In vivo powering of pacemaker by breathing-driven implanted triboelectric nanogenerator

Advanced Implantable Biomedical Devices Enabled by Triboelectric Nanogenerators

Implantable biomedical devices (IMDs) play essential roles in healthcare. Subject to the limited battery life, IMDs cannot achieve long-term in situ monitoring, diagnosis, and treatment. The proposal and rapid development of triboelectric nanogenerators free IMDs from the shackles of batteries and spawn a self-powered healthcare system. This review aims to overview the development of IMDs based on triboelectric nanogenerators, divided into self-powered biosensors, in vivo energy harvesting devices, and direct electrical stimulation therapy devices. Meanwhile, future challenges and opportunities are discussed according to the development requirements of current-level self-powered IMDs to enhance output performance, develop advanced triboelectric nanogenerators with multifunctional materials, and self-driven close-looped diagnosis and treatment systems.

Filling the gap between topological insulator nanomaterials and triboelectric nanogenerators

Reliable energy modules and higher-sensitivity, higher-density, lower-powered sensing systems are constantly required to develop wearable electronics and the Internet of Things technology. As an emerging technology, triboelectric nanogenerators have been potentially guiding the landscape of sustainable power units and energy-efficient sensors. However, the existing triboelectric series is primarily populated by polymers and rubbers, limiting triboelectric sensing plasticity to some extent owing to their stiff surface electronic structures. To enrich the current triboelectric group, we explore the triboelectric properties of the topological insulator nanofilm by Kelvin probe force microscopy and reveal its relatively positive electrification charging performance. Both the larger surface potential difference and the conductive surface states of the nanofilms synergistically improve the charge transfer behavior between the selected triboelectric media, endowing the topological insulator-based triboelectric nanogenerator with considerable output performance. Besides serving as a wearable power source, the ultra-compact device array demonstrates innovative system-level sensing capabilities, including precise monitoring of dynamic objects and real-time signal control at the human-machine interface. This work fills the blank between topological quantum matters and triboelectric nanogenerators and, more importantly, exploits the significant potential of topological insulator nanofilms for self-powered flexible/wearable electronics and scalable sensing technologies.

Advances in Inorganic Nanomaterials for Triboelectric Nanogenerators

Triboelectric nanogenerators (TENGs) that utilize triboelectrification and electrostatic induction to convert mechanical energy to electricity have attracted increasing interest in the last 10 years. As a universal physical phenomenon, triboelectrification can occur between any two surfaces that experience physical contact and separation regardless of the type of material. For this reason, many materials, including both organic and inorganic materials, have been studied in TENGs with different purposes. Although organic polymers are mainly used as triboelectric materials in TENGs, the application of inorganic nanomaterials has also been intensively studied because of their unique dielectric, electric, piezoelectric, and optical properties, which can improve the performance of TENGs. A review of how inorganic nanomaterials are used in TENGs would help researchers gain an overview of the progress in this area. Here, we present a review to summarize how inorganic nanomaterials are utilized in TENGs based on the roles, types, and characteristics of the nanomaterials.

Bio-inspired flexible electronics for smart E-skin

"Learning from nature" provides endless inspiration for scientists to invent new materials and devices. Here, we review state-of-the-art technologies in flexible electronics, with a focus on bio-inspired smart skins. This review focuses on the development of E-skin for sensing a variety of parameters such as mechanical loads, temperature, light, and biochemical cues, with a trend of increased integration of multiple functions. It highlights the most recent advances in flexible electronics inspired by animals such as chameleons, squids, and octopi whose bodies have remarkable camouflage, mimicry, or self-healing attributes. Implantable devices, being overlapped with smart E-skin in a broad sense, are included in this review. This review outlines the remaining challenges in flexible electronics and the prospects for future development for biomedical applications. STATEMENT OF SIGNIFICANCE: This article reviews the state-of-the-art technologies of bio-inspired smart electronic skin (E-skin) developed in a "learning-mimicking-creating" (LMC) cycle. We emphasize the most recent innovations in the development of E-skin for sensing physical changes and biochemical cues, and for integrating multiple sensing modalities. We discuss the achievements in implantable materials, wireless communication, and device design pertaining to implantable flexible electronics. This review will provide prospective insights integrating material, electronics, and mechanical engineering viewpoints to foster new ideas for next-generation smart E-skin.

Recent progress of self-powered respiration monitoring systems

Wearable and implantable medical devices are playing more and more key roles in disease diagnosis and health management. Various biosensors and systems have been used for respiration monitoring. Among them, self-powered sensors have some special characteristics such as low-cost, easy preparation, highly designable, and diversified. The respiratory airflow can drive the self-powered sensors directly to convert mechanical energy of the airflow into electricity. One of the major goals of the self-powered sensors and systems is realizing health monitoring and diagnosis. The relationship between the output signals and the models of respiratory diseases has not been studied deeply and clearly. Therefore, how to find an accurate relationship between them is a challenging and significant research topic. This review summarized the recent progress of the self-powered respiratory sensors and systems from aspects of device principle, output property, detecting index and so on. The challenges and perspectives have also been discussed for reference to the researchers who are interested in the field of self-powered sensors.

