strengths and limitations of the three main strategies that imply additive manufacturing for the implementation of cranial prosthesis: (i) direct printing of PLA (polylactic acid) skullcaps, mould casting of poly(methyl methacrylate) (PMMA) prosthesis using (ii) silicone mould manufactured from a 3D printed master, (iii) 3Dprinted TPU (thermoplastic polyurethane) mould. RESULTS: All solutions achieved good geometric accuracy and excellent mechanical resistance. Direct printing of the PLA resulted in the fastest strategy, followed by PMMA casting in a silicone mould. CONCLUSIONS: The use of silicone was overall more advantageous, due to lower costs and the possibility of sterilization by using autoclaving.

Machine learning and reduced order modelling for the simulation of braided stent deployment.

Endoluminal reconstruction using flow diverters represents a novel paradigm for the minimally invasive treatment of intracranial aneurysms. The configuration assumed by these very dense braided stents once deployed within the parent vessel is not easily predictable and medical volumetric images alone may be insufficient to plan the treatment satisfactorily. Therefore, here we propose a fast and accurate machine learning and reduced order modelling framework, based on finite element simulations, to assist practitioners in the planning and interventional stages. It consists of a first classification step to determine a priori whether a simulation will be successful (good conformity between stent and vessel) or not from a clinical perspective, followed by a regression step that provides an approximated solution of the deployed stent configuration. The latter is achieved using a non-intrusive reduced order modelling scheme that combines the proper orthogonal decomposition algorithm and Gaussian process regression. The workflow was validated on an idealized intracranial artery with a saccular aneurysm and the effect of six geometrical and surgical parameters on the outcome of stent deployment was studied. We trained six machine learning models on a dataset of varying size and obtained classifiers with up to 95% accuracy in predicting the deployment outcome. The support vector machine model outperformed the others when considering a small dataset of 50 training cases, with an accuracy of 93% and a specificity of 97%. On the other hand, real-time predictions of the stent deployed configuration were achieved with an average validation error between predicted and high-fidelity results never greater than the spatial resolution of 3D rotational angiography, the imaging technique with the best spatial resolution (0.15 mm). Such accurate predictions can be reached even with a small database of 47 simulations: by increasing the training simulations to 147, the average prediction error is reduced to 0.07 mm. These results are promising as they demonstrate the ability of these techniques to achieve simulations within a few milliseconds while retaining the mechanical realism and predictability of the stent deployed configuration.

Electrically conductive scaffolds mimicking the hierarchical structure of cardiac myofibers.

Electrically conductive scaffolds, mimicking the unique directional alignment of muscle fibers in the myocardium, are fabricated using the 3D printing micro-stereolithography technique. Polyethylene glycol diacrylate (photo-sensitive polymer), Irgacure 819 (photo-initiator), curcumin (dye) and polyaniline (conductive polymer) are blended to make the conductive ink that is crosslinked using free radical photo-polymerization reaction. Curcumin acts as a liquid filter and prevents light from penetrating deep into the photo-sensitive solution and plays a central role in the 3D printing process. The obtained scaffolds demonstrate well defined morphology with an average pore size of 300 ± 15 µm and semi-conducting properties with a conductivity of ~ 10-6 S/m. Cyclic voltammetry analyses detect the electroactivity and highlight how the electron transfer also involve an ionic diffusion between the polymer and the electrolyte solution. Scaffolds reach their maximum swelling extent 30 min after immersing in the PBS at 37 °C and after 4 weeks they demonstrate a slow hydrolytic degradation rate typical of polyethylene glycol network. Conductive scaffolds display tunable conductivity and provide an optimal environment to the cultured mouse cardiac progenitor cells.

Fabrication of Compliant and Transparent Hollow Cerebral Vascular Phantoms for In Vitro Studies Using 3D Printing and Spin-Dip Coating.

Endovascular surgery through flow diverters and coils is increasingly used for the minimally invasive treatment of intracranial aneurysms. To study the effectiveness of these devices, in vitro tests are performed in which synthetic vascular phantoms are typically used to reproduce in vivo conditions. In this paper, we propose a manufacturing process to obtain compliant and transparent hollow vessel replicas to assess the mechanical behaviour of endovascular devices and perform flow measurements. The vessel models were obtained in three main steps. First, a mould was 3D-printed in a water-soluble material; two techniques, fusion deposition modelling and stereolithography, were compared for this purpose. Then, the mould was covered with a thin layer of silicone through spin-dip coating, and finally, when the silicone layer solidified, it was dissolved in a hot water bath. The final models were tested in terms of the quality of the final results, the mechanical properties of the silicone, thickness uniformity, and transparency properties. The proposed approach makes it possible to produce models of different sizes and complexity whose transparency and mechanical properties are suitable for in vitro experiments. Its applicability is demonstrated through idealised and patient-specific cases.

Additive Manufacturing for Neurosurgery: Digital Light Processing of Individualized Patient-Specific Cerebral Aneurysms.

