Methods for medical applications

According to previous research, shore 40 A casting silicone is currently one of the more suitable materials for simulating the physical behavior of the airways in medicine simulation. This is essential to attain high-fidelity manikins that can perfectly mimic the simulated anatomic region, not just geometrically, but also in terms of haptic feedback. Due to the geometrical complexity of the tracheo-bronchial tree, mold design is a difficult and time-consuming process. An interactive modeling procedure for modeling mold parts for tracheo-bronchial tree casting is proposed in this paper, with the purpose of reducing modeling time without compromising quality. Following the definition of a standard modeling procedure, this was implemented in the Matlab language by using an IGES and STL editing toolbox. By using the interactive procedure it is possible to reduce the time required for virtual modeling from several hours to less than 1 min. Given this preliminary result, the proposed procedure will be further tested and developed in the near future, with the possibility of automating other lower airway modeling steps, such as vent generation and mounting holes/pins.

Keywords: 3D modelling , Airway simulation , Interactive design , Mold casting

BACKGROUND: Healthcare sector has a significant impact on the environment and people well-being. Therefore, it is interesting to understand how healthcare contributes to sustainable development. OBJECTIVE: The study aims to perform a literature review on the methodologies applied to quantify environmental impact in healthcare with an attention to telemedicine activities. METHODS: Scopus and PubMed databases were investigated between 2018 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) frameworks was followed for article selection. RESULTS: From initial 183 articles, 50 full-studies were included. Life-cycle assessment method proved to be a standard for assessing the impact of devices used in clinical practice. Indeed, for the investigation of care activities a unique methodology was not defined. The assessment of telemedicine is mainly based on avoided travels, and a standard methodology is still missing. CONCLUSIONS: To move toward a sustainable development other aspects of sustainability should be investigated.

Keywords: Environmental Impacts , Healthcare , Sustainable Development , Telemedicine

BACKGROUND: Rehabilitation plays a key role in the recovery of upper extremity function after breast cancer surgery. Motion capture (mocap) systems for serious gaming have shown the potential to enable home-based rehabilitation, but clinical accuracy needs to be examined. OBJECTIVES: Validation of markerless mocap systems for telerehabilitation after breast cancer surgical intervention. METHODS: The accuracy of the markerless mocap device Azure Kinect in detecting compensatory movements and postural disturbances has been compared to a gold standard Optitrack system in five volunteers. Subsequently, a serious game for mocap-based shoulder exercises has been developed and integrated into a telerehabilitation platform. RESULTS: The Azure Kinect shows good reliability for scapular elevation (ICC >0.80; MAE <2.1 cm) and trunk tilt (ICC=0.88; MAE=5°), moderate reliability for rounded shoulders (ICC=0.51; MAE=2.6cm) and poor reliability for kyphosis angle (ICC=0.22; MAE=18°). CONCLUSION: The Azure Kinect provides reasonable performance for shoulder rehabilitation. The proposed telerehabilitation platform has been tested by rehabilitation specialists and received positive feedback.

Keywords: Breast Neoplasms , Exercise Therapy , Exergaming , Motion Capture , Telerehabilitation

An area of interest in orthopaedics is the development of efficient customized neck orthoses, considered that pathologies which affect the neck area are widespread. Advanced acquisition and modelling approaches combined with Additive Manufacturing (AM) can potentially provide customized orthoses with improved performance and complexity. However, in the design of these devices, besides functional and structural requirements, benefit and comfort of the patient should be a main concern, in particular, at the early stage of design during the acquisition of the body's part, and while using the printed orthosis. In this paper, a scanning system with three sensors was developed which allows a fast, about 5 s, and accurate acquisition of the neck area with minimum discomfort for the patient. A neck orthosis with a ventilation pattern obtained by Topology Optimization (TO), lightened by about 35%, was also established. In fact, a main role for comfort is played by the ventilation pattern which contributes both to lightness and breathability. Its structural and comfort performance was evaluated in comparison with an orthosis with a ventilation pattern configured by Voronoi cells. Structural assessment was carried out by means of finite element analysis under main loading conditions. An evaluation of neck temperatures in relation to wearing 3D printed prototypes, manufactured with Hemp Bio-Plastic® filament, was finally conducted by means of a thermal imaging camera. TO orthosis prototype showed a better performance regarding thermal comfort, with a maximum increase of neck temperature less than 1 °C, which makes the proposed configuration very promising for user's comfort.