Additively manufactured nano-mechanical energy harvesting systems: advancements, potential applications, challenges and future perspectives

Additively manufactured nano-MEH systems are widely used to harvest energy from renewable and sustainable energy sources such as wind, ocean, sunlight, raindrops, and ambient vibrations. A comprehensive study focusing on in-depth technology evolution, applications, problems, and future trends of specifically 3D printed nano-MEH systems with an energy point of view is rarely conducted. Therefore, this paper looks into the state-of-the-art technologies, energy harvesting sources/methods, performance, implementations, emerging applications, potential challenges, and future perspectives of additively manufactured nano-mechanical energy harvesting (3DP-NMEH) systems. The prevailing challenges concerning renewable energy harvesting capacities, optimal energy scavenging, power management, material functionalization, sustainable prototyping strategies, new materials, commercialization, and hybridization are discussed. A novel solution is proposed for renewable energy generation and medicinal purposes based on the sustainable utilization of recyclable municipal and medical waste generated during the COVID-19 pandemic. Finally, recommendations for future research are presented concerning the cutting-edge issues hurdling the optimal exploitation of renewable energy resources through NMEHs. China and the USA are the most significant leading forces in enhancing 3DP-NMEH technology, with more than 75% contributions collectively. The reported output energy capacities of additively manufactured nano-MEH systems were 0.5-32 mW, 0.0002-45.6 mW, and 0.3-4.67 mW for electromagnetic, piezoelectric, and triboelectric nanogenerators, respectively. The optimal strategies and techniques to enhance these energy capacities are compiled in this paper.

Physiologically Self-Regulated, Fully Implantable, Battery-Free System for Peripheral Nerve Restoration

The long-segment peripheral nerve injury (PNI) represents a global medical challenge, leading to incomplete nerve tissue recovery and unsatisfactory functional reconstruction. However, the current electrical stimulation (ES) apparatuses fail perfect nerve repair due to their inability of the variable synchronous self-regulated function with physiological states. It is urgent to develop an implantable ES platform with physiologically adaptive function to provide instantaneous and nerve-preferred ES. Here, a physiologically self-regulated electrical signal is generated by integrating a novel tribo/piezoelectric hybrid nanogenerator with a nanoporous nerve guide conduit to construct a fully implantable neural electrical stimulation (FI-NES) system. The optimal neural ES parameters completely originate from the body itself and are highly self-responsive to different physiological states. The morphological evaluation, representative protein expression level, and functional reconstruction of the regenerated nerves are conducted to assess the PNI recovery process. Evidence shows that the recovery effect of 15 mm length nerve defects under the guidance of the FI-NES system is significantly close to the autograft. The designed FI-NES system provides an effective method for long-term accelerating the recovery of PNI in vivo and is also appropriate for other tissue injury or neurodegenerative diseases.

Powering Implantable and Ingestible Electronics

Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.

Autocharging Techniques for Implantable Medical Applications

Implantable devices have successfully proven their reliability and efficiency in the medical field due to their immense support in a variety of aspects concerning the monitoring of patients and treatment in many ways. Moreover, they assist the medical field in disease diagnosis and prevention. However, the devices' power sources rely on batteries, and with this reliance, comes certain complications. For example, their depletion may lead to surgical interference or leakage into the human body. Implicit studies have found ways to reduce the battery size or in some cases to eliminate its use entirely; these studies suggest the use of biocompatible harvesters that can support the device consumption by generating power. Harvesting mechanisms can be executed using a variety of biocompatible materials, namely, piezoelectric and triboelectric nanogenerators, biofuel cells, and environmental sources. As with all methods for implementing biocompatible harvesters, some of them are low in terms of power consumption and some are dependent on the device and the place of implantation. In this review, we discuss the application of harvesters into implantable devices and evaluate the different materials and methods and examine how new and improved circuits will help in assisting the generators to sustain the function of medical devices.

Efficient design optimization of a miniaturized thermoelectric generator for electrically active implants based on parametric model order reduction

This research focuses on the design of a miniaturized thermoelectric generator (TEG) for electrically active implants. Its design optimization is performed using the finite element method. A simplified TEG model is obtained by replacing the thermocouple array with a single representative thermopile, which considers the number and fill factor of the thermocouples as parameters. Instead of rebuilding the geometry of a detailed model with multiple thermocouples, the simplified model adapts the material properties of its representative thermopile, facilitating design optimization. We extend the model by integrating the simplified TEG together with a housing inside a human tissue model for thermoelectric analysis. For computation efficiency and applicability of model order reduction (MOR), a thermal model is derived from the thermoelectric one, with the Peltier effect being considered through an effective thermal conductivity. Through parametric MOR, two parametric reduced-order models are generated from the full-scale thermoelectric and thermal model, respectively. Furthermore, we demonstrate the design optimization of TEG both in full-scale and reduced-order model for maximal power output and sufficient voltage output.

A Bioresorbable Dynamic Pressure Sensor for Cardiovascular Postoperative Care

Bioresorbable electronics that can be absorbed and become part of the organism after their service life are a new trend to avoid secondary invasive surgery. However, the material limitation is a significant challenge. There are fewer biodegradable materials with pressure-sensitive properties. Here, a pressure sensor based on the triboelectric effect between bioabsorbable materials is reported. This effect is available in almost all materials. The bioresorbable triboelectric sensor (BTS) can directly convert ambient pressure changes into electrical signals. This device successfully identifies abnormal vascular occlusion events in large animals (dogs). The service life of the BTS reaches 5 days with a high service efficiency (5.95%). The BTS offers excellent sensitivity (11 mV mmHg^-1 ), linearity (R²  = 0.993), and good durability (450 000 cycles). The antibacterial bioresorbable materials (poly(lactic acid)-(chitosan 4%)) for the BTS can achieve 99% sterilization. Triboelectric devices are expected to be applied in postoperative care as bioresorbable electronics.

