Wearable and flexible electronics for continuous molecular monitoring

Non-toxic near-infrared light-emitting diodes

Harnessing cost-efficient printable semiconductor materials as near-infrared (NIR) emitters in light-emitting diodes (LEDs) is extremely attractive for sensing and diagnostics, telecommunications, and biomedical sciences. However, the most efficient NIR LEDs suitable for printable electronics rely on emissive materials containing precious transition metal ions (such as platinum), which have triggered concerns about their poor biocompatibility and sustainability. Here, we review and highlight the latest progress in NIR LEDs based on non-toxic and low-cost functional materials suitable for solution-processing deposition. Different approaches to achieve NIR emission from organic and hybrid materials are discussed, with particular focus on fluorescent and exciplex-forming host-guest systems, thermally activated delayed fluorescent molecules, aggregation-induced emission fluorophores, as well as lead-free perovskites. Alternative strategies leveraging photonic microcavity effects and surface plasmon resonances to enhance the emission of such materials in the NIR are also presented. Finally, an outlook for critical challenges and opportunities of non-toxic NIR LEDs is provided.

Microneedle-Based Potentiometric Sensing System for Continuous Monitoring of Multiple Electrolytes in Skin Interstitial Fluids

Electrolytes play a pivotal role in regulating cardiovascular functions, hydration, and muscle activation. The current standards for monitoring electrolytes involve periodic sampling of blood and measurements using laboratory techniques, which are often uncomfortable/inconvenient to the subjects and add considerable expense to the management of their underlying disease conditions. The wide range of electrolytes in skin interstitial fluids (ISFs) and their correlations with those in plasma create exciting opportunities for applications such as electrolyte and circadian metabolism monitoring. However, it has been challenging to monitor these electrolytes in the skin ISFs. In this study, we report a minimally invasive microneedle-based potentiometric sensing system for multiplexed and continuous monitoring of Na⁺ and K⁺ in the skin ISFs. The potentiometric sensing system consists of a miniaturized stainless-steel hollow microneedle to prevent sensor delamination and a set of modified microneedle electrodes for multiplex monitoring. We demonstrate the measurement of Na⁺ and K⁺ in artificial ISFs with a fast response time, excellent reversibility and repeatability, adequate selectivity, and negligible potential interferences upon the addition of a physiologically relevant concentration of metabolites, dietary biomarkers, and nutrients. In addition, the sensor maintains the sensitivity after multiple insertions into the chicken skin model. Furthermore, the measurements in artificial ISFs using calibrated sensors confirm the accurate measurements of physiological electrolytes in artificial ISFs. Finally, the skin-mimicking phantom gel and chicken skin model experiments demonstrate the sensor's potential for minimally invasive monitoring of electrolytes in skin ISFs. The developed sensor platform can be adapted for a wide range of other applications, including real-time monitoring of nutrients, metabolites, and proteins.

Catalytic effects of magnetic and conductive nanoparticles on immobilized glucose oxidase in skin sensors

Wearable skin sensors is a promising technology for real-time health care monitoring. They are of particular interest for monitoring glucose in diabetic patients. The concentration of glucose in sweat can be more than two orders of magnitude lower than in blood. In consequence, the scientific and technological efforts are focused in developing new concepts to enhance the sensitivity, decrease the limit of detection (LOD) and reduce the response time (RT) of glucose skin sensors. This work explores the effect of adsorbed superparamagnetic magnetite nanoparticles (MNPs) and conductive nanoparticles (CNPs) on carbon nanotube substrates (CNTs) used to immobilize glucose oxidase enzyme in the working electrode of skin sensors. MNPs and CNPs are made of magnetite and gold, respectively. The performance of the sensors was tested in standard buffer solution, artificial sweat, fresh sweat and on the skin of a healthy volunteer during an exercise session. In the case of artificial sweat, the presence of MNPs accelerated the RT from 7 to 5 s at the expense of increasing the LOD from 0.017 to 0.022 mM with slight increase of the sensitivity from 4.90 to 5.09μAm M^-1cm^-2. The presence of CNPs greatly accelerated the RT from 7 to 2 s and lowered the LOD from 0.017 to 0.014 mM at the expense of a great diminution of the sensitivity from 4.90 to 4.09μAm M^-1cm^-2. These effects were explained mechanistically by analyzing the changes in the concentration of free oxygen and electrons promoted by MNPs and CNPs in the CNTs and its consequences on the the glucose oxidation process.

Paper-based wearable electronics

Skin-interfaced wearable electronics can find a broad spectrum of applications in healthcare, human-machine interface, robotics, and others. The state-of-the-art wearable electronics usually suffer from costly and complex fabrication procedures and nonbiodegradable polymer substrates. Paper, comprising entangled micro- or nano-scale cellulose fibers, is compatible with scalable fabrication techniques and emerges as a sustainable, inexpensive, disposable, and biocompatible substrate for wearable electronics. Given various attractive properties (e.g., breathability, flexibility, biocompatibility, and biodegradability) and rich tunability of surface chemistry and porous structures, paper offers many exciting opportunities for wearable electronics. In this review, we first introduce the intriguing properties of paper-based wearable electronics and strategies for cellulose modifications to satisfy specific demands. We then overview the applications of paper-based devices in biosensing, energy storage and generation, optoelectronics, soft actuators, and several others. Finally, we discuss some challenges that need to be addressed before practical uses and wide implementation of paper-based wearable electronics.

SP, N. M, Barik AK, Pai KM, Unnikrishnan VK, George SD, Kartha VB, Chidangil S. Photonics of human saliva: potential optical methods for the screening of abnormal health conditions and infections

Human saliva can be treated as a pool of biological markers able to reflect on the state of personal health. Recent years have witnessed an increase in the use of optical devices for the analysis of body fluids. Several groups have carried out studies investigating the potential of saliva as a non-invasive and reliable clinical specimen for use in medical diagnostics. This brief review aims to highlight the optical technologies, mainly surface plasmon resonance (SPR), Raman, and Fourier transform infrared (FTIR) spectroscopy, which are being used for the probing of saliva for diverse biomedical applications. Advances in bio photonics offer the promise of unambiguous, objective and fast detection of abnormal health conditions and viral infections (such as COVID-19) from the analysis of saliva.

