Wearable and flexible electronics for continuous molecular monitoring

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.

A Review on Electrospinning as Versatile Supports for Diverse Nanofibers and Their Applications in Environmental Sensing

Rapid industrialization is accompanied by the deterioration of the natural environment. The deepening crisis associated with the ecological environment has garnered widespread attention toward strengthening environmental monitoring and protection. Environmental sensors are one of the key technologies for environmental monitoring, ultimately enabling environmental protection. In recent decades, micro/nanomaterials have been widely studied and applied in environmental sensing owing to their unique dimensional properties. Electrospinning has been developed and adopted as a facile, quick, and effective technology to produce continuous micro- and nanofiber materials. The technology has advanced rapidly and become one of the hotspots in the field of nanomaterials research. Environmental sensors made from electrospun nanofibers possess many advantages, such as having a porous structure and high specific surface area, which effectively improve their performance in environmental sensing. Furthermore, by introducing functional nanomaterials (carbon nanotubes, metal oxides, conjugated polymers, etc.) into electrospun fibers, synergistic effects between different materials can be utilized to improve the catalytic activity and sensitivity of the sensors. In this review, we aimed to outline the progress of research over the past decade on electrospinning nanofibers with different morphologies and functional characteristics in environmental sensors.

Electronically powered drug delivery devices: considerations and challenges

INTRODUCTION

Electronically powered drug delivery devices enable a controlled drug release route for a more convenient and painless way with reduced side effects. The current advances in microfabrication and microelectronics have facilitated miniaturization and intelligence with the integration of sensors and wireless communication modules. These devices have become an essential component of commercialized on-demand drug delivery.

AREAS COVERED

This review aims to provide a concise overview of current progress in electronically powered drug devices, focusing on delivery strategies, manufacturing techniques, and control circuit design with specific examples.

EXPERT OPINION

The application of electronically powered drug delivery systems is now considered a feasible therapeutic approach with improved drug release efficiency and increased patient comfort. It is anticipated that these technologies will gradually fulfill clinical needs and resolve commercialization challenges in the future. This review discusses the current advances in electronic drug delivery devices, especially focusing on designing strategies to achieve an effective drug release, as well as the perspectives and challenges for future applications in clinical therapy.

The development of wearable technologies and their potential for measuring nutrient intake: Towards precision nutrition

Appropriate food intake and nutritional status are crucial for the maintenance of health and disease prevention. Conventional dietary assessment is mainly based on comparisons of nutrient intakes with reference intakes, failing to meet the needs of personalised nutritional guidance based on individual nutritional status. Given their capability of providing insights into health information non-invasively in real time, wearable technologies offer great opportunities for nutrition monitoring. Nutrient metabolic profiles can be monitored immediately and continuously which could potentially offer the possibility for the tracking and guiding of nutrient intake. Here, we review and highlight the recent advances in wearable sensors from the perspective of sensing technologies for nutrient detection in biofluids. The integration of biosensors with wearable devices serves as an ideal platform for the analysis of biofluids including sweat, saliva and tears. The wearable sensing systems applied to the analysis of typical nutrients and important metabolites are demonstrated in terms of carbohydrates, proteins, lipids, vitamins, minerals and others. Taking advantage of their high flexibility and lightweight, wearable sensors have been widely developed for the in situ quantitative detection of metabolic biomarkers. The technical principles, detection methods and applications are summarised. The challenges and future perspectives for wearable nutrition monitoring devices are discussed including the need to better determine relationships among nutrient metabolic profile, nutrient intake and food intake. With the development of materials, sensing techniques and manufacturing processes, wearable technologies are paving the way towards personalised precision nutrition, although there is still a long way to go before they can be utilised for practical clinical applications. Joint research efforts between nutrition scientists, doctors, engineers and sensor researchers are essential to further accelerate the realisation of reliable and practical wearable nutrition monitoring platforms.

Single Wire Capacitive Wireless Power Transfer System for Wearable Biomedical Sensors Based on Flexible Graphene Film Material

This paper provides a special flexible graphene film based capacitive wireless power transfer (FGCPT) system for powering biomedical sensors of smart wearable devices. The graphene conductive material is flexible, transparent, highly conductive, and impermeable to most gases and liquids. Generally, the coupling structure of capacitive wireless power transfer (CPT) system is consisted of metal plates. However, it is hard to use for the biomedical sensors as the low power density and big volume. The shape of graphene conductive material could be easily built and changed according to the application requirements. In this paper, the power supply of biomedical sensing system could be accomplished by a single graphene film which is acted as the receiver of FGCPT system. The 200 mW power level is achieved with the maximum 9 V output voltage. The theory and calculation are verified by the simulated and experimental results.

Advanced Three-Dimensional Microelectrode Architecture Design for High-Performance On-Chip Micro-Supercapacitors

The rapid development of miniaturized electronic devices has greatly stimulated the endless pursuit of high-performance on-chip micro-supercapacitors (MSCs) delivering both high energy and power densities. To this end, an advanced three-dimensional (3D) microelectrode architecture design offers enormous opportunities due to high mass loading of active materials, large specific surface areas, fast ion diffusion kinetics, and short electron transport pathways. In this review, we summarize the recent advances in the rational design of 3D architectured microelectrodes including 3D dense microelectrodes, 3D nanoporous microelectrodes, and 3D macroporous microelectrodes. Furthermore, the emergent microfabrication strategies are discussed in detail in terms of charge storage mechanisms and structure-performance correlation for on-chip MSCs. Finally, we conclude with a perspective on future opportunities and challenges in this thriving field.