Materials Perspectives for Self-Powered Cardiac Implantable Electronic Devices toward Clinical Translation

Represented by pacemakers, implantable electronic devices (CIEDs) are playing a vital life-saving role in modern society. Although the current CIEDs are evolving quickly in terms of performance, safety, and miniaturization, the bulky and rigid battery creates the largest hurdle toward further development of a soft system that can be attached and conform to tissues without causing undesirable physiologic changes. Over 50% of patients with pacemakers require additional surgery procedures to replace a drained battery. Abrupt battery malfunction and failure contributes up to 2.4% of implanted leadless pacemakers. The battery also has risks of lethal interference with diagnostic magnetic resonance imaging (MRI). Applying the implantable nanogenerators (i-NGs) technology to CIEDs is regarded as a promising solution to the battery challenge and enables self-powering capability. I-NGs based on the principle of either triboelectricity (TENG) or piezoelectricity (PENG) can convert biomechanical energy into electricity effectively. Meanwhile, a complete heartbeat cycle provides a biomechanical energy of ~0.7 J or an average power of 0.93 W, which is sufficient for the operation of CIEDs considering the power consumption of 5-10 μW for a pacemaker and 10-100 μW for a cardiac defibrillator. It is therefore practical to leverage the effective, soft, flexible, lightweight, and biocompatible i-NGs to eliminate the bulky battery component in CIEDs and achieve self-sustainable operation. In this rapidly evolving interdisciplinary field, materials innovation acts as a cornerstone that frames the technology development. Here we bring a few critical perspectives regarding materials design and engineering, which are essential in leading the NG-powered CIEDs toward clinical translations. This Account starts with a brief introduction of the cardiac electrophysiology, as well as its short history to interface the state-of-the-art cardiac NG technologies. Three key components of NG-powered CIEDs are discussed in detail, including the NG device itself, the packaging material, and the stimulation electrodes. Cardiac NG is the essential component that converts heartbeat energy into electricity. It demands high-performance electromechanical coupling materials with long-term dynamic stability. The packaging material is critical to ensure a long-term stable operation of the device on a beating heart. Given the unique operation environment, a few criteria need to be considered in its development, including flexibility, biocompatibility, antifouling, hemocompatibility, and bioadhesion. The stimulation electrodes are the only material interfacing the heart tissue electrically. They should provide capacitive charge injection and mimic the soft and wet intrinsic tissues for the sake of stable biointerfaces. Driven by the rapid materials and device advancement, we envision that the evolution of NG-based CIEDs will quickly move from epicardiac to intracardiac, from single-function to multifunction, and with a minimal-invasive implantation procedure. This trend of development will open many research opportunities in emerging materials science and engineering, which will eventually lead the NG technology to a prevailing strategy for powering future CIEDs.

Hybrid Triboelectric-Electromagnetic Nanogenerators for Mechanical Energy Harvesting: A Review

Motion-driven electromagnetic-triboelectric energy generators (E-TENGs) hold a great potential to provide higher voltages, higher currents and wider operating bandwidths than both electromagnetic and triboelectric generators standing alone. Therefore, they are promising solutions to autonomously supply a broad range of highly sophisticated devices. This paper provides a thorough review focused on major recent breakthroughs in the area of electromagnetic-triboelectric vibrational energy harvesting. A detailed analysis was conducted on various architectures including rotational, pendulum, linear, sliding, cantilever, flexible blade, multidimensional and magnetoelectric, and the following hybrid technologies. They enable highly efficient ways to harvest electric energy from many forms of vibrational, rotational, biomechanical, wave, wind and thermal sources, among others. Open-circuit voltages up to 75 V, short-circuit currents up to 60 mA and instantaneous power up to 144 mW were already achieved by these nanogenerators. Their transduction mechanisms, including proposed models to make intelligible the involved physical phenomena, are also overviewed here. A comprehensive analysis was performed to compare their respective construction designs, external excitations and electric outputs. The results highlight the potential of hybrid E-TENGs to convert unused mechanical motion into electric energy for both large- and small-scale applications. Finally, this paper proposes future research directions toward optimization of energy conversion efficiency, power management, durability and stability, packaging, energy storage, operation input, research of transduction mechanisms, quantitative standardization, system integration, miniaturization and multi-energy hybrid cells.

From contact electrification to triboelectric nanogenerators

Although the contact electrification (CE) (or usually called 'triboelectrification') effect has been known for over 2600 years, its scientific mechanism still remains debated after decades. Interest in studying CE has been recently revisited due to the invention of triboelectric nanogenerators (TENGs), which are the most effective approach for converting random, low-frequency mechanical energy (called high entropy energy) into electric power for distributed energy applications. This review is composed of three parts that are coherently linked, ranging from basic physics, through classical electrodynamics, to technological advances and engineering applications. First, the mechanisms of CE are studied for general cases involving solids, liquids and gas phases. Various physics models are presented to explain the fundamentals of CE by illustrating that electron transfer is the dominant mechanism for CE for solid-solid interfaces. Electron transfer also occurs in the CE at liquid-solid and liquid-liquid interfaces. An electron-cloud overlap model is proposed to explain CE in general. This electron transfer model is extended to liquid-solid interfaces, leading to a revision of the formation mechanism of the electric double layer at liquid-solid interfaces. Second, by adding a time-dependent polarization termPscreated by the CE-induced surface electrostatic charges in the displacement fieldD, we expand Maxwell's equations to include both the medium polarizations due to electric field (P) and mechanical aggitation and medium boundary movement induced polarization term (Ps). From these, the output power, electromagnetic (EM) behaviour and current transport equation for a TENG are systematically derived from first principles. A general solution is presented for the modified Maxwell's equations, and analytical solutions for the output potential are provided for a few cases. The displacement current arising fromε∂E/∂t is responsible for EM waves, while the newly added term ∂Ps/∂t is responsible for energy and sensors. This work sets the standard theory for quantifying the performance and EM behaviour of TENGs in general. Finally, we review the applications of TENGs for harvesting all kinds of available mechanical energy that is wasted in our daily life, such as human motion, walking, vibration, mechanical triggering, rotating tires, wind, flowing water and more. A summary is provided about the applications of TENGs in energy science, environmental protection, wearable electronics, self-powered sensors, medical science, robotics and artificial intelligence.