Keywords: Additive manufacturing , CAD , Orthosis modelling , Reverse engineering , Thermal comfort , Topology optimization

Primary dentition is crucial in influencing the emergence of permanent teeth. Premature primary tooth loss can result in undesired tooth motions and space loss in the permanent dentition. Typically, fixed or removable dental appliances are adopted to maintain edentulous space until the eruption of permanent teeth. However, traditional space maintainers have limitations in terms of variability in tooth anatomy, potential allergic reactions in some individuals (i.e., nickel sensitivity), difficulties in maintaining oral hygiene, and patient acceptance. The present study introduces a fully digital framework for the design and manufacturing of customized pediatric unilateral space maintainers using generative algorithms. The proposed approach overcomes the current challenges by using a biocompatible resin material and optimizing the device's size, design, and color. The methodology involves intraoral scanning, surface selection, and trim, generative 3D modeling, finite element analysis (FEA), and additive manufacturing (AM) through vat photopolymerization. FEA results demonstrate the device's mechanical performance and reliability, while additive manufacturing ensures design freedom, high resolution, surface finishing, dimensional accuracy, and proper fit. The mechanical interlocking system facilitates easy and effective positioning of the device. This digital approach offers the potential for wider usage of space maintainers and can be further validated through experimental assessments and clinical studies.

Keywords: 3D printing , digital space maintainer , FEA analysis , generative design , pediatric dentistry

The aim of this review is to provide a comprehensive overview of the existing literature concerning the applications of positron emission tomography (PET) radiomics in lung cancer patient candidates or those undergoing immunotherapy. Materials and Methods: A systematic review was conducted on databases and web sources. English-language original articles were considered. The title and abstract were independently reviewed to evaluate study inclusion. Duplicate, out-of-topic, and review papers, or editorials, articles, and letters to editors were excluded. For each study, the radiomics analysis was assessed based on the radiomics quality score (RQS 2.0). The review was registered on the PROSPERO database with the number CRD42023402302. Results: Fifteen papers were included, thirteen were qualified as using conventional radiomics approaches, and two used deep learning radiomics. The content of each study was different; indeed, seven papers investigated the potential ability of radiomics to predict PD-L1 expression and tumor microenvironment before starting immunotherapy. Moreover, two evaluated the prediction of response, and four investigated the utility of radiomics to predict the response to immunotherapy. Finally, two papers investigated the prediction of adverse events due to immunotherapy. Conclusions: Radiomics is promising for the evaluation of TME and for the prediction of response to immunotherapy, but some limitations should be overcome.

Keywords: immunotherapy , lung cancer , PD-L1 , PET , response to therapy

A fundamental outcome of bone tissue engineering is the regeneration of bone defects presenting large dimensions. A promising solution in biomedical practice is the implantation of biomimetic scaffolds, i.e. porous structures mimicking the natural shapes of healthy bone tissues, which are colonized by mesenchymal stem cells and that support the growth of the regenerating tissues, until the complete healing process is realized. This work presented a workflow for the geometrical modeling and the mechanical design of beam-based, bilayered, and conformal scaffolds, mimicking the human cortico-cancellous bone structure for filling a large dimension defect in the mandibular bone of an injured patient. An isotropic Voronoi topology built on a refined point set generated by a high-quality meshing algorithm was adopted for lattice generation, which led to an open-cell architecture characterized by full connectivity and uniform cell size. Such geometrical and structural features represent crucially important requirements for maximizing the osteointegration and the vascularization of the implanted scaffold. An irregular scaffold was modelled, including a cortical and a sponge layer. The beam radii of both layers were determined by matching the elastic properties of the corresponding bone tissues, thus minimizing the stress shielding effects. Interestingly, several scaffold properties deriving from the proposed procedure, such as the porosity and the pore size, were in good agreement with those reported in the literature.