Wearable chemical sensors for biomarker discovery in the omics era

Biomarkers are crucial biological indicators in medical diagnostics and therapy. However, the process of biomarker discovery and validation is hindered by a lack of standardized protocols for analytical studies, storage and sample collection. Wearable chemical sensors provide a real-time, non-invasive alternative to typical laboratory blood analysis, and are an effective tool for exploring novel biomarkers in alternative body fluids, such as sweat, saliva, tears and interstitial fluid. These devices may enable remote at-home personalized health monitoring and substantially reduce the healthcare costs. This Review introduces criteria, strategies and technologies involved in biomarker discovery using wearable chemical sensors. Electrochemical and optical detection techniques are discussed, along with the materials and system-level considerations for wearable chemical sensors. Lastly, this Review describes how the large sets of temporal data collected by wearable sensors, coupled with modern data analysis approaches, would open the door for discovering new biomarkers towards precision medicine.

Autonomous wearable sweat rate monitoring based on digitized microbubble detection

Advancements in wearable bioanalytical microsystems have enabled diurnal and (semi)continuous monitoring of physiologically-relevant indices that are accessible through probing sweat. To deliver an undistorted and physiologically-meaningful interpretation of these readings, tracking the sweat secretion rate is essential, because it allows for calibrating the biomarker readings against variations in sweat secretion and inferring the body's hydration/electrolyte homeostasis status. To realize an autonomous wearable solution with intrinsically high signal-to-noise ratio sweat rate sensing capabilities, here, we devise a digitized microbubble detection mechanism-delivered by a hybrid microfluidic/electronic system with a compact footprint. This mechanism is based on the intermittent generation of microliter-scale bubbles via electrolysis and the instantaneous measurement of their time-of-flight (and thus, velocity) via impedimetric sensing. In this way, we overcome the limitations of previously proposed sweat rate sensing modalities that are inherently susceptible to non-targeted secretion characteristics (pH, conductivity, and temperature), constrained by volume, or lack system integration for autonomous on-body operation. By deploying our solution in human subject trials, we validate the utility of our solution for seamless monitoring of exercise- and iontophoretically-induced sweat secretion profiles.

A wearable electrochemical biosensor for the monitoring of metabolites and nutrients

Wearable non-invasive biosensors for the continuous monitoring of metabolites in sweat can detect a few analytes at sufficiently high concentrations, typically during vigorous exercise so as to generate sufficient quantity of the biofluid. Here we report the design and performance of a wearable electrochemical biosensor for the continuous analysis, in sweat during physical exercise and at rest, of trace levels of multiple metabolites and nutrients, including all essential amino acids and vitamins. The biosensor consists of graphene electrodes that can be repeatedly regenerated in situ, functionalized with metabolite-specific antibody-like molecularly imprinted polymers and redox-active reporter nanoparticles, and integrated with modules for iontophoresis-based sweat induction, microfluidic sweat sampling, signal processing and calibration, and wireless communication. In volunteers, the biosensor enabled the real-time monitoring of the intake of amino acids and their levels during physical exercise, as well as the assessment of the risk of metabolic syndrome (by correlating amino acid levels in serum and sweat). The monitoring of metabolites for the early identification of abnormal health conditions could facilitate applications in precision nutrition.

A Bifunctional Fully Integrated Wearable Tracker for Epidermal Sweat and Wound Exudate Multiple Biomarkers Monitoring

Fully integrated wearable electronics that combine the extraordinary feature of incessant and on-body operation with the distinctive external equipment-free trait are the ultimate goal of modern wearables. Epidermal sweat and wound exudate, as two noninvasively accessible biofluids on/surrounding the skin, reflect underlying health conditions. However, the design of universal wearable sensors with the bifunctional capability to monitor both epidermal secretions is still a challenge. Here, a single bifunctional fully integrated wearable tracker for wirelessly, simultaneously, and dynamically in situ measuring multiple epidermal sweat or wound exudate biomarkers is propos. Considering the electrolytes (e.g., Na⁺ , K⁺ , and H⁺ ) and metabolites (e.g., uric acid (UA)) levels in sweat or wound exudate may correlate with health or wound conditions, the dynamic and skin-on tracking of the biomarkers of Na⁺ , K⁺ , pH, and UA levels in sweat under subjects' exercise and in wound exudate during subjects' wound healing are performed through the seamless integration of microfluidic, sensing, and electronic modules. Its applicability is evaluated for noninvasive hyperuricemia management in hyperuricemia/healthy subjects through a purine-rich intake test and for wound management in subjects' infected wounds through a control medical treatment.

Wearable respiratory sensors for COVID-19 monitoring

Since its outbreak in 2019, COVID-19 becomes a pandemic, severely burdening the public healthcare systems and causing an economic burden. Thus, societies around the world are prioritizing a return to normal. However, fighting the recession could rekindle the pandemic owing to the lightning-fast transmission rate of SARS-CoV-2. Furthermore, many of those who are infected remain asymptomatic for several days, leading to the increased possibility of unintended transmission of the virus. Thus, developing rigorous and universal testing technologies to continuously detect COVID-19 for entire populations remains a critical challenge that needs to be overcome. Wearable respiratory sensors can monitor biomechanical signals such as the abnormities in respiratory rate and cough frequency caused by COVID-19, as well as biochemical signals such as viral biomarkers from exhaled breaths. The point-of-care system enabled by advanced respiratory sensors is expected to promote better control of the pandemic by providing an accessible, continuous, widespread, noninvasive, and reliable solution for COVID-19 diagnosis, monitoring, and management.

