Self-Powered Implantable Medical Devices: Photovoltaic Energy Harvesting Review

Flexible silicon for high-performance photovoltaics, photodetectors and bio-interfaced electronics

Silicon (Si) is currently the most mature and reliable semiconductor material in the industry, playing a pivotal role in the development of modern microelectronics, renewable energy, and bio-electronic technologies. In recent years, widespread research attention has been devoted to the development of advanced flexible electronics, photovoltaics, and bio-interfaced sensors/detectors, boosting their emerging applications in distributed energy sources, healthcare, environmental monitoring, and brain-computer interfaces (BCIs). Despite the rigid and brittle nature of Si, a series of new fabrication technologies and integration strategies have been developed to enable a wide range of c-Si-based high-performance flexible photovoltaics and electronics, which were previously only achievable with intrinsically soft organic and polymer semiconductors. More interestingly, programmable geometric engineering of crystalline silicon (c-Si) units and logic circuits has been explored to enable the fabrication of various highly flexible nanoprobes for intracellular sensing and the deployment of soft BCI matrices to record and understand brain neural activities for the development of advanced neuroprosthetics. This review will systematically examine the latest progress in the fabrication of Si-based flexible solar cells, photodetectors, and biological probing interfaces over the past decade, identifying key design principles, mechanisms, and technological milestones achieved through novel geometry, morphology, and composition control. These advancements, when combined, will not only promote the practical applications of sustainable energy and wearable electronics but also spur new breakthroughs in emerging human-machine interfaces (HMIs) and artificial intelligence applications, which hold significant implications for understanding neural activities, implementing more efficient artificial Intelligence (AI) algorithms, and developing new therapies or treatments. Finally, we will summarize and provide an outlook on the current challenges and future opportunities of Si-based electronics, flexible optoelectronics, and bio-sensing.

Advances in proteins, polysaccharides, and composite biomaterials for enhanced wound healing via microenvironment management: A review

Wound management is crucial yet imposes substantial social and economic burdens on patients and healthcare systems. The recent rapid advancements in biomaterials and manufacturing technology have created favorable conditions for expediting wound healing. This review examines the latest developments in biomacromolecule-based wound dressings, with a particular focus on proteins and polysaccharides, and their role in modulating the wound microenvironment. The importance of extracellular matrix (ECM)-inspired materials, such as hydrogels and biomimetic dressings, is emphasized. Additionally, this review explores the functionalization of wound dressings, emphasizing properties such as hemostatic capabilities, pain relief, antimicrobial activity, and innovative smart functions like electroceuticals and wound condition monitoring. The study integrates discussions on both the macroscopic healing outcomes and the microscopic pathophysiological mechanisms, highlighting recent advances in managing wound environments to expedite healing. Finally, the review critically assesses the challenges associated with the clinical translation of these wound-healing materials in the future.

3D-Printed Shape Memory and Piezoelectric Bifunctional Thermoplastic Polyurethane/Polyvinylidene Fluoride Porous Composite Scaffold for Bone Regeneration

Physical stimulations such as mechanical and electric stimulation can continuously work on bone defect locations to maintain and enhance cell activity, and it has become a hotspot for research in the field of bone repair. Herein, bifunctional porous composite scaffolds with shape memory and piezoelectric functions were fabricated using thermoplastic polyurethane (TPU) and poly(vinylidene fluoride) through triply periodic minimal surfaces design and selective laser sintering technology. Thereinto, the shape fixity ratio and recovery ratio of the composite scaffold reached 98.6% and 81.2%, respectively, showing excellent shape memory functions. More importantly, its piezoelectric coefficient (d33 = 2.47 pC/N) is close to the piezoelectric constant of bone tissue (d33 = 0.7-2.3 pC/N), and the voltage released during the compression process can reach 0.5 V. Furthermore, cyclic compression experiments showed that the strength of composite scaffold was up to 8.3 times compared with the TPU scaffold. Besides, the composite scaffold showed excellent cytocompatibility. In conclusion, the composite scaffold is expected to continuously generate mechanical and electric stimulation due to shape memory and piezoelectric function, respectively, which provide an effective strategy for bone repair.

