Episode #80 | Live from San Francisco: Innovation in 3D Printing & Bioprinting

3DHEALS kicked off its first in-person/hybrid event in 2025 in San Francisco, welcoming investors, entrepreneurs, and innovators in the space. The healthcare industry is transforming, driven by 3D printing and bioprinting technologies redefining patient care. This exclusive in-person hybrid event offered an opportunity to explore the latest advancements in custom prosthetics, implants, bioprinted tissues, and scaffolds.  The remarkable convergence of 3D printing and healthcare transforms medicine through customized solutions that weren't possible a decade ago. This episode brings together five leaders in the healthcare field who are harnessing additive manufacturing to solve real clinical problems and improve patient outcomes.

Summary:

• 3D-printed spinal implants have evolved from simple titanium cages to sophisticated expandable devices that restore alignment and relieve nerve compression
• Patient-specific radiation shields protect healthy tissue during cancer treatment, reducing devastating side effects like oral mucositis
• Bioprinted organoids are creating human-derived testing platforms for drug discovery
• 3D-printed trabecular metal structures are providing better bone integration for joint replacements
• AR/VR integration with 3D printing is a robust tool for surgical planning, training, and patient education..
• Evidence-based innovation remains critical, focusing on validated clinical problems rather than technology for technology's sake.
• The shift toward ambulatory surgical centers drives demand for minimally invasive solutions that 3D printing can uniquely deliver.
• Investment in medical 3D printing continues as clinical applications expand.

The experts emphasize that successful innovation must be evidence-based, addressing validated clinical problems rather than pursuing complexity for its own sake. The speakers agreed, "Just because it's complex doesn't mean it's better." This wisdom encapsulates the mindful approach needed as we continue exploring the vast potential of 3D printing in healthcare.

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Watch this event recording on demand.

Check out our blog for an in-depth analysis of the event!

Youtube Event Highlight Playlist.

Chapters

• 0:00 Welcome and Introduction to 3D Heels
• 4:23 Josh Mikulich: Evolution of 3D Printing in Spine Surgery
• 21:01 Bhushan Mahadik: Bioprinting Applications and Research Trends
• 44:29 Rajan Patel: Additive Manufacturing in Cancer Treatment
• 1:04:36 Dr. Kuan-Lin Chen: Evidence-Based Innovation in Orthopedics
• 1:24:07 Dr. Jesse Cordier: AR/VR Integration and Investment Landscape

Transcript

Speaker 1: 0:01

Hello guys, let's see we have three people logged in. That's a sign of life. Good evening everyone. Thanks for coming in virtually. We have a room full of very happy attendees drinking and eating. I just want to report live from the conference here, live from the conference here.

Speaker 1: 0:28

But I want to start things on schedule and this is the first San Francisco in-person or hybrid event for us, 3d Heels, and as a company, we have three missions. One is to educate people about 3D printing healthcare. You know specifically what kind of applications are really viable using 3D printing and bioprinting and related 3D technology as we are expanding the topic. Number two mission we have is networking. So in the past several years, hello David, we mostly 100% virtual, but now that things are normalizing, we're going to do more and more in person.

Speaker 1: 1:07

In-person events difficult, also pretty challenging logistically to attend, but if you're entirely trying to reorganize the event, please join us. And number three is Pitch3D program. Pitch3d program, which is a very straightforward program. We don't charge any money for early stage startups, which means pre-seed to Series A. We help them to connect with 30 plus institutional investors directly and if you're interested, please apply. You can go onto our website, pitch3d, and apply to pitch through our program. Okay, so without further ado, I am going to start to start our presentation, and let me just check the order of the speaker. One second Not streamlined here. Yeah, one second Not streamlined here.

Speaker 2: 2:06

Yeah.

Speaker 1: 2:08

Do you mind asking them to come in, please? Ding ding ding, ding ding ding. Yes, okay, we're starting presentation guys, all right. All right. Oh, the first speaker is Josh McCulloch. Okay, he currently is working at ArthroVax. In fact, because we only have one podium, I will ask speakers to just introduce yourself. Okay, so I don't have to come back in. Okay, all right, Awesome.

Speaker 3: 2:40

And stay put? Or can I wander with the microphone, or is it best if I stay here?

Speaker 1: 2:43

Best to stay here. And where is the phone? The phone is here, okay, so your presentation, okay, this is yours. I believe All right, that's yours.

Speaker 3: 3:10

Thank you, okay, and then advanced slide. Is there a wand or we can just use the arrow?

Speaker 1: 3:19

Yeah, this is not as a One sec. Let me just do this, there you go. Let me just do this, there you go. So you should stay here, because it's recording you from this camera and the voice.

Speaker 3: 3:35

Okay, and then if I want to change slides, you have it.

Speaker 1: 3:37

You can just do this. No, just click. Okay, use the finger.

Speaker 3: 3:52

You can just go right or left. Okay, here we go. I try not to put you, put everybody to sleep. I'm josh micklelidge. I work for a company called evolution. Evolution surgical. That is an exclusive agency, uh for arthrex, a large medical device company spanning the globe and currently let me get through this so everything that I talk about obviously this has nothing to do with Evolution Surgical or Arthrex. These are sort of ideas and experiences that I've had in the past with 3D printing and current ideas that I have around 3D printing in the field of spine surgery, around 3D printing in the field of spine surgery. All right, so a little walk down memory lane. This is our booth at the first 3D Heels Conference in San Francisco back in 2017.

Speaker 3: 4:37

A very fond memory of Dean Carson and I at that conference and Paul came out from Australia to speak. Fantastic experience and still very much relevant to today. So I started as a medical device rep and had no idea that I would fall in love with the field of all things medical device. And at that time 3D printing was just kind of being applied to medical devices, both in the total joint replacement world as well as in spine. I remember these pictures represent, on the left here two basic implants and then on the right these knee jigs were being introduced by a company called Medacta and at the same time these spinal implants are being introduced by a company called 4Web. And I remember going around and talking to the spine surgeons and I said, hey, I've got this cool implant. And they said, well, we'll never stop using this peak stuff because titanium is too hard and bone won't fuse to it. And I said, well, this is kind of different. I think you know, maybe give it a shot. No, no, I'm not changing from peak. And I reached out at that time to Paul Durso, who was running anatomics in Australia, and I said I really think this 3D printing thing is going to be a big deal. And I went out and started my own independent distributorship and started adding products to my bag and he said Josh, you know it's ironic, you're reaching out because I think it's a very big deal and I'm going to be heading to the Bay Area very soon why don't we meet up? And he, you know, comes, we meet up, he puts out all these different implants and these are things that I still to this day have not seen anybody else do, all custom patient specific stuff. And I also met Dean Carson, who ended up being his VP, and Gibran Maher, who was also part of the sales team, and really us three were bringing this message to the US market at that time. And I was also running my own agency and started picking up 3D printed guide for hip surgery at Stanford, where we used a very patient specific method to make sure the cup was in the right place to reduce the rate of dislocation.

Speaker 3: 6:53

And then some early 3D printed implants and then also HAP coated implants. And then I became fully immersed. So I'm not an engineer by background or you know, and this stuff is just. I fell in love with it, became very passionate about it and Paul and I met with Swinburne University. They offered me the opportunity to start a PhD or start in a PhD program there and it was all around localized 3D printing for surgical tools and implants and that was basically the thesis. And also CSIRO, the federal agency in Australia, co-located in San Mateo. So I was working a little bit with CSIRO through anatomics, because they print a lot of the anatomics implants over in Australia, atomics implants over in Australia, and these are two implants, or sorry, guides, for spine surgery and then a custom 3D printed chest wall implant.