Energy-efficient IoT based improved health monitoring system for sports persons

Nowadays, wearable technology and the Internet of Things (IoT) are transforming the healthcare sector by refining the way how devices, applications, and people connect and interact with each other. IoT applications in sports are tremendously useful to monitor health and reduce the risk factor. The battery life of wearable and accurate monitoring has been considered a significant challenge in sports medicine. Hence, in this paper, Energy Efficient IoT based Improved Health Monitoring system (EEIoT-IHMS) has been proposed for accurate and continuous sports person’s health monitoring system. This paper determines the optimal set of clusters based on sensor features, in which power usage has been minimized by duty cycling with optimized prediction accuracy. The experimental results demonstrate that the proposed (EEIoT-IHMS) enhances accuracy ratio, improves battery life, and reduces energy consumption compared to other popular methods.

Novel Conformal Skin Patch with Embedded Thin-Film Electrodes for Early Detection of Extravasation

Extravasation is a complication of intravenous (IV) cannulation in which vesicant drugs leak from a vein into the surrounding subcutaneous tissue. The severity of extravasation depends on the type, concentration, and volume of drugs that accumulate in the subcutaneous tissue. Rapid detection of extravasation can facilitate prompt medical intervention, minimizing tissue damage, and preventing adverse events. In this study, we present two portable sensor patches, namely gold- and carbon-based sensing patches, for early detection of extravasation. The gold-based sensor patch detected extravasated fluid of volume as low as 2 mL in in vivo animal models and human clinical trials; the patch exhibited a resistance change of 41%. The carbon-based sensor patch exhibited a resistance change of 51% for 2 mL of extravasated fluid, and fabrication throughput and cost-effectiveness are superior for this patch compared with the gold-based sensing patch.

A review on nanostructured thin films on flexible substrates: links between strains and magnetic properties

This paper provides a topical review of work on systems based on magnetic nanostructured thin films on polymer substrates. This topic has indeed experienced a significant growth in the last ten years. Several studies show a strong potential of these systems for a number of applications requiring functionalities on non-planar surfaces. However, the deformations necessary for this type of applications are likely to modify their magnetic properties, and the relationships between strain fields, potential damages and functional properties must be well understood. This review focuses both on the development of techniques dedicated to this research, on the synthesis of the experimental results obtained over the last ten years and on the perspectives related to stretchable or flexible magnetoelectric systems. In particular, the article focuses on the links between magnetic behavior and the strain field developing during the whole history of these systems (elaboration, reversible and irreversible loading).

Stretchable wideband dipole antennas and rectennas for RF energy harvesting

The ultimate application of bio-integrated, stretchable electronics hinges on the indispensable modules of stretchable wireless data transmission and power supplies. While radiofrequency (RF) antennas and rectennas could enable wireless communication and RF energy harvesting in the far-field, their performance deteriorates because of the frequency detuning from mechanical deformations. Here, stretchable wideband antennas and rectennas are introduced to robustly operate and combine received RF power over their wideband upon mechanical deformations. Devices with stretchable wideband antennas and rectennas create application opportunities such as self-powered systems, remote monitoring of the environment, and clean energy. A comprehensive set of manufacturing schemes, device components, and theoretical design tools for the stretchable wideband antennas and rectennas is reported. A stretchable wideband rectenna integrated with various functional sensing modules and its demonstration with enhanced effective rectenna efficiency over the state-of-the-art by 10-100 times illustrates a system-level example of this technology.

A flexible multiplexed immunosensor for point-of-care in situ wound monitoring

Chronic wounds arise from interruption of normal healing due to many potential pathophysiological factors. Monitoring these multivariate factors can provide personalized diagnostic information for wound management, but current sensing technologies use complex laboratory tests or track a limited number of wound parameters. We report a flexible biosensing platform for multiplexed profiling of the wound microenvironment, inflammation, and infection state at the point of care. This platform integrates a sensor array for measuring inflammatory mediators [tumor necrosis factor-α, interleukin-6 (IL-6), IL-8, and transforming growth factor-β1], microbial burden (Staphylococcus aureus), and physicochemical parameters (temperature and pH) with a microfluidic wound exudate collector and flexible electronics for wireless, smartphone-based data readout. We demonstrate in situ multiplexed monitoring in a mouse wound model and also profile wound exudates from patients with venous leg ulcers. This technology may facilitate more timely and personalized wound management to improve chronic wound healing outcomes.

Small-volume detection: platform developments for clinically-relevant applications

Biochemical analysis of human body fluids is a frequent and fruitful strategy for disease diagnosis. Point-of-care (POC) diagnostics offers the tantalizing possibility of providing rapid diagnostic results in non-laboratory settings. Successful diagnostic testing using body fluids has been reported on in the literature; however, small-volume detection devices, which offer remarkable advantages such as portability, inexpensiveness, capacity for mass production, and tiny sample volume requirements have not been thoroughly discussed. Here, we review progress in this research field, with a focus on developments since 2015. In this review article, we provide a summary of articles that have detailed the development of small-volume detection strategies using clinical samples over the course of the last 5 years. Topics covered include small-volume detection strategies in ophthalmology, dermatology or plastic surgery, otolaryngology, and cerebrospinal fluid analysis. In ophthalmology, advances in technology could be applied to examine tear or anterior chamber (AC) fluid for glucose, lactoferrin, interferon, or VEGF. These approaches could impact detection and care for diseases including diabetic mellitus, dry-eye disease, and age-related maculopathy. Early detection and easy monitoring are critical approaches for improving overall care and outcome. In dermatology or plastic surgery, small-volume detection strategies have been applied for passive or interactive wound dressing, wound healing monitoring, and blister fluid analysis for autoimmune disease diagnosis. In otolaryngology, the analysis of nasal secretions and mucosa could be used to differentiate between allergic responses and infectious diseases. Cerebrospinal fluid analysis could be applied in neurodegenerative diseases, central neural system infection and tumor diagnosis. Other small-volume fluids that have been analyzed for diagnostic and monitoring purposes include semen and cervico-vaginal fluids. We include more details regarding each of these fluids, associated collection and detection devices, and approaches in our review.