Advanced Energy Harvesters and Energy Storage for Powering Wearable and Implantable Medical Devices

Wearable and implantable active medical devices (WIMDs) are transformative solutions for improving healthcare, offering continuous health monitoring, early disease detection, targeted treatments, personalized medicine, and connected health capabilities. Commercialized WIMDs use primary or rechargeable batteries to power their sensing, actuation, stimulation, and communication functions, and periodic battery replacements of implanted active medical devices pose major risks of surgical infections or inconvenience to users. Addressing the energy source challenge is critical for meeting the growing demand of the WIMD market that is reaching valuations in the tens of billions of dollars. This review critically assesses the recent advances in energy harvesting and storage technologies that can potentially eliminate the need for battery replacements. With a key focus on advanced materials that can enable energy harvesters to meet the energy needs of WIMDs, this review examines the crucial roles of advanced materials in improving the efficiencies of energy harvesters, wireless charging, and energy storage devices. This review concludes by highlighting the key challenges and opportunities in advanced materials necessary to achieve the vision of self-powered wearable and implantable active medical devices, eliminating the risks associated with surgical battery replacement and the inconvenience of frequent manual recharging.

Powering the future: Exploring self-charging cardiac implantable electronic devices and the Qi revolution

The incidence and prevalence of cardiovascular diseases (CVD) have risen over the last few decades worldwide, resulting in a cost burden to healthcare systems and increasingly complex procedures. Among many strategies for treating heart diseases, treating arrhythmias using cardiac implantable electronic devices (CIEDs) has been shown to improve quality of life and reduce the incidence of sudden cardiac death. The battery-powered CIEDs have the inherent challenge of regular battery replacements depending upon energy usage for their programmed tasks. Nanogenerator-based  energy harvesters have been extensively studied, developed, and optimized continuously in recent years to overcome this challenge owing to their merits of self-powering abilities and good biocompatibility. Although these nanogenerators and others currently used in energy harvesters, such as biofuel cells (BFCs) exhibit an infinite spectrum of uses for this novel technology, their demerits should not be dismissed. Despite the emergence of Qi wireless power transfer (WPT) has revolutionized the technological world, its application in CIEDs has yet to be studied well. This review outlines the working principles and applications of currently employed energy harvesters to provide a preliminary exploration of CIEDs based on Qi WPT, which may be a promising technology for the next generation of functionalized CIEDs.

Flexible Organic Photovoltaic-Powered Hydrogel Bioelectronic Dressing With Biomimetic Electrical Stimulation for Healing Infected Diabetic Wounds

Electrical stimulation (ES) is proposed as a therapeutic solution for managing chronic wounds. However, its widespread clinical adoption is limited by the requirement of additional extracorporeal devices to power ES-based wound dressings. In this study, a novel sandwich-structured photovoltaic microcurrent hydrogel dressing (PMH dressing) is designed for treating diabetic wounds. This innovative dressing comprises flexible organic photovoltaic (OPV) cells, a flexible micro-electro-mechanical systems (MEMS) electrode, and a multifunctional hydrogel serving as an electrode-tissue interface. The PMH dressing is engineered to administer ES, mimicking the physiological injury current occurring naturally in wounds when exposed to light; thus, facilitating wound healing. In vitro experiments are performed to validate the PMH dressing's exceptional biocompatibility and robust antibacterial properties. In vivo experiments and proteomic analysis reveal that the proposed PMH dressing significantly accelerates the healing of infected diabetic wounds by enhancing extracellular matrix regeneration, eliminating bacteria, regulating inflammatory responses, and modulating vascular functions. Therefore, the PMH dressing is a potent, versatile, and effective solution for diabetic wound care, paving the way for advancements in wireless ES wound dressings.

Recent Advances in Bioelectronics for Localized Drug Delivery

The last decade has witnessed remarkable advancements in bioelectronics, ushering in a new era of wearable and implantable devices for drug delivery. By utilizing miniaturized system design and/or flexible materials, bioelectronics illustrates ideal integration with target organs and tissues, making them ideal platforms for localized drug delivery. Furthermore, the development of electrically assisted drug delivery systems has enhanced the efficiency and safety of therapeutic administration, particularly for the macromolecules that encounter additional challenges in penetrating biological barriers. In this review, a concise overview of recent progress in bioelectronic devices for in vivo localized drug delivery, with highlights on the latest trends in device design, working principles, and their corresponding functionalities, is provided. The reported systems based on their targeted delivery locations as wearable systems, ingestible systems, and implantable systems are categorized. Each category is introduced in detail by highlighting the special requirements for devices and the corresponding solutions. The remaining challenges in this field and future directions are also discussed.