Keywords: Biomimetic scaffolds , Bone tissue engineering , CAD modeling , Lattice structures , Mechanical simulation

Among the main features of Industry 4.0, digitization and the evolution of the human-machine interaction occupy a central role. These concepts are transferring even in the health domain, moving toward Healthcare 4.0. The new concept of Industry 5.0 further promotes the human-centric perspective focusing on the consideration of human factors. In this context, training for workers, both in the industry and in the healthcare sectors, needs to be strongly human-centred to be efficient and effective. This paper refers to simulation-based training and aims to provide a transdisciplinary framework for the simulation assessment from the learners' perspective. The final scope is to outline a set of data-driven guidelines for the simulation optimization and redesign, throughout a human-centred approach, aiming to improve the workers' performance and the overall learning process, considering the physical, cognitive, and emotional conditions. The proposed method is suitable for each kind of training (both traditional and with the use of virtual reality/augmented reality systems) and relevant for every sector. Two different use cases are presented, respectively referring to the healthcare and industry fields, proposing a unique assessment protocol. The healthcare use case considered the low-fidelity simulation of lumbar puncture, while the industrial use case referred to the replacement of the engine oil filter on tractors. Although the great differences between the content of the use cases, the results obtained about performance as well as cognitive and emotional states are close enough to define a common set of guidelines to redesign and optimize the simulation-based training.

Keywords: Design optimization , Ergonomics , Healthcare 4.0 , Human Factors , Industry 4.0 , Simulation-based training

The population aging phenomenon has been increasing in the last years and will become prevailing in the future ones. In the era of Healthcare 4.0, the application of information and communication technologies (ICT) is the main enabler for the health and social care sectors, advancing user-centered care and preventing or delaying frailty conditions. This work focuses on a preliminary usability and user experience (UX) assessment regarding a self-monitoring device, smartphone, and tablet, with a 5-users sample. The user interface layout and content of smartphone and tablet have been previously simplified according to the human-computer interaction principles, to hinder the digital divide inherent to the Silver Generation. Structured and semi-structured interviews have been conducted to evaluate users' expectations, familiarity, and acceptance of ICT devices. A specific assessment protocol has been designed to evaluate the usability of devices. Preliminary results show that all participants were able to complete the test with few committed errors. However, even if a good inclination toward the use of smart technologies emerged, the need for digital mediation and individual training sessions is undisputed.

Keywords: Elderly , healthy ageing , self-monitoring , telemedicine , usability , user experience

Approximately 10% of hospitalized patients develops decubitus ulcers that quickly degenerates into chronic illness that reduces the quality of life and requires expensive clinical management. The use of an anti-decubitus active mattress, that automatically redistributes the pressure loads, reduces the occurrence of new lesions and promotes the healing of the pre-existing ones. The aim of this work is to design and develop two tools to support the design of an anti-decubitus active mattress. Almost all the systems found in literature are based on the classification of pressure maps through machine learning and are difficultly usable in the design context. This work proposes a pressure map Classifier and an Interactive Simulator of the mattress, based on a simpler logic, by integrating image processing techniques and functioning simulations. The Classifier can recognize the patient's pressure maps and classify them according to six reference sleep postures. The Interactive Simulator allows to understand the operating mechanisms of the mattress and to test the controller and the various control logics in the absence of a physical prototype.

Keywords: Active Anti-decubitus Mattress , Images Classifier , New product development , Simulation , User centred design

Background: The right comprehension of ischemic stroke pathogenesis guarantees the best prevention therapy. The term “patent foramen ovale (PFO) related stroke” has been proposed for those events where PFO is supposed to be pathogenetic, but their definition is challenging. A multidisciplinary evaluation in a "Heart & Brain" team (HBteam) including stroke neurologists and interventional cardiologists was therefore highly recommended in the recent guidelines of secondary stroke prevention. Objective: We aimed at describing the organization of the HBteam of Careggi-University-Hospital of Florence (Italy), and the results of the first seven years of activity. Methods: In 2016 Interventional Cardiologists and Stroke Neurologists set up an outpatient clinic for the joined evaluation of patients with PFO and other cardio/neurological conditions. A specific diagnostic-therapeutic hospital plan was produced for PFO patients. Patient empowerment was guaranteed by a hospital explicative webpage, a booklet regarding risks/benefits of PFO closure and a 3D heartmodel to simulate the intervention. Data were collected in a dedicated registry. Results: We evaluated 594 patients for PFO, 40 for left atrial appendage closure and 38 for other conditions. In 20% of PFO-patients, HBteam diagnosis was discordant from that of referring physicians, 14% were stroke misdiagnoses. We advised against closure in 53% of patients. At follow-up 94% of closed patients had no/minimum residual shunt; 3 patients had a cerebral ischemic event. Conclusions: A dedicated HBteam represents a unique opportunity to share decisions with patients after a thorough empowerment process. The joining of cardioneurological skills allows a better classification of PFO-patients, reducing futile interventions.