Ultrasound-Powered Implants: A Critical Review of Piezoelectric Material Selection and Applications

Ultrasound-powered implants (UPIs) represent cutting edge power sources for implantable medical devices (IMDs), as their powering strategy allows for extended functional lifetime, decreased size, increased implant depth, and improved biocompatibility. IMDs are limited by their reliance on batteries. While batteries proved a stable power supply, batteries feature relatively large sizes, limited life spans, and toxic material compositions. Accordingly, energy harvesting and wireless power transfer (WPT) strategies are attracting increasing attention by researchers as alternative reliable power sources. Piezoelectric energy scavenging has shown promise for low power applications. However, energy scavenging devices need be located near sources of movement, and the power stream may suffer from occasional interruptions. WPT overcomes such challenges by more stable, on-demand power to IMDs. Among the various forms of WPT, ultrasound powering offers distinct advantages such as low tissue-mediated attenuation, a higher approved safe dose (720 mW cm^-2 ), and improved efficiency at smaller device sizes. This study presents and discusses the state-of-the-art in UPIs by reviewing piezoelectric materials and harvesting devices including lead-based inorganic, lead-free inorganic, and organic polymers. A comparative discussion is also presented of the functional material properties, architecture, and performance metrics, together with an overview of the applications where UPIs are being deployed.

Recent Advances of Energy Solutions for Implantable Bioelectronics

The emerging field of implantable bioelectronics has attracted widespread attention in modern society because it can improve treatment outcomes, reduce healthcare costs, and lead to an improvement in the quality of life. However, their continuous operation is often limited by conventional bulky and rigid batteries with a limited lifespan, which must be surgically removed after completing their missions and/or replaced after being exhausted. Herein, this paper gives a comprehensive review of recent advances in nonconventional energy solutions for implantable bioelectronics, emphasizing the miniaturized, flexible, biocompatible, and biodegradable power devices. According to their source of energy, the promising alternative energy solutions are sorted into three main categories, including energy storage devices (batteries and supercapacitors), internal energy-harvesting devices (including biofuel cells, piezoelectric/triboelectric energy harvesters, thermoelectric and biopotential power generators), and external wireless power transmission technologies (including inductive coupling/radiofrequency, ultrasound-induced, and photovoltaic devices). Their fundamentals, materials strategies, structural design, output performances, animal experiments, and typical biomedical applications are also discussed. It is expected to offer complementary power sources to extend the battery lifetime of bioelectronics while acting as an independent power supply. Thereafter, the existing challenges and perspectives associated with these powering devices are also outlined, with a focus on implantable bioelectronics.

Bioinspired, Nanostructure-Amplified, Subcutaneous Light Harvesting to Power Implantable Biomedical Electronics

Implantable biomedical electronics hold immense promise for in vivo personalized healthy monitoring and even precise therapeutic intervention. Tremendous miniaturization of indwelling modules enables implanted biomedical devices to perform multiple functions with ultralow power consumption but exacerbates the technical challenges of supplying effective power to the devices in vivo. In this Perspective, we summarize new developments in transmitting near-infrared light from sunlight or a light-emitting diode into subcutaneously implanted photovoltaic cells, in which the light utilization efficiency can be amplified with the aid of nanostructured rear reflectors. Considering the many natural examples of nanostructure-induced structural coloration displayed by submarine animals, we wish to open up new prospects of bioinspired, nanostructure-amplified, subcutaneous light harvesting to power implanted biomedical electronics.

Self-powered technology based on nanogenerators for biomedical applications

Biomedical electronic devices have enormous benefits for healthcare and quality of life. Still, the long-term working of those devices remains a great challenge due to the short life and large volume of conventional batteries. Since the nanogenerators (NGs) invention, they have been widely used to convert various ambient mechanical energy sources into electrical energy. The self-powered technology based on NGs is dedicated to harvesting ambient energy to supply electronic devices, which is an effective pathway to conquer the energy insufficiency of biomedical electronic devices. With the aid of this technology, it is expected to develop self-powered biomedical electronic devices with advanced features and distinctive functions. The goal of this review is to summarize the existing self-powered technologies based on NGs and then review the applications based on self-powered technologies in the biomedical field during their rapid development in recent years, including two main directions. The first is the NGs as independent sensors to converts biomechanical energy and heat energy into electrical signals to reflect health information. The second direction is to use the electrical energy produced by NGs to stimulate biological tissues or powering biomedical devices for achieving the purpose of medical application. Eventually, we have analyzed and discussed the remaining challenges and perspectives of the field. We believe that the self-powered technology based on NGs would advance the development of modern biomedical electronic devices.

Structural and Chemical Modifications Towards High-Performance of Triboelectric Nanogenerators

Harvesting abundant mechanical energy has been considered one of the promising technologies for developing autonomous self-powered active sensors, power units, and Internet-of-Things devices. Among various energy harvesting technologies, the triboelectric harvesters based on contact electrification have recently attracted much attention because of their advantages such as high performance, light weight, and simple design. Since the first triboelectric energy-harvesting device was reported, the continuous investigations for improving the output power have been carried out. This review article covers various methods proposed for the performance enhancement of triboelectric nanogenerators (TENGs), such as a triboelectric material selection, surface modification through the introduction of micro-/nano-patterns, and surface chemical functionalization, injecting charges, and their trapping. The main purpose of this work is to highlight and summarize recent advancements towards enhancing the TENG technology performance through implementing different approaches along with their potential applications. This paper presents a comprehensive review of the TENG technology and its factors affecting the output power as material selection, surface physical and chemical modification, charge injection, and trapping techniques.