Highly Efficient and Stable ITO-Free Organic Solar Cells Based on Squaraine N-Doped Quaternary Bulk Heterojunction

Simultaneously achieving high efficiency and robust device stability remains a significant challenge for organic solar cells (OSCs). Solving this challenge is highly dependent on the film morphology of the bulk heterojunction (BHJ) photoactive blends; however, there is a lack of rational control strategy. Herein, it is shown that the molecular crystallinity and nanomorphology of nonfullerene-based BHJ can be effectively controlled by a squaraine-based doping strategy, leading to an increase in device efficiency from 17.26% to 18.5% when doping 2 wt% squaraine into the PBDB-TF:BTP-eC9:PC71 BM ternary BHJ. The efficiency is further improved to 19.11% (certified 19.06%) using an indium-tin-oxide-free column-patterned microcavity (CPM) architecture. Combined with interfacial modification, CPM quaternary OSC excitingly shows an extrapolated lifetime of ≈23 years based on accelerated aging test, with the mechanism behind enhanced stability well studied. Furthermore, a flexible OSC module with a high and stable efficiency of 15.2% and an overall area of 5 cm2 is successfully fabricated, exhibiting a high average output power for wearable electronics. This work demonstrates that OSCs with new design of BHJ and device architecture are highly promising to be practical relevance with excellent performance and stability.

Skin Thermal Management for Subcutaneous Photoelectric Conversion Reaching 500 mW

Despite possessing higher tissue transmittance and maximum permissible exposure power density for skin relative to other electromagnetic waves, second near-infrared light (1000-1350 nm) is scarcely applicable to subcutaneous photoelectric conversion, owing to the companion photothermal effect. Here, skin thermal management is conceived to utmostly utilize the photothermal effect of a photovoltaic cell, which not only improves the photoelectric conversion efficiency but also eliminates skin hyperthermia. In vivo, the output power can be higher than 500 mW with a photoelectric conversion efficiency of 9.4%. This output power is promising to recharge all the clinically applied implantable devices via wireless power transmission, that is, clinical pacemakers (6-200 µW), drug pumps (0.5-2 mW), cochlear (5-40 mW), and wireless endo-photo cameras (≈100 mW).

Perspectives on recent advancements in energy harvesting, sensing and bio-medical applications of piezoelectric gels

The development of next-generation bioelectronics, as well as the powering of consumer and medical devices, require power sources that are soft, flexible, extensible, and even biocompatible. Traditional energy storage devices (typically, batteries and supercapacitors) are rigid, unrecyclable, offer short-lifetime, contain hazardous chemicals and possess poor biocompatibility, hindering their utilization in wearable electronics. Therefore, there is a genuine unmet need for a new generation of innovative energy-harvesting materials that are soft, flexible, bio-compatible, and bio-degradable. Piezoelectric gels or PiezoGels are a smart crystalline form of gels with polar ordered structures that belongs to the broader family of piezoelectric material, which generate electricity in response to mechanical stress or deformation. Given that PiezoGels are structurally similar to hydrogels, they offer several advantages including intrinsic chirality, crystallinity, degree of ordered structures, mechanical flexibility, biocompatibility, and biodegradability, emphasizing their potential applications ranging from power generation to bio-medical applications. Herein, we describe recent examples of new functional PiezoGel materials employed for energy harvesting, sensing, and wound dressing applications. First, this review focuses on the principles of piezoelectric generators (PEGs) and the advantages of using hydrogels as PiezoGels in energy and biomedical applications. Next, we provide a detailed discussion on the preparation, functionalization, and fabrication of PiezoGel-PEGs (P-PEGs) for the applications of energy harvesting, sensing and wound healing/dressing. Finally, this review concludes with a discussion of the current challenges and future directions of P-PEGs.

Wearable Transmitter Coil Design for Inductive Wireless Power Transfer to Implantable Devices

Wireless endovascular sensors and stimulators are emerging biomedical technologies for applications such as endovascular pressure monitoring, hyperthermia, and neural stimulations. Recently, coil-shaped stents have been proposed for inductive power transfer to endovascular devices using the stent as a receiver. However, less work has been done on the external transmitter components, so the maximum power transferable remains unknown. In this work, we design and evaluate a wearable transmitter coil that allows 50 mW power transfer in simulation.Clinical Relevance-This allows more accurate measurements and precise control of endovascular devices.

How Practical Are Fiber Supercapacitors for Wearable Energy Storage Applications?