Speaker 3: 7:49

That's actually a composite implant of two different things. It's titanium with a porous polyethylene structure where you can suture into it and suture the musculature to the implant. I also that picture. I didn't say I should say that that is in Lawrence Livermore Lab. I had the opportunity to go tour their additive manufacturing facility and that machine can 3D print a well an object in, without any structures, in a vial of fluid. So it passes a series of lasers through mirrors and is able to polymerize um an object in three-dimensional space. It's really unique. So that was an exciting thing and they let us take a picture in there. I also saw a bunch of other wild things that were really interesting, so that was a really cool experience. However, um, I do have a family and you, I have to pay my bills. And COVID hit and I realized that I cannot do this PhD program. It was just too much. At that time I couldn't fly to Australia. They were completely locked down. One case of COVID and you know they shut the whole country down, so I backed out of that. But it was a great experience.

Speaker 3: 9:01

Here's some conclusions to the research I had. So number one there is no consensus for fusion criteria of a spinal implant and the preclinical models are really not consistent. So there is no systematic review for preclinical models of interbody fusion devices and I think these research opportunities also probably represent market opportunities in there. I spoke with Bill Walsh and there are some preclinical models that are better for testing spinal implants than others. So I think it's probably inhumane that we're using beagles and other animals that don't closely match the anatomy of a human and also not testing an implant in the intervertebral space just really doesn't make sense. If you're testing an implant in the distal femur and it's not going in the distal femur, you may have varied results there. I also did not find any alien technology that fuses faster or better than those of similar kinds. So there was no accelerated titanium that fused 100% of the time. And then, lastly, in the spine and inner body world, there are some implants that don't have a graft window in them and they seem to be performing pretty well. So that feature may or may not be an important part of future devices.

Speaker 3: 10:21

Today I'd like to talk about these topics. So expandable implants, thinking outside titanium this slide speaks for itself. Quick facts about interbody devices. So they can't create fusion. You really have to do the carpentry and also lock down the segment of the spine in order for it to fuse. You can't put something in there and it just automatically does it magically. And they are more than just a spacer now. So they're being used to correct imbalances and then they're also being used to distract the space, to free up the nerve root.

Speaker 3: 11:02

So surgeons are asking a lot out of their interbody fusion devices. Now, expandable cages are very similar to building a ship in a bottle. You want to get through the smallest portal and then get to the biggest footprint, and so this is what a surgeon may ask you. You know, I want it to fit like that, but I got to get around that nerve root through this port. And here's an example of a static cage and an expandable cage. That expandable cage is not only filling that space but it's also distracting it open enough for the foramen to or for the nerve root to be freed up in the foramen there, and it's restoring the lordotic angle of the spine as well.

Speaker 3: 11:41

So here's some early examples of expandable spinal interbody devices. And you know this implant here, stax. It's a series of wafers that you feed into the casing of that implant in order to raise it up. The blue centered one is a ramp sort of method where you expand the implant up on a ramp, and then the cylindrical where you're turning a little washer inside of that and opening it up that way. And then now things have kind of evolved into these cam-driven implants that can expand in two planes so you're really able to fill that space much better in both planes. And then also there's balloon technologies that you can deploy through a small port and then fill up with bone graft and create fusion there.

Speaker 3: 12:27

And I've been thinking a lot about this. My good buddy of mine and colleague, former colleague Matt's in the back of the room and whenever we have an extra moment we grab a beer and we often talk about, you know, cool ideas, right, and thinking outside of these very locked up devices IP wise up devices, ip wise. And one of the things that I've been thinking about is some kind of foam that's similar to like what you'd find in a Nike running shoe, a 3D printed foam that you could control the durometer so that when you put it in it's under pressure and you release it in a capsule or something and maybe the front can expand higher than the back to create the lordotic angle or a series of hinges, like that toy that I think it's called a Buckyball, that toy that you can kind of expand and contract and maybe drive it with a cam and then fill it up with bone graft and just playing around with cool ideas for expandable cages. But I think at the end of the day, those other devices are great devices but I think they're very locked up with IP. So I think you really have to think outside the box and I think that you know sometimes those ideas come from places outside of a medical device.

Speaker 3: 13:28

So another area of where 3D printing can impact spine surgery is just disposable kits of instrumentation. You know, cost is kind of out of control and you know, as a rep. Some of the things that we deal with is lost instrumentation, missing screws or that special driver that the surgeon really likes, that all of a sudden you get up to surgery it's not in the tray. What are you going to do and this is a very repeatable thing to deliver to somebody, especially if the quality of the instruments are adequate. A lot of businesses or I call it business surgeries are moving to the ASC and you know, having something that's more ASC friendly, that can be. The cost can be controlled. We're not opening up trays because we can't find something or we want something else. We can really control the cost there and and have a more predictable episode of care and and then I think the quality is really improving on these instruments. I mean, those look great to me. There's metal there and on my next slide here you've got a spine retractor. So it's not just the instrumentation and the implants but the means of getting to the place that you want to go in.

Speaker 3: 14:29

The spine is important as well and it's kind of standard of care in a lot of procedures already. If you look at sports medicine, they have kits. Arthrex sells a sports medicine kit for many different procedures. That is currently standard of care for many different procedures. That is currently standard of care. And then also the total joint replacement world has seen 3D printed tools in the conformance as an example Another one here. So anatomic simulators have come a long way.

Speaker 3: 15:01

We use these at our booths at conferences and the tissue planes are now very realistic. You can simulate a pathology that a patient has. So if you want to create a spondylolisthesis in this thing it's no longer just a basic. You know lumbar spine you can really get creative and create things, create pathologies with the 3D printing and also just the musculature and tissue and stuff is becoming very realistic. So I love these things. The best thing you can use is a cadaver when you want to get in and you know, especially like spinal endoscopy right now, it's very tricky and there's nothing beats a cadaver. However, they're expensive and there's a lot that goes into these labs. That we do so anytime you can use one of these, especially for a quick demonstration or a booth, is great and there's a bunch of companies. But you know, maybe this is most of what I found out there. I think there's still a lot of opportunity in the simulator world to use to apply 3D printing and bioprinting.

Speaker 3: 16:04

So if you look at the evolution of spinal implants, it sort of started with bone. You know you have femoral ring allografts and then machined allografts. Then it went to sort of these titanium implants. But then the titanium implants were too stiff and bone didn't grow into them. So things change over to peak, because peak has a better modulus of elasticity, it's also more radiographically friendly, but then also bone didn't grow into that. So you know, the porous titanium came and now we have porous Peak.

Speaker 3: 16:33

One of the funny things about this is that the stiffness of titanium is now kind of we're getting less and less stiff with the material. And I beg the question, or it begs the question are we just you know, you end up in lattice land my lattice is better than this lattice is better than that lattice and bone grows into my bedder and all this kind of stuff Are we just kind of going back towards bone? I did a deep dive into all the fusion data out there, the published articles, and I think what I found was well, I know what I found was that most of these cages are fusing in the lower to mid-90s, no matter what lattice and what kind of methodology you're using. So I'm sure that there are nuances to porosity and things like that, but at the end of the day, if we're driving towards less and less stiff material, we're going to end up back at bone. This is an example of the Dimension Inc material that was FDA cleared recently. I think that kind of paves the pathway for next-gen implants there. And then another example of a magnesium implant that is a very controlled, not like the past magnesium implants At least it would seem that way and my thoughts on this is that you could take bone marrow, aspirate and soak the implant and create a bioactive synthetic bone sort of implant there that may actually rival any of the 3D printed titanium implants potentially. So I think this is a promising field in spine surgery. I think it's something that I think we'll see more of.