This study aims at demonstrating the feasibility of reproducing individualized patient-specific three-dimensional models of cerebral aneurysms by using the direct light processing (DLP) 3D printing technique in a low-time and inexpensive way. Such models were used to help neurosurgeons understand the anatomy of the aneurysms together with the surrounding vessels and their relationships, providing, therefore, a tangible supporting tool with which to train and plan surgical operations. The starting 3D models were obtained by processing the computed tomography angiographies and the digital subtraction angiographies of three patients. Then, a 3D DLP printer was used to print the models, and, if acceptable, on the basis of the neurosurgeon's opinion, they were used for the planning of the neurosurgery operation and patient information. All the models were printed within three hours, providing a comprehensive representation of the cerebral aneurysms and the surrounding structures and improving the understanding of their anatomy and simplifying the planning of the surgical operation.

Surface Finishing of Additive Manufactured Ti-6Al-4V Alloy: A Comparison between Abrasive Fluidized Bed and Laser Finishing.

Metal additive manufacturing is a major concern for advanced manufacturing industries thanks to its ability to manufacture complex-shaped parts in materials that are difficult to machine using conventional methods. Nowadays, it is increasingly being used in the industrial manufacturing of titanium-alloy components for aerospace and medical industries; however, the main weakness of structural parts is the fatigue life, which is affected by surface quality, meaning the micro-cracking of small surface defects induced by the manufacturing process. Laser finishing and Abrasive Fluidized Bed are proposed by the authors since they represent cost-effective and environment-friendly alternatives for automated surface finishing. A comparison between these two finishing technologies was established and discussed. Experimental tests investigated both mechanical properties and fatigue performances. The tests also focused on understanding the basic mechanisms involved in fatigue failures of machined Ti-6Al-4V components fabricated via Electron Beam Melting and the effects of operational parameters. X-ray tomography was used to evaluate the internal porosity to better explain the fatigue behaviour. The results demonstrated the capability of Laser finishing and Abrasive Fluidized Beds to improve failure performances. Life Cycle Analysis was additionally performed to verify the effectiveness of the proposed technologies in terms of environmental impact and resource consumption.

FIMEC Test to Evaluate the Water Uptake of Coated and Uncoated CFRP Composites.

This study focuses on the application of the FIMEC (flat-top cylinder indenter for mechanical characterization) indentation test to evaluate the effect of water uptake on the mechanical properties of high-performance materials, in particular CFRP (carbon fibre reinforced polymer) composites. Coated and uncoated samples were analyzed. Silicon-based and siloxane coatings were formulated and applied to CFRP to reduce the moisture absorption of the material. The FIMEC test was adopted to study the reduction of the stiffness of CFRP plates for different ageing in water. The evolution of mechanical properties is reported as a function of the water uptake. IR analyses and weight variation measures were used as supporting data. Experimental results show that the FIMEC test is suitable to assess the stiffness reduction due to the aging in water and to identify coatings able to minimize the water uptake.

Environmental and Economic Analysis of FDM, SLS and MJF Additive Manufacturing Technologies.

In this study, the authors present a comparative analysis of different additive manufacturing (AM) technologies for high-performance components. Four 3D printers, currently available on the Italian national manufacturing market and belonging to three different AM technologies, were considered. The analysis focused on technical aspects to highlight the characteristics and performance limits of each technology, economic aspects to allow for an assessment of the costs associated with the different processes, and environmental aspects to focus on the impact of the production cycles associated with these technologies on the ecosystem, resources and human health. This study highlighted the current limits of additive manufacturing technologies in terms of production capacity in the case of large-scale production of plastic components, especially large ones. At the same time, this study highlights how the geometry of the object to be developed greatly influences the optimal choice between the various AM technologies, in both technological and economic terms. Fused deposition modeling (FDM) is the technology that exhibits the greatest limitations hindering mass production due to production times and costs, but also due to the associated environmental impact.

Improving Performance of an Open Cell Aluminium Foam through Electro-Deposition of Nickel.

The aim of this work is to investigate the mechanical performances and corrosion resistance of open-cell aluminium foams with an electroplated nickel coating. The influence of two different electrolytic solutions on mechanical properties and corrosion resistance was studied: The Watts solution (nickel sulphate-based solution) and a nickel sulphamate solution (widely adopted). Scanning electron microscopy and stereoscopic analysis allowed for the estimation of the coating uniformity and adhesion to the substrate. In order to assess the improvement of performances, compression and corrosion tests were performed on coated and uncoated foams. In addition, annealing was investigated in relation to different operational parameters, related both to electro-deposition (electrolyte, deposition current and time) and to annealing (treatment temperature). From the results, the yield stress and the corrosion resistance improved. Moreover, the annealing at increasing temperature was found to reduce the yield stress, but Ni-coated foams showed higher values of stress for all the considered treatment temperatures.