Future wearable electronics and smart textiles face a major challenge in the development of energy storage devices that are high-performing while still being flexible, lightweight, and safe. Fiber supercapacitors are one of the most promising energy storage technologies for such applications due to their excellent electrochemical characteristics and mechanical flexibility. Over the past decade, researchers have put in tremendous effort and made significant progress on fiber supercapacitors. It is now the time to assess the outcomes to ensure that this kind of energy storage device will be practical for future wearable electronics and smart textiles. While the materials, fabrication methods, and energy storage performance of fiber supercapacitors have been summarized and evaluated in many previous publications, this review paper focuses on two practical questions: Are the reported devices providing sufficient energy and power densities to wearable electronics? Are the reported devices flexible and durable enough to be integrated into smart textiles? To answer the first question, we not only review the electrochemical performance of the reported fiber supercapacitors but also compare them to the power needs of a variety of commercial electronics. To answer the second question, we review the general approaches to assess the flexibility of wearable textiles and suggest standard methods to evaluate the mechanical flexibility and stability of fiber supercapacitors for future studies. Lastly, this article summarizes the challenges for the practical application of fiber supercapacitors and proposes possible solutions.

Expedient secondary functions of flexible piezoelectrics for biomedical energy harvesting

Flexible piezoelectrics realise the conversion between mechanical movements and electrical power by conformally attaching onto curvilinear surfaces, which are promising for energy harvesting of biomedical devices due to their sustainable body movements and/or deformations. Developing secondary functions of flexible piezoelectric energy harvesters is becoming increasingly significant in recent years via aiming at issues that cannot be addressed or mitigated by merely increasing piezoelectric efficiencies. These issues include loose interfacial contact and pucker generation by stretching, power shortage or instability induced by inadequate mechanical energy, and premature function degeneration or failure caused by fatigue fracture after cyclic deformations. Herein, the expedient secondary functions of flexible piezoelectrics to mitigate above issues are reviewed, including stretchability, hybrid energy harvesting, and self-healing. Efforts have been devoted to understanding the state-of-the-art strategies and their mechanisms of achieving secondary functions based on piezoelectric fundamentals. The link between structural characteristic and function performance is unravelled by providing insights into carefully selected progresses. The remaining challenges of developing secondary functions are proposed in the end with corresponding outlooks. The current work hopes to help and inspire future research in this promising field focusing on developing the secondary functions of flexible piezoelectric energy harvesters.

Low-cost and prototype-friendly method for biocompatible encapsulation of implantable electronics with epoxy overmolding, hermetic feedthroughs and P3HT coating

The research of novel implantable medical devices is one of the most attractive, yet complex areas in the biomedical field. The design and development of sufficiently small devices working in an in vivo environment is challenging but successful encapsulation of such devices is even more so. Industry-standard methods using glass and titanium are too expensive and tedious, and epoxy or silicone encapsulation is prone to water ingress with cable feedthroughs being the most frequent point of failure. This paper describes a universal and straightforward method for reliable encapsulation of circuit boards that achieves ISO10993 compliance. A two-part PVDF mold was machined using a conventional 3-axis machining center. Then, the circuit board with a hermetic feedthrough was placed in the mold and epoxy resin was injected into the mold under pressure to fill the cavity. Finally, the biocompatibility was further enhanced with an inert P3HT polymer coating which can be easily formulated into an ink. The biocompatibility of the encapsulants was assessed according to ISO10993. The endurance of the presented solution compared to silicone potting and epoxy potting was assessed by submersion in phosphate-buffered saline solution at 37 °C. The proposed method showed superior results to PDMS and simple epoxy potting.

Online Seizure Prediction System: A Novel Probabilistic Approach for Efficient Prediction of Epileptic Seizure with iEEG Signal

Background:

1% of people around the world are suffering from epilepsy. It is, therefore crucial to propose an efficient automated seizure prediction tool implemented in a portable device that uses the electroencephalogram (EEG) signal to enhance epileptic patients’ life quality.

Methods:

In this study, we focused on time-domain features to achieve discriminative information at a low CPU cost extracted from the intracranial electroencephalogram (iEEG) signals of six patients. The probabilistic framework based on XGBoost classifier requires the mean and maximum probability of the non-seizure and the seizure occurrence period segments. Once all these parameters are set for each patient, the medical decision maker can send alarm based on well-defined thresholds.

Results:

While finding a unique model for all patients is really challenging, and our modelling results demonstrated that the proposed algorithm can be an efficient tool for reliable and clinically relevant seizure forecasting. Using iEEG signals, the proposed algorithm can forecast seizures, informing a patient about 75 minutes before a seizure would occur, a period large enough for patients to take practical actions to minimize the potential impacts of the seizure.