Speaker 3: 18:10

Lastly, I just want to connect everybody here with a few of my friends. I mean, what would be my presentation without a couple of shameless plugs? So these are things that I think are pretty cool. A good buddy of mine, luke, is working on an implant that has a charged core that creates a piezoelectric effect in the implant, so it's generating a little electro field there and he's seeing some promising results in preclinical studies and that's a 3D printed titanium shell around it. So if you're interested in that, I would put you in touch with Luke and here's some references that he has on the material. And then Gibran, in Australia, my former colleague at Anatomics, has created an entire 3D printed spine company. Well, the company is not 3D printed but the products are, and he's a good buddy of mine as well, and I would love to put you in touch if you're looking to partner with a company that is 3d printing spinal implants. So I ran through that pretty quickly, but if you have any questions, I'm happy to answer.

Speaker 5: 19:14

Yeah.

Speaker 3: 19:15

Okay.

Speaker 1: 19:16

All right Thanks everyone.

Speaker 5: 19:29

I think I can find my presentation, that'd be great. Okay, yeah, that's me, oh, shoot oh is.

Speaker 1: 20:29

Is it sharing? Yeah, it is One second Sorry.

Speaker 5: 20:35

I'm also terrible at Mac.

Speaker 1: 20:41

The question is oh yeah, here we are. No, we're not sharing, Okay.

Speaker 2: 20:46

There you go.

Speaker 5: 20:49

Now we're sharing. Okay, all right, cool. Well, good evening everyone. My name is Bhushan Mahadik and I'm actually with Prelis Biologics. That is not too far from here in Berkeley, and we are actually a drug discovery company, but that is absolutely not my background.

Speaker 5: 21:16

I have been in the field of tissue engineering and regenerative medicine for a long time and when I was called to talk about 3D printing and bioprinting, I was thinking well, that is a pretty broad topic to talk about, because it has been a field that has been evolving for a very long time, and one of my favorite ways to actually picture and think about how this field has been evolving is to just look at the publications. My background and a lot of the things that I've done is from the academic realm, so I've been involved in a lot of different kinds of research involving 3D printing, bioreactors for a whole lot of different tissue-based applications, and obviously, as researchers and academicians do, they go to PubMed, and that is what I did. And what's really fascinating about this to me is, if you just look at the number of research articles that have been published over the last 20 years which doesn't seem like a long time, but it is there has been a phenomenal rise in just the number of people that talk about 3D printing or bioprinting. And I'm talking at the moment almost 6,000 papers that are published yearly that do 3D printing 1,000 a year more than that just talking about bioprinting and that's almost like a 150% increase year after year. And that tells me the volume and the speed at which this field has been growing. It's exponential and that to me is, you know, very interesting because there's a lot of research that is being done that is outside of just the academic realm and it covers a lot of different applications.

Speaker 5: 22:57

We just heard from Josh about a lot of different interesting bone applications for 3D printing that are being done. It goes obviously way beyond that from a 3D printing or bioprinting perspective. We have 3D printing applications for 3D printing anatomical models for different kinds of surgical applications. My favorite is the development of complex in vitro models. We use that to be able to better inform ourselves about different kinds of disease, models that we can use and test pre-screen therapeutics for to better understand native biology, because you cannot go in vivo to supplement animal models, because 3D printing with human systems is probably a better, smarter, safer choice. There's obviously a lot of work done in 3D printing with human systems is probably a better, smarter, safer choice. There's obviously a lot of work done in 3D printed biomedical devices, which obviously I don't have to tell this crowd it is actually.

Speaker 5: 23:54

Dentistry was actually one of the first fields that really picked up 3D printing, before any of the other fields did. And the way my dental surgeon friend put it, dentists are okay with risks that's what he told me because they are okay with implanting things in people's mouths and trying to fix their teeth. 3d printing was one of the first early adoptions that they did for their technology and now obviously that field has exploded, even in dentistry as well. Pharmaceuticals there has been some research going on in terms of 3D printing drugs that can be used for time release or different kinds of API in a 3D printed manner. There are advantages and disadvantages of that, obviously, but that also is being done. And finally, my other favorite is implantables. A lot of 3D printed constructs are used in implantation, not just for hard tissue, but also being explored for soft tissue as well. The simplest one, although it's not really simple, would be skin grafts that are used for implantation, but obviously the field is moving towards more of the soft tissue for musculoskeletal and other applications as well. So there are a lot of different applications and the field is very interesting, at least to me.

Speaker 5: 25:09

But again, when I come at it from a research perspective, the parameter space in which you can do 3D printing or bioprinting is really large. I'm talking about a lot of different factors that go into what you actually 3D print, and it's really an application-driven decision. Are you doing bone? Are you doing you know, carb, muscle? Are you doing skin? Are you doing, you know, liver, kidney, heart, whatever it is? There's a lot of factors that we have to consider, like what are the kinds of biomaterials you're using, especially for bioprinting? Is it a natural, a synthetic? Does it degrade, does it change with time? What are the biomolecules that are being incorporated? What are the impacts of the chemokines, cytokines, and how, ultimately, they impact the cells? Because if you're talking about bioprinting, well, you're talking cells and you have to then take into account how a cell functions inside of your 3D printed construct, how it interacts, interfaces and then changes the construct itself.

Speaker 5: 26:09

So the parameter space, like I said, is very large, and so are the print platforms. You know we started 3D printing back. Actually, the first 3D printer platform would be like in the 1980s with stereolithography. That was truly the first printing that came out, but then again it has exploded. From that, you have stereolithography, extrusion-based printing, fdm printing, sls, inkjet and hybrid technologies that are also being developed right now, and the platform you choose for your printing also ultimately impacts the product that you make as well.

Speaker 5: 26:41

So, that being said, because the parameter space is so large, one of my guiding principles when I think about 3D printing or bioprinting is just because it's complex doesn't mean it's better. Sometimes a simple solution is probably what you need. And I say that because, obviously you know, from a research perspective, I have worked with collaborations that have looked at projects where it's like oh, I want to print something really cool that is really complex of multi-materials, a lot of biomolecules, and I want to use this for a particular. I want to make a functioning liver. I want to 3D print a functioning heart. Well, that's great, but it's very complex and that does not mean it will work. So that doesn't mean it's not useful, but it's more complicated than that, although it sounds very fancy.

Speaker 5: 27:27

So we can go on and talk hours of all the different tissues that we can do 3D printing with and, like I said, this field has exploded a lot over the past few years. There are models for liver, bone, cranial implants, joint tissue my favorite topic, because it's extremely complicated to 3D print joint tissue, like cartilage, tendon, bone, and one of the reasons and it's actually primed for 3D printing or bioprinting because it's a lot of complexity in a very small space. Joint tissue is heterogeneous in terms of cellular structure, in terms of matrix composition, in terms of its physical characteristics. So to be able to pack all of that into a single piece of cartilage or a tendon, it's complicated and 3D printing is probably the way to do it, but it's also very challenging. So it's a very interesting area of research. Obviously not a lot of or any commercial products that come out of it, for very good reason. Kidney models, large.

Speaker 5: 28:44

Thinking about it and thinking about well, what should I really be talking about? Like I said, I have shifted my focus from doing a lot of 3D printing to drug discovery, and with that comes immunology. Immunology and that actually also is a very fascinating topic, because anytime you think about something that is implanted, the first question you would ask is well, what does the body do? Does it reject it? Does it incorporate with it. What is the immune response? And that's something that the field has realized over time as they started doing these implants and thought well, this got rejected in the body. There's fibrotic tissue, there is just rejection, there is just macrophage invasion. Whatever it is, the implant did not work. So the immune response of something that is 3D printed, bioprinted and eventually incorporated into the body is very important.