Restoring Tactile Sensation Using a Triboelectric Nanogenerator

Loss of tactile sensation is a common occurrence in patients with traumatic peripheral nerve injury or soft tissue loss, but as yet, solutions for restoring such sensation are limited. Implanted neuro-prosthetics are a promising direction for tactile sensory restoration, but available technologies have substantial shortcomings, including complexity of use and of production and the need for an external power supply. In this work, we propose, fabricate, and demonstrate the use of a triboelectric nanogenerator (TENG) as a relatively simple, self-powered, biocompatible, sensitive, and flexible device for restoring tactile sensation. This integrated tactile TENG (TENG-IT) device is implanted under the skin and translates tactile pressure into electrical potential, which it relays via cuff electrodes to healthy sensory nerves, thereby stimulating them, to mimic tactile sensation. We show that the device elicits electrical activity in sensory neurons in vitro, and that the extent of this activity is dependent on the level of tactile pressure applied to the device. We subsequently demonstrate the TENG-IT in vivo, showing that it provides tactile sensation capabilities (as measured by a von Frey test) to rats in which sensation in the hindfoot was blocked through transection of the distal tibial nerve. These findings point to the substantial potential of self-powered TENG-based implanted devices as a means of restoring tactile sensation.

Natural Rubber-TiO2 Nanocomposite Film for Triboelectric Nanogenerator Application

In this research, natural rubber (NR)-TiO2 nanocomposites were developed for triboelectric nanogenerator (TENG) application to harvest mechanical energy into electrical energy. Rutile TiO2 nanoparticles were used as fillers in NR material to improve dielectric properties so as to enhance the energy conversion performance of the NR composite TENG. The effect of filler concentration on TENG performance of the NR-TiO2 composites was investigated. In addition, ball-milling method was employed to reduce the agglomeration of TiO2 nanoparticles in order to improve their dispersion in the NR film. It was found that the TENG performance was significantly enhanced due to the increased dielectric constant of the NR-TiO2 composite films fabricated from the ball-milled TiO2. The TENG, fabricated from the NR-TiO2 composite using 24 h ball-milled TiO2 at 0.5%wt, delivered the highest power density of 237 mW/m2, which was almost four times higher than that of pristine NR TENG. Furthermore, the applications of the fabricated NR-TiO2 TENG as a power source to operate portable electronics devices were also demonstrated.

Advances in Smart Sensing and Medical Electronics by Self-Powered Sensors Based on Triboelectric Nanogenerators

With the rapid progress of artificial intelligence, humans are moving toward the era of the intelligent connection of all things. Therefore, the demand for sensors is drastically increasing with developing intelligent social applications. Traditional sensors must be triggered by an external power source and the energy consumption is high for equipment that is widely distributed and working intermittently, which is not conducive to developing sustainable green and healthy applications. However, self-powered sensors based on triboelectric nanogenerators (TENG) can autonomously harvest energy from the surrounding environment and convert this energy into electrical energy for storage. Sensors can also be self-powered without an external power supply, which is vital for smart cities, smart homes, smart transportation, environmental monitoring, wearable devices, and bio-medicine. This review mainly summarizes the working mechanism of TENG and the research progress of self-powered sensors based on TENG about the Internet of Things (IoT), robotics, human–computer interaction, and intelligent medical fields in recent years.

Progress on Self-Powered Wearable and Implantable Systems Driven by Nanogenerators

With the rapid development of the internet of things (IoT), sustainable self-powered wireless sensory systems and diverse wearable and implantable electronic devices have surged recently. Under such an opportunity, nanogenerators, which can convert continuous mechanical energy into usable electricity, have been regarded as one of the critical technologies for self-powered systems, based on the high sensitivity, flexibility, and biocompatibility of piezoelectric nanogenerators (PENGs) and triboelectric nanogenerators (TENGs). In this review, we have thoroughly analyzed the materials and structures of wearable and implantable PENGs and TENGs, aiming to make clear how to tailor a self-power system into specific applications. The advantages in TENG and PENG are taken to effectuate wearable and implantable human-oriented applications, such as self-charging power packages, physiological and kinematic monitoring, in vivo and in vitro healing, and electrical stimulation. This review comprehensively elucidates the recent advances and future outlook regarding the human body's self-powered systems.

Energy Harvesting and Storage with Soft and Stretchable Materials

This review highlights various modes of converting ambient sources of energy into electricity using soft and stretchable materials. These mechanical properties are useful for emerging classes of stretchable electronics, e-skins, bio-integrated wearables, and soft robotics. The ability to harness energy from the environment allows these types of devices to be tetherless, thereby leading to a greater range of motion (in the case of robotics), better compliance (in the case of wearables and e-skins), and increased application space (in the case of electronics). A variety of energy sources are available including mechanical (vibrations, human motion, wind/fluid motion), electromagnetic (radio frequency (RF), solar), and thermodynamic (chemical or thermal energy). This review briefly summarizes harvesting mechanisms and focuses on the materials' strategies to render such devices into soft or stretchable embodiments.

Functional Fibers and Fabrics for Soft Robotics, Wearables, and Human-Robot Interface

Soft robotics inspired by the movement of living organisms, with excellent adaptability and accuracy for accomplishing tasks, are highly desirable for efficient operations and safe interactions with human. With the emerging wearable electronics, higher tactility and skin affinity are pursued for safe and user-friendly human-robot interactions. Fabrics interlocked by fibers perform traditional static functions such as warming, protection, and fashion. Recently, dynamic fibers and fabrics are favorable to deliver active stimulus responses such as sensing and actuating abilities for soft-robots and wearables. First, the responsive mechanisms of fiber/fabric actuators and their performances under various external stimuli are reviewed. Fiber/yarn-based artificial muscles for soft-robots manipulation and assistance in human motion are discussed, as well as smart clothes for improving human perception. Second, the geometric designs, fabrications, mechanisms, and functions of fibers/fabrics for sensing and energy harvesting from the human body and environments are summarized. Effective integration between the electronic components with garments, human skin, and living organisms is illustrated, presenting multifunctional platforms with self-powered potential for human-robot interactions and biomedicine. Lastly, the relationships between robotic/wearable fibers/fabrics and the external stimuli, together with the challenges and possible routes for revolutionizing the robotic fibers/fabrics and wearables in this new era are proposed.

