Continuous Heart Volume Monitoring by Fully Implantable Soft Strain Sensor

Smart Bioelectronics for Real-Time Diagnosis and Therapy of Body Organ Functions

Noncommunicable diseases (NCDs) associated with cardiovascular, neurological, and gastrointestinal disorders remain a leading cause of global mortality, sounding the alarm for the urgent need for better diagnostic and therapeutic solutions. Wearable and implantable biointegrated electronics offer a groundbreaking solution, combining real-time, high-resolution monitoring with innovative treatment capabilities tailored to specific organ functions. In this comprehensive review, we focus on the diseases affecting the brain, heart, gastrointestinal organs, bladder, and adrenal gland, along with their associated physiological parameters. Additionally, we provide an overview of the characteristics of these parameters and explore the potential of bioelectronic devices for in situ sensing and therapeutic applications and highlight the recent advancements in their deployment across specific organs. Finally, we analyze the current challenges and prospects of implementing closed-loop feedback control systems in integrated sensor-therapy applications. By emphasizing organ-specific applications and advocating for closed-loop systems, this review highlights the potential of future bioelectronics to address physiological needs and serves as a guide for researchers navigating the interdisciplinary fields of diagnostics, therapeutics, and personalized medicine.

Advancements in Bio-Integrated Flexible Electronics for Hemodynamic Monitoring in Cardiovascular Healthcare

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, highlighting the urgent need for effective monitoring and prevention strategies. The rapid advancement of flexible sensing technology and the development of conformal sensors have attracted significant attention due to their potential for continuous, real-time assessment of cardiovascular health over extended periods. This review outlines recent advancements in bio-integrated flexible electronics designed for hemodynamic monitoring and broader CVD healthcare applications. It introduces key physiological indicators relevant to hemodynamics, including heart rate, blood pressure, blood flow velocity, and cardiac output. Next, it discusses flexible bio-integrated electronics engineering strategies, such as working principles and configuration designs. Various non-invasive and invasive bio-integrated devices for monitoring these hemodynamic indicators are then presented. Additionally, the review highlights the role of artificial intelligence algorithms and their practical applications in bio-integrated electronics for hemodynamic detection. Finally, it proposes future directions and addresses potential challenges in the field.

A low-cost biocompatible and biodegradable multipurpose resistive ink for monitoring biological systems

Flexible and biocompatible strain sensors are becoming increasingly important in fields such as health monitoring, wearable electronics, and environmental sensing because they offer significant advantages over conventional rigid systems. However, they lack the versatility and ecological and physiological biocompatibility necessary for broader integration within biological systems. Here, we describe the development of an inexpensive water-based plasticized chitosan-carbon black composite ink that can be used to produce conductive and biocompatible strain sensors. The ink can be applied to various surfaces, including skin, internal organs, and other biological tissues, using numerous methods, such as painting, dipping, and stamping. Furthermore, this unprecedented ability to attach and conform to biological surfaces allows the exploration of secondary sensing innovations, such as exploiting skin wrinkles to improve sensitivity. This study demonstrates that the ink exhibits a reliable change in electrical resistance in response to a wide range of motions, from subtle vibrations during speech and heartbeats to extensive articulations, like finger and elbow movements. This exceptional sensitivity range, biocompatibility, and the ink's low cost, biodegradability, and ease of removal enhance its applicability in sustainable, temporary, and customizable sensing solutions, highlighting its potential for versatile applications in human health monitoring, motion detection, and environmental sensing.

Flexible Electrode Arrays Based on a Wide Bandgap Semiconductors for Chronic Implantable Multiplexed Sensing and Heart Pacemakers