Speaker 5: 29:35

So for me, when I think of these fibrinated constructs, there are two things that come out of it. One is that they inform, which means you're developing a model system to better understand something, a particular question, or you implant. It can be a repair, regeneration, restoration applications. Oh, there you go. So, speaking of immune response, this is one of the works that we did at the University of Maryland in John Fisher's lab when I was over there, and this is a very good and interesting case study of using 3D printing or bioprinting in this case for a function to a form fit, and the challenge over here was the application of using 3D printing for a nipple areola complex Breast cancer survivors, patients who have undergone mastectomy. There's actually a very serious clinical need to be able to restore, if nothing else, a nipple areola complex and the current clinical solutions for it are actually very lacking, because anything that you do to try to restore this particular tissue does not sustain over long term.

Speaker 5: 30:48

So one of the recent questions that this particular student asked was well, can I 3D print that? And this is actually a very interesting material problem and an interesting biological problem, because you want something that can go inside the body and that can maintain form for a very long period of time and I'm talking about non-degradable tissue, right, but that's still. It cannot be something hard. It's soft tissue, but it's still non-degradable. So what she really did was something very interesting, was she 3D printed this construct using a hybrid material of something that is non-degradable a PEG-based product, and something that is degradable, like Gelma gelatin methacrylate, which is a collagen-derived complex. So the reason why you create something that is a hybrid is because you want the form that comes from your PEG construct that does not degrade when you implant, but you want something that is biologically friendly, and that's why she used gelatin that allows for cellular infiltration, that allows for functionality and, more importantly, does not have severe rejection when it is implanted. And it's actually pretty cool because you can actually see the different layers of what she printed. The white was the non-degradable and the pink was the degradable material that she did, and we were able to show that the cells within the degradable construct were alive after 14 days.

Speaker 5: 32:10

So there's a lot of research that went into how do you actually print a hybrid material with this particular shape and still retain that shape after you try to digest it, so you can actually see the post image over there. Well, the degradable gelma has kind of gone away and what you're left with is a skeletal structure. The idea behind that would be well, when you implant it into your body, eventually anything degrades and dies down. But the hope is that your body then starts reconstructing its own tissue and it needs a scaffold to be able to reconstruct something around. And the purpose of the non-degradable part would that it would stay, provide the support while allowing for cellular infiltration. Well, that's great.

Speaker 5: 32:51

You 3D printed, but how does it actually perform? Because one of the questions, like I just said, is how does the immune system respond to it when you put it in vivo? So she did mouse models and the results were actually quite promising. This was a subcutaneous implant that she did off the nipple areola into the mouse, and you can actually just look at this picture over here. These are the scaffolds that we printed. We had to scale them down because this mouse were tiny and it would be a very large scaffold that we had to implant.

Speaker 5: 33:24

But she did different combinations and ratios or proportions of the PEG to the GELMA and the hybrids that you see in between and, not surprisingly, the more digestible material you have, over a period of four weeks that gets completely digested and destroyed. But if you have something like PEG which is not degradable, you maintain that structure. So the answer that you want is something in between, where you want something that's not fully digestible but you want something that maintains that structure. That's part number one, and part number two is what kind of immune response do we get? Notably, what we did see was vascularization inside these constructs. The cells were able to infiltrate inside the scaffold itself, develop vascularization. We did see infiltration of macrophages and a few of these immune cell types, granulocytes, et cetera, but nothing that screamed that there's a complete implant rejection. A little bit of fibrotic capsule that were formed, but that's again not surprising for anything that is implanted into the body.

Speaker 5: 34:28

But overall, what this told me was that it's a very neat experiment for how you can incorporate bioprinting into something that is a real world application of something that is implantable. So that to me, really stood out and the main takeaway for me from this was well, the immune response that you see over here is quite critical and as we go into how the field of 3D printing is being evolving, what I've noticed as I look at all of these articles and fields of research is it's being used more and more for immune models themselves. The field of drug discovery and, more specifically, antibody production and discovery, relies on a lot of animal models, a lot of traditional technologies like phage display, using hybridomas, using mouse models, humanizing mouse antibodies so that they can be put into patients, and the key word over there is humanizing them. They come from something that is animal derived and we'll get to why. That is critical, at least for my work, for what I do right now. But you can use 3D printing for something like antibody generation, as this group did over here, where they mixed murine immune cells, essentially 3D printed that into a collagen matrix and let these cells do what they do B cells, producing antibodies over a period of time, and essentially what they found out was that they were able to generate antibodies against two foreign antigens, sars and Ovalbumin. That's interesting because they were able to incorporate the concept of 3D printing with something completely alien. Like antibody discovery, it's not something quite common and, again, if you look into research, that is really not at least as mainstream as some other 3D printing and bioprinting applications. But again, the field is evolving so you never know where this goes forward. The other thing is using 3D printing for model testing. Like I'd mentioned, you can either use something to inform or implant, and I just talked about implant. The inform for me, is very important because you can do things with 3D printed models that give you the level of complexity that you want that you don't necessarily get from a mouse model or an in vivo model, because it's a lot more complex.

Speaker 5: 36:57

Case in point over here was to test the efficacy of a bispecific antibody that this particular group wanted to investigate for treating kidney cancers. So this particular model that they did was engineering a 3D kidney organoid and then 3D printing a bioreactor within that to test how their bispecific antibody responds to the tumor when incorporated in the presence of circulating blood cells, almost like what you would do if you were trying to test this in preclinical applications. When you give a therapeutic to a mouse, you are accounting for the fact that it's circulating through your bloodstream and eventually finds its way to a tumor that it's then supposed to treat, which is exactly the model that they were trying to replicate over here. It's a very nice paper. Bottom line in this is that it actually did work. They were able to show that this therapeutic was able to target these kidney organoids inside a perfusible circulating system, while not targeting other non-specific cell types that are also in that organoid. So it means, for at least their purposes, their particular therapeutic was target specific, which is kind of the answer that you want to get out of a complex model like this Does your therapeutic work? Is it a good model to actually test it out? So to me, that is also a very useful application of bioprinting, and that kind of goes to what I do right now.

Speaker 5: 38:27

Like I said, I work at Frellis, which is a drug discovery company, which normally you wouldn't really associate with 3D printing, but what we have is a platform of an externalized immune system or the excess platform I just talked about. You know the traditional drug discovery that people do, which is you use mouse models, hybridomas, you use face display, things that the pharmaceutical company has been doing for a very long time, and there are upsides to it and there are downsides to it, the biggest downside being it is a humanized system, which means it is animal derived, that you then make it fit for human purpose and what we are doing right now is actually sourcing these cells of interest directly from humans. So it's a human to human antibody development system system and what we're doing is engineering the organoids to essentially generate the kind of immune response you want, so that the B cells in question generate the antibodies we want. So that essentially makes it a very target, agnostic platform for antibody generation. That means we can develop antibodies or therapeutics for cancer inflammation, can develop antibodies or therapeutics for cancer, inflammation, obesity, cardiometabolic, depending on what the target is and what the interest is. It is an agnostic platform and the way we actually do that is via using 3D models and 3D organoid systems.

Speaker 5: 40:03

We are recapitulating essential elements of the lymph node, which is where all of the antibody production of your body happens, and within the lymph node itself there are these things called the germinal centers, which is essentially where all of the B-cell activation and interaction of the T-cells actually occurs.

Speaker 5: 40:15

That gives you very high affinity, highly specific antibodies and the reality of the system is in our human body. This system is extremely sophisticated, very complicated, hard to actually replicate outside, but that is what we are trying to do using a 3D printed system. We have what we call the holographic two-photon lithography printing, which is a two-photon printing system that we use to 3D print our scaffolds that we then use as a platform for generating our organoids. So we have been doing that and have been relatively successful. Like I said, there are elements of biomolecules, biomaterials, the form and the cells that are involved in actually generating these organoids that we are then doing our drug discovery with, again, a completely offshoot application of a bioprinter or 3-printer construct, which is completely relevant from a clinical perspective. I think I'm going very fast, but that's fine.