Optical glucose biosensor built-in disposable strips and wearable electronic devices

On-demand screening, real-time monitoring and rapid diagnosis of ubiquitous diseases, such as diabetes, at early stages are indispensable in personalised treatment. Emerging impacts of nano/microscale materials on optical and portable biosensor strips and devices have become increasingly important in the remarkable development of sensitive visualisation (i.e. visible inspection by the human eye) assays, low-cost analyses and personalised home testing of patients with diabetes. With the increasing public attention regarding the self-monitoring of diabetes, the development of visual readout, easy-to-use and wearable biosensors has gained considerable interest. Our comprehensive review bridges the practical assessment gap between optical bio-visualisation assays, disposable test strips, sensor array designs and full integration into flexible skin-based or contact lens devices with the on-site wireless signal transmission of glucose detection in physiological fluids. To date, the fully modulated integration of nano/microscale optical biosensors into wearable electronic devices, such as smartphones, is critical to prolong periods of indoor and outdoor clinical diagnostics. Focus should be given to the improvements of invasive, wireless and portable sensing technologies to improve the applicability and reliability of screen display, continuous monitoring, dynamic data visualisation, online acquisition and self and in-home healthcare management of patients with diabetes.

Wearable Sensors and Systems for Wound Healing-Related pH and Temperature Detection

Wound healing is a complex tissue regeneration process involving many changes in multiple physiological parameters. The pH and temperature of a wound site have long been recognized as important biomarkers for assessing wound healing status. For effective wound management, wound dressings integrated with wearable sensors and systems used for continuous monitoring of pH and temperature have received much attention in recent years. Herein, recent advances in the development of wearable pH and temperature sensors and systems based on different sensing mechanisms for wound status monitoring and treatment are comprehensively summarized. Challenges in the areas of sensing performance, infection identification threshold, large-area 3-dimensional detection, and long-term reliable monitoring in current wearable sensors/systems and emerging solutions are emphasized, providing critical insights into the development of wearable sensors and systems for wound healing monitoring and management.

Flexible electrochemical biosensors for healthcare monitoring

As the interest in wearable devices has increased recently, increasing biosensor flexibility has begun to attract considerable attention. Among the various types of biosensors, electrochemical biosensors are uniquely suited for the development of such flexible biosensors due to their many advantages, including their fast response, inherent miniaturization, convenient operation, and portability. Therefore, many studies on flexible electrochemical biosensors have been conducted in recent years to achieve non-invasive and real-time monitoring of body fluids such as tears, sweat, and saliva. To achieve this, various substrates, novel nanomaterials, and detection techniques have been utilized to develop conductive flexible platforms that can be applied to create flexible electrochemical biosensors. In this review, we discussed recently reported flexible electrochemical biosensors and divided them into specific categories including materials for flexible substrate, fabrication techniques for flexible biosensor development, and recently developed flexible electrochemical biosensors to externally monitor target molecules, thereby providing a means to noninvasively examine cells and body fluid samples. In conclusion, this review will discuss the materials, methods, recent studies, and perspectives on flexible electrochemical biosensors for healthcare monitoring and wearable biosensing systems.

Advances in airborne microorganisms detection using biosensors: A critical review

Humanity has been facing the threat of a variety of infectious diseases. Airborne microorganisms can cause airborne infectious diseases, which spread rapidly and extensively, causing huge losses to human society on a global scale. In recent years, the detection technology for airborne microorganisms has developed rapidly; it can be roughly divided into biochemical, immune, and molecular technologies. However, these technologies still have some shortcomings; they are time-consuming and have low sensitivity and poor stability. Most of them need to be used in the ideal environment of a laboratory, which limits their applications. A biosensor is a device that converts biological signals into detectable signals. As an interdisciplinary field, biosensors have successfully introduced a variety of technologies for bio-detection. Given their fast analysis speed, high sensitivity, good portability, strong specificity, and low cost, biosensors have been widely used in environmental monitoring, medical research, food and agricultural safety, military medicine and other fields. In recent years, the performance of biosensors has greatly improved, becoming a promising technology for airborne microorganism detection. This review introduces the detection principle of biosensors from the three aspects of component identification, energy conversion principle, and signal amplification. It also summarizes its research and application in airborne microorganism detection. The new progress and future development trend of the biosensor detection of airborne microorganisms are analyzed.

Structurally coloured contact lens sensor for point-of-care ophthalmic health monitoring

Point-of-care (POC) diagnosis is of great significance in offering precise and personalized treatment for patients with eye diseases. Contact lenses, as a kind of popular wearable device on the eye, provide a suitable platform for the integration of biosensors for the POC diagnosis of eye diseases. However, existing contact lens sensors usually involve complex electronics and circuits, the manufacturing of which is complicated and signal readout requires additional instruments. To realize the instrument-free detection of pathologically relevant signals of eye diseases, we successfully established a structurally coloured contact lens sensor with a tunable colour in this investigation, which can directly report changes in moisture and pressure that are critical signs for xerophthalmia and glaucoma diagnosis, respectively, by altering colours. Importantly, this structurally coloured contact lens sensor is made solely from a biocompatible hydrogel, without the addition of any chemical pigments, therefore exhibiting superior biosafety and wearing comfort for wearable applications. With both excellent biocompatibility and sensing capabilities, this structurally coloured contact lens sensors thus holds great promise for instrument-free ophthalmic health monitoring, which will benefit a large proportion of the population that have a high risk of eye disease.

Recent progress, challenges, and opportunities for wearable biochemical sensors for sweat analysis

Sweat is a promising, yet relatively unexplored biofluid containing biochemical information that offers broad insights into the underlying dynamic metabolic activity of the human body. The rich composition of electrolytes, metabolites, hormones, proteins, nucleic acids, micronutrients, and exogenous agents found in sweat dynamically vary in response to the state of health, stress, and diet. Emerging classes of skin-interfaced wearable sensors offer powerful capabilities for the real-time, continuous analysis of sweat produced by the eccrine glands in a manner suitable for use in athletics, consumer wellness, military, and healthcare industries. This perspective examines the rapid and continuous progress of wearable sweat sensors through the most advanced embodiments that address the fundamental challenges currently restricting widespread deployment. It concludes with a discussion of efforts to expand the overall utility of wearable sweat sensors and opportunities for commercialization, in which advances in biochemical sensor technologies will be critically important.

