Self-powered cardiac pacemaker enabled by flexible single crystalline PMN-PT piezoelectric energy harvester

Conceptual Piezoelectric-Based Energy Harvester from In Vivo Heartbeats' Cyclic Kinetic Motion for Leadless Intracardiac Pacemakers

This paper studies the development of piezoelectric energy harvesting for self-powered leadless intracardiac pacemakers. The energy harvester fit inside the battery compartment, assuming that the energy harvester would replace the battery with a smaller rechargeable battery capacity. The power output analysis was derived from the three-dimensional finite element analysis and in vivo heart measurements. A Doppler laser at the anterior basal in the right ventricle directly measured the heart's kinetic motion. Piezoceramics in the cantilevered configuration were studied. The heart motion was periodic but not harmonic and shock-based. This study found that energy can be harvested by applying periodic bio-movements (cardiac motion). The results also showed that the energy harvester can generate 1.1 V voltage. The effect of various geometrical parameters on power generation was studied. This approach offers potential for self-powered implantable medical devices, with the harvested energy used to power devices such as pacemakers.

Self-Charging Power System Empowered by Bismuth Halide Perovskite-Based Hybrid Nanogenerator and Lithium-ion Battery

Halide perovskite, renowned for its multifunctional properties, shows considerable promise for realizing self-charging power systems. In this study, a lead-free methylammonium bismuth iodide (MA3Bi2I9) perovskite is used to create a self-charging power unit (SPU). This involves constructing a hybrid piezoelectric-triboelectric nanogenerator (Hybrid-TENG) and utilizing MA3Bi2I9 for energy storage as an anode in a lithium-ion battery (LIB). Initially, MA3Bi2I9 nanorods are synthesized and composited with a polystyrene-block-poly(ethylene-ran-butylene)-block-polystyrene polymer. The dielectric and mechanical properties of composite films having perovskite loading content are investigated. The optimized Hybrid-TENG exhibits superior performance, generating a voltage of 537 V, current density of 13.2 µA cm- 2, and maximum power density of 3.04 mW cm-2, which can be attributed to the high piezoelectric coefficient of MA3Bi2I9 nanorods (≈20.6 pm V-1). A MA3Bi2I9 thin film, serving as an electrode in LIB, demonstrates a high specific capacity of 2378.9 mAh cm-3 (578.8 mAh g-1) with a capacity retention of ≈87.5% over 100 cycles, underscoring its stable performance. Furthermore, a Hybrid-TENG is employed to charge the MA3Bi2I9-based LIB, thus realizing an SPU for driving portable electronics. This study highlights the promising potential of perovskites for developing efficient nanogenerators and LIBs, paving the way for sustainable energy solutions in small-scale electronics.

Implanted Carbon Nanotubes Harvest Electrical Energy from Heartbeat for Medical Implants

Reliability of power supply for current implantable electronic devices is a critical issue for longevity and for reducing the risk of device failure. Energy harvesting is an emerging technology, representing a strategy for establishing autonomous power supply by utilizing biomechanical movements in human body. Here, a novel "Twistron energy cell harvester" (TECH), consisting of coiled carbon nanotube yarn that converts mechanical energy of the beating heart into electrical energy, is presented. The performance of TECH is evaluated in an in vitro artificial heartbeat system which simulates the deformation pattern of the cardiac surface, reaching a maximum peak power of 1.42 W kg-1 and average power of 0.39 W kg-1 at 60 beats per minute. In vivo implantation of TECH onto the left ventricular surface in a porcine model continuously generates electrical energy from cardiac contraction. The generated electrical energy is used for direct pacing of the heart as documented by extensive electrophysiology mapping. Implanted modified carbon nanotubes are applicable as a source for harvesting biomechanical energy from cardiac motion for power supply or cardiac pacing.

Organic Passivation-Enhanced Ferroelectricity in Perovskite Oxide Films

Perovskite oxides and organic-inorganic halide perovskite materials, with numerous fascinating features, have been subjected to extensive studies. Most of the properties of perovskite materials are dependence on their ferroelectricity that denoted by remanent polarization (Pr). Thus, the increase of Pr in perovskite films is mainly an effort in material physics. At present, commonplace improvement schemes, i.e., controlling material crystallinity, and post-annealing by using a high-temperature process, are normally used. However, a simpler and temporal strategy for Pr improvement is always unavailable to perovskite material researchers. In this study, an organic coating layer, low-temperature, and vacuum-free strategy is proposed to improve the Pr, directly increasing the Pr from 36 to 56 µC cm-2. Further study finds that the increased Pr originates from the suppression of the oxygen defects and Ti defects. This organic coating layer strategy for passivating the defects may open a new way for the preparation of higher-performance and cost-effective perovskite products, further improving its prospective for application in the electron devices field.

Bias-Free Cardiac Monitoring Capsule

Cardiovascular disease (CVD) remains the leading cause of death worldwide. Patients often fail to recognize the early signs of CVDs, which display irregularities in cardiac contractility and may ultimately lead to heart failure. Therefore, continuously monitoring the abnormal changes in cardiac contractility may represent a novel approach to long-term CVD surveillance. Here, a zero-power consumption and implantable bias-free cardiac monitoring capsule (BCMC) is introduced based on the triboelectric effect for cardiac contractility monitoring in situ. The output performance of BCMC is improved over 10 times with nanoparticle self-adsorption method. This device can be implanted into the right ventricle of swine using catheter intervention to detect the change of cardiac contractility and the corresponding CVDs. The physiological signals can be wirelessly transmitted to a mobile terminal for analysis through the acquisition and transmission module. This work contributes to a new option for precise monitoring and early diagnosis of CVDs.

High-performance piezoelectric energy harvesting in amorphous perovskite thin films deposited directly on a plastic substrate

Most reported thin-film piezoelectric energy harvesters have been based on cantilever-type crystalline ferroelectric oxide thin films deposited on rigid substrates, which utilize vibrational input sources. Herein, we introduce flexible amorphous thin-film energy harvesters based on perovskite CaCu3Ti4O12 (CCTO) thin films on a plastic substrate for highly competitive electromechanical energy harvesting. The room-temperature sputtering of CCTO thin films enable the use of plastic substrates to secure reliable flexibility, which has not been available thus far. Surprisingly, the resultant amorphous nature of the films results in an output voltage and power density of ~38.7 V and ~2.8 × 106 μW cm-3, respectively, which break the previously reported record for typical polycrystalline ferroelectric oxide thin-film cantilevers. The origin of this excellent electromechanical energy conversion is systematically explored as being related to the localized permanent dipoles of TiO6 octahedra and lowered dielectric constant in the amorphous state, depending on the stoichiometry and defect states. This is the leading example of a high-performance flexible piezoelectric energy harvester based on perovskite oxides not requiring a complex process for transferring films onto a plastic substrate.

Extended Review Concerning the Integration of Electrochemical Biosensors into Modern IoT and Wearable Devices

Electrochemical biosensors include a recognition component and an electronic transducer, which detect the body fluids with a high degree of accuracy. More importantly, they generate timely readings of the related physiological parameters, and they are suitable for integration into portable, wearable and implantable devices that are significant relative to point-of-care diagnostics scenarios. As an example, the personal glucose meter fundamentally improves the management of diabetes in the comfort of the patients' homes. This review paper analyzes the principles of electrochemical biosensing and the structural features of electrochemical biosensors relative to the implementation of health monitoring and disease diagnostics strategies. The analysis particularly considers the integration of the biosensors into wearable, portable, and implantable systems. The fundamental aim of this paper is to present and critically evaluate the identified significant developments in the scope of electrochemical biosensing for preventive and customized point-of-care diagnostic devices. The paper also approaches the most important engineering challenges that should be addressed in order to improve the sensing accuracy, and enable multiplexing and one-step processes, which mediate the integration of electrochemical biosensing devices into digital healthcare scenarios.

Motion Characterization of Pacemaker Lead Wire In Vivo for Piezoelectric Energy Harvesting Applications

PURPOSE

Piezoelectric energy harvesters (PEH) for cardiac pacemakers typically use animal models to assess the performance of the PEH. However, if considering multiple designs, the use of animal models and prototyping increases costs and time. To reduce the use of animal models in research for pacemaker energy harvesting applications, this study investigates the motion of a pacemaker lead wire (PLW) in vivo using fluoroscopy imaging to quantify the position and displacements as a function of time, such that the data can be used in computer simulations.

METHODS

The proposed technique uses fluoroscopy imaging video data of a dual chamber pacemaker implanted in a patient, and image processing allows for the motion of the PLW captured. The motion is discretized into nodes for ease of implementation in finite element software. FEA simulation is presented using a piezoelectric energy harvester design integrated in the lead wire, and the energy output is predicted by finite element computer simulation.

RESULTS

A 2-dimensional analysis is conducted with the fluoroscopy imaging video data to characterize the PLW motion and results show close agreement with literature values. Simulations with an energy harvesting circuit using the nodal position and displacement data shows that a PEH integrated in the PLW can generate a direct current voltage of 1.12 V and power output of 0.125 μW, potentially extending the battery life of pacemakers by 0.75-1 years.

CONCLUSIONS

The results suggest that fluoroscopy imaging data can be effective in evaluating PEH designs rather than using animal models, saving time and costs.

Biomimetic Exogenous "Tissue Batteries" as Artificial Power Sources for Implantable Bioelectronic Devices Manufacturing

Implantable bioelectronic devices (IBDs) have gained attention for their capacity to conformably detect physiological and pathological signals and further provide internal therapy. However, traditional power sources integrated into these IBDs possess intricate limitations such as bulkiness, rigidity, and biotoxicity. Recently, artificial "tissue batteries" (ATBs) have diffusely developed as artificial power sources for IBDs manufacturing, enabling comprehensive biological-activity monitoring, diagnosis, and therapy. ATBs are on-demand and designed to accommodate the soft and confining curved placement space of organisms, minimizing interface discrepancies, and providing ample power for clinical applications. This review presents the near-term advancements in ATBs, with a focus on their miniaturization, flexibility, biodegradability, and power density. Furthermore, it delves into material-screening, structural-design, and energy density across three distinct categories of TBs, distinguished by power supply strategies. These types encompass innovative energy storage devices (chemical batteries and supercapacitors), power conversion devices that harness power from human-body (biofuel cells, thermoelectric nanogenerators, bio-potential devices, piezoelectric harvesters, and triboelectric devices), and energy transfer devices that receive and utilize external energy (radiofrequency-ultrasound energy harvesters, ultrasound-induced energy harvesters, and photovoltaic devices). Ultimately, future challenges and prospects emphasize ATBs with the indispensability of bio-safety, flexibility, and high-volume energy density as crucial components in long-term implantable bioelectronic devices.

Materials-Driven Soft Wearable Bioelectronics for Connected Healthcare

In the era of Internet-of-things, many things can stay connected; however, biological systems, including those necessary for human health, remain unable to stay connected to the global Internet due to the lack of soft conformal biosensors. The fundamental challenge lies in the fact that electronics and biology are distinct and incompatible, as they are based on different materials via different functioning principles. In particular, the human body is soft and curvilinear, yet electronics are typically rigid and planar. Recent advances in materials and materials design have generated tremendous opportunities to design soft wearable bioelectronics, which may bridge the gap, enabling the ultimate dream of connected healthcare for anyone, anytime, and anywhere. We begin with a review of the historical development of healthcare, indicating the significant trend of connected healthcare. This is followed by the focal point of discussion about new materials and materials design, particularly low-dimensional nanomaterials. We summarize material types and their attributes for designing soft bioelectronic sensors; we also cover their synthesis and fabrication methods, including top-down, bottom-up, and their combined approaches. Next, we discuss the wearable energy challenges and progress made to date. In addition to front-end wearable devices, we also describe back-end machine learning algorithms, artificial intelligence, telecommunication, and software. Afterward, we describe the integration of soft wearable bioelectronic systems which have been applied in various testbeds in real-world settings, including laboratories that are preclinical and clinical environments. Finally, we narrate the remaining challenges and opportunities in conjunction with our perspectives.

Piezoelectric nanogenerators for self-powered wearable and implantable bioelectronic devices

One of the recent innovations in the field of personalized healthcare is the piezoelectric nanogenerators (PENGs) for various clinical applications, including self-powered sensors, drug delivery, tissue regeneration etc. Such innovations are perceived to potentially address some of the unmet clinical needs, e.g., limited life-span of implantable biomedical devices (e.g., pacemaker) and replacement related complications. To this end, the generation of green energy from biomechanical sources for wearable and implantable bioelectronic devices gained considerable attention in the scientific community. In this perspective, this article provides a comprehensive state-of-the-art review on the recent developments in the processing, applications and associated concerns of piezoelectric materials (synthetic/biological) for personalized healthcare applications. In particular, this review briefly discusses the concepts of piezoelectric energy harvesting, piezoelectric materials (ceramics, polymers, nature-inspired), and the various applications of piezoelectric nanogenerators, such as, self-powered sensors, self-powered pacemakers, deep brain stimulators etc. Important distinction has been made in terms of the potential clinical applications of PENGs, either as wearable or implantable bioelectronic devices. While discussing the potential applications as implantable devices, the biocompatibility of the several hybrid devices using large animal models is summarized. This review closes with the futuristic vision of integrating data science approaches in developmental pipeline of PENGs as well as clinical translation of the next generation PENGs. STATEMENT OF SIGNIFICANCE: Piezoelectric nanogenerators (PENGs) hold great promise for transforming personalized healthcare through self-powered sensors, drug delivery systems, and tissue regeneration. The limited battery life of implantable devices like pacemakers presents a significant challenge, leading to complications from repititive surgeries. To address such a critical issue, researchers are focusing on generating green energy from biomechanical sources to power wearable and implantable bioelectronic devices. This comprehensive review critically examines the latest advancements in synthetic and nature-inspired piezoelectric materials for PENGs in personalized healthcare. Moreover, it discusses the potential of piezoelectric materials and data science approaches to enhance the efficiency and reliability of personalized healthcare devices for clinical applications.

A Review on Electroactive Polymer-Metal Composites: Development and Applications for Tissue Regeneration

Electroactive polymer-metal composites (EAPMCs) have gained significant attention in tissue engineering owing to their exceptional mechanical and electrical properties. EAPMCs develop by combining an electroactive polymer matrix and a conductive metal. The design considerations include choosing an appropriate metal that provides mechanical strength and electrical conductivity and selecting an electroactive polymer that displays biocompatibility and electrical responsiveness. Interface engineering and surface modification techniques are also crucial for enhancing the adhesion and biocompatibility of composites. The potential of EAPMC-based tissue engineering revolves around its ability to promote cellular responses, such as cell adhesion, proliferation, and differentiation, through electrical stimulation. The electrical properties of these composites can be used to mimic natural electrical signals within tissues and organs, thereby aiding tissue regeneration. Furthermore, the mechanical characteristics of the metallic components provide structural reinforcement and can be modified to align with the distinct demands of various tissues. EAPMCs have extraordinary potential as regenerative biomaterials owing to their ability to promote beneficial effects in numerous electrically responsive cells. This study emphasizes the characteristics and applications of EAPMCs in tissue engineering.

Recent development of piezoelectric biosensors for physiological signal detection and machine learning assisted cardiovascular disease diagnosis

As cardiovascular disease stands as a global primary cause of mortality, there has been an urgent need for continuous and real-time heart monitoring to effectively identify irregular heart rhythms and to offer timely patient alerts. However, conventional cardiac monitoring systems encounter challenges due to inflexible interfaces and discomfort during prolonged monitoring. In this review article, we address these issues by emphasizing the recent development of the flexible, wearable, and comfortable piezoelectric passive sensor assisted by machine learning technology for diagnosis. This innovative device not only harmonizes with the dynamic mechanical properties of human skin but also facilitates continuous and real-time collection of physiological signals. Addressing identified challenges and constraints, this review provides insights into recent advances in piezoelectric cardiac sensors, from devices to circuit systems. Furthermore, this review delves into the integration of machine learning technologies, showcasing their pivotal role in facilitating continuous and real-time assessment of cardiac status. The synergistic combination of flexible piezoelectric sensor design and machine learning holds substantial potential in automating the detection of cardiac irregularities with minimal human intervention. This transformative approach has the power to revolutionize patient care paradigms.

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.

Fish-Wearable Piezoelectric Nanogenerator for Dual-Modal Energy Scavenging from Fish-Tailing

Aiming to develop a self-powered bioelectric tag for fish behavioral studies, here we present a fish-wearable piezoelectric nanogenerator (FWPNG) that can simultaneously harvest the strain energy and the flow impact energy caused by fish-tailing. The FWPNG is fabricated by transferring a 2 μm-thick Nb0.02-Pb(Zr0.6Ti0.4)O3 (PZT) layer from a silicon substrate to a spin-coated polyimide film via a novel zinc oxide (ZnO) release process. The open-circuit voltage of the strain energy harvester reaches 2.3 V under a strain of 1% at an ultra-low frequency of 1 Hz, and output voltage of the impact energy harvester reaches a 0.3 V under a pressure of 82.6 kPa at 1 Hz, which is in good agreement with our theoretical analysis. As a proof-of-concept demonstration, an event-driven underwater acoustic transmitter is developed by utilizing the FWPNG as a trigger switch. Acoustic transmission occurs when the amplitude of fish-tailing is larger than a preset threshold. The dual-modal FWPNG device shows the potential application in self-powered biotags for animal behavioral studies and ocean explorations.

Strategies for enhancing low-frequency performances of triboelectric, electrochemical, piezoelectric, and dielectric elastomer energy harvesting: recent progress and challenges

Mechanical energy harvesting transforms various forms of mechanical energy, including ocean waves, wind, and human motions, into electrical energy, providing a viable solution to address the depletion of fossil fuels and environmental problems. However, one major obstacle for the direct conversion of mechanical energy into electricity is the low frequency of the majority of mechanical energy sources (≤5 Hz), resulting in low energy conversion efficiency, output power and output current. Over recent years, a numerous innovative technologies have been reported to enable improved energy harvesting utilizing various mechanisms. This review aims to present an in-depth analysis of the research progress in low-frequency energy harvesting technologies that rely on triboelectric, electrochemical, piezoelectric, and dielectric elastomer effects. The discussion commences with an overview of the difficulties associated with low-frequency energy harvesting. The critical aspects that impact the low-frequency performance of mechanical energy harvesters, including working mechanisms, environmental factors, and device compositions, are elucidated, while the advantages and disadvantages of different mechanisms in low-frequency operation are compared and summarized. Moreover, this review expounds on the strategies that can improve the low-frequency energy harvesting performance through the modulations of material compositions, structures, and devices. It also showcases the applications of mechanical energy harvesters in energy harvesting via waves, wind, and human motions. Finally, the recommended choices of mechanical energy harvesters with different mechanisms for various applications are offered, which can assist in the design and fabrication process.

Review of Zinc Oxide Piezoelectric Nanogenerators: Piezoelectric Properties, Composite Structures and Power Output

Lead-containing piezoelectric materials typically show the highest energy conversion efficiencies, but due to their toxicity they will be limited in future applications. In their bulk form, the piezoelectric properties of lead-free piezoelectric materials are significantly lower than lead-containing materials. However, the piezoelectric properties of lead-free piezoelectric materials at the nano scale can be significantly larger than the bulk scale. This review looks at the suitability of ZnO nanostructures as candidate lead-free piezoelectric materials for use in piezoelectric nanogenerators (PENGs) based on their piezoelectric properties. Of the papers reviewed, Neodymium-doped ZnO nanorods (NRs) have a comparable piezoelectric strain constant to bulk lead-based piezoelectric materials and hence are good candidates for PENGs. Piezoelectric energy harvesters typically have low power outputs and an improvement in their power density is needed. This review systematically reviews the different composite structures of ZnO PENGs to determine the effect of composite structure on power output. State-of-the-art techniques to increase the power output of PENGs are presented. Of the PENGs reviewed, the highest power output belonged to a vertically aligned ZnO nanowire (NWs) PENG (1-3 nanowire composite) with a power output of 45.87 μW/cm2 under finger tapping. Future directions of research and challenges are discussed.

A Piezoelectric MEMS Speaker with a Combined Function of a Silent Alarm

To explore the versatility of speakers, a piezoelectric micro-electro-mechanical system (MEMS) speaker combining the function of a silent alarm is proposed, which mainly comprises a lead zirconate titanate (PZT) actuation layer and a rigid-flexible coupling supporting layer. Measurements performed on encapsulated prototypes mounted to an artificial ear simulator have revealed that, compared to a speaker with a rigid supporting layer, the sound pressure level (SPL) of the proposed piezoelectric MEMS speaker with a rigid-flexible coupling supporting layer is significantly higher and is especially higher by 4.1-20.1 dB in the frequency range from 20 Hz to 4.2 kHz, indicating that the rigid-flexible coupling supporting layer can improve the SPL significantly in low frequency. Moreover, the spectral distribution characteristic of its playback audio is similar to that of the commercial electromagnetic type. The device can also function as a silent alarm based on oral airflows in dangerous situations, as it performs well at recognizing words according to their unique voltage-signal characteristics, and can avoid the effects of external sound noise, body movement, long distance, and occlusion. This strategy provides inspiration for functional diversification of piezoelectric MEMS speakers.

Device integration of electrochemical biosensors

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

Flexible Lead-Free Piezoelectric Ba0.94Sr0.06Sn0.09Ti0.91O3/PDMS Composite for Self-Powered Human Motion Monitoring

Piezoelectric wearable electronics, which can sense external pressure, have attracted widespread attention. However, the enhancement of electromechanical coupling performance remains a great challenge. Here, a new solid solution of Ba_1-xSr_xSn_0.09Ti_0.91O₃ (x = 0.00~0.08) is prepared to explore potential high-performance, lead-free piezoelectric ceramics. The coexistence of the rhombohedral phase, orthorhombic phase and tetragonal phase is determined in a ceramic with x = 0.06, showing enhanced electrical performance with a piezoelectric coefficient of d₃₃~650 pC/N. Furthermore, Ba_0.94Sr_0.06Sn_0.09Ti_0.91O₃ (BSST) is co-blended with PDMS to prepare flexible piezoelectric nanogenerators (PENGs) and their performance is explored. The effects of inorganic particle concentration and distribution on the piezoelectric output of the composite are systematically analyzed by experimental tests and computational simulations. As a result, the optimal V_OC and I_SC of the PENG (40 wt%) can reach 3.05 V and 44.5 nA, respectively, at 138.89 kPa, and the optimal sensitivity of the device is up to 21.09 mV/kPa. Due to the flexibility of the device, the prepared PENG can be attached to the surface of human skin as a sensor to monitor vital movements of the neck, fingers, elbows, spine, knees and feet of people, thus warning of dangerous behavior or incorrect posture and providing support for sports rehabilitation.

Intelligent wearable devices based on nanomaterials and nanostructures for healthcare

Emerging classes of flexible electronic sensors as alternatives to conventional rigid sensors offer a powerful set of capabilities for detecting and quantifying physiological and physical signals from human skin in personal healthcare. Unfortunately, the practical applications and commercialization of flexible sensors are generally limited by certain unsatisfactory aspects of their performance, such as biocompatibility, low sensing range, power supply, or single sensory function. This review intends to provide up-to-date literature on wearable devices for smart healthcare. A systematic review is provided, from sensors based on nanomaterials and nanostructures, algorithms, to multifunctional integrated devices with stretchability, self-powered performance, and biocompatibility. Typical electromechanical sensors are investigated with a specific focus on the strategies for constructing high-performance sensors based on nanomaterials and nanostructures. Then, the review emphasizes the importance of tailoring the fabrication techniques in order to improve stretchability, biocompatibility, and self-powered performance. The construction of wearable devices with high integration, high performance, and multi-functionalization for multiparameter healthcare is discussed in depth. Integrating wearable devices with appropriate machine learning algorithms is summarized. After interpretation of the algorithms, intelligent predictions are produced to give instructions or predictions for smart implementations. It is desired that this review will offer guidance for future excellence in flexible wearable sensing technologies and provide insight into commercial wearable sensors.

Correlating multimode strain and electrode configurations for high-performance gradient-index phononic crystal-based piezoelectric energy harvesting

A gradient-index phononic crystal (GRIN PnC) capable of manipulating wave propagation can serve as an excellent input wave energy focusing platform for amplifying energy harvesting power generation. However, despite its remarkable focusing capability, the finite wavelength of the propagating elastic waves in the focal area causes voltage cancellation inside a piezoelectric element under multimode strains having opposite directions; this limits the capacity of the GRIN PnC-based energy harvesting system. This study demonstrates a rational electrode configuration for a piezoelectric energy harvesting (PEH) device that can maximize the performance of a given GRIN PnC platform. The multimode strain analysis experimentally performed on the PEHs distributed over the focusing area confirms that the patterned electrode PEH configuration is the most effective in alleviating strain and voltage cancellation while efficiently transferring the focused elastic wave energy. Furthermore, a proper combination of electrical connections between the patterned electrodes substantially increases the piezoelectric potential across the ceramic by maximizing the strain difference. The simultaneous tailoring of the piezoelectric ceramic composition and the electrode configuration leads to a maximum power generation of 7.06 mW even under off-resonance conditions, the largest ever reported in elastic wave energy harvesting.

Perovskite Piezoelectric-Based Flexible Energy Harvesters for Self-Powered Implantable and Wearable IoT Devices

In the ongoing fourth industrial revolution, the internet of things (IoT) will play a crucial role in collecting and analyzing information related to human healthcare, public safety, environmental monitoring and home/industrial automation. Even though conventional batteries are widely used to operate IoT devices as a power source, these batteries have a drawback of limited capacity, which impedes broad commercialization of the IoT. In this regard, piezoelectric energy harvesting technology has attracted a great deal of attention because piezoelectric materials can convert electricity from mechanical and vibrational movements in the ambient environment. In particular, piezoelectric-based flexible energy harvesters can precisely harvest tiny mechanical movements of muscles and internal organs from the human body to produce electricity. These inherent properties of flexible piezoelectric harvesters make it possible to eliminate conventional batteries for lifetime extension of implantable and wearable IoTs. This paper describes the progress of piezoelectric perovskite material-based flexible energy harvesters for self-powered IoT devices for biomedical/wearable electronics over the last decade.

Investigating the influence of the viscoelastic material as a heart muscle simulator on the powering leadless pacemaker from heartbeats by using a piezoelectric beam

This paper studies experimentally and analytically the influence of the viscoelastic cardiac muscle on the energy harvesting from heartbeats for powering the leadless pacemakers by using a piezoelectric beam. An appropriate representative gel-type viscoelastic material that mimics the heart tissue is used in the tests. The piezoelectric beam coupled with a gel-type material is analytically modeled, and experimentally tested. By considering a combination of the translational standard linear solid model and a rotational spring component for the gel-type material, the analytical model of the coupled system is developed utilizing the generalized Hamilton’s principle. The system is attached on top of a shaker and excited harmonically, and the time history of output voltage and accelerations are measured. The analytical model is verified by experimental results for the tip displacement, voltage, generated power, phase-portraits histories, and voltage FRF with harmonic base excitations. Transmissibility analysis by the analytical model shows that for excitation frequencies beyond a specific frequency, the viscoelastic material can magnify the amplitude of the excitation and incredibly improve the power generation. Experimental results demonstrate that by coupling the gel into the harvester, oscillations of the tip are increased into high energy orbits and large tip deflections around the resonance frequency. The significantly widened frequency bandwidth and the increased power output at specific input frequencies are the other results of considering the viscoelastic characteristics of the heart wall in the dynamic investigations. By simulating the response of the energy harvesting system to the heartbeat impulsive rhythm, when the energy harvesting system is attached to the viscoelastic material, the output power is increased from 18 to 55 µW. The obtained results reveal that influence of the viscoelastic properties of the heart muscle is crucial in the accurate design of the energy harvesting system for the self-powered medical leadless pacemaker.

Flexible lead-free piezoelectric arrays for high-efficiency wireless ultrasonic energy transfer and communication

Implantable medical electronics (IMEs) are now becoming increasingly prevalent for diagnostic and therapeutic purposes. Despite extensive efforts, a primary challenge for IMEs is reliable wireless power and communication to provide well-controlled, therapeutically relevant effects. Ultrasonic energy transfer and communication (UETC) employing traveling ultrasound waves to transmit energy has emerged as a promising wireless strategy for IMEs. Nevertheless, conventional UETC systems are rigid, bulky, and based on toxic lead-based piezoelectric materials, raising efficiency and safety concerns. Here, we present a novel transcutaneous UETC system based on a two-dimensional flexible lead-free piezoelectric array (f-LFPA) that hybridizes high-performance (piezoelectric coefficient d₃₃ ≈ 503 pC N^-1) (K,Na)NbO₃-based eco-friendly piezo-units with soft structural components. The newly developed lead-free piezo-unit exhibits submicron ferroelectric domains and superior energy harvesting figures of merit (d₃₃g₃₃ ≈ 20 000 × 10^-15 m² N^-1), resulting in the prepared f-LFPA demonstrating a high output voltage of 22.4 V, a power density of 0.145 W cm^-2, and a signal-to-noise ratio of more than 30 dB within the FDA safety limits, while maintaining the flexibility for wide-angle receiving. Further ex vivo experiment demonstrates the adequate power supply capabilities of the f-LFPA and its possible application in future implantable eco-friendly bioelectronics for diagnostics, therapy, and real-time monitoring.

PVDF Energy Harvester for Prolonging the Battery Life of Cardiac Pacemakers

Patients who have an implantable cardiac pacemaker that survive beyond the operational life of the device require replacement surgeries that increase healthcare costs and may possibly introduce post-operative complications such as infection. In this paper, we propose a piezoelectric energy harvester design for powering pacemakers to extend their operational life. The design uses a thin strip of piezoelectric PVDF that captures energy from bending of the lead wire. We assemble a prototype to validate a finite element model, and then use the finite element model to characterize the power output of the design based on a cantilever beam loading condition, where displacement at the cantilever tip simulated heart motion. The voltage output from the prototype was compared to the output from the finite element simulation and the finite element simulation provided a good estimate of the voltage output. Further finite element analysis showed that for a 10 cm long section of the proposed design, a 9.1 mm tip displacement provided a power output of 1 μW and a voltage output of ±1.4 V during each cycle.

High Energy Storage Performance of All-Inorganic Flexible Antiferroelectric-Insulator Multilayered Thin Films

With the increasingly high requirements for wearable and flexible devices, traditional inorganic capacitors cannot meet the flexible demand of next-generation electronic devices. In this work, the energy storage property of all-inorganic flexible films has been systematically studied. PbZrO₃ (PZO) and Al₂O₃ (AO) are selected as the antiferroelectric layer and insulating layer, respectively. The heterostructured films are prepared on the fluorphlogopite (F-Mica) substrate by chemical solution deposition. The microstructure, polarization behavior, and energy storage performances are investigated. The results demonstrate that the AO/PZO/AO/PZO/AO (APAPA) multilayered thin film possesses a greatly improved energy storage density (W_rec) of 28.1 J/cm³ with an excellent energy storage efficiency (η) of 80.1%, which is ascribed to the enhanced breakdown strength and large difference in polarization. Furthermore, the capacitive films exhibit good stability under a wide working temperature range of 25-140 °C and an electric fatigue endurance of 10⁷ cycles. Besides, the energy storage performances are almost unchanged after 10⁴ bending cycles, demonstrating an excellent mechanical bending endurance. This work sheds light on the preparation technology and improvement of the dielectric energy storage performance for all-inorganic flexible multilayered thin films.

A Ceramic-Electrolyte Glucose Fuel Cell for Implantable Electronics

Next-generation implantable devices such as sensors, drug-delivery systems, and electroceuticals require efficient, reliable, and highly miniaturized power sources. Existing power sources such as the Li-I₂ pacemaker battery exhibit limited scale-down potential without sacrificing capacity, and therefore, alternatives are needed to power miniaturized implants. This work shows that ceramic electrolytes can be used in potentially implantable glucose fuel cells with unprecedented miniaturization. Specifically, a ceramic glucose fuel cell-based on the proton-conducting electrolyte ceria-that is composed of a freestanding membrane of thickness below 400 nm and fully integrated into silicon for easy integration into bioelectronics is demonstrated. In contrast to polymeric membranes, all materials used are highly temperature stable, making thermal sterilization for implantation trivial. A peak power density of 43 µW cm^-2 , and an unusually high statistical verification of successful fabrication and electrochemical function across 150 devices for open-circuit voltage and 12 devices for power density, enabled by a specifically designed testing apparatus and protocol, is demonstrated. The findings demonstrate that ceramic-based micro-glucose-fuel-cells constitute the smallest potentially implantable power sources to date and are viable options to power the next generation of highly miniaturized implantable medical devices.

Metal-Free Perovskite Piezoelectric Nanogenerators for Human-Machine Interfaces and Self-Powered Electrical Stimulation Applications

Single crystal metal-free halide perovskites have received great attention in recent years owing to their excellent piezoelectric and ferroelectric properties. However, the nanotoxicity and piezoelectricity within the nanoscale of such materials have yet been reported for the demonstration of practical applications. In this work, the observation of intrinsic piezoelectricity in metal-free perovskite (MDABCO-NH₄ I₃ ) films using piezoresponse force microscopy (PFM) is reported. A cytotoxicity test is also performed on MDABCO-NH₄ I₃ to evaluate its low-toxic nature. The as-synthesized MDABCO-NH₄ I₃ is further integrated into a piezoelectric nanogenerator (PENG). The MDABCO-NH₄ I₃ -based PENG (MN-PENG) exhibits optimal output voltage and current of 15.9 V and 54.5 nA, respectively. In addition, the MN-PENG can serve as a self-powered strain sensor for human-machine interface applications or be adopted in in vitro electrical stimulation devices. This work demonstrates a path of perovskite-based PENG with high performance, low toxicity, and multifunctionality for future advanced wearable sensors and portable therapeutic systems.

Ferroelectric Polymer Nanofibers Reminiscent of Morphotropic Phase Boundary Behavior for Improved Piezoelectric Energy Harvesting

Ferroelectric and piezoelectric polymers have attracted great attention from many research and engineering fields due to its mechanical robustness and flexibility as well as cost-effectiveness and easy processibility. Nevertheless, the electrical performance of piezoelectric polymers is very hard to reach that of piezoelectric ceramics basically and physically, even in the case of the representative ferroelectric polymer, poly(vinylidene fluoride-co-trifluoroethylene) (P(VDF-TrFE)). Very recently, the concept for the morphotropic phase boundary (MPB), which has been exclusive in the field of high-performance piezoelectric ceramics, has been surprisingly confirmed in P(VDF-TrFE) piezoelectric copolymers by the groups. This study demonstrates the exceptional behaviors reminiscent of MPB and relaxor ferroelectrics in the feature of widely utilized electrospun P(VDF-TrFE) nanofibers. Consequently, an energy harvesting device that exceeds the performance limitation of the existing P(VDF-TrFE) materials is developed. Even the unpoled MPB-based P(VDF-TrFE) nanofibers show higher output than the electrically poled normal P(VDF-TrFE) nanofibers. This study is the first step toward the manufacture of a new generation of piezoelectric polymers with practical applications.

A Non-Resonant Piezoelectric-Electromagnetic-Triboelectric Hybrid Energy Harvester for Low-Frequency Human Motions

With the rapid development of wireless communication and micro-power technologies, smart wearable devices with various functionalities appear more and more in our daily lives. Nevertheless, they normally possess short battery life and need to be recharged with external power sources with a long charging time, which seriously affects the user experience. To help extend the battery life or even replace it, a non-resonant piezoelectric-electromagnetic-triboelectric hybrid energy harvester is presented to effectively harvest energy from low-frequency human motions. In the designed structure, a moving magnet is used to simultaneously excite the three integrated energy collection units (i.e., piezoelectric, electromagnetic, and triboelectric) with a synergistic effect, such that the overall output power and energy-harvesting efficiency of the hybrid device can be greatly improved under various excitations. The experimental results show that with a vibration frequency of 4 Hz and a displacement of 200 mm, the hybrid energy harvester obtains a maximum output power of 26.17 mW at 70 kΩ for one piezoelectric generator (PEG) unit, 87.1 mW at 500 Ω for one electromagnetic generator (EMG) unit, and 63 μW at 140 MΩ for one triboelectric nanogenerator (TENG) unit, respectively. Then, the generated outputs are adopted for capacitor charging, which reveals that the performance of the three-unit integration is remarkably stronger than that of individual units. Finally, the practical energy-harvesting experiments conducted on various body parts such as wrist, calf, hand, and waist indicate that the proposed hybrid energy harvester has promising application potential in constructing a self-powered wearable system as the sustainable power source.

Piezoelectric nanogenerators for personalized healthcare

The development of flexible piezoelectric nanogenerators has experienced rapid progress in the past decade and is serving as the technological foundation of future state-of-the-art personalized healthcare. Due to their highly efficient mechanical-to-electrical energy conversion, easy implementation, and self-powering nature, these devices permit a plethora of innovative healthcare applications in the space of active sensing, electrical stimulation therapy, as well as passive human biomechanical energy harvesting to third party power on-body devices. This article gives a comprehensive review of the piezoelectric nanogenerators for personalized healthcare. After a brief introduction to the fundamental physical science of the piezoelectric effect, material engineering strategies, device structural designs, and human-body centered energy harvesting, sensing, and therapeutics applications are also systematically discussed. In addition, the challenges and opportunities of utilizing piezoelectric nanogenerators for self-powered bioelectronics and personalized healthcare are outlined in detail.

Enhanced Electromechanical Response in PVDF-BNBT Composite Nanofibers for Flexible Sensor Applications

Wearable energy harvesters and sensors have recently attracted significant attention with the rapid development of artificial intelligence and the Internet of Things (IoT). Compared to high-output bulk materials, these wearable devices are mainly fabricated by thin-film-based materials that limit their application. Therefore, the enhancement of output voltage and power for these devices has recently become an urgent topic. In this paper, the lead-free bismuth titanate-barium titanate (0.93(Na_0.5Bi_0.5)TiO₃-0.07BaTiO₃(BNBT)) nanoparticles and nanofibers were embedded into the PVDF nanofibers. They produced high inorganic electrical voltage coefficients, high electromechanical coupling coefficients, and environmentally friendly properties that enhance the electromechanical performance of pure PVDF nanofibers, and they are all the critical requirements for modern flexible pressure sensors. In detail, PVDF and PVDF-based composites nanofibers were prepared by electrospinning, and different flexible sandwich composite devices were fabricated by the PDMS encapsulation method. As a result, the six-time enhancement maximum output voltage was obtained in a PVDF-BNBT (fiber)-based composite sensor compared to the pure PVDF one. Our results indicate that the output voltage of the pressure sensors has been significantly enhanced, and the development gate is enabled by analyzing the related physical process and influence mechanism.

Multiple droplets on a conical fiber: formation, motion, and droplet mergers

Small droplets on slender conical fibers spontaneously move along the fiber due to capillary action. The droplet motion depends on the geometry of the cone, the surface wettability, the surface tension, the viscosity, and the droplet size. Here we study with experiments and numerical simulations, the formation, spontaneous motion, and the eventual merger, of multiple droplets on slender conical fibers as they interact with each other. The droplet size and their spacing on the fibre is controlled by the Plateau-Rayleigh instability after dip-coating the conical fiber. Once these droplets are formed on the fiber, they spontaneously start to move. Since droplets of different size move with different speeds, they effectively coarsen the droplet patterning by merging on the fiber. The droplet merging process affects locally the droplet speed and alters the spatiotemporal film deposition on the fiber.

A review of advances in multifunctional XTiO3 perovskite-type oxides as piezo-photocatalysts for environmental remediation and energy production

Over more than three decades, the field of engineering of photocatalytic materials with unique properties and enhanced performance has received a huge attention. In this regard, different classes of materials were fabricated and used for different photocatalytic applications. Among these materials, recently multifunctional XTiO₃ perovskites have drawn outstanding interest towards environmental remediation and energy conversion thanks to their unique structural, optical, physiochemical, electrical and thermal characteristics. XTiO₃ perovskites are able to initiate different surface catalytic reactions. