A wearable patch for continuous analysis of thermoregulatory sweat at rest

Flexible and Wearable Biosensors for Monitoring Health Conditions

Flexible and wearable biosensors have received tremendous attention over the past decade owing to their great potential applications in the field of health and medicine. Wearable biosensors serve as an ideal platform for real-time and continuous health monitoring, which exhibit unique properties such as self-powered, lightweight, low cost, high flexibility, detection convenience, and great conformability. This review introduces the recent research progress in wearable biosensors. First of all, the biological fluids often detected by wearable biosensors are proposed. Then, the existing micro-nanofabrication technologies and basic characteristics of wearable biosensors are summarized. Then, their application manners and information processing are also highlighted in the paper. Massive cutting-edge research examples are introduced such as wearable physiological pressure sensors, wearable sweat sensors, and wearable self-powered biosensors. As a significant content, the detection mechanism of these sensors was detailed with examples to help readers understand this area. Finally, the current challenges and future perspectives are proposed to push this research area forward and expand practical applications in the future.

Fluid-based wearable sensors: a turning point in personalized healthcare

Nowadays, it has become very popular to develop wearable devices that can monitor biomarkers to analyze the health status of the human body more comprehensively and accurately. Wearable sensors, specially designed for home care services, show great promise with their ease of use, especially during pandemic periods. Scientists have conducted many innovative studies on new wearable sensors that can noninvasively and simultaneously monitor biochemical indicators in body fluids for disease prediction, diagnosis, and management. Using noninvasive electrochemical sensors, biomarkers can be detected in tears, saliva, perspiration, and skin interstitial fluid (ISF). In this review, biofluids used for noninvasive wearable sensor detection under four main headings, saliva, sweat, tears, and ISF-based wearable sensors, were examined in detail. This report analyzes nearly 50 recent articles from 2017 to 2023. Based on current research, this review also discusses the evolution of wearable sensors, potential implementation challenges, and future prospects.

Versatile sweat bioanalysis on demand with hydrogel-programmed wearables

Wearable sweat bioanalysis is promising for non-invasive diagnostics of diseases. However, collection of representative sweat samples without disturbing daily life and wearable bioanalysis of targets that are clinically significant are still challenging. In this work, we report on a versatile method for the sweat bioanalysis. The method is based on a thermoresponsive hydrogel which can imperceptibly absorb slowly secreted sweat without stimulation such as heat or sport exercise. The wearable bioanalysis is accomplished by programmed electric heating of hydrogel modules to 42°C to release absorbed sweat or preloaded reagents into a microfluidic detection channel. Using our method, not only one-step detection of glucose but also multi-step immunoassay of cortisol is accomplished within 1 h, even at a very low sweat rate. Our test results are also compared with those obtained with conventional blood samples and stimulated sweat samples to evaluate the applicability of our method to non-invasive clinical practice.

Stimuli-bioresponsive hydrogels as new generation materials for implantable, wearable, and disposable biosensors for medical diagnostics: Principles, opportunities, and challenges

Hydrogels are excellent water-swollen polymeric materials for use in wearable, implantable, and disposable biosensors. Hydrogels have unique properties such as low cost, ease of preparation, transparency, rapid response to external conditions, biocompatibility and self-adhesion to the skin, flexibility, and strain sensitivity, making them ideal for use in biosensor platforms. This review provides a detailed overview of advanced applications of stimuli-responsive hydrogels in biosensor platforms, from hydrogel synthesis and functionalization for bioreceptor immobilization to several important diagnostic applications. Emphasis is placed on recent advances in the fabrication of ultrasensitive fluorescent and electrically conductive hydrogels and their applications in wearable, implantable, and disposable biosensors for quantitative measurements. Design, modification, and assembly techniques of fluorescent, ionically conductive, and electrically conductive hydrogels to improve performance will be addressed. The advantages and performance improvements of immobilizing bioreceptors (e.g., antibodies, enzymes, and aptamers), and incorporating fluorescent and electrically conductive nanomaterials are described, as are their limitations. Potential applications of hydrogels in implantable, wearable, disposable portable biosensors for quantitative detection of the various bioanalytes (ions, molecules, drugs, proteins, and biomarkers) are discussed. Finally, the global market for hydrogel-based biosensors and future challenges and prospects are discussed in detail.

Evolution of nanostructured skin patches towards multifunctional wearable platforms for biomedical applications

Recent advances in the field of skin patches have promoted the development of wearable and implantable bioelectronics for long-term, continuous healthcare management and targeted therapy. However, the design of electronic skin (e-skin) patches with stretchable components is still challenging and requires an in-depth understanding of the skin-attachable substrate layer, functional biomaterials and advanced self-powered electronics. In this comprehensive review, we present the evolution of skin patches from functional nanostructured materials to multi-functional and stimuli-responsive patches towards flexible substrates and emerging biomaterials for e-skin patches, including the material selection, structure design and promising applications. Stretchable sensors and self-powered e-skin patches are also discussed, ranging from electrical stimulation for clinical procedures to continuous health monitoring and integrated systems for comprehensive healthcare management. Moreover, an integrated energy harvester with bioelectronics enables the fabrication of self-powered electronic skin patches, which can effectively solve the energy supply and overcome the drawbacks induced by bulky battery-driven devices. However, to realize the full potential offered by these advancements, several challenges must be addressed for next-generation e-skin patches. Finally, future opportunities and positive outlooks are presented on the future directions of bioelectronics. It is believed that innovative material design, structure engineering, and in-depth study of fundamental principles can foster the rapid evolution of electronic skin patches, and eventually enable self-powered close-looped bioelectronic systems to benefit mankind.