Tough, Self-Healing, and Conductive Elastomer ─Ionic PEGgel

Ionically conductive elastomers are necessary for realizing human-machine interfaces, bioelectronic applications, or durable wearable sensors. Current design strategies, however, often suffer from solvent leakage and evaporation, or from poor mechanical properties. Here, we report a strategy to fabricate ionic elastomers (IHPs) demonstrating high conductivity (0.04 S m-1), excellent electrochemical stability (>60,000 cycles), ultra-stretchability (up to 1400%), high toughness (7.16 MJ m-3), and fast self-healing properties, enabling the restoration of ionic conductivity within seconds, as well as no solvent leakage. The ionic elastomer is composed of in situ formed physically cross-linked poly(2-hydroxyethyl methacrylate) networks and poly(ethylene glycol) (PEG). The long molecular chains of PEG serve as a solvent for dissolving electrolytes, improve its long-term stability, reduce solvent leakage, and ensure the outstanding mechanical properties of the IHP. Surprisingly, the incorporation of ions into PEG simultaneously enhances the strength and toughness of the elastomer. The strengthening and toughening mechanisms were further revealed by molecular simulation. We demonstrate an application of the IHPs as (a) flexible sensors for strain or temperature sensing, (b) skin electrodes for recording electrocardiograms, and (c) a tough and sensing material for pneumatic artificial muscles. The proposed strategy is simple and easily scalable and can further inspire the design of novel ionic elastomers for ionotronics applications.

Recent Progress on Flexible Room-Temperature Gas Sensors Based on Metal Oxide Semiconductor

With the rapid development of the Internet of Things, there is a great demand for portable gas sensors. Metal oxide semiconductors (MOS) are one of the most traditional and well-studied gas sensing materials and have been widely used to prepare various commercial gas sensors. However, it is limited by high operating temperature. The current research works are directed towards fabricating high-performance flexible room-temperature (FRT) gas sensors, which are effective in simplifying the structure of MOS-based sensors, reducing power consumption, and expanding the application of portable devices. This article presents the recent research progress of MOS-based FRT gas sensors in terms of sensing mechanism, performance, flexibility characteristics, and applications. This review comprehensively summarizes and discusses five types of MOS-based FRT gas sensors, including pristine MOS, noble metal nanoparticles modified MOS, organic polymers modified MOS, carbon-based materials (carbon nanotubes and graphene derivatives) modified MOS, and two-dimensional transition metal dichalcogenides materials modified MOS. The effect of light-illuminated to improve gas sensing performance is further discussed. Furthermore, the applications and future perspectives of FRT gas sensors are also discussed.

Graphene and Its Derivatives: Synthesis and Application in the Electrochemical Detection of Analytes in Sweat

Wearable sensors and invasive devices have been studied extensively in recent years as the demand for real-time human healthcare applications and seamless human-machine interaction has risen exponentially. An explosion in sensor research throughout the globe has been ignited by the unique features such as thermal, electrical, and mechanical properties of graphene. This includes wearable sensors and implants, which can detect a wide range of data, including body temperature, pulse oxygenation, blood pressure, glucose, and the other analytes present in sweat. Graphene-based sensors for real-time human health monitoring are also being developed. This review is a comprehensive discussion about the properties of graphene, routes to its synthesis, derivatives of graphene, etc. Moreover, the basic features of a biosensor along with the chemistry of sweat are also discussed in detail. The review mainly focusses on the graphene and its derivative-based wearable sensors for the detection of analytes in sweat. Graphene-based sensors for health monitoring will be examined and explained in this study as an overview of the most current innovations in sensor designs, sensing processes, technological advancements, sensor system components, and potential hurdles. The future holds great opportunities for the development of efficient and advanced graphene-based sensors for the detection of analytes in sweat.

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.

Uncovering the Sweat Biofouling Components and Distributions in Electrochemical Sensors

Interest is growing in the creation of wearable sweat sensors for continuous, low-cost, and noninvasive health diagnosis at the molecular level. The biofouling phenomenon leads to degradation of sweat sensors' performance over time, further limiting the successive monitoring of human health status. However, to date, the mechanism of sweat fouling is still unclear, with the inability to provide effective guidance on antifouling strategies. This study clarifies chemical compositions in sweat fouling and fouling distributions on the surface of sensors. Gold film electrodes were prepared on glass and poly(ethylene terephthalate) (PET) substrates and contaminated by human facial sweat (from eccrine sweat glands and apocrine sweat glands) and palm sweat (only from eccrine sweat glands). A scanning electron microscope (SEM), an optical microscope (OM), and an atomic force microscope (AFM) were employed to study the surface morphology of biofouling electrodes. The existence of sweat fouling was characterized by AFM adhesion force, a Fourier transform infrared spectrometer (FTIR), and X-ray photoelectron spectra (XPS). FTIR along with XPS was adopted to analyze the biofouling components, and differential reflectance spectroscopy (DRS) was undertaken to observe the distribution of biofouling on the surface of the electrodes. As a result, we found that neither skin cell pieces nor recognized protein adsorption is the dominant source of biofouling, but the lipids in sweat form an inhomogeneous fouling layer on the electrode surface to reduce the electrochemical reactivity of sensors. This study provides deeper insights into sweat biofouling components and distributions and points out the right direction for resolving the problem of limited continuity in wearable sweat sensors.

Designing Inorganic Semiconductors with Cold-Rolling Processability

While metals can be readily processed and reshaped by cold rolling, most bulk inorganic semiconductors are brittle materials that tend to fracture when plastically deformed. Manufacturing thin sheets and foils of inorganic semiconductors is therefore a bottleneck problem, severely restricting their use in flexible electronic applications. It is recently reported that a few single-crystalline 2D van der Waals (vdW) semiconductors, such as InSe, are deformable under compressive stress. Here it is demonstrated that intralayer fracture toughness can be tailored via compositional design to make inorganic semiconductors processable by cold rolling. Systematic ab initio calculations covering a range of van der Waals semiconductors homologous to InSe are reported, leading to material-property maps that forecast trends in both the susceptibility to interlayer slip and the intralayer fracture toughness against cracking. GaSe is predicted, and experimentally confirmed, to be practically amenable to being rolled to large (three quarters) thickness reduction and length extension by a factor of three. The fracture toughness and cleavage energy are predicted to be 0.25 MPa m0.5 and 15 meV Å-2 , respectively. The findings open a new realm of possibility for alloy selection and design toward processing-friendly group-III chalcogenides for practical applications.