Implantable systems with chronic stability, high sensing performance, and extensive spatial-temporal resolution are a growing focus for monitoring and treating several diseases such as epilepsy, Parkinson's disease, chronic pain, and cardiac arrhythmias. These systems demand exceptional bendability, scalable size, durable electrode materials, and well-encapsulated metal interconnects. However, existing chronic implantable bioelectronic systems largely rely on materials prone to corrosion in biofluids, such as silicon nanomembranes or metals. This study introduces a multielectrode array featuring a wide bandgap (WBG) material as electrodes, demonstrating its suitability for chronic implantable applications. Our devices exhibit excellent flexibility and longevity, taking advantage of the low bending stiffness and chemical inertness in WBG nanomembranes and multimodalities for physical health monitoring, including temperature, strain, and impedance sensing. Our top-down manufacturing process enables the formation of distributed electrode arrays that can be seamlessly integrated onto the curvilinear surfaces of skins. As proof of concept for chronic cardiac pacing applications, we demonstrate the effective pacing functionality of our devices on rabbit hearts through a set of ex vivo experiments. The engineering approach proposed in this study overcomes the drawbacks of prior WBG material fabrication techniques, resulting in an implantable system with high bendability, effective pacing, and high-performance sensing.

Performance and Robustness of Physiological Controllers With Integrated Pressure Sensors on Inflow Cannula

The control of left ventricular assist devices (LVADs) requires sensors and/or estimators to account for the physiological state of the patient and apply advanced controllers. Sensor characteristics are a challenge when using implantable pressure sensors because they influence the quality of physiological control and the robustness of the controlled system. The objective of this work is to investigate the performance and robustness of LVAD controllers that operate based on LVAD integrated pressure sensors. Four pressure-based LVAD controllers are tested with a HeartMate 3 that has an integrated pressure sensor. Controller sensitivity as well as robustness to sensor drift and noise are evaluated based on controller response to large changes in preload and afterload. A fail-safe strategy for sensor failure used also to investigate the reliable operation of the LVAD in realistic conditions. All tested controllers are sensitive to drifting pressure signals, which can lead to unstable behavior. The results show that two controllers are robust to noise. The other two controllers show high deviation and oscillation in cardiac output even for small noise. Additionally, a noticeable difference of the controller's response between simulated and measured pressure input was observed, indicating the need for a robust controller design. Reliable operation even in the event of a sensor failure was achieved on the basis of a fail-safe control system.

One-Dimensional Implantable Sensors for Accurately Monitoring Physiological and Biochemical Signals

In recent years, one-dimensional (1D) implantable sensors have received considerable attention and rapid development in the biomedical field due to their unique structural characteristics and high integration capability. These sensors can be implanted into the human body with minimal invasiveness, facilitating real-time and accurate monitoring of various physiological and pathological parameters. This review examines the latest advancements in 1D implantable sensors, focusing on the material design of sensors, device integration, implantation methods, and the construction of the stable sensor-tissue interface. Furthermore, a comprehensive overview is provided regarding the applications and future research directions for 1D implantable sensors with an ultimate aim to promote their utilization in personalized healthcare and precision medicine.

A Simple Method to Manufacture a Force Sensor Array Based on a Single-Material 3D-Printed Piezoresistive Foam and Metal Coating

Nowadays, 3D printing is becoming an increasingly common option for the manufacturing of sensors, primarily due to its capacity to produce intricate geometric shapes. However, a significant challenge persists in integrating multiple materials during printing, for various reasons. In this study, we propose a straightforward approach that combines 3D printing with metal coating to create an array of resistive force sensors from a single material. The core concept involves printing a sensing element using a conductive material and subsequently separating it into distinct parts using metal-coated lines connected to the electrical ground. This post-printing separation process involves manual intervention utilizing a stencil and metallic spray. The primary obstacle lies in establishing a sufficient contact surface between the sprayed metal and the structure, to ensure effective isolation among different zones. To address this challenge, we suggest employing a lattice structure to augment the contact surface area. Through experimental validation, we demonstrate the feasibility of fabricating two sensing elements from a single-material 3D-printed structure, with a maximum electrical isolation ratio between the sensors of above 30. These findings hold promise for the development of a new generation of low-tech 3D-printed force/displacement sensor arrays.

