3D printing in the battle against COVID-19

Comparison of Macintosh Laryngoscope, King Vision®, VividTrac®, AirAngel Blade®, and a Custom-Made 3D-Printed Video Laryngoscope for Difficult and Normal Airways in Mannequins by Novices-A Non-Inferiority Trial

Background: Endotracheal intubation (ETI) is a cornerstone of airway management. The gold standard device for ETI is still the direct laryngoscope (DL). However, video laryngoscopes (VLs) are now also widely available and have several proven advantages. The VL technique has been included in the major airway management guidelines. During the COVID-19 pandemic, supply chain disruption has raised demand for 3D-printed medical equipment, including 3D-printed VLs. However, studies on performance are only sparsely available; thus, we aimed to compare 3D-printed VLs to the DL and other VLs made with conventional manufacturing technology. Methods: Forty-eight medical students were recruited to serve as novice users. Following brief, standardized training, students executed ETI with the DL, the King Vision® (KV), the VividTrac® (VT), the AirAngel Blade® (AAB), and a custom-made 3D-printed VL (3DVL) on the Laerdal® airway management trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma, and user satisfaction. Results: The KV and VT are proved to be superior (p < 0.05) to the DL in both scenarios. The 3DVL's performance was similar (p > 0.05) or significantly better than that of the DL and mainly non-inferior (p > 0.05) compared to the KV and VT in both scenarios. Regardless of the scenario, the AAB proved to be inferior (p < 0.05) even to the DL in the majority of the variables. The differences between the devices were more pronounced in the difficult airway scenario. The user satisfaction scores were in concordance with the aforementioned performance of the scopes. Conclusions: Based upon our results, we cannot recommend the AAB over the DL, KV, or VT. However, as the 3DVL showed, 3D printing indeed can provide useful or even superior VLs, but prior to clinical use, meticulous evaluation might be recommended.

Development of a Cost-Effective 3D-Printed Airway Suction Simulator for Respiratory Therapy Students

BACKGROUND

Three-dimensional (3D)-printed models are cost-effective and can be customized by trainers. This study designed a 3D-printed airway suction simulator for use by respiratory therapy (RT) students. The objective was to demonstrate the cost-effectiveness and application of 3D-printed models in respiratory care training, aiming to enhance the educational experience for RT students.

METHODS

This study developed a 3D-printed airway suction simulator that was cost-effective. A randomized controlled trial was conducted involving RT students to compare effectiveness in a 3D-model group and a control group. Skill assessments and written examinations were used to evaluate the participants' knowledge and skills.

RESULTS

A total of 38 second-year RT students were randomly assigned to either the 3D-model group (n = 19) or the control group (n = 19). One participant in the 3D-model group was lost to follow-up during the planned direct observation of procedural skills (DOPS) assessment and satisfaction questionnaire completion. The posttest written examination scores were significantly higher in the 3D-model group than in the control group (100% vs 80%, P = .02). The scores from the DOPS and satisfaction questionnaire were comparable in the 2 groups.

CONCLUSIONS

This study demonstrated that 3D printing can be used to create a safe and cost-effective airway suction simulator for use by RT students, with potential to enhance training methods. Further research is necessary.

Institutional Strategies to Maintain and Grow Imaging Research During the COVID-19 Pandemic

Understanding imaging research experiences, challenges, and strategies for academic radiology departments during and after COVID-19 is critical to prepare for future disruptive events. We summarize key insights and programmatic initiatives at major academic hospitals across the world, based on literature review and meetings of the Radiological Society of North America Vice Chairs of Research (RSNA VCR) group. Through expert discussion and case studies, we provide suggested guidelines to maintain and grow radiology research in the postpandemic era.

Is COVID-19 the "Catalyst" to Incorporate 3D Printing Technology into the Manufacturing Industry?