Recent Advancements in Physiological, Biochemical, and Multimodal Sensors Based on Flexible Substrates: Strategies, Technologies, and Integrations

Flexible wearable devices have been widely used in biomedical applications, the Internet of Things, and other fields, attracting the attention of many researchers. The physiological and biochemical information on the human body reflects various health states, providing essential data for human health examination and personalized medical treatment. Meanwhile, physiological and biochemical information reveals the moving state and position of the human body, and it is the data basis for realizing human-computer interactions. Flexible wearable physiological and biochemical sensors provide real-time, human-friendly monitoring because of their light weight, wearability, and high flexibility. This paper reviews the latest advancements, strategies, and technologies of flexibly wearable physiological and biochemical sensors (pressure, strain, humidity, saliva, sweat, and tears). Next, we systematically summarize the integration principles of flexible physiological and biochemical sensors with the current research progress. Finally, important directions and challenges of physiological, biochemical, and multimodal sensors are proposed to realize their potential applications for human movement, health monitoring, and personalized medicine.

Mass transport limitations for electrochemical sensing in low-flux excretory fluids

Despite non-invasive instant monitoring of sweat metabolites is becoming a general trend in early diagnostics and screening, the reliability and accuracy of the on-skin electrochemical biosensors in real-life scenarios still remain questionable. As a rule, mass transport effects in scantily excreted liquids are ignored, when considering the design of such wearable setups. Here we provide a comprehensive investigation of the disruption factors for commonly used Prussian Blue based (bio)sensors under different hydrodynamic conditions (2 × 10^-5 - 5 × 10⁰ mm s^-1 electrolyte velocity). A huge effect of flow on the (bio)sensors response has been revealed and explained with transport limitations for both analyte influx and reaction product outflux. It suggests no need for improving the sensor sensitivity, while minimizing analyte consumption and enhancing product withdrawal. Some strategies concerning measurement schemes and sensor design ensuring reliable sweat analysis have been discussed and illustrated for lactate and glucose on-skin monitoring.

Skin-Interfaced Wearable Sweat Sensors for Precision Medicine

Wearable sensors hold great potential in empowering personalized health monitoring, predictive analytics, and timely intervention toward personalized healthcare. Advances in flexible electronics, materials science, and electrochemistry have spurred the development of wearable sweat sensors that enable the continuous and noninvasive screening of analytes indicative of health status. Existing major challenges in wearable sensors include: improving the sweat extraction and sweat sensing capabilities, improving the form factor of the wearable device for minimal discomfort and reliable measurements when worn, and understanding the clinical value of sweat analytes toward biomarker discovery. This review provides a comprehensive review of wearable sweat sensors and outlines state-of-the-art technologies and research that strive to bridge these gaps. The physiology of sweat, materials, biosensing mechanisms and advances, and approaches for sweat induction and sampling are introduced. Additionally, design considerations for the system-level development of wearable sweat sensing devices, spanning from strategies for prolonged sweat extraction to efficient powering of wearables, are discussed. Furthermore, the applications, data analytics, commercialization efforts, challenges, and prospects of wearable sweat sensors for precision medicine are discussed.

Hydrovoltaic Nanogenerators for Self-Powered Sweat Electrolyte Analysis

Human sweat comprises various electrolytes that are health status indicators. Conventional potentiometric electrolyte sensors require an electrical power source, which is expensive, bulky, and requires a complex architecture. Herein, this work demonstrates an electric nanogenerator fabricated using silicon nanowire (SiNW) arrays comprising modified carbon nanoparticles. The SiNW arrays platform is demonstrated as an effective self-powered sensor for sweat electrolyte analysis. It has been shown that an evaporation-induced water flow in nanochannels can yield an open-circuit voltage (V_oc ) of 0.45 V and a short-circuit current of 10.2 µA at room temperature as a result of overlapped electric double layers. The electrolyte in the water flow results in a V_oc decrease due to the charge shielding effect. The V_oc is inversely proportional to the electrolyte concentration. The fabricated hydrovoltaic device shows the capability for sensing electrolytes in human sweat, which is useful in evaluating the hydration status of volunteers following intense physical exercise. The device depicts a novel response mechanism compared to conventional electrochemical sensors. Furthermore, the hydrovoltaic device shows a maximum output power of 1.42 µW, and as such has been successfully shown to drive various electronic devices including light-emitting diodes, a calculator, and an electronic timer.

Wearable Plasmonic Sweat Biosensor for Acetaminophen Drug Monitoring

Monitoring the acetaminophen dosage is important to prevent the occurrence of adverse reactions such as liver failure and kidney damage. Traditional approaches to monitoring acetaminophen dosage mainly rely on invasive blood collection. Herein, we developed a noninvasive microfluidic-based wearable plasmonic sensor to achieve simultaneous sweat sampling and acetaminophen drug monitoring for vital signs. The fabricated sensor employs an Au nanosphere cone array as the key sensing component, which poses a substrate with surface-enhanced Raman scattering (SERS) activity to noninvasively and sensitively detect the fingerprint of acetaminophen molecules based on its unique SERS spectrum. The developed sensor enabled the sensitive detection and quantification of acetaminophen at concentrations as low as 0.13 μM. We further evaluated the sweat sensor integrated with a Raman spectrometer for monitoring acetaminophen in drug-administered subjects. These results indicated that the sweat sensor could measure acetaminophen levels and reflect drug metabolism. The sweat sensors have revolutionized wearable sensing technology by adopting label-free and sensitive molecular tracking methods for noninvasive and point-of-care drug monitoring and management.

Dual-signal readout paper-based wearable biosensor with a 3D origami structure for multiplexed analyte detection in sweat

In this research, we design and implement a small, convenient, and noninvasive paper-based microfluidic sweat sensor that can simultaneously detect multiple key biomarkers in human sweat. The origami structure of the chip includes colorimetric and electrochemical sensing regions. Different colorimetric sensing regions are modified with specific chromogenic reagents to selectively identify glucose, lactate, uric acid, and magnesium ions in sweat, as well as the pH value. The regions of electrochemical sensing detect cortisol in sweat by molecular imprinting. The entire chip is composed of hydrophilically and hydrophobically treated filter paper, and 3D microfluidic channels are constructed by using folding paper. The thread-based channels formed after the hydrophilic and hydrophobic modifications are used to control the rate of sweat flow, which in turn can be used to control the sequence of reactions in the differently developing colored regions to ensure that signals of the best color can be captured simultaneously by the colorimetric sensing regions. Finally, the results of on-body experiments verify the reliability of the proposed sweat sensor and its potential for the noninvasive identification of a variety of sweat biomarkers.