Speaker 5: 41:13

Yeah, and the last thing I wanted to say is the use of bioreactors. I did talk about perfusion systems. To me also, this complements how a 3D-printed system works. A static system by itself is useful, but the human body is very dynamic. Bones have pressure, cartilage or tendons, they have tension, blood has flow. There's a lot of physical stimuli that actually occurs inside your body. So the role of bioreactors is to then incorporate that into an in vitro system as well. So, again, a lot of interesting work that goes on, and you know, most of us are familiar with bioreactors. But from an expansion perspective, we use bioreactors for, you know, expansion cells or again, actually for antibody production. But a flip side of that is how to actually use that to make more biologically relevant models. And again, another fascinating field of work. So that's my last slide.

Speaker 5: 42:13

So I am done, and the only last thought I have for this is it's a question that I ask anyone who does, who is interested in 3D printing, is do you really need to 3D print? Because it is complicated? Um, you know there are advantages and disadvantages to it, but if you really do, these are some of the questions that you should absolutely consider. Uh, like, what is your application. Do you really need it to be that complex? Because yes, then that's great, then we can talk about. You know how we can actually do it.

Speaker 5: 42:41

What is the form that you want to generate? You know, if you have 3d printing on the area complex for that form, great, that's a particular purpose. And, the most important of all, if you're trying to make something that is commercial, is it reproducible? Because more often than not, it is actually hard to do on a commercial scale. So a lot of different things to consider, but that, in the gist, is what I think of 3D printing. So I will stop because I know I'm over, but I'm happy to take questions at the end. Thanks, guys. There you go.

Speaker 1: 43:24

Start sharing this Spirit. Okay, let's see, let's see how. Let's see, let's share this.

Speaker 4: 44:15

You just up and down, change side. Next is up.

Speaker 1: 44:17

Just use your finger. Next is up, just use your finger.

Speaker 4: 44:22

Okay.

Speaker 1: 44:23

And you can introduce yourself too. Awesome.

Speaker 4: 44:27

This is the camera Fantastic, so stand right here. Yeah, awesome. Thank you, jenny. Thank you for having me and pleasure to meet you all. I have known Jenny for quite a few years now. This is the first time I'm actually helping her out by attending one of these meetings and presenting, so thank you. My background I'm a medical device developer. I've been doing this for quite a few decades now. I also have an incubator and an investor arm, so I do a lot of different things. Today I'm going to be talking about additive manufacturing in oncology.

Speaker 1: 45:14

Focusing just this doesn't look right. One second, make this bigger. Okay, I just don't know if people are, but the audience was remote. Can you tell me if you're seeing the slide? I'm not really sure, actually.

Speaker 4: 46:08

Thank you, Did I break the system?

Speaker 1: 46:14

No, I think it's just. The PDF version is tricky, but I think people can see it here and try to stand closer to this so we can hear you.

Speaker 4: 46:22

Okay, awesome, so let's just dive into it. So, additive manufacturing I have been using it for quite a few years now, basically from a prototyping perspective. So I saw some great presentations about how deep you can go into 3D printing. My application is very simple. I like what you said keep it simple and we have come up with something which is a simple solution to a complex problem, and I'm not the founder of this. We got this licensing technology from MD Anderson Cancer Center. They basically developed this over a decade in trying to solve the problem of minimizing side effects as a result of cancer therapy, and they then wanted to commercialize it. And, to your point earlier, it's not easy to commercialize 3D printing technology for the medical device application, and I'm not just talking about the scalability version, but also cost regulatory compliance reimbursement. So what I'm going to give you is an example of how we have taken additive manufacturing technology and launched a product in the oncology space.

Speaker 4: 47:37

So most of you probably know this. You know cancer used to be an acute condition. You got diagnosed with cancer and you died. What has happened with the advancement in technology is that it's become more of a chronic disease Early diagnosis, a lot of different treatments, a lot of very complicated drug treatments have started keeping the patients alive for a much longer time. Now the bad news about that is that they also live with side effects and, like this graph says you know, 18 million are survivors, with 4 million going through oral mucositis. Now you have seen people without hair who have gone through cancer therapy. What you probably haven't seen is this, which is oral mucositis. It's literally imagine sun burning the inside of your mouth. So when a patient goes through radiation or chemo treatment, it destroys the inside of the mouth to a point where they cannot eat. They have to be fed using a tube, they don't speak and more than 30% of patients die because of the side effects. The toll is huge, both financial as well as on humans, for the chemotherapy patient, which is a large population of cancer treatments that go through chemo. More than 40% of patients have side effects of oral mucositis Radiation therapy, especially for head and neck cancer. More than 90% of patients have oral mucositis and the worst part is you know 20% of patients they get hospitalized with a cost of $40,000 per patient. So the impact is huge.

Speaker 4: 49:24

The solution is a simple one, which was developed, like I said, at MD Anderson over 12 years ago and a lot of clinical studies have been presented. The most compelling is that more than 75% of patients' oral mucositis could be prevented if you have a patient-specific solution for that cancer patient and I will dive into what that means and then these other statistics, also shown through clinical evidence, are just another advantage of this technology. So, talking about simple solution, you know the simplest thing that you can do if you are going through radiation technology is separate the healthy tissue away from the tumor. So what they do like it is shown in the CT scan of a head and a cancer patient going through radiation treatment is that you remove the tongue or displace the tongue away from the tumor which is in this red zone, and as a result of that, if you notice in the graph, the tongue is protected from the radiation. So, essentially, if you can create a part which can go inside the mouth during radiation, push the healthy tissue away from the tumor, no matter where the location is, and then do the radiation treatment, you're essentially protecting the organs. Very clever idea, very simple solution, and what we did is we have commercialized that. Basically, md Anderson gave us the research formula of what is needed. How do you come up with a device which essentially keeps the mouth open, pushes the healthy tissue away and then allows the patient to be comfortably treated during radiation treatment. And the patient specificity is extremely important here, because no two patients are alike and each part has to be made custom. This was not possible a few years ago and 3D printing or additive manufacturing is a result that we're able to do this. We are able to get precise measurements of the mouth using optical scan of a cancer patient and create a stent which allows them to be treated without side effects. This probably is the most appropriate additive manufacturing slide, jenny.

Speaker 4: 51:52

The other two presenters were very technical. Mine is more towards startups, investment, medical device development, et cetera. But this to me, is what is exciting from an additive manufacturing perspective. The first image here shows that no matter what the patient type is whether they're edentulous, which is no teeth, or partially edentulous, like Sean, or have all the teeth and any other deformities in their mouth, we can optically scan it Once we take the STL file from there. Now we have our automated software which converts that optical image of the patient into the stent that is needed for creating the radiotherapy treatment device.

Speaker 4: 52:37

Unlike dentists who have adopted this technology. There's a couple of differences. You know this is still being used in the mouth, but it is a 510k clear product. Class 2 dentist devices are not class 2 devices. They can go from design to manufacturing and probably get away with murder.

Speaker 4: 52:56

We had to create we. We had to actually go through a lot of heavy lifting to commercialize it. And then the second thing that's more important for us in oncology is the time. So I remember going to my dentist and I said hey, do you have a scanner? And it's like no, I don't have a scanner, but I know somebody who's got a scanner, so we go get the scanner. They create a part like, okay, let's look at the part. Oh, I don't have a scanner, but I know somebody who's got a scanner, so we go get the scanner. They create a part Like, okay, let's look at the part, oh, this doesn't look right, go back. And this went on for a few weeks before I actually got the part. And then I finally gave up. I said can we just go to the old school way of, you know, putting a wax putty and creating a mold? And this was allowed in dentistry. In oncology you have three days.

Speaker 4: 53:42

So our biggest challenge in additive manufacturing was to create something which would allow us to go from an optical scan to a stent as fast as possible. Theoretically, we can do it in one day, but we're trying to be more optimistic and practical, because our biggest issue here is shipping and receiving in hospitals. So now it's getting into non-3D printed. So I'm gonna go a little bit faster, jenny, if it's okay, slow me down, guys, if you need. But our product is differentiated really well. Mainly, the biggest thing is patient specificity. These other competitors are not, and so they would use the product, but it would not allow you to move the healthy tissue away as needed.

Speaker 4: 54:30

Our technology is based on a platform for addressing oral mucositis, and before, during and after is our focus. The first product the bottom left image is the one that is already launched. We have FDA cleared the product. It's being sold. The top right is the one that we're working on now, submitting FDA for clearance this year, and that's a cryotherapy device where we're going to have the same approach of taking an optical scan and providing cooling channels inside the stent so that the inside of the mouth can be cooled. And then the bottom right is a drug delivery device. And, as I was listening to Josh. You know we have another idea where we also want to do some nerve stimulation inside the mouth, for which we may need, you know, some electrical circuitry inside.

Speaker 4: 55:25

A lot of different application are possible with this. This is our team, the founding team at the top row, like I said, you know, our incubator comes up with a lot of different ideas. This is one of the companies that we have spun out and we're working on on developing a few others, and the bottom row is from our strategic partners at MD Anderson and Ricoh who's doing our manufacturing and distribution. Clinical advisors are very important from a investment perspective to get the KOLs to sort of endorse your technology. These guys are some famous names in the space. Current activities like I said, we already are launching Stentra in the marketplace. Some of the names out on the right are the ones we're working with. We're looking at a few new applications for the product and then clinical studies to develop our pipeline product. And then this is marketing. I'm gonna skip through this. This is basically the problem statement.

Speaker 4: 56:38

You know there are millions of cancer patients that go through this side effect and it's a huge opportunity from an investment as well as a potential solution perspective, and 3D printing has allowed us to do that. I'm going to skip through the funding slide. This is for investment summary. I'm going to skip through that and this is my last slide. This is for investment summary. I'm going to skip through that and this is my last slide. But I think this when I got involved in 3D printing, I was fortunate because we were literally placed right next to the first machine that was built in Southern California. I was at Minimed, which was a startup at that time, and that was 89.

Speaker 4: 57:22

Some of you probably were not born and I thought this was ridiculous. This is like how is this possible? Because I was used to machined parts. How can you make these parts and how are they going to function? And you fast forward now to 3D printing and you don't even think about doing any kind of mathematical analysis if the part is going to work or not. You just 3D print it, test it and it goes off into production. I love that, and oncology is one of our main focus right now, mainly because of MD Anderson. We're starting here. Our next product is for liver cancer. Md Anderson, we're starting here. Our next product is for liver cancer and also we're going to be looking at some of the bioprinting solutions that were very early in the stage. So please stop by or email me if you have any questions, and thank you for entertaining.

Speaker 5: 58:26

Thank you so.

Speaker 1: 58:54

Okay, let me. You probably want to share this presentation mode here.

Speaker 6: 59:11

It's okay, it's still full screen mode.

Speaker 1: 59:15

Okay, you have 71.

Speaker 6: 59:17

Oh no, it's very quick, don't worry. So, yeah, hi everyone. Oh, I really enjoyed the previous presentations and it's really a pleasure to be here. So today I'm going to talk about evidence-based innovation. I'm also a pedic surgeon by training and I'm joining a venture now to go into the investor side. 3d printing is a really great, wonderful journey during my residence training and also solving clinical challenges during the clinical works stage of my life. Is it moving? Okay? Oh, yeah, so I'm currently the medical advisor in AMAD Ventures. Yesterday, we just launched our portfolio company, spira Medical. We're a co-investor with. It raised 120 million and for me, the reason why I was hired into this group is we're expanding our indication into the field of orthopedics. We look into orthopedic surgery, especially in minimally invasive intervention, and also we create a CDMO platform for new startups trying to collaborate with us to do a co-development. So a little bit about my background. I'm also a hip and knee surgeon by training and then also I did because of my interest in design. I did my master's degree at UC Berkeley and UCSF, so that's actually the fun time.

Speaker 6: 1:00:58

When I started, I met Jenny. So this is a 2018 3D Heels San Francisco. It's my first 3D Heels experience and I totally feel the passion from Jenny and got a lot of inspiration and that's a really true foundation of how I pivot and actually leaning towards my career. So after this meeting, after graduation I came back to Taipei and then during the meeting I talked to Jenny and saying that, hey, why not we have a after going back to Taipei, why not have a 3D Hills Taipei chapter? So that was my first year in residency Really tough, 100 hours per week. And then we made it happen. So that was in our clinical innovation center at Taipei Veteran General Hospital. Even though it's called Veteran General Hospital, it's the largest public hospital in Taiwan, so the president and all the government leaders and industry leaders are treated in this hospital. So there were 150 attendees and Jenny was there and I truly value that experience.

Speaker 6: 1:02:14

And then later on the story continues. So besides being a clinician, I'm more like a designer. I initiated myself as a designer Before going to med school. I really loved separating electronics and all mechanical devices. I thought about going to mechanical engineering in my career, but a lot of my families are actually physicians in the area of medicine, so it makes like a default to go into medicine. But I didn't give up in trying to design, build some stuff for us, for the patient, because, uh, as all you know, a great product that helps a patient, a million patient at a time. So this is a just a quick example of how I utilize, utilize 3D printing in terms of patient care.

Speaker 6: 1:03:06

So a little bit about background. So this is a device for ulnar shortening procedure. Ulnar impaction is a condition that happens usually after a radius fracture. It's a very common osteoporotic fracture and when the bone got shortened your ulna got impacted with the couple bones. So there are already existing several different systems in large manufacturers like OccuMed that have good systems in shortening the ulna to reduce the infection. However, in Taiwan, where I train from, we have national health insurance, so it's a universal care, but those specific systems are actually not covered by insurance. So, however, those patients are usually underserved because poorly managed fracture. Those patient segments are really poor. So in order to make the same quality of treatment, I designed, used 3D additive manufacturing in Colabora's E-Tree, a thousand ISO certified additive manufacturing facility in Taiwan, to build a device that works well with the already reimbursed implants. So that's enhanced the quality of those procedures. So that's just a short glimpse about, in addition to clinicians what I do during my training. So I did a lot of designs and so many projects so many hours after 1 am, which I sometimes after the busy scheduled days. So some of my projects collaborate with my professors.

Speaker 6: 1:04:54

He started a company treating complex tumor conditions without osteotomy and the preliminary prototypes of this device all did all made possible by 3D printing and also cryo-surgical devices with making cryogels for intrabone lesions, tumor lesions. This is actually published in COR and actually got in the OKU textbook, which is a common textbook that all orthopedic surgeons around the world study before their board exam. So for orthopedics it's a really exciting time for orthopedic surgeons to step into 3D printing. So in addition to surgical guides and jigs, this is actually already commercialized by Stryker for total and co-guidance. As a tumor joint reconstruction surgeon myself, of course, large defect reconstruction is a well-known area of application with patient-specific design and print out the metal, big metal part for reconstruction. However, currently the company is going to be overvalued because actually the cases that require this kind of treatment is really limited. And also from several teams from Italy, from Hong Kong, some producers team doing this kind of procedure, all of them has consensus that infection per set of joint infection is still a challenge. Some additional coatings and different management of the surface of the implant is warranted to make this a more reliable product. But look on the bright side, this is already making a huge fortune and transform the orthopedic industry a lot. So it's enhanced.