Conclusion:

We posit that the ability to distinguish interictal intracranial EEG from pre-ictal signals at some low computational cost may be the first step towards an implanted portable semi-automatic seizure suppression system in the near future. It is believed that our seizure prediction technique can conceivably be coupled with treatment techniques aimed at interrupting the process even prior to a seizure initiates to develop.

Subcutaneous power supply by NIR-II light

Implantable medical devices are wished to be recharged via contactless power transfer technologies without interventional operations. Superior to subcutaneous power supply by visible light or electromagnetic wave, second near-infrared (NIR-II) light is predicted to possess 60 times subcutaneous power transmission but hard to be utilized. Here we report a photo-thermal-electric converter via the combination of photothermal conversion and thermoelectric conversion. It is able to generate an output power as high as 195 mW under the coverage of excised tissues, presenting advantages of non-invasion, high output power, negligible biological damage, and deep tissue penetration. As an in vivo demonstration, the output power of a packaged converter in the abdominal cavity of a rabbit reaches 20 mW under NIR-II light irradiation through the rabbit skin with a thickness of 8.5 mm. This value is high enough to recharge an implanted high-power-consumption wireless camera and transfer video signal out of body in real-time.

Actuators for Implantable Devices: A Broad View

The choice of actuators dictates how an implantable biomedical device moves. Specifically, the concept of implantable robots consists of the three pillars: actuators, sensors, and powering. Robotic devices that require active motion are driven by a biocompatible actuator. Depending on the actuating mechanism, different types of actuators vary remarkably in strain/stress output, frequency, power consumption, and durability. Most reviews to date focus on specific type of actuating mechanism (electric, photonic, electrothermal, etc.) for biomedical applications. With a rapidly expanding library of novel actuators, however, the granular boundaries between subcategories turns the selection of actuators a laborious task, which can be particularly time-consuming to those unfamiliar with actuation. To offer a broad view, this study (1) showcases the recent advances in various types of actuating technologies that can be potentially implemented in vivo, (2) outlines technical advantages and the limitations of each type, and (3) provides use-specific suggestions on actuator choice for applications such as drug delivery, cardiovascular, and endoscopy implants.

Anti-Reflective Zeolite Coating for Implantable Bioelectronic Devices

Since sunlight is one of the most easily available and clean energy supplies, solar cell development and the improvement of its conversion efficiency represent a highly interesting topic. Superficial light reflection is one of the limiting factors of the photovoltaic cells (PV) efficiency. To this end, interfacial layer with anti-reflective properties reduces this phenomenon, improving the energy potentially available for transduction. Nanoporous materials, because of the correlation between the refractive index and the porosity, allow low reflection, improving light transmission through the coating. In this work, anti-reflective coatings (ARCs) deposited on commercial PV cells, which were fabricated using two different Linde Type A (LTA) zeolites (type 3A and 4A), have been investigated. The proposed technique allows an easier deposition of a zeolite-based mixture, avoiding the use of chemicals and elevated temperature calcination processes. Results using radiation in the range 470–610 nm evidenced substantial enhancement of the fill factor, with maximum achieved values of over 40%. At 590 and 610 nm, which are the most interesting bands for implantable devices, FF is improved, with a maximum of 22% and 10%, respectively. ARCs differences are mostly related to the morphology of the zeolite powder used, which resulted in thicker and rougher coatings using zeolite 3A. The proposed approach allows a simple and reliable deposition technique, which can be of interest for implantable medical devices.

Wireless interfaces for brain neurotechnologies

Wireless interfaces enable brain-implanted devices to remotely interact with the external world. They are critical components in modern research and clinical neurotechnologies and play a central role in determining their overall size, lifetime and functionality. Wireless interfaces use a wide range of modalities-including radio-frequency fields, acoustic waves and light-to transfer energy and data to and from an implanted device. These forms of energy interact with living tissue through distinct mechanisms and therefore lead to systems with vastly different form factors, operating characteristics, and safety considerations. This paper reviews recent advances in the development of wireless interfaces for brain neurotechnologies. We summarize the requirements that state-of-the-art brain-implanted devices impose on the wireless interface, and discuss the working principles and applications of wireless interfaces based on each modality. We also investigate challenges associated with wireless brain neurotechnologies and discuss emerging solutions permitted by recent developments in electrical engineering and materials science. This article is part of the theme issue 'Advanced neurotechnologies: translating innovation for health and well-being'.