Technology Roadmap for Flexible Sensors

Humans rely increasingly on sensors to address grand challenges and to improve quality of life in the era of digitalization and big data. For ubiquitous sensing, flexible sensors are developed to overcome the limitations of conventional rigid counterparts. Despite rapid advancement in bench-side research over the last decade, the market adoption of flexible sensors remains limited. To ease and to expedite their deployment, here, we identify bottlenecks hindering the maturation of flexible sensors and propose promising solutions. We first analyze challenges in achieving satisfactory sensing performance for real-world applications and then summarize issues in compatible sensor-biology interfaces, followed by brief discussions on powering and connecting sensor networks. Issues en route to commercialization and for sustainable growth of the sector are also analyzed, highlighting environmental concerns and emphasizing nontechnical issues such as business, regulatory, and ethical considerations. Additionally, we look at future intelligent flexible sensors. In proposing a comprehensive roadmap, we hope to steer research efforts towards common goals and to guide coordinated development strategies from disparate communities. Through such collaborative efforts, scientific breakthroughs can be made sooner and capitalized for the betterment of humanity.

Skin-Interfaced Superhydrophobic Insensible Sweat Sensors for Evaluating Body Thermoregulation and Skin Barrier Functions

Monitoring sweat rate is vital for estimating sweat loss and accurately measuring biomarkers of interest. Although various optical or electrical sensors have been developed to monitor the sensible sweat rate, the quantification of the insensible sweat rate that is directly related to body thermoregulation and skin barrier functions still remains a challenge. This work introduces a superhydrophobic sweat sensor based on a polyacrylate sodium/MXene composite sandwiched between two superhydrophobic textile layers to continuously measure sweat vapor from insensible sweat with high sensitivity and rapid response. The superhydrophobic textile on a holey thin substrate with reduced stiffness and excellent breathability allows the permeation of sweat vapor, while preventing the sensor from being affected by the external water droplets and internal sensible sweat. Integrating the insensible sweat sensor with a flexible wireless communication and powering module further yields a standalone sensing system to continuously monitor insensible sweat rates at different body locations for diverse application scenarios. Proof-of-concept demonstrations on human subjects showcase the feasibility to continuously evaluate the body's thermoregulation and skin barrier functions for the assessment of thermal comfort, disease conditions, and nervous system activity. The results presented in this work also provide a low-cost device platform to detect other health-relevant biomarkers in the sweat (vapor) as the next-generation sweat sensor for smart healthcare and personalized medicine.

Large area roll-to-roll printed semiconducting carbon nanotube thin films for flexible carbon-based electronics

A universal roll-to-roll (R2R) printing approach was developed to construct large area (8 cm × 14 cm) semiconducting single-walled carbon nanotube (sc-SWCNT) thin films on flexible substrates (such as polyethylene terephthalate (PET), paper, and Al foils) at a printing speed of 8 m min^-1 using highly concentrated sc-SWCNT inks and crosslinked poly-4-vinylphenol (c-PVP) as the adhesion layer. Bottom-gated and top-gated flexible printed p-type TFTs based on R2R printed sc-SWCNT thin films exhibited good electrical properties with a carrier mobility of ∼11.9 cm² V^-1 s^-1, I_on/I_off ratios of ∼10⁶, small hysteresis, and a subthreshold swing (SS) of 70-80 mV dec^-1 at low gate operating voltages (±1 V), and excellent mechanical flexibility. Furthermore, the flexible printed complementary metal oxide semiconductor (CMOS) inverters demonstrated rail-to-rail voltage output characteristics under an operating voltage as low as V_DD = -0.2 V, a voltage gain of 10.8 at V_DD = -0.8 V, and power consumption as low as 0.056 nW at V_DD = -0.2 V. To the best of our knowledge, the electrical properties of the printed SWCNT TFTs (such as I_on/I_off ratio, mobility, operating voltage, and mechanical flexibility) and printed CMOS inverters based on the R2R printed sc-SWCNT active layer in this work are excellent compared to those of R2R printed SWCNT TFTs reported in the literature. Consequently, the universal R2R printing method reported in this work could promote the development of fully printed low-cost, large-area, high-output, and flexible carbon-based electronics.

Sequentially Coated Wavy Nanowire Composite Transparent Electrode for Stretchable Solar Cells

Recent advances in fabricating stretchable and transparent electrodes have led to various techniques for establishing next-generation form-factor optoelectronic devices. Wavy Ag nanowire networks with large curvature radii are promising platforms as stretchable and transparent electrodes due to their high electrical conductivity and stretchability even at very high transparency. However, there are disadvantages such as intrinsic nonregular conductivity, large surface roughness, and nanowire oxidation in air. Here, we introduce electrically synergistic but mechanically independent composite electrodes by sequentially introducing conducting polymers and ionic liquids into the wavy Ag nanowire network to maintain the superior performance of the stretchable transparent electrode while ensuring overall conductivity, lower roughness, and long-term stability. In particular, plenty of ionic liquids can be incorporated into the uniformly coated conducting polymer so that the elastic modulus can be significantly lowered and sliding can occur at the nanowire interface, thereby obtaining the high mechanical stretchability of the composite electrode. Finally, as a result of applying the composite film as the stretchable transparent electrode of stretchable organic solar cells, the organic solar cell exhibits a high power conversion efficiency of 11.3% and 89% compared to the initial efficiency even at 20% tensile strain, demonstrating excellent stretching stability.