Implementation of an epicardial implantable MEMS sensor for continuous and real-time postoperative assessment of left ventricular activity in adult minipigs over a short- and long-term period

The sensing of left ventricular (LV) activity is fundamental in the diagnosis and monitoring of cardiovascular health in high-risk patients after cardiac surgery to achieve better short- and long-term outcome. Conventional approaches rely on noninvasive measurements even if, in the latest years, invasive microelectromechanical systems (MEMS) sensors have emerged as a valuable approach for precise and continuous monitoring of cardiac activity. The main challenges in designing cardiac MEMS sensors are represented by miniaturization, biocompatibility, and long-term stability. Here, we present a MEMS piezoresistive cardiac sensor capable of continuous monitoring of LV activity over time following epicardial implantation with a pericardial patch graft in adult minipigs. In acute and chronic scenarios, the sensor was able to compute heart rate with a root mean square error lower than 2 BPM. Early after up to 1 month of implantation, the device was able to record the heart activity during the most important phases of the cardiac cycle (systole and diastole peaks). The sensor signal waveform, in addition, closely reflected the typical waveforms of pressure signal obtained via intraventricular catheters, offering a safer alternative to heart catheterization. Furthermore, histological analysis of the LV implantation site following sensor retrieval revealed no evidence of myocardial fibrosis. Our results suggest that the epicardial LV implantation of an MEMS sensor is a suitable and reliable approach for direct continuous monitoring of cardiac activity. This work envisions the use of this sensor as a cardiac sensing device in closed-loop applications for patients undergoing heart surgery.

Postoperative Long-Term Monitoring of Mechanical Characteristics in Reconstructed Soft Tissues Using Biocompatible, Immune-Tolerant, and Wireless Electronic Sutures

Accurate postoperative assessment of varying mechanical properties is crucial for customizing patient-specific treatments and optimizing rehabilitation strategies following Achilles tendon (AT) rupture and reconstruction surgery. This study introduces a wireless, chip-less, and immune-tolerant in vivo strain-sensing suture designed to continuously monitor mechanical stiffness variations in the reconstructed AT throughout the healing process. This innovative sensing suture integrates a standard medical suturing thread with a wireless fiber strain-sensing system, which incorporates a fiber strain sensor and a double-layered inductive coil for wireless readout. The winding design of Au nanoparticle-based fiber electrodes and a hollow core contribute to the fiber strain sensor's high sensitivity (factor of 6.2 and 15.1 pF for revised sensitivity), negligible hysteresis, and durability over 10,000 stretching cycles. To ensure biocompatibility and immune tolerance during extended in vivo periods, an antibiofouling lubricant layer was applied to the sensing suture. Using this sensing system, we successfully monitored the strain responses of the reconstructed AT in an in vivo porcine model. This facilitated the postoperative assessment of mechanical stiffness variations through a well-established analytical model during the healing period.

Soft mechanical sensors for wearable and implantable applications

Wearable and implantable sensing of biomechanical signals such as pressure, strain, shear, and vibration can enable a multitude of human-integrated applications, including on-skin monitoring of vital signs, motion tracking, monitoring of internal organ condition, restoration of lost/impaired mechanoreception, among many others. The mechanical conformability of such sensors to the human skin and tissue is critical to enhancing their biocompatibility and sensing accuracy. As such, in the recent decade, significant efforts have been made in the development of soft mechanical sensors. To satisfy the requirements of different wearable and implantable applications, such sensors have been imparted with various additional properties to make them better suited for the varied contexts of human-integrated applications. In this review, focusing on the four major types of soft mechanical sensors for pressure, strain, shear, and vibration, we discussed the recent material and device design innovations for achieving several important properties, including flexibility and stretchability, bioresorbability and biodegradability, self-healing properties, breathability, transparency, wireless communication capabilities, and high-density integration. We then went on to discuss the current research state of the use of such novel soft mechanical sensors in wearable and implantable applications, based on which future research needs were further discussed. This article is categorized under: Diagnostic Tools > Biosensing Diagnostic Tools > Diagnostic Nanodevices Implantable Materials and Surgical Technologies > Nanomaterials and Implants.