Fabrication and application of biocompatible nanogenerators

As a new sustainable energy source, ubiquitous mechanical energy has received great attention and was successfully harvested by different types of nanogenerators. Among them, biocompatible nanogenerators are of particular interests due to their potential for biomedical applications. In this review, we provide an overview of the recent achievements in the fabrication and application of biocompatible nanogenerators. The development process and working mechanism of nanogenerators are introduced. Different biocompatible materials for energy harvesting, such as amino acids, peptide, silk protein, and cellulose, are discussed and compared. We then discuss different applications of biocompatible nanogenerators. We conclude with the challenges and potential research directions in this emerging field.

Compressible and Stretchable Magnetoelectric Sensors Based on Liquid Metals for Highly Sensitive, Self-Powered Respiratory Monitoring

Healthcare monitoring, especially for respiration, has attracted tremendous attention from academics considering the great significance of health information feedback. The respiratory rate, as a critical health indicator, has been used to screen and evaluate potential illness risks in early medical diagnoses. A self-powered sensing system for medical monitoring is critical and imperative due to needless battery replacement and simple assembly. However, the development of a self-powered respiratory sensor with highly sensitive performance is still a daunting challenge. In this work, a compressible and stretchable magnetoelectric sensor (CSMS) with an arch-shaped air gap is reported, enabling self-powered respiratory monitoring driven by exhaled/inhaled breath. The CSMS contains two key functional materials: liquid metals and magnetic powders both with low Young's modulus, allowing for sensing compressibility and stretchability simultaneously. More importantly, such a magnetoelectric sensor exhibits mechanoelectrical converting capacity under an external force, which has been verified by Maxwell numerical simulation. Owing to the air-layer introduction, the magnetoelectric sensors achieve high sensitivity (up to 17.73 kPa^-1), fast response, and long-term stability. The highly sensitive and self-powered magnetoelectric sensor can be further applied as a noninvasive, miniaturized, and portable respiratory monitoring system with the aim of warning for potential health risks. We anticipate that this technique will create an avenue for self-powered respiratory monitoring fields.

Wearable and Implantable Electroceuticals for Therapeutic Electrostimulations

Wearable and implantable electroceuticals (WIEs) for therapeutic electrostimulation (ES) have become indispensable medical devices in modern healthcare. In addition to functionality, device miniaturization, conformability, biocompatibility, and/or biodegradability are the main engineering targets for the development and clinical translation of WIEs. Recent innovations are mainly focused on wearable/implantable power sources, advanced conformable electrodes, and efficient ES on targeted organs and tissues. Herein, nanogenerators as a hotspot wearable/implantable energy-harvesting technique suitable for powering WIEs are reviewed. Then, electrodes for comfortable attachment and efficient delivery of electrical signals to targeted tissue/organ are introduced and compared. A few promising application directions of ES are discussed, including heart stimulation, nerve modulation, skin regeneration, muscle activation, and assistance to other therapeutic modalities.

Triboelectric Effect Enabled Self-Powered, Point-of-Care Diagnostics: Opportunities for Developing ASSURED and REASSURED Devices

The use of rapid point-of-care (PoC) diagnostics in conjunction with physiological signal monitoring has seen tremendous progress in their availability and uptake, particularly in low- and middle-income countries (LMICs). However, to truly overcome infrastructural and resource constraints, there is an urgent need for self-powered devices which can enable on-demand and/or continuous monitoring of patients. The past decade has seen the rapid rise of triboelectric nanogenerators (TENGs) as the choice for high-efficiency energy harvesting for developing self-powered systems as well as for use as sensors. This review provides an overview of the current state of the art of such wearable sensors and end-to-end solutions for physiological and biomarker monitoring. We further discuss the current constraints and bottlenecks of these devices and systems and provide an outlook on the development of TENG-enabled PoC/monitoring devices that could eventually meet criteria formulated specifically for use in LMICs.

Triboelectric nanogenerators for human-health care

Since the world's first triboelectric nanogenerator (TENG) was proposed in 2012, numerous TENG-based devices and equipment have sprung up in various fields. In particular, TENG has great potential in the field of human-health care due to its small size, self-powered and low cost. With the continuous deepening of TENG research, its structure, function and technical concept are becoming more and more abundant. In order to summarize the progress and development status of TENG in health care, based on the different types of applications subdirection, this paper reviews the TENG-based research work of this field in recent eight years. The characteristics of various types of TENG-based applications and their corresponding technologies are introduced and analyzed, under the comparison of their structure and performance. This review is dedicated to provide reference and inspiration for the future development and innovation of TENG for health care.