Emerging Optoelectronic Devices Based on Microscale LEDs and Their Use as Implantable Biomedical Applications

Thin-film microscale light-emitting diodes (LEDs) are efficient light sources and their integrated applications offer robust capabilities and potential strategies in biomedical science. By leveraging innovations in the design of optoelectronic semiconductor structures, advanced fabrication techniques, biocompatible encapsulation, remote control circuits, wireless power supply strategies, etc., these emerging applications provide implantable probes that differ from conventional tethering techniques such as optical fibers. This review introduces the recent advancements of thin-film microscale LEDs for biomedical applications, covering the device lift-off and transfer printing fabrication processes and the representative biomedical applications for light stimulation, therapy, and photometric biosensing. Wireless power delivery systems have been outlined and discussed to facilitate the operation of implantable probes. With such wireless, battery-free, and minimally invasive implantable light-source probes, these biomedical applications offer excellent opportunities and instruments for both biomedical sciences research and clinical diagnosis and therapy.

Developments in Deep Brain Stimulators for Successful Aging Towards Smart Devices—An Overview

This work provides an overview of the present state-of-the-art in the development of deep brain Deep Brain Stimulation (DBS) and how such devices alleviate motor and cognitive disorders for a successful aging. This work reviews chronic diseases that are addressable via DBS, reporting also the treatment efficacies. The underlying mechanism for DBS is also reported. A discussion on hardware developments focusing on DBS control paradigms is included specifically the open- and closed-loop “smart” control implementations. Furthermore, developments towards a “smart” DBS, while considering the design challenges, current state of the art, and constraints, are also presented. This work also showcased different methods, using ambient energy scavenging, that offer alternative solutions to prolong the battery life of the DBS device. These are geared towards a low maintenance, semi-autonomous, and less disruptive device to be used by the elderly patient suffering from motor and cognitive disorders.

Advanced Implantable Biomedical Devices Enabled by Triboelectric Nanogenerators

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

A self-powered wearable brain-machine-interface system for ceasing action

A self-powered wearable brain-machine-interface system with pulse detection and brain stimulation for ceasing action has been realized. The system is composed of (1) a power supply unit that employs a piezoelectric generator and converts the mechanical energy of human daily activities into electricity; (2) a neck pulse biosensor that allows continuous measurements of carotid pulse by using a piezoelectric polyvinylidene fluoride film; (3) a data analysis module that enables a coordinated brain-machine-interface system to output brain stimulation signals; and (4) brain stimulating electrodes linked to the brain that implement behavioral intervention. Demonstration of the system with stimulating electrodes implanted in the periaqueductal gray (PAG) in running mice reveals the great effect of forced ceasing action. The mice stop their running within several seconds when the stimulation signals are sent into the PAG brain region (inducing fear). This self-powered scheme for neural stimulation realizes specific behavioral intervention without any external power supply, thus providing a new concept for future behavior intervention.

Enhancement of patterned triboelectric output performance by an interfacial polymer layer for energy harvesting application

Efficaciously scavenging waste mechanical energy from the environment is an emerging field in the self-powered and self-governing electronics systems which solves battery limitations. It demonstrates enormous potential in various fields such as wireless devices, vesture, and portable electronic devices. Different surface textured PET triboelectric nanogenerators (TENGs) were developed by the laser pattern method in the previous work, with the line textured TENG device showing improved performance due to a larger surface contact area. Here, a polyethylene oxide (PEO) and polyvinyl alcohol (PVA) coated line patterned PET-based TENG was developed for the conversion of mechanical energy into useful electric energy. The PEO layer boosted the TENG output to 4 times higher than that of the PA6-laser patterned PET TENG device (our previous report) and 2-fold higher than that of a pristine line patterned TENG. It generated an open-circuit voltage, short circuit current, and instantaneous power density of 131 V, 2.32 μA, and 41.6 μW cm^-2, respectively. The as-fabricated device was tested for 10 000 cycles for reliability evaluation, which shows no significant performance degradation. In addition, the device was deployed to power 10 LEDs with high intensity. Thus, this device can be used for ambient mechanical energy conversion and to power micro and nano-electronic devices.