A stable Cd-MOF as a dual-responsive luminescent biosensor for the determination of urinary diphenyl phosphate and hippuric acid as biomarkers for human triphenyl phosphate and toluene poisoning

Rapid and accurate determination of biomarkers of human poisoning in real urine is of great significance for the assessment of health status. Herein, a luminescent urea-functionalized metal-organic framework (MOF), {[Cd(L)_0.5(bpbix)]·x(solv)}_n (1) (H₄L = 5,5'-(((naphthalene-1,5-diylbis(azanediyl))bis(carbonyl))bis(azanediyl))diisophthalic acid; bpbix = 4,4'-bis((1H-imidazol-1-yl)methyl)biphenyl), has been successfully synthesized, and exhibits good stability in aqueous solutions in the normal urinary pH range and real urine. Complex 1 can serve as a dual-responsive luminescent biosensor for the detection of diphenyl phosphate (DPP) and hippuric acid (HA) as biomarkers of flame retardant triphenyl phosphate and toluene poisoning, and shows the advantages of high sensitivity, rapid response, good anti-interference capability, and reversibility. More significantly, complex 1 is successfully applied to the sensitive and accurate detection of DPP and HA in real urine with satisfactory recoveries. This work presents a dual-responsive luminescent MOF-based biosensor for simple, rapid, accurate, and reversible determination of urinary DPP and HA, which has promising application potential for the diagnosis of diseases related to triphenyl phosphate and toluene poisoning.

Design and Testing of Autonomous Chargeable and Wearable Sweat/Ionic Liquid-Based Supercapacitors

This work demonstrates ionic liquid electrolyte-inscribed sweat-based dual electrolyte functioning supercapacitors capable of self-charging through sweat electrolyte function under a non-enzymatic route. The supercapacitor electrodes are fabricated from TREN (tris(2-aminoethyl)amine), poly-3,4-ethylenedioxythiophene, and a graphene oxide mixture with copper-mediated chelate, and this polymer-GO-metal chelate film can produce excellent energy harvest/storage performance from a sweat and ionic liquid integrated electrolyte system. The fabricated device is specifically designed to reduce deterioration using a typical planar structure. In the presence of sweat with ionic liquid, the dual electrolyte mode supercapacitor exhibits a maximum areal capacitance of 3600 mF cm-2 , and the energy density is 450 mWhcm-2 , which is more than 100 times greater than that from previously reported supercapacitors. The supercapacitors were fabricated/attached directly to textile fabrics as well as ITO-PET (Indium tin oxide (ITO)-polyethylene terephthalate (PET) film to study their performance on the human body during exercise. The self-charging performance with respect to sweat wetting time for the sweat@ionic liquid dual electrolyte showed that the supercapacitor performed well on both fabric and film. These devices exhibited good response for pH effect and biocompatibility, and as such present a promising multi-functional energy system as a stable power source for next-generation wearable smart electronics.

Liquid Metal-Based Flexible and Wearable Sensor for Functional Human-Machine Interface

Rigid sensors are a mature type of sensor, but their poor deformation and flexibility limit their application range. The appearance and development of flexible sensors provide an opportunity to solve this problem. In this paper, a resistive flexible sensor utilizes gallium-based liquid metal (eutectic gallium indium alloy, EGaIn) and poly(dimethylsiloxane) (PDMS) and is fabricated using an injecting thin-line patterning technique based on soft lithography. Combining the scalable fabrication process and unique wire-shaped liquid metal design enables sensitive multifunctional measurement under stretching and bending loads. Furthermore, the flexible sensor is combined with the glove to demonstrate the application of the wearable sensor glove in the detection of finger joint angle and gesture control, which offers the ability of integration and multifunctional sensing of all-soft wearable physical microsystems for human-machine interfaces. It shows its application potential in medical rehabilitation, intelligent control, and so on.

An accurate wearable hydration sensor: Real-world evaluation of practical use

A wearable body hydration sensor employing photoplethysmographic and galvanic biosensors was field evaluated using 240 human participants with equal numbers of men and women volunteers. Monitoring of water mass loss due to perspiration was performed by medical balance measurements following one of two different treadmill physical exercise regimens over 90 minutes in 15-minute intervals with intervening 10-minute rest periods. Participants wore two different models of the dehydration body monitor device mated to commercially-available smartwatches (Samsung Gear S2 and Samsung Gear Fit2). Device output was recorded by Bluetooth wireless link to a standard smartphone in 20-second blocks. Comparison of the devices with the standard measurement method (change in body mass measured by medical balance) indicated very close agreement between changes in body water mass and device output (percent normalized mean root square error averaged approximately 2% for all participants). Bland-Altman analyses of method agreement indicated that <5% of participant values fell outside of the 95% confidence interval limits of agreement and all measured value differences were normally distributed around the line of equality. The results of this first-ever field trial of a practical, wearable hydration monitor suggests that this device will be a reliable tool to aid in geriatric hydration monitoring and physical training scenarios.

A pH-independent electrochemical aptamer-based biosensor supports quantitative, real-time measurement in vivo

The development of biosensors capable of achieving accurate and precise molecular measurements in the living body in pH-variable biological environments (e.g. subcellular organelles, biological fluids and organs) plays a significant role in personalized medicine. Because they recapitulate the conformation-linked signaling mechanisms, electrochemical aptamer-based (E-AB) sensors are good candidates to fill this role. However, this class of sensors suffers from a lack of a stable and pH-independent redox reporter to support their utility under pH-variable conditions. Here, in response, we demonstrate the efficiency of an electron donor π-extended tetrathiafulvalene (exTTF) as an excellent candidate (due to its good electrochemical stability and no proton participation in its redox reaction) of pH-independent redox reporters. Its use has allowed improvement of E-AB sensing performance in biological fluids under different pH conditions, achieving high-frequency, real-time molecular measurements in biological samples both in vitro and in the bladders of living rats.