Soft Electronics for Health Monitoring Assisted by Machine Learning

Due to the development of the novel materials, the past two decades have witnessed the rapid advances of soft electronics. The soft electronics have huge potential in the physical sign monitoring and health care. One of the important advantages of soft electronics is forming good interface with skin, which can increase the user scale and improve the signal quality. Therefore, it is easy to build the specific dataset, which is important to improve the performance of machine learning algorithm. At the same time, with the assistance of machine learning algorithm, the soft electronics have become more and more intelligent to realize real-time analysis and diagnosis. The soft electronics and machining learning algorithms complement each other very well. It is indubitable that the soft electronics will bring us to a healthier and more intelligent world in the near future. Therefore, in this review, we will give a careful introduction about the new soft material, physiological signal detected by soft devices, and the soft devices assisted by machine learning algorithm. Some soft materials will be discussed such as two-dimensional material, carbon nanotube, nanowire, nanomesh, and hydrogel. Then, soft sensors will be discussed according to the physiological signal types (pulse, respiration, human motion, intraocular pressure, phonation, etc.). After that, the soft electronics assisted by various algorithms will be reviewed, including some classical algorithms and powerful neural network algorithms. Especially, the soft device assisted by neural network will be introduced carefully. Finally, the outlook, challenge, and conclusion of soft system powered by machine learning algorithm will be discussed.

Self-Powered Wireless Flexible Ionogel Wearable Devices

Ionogels are promising soft materials for flexible wearable devices because of their unique features such as ionic conductivity and thermal stability. Ionogels reported to date show excellent sensing sensitivity; however, they suffer from a complicated external power supply. Herein, we report a self-powered wearable device based on an ionogel incorporating poly(vinylidene fluoride) (PVDF). The three-dimensional (3D) printed PVDF-ionogel exhibits amazing stretchability (1500%), high conductivity (0.36 S/m at 105 Hz), and an extremely low glass transition temperature (-84 °C). Moreover, the flexible wearable devices assembled from the PVDF-ionogel can precisely detect physiological signals (e.g., wrist, gesture, running, etc.) with a self-powered supply. Most significantly, a self-powered wireless flexible wearable device based on our PVDF-ionogel achieves monitoring healthcare of a human by transmitting obtained signals with a Bluetooth module timely and accurately. This work provides a facile and efficient method for fabricating cost-effective wireless wearable devices with a self-powered supply, enabling their potential applications for healthcare, motion detection, human-machine interfaces, etc.

MicroSweat: A Wearable Microfluidic Patch for Noninvasive and Reliable Sweat Collection Enables Human Stress Monitoring

Stress affects cognition, behavior, and physiology, leading to lasting physical and mental illness. The ability to detect and measure stress, however, is poor. Increased circulating cortisol during stress is mirrored by cortisol release from sweat glands, providing an opportunity to use it as an external biomarker for monitoring internal emotional state. Despite the attempts at using wearable sensors for monitoring sweat cortisol, there is a lack of reliable wearable sweat collection devices that preserve the concentration and integrity of sweat biomolecules corresponding to stress levels. Here, a flexible, self-powered, evaporation-free, bubble-free, surfactant-free, and scalable capillary microfluidic device, MicroSweat, is fabricated to reliably collect human sweat from different body locations. Cortisol levels are detected corresponding to severe stress ranging from 25 to 125 ng mL^-1 averaged across multiple body regions and 100-1000 ng mL^-1 from the axilla. A positive nonlinear correlation exists between cortisol concentration and stress levels quantified using the perceived stress scale (PSS). Moreover, owing to the sweat variation in response to environmental effects and physiological differences, the longitudinal and personalized profile of sweat cortisol is acquired, for the first time, for various body locations. The obtained sweat cortisol data is crucial for analyzing human stress in personalized and clinical healthcare sectors.

Moving toward smart biomedical sensing

The development of novel biomedical sensors as highly promising devices/tools in early diagnosis and therapy monitoring of many diseases and disorders has recently witnessed unprecedented growth; more and faster than ever. Nonetheless, on the eve of Industry 5.0 and by learning from defects of current sensors in smart diagnostics of pandemics, there is still a long way to go to achieve the ideal biomedical sensors capable of meeting the growing needs and expectations for smart biomedical/diagnostic sensing through eHealth systems. Herein, an overview is provided to highlight the importance and necessity of an inevitable transition in the era of digital health/Healthcare 4.0 towards smart biomedical/diagnostic sensing and how to approach it via new digital technologies including Internet of Things (IoT), artificial intelligence, IoT gateways (smartphones, readers), etc. This review will bring together the different types of smartphone/reader-based biomedical sensors, which have been employing for a wide variety of optical/electrical/electrochemical biosensing applications and paving the way for future eHealth diagnostic devices by moving towards smart biomedical sensing. Here, alongside highlighting the characteristics/criteria that should be met by the developed sensors towards smart biomedical sensing, the challenging issues ahead are delineated along with a comprehensive outlook on this extremely necessary field.

Flexible Sweat Sensors: From Films to Textiles

Flexible sweat sensors have found widespread potential applications for long-term wear and tracking and real-time monitoring of human health. However, the main substrate currently used in common flexible sweat sensors is thin film, which has disadvantages such as poor air permeability and the need for additional wearables. In this Review, the recent progress of sweat sensors has been systematically summarized by the types of monitoring methods of sweat sensors. In addition, this Review introduces and compares the performance of sweat sensors based on thin film and textile substrates such as fiber/yarn. Finally, opportunities and suggestions for the development of flexible sweat sensors are presented by summarizing the integration methods of sensors and human body monitoring sites.

Sweat as a diagnostic biofluid

Skin-interfaced microfluidic systems help assess health status and chemical exposure.

Device integration of electrochemical biosensors

Electrochemical biosensors incorporate a recognition element and an electronic transducer for the highly sensitive detection of analytes in body fluids. Importantly, they can provide rapid readouts and they can be integrated into portable, wearable and implantable devices for point-of-care diagnostics; for example, the personal glucose meter enables at-home assessment of blood glucose levels, greatly improving the management of diabetes. In this Review, we discuss the principles of electrochemical biosensing and the design of electrochemical biosensor devices for health monitoring and disease diagnostics, with a particular focus on device integration into wearable, portable and implantable systems. Finally, we outline the key engineering challenges that need to be addressed to improve sensing accuracy, enable multiplexing and one-step processes, and integrate electrochemical biosensing devices in digital health-care pathways.

Nonenzymatic Sweat Wearable Uric Acid Sensor Based on N-Doped Reduced Graphene Oxide/Au Dual Aerogels

Sweat wearable sensors enable noninvasive and real-time metabolite monitoring in human health management but lack accuracy and wearable applicability. The rational design of sensing electrode materials will be critical yet challenging. Herein, we report a dual aerogel-based nonenzymatic wearable sensor for the sensitive and selective detection of uric acid (UA) in human sweat. The three-dimensional porous dual-structural aerogels composed of Au nanowires and N-doped graphene nanosheets (noted as N-rGO/Au DAs) provide a large active surface, abundant access to the target, rapid electron transfer pathways, and a high intrinsic activity. Thus, a direct UA electro-oxidation is demonstrated at the N-rGO/Au DAs with a much higher activity than those at the individual gels (i.e., Au and N-rGO). Moreover, the resulting sensing chip displays high performance with a good anti-interfering ability, long-term stability, and excellent flexibility toward the UA detection. With the assistance of a wireless circuit, a wearable sensor is successfully applied in the real-time UA monitoring on human skin. The obtained result is comparable to that evaluated by high-performance liquid chromatography. This dual aerogel-based nonenzymatic biosensing platform not only holds considerable promise for the reliable sweat metabolite monitoring but also opens an avenue for metal-based aerogels as flexible electrodes in wearable sensing.

Heart Rate Estimation from Incomplete Electrocardiography Signals

As one of the most remarkable indicators of physiological health, heart rate (HR) has become an unfailing investigation for researchers. Unlike many existing methods, this article proposes an approach to implement short-time HR estimation from electrocardiography in time series missing patterns. Benefiting from the rapid development of deep learning, we adopted a bidirectional long short-term memory model (Bi-LSTM) and temporal convolution network (TCN) to recover complete heartbeat signals from those with durations are less than one cardiac cycle, and the estimated HR from recovered segment combining the input and the predicted output. We also compared the performance of Bi-LSTM and TCN in PhysioNet dataset. Validating the method over a resting heart rate range of 60−120 bpm in the database without significant arrhythmias and a corresponding range of 30−150 bpm in the database with arrhythmias, we found that networks provide an estimated approach for incomplete signals in a fixed format. These results are consistent with real heartbeats in the normal heartbeat dataset (γ > 0.7, RMSE < 10) and in the arrhythmia database (γ > 0.6, RMSE < 30), verifying that HR could be estimated by models in advance. We also discussed the short-time limits for the predictive model. It could be used for physiological purposes such as mobile sensing in time-constrained scenarios, and providing useful insights for better time series analyses in missing data patterns.

Liquid Metal-Based Electronics for On-Skin Healthcare

Wearable devices are receiving growing interest in modern technologies for realizing multiple on-skin purposes, including flexible display, flexible e-textiles, and, most importantly, flexible epidermal healthcare. A 'BEER' requirement, i.e., biocompatibility, electrical elasticity, and robustness, is first proposed here for all the on-skin healthcare electronics for epidermal applications. This requirement would guide the designing of the next-generation on-skin healthcare electronics. For conventional stretchable electronics, the rigid conductive materials, e.g., gold nanoparticles and silver nanofibers, would suffer from an easy-to-fail interface with elastic substrates due to a Young's modulus mismatch. Liquid metal (LM) with high conductivity and stretchability has emerged as a promising solution for robust stretchable epidermal electronics. In addition, the fundamental physical, chemical, and biocompatible properties of LM are illustrated. Furthermore, the fabrication strategies of LM are outlined for pure LM, LM composites, and LM circuits based on the surface tension control. Five dominant epidermal healthcare applications of LM are illustrated, including electrodes, interconnectors, mechanical sensors, thermal management, and biomedical and sustainable applications. Finally, the key challenges and perspectives of LM are identified for the future research vision.

Wearable and flexible electrochemical sensors for sweat analysis: a review

Flexible wearable sweat sensors allow continuous, real-time, noninvasive detection of sweat analytes, provide insight into human physiology at the molecular level, and have received significant attention for their promising applications in personalized health monitoring. Electrochemical sensors are the best choice for wearable sweat sensors due to their high performance, low cost, miniaturization, and wide applicability. Recent developments in soft microfluidics, multiplexed biosensing, energy harvesting devices, and materials have advanced the compatibility of wearable electrochemical sweat-sensing platforms. In this review, we summarize the potential of sweat for medical detection and methods for sweat stimulation and collection. This paper provides an overview of the components of wearable sweat sensors and recent developments in materials and power supply technologies and highlights some typical sensing platforms for different types of analytes. Finally, the paper ends with a discussion of the challenges and a view of the prospective development of this exciting field.

Artificial Neural Network-Assisted Wearable Flexible Sweat Patch for Drug Management in Parkinson's Patients Based on Vacancy-Engineered Processing of g-C3N4

Herein, we developed a flexible, low-cost non-enzymatic sweat sensing chip for in situ acquisition of bioinformation in sweat of individuals under exercise conditions to advance personal health monitoring and medication management for patients with Parkinson's disease. This low-cost, flexible, wearable sweat sensor consists of a printed screen electrode modified with g-C₃N₄ material and an external MSME element. The doping strategy and surface activation strategy of the g-C₃N₄-based exhibited efficient glucose oxidase-like activity and electrochemical activity when testing l-dopa and glucose in sweat. The optimized signal was transmitted to a smartphone for processing 12 individuals with simulated dosing, enabling continuous monitoring of l-dopa metabolism in sweat and management of dosing. The generalization ability and robustness of models constructed by methods such as multiple linear regression, artificial neural networks, and convolutional neural networks were compared cross-sectionally. Deep learning models based on artificial neural networks help develop a user-personalized medication administration reminder system, which provides a promising paradigm for reliable medication supervision for Parkinson's patients in the Internet of Things era.

Self-Testing of Ketone Bodies, along with Glucose, Using Touch-Based Sweat Analysis

β-Hydroxybutyrate (HB) is one of the main physiological ketone bodies that play key roles in human health and wellness. Besides their important role in diabetes ketoacidosis, ketone bodies are currently receiving tremendous attention for personal nutrition in connection to the growing popularity of oral ketone supplements. Accordingly, there are urgent needs for developing a rapid, simple, and low-cost device for frequent onsite measurements of β-hydroxybutyrate (HB), one of the main physiological ketone bodies. However, real-time profiling of dynamically changing HB concentrations is challenging and still limited to laboratory settings or to painful and invasive measurements (e.g., a commercial blood ketone meter). Herein, we address the critical need for pain-free frequent HB measurements in decentralized settings and report on a reliable noninvasive, simple, and rapid touch-based sweat HB testing and on its ability to track dynamic HB changes in secreted fingertip sweat, following the intake of commercial ketone supplements. The new touch-based HB detection method relies on an instantaneous collection of the fingertip sweat at rest on a porous poly(vinyl alcohol) (PVA) hydrogel that transports the sweat to a biocatalytic layer, composed of the β-hydroxybutyrate dehydrogenase (HBD) enzyme and its nicotinamide adenine dinucleotide (NAD⁺) cofactor, covering the modified screen-printed carbon working electrode. As a result, the sweat HB can be measured rapidly by the mediated oxidation reaction of the nicotinamide adenine dinucleotide (NADH) product. A personalized HB dose-response relationship is demonstrated within a group of healthy human subjects taking commercial ketone supplements, along with a correlation between the sweat and capillary blood HB levels. Furthermore, a dual disposable biosensing device, consisting of neighboring ketone and glucose enzyme electrodes on a single-strip substrate, has been developed toward the simultaneous touch-based detection of dynamically changing sweat HB and glucose levels, following the intake of ketone and glucose drinks.

Nonwoven/Nanomembrane Composite Functional Sweat Pads

Sweat is a natural body excretion produced by skin glands, and the body cools itself by releasing salty sweat. Wetness in the underarms and feet for long durations causes itchiness and an unpleasant smell. Skin-friendly reusable sweat pads could be used to absorb sweat. Transportation of moisture and functionality is the current challenge that many researchers are working on. This study aims to develop a functional and breathable sweat pad with antimicrobial and quick drying performance. Three layered functional sweat pads (FSP) are prepared in which the inner layer is made of an optimized needle-punched coolmax/polypropylene nonwoven blend. This layer is then dipped in antimicrobial ZnO solution (2, 4, and 6 wt.%), and super absorbent polymer (SAP) is embedded, and this is called a functional nonwoven (FNW1) sheet. Electrospun nanofiber-based nanomembranes of polyamide-6 are optimized for bead-free fibers. They are used as a middle layer to enhance the pad's functionality, and the third layer is again made of needle-punched optimized coolmax/polypropylene nonwoven sheets. A simple nonwoven-based sweat pad (SSP) is also prepared for comparison purposes. Nonwoven sheets are optimized based on better comfort properties, including air/water vapor permeability and moisture management (MMT). Nonwoven webs having a higher proportion of coolmax show better air permeability and moisture transfer from the inner to the outer layer. Antimicrobial activity of the functional nonwoven layer showed 8 mm of bacterial growth, but SSP and FSP showed only 6 mm of growth against Staphylococcus aureus. FSP showed superior comfort and antibacterial properties. This study could be a footstone toward highly functional sweat pads with remarkable comfort properties.

Highly Stretchable Sensor Based on Fluid Dynamics-Assisted Graphene Inks for Real-Time Monitoring of Sweat

Graphene inks have recently attracted attention for the development of printed wearable and flexible electronics and sensors not only because of their high conductivity and low cost but also because they are suitable for high-speed printing. Although reliable and scalable printing technologies are well established, further improvement in graphene inks in terms of electrical conductivity, stretchability/flexibility, and mass production is necessary for sensors for real-time monitoring. Herein, highly stretchable and conductive graphene inks were prepared by an efficient and scalable fluid dynamics-assisted exfoliation of graphite and a mixing process with elastomeric Ecoflex. After printing inks onto textile substrates, the serpentine-patterned conductors exhibited high conductivity and stable resistance even under a mechanically stretched state (a strain of 150%). Electrochemical sensors that detect sodium ions were fabricated on this conducting platform. These sensors indicated high potentiometric sensing ability under different mechanical deformations. To demonstrate the on-body performance of the developed sensors, real-time monitoring of sodium-ion concentration in the sweat of a human subject was carried out during an indoor stationary cycling exercise.

A Comprehensive Review of the Recent Developments in Wearable Sweat-Sensing Devices

Sweat analysis offers non-invasive real-time on-body measurement for wearable sensors. However, there are still gaps in current developed sweat-sensing devices (SSDs) regarding the concerns of mixing fresh and old sweat and real-time measurement, which are the requirements to ensure accurate the measurement of wearable devices. This review paper discusses these limitations by aiding model designs, features, performance, and the device operation for exploring the SSDs used in different sweat collection tools, focusing on continuous and non-continuous flow sweat analysis. In addition, the paper also comprehensively presents various sweat biomarkers that have been explored by earlier works in order to broaden the use of non-invasive sweat samples in healthcare and related applications. This work also discusses the target analyte's response mechanism for different sweat compositions, categories of sweat collection devices, and recent advances in SSDs regarding optimal design, functionality, and performance.

Wearable, wireless, multi-sensor device for monitoring tissue circulation after free-tissue transplantation: a multicentre clinical trial

Wearable sensors have seen remarkable recent technological developments, and their role in healthcare is expected to expand. Specifically, monitoring tissue circulation in patients who have undergone reconstructive surgery is critical because blood flow deficiencies must be rescued within hours or the transplant will fail due to thrombosis/haematoma within the artery or vein. We design a wearable, wireless, continuous, multipoint sensor to monitor tissue circulation. The system measures pulse waves, skin colour, and tissue temperature to reproduce physician assessment. Data are analysed in real time for patient risk using an algorithm. This multicentre clinical trial involved 73 patients who underwent transplant surgery and had their tissue circulation monitored until postoperative day 7. Herein, we show that the overall agreement rate between physician and sensor findings is 99.2%. In addition, the patient questionnaire results indicate that the device is easy to wear. The sensor demonstrates non-invasive, real-time, continuous, multi-point, wireless, and reliable monitoring for postoperative care. This wearable system can improve the success rate of reconstructive surgeries.

Probabilistic quotient’s work and pharmacokinetics’ contribution: countering size effect in metabolic time series measurements

Metabolomic time course analyses of biofluids are highly relevant for clinical diagnostics. However, many sampling methods suffer from unknown sample sizes, commonly known as size effects. This prevents absolute quantification of biomarkers. Recently, several mathematical post acquisition normalization methods have been developed to overcome these problems either by exploiting already known pharmacokinetic information or by statistical means. Here we present an improved normalization method, MIX, that combines the advantages of both approaches. It couples two normalization terms, one based on a pharmacokinetic model (PKM) and the other representing a popular statistical approach, probabilistic quotient normalization (PQN), in a single model. To test the performance of MIX, we generated synthetic data closely resembling real finger sweat metabolome measurements. We show that MIX normalization successfully tackles key weaknesses of the individual strategies: it (i) reduces the risk of overfitting with PKM, and (ii), contrary to PQN, it allows to compute sample volumes. Finally, we validate MIX by using real finger sweat as well as blood plasma metabolome data and demonstrate that MIX allows to better and more robustly correct for size effects. In conclusion, the MIX method improves the reliability and robustness of quantitative biomarker detection in finger sweat and other biofluids, paving the way for biomarker discovery and hypothesis generation from metabolomic time course data.

Mucosa-interfacing electronics

The surface mucosa that lines many of our organs houses myriad biometric signals and, therefore, has great potential as a sensor-tissue interface for high-fidelity and long-term biosensing. However, progress is still nascent for mucosa-interfacing electronics owing to challenges with establishing robust sensor-tissue interfaces; device localization, retention and removal; and power and data transfer. This is in sharp contrast to the rapidly advancing field of skin-interfacing electronics, which are replacing traditional hospital visits with minimally invasive, real-time, continuous and untethered biosensing. This Review aims to bridge the gap between skin-interfacing electronics and mucosa-interfacing electronics systems through a comparison of the properties and functions of the skin and internal mucosal surfaces. The major physiological signals accessible through mucosa-lined organs are surveyed and design considerations for the next generation of mucosa-interfacing electronics are outlined based on state-of-the-art developments in bio-integrated electronics. With this Review, we aim to inspire hardware solutions that can serve as a foundation for developing personalized biosensing from the mucosa, a relatively uncharted field with great scientific and clinical potential.

A Portable Sweat Sensor Based on Carbon Quantum Dots for Multiplex Detection of Cardiovascular Health Biomarkers

The future of personalized diagnostics and treatment of cardiovascular diseases lies in the use of portable sensors. Portable sensors can acquire biomarker information in biological fluids such as sweat, an approach that mitigates the shortcomings of conventional hospital-centered healthcare. Low sensitivity, selectivity, and specificity remain bottlenecks for the widespread use of portable sensors. Herein, we demonstrate a portable sensor that simultaneously detects Na⁺, ascorbic acid, and human neuropeptide Y in sweat, all useful biomarkers to index cardiovascular health. The portable sensor comprises a six-electrode system containing three working electrodes, two reference electrodes, and one counter electrode. The working electrodes were prepared by depositing sensing components on carbon quantum dot (CQD) electrodes. The sensing mechanisms were based on selective ion recognition, enzyme catalytic reaction, and immune response, which guarantees specificity to corresponding targets. The CQDs offer massive reactive sites and effectively reduce the interfacial impedance during the sensing reaction, thereby enhancing the three biomarkers' detection sensitivity. As evidence of portable sensor capability, we demonstrate herein its effective simultaneous detection of the three biomarkers in a real sweat from healthy volunteers during routine activities including exercise, extra ascorbic acid ingestion, and extra Na⁺ ingestion. As such, the sensor shows promise for real-time noninvasive personalized medical diagnostics and metabolic wellness management.

Simple, Skin-Attachable, and Multifunctional Colorimetric Sweat Sensor

In situ analysis of sweat provides a simple, convenient, cost-effective, and noninvasive approach for the early diagnosis of physical illness in humans and is particularly useful in family care. In this study, a flexible and skin-attachable colorimetric sweat sensor for multiplexed analysis is developed using a simple, cost-effective, and convenient method. The obtained sweat sensor can be used to simultaneously detect glucose, lactate, urea, and pH value in sweat, as well as sweat loss and skin temperature. Only 2.5 μL of sweat is enough for the whole test, and the sweat loss and chemical-sensing results can be read out conveniently by naked eyes or a smartphone. In addition, body temperature can also be detected with an additional electrical circuit. Our sweat sensor provides a new, cost-effective, and convenient approach for in vitro diagnosis of multiple components in sweat, and the easy fabrication and cost-effectiveness make our sensor commercializable in the near future.

Utilizing Gradient Porous Graphene Substrate as the Solid-Contact Layer To Enhance Wearable Electrochemical Sweat Sensor Sensitivity

Wearable sweat monitoring represents an attractive opportunity for personalized healthcare and for evaluating sports performance. One of the limitations with such monitoring, however, is water layer formation upon cycling of ion-selective sensors, leading to degraded sensitivity and long-term instability. Our report is the first to use chemical vapor deposition-grown, three-dimensional, graphene-based, gradient porous electrodes to minimize such water layer formation. The proposed design reduces the ion diffusion path within the polymeric ion-selective membrane and enhances the electroactive surface for highly sensitive, real-time detection of Na⁺ ions in human sweat with high selectivity. We obtained a 7-fold enhancement in electroactive surface against 2D electrodes (e.g., carbon, gold), yielding a sensitivity of 65.1 ± 0.25 mV decade^-1 (n = 3, RSD = 0.39%), the highest to date for wearable Na⁺ sweat sensors. The on-body sweat sensing performance is comparable to that of ICP-MS, suggesting its feasibility for health evaluation through sweat.

An unconventional vertical fluidic-controlled wearable platform for synchronously detecting sweat rate and electrolyte concentration

Epidermal microfluidic devices with long microchannels have been developed for continuous sweat analysis, which are crucial to assess personal hydration status and underlying health conditions. However, the flow resistance in long channels and the ionic concentration variation significantly affect the accuracy of both the sweat rate and electrolyte concentration measurements. Herein, we present a novel fluidic-controlled wearable platform for synchronously dropwise-detecting the sweat rate and total electrolyte concentration. The unconventional platform consisting of a vertically shortened channel, a pair of embedded electrodes and an absorption layer, is designed to minimize the flow resistance and transform sweat fluidics into uniform micro-droplets for chronological and dropwise detection. Real-time sweat conductance is decoupled from a square-wave-like curve, where the sweat rate and electrolyte concentration can be derived from the interval time and peak value, respectively. Flexible and wearable band devices are demonstrated to show their potential application for hydration status assessment during exercises.

Hydrogel-extraction technique for non-invasive detection of blue fluorescent substances in plant leaves

This paper reports a new hydrogel extraction technique for detecting blue fluorescent substances in plant leaves. These blue fluorescent substances were extracted by placing a hydrogel film on the leaf of a cherry tomato plant infected with Ralstonia solanacearum; herein, chlorogenic acid was confirmed to be a blue fluorescent substance. The wavelength at the maximum fluorescence intensity of the film after the hydrogel extraction was similar to that of the methanolic extract obtained from the infected cherry tomato leaves. Chlorophyll was not extracted from the hydrogel film because no fluorescence peak was observed at 680 nm. Accordingly, the blue fluorescence of the substances extracted from the hydrogel film was not quenched by the strong absorption of chlorophyll in the blue light region. This hydrogel extraction technique can potentially detect small amounts of blue fluorescent substances and the changes in its amount within the leaves of infected plants. These changes in the amount of blue fluorescent substances in the early stages of infection can be used to detect presymptomatic infections. Therefore, hydrogel extraction is a promising technique for the noninvasive detection of infections before onset.

Self-Healing and Shape-Editable Wearable Supercapacitors Based on Highly Stretchable Hydrogel Electrolytes

Shape editability combined with a self-healing capability and long-term cycling durability are highly desirable properties for wearable supercapacitors. Most wearable supercapacitors have rigid architecture and lack the capacity for editability into desirable shapes. Through sandwiching hydrogel electrolytes between two electrodes, a suite of wearable supercapacitors that integrate desirable properties namely: repeated shape editability, excellent self-healing capability, and long-term cycling durability is demonstrated. A strategy is proposed to enhance the long-term cycling durability by utilizing hydrogel electrolytes with unique cross-linking structures. The dynamic crosslinking sites are formed by quadruple H bonds and hydrophobic association, stabilizing the supercapacitors from inorganic ion disruption during charge-discharge processes. The fabricated supercapacitors result in the capacitance retention rates of 99.6% and 95.8% after 5000 and 10 000 charge-discharge cycles, respectively, which are much higher than others reported in the literature. Furthermore, the supercapacitor sheets can be repeatedly processed into various shapes without any capacitance loss. The supercapacitors exhibit a 95% capacitance retention rate after five cutting/self-healing cycles, indicative of their excellent self-healing performance. To demonstrate real-life applicability, the wearable supercapacitors are successfully used to power a light-emitting diode and an electronic watch.

Smartphone-Based Multiplexed Biosensing Tools for Health Monitoring

Many emerging technologies have the potential to improve health care by providing more personalized approaches or early diagnostic methods. In this review, we cover smartphone-based multiplexed sensors as affordable and portable sensing platforms for point-of-care devices. Multiplexing has been gaining attention recently for clinical diagnosis considering certain diseases require analysis of complex biological networks instead of single-marker analysis. Smartphones offer tremendous possibilities for on-site detection analysis due to their portability, high accessibility, fast sample processing, and robust imaging capabilities. Straightforward digital analysis and convenient user interfaces support networked health care systems and individualized health monitoring. Detailed biomarker profiling provides fast and accurate analysis for disease diagnosis for limited sample volume collection. Here, multiplexed smartphone-based assays with optical and electrochemical components are covered. Possible wireless or wired communication actuators and portable and wearable sensing integration for various sensing applications are discussed. The crucial features and the weaknesses of these devices are critically evaluated.

End-to-end design of wearable sensors

Wearable devices provide an alternative pathway to clinical diagnostics by exploiting various physical, chemical and biological sensors to mine physiological (biophysical and/or biochemical) information in real time (preferably, continuously) and in a non-invasive or minimally invasive manner. These sensors can be worn in the form of glasses, jewellery, face masks, wristwatches, fitness bands, tattoo-like devices, bandages or other patches, and textiles. Wearables such as smartwatches have already proved their capability for the early detection and monitoring of the progression and treatment of various diseases, such as COVID-19 and Parkinson disease, through biophysical signals. Next-generation wearable sensors that enable the multimodal and/or multiplexed measurement of physical parameters and biochemical markers in real time and continuously could be a transformative technology for diagnostics, allowing for high-resolution and time-resolved historical recording of the health status of an individual. In this Review, we examine the building blocks of such wearable sensors, including the substrate materials, sensing mechanisms, power modules and decision-making units, by reflecting on the recent developments in the materials, engineering and data science of these components. Finally, we synthesize current trends in the field to provide predictions for the future trajectory of wearable sensors.

Surface Engineering of Laser-Induced Graphene Enables Long-Term Monitoring of On-Body Uric Acid and pH Simultaneously

Laser-induced graphene (LIG) suffers from serious decay in long-term biosensing, which greatly restricts its practical applications. Herein, we report a new strategy to engineer the LIG surface with Au clusters and chitosan sequentially to form a C-Au-LIG electrode with a superhydrophilic and highly conductive 3D graphene surface, which demonstrates superior performance and negligible decay in both long-term storage and practical usage in vitro and in vivo environments. Moreover, the C-Au-LIG electrode can be used for detecting uric acid (UA) and pH simultaneously from a single differential pulse voltammetry curve with low-detection limitation, high accuracy, and negligible interference with other sweat biomarkers. The integrated C-Au-LIG wearable biosensor was employed to continuously monitor the UA content in human sweat, which can well reflect the daily intake of purines for at least 10 days. Therefore, the C-Au-LIG electrode demonstrates significant application potential and provides inspiration for surface engineering of other biosensor materials and electrodes.