Characterization of Bio-Inspired Electro-Conductive Soy Protein Films

Protein-based conductive materials are gaining attention as alternative components of electronic devices for value-added applications. In this regard, soy protein isolate (SPI) was processed by extrusion in order to obtain SPI pellets, subsequently molded into SPI films by hot pressing, resulting in homogeneous and transparent films, as shown by scanning electron microscopy and UV-vis spectroscopy analyses, respectively. During processing, SPI denatured and refolded through intermolecular interactions with glycerol, causing a major exposition of tryptophan residues and fluorescence emission, affecting charge distribution and electron transport properties. Regarding electrical conductivity, the value found (9.889 × 10⁻⁴ S/m) is characteristic of electrical semiconductors, such as silicon, and higher than that found for other natural polymers. Additionally, the behavior of the films in contact with water was analyzed, indicating a controlled swelling and a hydrolytic surface, which is of great relevance for cell adhesion and spreading. In fact, cytotoxicity studies showed that the developed SPI films were biocompatible, according to the guidelines for the biological evaluation of medical devices. Therefore, these SPI films are uniquely suited as bioelectronics because they conduct both ionic and electronic currents, which is not accessible for the traditional metallic conductors.

Leverage Surface Chemistry for High-Performance Triboelectric Nanogenerators

Triboelectric Nanogenerators (TENGs) are a highly efficient approach for mechanical-to-electrical energy conversion based on the coupling effects of contact electrification and electrostatic induction. TENGs have been intensively applied as both sustainable power sources and self-powered active sensors with a collection of compelling features, including lightweight, low cost, flexible structures, extensive material selections, and high performances at low operating frequencies. The output performance of TENGs is largely determined by the surface triboelectric charges density. Thus, manipulating the surface chemical properties via appropriate modification methods is one of the most fundamental strategies to improve the output performances of TENGs. This article systematically reviews the recently reported chemical modification methods for building up high-performance TENGs from four aspects: functional groups modification, ion implantation and decoration, dielectric property engineering, and functional sublayers insertion. This review will highlight the contribution of surface chemistry to the field of triboelectric nanogenerators by assessing the problems that are in desperate need of solving and discussing the field's future directions.

Advances in triboelectric nanogenerators for biomedical sensing

Biomedical sensors have been essential in improving healthcare outcomes over the past 30 years, though limited power source access and user wearability restraints have prevented them from taking a constant and active biomedical sensing role in our daily lives. Triboelectric nanogenerators (TENGs) have demonstrated exceptional capabilities and versatility in delivering self-powered and wear-optimized biomedical sensors, and are paving the way for a novel platform technology able to fully integrate into the developing 5G/Internet-of-Things ecosystem. This novel paradigm of TENG-based biomedical sensors aspires to provide ubiquitous and omnipresent real-time biomedical sensing for us all. In this review, we cover the remarkable developments in TENG-based biomedical sensing which have arisen in the last octennium, focusing on both in-body and on-body biomedical sensing solutions. We begin by covering TENG as biomedical sensors in the most relevant, mortality-associated clinical fields of pneumology and cardiology, as well as other organ-related biomedical sensing abilities including ambulation. We also include an overview of ambient biomedical sensing as a field of growing interest in occupational health monitoring. Finally, we explore TENGs as power sources for third party biomedical sensors in a number of fields, and conclude our review by focusing on the future perspectives of TENG biomedical sensors, highlighting key areas of attention to fully translate TENG-based biomedical sensors into clinically and commercially viable digital and wireless consumer and health products.

Multifunctional Artificial Artery from Direct 3D Printing with Built-In Ferroelectricity and Tissue-Matching Modulus for Real-Time Sensing and Occlusion Monitoring

Treating vascular grafts failure requires complex surgery procedures and is associated with high risks. A real-time monitoring vascular system enables quick and reliable identification of complications and initiates safer treatments early. Here, an electric fieldassisted 3D printing technology is developed to fabricate in situ-poled ferroelectric artificial arteries that offer battery-free real-time blood pressure sensing and occlusion monitoring capability. The functional artery architecture is made possible by the development of a ferroelectric biocomposite which can be quickly polarized during printing and reshaped into devised objects. The synergistic effect from the potassium sodium niobite particles and the polyvinylidene fluoride polymer matrix yields a superb piezoelectric performance (bulk-scale d 33 > 12 pC N-1). The sinusoidal architecture brings the mechanical modulus close to the level of blood vessels. The desired piezoelectric and mechanical properties of the artificial artery provide an excellent sensitivity to pressure change (0.306 mV mmHg-1, R 2 > 0.99) within the range of human blood pressure (11.25-225.00 mmHg). The high pressure sensitivity and the ability to detect subtle vessel motion pattern change enable early detection of partial occlusion (e.g., thrombosis), allowing for preventing grafts failure. This work demonstrates a promising strategy of incorporating multifunctionality to artificial biological systems for smart healthcare systems.

A Review and Perspective for the Development of Triboelectric Nanogenerator (TENG)-Based Self-Powered Neuroprosthetics

Neuroprosthetics have become a powerful toolkit for clinical interventions of various diseases that affect the central nervous or peripheral nervous systems, such as deep brain stimulation (DBS), functional electrical stimulation (FES), and vagus nerve stimulation (VNS), by electrically stimulating different neuronal structures. To prolong the lifetime of implanted devices, researchers have developed power sources with different approaches. Among them, the triboelectric nanogenerator (TENG) is the only one to achieve direct nerve stimulations, showing great potential in the realization of a self-powered neuroprosthetic system in the future. In this review, the current development and progress of the TENG-based stimulation of various kinds of nervous systems are systematically summarized. Then, based on the requirements of the neuroprosthetic system in a real application and the development of current techniques, a perspective of a more sophisticated neuroprosthetic system is proposed, which includes components of a thin-film TENG device with a biocompatible package, an amplification circuit to enhance the output, and a self-powered high-frequency switch to generate high-frequency current pulses for nerve stimulations. Then, we review and evaluate the recent development and progress of each part.