The contribution of the fight against COVID-19 to the incorporation of 3D printing technology into the manufacturing industry is the research question of this study. By observing the structure of initiatives of hobbyists and enterprises in the 3D printing industry that are printing health care equipment for nursing staff, we conclude that 3D printing technology could be used for mass production under a different production model. We propose two different typologies of a factory's structure, calling them "Adjust-Semi Cloud Factory 1" and "Semi-Cloud Factory 2." To measure the effectiveness of these new types of factories, we propose a framework based on characteristics and aspects of knowledge management.

Evaluations of 3D-Printed Surgical Mask Tension Release Bands for Common COVID-19 Use with Biomechanics, Sensor Array System, and Finite Element Analysis

A mask is one of the most basic protections to prevent the transmission of COVID-19. Surgical mask tension release bands (SMTRBs) are commonly used to ease the pain caused by prolonged mask use. However, the structural strength of SMTRBs and the effect that wearing masks with SMTRBs has on the face are unclear. Thus, this study assessed the mechanics of seven different types of 3D-printed SMTRBs. In this study, a tensile testing machine, a sensor array system, and finite element analysis were used to evaluate the mechanisms of seven SMTRBs. The tensile testing machine was applied to measure the breaking strength, elongation, stiffness, and rupture of the band. The sensor array system was used to calculate the pressure on the face when the band was used together with the mask. Finite element analysis was applied to evaluate the level of stress on the SMTRB structure when each of the seven bands was subjected to external force. The results demonstrated that thick SMTRBs put more pressure on the face but had greater structural strength. The thinner bands did not break easily; however, the mask ear loops tended to slip off more often. In addition, the size of the band hook affected the magnitude of the external force. This study provides a biomechanical reference for the future design of SMTRBs.

Comparison of Effectiveness between Wycope Video Laryngoscope, C-MAC Video Laryngoscope, and Direct Laryngoscope in Intubation of Elective Surgery Patients

OBJECTIVE

Airway management has undergone a dramatic transformation since the arrival of video laryngoscope (VL). VL has higher intubation success rate on first try and lower complications in comparison to direct laryngoscope (DL). The use of VL is recommended in intubating COVID-19 patients to speed up intubation time and reduce failure rate. A team from Airlangga University developed Wycope Video Laryngoscope (Wycope VL), a VL with Wi-Fi connection to smartphones for an easier VL with low cost. This study aimed to compare the effectiveness of Wycope VL, C-MAC Video Laryngoscope (C-MAC VL), and DL.

MATERIALS AND METHODS

This study was an analytic observational study with a cross sectional design, involving 63 patients who were divided into 3 groups based on the type of laryngoscope, namely Wycope VL, C-MAC VL, and DL. Intubation is carried out by 4th year anaesthesiology resident. Research subjects were patients who will undergo elective surgery at Dr. Soetomo General Hospital under general anaesthesia using orotracheal tube. Inclusion age of 19-64 years, PS ASA 1-2, no anatomical abnormalities of the airway, did not have difficult airway, and was willing to participate in the study.

RESULTS

All patients were successfully intubated without complications. C-MAC VL (5.33±1.42 seconds) and Wycope VL (5.95±0.74 seconds) was significantly faster in seeing vocal folds and glottis compared to DL (7.14±0.72 seconds) with P=0.000. DL was significantly faster in average time of intubation (15.52±5.90 seconds) compared to C-MAC VL (16.95±1.11 seconds) and Wycope VL (20.29±2.81 seconds) with P=0.000.

CONCLUSION

DL was faster compared to VL in speed of intubation while C-MAC VL and Wycope VL was faster in viewing the vocal folds and glottis compared to DL.

3D-printed graphene polylactic acid devices resistant to SARS-CoV-2: Sunlight-mediated sterilization of additive manufactured objects

Additive manufacturing has played a crucial role in the COVID-19 global emergency allowing for rapid production of medical devices, indispensable tools for hospitals, or personal protection equipment. However, medical devices, especially in nosocomial environments, represent high touch surfaces prone to viral infection and currently used filaments for 3D printing can't inhibit transmission of virus [1]. Graphene-family materials are capable of reinforcing mechanical, optical and thermal properties of 3D printed constructs. In particular, graphene can adsorb near-infrared light with high efficiency. Here we demonstrate that the addition of graphene nanoplatelets to PLA filaments (PLA-G) allows the creation of 3D-printed devices that can be sterilized by near-infrared light exposure at power density analog to sunlight. This method has been used to kill SARS-CoV-2 viral particles on the surface of 3D printed PLA-G by 3 min of exposure. 3D-printed PLA-G is highly biocompatible and can represent the ideal material for the production of sterilizable personal protective equipment and daily life objects intended for multiple users.