Keywords: Closure , Heart and brain team , Ischemic stroke , Multidisciplinary , Patent foramen ovale , PFO

Purpose: Left atrial appendage occlusion (LAAO) is a structural interventional cardiology procedure that offers several possibilities for the application of additive manufacturing technologies. The literature shows a growing interest in the use of 3D-printed models for LAAO procedure planning and occlusion device choice. This study aims to describe a full workflow to create a 3D-printed LAA model for LAAO procedure planning. Design/methodology/approach: The workflow starts with the patient's computed tomography diagnostic image selection. Segmentation in a commercial software provides initial geometrical models in standard tessellation language (STL) format that are then preprocessed for print in dedicated software. Models are printed using a commercial stereolithography machine and postprocessing is performed. Findings: Models produced with the described workflow have been used at the Careggi Hospital of Florence as LAAO auxiliary planning tool in 10 cases of interest, demonstrating a good correlation with state-of-the-art software for device selection and improving the surgeon's understanding of patient anatomy and device positioning. Originality/value: 3D-printed models for the LAAO planning are already described in the literature. The novelty of the article lies in the detailed description of a robust workflow for the creation of these models. The robustness of the method is demonstrated by the coherent results obtained for the 10 different cases studied.

Keywords: 3D Printing , Additive manufacturing , Heart model , Left atrial appendage occlusion , Left atrium , Stereolithography , Structural heart surgery , Surgical planning

[No abstract available]

Assistive devices are designed to enhance individuals with disabilities' functional abilities. The rise of 3D printing technology enabled the production of individualized assistive devices (IADs). A REHAB-LAB is intended for IAD provision involving technical referents and occupational therapists. This study aimed to develop the REHAB-LAB logic model; to explore its fidelity and desirability; and to explore the characteristics of arising initiatives of IAD production. The REHAB-LAB logic model development involved stakeholders throughout the research process. A pragmatic multimethod approach followed two phases 1) logic model development and 2) exploration of its fidelity and desirability. The REHAB-LAB logic model presented the resources (equipment, space, human) required to implement IAD provision in a rehabilitation center, and the expected deliverables (activities and outputs). The REHAB-LAB logic model highlights the interdisciplinarity of IAD provision including occupational therapists, doctors, engineers, managers, and technical referents and places the users at the center of the IAD production. Results confirmed the fidelity and desirability of the REHAB-LAB logic model. The REHAB-LAB logic model can be used as a reference for future healthcare organizations wishing to implement an IAD provision. This research highlighted the interest of IAD provision based on the REHAB-LAB model involving users and transdisciplinary practices.

Keywords: 3D-printing , assistive technology , co-design , co-development , logic model , occupational therapy , user-centered design

The design of biomimetic porous scaffolds has been gaining attention in the biomedical sector lately. Shells, marine sponges, shark teeth, cancellous bone, sea urchin spine, and the armadillo armor structure are examples of biological systems that have already been studied to drive the design of innovative, porous, and multifunctional structures. Among these, triply periodic minimal surfaces (TPMSs) have attracted the attention of scientists for the fabrication of biomimetic porous scaffolds. The interest stems from their outstanding properties, which include mathematical controllable geometry features, highly interconnected porous architectures, high surface area to volume ratio, less stress concentration, tunable mechanical properties, and increased permeability. All these distinguishing features enable better cell adhesion, optimal integration to the surrounding tissue avoiding stress shieldings, a good permeability of fluid media and oxygen, and the possibility of vascularization. However, the sophisticated geometry of these TPMS-based structures has proven challenging to fabricate by conventional methods. The emergence of additive manufacturing (AM) and the enhanced manufacturing freedoms and flexibility it guarantees could solve some of the bottlenecks, thus leading to a surge of interest in designing and fabricating such structures in this field. Also, the feasibility of using AM technologies allows for obtaining size programmable TPMS printable in various materials, from polymers to metal alloys. Here, a comprehensive overview of 3D-printed TPMS porous structures is provided from a design for additive manufacturing (DfAM) and application perspective. First, design strategies, geometry design algorithms, and related topological optimization are introduced according to diverse requirements. Based on that, the performance control of TPMS and the pros and cons of the different AM processes for fabricating TPMS scaffolds are summarized. Lastly, practical applications of 3D-printed biomimetic TPMS porous structures for the biomedical field are presented to clarify the advantages and potential of such structures.