Pioneering healthcare with soft robotic devices: A review

Recent advancements in soft robotics have been emerging as an exciting paradigm in engineering due to their inherent compliance, safe human interaction, and ease of adaptation with wearable electronics. Soft robotic devices have the potential to provide innovative solutions and expand the horizons of possibilities for biomedical applications by bringing robots closer to natural creatures. In this review, we survey several promising soft robot technologies, including flexible fluidic actuators, shape memory alloys, cable-driven mechanisms, magnetically driven mechanisms, and soft sensors. Selected applications of soft robotic devices as medical devices are discussed, such as surgical intervention, soft implants, rehabilitation and assistive devices, soft robotic exosuits, and prosthetics. We focus on how soft robotics can improve the effectiveness, safety and patient experience for each use case, and highlight current research and clinical challenges, such as biocompatibility, long-term stability, and durability. Finally, we discuss potential directions and approaches to address these challenges for soft robotic devices to move toward real clinical translations in the future.

Flexible electronics for cardiovascular healthcare monitoring

Cardiovascular diseases (CVDs) are one of the most urgent threats to humans worldwide, which are responsible for almost one-third of global mortality. Over the last decade, research on flexible electronics for monitoring and treatment of CVDs has attracted tremendous attention. In contrast to conventional medical instruments in hospitals that are usually bulky, hard to move, monofunctional, and time-consuming, flexible electronics are capable of continuous, noninvasive, real-time, and portable monitoring. Notable progress has been made in this emerging field, and thus a number of significant achievements and concomitant research prospects deserve attention for practical implementation. Here, we comprehensively review the latest progress of flexible electronics for CVDs, focusing on new functions provided by flexible electronics. First, the characteristics of CVDs and flexible electronics and the foundation of their combination are briefly reviewed. Then, four representative applications of flexible electronics for CVDs are elaborated: blood pressure (BP) monitoring, electrocardiogram (ECG) monitoring, echocardiogram monitoring, and direct epicardium monitoring. Their operational principles, progress, merits and demerits, and future efforts are discussed. Finally, the remaining challenges and opportunities for flexible electronics for cardiovascular healthcare are outlined.

Jacketed elastomeric tubes for passive self-regulation of pulsatile flow

Regulating pulsatile flow is important to achieve optimal separation and mixing and enhanced heat transfer in microfluidic devices, as well as maintaining homeostasis in biological systems. The human aorta, a composite and layered tube made (among others) of elastin and collagen, is an inspiration for researchers who seek an engineering solution for a self-regulation of pulsatile flow. Here, we present a bio-inspired approach showing that fabric-jacketed elastomeric tubes, manufactured using commercially available silicone rubber and knitted textiles, can be used to regulate pulsatile flow. Our tubes are evaluated via incorporation into a mock-circulatory 'flow loop' that replicates the pulsatile fluid flow conditions of an ex-vivo heart perfusion (EVHP) device, a machine used in heart transplants. Pressure waveforms measured near the elastomeric tubing clearly indicated an effective flow regulation. The 'dynamic stiffening' behavior of the tubes during deformation is analyzed quantitatively. Broadly, the fabric jackets allow for the tubes to experience greater magnitudes of pressure and distension without risk of asymmetric aneurysm within the expected operating time of an EVHP. Owing to its highly tunable nature, our design may serve as a basis for tubing systems that require passive self-regulation of pulsatile flow.

Continuous Monitoring of Blood Pressure and Vascular Hemodynamic Properties With Miniature Extravascular Hall-Based Magnetic Sensor

Continuous measurement of vascular and hemodynamic parameters could improve monitoring of disease progression and enable timely clinical decision making and therapy surveillance in patients suffering from cardiovascular diseases. However, no reliable extravascular implantable sensor technology is currently available. Here, we report the design, characterization, and validation of an extravascular, magnetic flux sensing device capable of capturing the waveforms of the arterial wall diameter, arterial circumferential strain, and arterial pressure without restricting the arterial wall. The implantable sensing device, comprising a magnet and a magnetic flux sensing assembly, both encapsulated in biocompatible structures, has shown to be robust, with temperature and cyclic-loading stability. Continuous and accurate monitoring of arterial blood pressure and vascular properties was demonstrated with the proposed sensor in vitro with a silicone artery model and validated in vivo in a porcine model mimicking physiologic and pathologic hemodynamic conditions. The captured waveforms were further used to deduce the respiration frequency, the duration of the cardiac systolic phase, and the pulse wave velocity. The findings of this study not only suggest that the proposed sensing technology is a promising platform for accurate monitoring of arterial blood pressure and vascular properties, but also highlight the necessary changes in the technology and the implantation procedure to allow the translation of the sensing device in the clinical setting.

Decoupling Transmission and Transduction for Improved Durability of Highly Stretchable, Soft Strain Sensing: Applications in Human Health Monitoring

This work presents a modular approach to the development of strain sensors for large deformations. The proposed method separates the extension and signal transduction mechanisms using a soft, elastomeric transmission and a high-sensitivity microelectromechanical system (MEMS) transducer. By separating the transmission and transduction, they can be optimized independently for application-specific mechanical and electrical performance. This work investigates the potential of this approach for human health monitoring as an implantable cardiac strain sensor for measuring global longitudinal strain (GLS). The durability of the sensor was evaluated by conducting cyclic loading tests over one million cycles, and the results showed negligible drift. To account for hysteresis and frequency-dependent effects, a lumped-parameter model was developed to represent the viscoelastic behavior of the sensor. Multiple model orders were considered and compared using validation and test data sets that mimic physiologically relevant dynamics. Results support the choice of a second-order model, which reduces error by 73% compared to a linear calibration. In addition, we evaluated the suitability of this sensor for the proposed application by demonstrating its ability to operate on compliant, curved surfaces. The effects of friction and boundary conditions are also empirically assessed and discussed.

Functional Fiber Materials to Smart Fiber Devices

The development of fiber materials has accompanied the evolution of human civilization for centuries. Recent advances in materials science and chemistry offered fibers new applications with various functions, including energy harvesting, energy storing, displaying, health monitoring and treating, and computing. The unique one-dimensional shape of fiber devices endows them advantages to work as human-interfaced electronics due to the small size, lightweight, flexibility, and feasibility for integration into large-scale textile systems. In this review, we first present a discussion of the basics of fiber materials and the design principles of fiber devices, followed by a comprehensive analysis on recently developed fiber devices. Finally, we provide the current challenges facing this field and give an outlook on future research directions. With novel fiber devices and new applications continuing to be discovered after two decades of research, we envision that new fiber devices could have an important impact on our life in the near future.

Ultra-Thin Flexible Encapsulating Materials for Soft Bio-Integrated Electronics

Recently, bioelectronic devices extensively researched and developed through the convergence of flexible biocompatible materials and electronics design that enables  more precise diagnostics and therapeutics in human health care and opens up the potential to expand into various fields, such as clinical medicine and biomedical research. To establish an accurate and stable bidirectional bio-interface, protection against the external environment and high mechanical deformation is essential for wearable bioelectronic devices. In the case of implantable bioelectronics, special encapsulation materials and optimized mechanical designs and configurations that provide electronic stability and functionality are required for accommodating various organ properties, lifespans, and functions in the biofluid environment. Here, this study introduces recent developments of ultra-thin encapsulations with novel materials that can preserve or even improve the electrical performance of wearable and implantable bio-integrated electronics by supporting safety and stability for protection from destruction and contamination as well as optimizing the use of bioelectronic systems in physiological environments. In addition, a summary of the materials, methods, and characteristics of the most widely used encapsulation technologies is introduced, thereby providing a strategic selection of appropriate choices of recently developed flexible bioelectronics.

Recent Progress in Materials Chemistry to Advance Flexible Bioelectronics in Medicine

Designing bioelectronic devices that seamlessly integrate with the human body is a technological pursuit of great importance. Bioelectronic medical devices that reliably and chronically interface with the body can advance neuroscience, health monitoring, diagnostics, and therapeutics. Recent major efforts focus on investigating strategies to fabricate flexible, stretchable, and soft electronic devices, and advances in materials chemistry have emerged as fundamental to the creation of the next generation of bioelectronics. This review summarizes contemporary advances and forthcoming technical challenges related to three principal components of bioelectronic devices: i) substrates and structural materials, ii) barrier and encapsulation materials, and iii) conductive materials. Through notable illustrations from the literature, integration and device fabrication strategies and associated challenges for each material class are highlighted.

Magnetic Manipulation of Nanowires for Engineered Stretchable Electronics

Nanowires are often key ingredients of high-tech composite materials. The properties and performance of devices created using these, depend heavily on the structure and density of the embedded nanowires. Despite significant efforts, a process that can be adapted to different materials, compatible with current nanowire deposition methods, and that is able to control both variables simultaneously has not been achieved yet. In this work, we show that we can use low magnetic fields (80 mT) to manipulate nanowires by electrostatically coating them with superparamagnetic iron oxide nanoparticles in an aqueous solution. Monolayers, multilayers, and hierarchical structures of oriented nanowires were achieved in a highly ordered manner using vacuum filtration for two types of nanowires: silver and gold-coated titanium dioxide nanowires. The produced films were embedded in an elastomer, and the strain-dependent electrical properties of the resulting composites were investigated. The orientation of the assembly with respect to the tensile strain heavily impacts the performance of the composites. Composites containing nanowires perpendicular to the strain direction exhibit an extremely low gauge factor. On the other hand, when nanowires are arranged parallel to the strain direction, the composites have a high gauge factor. The possibility to orient nanowires during the processing steps is not only interesting for the shown strain sensing application but also expected to be useful in many other areas of material science.

Recent Advances in Printing Technologies of Nanomaterials for Implantable Wireless Systems in Health Monitoring and Diagnosis

The development of wireless implantable sensors and integrated systems, enabled by advances in flexible and stretchable electronics technologies, is emerging to advance human health monitoring, diagnosis, and treatment. Progress in material and fabrication strategies allows for implantable electronics for unobtrusive monitoring via seamlessly interfacing with tissues and wirelessly communicating. Combining new nanomaterials and customizable printing processes offers unique possibilities for high-performance implantable electronics. Here, this report summarizes the recent progress and advances in nanomaterials and printing technologies to develop wireless implantable sensors and electronics. Advances in materials and printing processes are reviewed with a focus on challenges in implantable applications. Demonstrations of wireless implantable electronics and advantages based on these technologies are discussed. Lastly, existing challenges and future directions of nanomaterials and printing are described.

Materials, Electrical Performance, Mechanisms, Applications, and Manufacturing Approaches for Flexible Strain Sensors

With the recent great progress made in flexible and wearable electronic materials, the upcoming next generation of skin-mountable and implantable smart devices holds extensive potential applications for the lifestyle modifying, including personalized health monitoring, human-machine interfaces, soft robots, and implantable biomedical devices. As a core member within the wearable electronics family, flexible strain sensors play an essential role in the structure design and functional optimization. To further enhance the stretchability, flexibility, sensitivity, and electricity performances of the flexible strain sensors, enormous efforts have been done covering the materials design, manufacturing approaches and various applications. Thus, this review summarizes the latest advances in flexible strain sensors over recent years from the material, application, and manufacturing strategies. Firstly, the critical parameters measuring the performances of flexible strain sensors and materials development contains different flexible substrates, new nano- and hybrid- materials are introduced. Then, the developed working mechanisms, theoretical analysis, and computational simulation are presented. Next, based on different material design, diverse applications including human motion detection and health monitoring, soft robotics and human-machine interface, implantable devices, and biomedical applications are highlighted. Finally, synthesis consideration of the massive production industry of flexible strain sensors in the future; different fabrication approaches that are fully expected are classified and discussed.

Soft Electronics Based on Stretchable and Conductive Nanocomposites for Biomedical Applications

Research on the field of implantable electronic devices that can be directly applied in the body with various functionalities is increasingly intensifying due to its great potential for various therapeutic applications. While conventional implantable electronics generally include rigid and hard conductive materials, their surrounding biological objects are soft and dynamic. The mechanical mismatch between implanted devices and biological environments induces damages in the body especially for long-term applications. Stretchable electronics with outstanding mechanical compliance with biological objects effectively improve such limitations of existing rigid implantable electronics. In this article, the recent progress of implantable soft electronics based on various conductive nanocomposites is systematically described. In particular, representative fabrication approaches of conductive and stretchable nanocomposites for implantable soft electronics and various in vivo applications of implantable soft electronics are focused on. To conclude, challenges and perspectives of current implantable soft electronics that should be considered for further advances are discussed.