Fabrication of hydrophobic PLA filaments for additive manufacturing

There is an ever-greater need for self-cleaning and water-repelling properties of hydrophobic materials at this time in history, mainly due to the coronavirus disease 2019 (COVID-19) pandemic. However, the fabrication processes used to create hydrophobic materials are typically time-consuming and costly. Thus, this study aims to create hydrophobic materials based on low-cost manufacturing. In this study, polylactic acid (PLA) was mixed with various concentrations of hexadecyltrimethoxysilane (HDTMS) and polytetrafluoroethylene (PTFE) with the aid of solvents, chloroform, and acetone, through the solvent casting and melt extrusion process, which is capable of producing hydrophobic PLA filaments suitable for additive manufacturing (AM). Water contact angle (WCA) measurements were performed to verify the improved hydrophobicity of PLA/HDTMS/PTFE filaments. According to the results, it was discovered that the best filament WCAs were achieved with 2 g (10 wt%) of PLA, 0.2 ml of HDTMS, and 1 ml of PTFE (2 g PLA + 0.2 ml HDTMS + 1 ml PTFE), producing an average WCA of 131.6° and the highest WCA of 132.7°. These results indicate that adding HDTMS and PTFE to PLA significantly enhances filament hydrophobicity. Additionally, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA) techniques were utilized to characterize the surface morphology, molecular interactions, and thermal decompositions of the prepared PLA/HDTMS/PTFE filaments. This study revealed that compared to 2 g of pure PLA filament, HDTMS and PTFE altered the microstructure of the filament. Its thermal degradation temperature was impacted, but the melting temperature was not. Therefore, the PLA/HDTMS/PTFE filament is good enough to be printed by the fused filament fabrication (FFF) AM process.

Quality versus emergency: How good were ventilation fittings produced by additive manufacturing to address shortages during the COVID19 pandemic?

OBJECTIVE

The coronavirus disease pandemic (COVID-19) increased the risk of shortage in intensive care devices, including fittings with intentional leaks. 3D-printing has been used worldwide to produce missing devices. Here we provide key elements towards better quality control of 3D-printed ventilation fittings in a context of sanitary crisis.

MATERIAL AND METHODS

Five 3D-printed designs were assessed for non-intentional (junctional and parietal) and intentional leaks: 4 fittings 3D-printed in-house using FDeposition Modelling (FDM), 1 FDM 3D-printed fitting provided by an independent maker, and 2 fittings 3D-printed in-house using Polyjet technology. Five industrial models were included as controls. Two values of wall thickness and the use of coating were tested for in-house FDM-printed devices.

RESULTS

Industrial and Polyjet-printed fittings had no parietal and junctional leaks, and satisfactory intentional leaks. In-house FDM-printed fittings had constant parietal leaks without coating, but this post-treatment method was efficient in controlling parietal sealing, even in devices with thinner walls (0.7 mm vs 2.3 mm). Nevertheless, the use of coating systematically induced absent or insufficient intentional leaks. Junctional leaks were constant with FDM-printed fittings but could be controlled using rubber junctions rather than usual rigid junctions. The properties of Polyjet-printed and FDM-printed fittings were stable over a period of 18 months.

CONCLUSIONS

3D-printing is a valid technology to produce ventilation devices but requires care in the choice of printing methods, raw materials, and post-treatment procedures. Even in a context of sanitary crisis, devices produced outside hospitals should be used only after professional quality control, with precise data available on printing protocols. The mechanical properties of ventilation devices are crucial for efficient ventilation, avoiding rebreathing of CO2, and preventing the dispersion of viral particles that can contaminate health professionals. Specific norms are still required to formalise quality control procedures for ventilation fittings, with the rise of 3D-printing initiatives and the perspective of new pandemics.

A Review of Polymer-Based Materials for Fused Filament Fabrication (FFF): Focus on Sustainability and Recycled Materials

Recently, Fused Filament Fabrication (FFF), one of the most encouraging additive manufacturing (AM) techniques, has fascinated great attention. Although FFF is growing into a manufacturing device with considerable technological and material innovations, there still is a challenge to convert FFF-printed prototypes into functional objects for industrial applications. Polymer components manufactured by FFF process possess, in fact, low and anisotropic mechanical properties, compared to the same parts, obtained by using traditional building methods. The poor mechanical properties of the FFF-printed objects could be attributed to the weak interlayer bond interface that develops during the layer deposition process and to the commercial thermoplastic materials used. In order to increase the final properties of the 3D printed models, several polymer-based composites and nanocomposites have been proposed for FFF process. However, even if the mechanical properties greatly increase, these materials are not all biodegradable. Consequently, their waste disposal represents an important issue that needs an urgent solution. Several scientific researchers have therefore moved towards the development of natural or recyclable materials for FFF techniques. This review details current progress on innovative green materials for FFF, referring to all kinds of possible industrial applications, and in particular to the field of Cultural Heritage.

High-Impact Polystyrene Reinforced with Reduced Graphene Oxide as a Filament for Fused Filament Fabrication 3D Printing

Graphene and its derivatives, such as graphene oxide (GO) or reduced graphene oxide (rGO), due to their properties, have been enjoying great interest for over two decades, particularly in the context of additive manufacturing (AM) applications in recent years. High-impact polystyrene (HIPS) is a polymer used in 3D printing technology due to its high dimensional stability, low cost, and ease of processing. However, the ongoing development of AM creates the need to produce modern feedstock materials with better properties and functionality. This can be achieved by introducing reduced graphene oxide into the polymer matrix. In this study, printable composite filaments were prepared and characterized in terms of morphology and thermal and mechanical properties. Among the obtained HIPS/rGO composites, the filament containing 0.5 wt% of reduced graphene oxide had the best mechanical properties. Its tensile strength increased from 19.84 to 22.45 MPa, for pure HIPS and HIPS-0.5, respectively. Furthermore, when using the HIPS-0.5 filament in the printing process, no clogging of the nozzle was observed, which may indicate good dispersion of the rGO in the polymer matrix.

In Situ Printing and Functionalization of Hybrid Polymer-Ceramic Composites Using a Commercial 3D Printer and Dielectrophoresis-A Novel Conceptual Design

Three-dimensional printing-based additive manufacturing has emerged as a new frontier in materials science, with applications in the production of functionalized polymeric-based hybrid composites for various applications. In this work, a novel conceptual design was conceived in which an AC electric field was integrated into a commercial 3D printer (-based fused filament fabrication (FFF) working principle) to in situ manufacture hybrid composites having aligned ceramic filler particles. For this work, the thermoplastic poly lactic acid (PLA) was used as a polymer matrix while 10 vol% KNLN (K0.485Na0.485Li0.03NbO3) ceramic particles were chosen as a filler material. The degree of alignment of the ceramic powders depended upon print speed, printing temperature and distance between electrodes. At 210 °C and a 1 kV/mm applied electric field, printed samples showed nearly complete alignment of ceramic particles in the PLA matrix. This research shows that incorporating electric field sources into 3D printing processes would result in in situ ceramic particle alignment while preserving the other benefits of 3D printing.