Speaker 6: 1:06:50

Also OCS integration by 3D printing. So those are acetabular cups for total hip replacement. So before 3D printing well, I mean commercialized in orthopedic implants those are like sandblasting and HA coating the bone ingrowns, ungrowns. It's just not as good as currently used 3D printed trabecular metal. So it gives surgeons a huge confidence on having a good osseous integration. Huge confidence on having a good osseous integration because before this technology appears subsurgence will be worried about loosening afterwards and especially for complex bone geometry like developmental hip dysplasia, where the contact area is very limited. But with those trabecular metal 3D printed trabecular metal the contact area doesn't have to be so big. So it gives a lot of confidence for surgeons. And also going to total knees. So hip and knee consists of about 1.6 or 1.7 million procedure every year only the US, so very huge market, us, so very huge market. And so this kind of surface allows good bone healing in the Poloni procedure, which traditionally be done by cemented technique. And also, just very recently FDA cleared the Osseous fit stemless shoulder system, also targeting using 3d printed structure as a osus integration.

Speaker 6: 1:08:26

So, uh, a little bit my experience. I uh, in tvg's 3d printing center I tried, I established a different capability to realize surgeons and physicians idea to reality. So we put together metal metal data manufacturing facility and cnc machining and also plastic injection molding so a clinician inside the hospital can build and realize their ideas in-house. Yeah, yeah, so, uh, that's a little bit background of why, uh, I still have a I don't have a lot of gray hair to be a medical recruited as a medical advisor in the Venture Group. This is one of the portfolio company that we have the product for vertebral compression fracture we use percutaneously like a JEC system to restore the anatomical structure of a collapsed vertebral body. And there is predicate, one really famous predicate, but with this 3D geometry it creates a higher stability of the structure.

Speaker 6: 1:09:39

So a little bit glimpse of what's happening in oesophatic surgery. So, a little bit glimpse of what's happening in oesophatic surgery. So, as Josh and all of you mentioned, so the hospital cost is driving higher and higher and the percentage of costs, according to data, is 60% is labor. But to reduce costs it's very difficult just to cut people's salary. It's almost impossible to do that. So there's coming a different approach. So first of all, in osteopedic surgery, in total hip osteoplasty, the length of stay reduces significantly over the past few years. So in the early 2000s after total hit you can stay as much as one week, even like 30 years ago, maybe two weeks and some different services even longer. But to estimation, 3000 US dollars per day is very heavy burden for the insurance companies. So with this in mind, it's all trending towards ambulator, real surgical centers in a different setting. So the system is not cutting costs by eliminating staff, it's like recreating a different setting of treatment. So this is a data from AJRI.

Speaker 6: 1:11:07

The procedure done in ASCs grow exponentially and also divided by specialty type. Orthopedic and pain is the top two specialty to utilize this facility and ophthalmology for sure already be a long utilizer. But for if it's multi, so it means orthopedics procedure are often done in multi-specialty ASCs. So this actually creates a huge burden as a what's judged as a inventory management. So the question goes to uh, so asc? So who, who like what is the patient segment that can go be treated in ascs? So uh, current uh research and also practice is focusing on identifying optimal patient segment. Also do risk stratifications and we also try to think of strategic priorities.

Speaker 6: 1:12:09

So mis technique, any solutions that make the procedure more minimally invasive, recovery faster, that creates an opportunity. And also, if there's a solution because probably because MIS or that can reduce the grade of anesthesia from general anesthesia to hopefully nerve block, local anesthesia, that will create a huge opportunity. And also methods to accelerate post procedural recovery. And other things is like because ASC sometimes collaborate with university hospitals or different centers. How to streamline the operation is one area that can look into. So, for example, this year Zimmer acquired Paragon28. Paragon28 is a big company in the food and cold industry, so they're already in the ASC field for a long time. So this is viewed as a strategy to expedite their ASC penetration.

Speaker 6: 1:13:12

And also Arthrex, as Josh mentioned. I'm really excited to be able to meet you today. It's really advanced in developing endoscopic spine surgery. So traditionally you have to make a big wound to do decompressions and like different procedures, but now I think Arthrex is the most advanced company in the US to proceed to do the revolution in endoscopic spine surgery. It's really promising so that it enhances recovery. So also a trend that we see is, from manual to automation, a lot of robotic assisted solutions, not necessarily just the navigation itself, because the precision of the robotic arms creates a huge load of opportunities. That gives you data, even soft tissue tension in the field of osseoplasty, and it can be applied to different scenarios Under the setting of robotics. Some different technologies are popping out to try to replace the traditional light-based registration system to reduce the line-of-sight block. So, for example, chira is making a radar-based solution for registration and their cost is a lot lower than a current solution, also in terms of diagnosis.

Speaker 6: 1:14:46

So to us periprasetic joint infection is like the Nobel Prize level of topic to work on in osteopathic surgery. The incidence is around 1% in primary hip or knee osteoporosity but, as I said, the volume is so huge now. So just one percent means a huge economic burden and also, most most importantly, in patient level, there's intense comorbidities even doing the treatment itself for two stage standardized care you remove the implant, you put a temporary spacer and the patient can barely move for several weeks and then you re-implant it and the level of SESED is unpredictable. So there's no revolutionary solutions over the past 30 years. So this is the standard of care right now Just resected it, put a temporary spacer and then revision it and hopefully it will be be successful but not necessary. So osteotherapeutics is trying to make a solution that from weeks to seven days, but they are still under the trial right now and I think the trend is moving forwards from pure mechanical to also biologics, like different cellular-based treatment. However, the AOS and also AJSM has noticed that evidence-based is still very important. So evidence-based innovation solutions may initially lack supporting evidence, but make sure the problem you're solving should be clearly supported by the evidence. Yeah, so this is something it helped me a lot to share, so I want to share to everyone.

Speaker 6: 1:16:32

I always think is this real and validated clinical problem and is it an isolated issue or part of a broader set of contributing factors? And how large is the affected market or patient segment? And can you clearly define your patient persona? And is this problem transferable to other markets or settings? Those are the questions I generate. I ask all myself during my review of the different side decks and startups and I always tell myself don't jump into a solution too quickly. And I always tell myself don't jump into a solution too quickly.

Speaker 6: 1:17:03

So this is an example. Currently, this is often you can very commonly see the problem statement 80% of patients are satisfied with their knee after totaling it, only 80%. So the rest 20% not satisfied. So people are actually developing different solutions toward this. However we think about, is it really because the current implant technology being not adequate, or is it because the poor implanting technique or technology? Or is it actually because of preoperative care and the rehabilitation protocol is not sufficient enough? Or actually it's a 20% patient is not suitable, suitable for total knee, but they are dead for some reason. So we have to, uh, make a step back to think about it before we make a a conclusion.

Speaker 6: 1:17:55

So this is my framework of to help inventors as I came from, and investors think so find the contradiction of your design and understand what are the uncompromisable factors. So this is an engineer from Russia, a Russian engineer that promoted the trees method. It helped me a lot. So he coined this, as we want something, but not at the expense of something. So I'll do a quick explanation. So everybody knows this.

Speaker 6: 1:18:26

Right, this is putting in the breathing tube. So traditionally it's done like this you see a vocal cord, a little black hole, and you put the tube in. So you will say, oh, it's so difficult to see it this way, so why not put a camera on it? And two months later, the engineer was brainstorming. And then it comes with a full 4K camera, expandable stand, ergonomic handle and hours of image storage and Wi-Fi connectivity. And then you've got more than 24 hours battery life, super light, and you can upload your intubation process. However, when you open it, it's waiting for 40 seconds to turn on. And you can upload your intubation process. However, when you open it, it's waiting for 40 seconds to turn on. Yeah, so that's something that you, the development process, might missed.