Toward In Vivo Transdermal pH Sensing with a Validated Microneedle Membrane Electrode

We present herein the most complete characterization of microneedle (MN) potentiometric sensors for pH transdermal measurements for the time being. Initial in vitro assessment demonstrated suitable analytical performances (e.g., Nernstian slope, linear range of response from 8.5 to 5.0, and fast response time) in both buffer media and artificial interstitial fluid (ISF). Excellent repeatability and reproducibility together with adequate selectivity and resiliency facilitate the appropriateness of the new pH MN sensor for transdermal ISF analysis in healthcare. The ability to resist skin insertions was evaluated in several ex vivo setups using three different animal skins (i.e., chicken, pork, and rat). The developed pH MN sensor was able to withstand from 5 to 10 repetitive insertions in all the skins considered with a minimal change in the calibration graph (<3% variation in both slope and intercept after the insertions). Ex vivo pH measurements were validated by determining the pH with the MN sensor and a commercial pH electrode in chicken skin portions previously conditioned at several pH values, obtaining excellent results with an accuracy of <1% and a precision of <2% in all cases. Finally, pH MN sensors were applied for the very first time to transdermal measurements in rats together with two innovative validation procedures: (i) measuring subcutaneous pH directly with a commercial pH microelectrode and (ii) collecting ISF using hollow MNs and then the pH measurement of the sample with the pH microelectrode. The pH values obtained with pH MN sensors were statistically more similar to subcutaneous measurements, as inferred by a paired sample t-test at 95% of confidence level. Conveniently, the validation approaches could be translated to other analytes that are transdermally measured with MN sensors.

Recombinant Antibody Engineering Enables Reversible Binding for Continuous Protein Biosensing

Engineering antibodies to improve target specificity, reduce detection limits, or introduce novel functionality is an important research area for biosensor development. While various affinity biosensors have been developed to generate an output signal upon varying analyte concentrations, reversible and continuous protein monitoring in complex biological samples remains challenging. Herein, we explore the concept of directed evolution to modulate dissociation kinetics of a high affinity anti-epidermal growth factor receptor (EGFR) single-chain variable antibody fragment (scFv) to enable continuous protein sensing in a label-free binding assay. A mutant scFv library was generated from the wild type (WT) fragment via targeted permutation of four residues in the antibody-antigen-binding interface. A single round of phage display biopanning complemented with high-throughput screening methods then permitted isolation of a specific binder with fast reaction kinetics. We were able to obtain ∼30 times faster dissociation rates when compared to the WT without appreciably affecting overall affinity and specificity by targeting a single paratope that is known to contribute to the binding interaction. Suitability of a resulting mutant fragment to sense varying antigen concentrations in continuous mode was demonstrated in a modified label-free binding assay, achieving low nanomolar detection limits (K_D = 8.39 nM). We also confirmed these results using an independent detection mechanism developed previously by our group, incorporating a polarity-dependent fluorescent dye into the scFv and reading out EGFR binding based on fluorescence wavelength shifts. In future, this generic approach could be employed to generate improved or novel binders for proteins of interest, ready for deployment in a broad range of assay platforms.

ANTIGONE: A Programmable Energy-Efficient Current Digitizer for an ISFET Wearable Sweat Sensing System

This article describes the design and the characterization of the ANTIGONE (ANalog To dIGital cONvErter) ASIC (Application Specific Integrated Circuit) built in AMS 0.35 m technology for low dc-current sensing. This energy-efficient ASIC was specifically designed to interface with multiple Ion-Sensitive Field-Effect Transistors (ISFETs) and detect biomarkers like pH, Na+, K+ and Ca2+ in human sweat. The ISFET-ASIC system can allow real-time noninvasive and continuous health monitoring. The ANTIGONE ASIC architecture is based on the current-to-frequency converter through the charge balancing principle. The same front-end can digitize multiple currents produced by four sweat ISFET sensors in time multiplexing. The front-end demonstrates good linearity over a dynamic range that spans from 1 pA up to 500 nA. The consumed energy per conversion is less than 1 J. The chip is programmable and works in eight different modes of operation. The system uses a standard Serial Peripheral Interface (SPI) to configure, control and read the digitally converted sensor data. The chip is controlled by a portable device over Bluetooth Low Energy (BLE) through a Microcontroller Unit (MCU). The sweat sensing system is part of a bigger wearable platform that exploits the convergence of multiparameter biosensors and environmental sensors for personalized and preventive healthcare.

Highly Concentrated, Conductive, Defect-free Graphene Ink for Screen-Printed Sensor Application

Ultrathin and defect-free graphene ink is prepared through a high-throughput fluid dynamics process, resulting in a high exfoliation yield (53.5%) and a high concentration (47.5 mg mL^-1). A screen-printed graphene conductor exhibits a high electrical conductivity of 1.49 × 10⁴ S m^-1 and good mechanical flexibility. An electrochemical sodium ion sensor based on graphene ink exhibits an excellent potentiometric sensing performance in a mechanically bent state. Real-time monitoring of sodium ion concentration in sweat is demonstrated. Conductive inks based on graphene materials have received significant attention for the fabrication of a wide range of printed and flexible devices. However, the application of graphene fillers is limited by their restricted mass production and the low concentration of their suspensions. In this study, a highly concentrated and conductive ink based on defect-free graphene was developed by a scalable fluid dynamics process. A high shear exfoliation and mixing process enabled the production of graphene at a high concentration of 47.5 mg mL^-1 for graphene ink. The screen-printed graphene conductor exhibits a high electrical conductivity of 1.49 × 10⁴ S m^-1 and maintains high conductivity under mechanical bending, compressing, and fatigue tests. Based on the as-prepared graphene ink, a printed electrochemical sodium ion (Na⁺) sensor that shows high potentiometric sensing performance was fabricated. Further, by integrating a wireless electronic module, a prototype Na⁺-sensing watch is demonstrated for the real-time monitoring of the sodium ion concentration in human sweat during the indoor exercise of a volunteer. The scalable and efficient procedure for the preparation of graphene ink presented in this work is very promising for the low-cost, reproducible, and large-scale printing of flexible and wearable electronic devices.

Stretchable and tough conductive hydrogels for flexible pressure and strain sensors

Flexible pressure and strain sensors have great potential for applications in wearable and implantable devices, soft robotics and artificial skin. Compared to flexible sensors based on filler/elastomer composites, conductive hydrogels are advantageous due to their biomimetic structures and properties, as well as biocompatibility. Numerous chemical and structural designs provide unlimited opportunities to tune the properties and performance of conductive hydrogels to match various demands for practical applications. Many electronically and ionically conductive hydrogels have been developed to fabricate pressure and strain sensors with different configurations, including resistance type and capacitance type. The sensitivity, reliability and stability of hydrogel sensors are dependent on their network structures and mechanical properties. This review focuses on tough conductive hydrogels for flexible sensors. Representative strategies to prepare stretchable, strong, tough and self-healing hydrogels are briefly reviewed since these strategies are illuminating for the development of tough conductive hydrogels. Then, a general account on various conductive hydrogels is presented and discussed. Recent advances in tough conductive hydrogels with well designed network structures and their sensory performance are discussed in detail. A series of conductive hydrogel sensors and their application in wearable devices are reviewed. Some perspectives on flexible conductive hydrogel sensors and their applications are presented at the end.

Coupling of Silk Fibroin Nanofibrils Enzymatic Membrane with Ultra-Thin PtNPs/Graphene Film to Acquire Long and Stable On-Skin Sweat Glucose and Lactate Sensing

The applications of enzymatic biosensors are largely limited by their relatively poor stability and short lifespan. Herein, a bio-active porous enzymatic nanofiber (PEN) membrane composed of silk fibroin nanofibrils (SFNFs) and enzymes is developed to effectively retain the enzymes in the 3D space. The 3D functional scaffolds formed by SFNFs can immobilize enzymes and provide a large surface area for molecular/ion diffusion and biochemical reactions. The PEN membrane is subsequently attached to an ultra-thin PtNPs/graphene (Pt-G) nanocomposite film to facilitate the electron transport between the enzymes and electrodes, permitting highly effective glucose and lactate sensing with long and stable performance. The as-assembled glucose and lactate sensors demonstrate high sensitivity, good cyclic reproducibility, and in particular long-term stability of up to 25 and 23.6 h, respectively. These glucose sensors have a working life that is ≈1.25-times longer than that of the best available sensors reported so far. Moreover, a wearable platform based on the sensors is developed for real-time analysis of sweat during outdoor exercising to transmit signals to a mobile handset. The high sensitivity, comfort and long-term stability of the device can benefit for long-term in-line surveillance of physiological conditions.

Multitasking MXene Inks Enable High-Performance Printable Microelectrochemical Energy Storage Devices for All-Flexible Self-Powered Integrated Systems

The future of mankind holds great promise for things like the Internet of Things, personal health monitoring systems, and smart cities. To achieve this ambitious goal, it is imperative for electronics to be wearable, environmentally sustainable, and safe. However, large-scale manufacture of self-sufficient electronic systems by exploiting multifunctional materials still faces significant hurdles. Herein, multitasking aqueous printable MXene inks are reported as an additive-free high-capacitance electrode, sensitive pressure-sensing material, highly conducting current collector, metal-free interconnector, and conductive binder. By directly screen printing MXene inks, MXene-based micro-supercapacitors (MSCs) and lithium-ion microbatteries (LIMBs) are delicately fabricated on various substrates. The as-prepared MSCs exhibit ultrahigh areal capacitance of 1.1 F cm^-2 and the serially connected MSCs offer a record voltage of 60 V. The quasi-solid-state LIMBs deliver a robust areal energy density of 154 μWh cm^-2 . Furthermore, an all-flexible self-powered integrated system on a single substrate based on the multitasking MXene inks is demonstrated through seamless integration of a tandem solar cell, the LIMB, and an MXene hydrogel pressure sensor. Notably, this integrated system is exceptionally sensitive to body movements with a fast response time of 35 ms. Therefore, this multipurpose MXene ink opens a new avenue for powering future smart appliances.

Recent Advances in Patterning Natural Polymers: From Nanofabrication Techniques to Applications

The development of a flexible and efficient strategy to precisely fabricate polymer patterns is increasingly significant for many research areas, especially for cell biology, pharmaceutical science, tissue engineering, soft photonics, and bioelectronics. Recent advances of patterning natural polymers using various nanofabrication techniques, including photolithography, electron-beam lithography, dip-pen nanolithography, inkjet printing, soft lithography, and nanoimprint lithography are discussed here. Integrating nanofabrication techniques with naturally derived macromolecules provides a feasible route for transforming these polymer materials into versatile and sophisticated devices while maintaining their intrinsic and excellent properties. Furthermore, the corresponding applications of these natural polymer patterns generated by the above techniques are elaborated. In the end, a summary of this promising research field is offered and an outlook for the future is given. It is expected that advances in precise spatial patterns of natural polymers would provide new avenues for various applications, such as tissue engineering, flexible electronics, biomedical diagnosis, and soft photonics.

Recent advances in biofluid detection with micro/nanostructured bioelectronic devices

Most biofluids contain a wide variety of biochemical components that are closely related to human health. Analyzing biofluids, such as sweat and tears, may deepen our understanding in pathophysiologic conditions associated with human body, while providing a variety of useful information for the diagnosis and treatment of disorders and disease. Emerging classes of micro/nanostructured bioelectronic devices for biofluid detection represent a recent breakthrough development of critical importance in this context, including traditional biosensors (TBS) and micro/nanostructured biosensors (MNBS). Related biosensors are not restricted to flexible and wearable devices; solid devices are also involved here. This article is a timely overview of recent technical advances in this field, with an emphasis on the new insights of constituent materials, design architectures and detection methods of MNBS that support the necessary levels of biocompatibility, device functionality, and stable operation for component analysis. An additional section discusses and analyzes the existing challenges, possible solutions and future development of MNBS for detecting biofluids.

Rapid and Selective Biomarker Detection with Conductometric Sensors

The biomarker detection in human body fluids is crucial as biomarkers are important in diagnosing diseases. Conventional invasive techniques for biomarker detection are associated with infection, tissue damage, and discomfort. Non-invasive devices are an attractive alternative. Here, metal oxide (oxygen-deficient zinc oxide, ZnO) based conductometric sensors with two-terminal electrodes for rapid detection of biomarkers in real-time, are presented. This platform can be engineered for non-invasive, sensitive, and on-demand selective detection of biomarkers based on surface functionalization. The three novelties in this biosensing technique include an on-demand target selection device platform, short (<10 min) incubation times, and real-time monitoring of the biomarker of interest by electrical (resistance change) measurements. Cardiac inflammatory biomarkers interleukin 6 (IL-6) and C-reactive protein (CRP) are used as the model antigens. The devices can detect 100× lower concentration of IL-6 than healthy levels in human saliva and sweat and 1000× and ≈50× lower CRP concentrations than healthy levels in human saliva and sweat, respectively. The devices show high selectivity for IL-6 and CRP antigens when tested with a mixture of biomarkers. This sensor platform can be extended to selective measurements for viruses or DNA screening, which enables a new category of compact and rapid point-of-care medical devices.

Material innovation and mechanics design for substrates and encapsulation of flexible electronics: a review

Advances in materials and mechanics designs have led to the development of flexible electronics, which have important applications to human healthcare due to their good biocompatibility and conformal integration with biological tissue. Material innovation and mechanics design have played a key role in designing the substrates and encapsulations of flexible electronics for various bio-integrated systems. This review first introduces the inorganic materials and novel organic materials used for the substrates and encapsulation of flexible electronics, and summarizes their mechanics properties, permeability and optical transmission properties. The structural designs of the substrates are then introduced to ensure the reliability of flexible electronics, including the patterned and pre-strained designs to improve the stretchability, and the strain-isolation and -limiting substrates to reduce the deformation. Some emerging encapsulations are presented to protect the flexible electronics from degradation, environmental erosion or contamination, though they may slightly reduce the stretchability of flexible electronics.

Stretchable Electronics Based on PDMS Substrates

Stretchable electronics, which can retain their functions under stretching, have attracted great interest in recent decades. Elastic substrates, which bear the applied strain and regulate the strain distribution in circuits, are indispensable components in stretchable electronics. Moreover, the self-healing property of the substrate is a premise to endow stretchable electronics with the same characteristics, so the device may recover from failure resulting from large and frequent deformations. Therefore, the properties of the elastic substrate are crucial to the overall performance of stretchable devices. Poly(dimethylsiloxane) (PDMS) is widely used as the substrate material for stretchable electronics, not only because of its advantages, which include stable chemical properties, good thermal stability, transparency, and biological compatibility, but also because of its capability of attaining designer functionalities via surface modification and bulk property tailoring. Herein, the strategies for fabricating stretchable electronics on PDMS substrates are summarized, and the influence of the physical and chemical properties of PDMS, including surface chemical status, physical modulus, geometric structures, and self-healing properties, on the performance of stretchable electronics is discussed. Finally, the challenges and future opportunities of stretchable electronics based on PDMS substrates are considered.

A Bendable Biofuel Cell-Based Fully Integrated Biomedical Nanodevice for Point-of-Care Diagnosis of Scurvy

Fully integrated nanodevices that allow the complete functional implementation without an external accessory or equipment are deemed to be one of the most ideal and ultimate goals for modern nanodevice design and construction. In this work, we demonstrate the first example of a bendable biofuel cell (BFC)-based fully integrated biomedical nanodevice with simple, palm-sized, easy-to-carry, pump-free, cost-saving, and easy-to-use features for the point-of-care (POC) diagnosis of scurvy from a single drop of untreated human serum (down to 0.2 μL) by integrating a bendable and disposable vitamin C/air microfluidic BFC (micro-BFC) (named iezCard) for self-powered vitamin C biosensing with a custom mini digital LED voltmeter (named iezBox) for signal processing and transmission, along with a ″built-in″ biocomputing BUFFER gate for intelligent diagnosis. Under the simplicity- and practicability-oriented idea, a cost-effective strategy (e.g., biomass-derived hierarchical micro-mesoporous carbon aerogels, screen-printed technique, a single piece of Kimwipes paper, LED display, and universal components) was implemented for nanodevice design rather than any top-end or pricey method (e.g., photolithography/electron-beam evaporation, peristaltic pump, wireless system, and 3D printing technique), which enormously reduces the cost of feedstock down to ∼USD 2.55 per integrated kit including a disposal iezCard (∼USD 0.08 per test) and a reusable iezBox (∼USD 2.47 for large-scale tests). These distinctive and attractive features allow such a fully integrated biomedical nanodevice to fully satisfy the basic requirements for POC diagnosis of scurvy from a single drop of raw human serum and make it particularly appropriate for resource-poor settings, where there is a lack of medical facilities, funds, and qualified personnel.

A Wearable Surface-Enhanced Raman Scattering Sensor for Label-Free Molecular Detection

A wearable surface-enhanced Raman scattering (SERS) sensor has been developed as a patch type to utilize as a molecular sweat sensor. Here, the SERS patch sensor is designed to comprise a sweat-absorbing layer, which is an interface to the human skin, an SERS active layer, and a dermal protecting layer that prevents damage and contaminations. A silk fibroin protein film (SFF) is a basement layer that absorbs aqueous solutions and filtrates molecules larger than the nanopores created in the β-sheet matrix of the SFF. On the SFF layer, a plasmonic silver nanowire (AgNW) layer is formed to enhance the Raman signal of the molecules that penetrated through the SERS patch in a label-free method. A transparent dermal protecting layer (DP) allows laser penetration to the AgNW layer enabling Raman measurement through the SERS patch without its detachment from the surface. The molecular detection capability and time-dependent absorption properties of the SERS patch are investigated, and then, the feasibility of its use as a wearable drug detection sweat sensor is demonstrated using 2-fluoro-methamphetamine (2-FMA) on the human cadaver skin. It is believed that the developed SERS patch can be utilized as various flexible and wearable biosensors for healthcare monitoring.

Microfluidic Point-of-Care Testing: Commercial Landscape and Future Directions

Point-of-care testing (POCT) allows physicians to detect and diagnose diseases at or near the patient site, faster than conventional lab-based testing. The importance of POCT is considerably amplified in the trying times of the COVID-19 pandemic. Numerous point-of-care tests and diagnostic devices are available in the market including, but not limited to, glucose monitoring, pregnancy and infertility testing, infectious disease testing, cholesterol testing and cardiac markers. Integrating microfluidics in POCT allows fluid manipulation and detection in a singular device with minimal sample requirements. This review presents an overview of two technologies - (a.) Lateral Flow Assay (LFA) and (b.) Nucleic Acid Amplification - upon which a large chunk of microfluidic POCT diagnostics is based, some of their applications, and commercially available products. Apart from this, we also delve into other microfluidic-based diagnostics that currently dominate the in-vitro diagnostic (IVD) market, current testing landscape for COVID-19 and prospects of microfluidics in next generation diagnostics.

Self-Powered Flexible Sour Sensor for Detecting Ascorbic Acid Concentration Based on Triboelectrification/Enzymatic-Reaction Coupling Effect

Artificial sensory substitution systems can mimic human sensory organs through replacing the sensing process of a defective sensory receptor and transmitting the sensing signal into the nervous system. Here, we report a self-powered flexible gustation sour sensor for detecting ascorbic acid concentration. The material system comprises of Na2C2O4-Ppy with AAO modification, PDMS and Cu wire mesh. The working mechanism is contributed to the triboelectrification/enzymatic-reaction coupling effect, and the device can collect weak energy from body movements and directly output triboelectric current without any external power-units. The triboelectric output is affected by AA concentration, and the response is up to 34.82% against 15.625 mM/L of AA solution. Furthermore, a practical application in detecting ascorbic acid concentration of different drinks has been demonstrated. This work can encourage the development of wearable flexible electronics and this self-powered sour sensor has the potential that can be acted as a kind of gustatory receptors to build electronic tongues.

Wearable Sweat Biosensors Refresh Personalized Health/Medical Diagnostics

Sweat contains a broad range of critical biomarkers including ions, small molecules, and macromolecules that may indirectly or directly reflect the health status of the human body and thereby help track disease progression. Wearable sweat biosensors enable the collection and analysis of sweat in situ, achieving real-time, continuous, and noninvasive monitoring of human biochemical parameters at the molecular level. This review summarizes the physiological/pathological information of sweat and wearable sweat biosensors. First, the production of sweat pertaining to various electrolytes, metabolites, and proteins is described. Then, the compositions of the wearable sweat biosensors are summarized, and the design of each subsystem is introduced in detail. The latest applications of wearable sweat biosensors for outdoor, hospital, and family monitoring are highlighted. Finally, the review provides a summary and an outlook on the future developments and challenges of wearable sweat biosensors with the aim of advancing the field of wearable sweat monitoring technology.

Materials, Devices, and Systems of On-Skin Electrodes for Electrophysiological Monitoring and Human-Machine Interfaces

On-skin electrodes function as an ideal platform for collecting high-quality electrophysiological (EP) signals due to their unique characteristics, such as stretchability, conformal interfaces with skin, biocompatibility, and wearable comfort. The past decade has witnessed great advancements in performance optimization and function extension of on-skin electrodes. With continuous development and great promise for practical applications, on-skin electrodes are playing an increasingly important role in EP monitoring and human-machine interfaces (HMI). In this review, the latest progress in the development of on-skin electrodes and their integrated system is summarized. Desirable features of on-skin electrodes are briefly discussed from the perspective of performances. Then, recent advances in the development of electrode materials, followed by the analysis of strategies and methods to enhance adhesion and breathability of on-skin electrodes are examined. In addition, representative integrated electrode systems and practical applications of on-skin electrodes in healthcare monitoring and HMI are introduced in detail. It is concluded with the discussion of key challenges and opportunities for on-skin electrodes and their integrated systems.

A wrinkled structure of gold film greatly improves the signaling of electrochemical aptamer-based biosensors

Electrochemical aptamer-based (E-AB) sensors provide a great opportunity towards the goal of point-of-care and wearable sensing technologies due to their good sensitivity and selectivity. Nevertheless, the output signals from this sensor class remain low when sensors are interrogated via square-wave voltammetry. This low signaling limits the sensor's precision for its capability to detect small changes in target concentrations. To circumvent this, we proposed here the use of a readily shrink-induced, wrinkled Au-coating polyolefin film to immobilize a greater number of DNA probes and thus improve the signaling. Specifically, wrinkled gold film exhibits a 5.5-fold increase of surface area in comparison to the unwrinkled ones. Using these substrates we fabricated a set of E-AB sensors of three biological molecules, including kanamycin, doxorubicin and ATP. We achieved up to 10-fold increase in its current and also good accuracies within ±20% error in the target concentration range across 2 orders of magnitude.

A wrinkled gold substrate greatly improves the signaling of electrochemical aptamer-based biosensors, achieving up to 10-fold increase in signals.

Recent advances in energy-saving chemiresistive gas sensors: A review

With the tremendous advances in technology, gas-sensing devices are being popularly used in many distinct areas, including indoor environments, industries, aviation, and detectors for various toxic domestic gases and vapors. Even though the most popular type of gas sensor, namely, resistive-based gas sensors, have many advantages over other types of gas sensors, their high working temperatures lead to high energy consumption, thereby limiting their practical applications, especially in mobile and portable devices. As possible ways to deal with the high-power consumption of resistance-based sensors, different strategies such as self-heating, MEMS technology, and room-temperature operation using especial morphologies, have been introduced in recent years. In this review, we discuss different types of energy-saving chemisresitive gas sensors including self-heated gas sensors, MEMS based gas sensors, room temperature operated flexible/wearable sensor and their application in the fields of environmental monitoring. At the end, the review will be concluded by providing a summary, challenges, recent trends, and future perspectives.

Flexible and wearable electrochemical biosensors based on two-dimensional materials: Recent developments

The research interest in wearable sensors has tremendously increased in recent years. Amid the different biosensors, electrochemical biosensors are unparalleled and ideal for the design and manufacture of such flexible and wearable sensors because of their various benefits, including convenient operation, quick response, portability, and inherent miniaturization. A number of studies on flexible and wearable electrochemical biosensors have been reported in recent years for invasive/non-invasive and real-time monitoring of biologically relevant molecules such as glucose, lactate, dopamine, cortisol, and antigens. To attain this, novel two-dimensional nanomaterials and their hybrids, various substrates, and detection methods have been explored to fabricate flexible conductive platforms that can be used to develop flexible electrochemical biosensors. In particular, there are many advantages associated with the advent of two-dimensional materials, such as light weight, high stretchability, high performance, and excellent biocompatibility, which offer new opportunities to improve the performance of wearable electrochemical sensors. Therefore, it is urgently required to study wearable/flexible electrochemical biosensors based on two-dimensional nanomaterials for health care monitoring and clinical analysis. In this review, we described recently reported flexible electrochemical biosensors based on two-dimensional nanomaterials. We classified them into specific groups, including enzymatic/non-enzymatic biosensors and affinity biosensors (immunosensors), recent developments in flexible electrochemical immunosensors based on polymer and plastic substrates to monitor biologically relevant molecules. This review will discuss perspectives on flexible electrochemical biosensors based on two-dimensional materials for the clinical analysis and wearable biosensing devices, as well as the limitations and prospects of the these electrochemical flexible/wearable biosensors.Graphical abstract.

Wearable strain sensor for real-time sweat volume monitoring

Reliably monitoring sweat volume has attracted much attention due to its important role in the assessment of physiological health conditions and the prevention of dehydration. Here, we present the first example of wearable strain sensor for real-time sweat volume monitoring. Such sweat volume monitoring sensor is simply fabricated via embedding strain sensing fabric in super-absorbent hydrogels, the hydrogels can wick sweat up off the skin surface to swell and then trigger the strain sensing fabrics response. This sensor can realize real-time detection of sweat volume (0.15-700 μL), shows excellent repeatability and stability against movement or light interference, reliability in the non-pathological range (pH: 4-9 and salinity: 0-100 mM NaCl) in addition. Such sensor combing swellable hydrogels with strain sensing fabrics provides a novel measurement method of wearable devices for sweat volume monitoring.

Sweat-Based Noninvasive Skin-Patchable Urea Biosensors with Photonic Interpenetrating Polymer Network Films Integrated into PDMS Chips

A wearable noninvasive biosensor for in situ urea detection and quantification was developed using a urease-immobilized photonic interpenetrating polymer network (IPN_urease) film. The photonic IPN film was intertwined with solid-state cholesteric liquid crystals (CLC_solid) and a poly(acrylic acid) (PAA) network on a flexible poly(ethylene terephthalate) substrate adhered to a poly(dimethylsiloxane) (PDMS) chip that was fabricated using an aluminum mold. The presence of urea in the chemical matrix of human sweat red-shifted the reflected color of the photonic IPN_urease film, and quantification was achieved by observing the wavelength at the photonic band gap (λ_PBG) with a limit of detection of 0.4 mM and a linear range of 0.9-50 mM. The color changes observed in the photonic IPN film were digitalized using the CIE 1931 xy coordinates on a cell phone image, thereby enabling fast, direct diagnosis via a downloadable app. This novel PDMS chip can be expanded for use with other biosensors.

Emerging Telemedicine Tools for Remote COVID-19 Diagnosis, Monitoring, and Management

The management of the COVID-19 pandemic has relied on cautious contact tracing, quarantine, and sterilization protocols while we await a vaccine to be made widely available. Telemedicine or mobile health (mHealth) is well-positioned during this time to reduce potential disease spread and prevent overloading of the healthcare system through at-home COVID-19 screening, diagnosis, and monitoring. With the rise of mass-fabricated electronics for wearable and portable sensors, emerging telemedicine tools have been developed to address shortcomings in COVID-19 diagnostics, monitoring, and management. In this Perspective, we summarize current implementations of mHealth sensors for COVID-19, highlight recent technological advances, and provide an overview on how these tools may be utilized to better control the COVID-19 pandemic.

Flexible Electronics for Monitoring in vivo Electrophysiology and Metabolite Signals

Numerous efforts have been made to develop efficient biosensors for detecting analytes in the human body. However, biosensors are often developed on rigid materials, which limits their application on skin, organs, and other tissues in the human body where good flexibility is required. Developing flexible materials for biosensors that can be used on soft and irregularly shaped surfaces would significantly expand the clinical application of biosensors. In this review, we will provide a selective overview of recently developed flexible electronic devices and their applications for monitoring in vivo metabolite and electrophysiology signals. The article provides guidelines for the development of an in vivo signal monitoring system and emphasizes research from various disciplines for the further development of flexible electronics that can be used in more biomedical applications in the future.

Non-Invasive Blood Glucose Monitoring Technology: A Review

In recent years, with the rise of global diabetes, a growing number of subjects are suffering from pain and infections caused by the invasive nature of mainstream commercial glucose meters. Non-invasive blood glucose monitoring technology has become an international research topic and a new method which could bring relief to a vast number of patients. This paper reviews the research progress and major challenges of non-invasive blood glucose detection technology in recent years, and divides it into three categories: optics, microwave and electrochemistry, based on the detection principle. The technology covers medical, materials, optics, electromagnetic wave, chemistry, biology, computational science and other related fields. The advantages and limitations of non-invasive and invasive technologies as well as electrochemistry and optics in non-invasives are compared horizontally in this paper. In addition, the current research achievements and limitations of non-invasive electrochemical glucose sensing systems in continuous monitoring, point-of-care and clinical settings are highlighted, so as to discuss the development tendency in future research. With the rapid development of wearable technology and transdermal biosensors, non-invasive blood glucose monitoring will become more efficient, affordable, robust, and more competitive on the market.