On-Site, On-Demand 3D-Printed Nasopharyngeal Swabs to Improve the Access of Coronavirus Disease-19 Testing

Diagnostic testing that facilitates containment, surveillance, and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or future respiratory viruses, depends on a sample collection device that efficiently collects nasopharyngeal tissue and that can be manufactured on site when an outbreak or public health emergency is declared by a government. Here two novel stereolithography-based three-dimensional (3D)-printed nasopharyngeal swabs are reported which are made using a biocompatible and sterilizable photoresist. Such swabs are readily manufactured on-site and on-demand to ensure availability, if supply chain shortages emerge. Additionally, the 3D-printed swabs easily adapt to current workflow and testing procedures in hospital clinical laboratories to allow for effortless scaling up of test kits. Finally, the 3D-printed nasopharyngeal swabs demonstrate concordant SARS-CoV-2 testing results between the 3D-printed swabs and the COPAN commercial swabs, and enable detection of SARS-CoV-2 in clinical samples obtained from autopsies.

Artificial intelligence-driven assessment of radiological images for COVID-19

Artificial Intelligence (AI) methods have significant potential for diagnosis and prognosis of COVID-19 infections. Rapid identification of COVID-19 and its severity in individual patients is expected to enable better control of the disease individually and at-large. There has been remarkable interest by the scientific community in using imaging biomarkers to improve detection and management of COVID-19. Exploratory tools such as AI-based models may help explain the complex biological mechanisms and provide better understanding of the underlying pathophysiological processes. The present review focuses on AI-based COVID-19 studies as applies to chest x-ray (CXR) and computed tomography (CT) imaging modalities, and the associated challenges. Explicit radiomics, deep learning methods, and hybrid methods that combine both deep learning and explicit radiomics have the potential to enhance the ability and usefulness of radiological images to assist clinicians in the current COVID-19 pandemic. The aims of this review are: first, to outline COVID-19 AI-analysis workflows, including acquisition of data, feature selection, segmentation methods, feature extraction, and multi-variate model development and validation as appropriate for AI-based COVID-19 studies. Secondly, existing limitations of AI-based COVID-19 analyses are discussed, highlighting potential improvements that can be made. Finally, the impact of AI and radiomics methods and the associated clinical outcomes are summarized. In this review, pipelines that include the key steps for AI-based COVID-19 signatures identification are elaborated. Sample size, non-standard imaging protocols, segmentation, availability of public COVID-19 databases, combination of imaging and clinical information and full clinical validation remain major limitations and challenges. We conclude that AI-based assessment of CXR and CT images has significant potential as a viable pathway for the diagnosis, follow-up and prognosis of COVID-19.

Additive Manufacturing of Plastics Used for Protection against COVID19-The Influence of Chemical Disinfection by Alcohol on the Properties of ABS and PETG Polymers

In this paper, the influence of disinfection on structural and mechanical properties of additive manufactured (AM) parts was analyzed. All AM parts used for a fight against COVID19 were disinfected using available methods-including usage of alcohols, high temperature, ozonation, etc.-which influence on AM parts properties has not been sufficiently analyzed. During this research, three types of materials dedicated for were tested in four different disinfection times and two disinfection liquid concentrations. It has been registered that disinfection liquid penetrated void into material's volume, which caused an almost 20% decrease in tensile properties in parts manufactured using a glycol-modified version of polyethylene terephthalate (PETG).

Nanotechnology as a Shield against COVID-19: Current Advancement and Limitations

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health problem that the WHO declared a pandemic. COVID-19 has resulted in a worldwide lockdown and threatened to topple the global economy. The mortality of COVID-19 is comparatively low compared with previous SARS outbreaks, but the rate of spread of the disease and its morbidity is alarming. This virus can be transmitted human-to-human through droplets and close contact, and people of all ages are susceptible to this virus. With the advancements in nanotechnology, their remarkable properties, including their ability to amplify signal, can be used for the development of nanobiosensors and nanoimaging techniques that can be used for early-stage detection along with other diagnostic tools. Nano-based protection equipment and disinfecting agents can provide much-needed protection against SARS-CoV-2. Moreover, nanoparticles can serve as a carrier for antigens or as an adjuvant, thereby making way for the development of a new generation of vaccines. The present review elaborates the role of nanotechnology-based tactics used for the detection, diagnosis, protection, and treatment of COVID-19 caused by the SARS-CoV-2 virus.