Emerging single atom catalysts in gas sensors

Single atom catalysts (SACs) offer unprecedented opportunities for high-efficiency reactions taking place in many important fields of catalytic processes, electrochemistry, and photoreactions. Due to their maximized atomic utilization and unique electronic and chemical properties, SACs can provide high activity and excellent selectivity for gas adsorption and electron transport, leveraging SACs that enhance the detection sensitivity and selectivity to target gases. In the past few years, SACs including both noble (Pt, Pd, Au, etc.) and non-noble (Mn, Ni, Zn etc.) metals have been demonstrated to be very useful in optimizing sensing performances. However, a comprehensive review on this topic is still missing. Herein, we summarize the synthesis technologies of SACs that are applicable to gas sensors. The electronic and chemical interactions between SACs and host sensing materials, which are crucial to sensor functions, are discussed. Then, we highlight the application progress of various SACs in gas sensors. Prospects in the creation of new sensing materials with emerging SACs and versatile supports are also present. Finally, the challenges and prospects of SACs in the future development of sensors are analyzed.

Self-Powered Carbon Ink/Filter Paper Flexible Humidity Sensor Based on Moisture-Induced Voltage Generation

Cellulose paper-based materials are highly flexible, hydrophilic, low-cost, and environmentally friendly and are good substrates for use as humidity sensors. Therefore, developing a paper-based humidity sensor with facile fabrication, low cost, and high sensitivity is important for expanding its practical applications. Herein, we propose a CI/FP self-powered humidity sensor based on everyday items such as writing and drawing carbon ink (CI), cellulose filter paper (FP), and polyester conductive adhesive tape, which is fabricated with the help of facile dip-coating and pasting methods. This sensor is self-powered, and the paper-based material itself can absorb water molecules in a humid environment to generate humidity-related voltage and current, which can indirectly reflect the ambient humidity level. They are characterized by a wide relative humidity (RH) sensing range (11-98%), good linearity (R² = 0.97011), high response voltage (0.19 V), and excellent flexibility (over 1000 bends). This humidity sensor can be successfully applied to monitor human health (breathing, coughing), air humidity, and noncontact humidity sensing (skin, wet objects). This work not only proposes a low-cost and facile method for flexible humidity sensors but also provides a valuable strategy for the development of self-powered wearable electronics.

Surface Wettability for Skin-Interfaced Sensors and Devices

The practical applications of skin-interfaced sensors and devices in daily life hinge on the rational design of surface wettability to maintain device integrity and achieve improved sensing performance under complex hydrated conditions. Various bio-inspired strategies have been implemented to engineer desired surface wettability for varying hydrated conditions. Although the bodily fluids can negatively affect the device performance, they also provide a rich reservoir of health-relevant information and sustained energy for next-generation stretchable self-powered devices. As a result, the design and manipulation of the surface wettability are critical to effectively control the liquid behavior on the device surface for enhanced performance. The sensors and devices with engineered surface wettability can collect and analyze health biomarkers while being minimally affected by bodily fluids or ambient humid environments. The energy harvesters also benefit from surface wettability design to achieve enhanced performance for powering on-body electronics. In this review, we first summarize the commonly used approaches to tune the surface wettability for target applications toward stretchable self-powered devices. By considering the existing challenges, we also discuss the opportunities as a small fraction of potential future developments, which can lead to a new class of skin-interfaced devices for use in digital health and personalized medicine.

Materials with Tunable Optical Properties for Wearable Epidermal Sensing in Health Monitoring

Advances in wearable epidermal sensors have revolutionized the way that physiological signals are captured and measured for health monitoring. One major challenge is to convert physiological signals to easily readable signals in a convenient way. One possibility for wearable epidermal sensors is based on visible readouts. There are a range of materials whose optical properties can be tuned by parameters such as temperature, pH, light, and electric fields. Herein, this review covers and highlights a set of materials with tunable optical properties and their integration into wearable epidermal sensors for health monitoring. Specifically, the recent progress, fabrication, and applications of these materials for wearable epidermal sensors are summarized and discussed. Finally, the challenges and perspectives for the next generation wearable devices are proposed.

Wearable microfluidic patch with integrated capillary valves and pumps for sweat management and multiple biomarker analysis

Wearable sweat sensors are essential for providing insight into human physiological health. The currently developed microfluidic sweat sensors have demonstrated the function of collecting and storing sweat. However, they detect more average concentrations of substances based on time periods, which leads to the fact that in situ real-time measurement for multiple biomarkers remains a grand challenge. Here, we propose a wearable epidermal microfluidic patch with integrated microfluidic pumps and micro-valves for accelerated and continuous collection of the sweat, where the micro-pumps ensure the complete separation of old and new sweat for real-time detection of real concentration of biomarkers in sweat. The biomarker concentration at different time periods is detected by introducing a burst valve, which is used to assist in the analysis of the real-time detection. A quantitative relationship between the minimum burst pressure difference required for sequential collection and the size of the microchannel structure is established to overcome the effects of additional resistance at the gas-liquid interface. Additionally, the sensing modules, including sodium ion, chlorine ion, glucose, and pH level in sweat, are integrated into the patch to realize in situ, real-time detection of multiple biomarkers in the human sweat, decoding the correlation between changes in substance concentrations and physiological conditions. This work provides a unique and simplifying strategy for developing wearable sweat sensors for potential applications in health monitoring and disease diagnostics.