Biomedical PEVA Nanocomposite with Dual Clay Nanofiller: Cytotoxicity, Mechanical Properties, and Biostability

Poly(ethylene-vinyl acetate) (PEVA) nanocomposite incorporating dual clay nanofiller (DCN) of surface modified montmorillonite (S-MMT) and bentonite (Bent) was studied for biomedical applications. In order to overcome agglomeration of the DCN, the S-MMT and Bent were subjected to a physical treatment prior to being mixed with the copolymer to form nanocomposite material. The S-MMT and Bent were physically treated to become S-MMT(P) and Bent(pH-s), respectively, that could be more readily dispersed in the copolymer matrix due to increments in their basal spacing and loosening of their tactoid structure. The biocompatibility of both nanofillers was assessed through a fibroblast cell cytotoxicity assay. The mechanical properties of the neat PEVA, PEVA nanocomposites, and PEVA-DCN nanocomposites were evaluated using a tensile test for determining the best S-MMT(P):Bent(pH-s) ratio. The results were supported by morphological studies by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Biostability evaluation of the samples was conducted by comparing the ambient tensile test data with the in vitro tensile test data (after being immersed in simulated body fluid at 37 °C for 3 months). The results were supported by surface degradation analysis. Our results indicate that the cytotoxicity level of both nanofillers reduced upon the physical treatment process, making them safe to be used in low concentration as dual nanofillers in the PEVA-DCN nanocomposite. The results of tensile testing, SEM, and TEM proved that the ratio of 4:1 (S-MMT(P):Bent(pH-s)) provides a greater enhancement in the mechanical properties of the PEVA matrix. The biostability assessment indicated that the PEVA-DCN nanocomposite can achieve much better retention in tensile strength after being subjected to the simulated physiological fluid for 3 months with less surface degradation effect. These findings signify the potential of the S-MMT(P)/Bent(pH-s) as a reinforcing DCN, with simultaneous function as biostabilizing agent to the PEVA copolymer for implant application.

Autocharging Techniques for Implantable Medical Applications

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

Challenges to the development of the next generation of self-reporting cardiovascular implantable medical devices

Cardiovascular disease (CVD) is a group of heart and vasculature conditions which are the leading form of mortality worldwide. Blood vessels can become narrowed, restricting blood flow, and drive the majority of hearts attacks and strokes. Surgical interventions are frequently required; including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Despite successful opening of vessels and restoration of blood flow, often in-stent restenosis (ISR) and graft failure can still occur, resulting in subsequent patient morbidity and mortality. A new generation of cardiovascular implants that have sensors and real-time monitoring capabilities are being developed to combat ISR and graft failure. Self-reporting stent/graft technology could enable precision medicine-based healthcare by detecting the earliest features of disease, even before symptoms occur. Bringing an implantable medical device with wireless electronic sensing capabilities to market is complex and often obstructive undertaking. This critical review analyses the obstacles that need to be overcome for self-reporting stents/grafts to be developed and provide a precision-medicine based healthcare for cardiovascular patients. Here we assess the latest research and technological advancement in the field, the current devices and the market potential for their end-user implementation.

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

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

Wireless Power Delivery Techniques for Miniature Implantable Bioelectronics

Progress in implanted bioelectronic technology offers the opportunity to develop more effective tools for personalized electronic medicine. While there are numerous clinical and pre-clinical applications for these devices, power delivery to these systems can be challenging. Wireless battery-free devices offer advantages such as a smaller and lighter device footprint and reduced failures and infections by eliminating lead wires. However, with the development of wireless technologies, there are fundamental tradeoffs between five essential factors: power, miniaturization, depth, alignment tolerance, and transmitter distance, while still allowing devices to work within safety limits. These tradeoffs mean that multiple forms of wireless power transfer are necessary for different devices to best meet the needs for a given biological target. Here six different types of wireless power transfer technologies used in bioelectronic implants-inductive coupling, radio frequency, mid-field, ultrasound, magnetoelectrics, and light-are reviewed in context of the five tradeoffs listed above. This core group of wireless power modalities is then used to suggest possible future bioelectronic technologies and their biological applications.

Wireless Power Transfer and Telemetry for Implantable Bioelectronics

Implantable bioelectronic devices are becoming useful and prospective solutions for various diseases owing to their ability to monitor or manipulate body functions. However, conventional implantable devices (e.g., pacemaker and neurostimulator) are still bulky and rigid, which is mostly due to the energy storage component. In addition to mechanical mismatch between the bulky and rigid implantable device and the soft human tissue, another significant drawback is that the entire device should be surgically replaced once the initially stored energy is exhausted. Besides, retrieving physiological information across a closed epidermis is a tricky procedure. However, wireless interfaces for power and data transfer utilizing radio frequency (RF) microwave offer a promising solution for resolving such issues. While the RF interfacing devices for power and data transfer are extensively investigated and developed using conventional electronics, their application to implantable bioelectronics is still a challenge owing to the constraints and requirements of in vivo environments, such as mechanical softness, small module size, tissue attenuation, and biocompatibility. This work elucidates the recent advances in RF-based power transfer and telemetry for implantable bioelectronics to tackle such challenges.