Polysaccharide-based triboelectric nanogenerators: A review

Triboelectric nanogenerators (TENGs) are versatile electronic devices used for environmental energy harvesting and self-powered electronics with a wide range of potential applications. The rapid development of TENGs has caused great concern regarding the environmental impacts of conventional electronic devices. Under this context, researching alternatives to synthetic and toxic materials in electronics are of major significance. In this review, we focused on TENGs based on natural polysaccharide materials. Firstly, a general overview of the working mechanisms and materials for high-performance TENGs were summarized and discussed. Then, the recent progress of polysaccharide-based TENGs along with their potential applications reported in the literature from 2015 to 2020 was reviewed. Here, we aimed to present polysaccharide polymers as a promising and viable alternative to the development of green TENGs and tackle the challenges of recycling e-wastes.

Self-powered cardiovascular electronic devices and systems

Cardiovascular electronic devices have enormous benefits for health and quality of life but the long-term operation of these implantable and wearable devices remains a huge challenge owing to the limited life of batteries, which increases the risk of device failure and causes uncertainty among patients. A possible approach to overcoming the challenge of limited battery life is to harvest energy from the body and its ambient environment, including biomechanical, solar, thermal and biochemical energy, so that the devices can be self-powered. This strategy could allow the development of advanced features for cardiovascular electronic devices, such as extended life, miniaturization to improve comfort and conformability, and functions that integrate with real-time data transmission, mobile data processing and smart power utilization. In this Review, we present an update on self-powered cardiovascular implantable electronic devices and wearable active sensors. We summarize the existing self-powered technologies and their fundamental features. We then review the current applications of self-powered electronic devices in the cardiovascular field, which have two main goals. The first is to harvest energy from the body as a sustainable power source for cardiovascular electronic devices, such as cardiac pacemakers. The second is to use self-powered devices with low power consumption and high performance as active sensors to monitor physiological signals (for example, for active endocardial monitoring). Finally, we present the current challenges and future perspectives for the field.

Respiration-driven triboelectric nanogenerators for biomedical applications

As a fundamental and ubiquitous body motion, respiration offers a large amount of biomechanical energy with an average power up to the Watt level through movements of multiple muscles. The energy from respiration featured with excellent stability, accessibility and continuality inspires the design and engineering of biomechanical energy harvesting devices, such as triboelectric nanogenerators (TENGs), to realize human-powered electronics. This review article is thus dedicated to the emerging respiration-driven TENG technology, covering fundamentals, applications, and perspectives. Specifically, the human breathing mechanics are first introduced serving as the base for the developments of TENG devices with different configurations. Biomedical applications including electrical energy generation, healthcare monitoring, air filtration, gas sensing, electrostimulation, and powering implantable medical devices are then analyzed focusing on the design-application relationships. At last, current developments are summarized and critical challenges for driving these intriguing developments toward practical applications are discussed together with promising solutions.

Self-Powered Implantable Medical Devices: Photovoltaic Energy Harvesting Review

Implantable technologies are becoming more widespread for biomedical applications that include physical identification, health diagnosis, monitoring, recording, and treatment of human physiological traits. However, energy harvesting and power generation beneath the human tissue are still a major challenge. In this regard, self-powered implantable devices that scavenge energy from the human body are attractive for long-term monitoring of human physiological traits. Thanks to advancements in material science and nanotechnology, energy harvesting techniques that rely on piezoelectricity, thermoelectricity, biofuel, and radio frequency power transfer are emerging. However, all these techniques suffer from limitations that include low power output, bulky size, or low efficiency. Photovoltaic (PV) energy conversion is one of the most promising candidates for implantable applications due to their higher-power conversion efficiencies and small footprint. Herein, the latest implantable energy harvesting technologies are surveyed. A comparison between the different state-of-the-art power harvesting methods is also provided. Finally, recommendations are provided regarding the feasibility of PV cells as an in vivo energy harvester, with an emphasis on skin penetration, fabrication, encapsulation, durability, biocompatibility, and power management.

Micro triboelectric ultrasonic device for acoustic energy transfer and signal communication

As a promising energy converter, the requirement for miniaturization and high-accuracy of triboelectric nanogenerators always remains urgent. In this work, a micro triboelectric ultrasonic device was developed by integrating a triboelectric nanogenerator and micro-electro-mechanical systems technology. To date, it sets a world record for the smallest triboelectric device, with a 50 µm-sized diaphragm, and enables the working frequency to be brought to megahertz. This dramatically improves the miniaturization and chip integration of the triboelectric nanogenerator. With 63 kPa@1 MHz ultrasound input, the micro triboelectric ultrasonic device can generate the voltage signal of 16.8 mV and 12.7 mV through oil and sound-attenuation medium, respectively. It also achieved the signal-to-ratio of 20.54 dB and exhibited the practical potential for signal communication by modulating the incident ultrasound. Finally, detailed optimization approaches have also been proposed to further improve the output power of the micro triboelectric ultrasonic device.

Micro triboelectric ultrasonic device for acoustic energy transfer and signal communication

As a promising energy converter, the requirement for miniaturization and high-accuracy of triboelectric nanogenerators always remains urgent. In this work, a micro triboelectric ultrasonic device was developed by integrating a triboelectric nanogenerator and micro-electro-mechanical systems technology. To date, it sets a world record for the smallest triboelectric device, with a 50 µm-sized diaphragm, and enables the working frequency to be brought to megahertz. This dramatically improves the miniaturization and chip integration of the triboelectric nanogenerator. With 63 kPa@1 MHz ultrasound input, the micro triboelectric ultrasonic device can generate the voltage signal of 16.8 mV and 12.7 mV through oil and sound-attenuation medium, respectively. It also achieved the signal-to-ratio of 20.54 dB and exhibited the practical potential for signal communication by modulating the incident ultrasound. Finally, detailed optimization approaches have also been proposed to further improve the output power of the micro triboelectric ultrasonic device.