Keywords: Additive manufacturing , Biomimetic , Design for additive manufacturing , Metamaterials , Porous structures , Triply periodic minimal surfaces

In this paper we present the preliminary evaluation of an active soft bellow exoskeleton for assistance during overhead tasks. The evaluation was performed using objective (i.e., joint angles and muscle activations) and subjective (i.e., Borg Cr R-10 and System Usability Scale - SUS scales) measurements. The subject, involved in the experimental campaign, performed in laboratory conditions a drilling overhead task typical of the automotive industry, once using the exoskeleton and once without the exoskeleton. The preliminary results underlined the positive effect of the exoskeleton in terms of physical effort and usability.

Keywords: biomechanics , overhead tasks , soft exoskeletons , usability

In wide-ranging areas, including hydraulics, biomedical, automotive, and aerospace, there is often a need to move a fluid with a constant flow rate. This is difficult to achieve with any type of pump and usually other elements are inserted to regularize the output. This study focused on the peristaltic pump because there are few studies on it and it has some interesting features, such as extreme simplicity, a small number of components, and the extreme compactness of the whole system. The first part of this study is focused on analyzing the classical geometry of the peristaltic pump to understand the origin of the discontinuity in the flow rate; the second part proposes a new geometry that mitigates the flow irregularity by more than 200%. In this way, it is possible to use it in all the sectors where a constant flow rate is required but where insulation between the fluid and the machine is required. Together with the flow study, an analysis of how the main geometric parameters affect the operation of the pump is provided, complete with explanatory graphs and tables. A prototype made through additive manufacturing technologies is also proposed.

Keywords: 3D printing , calculation , constant flow rate , fluid transfer , peristaltic pump

Objectives: The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed. Materials and methods: Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated. Results: Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p >.05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region. Conclusions: The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects. Clinical relevance: This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.

Keywords: Bilateral sagittal split osteotomy (BSSO) , Body mass index (BMI) , Facial landmarks , Le Fort I osteotomy (LFI) , Soft tissue thickness (STT)

When humans and robots work together, ensuring safe cooperation must be a priority. This research aims to develop a novel real-time planning algorithm that can handle unpredictable human movements by both slowing down task execution and modifying the robot's path based on the proximity of the human operator. To achieve this, an efficient method for updating the robot's motion is developed using a two-fold control approach that combines B-splines and hidden Markov models. This allows the algorithm to adapt to a changing environment and avoid collisions. The proposed framework is thus validated using the Franka Emika Panda robot in a simple start–goal task. Our algorithm successfully avoids collision with the moving hand of an operator monitored by a fixed camera.

Keywords: hidden Markov models , human–robot interaction , obstacle avoidance , splines

Among biodegradable metallic materials, AZ31 Mg alloy is one of the most studied for biomedical applications. In orthopedics it is of particular interest for temporary implants in order to avoid a subsequent surgical removal. In addition to the biodegradability, the advantages of AZ31 include excellent biocompatibility, excellent osseointegration and an elastic modulus value similar to the human bone one. Furthermore, Mg is essential for the metabolism in many biological mechanisms and the Mg2+ ions, which are produced as a result of its degradation, are useful to promote healing and tissue growth. Finally, the alloy contains a low amount of Al which, in high concentration, could be harmful for the nervous system and osteoblasts. Like other Mg alloys, AZ31 has the disadvantage of quickly degradation in presence of biological fluids, therefore it is necessary controlling the corrosion rate in relation to bone tissue healing process. Corrosion processes can lead to a reduction of the implant's mechanical properties, compromising its functionality. The growth of LDH (Layered Double Hydroxides) on the surface of the AZ31 alloy is not only aimed to delay corrosion processes but also to incorporate medicines that can be released in-situ from the implant with local anti-inflammatory, analgesic, and antimicrobial action. The material would thus play an active role in the healing of bone tissue. This work reports and discusses the first results of an experimental campaign aimed at the identification of the optimal conditions for the LDH growth on the AZ31 alloy for applications in orthopedics.

Keywords: AZ31 , biodegradable materials , LDH (Layered Double Hydroxides) , magnesium alloys