A Review of Multi-Material 3D Printing of Functional Materials via Vat Photopolymerization

Additive manufacturing or 3D printing of materials is a prominent process technology which involves the fabrication of materials layer-by-layer or point-by-point in a subsequent manner. With recent advancements in additive manufacturing, the technology has excited a great potential for extension of simple designs to complex multi-material geometries. Vat photopolymerization is a subdivision of additive manufacturing which possesses many attractive features, including excellent printing resolution, high dimensional accuracy, low-cost manufacturing, and the ability to spatially control the material properties. However, the technology is currently limited by design strategies, material chemistries, and equipment limitations. This review aims to provide readers with a comprehensive comparison of different additive manufacturing technologies along with detailed knowledge on advances in multi-material vat photopolymerization technologies. Furthermore, we describe popular material chemistries both from the past and more recently, along with future prospects to address the material-related limitations of vat photopolymerization. Examples of the impressive multi-material capabilities inspired by nature which are applicable today in multiple areas of life are briefly presented in the applications section. Finally, we describe our point of view on the future prospects of 3D printed multi-material structures as well as on the way forward towards promising further advancements in vat photopolymerization.

Closing the loop for patients with Parkinson disease: where are we?

Although levodopa remains the most efficacious symptomatic therapy for Parkinson disease (PD), management of levodopa treatment during the advanced stages of the disease is extremely challenging. This difficulty is a result of levodopa's short half-life, a progressive narrowing of the therapeutic window, and major inter-patient and intra-patient variations in the dose-response relationship. Therefore, a suitable alternative to repeated oral administration of levodopa is being sought. Recent research efforts have focused on the development of novel levodopa delivery strategies and wearable physical sensors that track symptoms and disease progression. However, the need for methods to monitor the levels of levodopa present in the body in real time has been overlooked. Advances in chemical sensor technology mean that the development of wearable and mobile biosensors for continuous or frequent levodopa measurements is now possible. Such levodopa monitoring could help to deliver personalized and timely medication dosing to alleviate treatment-related fluctuations in the symptoms of PD. Therefore, with the aim of optimizing therapeutic management of PD and improving the quality of life of patients, we share our vision of a future closed-loop autonomous wearable 'sense-and-act' system. This system consists of a network of physical and chemical sensors coupled with a levodopa delivery device and is guided by effective big data fusion algorithms and machine learning methods.

Advanced wearable biosensors for the detection of body fluids and exhaled breath by graphene

Given the huge economic burden caused by chronic and acute diseases on human beings, it is an urgent requirement of a cost-effective diagnosis and monitoring process to treat and cure the disease in their preliminary stage to avoid severe complications. Wearable biosensors have been developed by using numerous materials for non-invasive, wireless, and consistent human health monitoring. Graphene, a 2D nanomaterial, has received considerable attention for the development of wearable biosensors due to its outstanding physical, chemical, and structural properties. Moreover, the extremely flexible, foldable, and biocompatible nature of graphene provide a wide scope for developing wearable biosensor devices. Therefore, graphene and its derivatives could be trending materials to fabricate wearable biosensor devices for remote human health management in the near future. Various biofluids and exhaled breath contain many relevant biomarkers which can be exploited by wearable biosensors non-invasively to identify diseases. In this article, we have discussed various methodologies and strategies for synthesizing and pattering graphene. Furthermore, general sensing mechanism of biosensors, and graphene-based biosensing devices for tear, sweat, interstitial fluid (ISF), saliva, and exhaled breath have also been explored and discussed thoroughly. Finally, current challenges and future prospective of graphene-based wearable biosensors have been evaluated with conclusion. Graphene is a promising 2D material for the development of wearable sensors. Various biofluids (sweat, tears, saliva and ISF) and exhaled breath contains many relevant biomarkers which facilitate in identify diseases. Biosensor is made up of biological recognition element such as enzyme, antibody, nucleic acid, hormone, organelle, or complete cell and physical (transducer, amplifier), provide fast response without causing organ harm.

Ag Functionalized In2O3 Derived From MIL-68(In) as an Efficient Electrochemical Glucose Sensor

In this study, Ag@In2O3 modified nickel foam (NF) was reported for its role as a non-enzymatic glucose sensor. Ag@In2O3 was prepared by a simple two-step method; preparation of a metal-organic framework (MOF) MIL-68(In) by solvothermal method, entrapment of Ag + by adding AgNO3 then drying it for 2 h to complete the entrapment process and subsequent calcination at 650°C for 3 h. The Ag@In2O3 modified NF was employed as a non-enzymatic glucose sensor to determine glucose concentrations in an alkaline medium. Two linear ranges were obtained from Ag@In2O3 modified electrode, i.e., 10 μM to 0.8 mM and 0.8–2.16 mM with a sensitivity of 3.31 mA mM−1 cm−2 and 1.51 mA mM−1 cm−2 respectively, with a detection limit of 0.49 µM. Ag@In2O3 modified NF exhibited high selectivity for glucose, among other interfering agents.

Smart Hydrogel Sensors with Antifreezing, Antifouling Properties for Wound Healing

Flexible electronic devices with biological therapeutic and sensing properties are one of the current research directions. Here, a multifunctional hydrogel for stress sensing and wound healing was prepared by a simple one-pot method and a solution replacement method. Among them, zwitterionic polymers promote wound healing by promoting the polarization of M2 macrophages, collagen deposition, and blood vessel formation. Glycerin can significantly improve the resilience and frost resistance of the hydrogel, ensuring that a sensor made using the hydrogel can work normally in a cold environment. In addition, zwitterionic polymers are highly biocompatible, providing excellent antibacterial adhesion to aid the wound healing process, and good electrical conductivity enhances sensing sensitivity and stability. Based on these properties, multifunctional hydrogels could detect human vital activities while promoting wound healing, providing new ideas for the fields of diagnosis and wound dressing.

Kirigami-Inspired Biodesign for Applications in Healthcare

Mechanically flexible and conformable materials and integrated devices have found diverse applications in personalized healthcare as diagnostics and therapeutics, tissue engineering and regenerative medicine constructs, surgical tools, secure systems, and assistive technologies. In order to impart optimal mechanical properties to the (bio)materials used in these applications, various strategies have been explored-from composites to structural engineering. In recent years, geometric cuts inspired by the art of paper-cutting, referred to as kirigami, have provided innovative opportunities for conferring precise mechanical properties via material removal. Kirigami-based approaches have been used for device design in areas ranging from soft bioelectronics to energy storage. In this review, the principles of kirigami-inspired engineering specifically for biomedical applications are discussed. Factors pertinent to their design, including cut geometry, materials, and fabrication, and the effect these parameters have on their properties and configurations are covered. Examples of kirigami designs in healthcare are presented, such as, various form factors of sensors (on skin, wearable), implantable devices, therapeutics, surgical procedures, and cellular scaffolds for regenerative medicine. Finally, the challenges and future scope for the successful translation of these biodesign concepts to broader deployment are discussed.

Recent Progress in Microneedles-Mediated Diagnosis, Therapy, and Theranostic Systems

Theranostic system combined diagnostic and therapeutic modalities is critical for the real-time monitoring of disease-related biomarkers and personalized therapy. Microneedles, as a multifunctional platform, are promising for transdermal diagnostics and drug delivery. They have shown attractive properties including painless skin penetration, easy self-administration, prominent therapeutic effects, and good biosafety. Herein, an overview of the microneedles-based diagnosis, therapies, and theranostic systems is given. Four microneedles-based detection methods are concluded based on the sensing mechanism: i) electrochemistry, ii) fluorometric, iii) colorimetric, and iv) Raman methods. Additionally, robust microneedles are suitable for implantable drug delivery. Microneedles-assisted transdermal drug delivery can be primarily classified as passive, active, and responsive drug release, based on the release mechanisms. Microneedles-assisted oral and implantable drug delivery mechanisms are also presented in this review. Furthermore, the key frontier developments in microneedles-mediated theranostic systems as the major selling points are emphasized in this review. These systems are classified into open-loop and closed-loop theranostic systems based on the indirectness and directness of feedback between the transdermal diagnosis and therapy, respectively. Finally, conclusions and future perspectives for next-generation microneedles-mediated theranostic systems are also discussed. Taken together, microneedle-based systems are promising as the new avenue for diagnosis, therapy, and disease-specific closed-loop theranostic applications.

Multifunctional flexible contact lens for eye health monitoring using inorganic magnetic oxide nanosheets

As a non-invasive innovative diagnosis platform, advanced flexible contact lenses can dynamically monitor vital ocular indicators, spot abnormalities and provide biofeedback guidance for real-time diagnosis and rehabilitation tracking of chronic eye diseases. However, most of the state-of-the-art reported contact lenses either can only monitor a single indicator at a time or realize multifunctional integration based on multiple materials. Herein, we developed a flexible multifunctional contact lens based on inorganic γ-Fe₂O₃@NiO magnetic oxide nanosheets, which can be attached conformally and seamlessly to the eyeball to simultaneously monitor glucose level in tears, eyeball movement, and intraocular pressure. The optimized contact lens has a reliable glucose detection limit (0.43 μmol), superior eye movement measurement accuracy (95.27%) and high intraocular pressure sensitivity (0.17 MHz mmHg^− 1). This work presents a concept in the biochemical and biophysical integrated sensing of ocular signals using contact lens via an innovative material, and provides a personalized and efficient way for health management.

In-situ preparation of lactate-sensing membrane for the noninvasive and wearable analysis of sweat

In the wearable electrochemical biosensors, sensing signal duration is significantly dependent on the long-term stability of functional materials modified on the flexible substrate, the effect of pH changes of sweat on the sensing device and signal fluctuation caused by the bending of sensor. Here, we proposed a wearable biosensor based on the lactate-sensing membrane mainly constituted by Prussian blue (PB), reduced graphene oxide (rGO), Au nanoparticles and lactate oxidase (LOx). Based on the in-situ layer-by-layer spin-coating preparation method, the electrode surface was covered with an extensive and uniform PB/GO membrane with a high stability. After the electro-reduction of GO to rGO and the combination of urchin-like Au particles with sufficient tentacles to LOx, the sensing membrane showed the improved electron transport from the enzyme active center to the electrode. Therefore, the wearable biosensor achieved a high sensitivity of 40.6 μA mM^-1 cm^-2 in a range of 1-222 μM and a low sensitivity of 1.9 μA mM^-1 cm^-2 in a wide range of 0.222-25 mM, satisfying the requirement of the typical test. In addition, with the excellent running and mechanical stability, the lactate biosensor was successfully applied on volunteers' skin for real-time monitoring of perspiration in vivo. The results were comparable with ex vivo measurements achieved by a commercial lactate sensor. The wearable electrochemical biosensor provides a good candidate in the future for the evaluation of human sweat in sports and biomedical fields.

Wearable Bioelectronics for Chronic Wound Management

Chronic wounds are a major healthcare issue and can adversely affect the lives of millions of patients around the world. The current wound management strategies have limited clinical efficacy due to labor-intensive lab analysis requirements, need for clinicians' experiences, long-term and frequent interventions, limiting therapeutic efficiency and applicability. The growing field of flexible bioelectronics enables a great potential for personalized wound care owing to its advantages such as wearability, low-cost, and rapid and simple application. Herein, recent advances in the development of wearable bioelectronics for monitoring and management of chronic wounds are comprehensively reviewed. First, the design principles and the key features of bioelectronics that can adapt to the unique wound milieu features are introduced. Next, the current state of wound biosensors and on-demand therapeutic systems are summarized and highlighted. Furthermore, we discuss the design criteria of the integrated closed loop devices. Finally, the future perspectives and challenges in wearable bioelectronics for wound care are discussed.

Skin bioelectronics towards long-term, continuous health monitoring

Skin bioelectronics are considered as an ideal platform for personalised healthcare because of their unique characteristics, such as thinness, light weight, good biocompatibility, excellent mechanical robustness, and great skin conformability. Recent advances in skin-interfaced bioelectronics have promoted various applications in healthcare and precision medicine. Particularly, skin bioelectronics for long-term, continuous health monitoring offer powerful analysis of a broad spectrum of health statuses, providing a route to early disease diagnosis and treatment. In this review, we discuss (1) representative healthcare sensing devices, (2) material and structure selection, device properties, and wireless technologies of skin bioelectronics towards long-term, continuous health monitoring, (3) healthcare applications: acquisition and analysis of electrophysiological, biophysical, and biochemical signals, and comprehensive monitoring, and (4) rational guidelines for the design of future skin bioelectronics for long-term, continuous health monitoring. Long-term, continuous health monitoring of advanced skin bioelectronics will open unprecedented opportunities for timely disease prevention, screening, diagnosis, and treatment, demonstrating great promise to revolutionise traditional medical practices.

Configurable direction sensitivity of skin-mounted microfluidic strain sensor with auxetic metamaterial

Electromechanical coupling plays a key role in determining the performance of stretchable strain sensor. Current regulation of the electromechanical coupling in stretchable strain sensor is largely restricted by the intrinsic mechanical properties of the device. In this study, a microfluidic strain sensor based on the core-shell package design with the auxetic metamaterial (AM) is presented. By overriding the mechanical properties of the device, the AM in the package effectively tunes the deformation of the microfluidic channel with the applied strain and configures the directional strain sensitivity with a large modulation range. The gauge factor (GF) of the strain sensor in the radial direction of the channel can be gradually shifted from the intrinsically negative value to a positive one by adopting the AMs with different designs. By simply replacing the AM in the package, the microfluidic strain sensor with the core-shell package can be configurated as an omnidirectional or directional stretchable strain sensor. With the directional sensitivity brought by the rational AM design, the application of the AM-integrated strain sensor in the skin-mounted tactile detection is demonstrated with high tolerance to unintended wrist movements.

Validation of the Application of Solid Contact Ion-Selective Electrode for Off-Body Sweat Ion Monitoring

The solid contact ion-selective electrode (ISE) is a promising skin-interfaced monitoring system for sweat ions. Despite a growing number of on-body usages of ISE with fancy new materials and device fabrications, there are very few reports attempting to validate ISE results with a gold standard technique. For this purpose, this work uses inductively coupled plasma-optical emission spectrometry (ICP-OES) as a reference technique to conduct a direct evaluation of the sweat sodium and potassium ion levels obtained by ISE in an off-body approach. Eight healthy male subjects were recruited to collect exercise-induced sweat. It was found that sweat sodium and potassium ions present a rather wide concentration range. The sweat sodium concentration did not vary greatly in an exercise period of half an hour, while the sweat potassium concentration typically decreased with exercise. Mineral drink intake had no clear impact on the sweat sodium level, but increased the sweat potassium level. A paired t-test and mean absolute relative difference (MARD) analysis, a method typically used for evaluating the performance of glucometers, was employed to compare the results of ISE and ICP-OES. The statistical analysis validated the feasibility of ISE for measuring sweat ions, although better accuracy is required. Our data suggests that overweight subjects are likely to possess a higher sweat sodium level.

A Flexible Aqueous Zinc-Iodine Microbattery with Unprecedented Energy Density

Currently, reported aqueous microbatteries (MBs) only show unsatisfactory electrochemical performance (≤120 mWh cm^-3 volumetric energy density and <1000 μWh cm^-2 areal energy density) and it remains challenging to develop durable aqueous MBs that can simultaneously offer both high volumetric and areal energy density. Herein, an in situ electrodeposition strategy is adopted to construct a flexible aqueous zinc-iodine MB (ZIDMB). Notably, the fabrication process well avoids the use of common additives (such as binders, conductive agents, and toxic solvent) and also bypasses subsequent time-consuming procedures such as grinding, coating, drying, etc., thus greatly simplifying the manufacture of the ZIDMB. Meanwhile, owing to the suppression of the shuttle effect of triiodide ions and the high ionic conductivity of the polyelectrolyte, the ZIDMB can simultaneously deliver record-high volumetric and areal energy densities of 1647.3 mWh cm^-3 and 2339.1 μWh cm^-2 , thus achieving values at least 13.5- and 2.3-fold better than those of best available aqueous MBs, respectively. This work affords an innovative strategy to construct an ideal micro-power-source for future miniaturized and integrated electronics.

Salivary biomarkers of neurodegenerative and demyelinating diseases and biosensors for their detection

Salivary analysis is gaining increasing interest as a novel and promising field of research for the diagnosis of neurodegenerative and demyelinating diseases related to aging. The collection of saliva offers several advantages, being noninvasive, stress-free, and repeatable. Moreover, the detection of biomarkers directly in saliva could allow an early diagnosis of the disease, leading to timely treatments. The aim of this manuscript is to highlight the most relevant researchers' findings relatively to salivary biomarkers of neurodegenerative and demyelinating diseases, and to describe innovative and advanced biosensing strategies for the detection of salivary biomarkers. This review is focused on five relevant aging-related neurodegenerative disorders (Alzheimer's disease, Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Multiple Sclerosis) and the salivary biomarkers most commonly associated with them. Advanced biosensors enabling molecular diagnostics for the detection of salivary biomarkers are presented, in order to stimulate future research in this direction and pave the way for their clinical application.