Speaker 6: 1:19:13

So achieve better visibility, but not at expense of the speed of use, is very important. So there's already a lot of commercialized product like this, and so currently the most uh widely adopted solution is the glide scope. That looks like a little bit different than traditional learning uh learning scope. So some companies actually bring this forward. Instead of bringing better visibility, they try to go easier insertion. So they built uh the stylet and the scope together as just a, as a, to advance the solution. So I really want to thank jenny so much for uh the foundation that you gave me and the guidance and then really helping, landed a great career that I have right now and then. Thank you all for your attention. Feel free to contact me. Yeah, thank you.

Speaker 2: 1:20:23

Okay, all right. Well, yeah, excellent talks. Everyone Really just inspirational. A lot of great things.

Speaker 2: 1:20:28

So I'm Dr Jesse Cordier. I'm a pediatric radiologist by training. I wear a few different hats. I'm also founder of Sierra Medical and Augmented Reality, startup and Pre-Certical Planning, training and Education and, most recently, I'm a managing partner of a new Ventures, dt Ventures, which is a venture studio that we're building in the healthcare platform. So a few different things.

Speaker 2: 1:20:48

But I was asked to talk a little bit about some trends in AR and VR and 3D printing in general, and also a little bit about the investment landscape. And so you know, really it's a lot of exciting times, a lot of things that are being built in the space of AR and VR for a number of different things and really things like medical training simulation this is a big area where we're seeing more traction adoption, surgical planning we'll talk a little bit more about this the AR overlap, the integration intraoperatively some of the challenges that would potentially can be seen there and more use of applications in pain management and therapy. So, again, a lot of really exciting things that are being done both with augmented and virtual reality, and I think these are very complementary to the 3D printing as well. You know, some of the work that we're doing specifically at Serum Medical is using AR and VR for, and specifically, augmented reality for printing and planning customized presurgical planning models that can be used to use for training, education and planning. This is an example of a heat map here, where we've taken the thickness and shown the thinnest areas in red, the darkest, thickest areas in green for a patient with an acetabular fracture, and we found, in particular, one of our most recent customers at UC Davis is using this to help better train and educate orthopedic surgery residents. We found that using AR, that the surgeons can better, the trainees can better classify the fractures properly and get this classified more early on in their training and get it classified correctly, and we know that the classification really drives the management. Is this conservatively managed? Is this managed with one type of operation or another, and so, particularly for complex fractures in the S-tablet, we found that this has been really useful for trainees and this is again very complementary to, I think, 3d printing, in the sense it can be used for rapid prototyping, this can be used for visualization, so a lot of things that I think are very good complements to this technology and, as we're seeing in both the sides of AR, vr and 3D printing, improving precision and outcome.

Speaker 2: 1:22:53

So, again, some of the early studies that we've done looked at using this to better help surgeons to preoperatively game plan how long will my surgery be, what type of equipment will I need? Rather than doing things on the fly, intraoperatively, they're able to think through this case and go in walking in with lower cognitive load, meaning there's fewer things buzzing around in their mind when they go into the surgery. They know what tools they're going to use, about how long the case is. All the other people know they have the right equipment there. So we found a much better, smoother case. It really allows for personalized treatment and planning. So, again, patient-specific designed implants these can all be really helpful for advancing the case. And patient education is really another interesting idea that we've been using this for and better helping the patients themselves to understand their process. So we did a study up at OHSU looking at this for spinal fractures and spinal trauma and helping this to better explain to the patient. You know what's going on, what treatment will we use, what is the problem? We found that that shows decreasing anxiety for the patient and that means also that there's better adherence to the treatment plan. So the better you can convey what's going on as a surgeon, as a physician, the better the patient will do. So what is the future outlook? We see continued investment in research, both at the corporate level, for large companies, technology companies investing into different types of hardware, expanding some of these things. We'll probably see areas of increased adoption of patient-specific applications and treatment and integration of AI, both for model creation, generation and processing. This is just kind of an interesting example here.

Speaker 2: 1:24:42

I just played around a little bit with this new model by give credit to below C2. This combines Claude with Blender and it's a connection. You can take the two so you can literally take text and turn it into a 3D model from text. You can use it to refine the model I asked it to. Here's some sample pictures to make a femur. That's not so great. Let's see. Can we add it, make it a little bit different, maybe make it a different color? It's getting there. I don't think it's quite there yet, but I would say that you know, at some point within a few years I think it is very possible to take a radiology report and then use that to generate a high-quality model that will be the Salter-Harris 2 fracture or the Toulot fracture and give example models that can be used for patient education, teaching and training. So again, you know this is where it is at now, but I think it really is a lot of opportunity for further growth, because these are really just generated from basic pictures or general model databases that they have that are generic, that it does much better if you ask it to make a chair or make some other things like that. But you know, I think, really good work in progress.

Speaker 2: 1:25:48

All right, a little bit about the investment landscape and the sort of an unnecessarily obnoxious AI generated image. Here we have this one about AR and VR. But, yeah, some interesting funding trends. I mean we've seen over the past decade about $980 million invested in this area and, interestingly, the other thing we'll talk a little bit about this it would be good for discussion is that really this peaked at around 2021, 2022 for the investment of about $252 million into this area, with US leading in investment of AR and VR, followed by Israel and then by France, with the early stage being sort of dominant in that particular area. And so you know it's interesting to think of what are the trends? Is the technology matching Really a lot of these trends we look for is the ecosystem being built, the infrastructure being built, the hardware that being standardized before sort of some of the adoptions, because there really is a good projection among the use cases for augmented and virtual reality here with continued expected growth and market growth both across a number of verticals in healthcare and construction, military applications, robotics, manufacturing, those all type of things where complementary to any kind of 3D imaging or printing, these type of tools can be useful as well.

Speaker 2: 1:27:06

So again, pretty large expected growth of the market overall and the market expected to continue to grow. So I think it's very exciting with the advancements in digitization and artificial intelligence, utilization of that and support from other funding organizations. So again, some key applications that we've seen is again, medical education, training, surgical planning and navigation and rehab. So again, a lot of these areas. And then just touching on things like we talked about, like patient education and helping patients better understand their plan and some of the notable developments we've noted increases in FDA clearance. So, for instance, our application has recently gotten FDA 510K clearance. So that process it will be interesting to see with some changes in governmental organizations, will this become faster or will this become more delayed. So it'll be interesting to see and follow these trends further. We'll probably see more AI integration for creation of models, more rapid turnaround and generation of that, and overall broader applications for AI. So again, questions. So regulatory impact, intra-procedural use Some of the challenges of using overlaying directly AR onto a human being is something called focal rivalry, where your eye is competing with a real object and a holographic object.

Speaker 2: 1:28:27

So really perfecting that type of registration is going to be still a challenge that is needing to be met and you know it's just an interesting question that we wonder. You know, why is that? Why has funding sort of changed? Is it because companies are moving towards supporting robotic performance over the performance of a human? Those are things to think about and, again, just an interesting question to pose.

Speaker 2: 1:28:49

Like you know, because of the integration of robotics and a number of things, is there a trend to use it? I think personally that you know humans augmented by these types of tools augmented reality and artificial intelligence they're going to continue to be very useful. And they say even for myself as a radiologist, where they're always questioning are you going to be replaced by AI or something like that I think they say that a person using AI is going to replace somebody not using AI, but not necessarily a human. So I think there's a lot of great things for trends here and so, yes, yes, I think it is overall revolutionizing uh growth and there's significant rapid uh impact for for this technology. Yeah, thank you very much thank you, jesse.

Speaker 1: 1:29:34

Thank you for listening to our presentation and thank you everyone who stayed online despite that we had multiple technical problems, and thank you for the audience here, but we're gonna stop broadcasting here and we're gonna do in-person live QA, so hopefully next time you can join us in person. See you next time. Bye.