Bimodal Nanocomposite Platform with Antibiofilm and Self-Powering Functionalities for Biomedical Applications

Advances in microelectronics and nanofabrication have led to the development of various implantable biomaterials. However, biofilm-associated infection on medical devices still remains a major hurdle that substantially undermines the clinical applicability and advancement of biomaterial systems. Given their attractive piezoelectric behavior, barium titanate (BTO)-based materials have also been used in biological applications. Despite its versatility, the feasibility of BTO-embedded biomaterials as anti-infectious implantable medical devices in the human body has not been explored yet. Here, the first demonstration of clinically viable BTO-nanocomposites is presented. It demonstrates potent antibiofilm properties against Streptococcus mutans without bactericidal effect while retaining their piezoelectric and mechanical behaviors. This antiadhesive effect led to ∼10-fold reduction in colony-forming units in vitro. To elucidate the underlying mechanism for this effect, data depicting unfavorable interaction energy profiles between BTO-nanocomposites and S. mutans using the classical and extended Derjaguin, Landau, Verwey, and Overbeek theories is presented. Direct cell-to-surface binding force data using atomic force microscopy also corroborate reduced adhesion between BTO-nanocomposites and S. mutans. Interestingly, the poling process on BTO-nanocomposites resulted in asymmetrical surface charge density on each side, which may help tackle two major issues in prosthetics-bacterial contamination and tissue integration. Finally, BTO-nanocomposites exhibit superior biocompatibility toward human gingival fibroblasts and keratinocytes. Overall, BTO-embedded composites exhibit broad-scale potential to be used in biological settings as energy-harvestable antibiofilm surfaces.

Recent Advances of Energy Solutions for Implantable Bioelectronics

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

The past, present, and future of remote patient monitoring in spine care: an overview

PURPOSE

Remote patient monitoring (RPM) has revolutionized the landscape of healthcare. From humble beginnings rooted in landline home telephone calls to present-day devices with near instantaneous wireless connectivity, the evolution of technology has ushered in an era of digital medicine and remote care. Presently, a vast array of healthcare data points can be automatically generated, analyzed, and forwarded to providers to supplement clinical decision-making. While RPM originated and was popularized within medicine, its role in orthopedics, and particularly within spine surgery, is evolving. We sought to provide an overview of RPM within orthopedics, with specific attention on spine care, analyzing its origins, present-day form, and prospects.

METHODS

We reviewed the literature to date as it pertains to RPM within healthcare at large, orthopedics, and spine care.

RESULTS

We detail the development and clinical use of wearable technology and smart implants, examining the underlying technology and evaluating the spectrum of their present-day and potential applications.

CONCLUSIONS

Technological advancements are not only reshaping the paradigm of musculoskeletal care but are also redefining the physician-patient relationship as well as reimagining traditional perspectives on healthcare data collection and privacy.

Energy Solutions for Wearable Sensors: A Review

Wearable sensors have gained popularity over the years since they offer constant and real-time physiological information about the human body. Wearable sensors have been applied in a variety of ways in clinical settings to monitor health conditions. These technologies require energy sources to carry out their projected functionalities. In this paper, we review the main energy sources used to power wearable sensors. These energy sources include batteries, solar cells, biofuel cells, supercapacitors, thermoelectric generators, piezoelectric and triboelectric generators, and radio frequency (RF) energy harvesters. Additionally, we discuss wireless power transfer and some hybrids of the above technologies. The advantages and drawbacks of each technology are considered along with the system components and attributes that make these devices function effectively. The objective of this review is to inform researchers about the latest developments in this field and present future research opportunities.

A Review of Power Management Integrated Circuits for Ultrasound-Based Energy Harvesting in Implantable Medical Devices

This paper aims to review the recent architectures of power management units for ultrasound-based energy harvesting, while focusing on battery-less implantable medical devices. In such systems, energy sustainability is based on piezoelectric devices and a power management circuit, which represents a key building block since it maximizes the power extracted from the piezoelectric devices and delivers it to the other building blocks of the implanted device. Since the power budget is strongly constrained by the dimension of the piezoelectric energy harvester, complexity of topologies have been increased bit by bit in order to achieve improved power efficiency also in difficult operative conditions. With this in mind, the introduced work consists of a comprehensive presentation of the main blocks of a generic power management unit for ultrasound-based energy harvesting and its operative principles, a review of the prior art and a comparative study of the performance achieved by the considered solutions. Finally, design guidelines are provided, allowing the designer to choose the best topology according to the given design specifications and technology adopted.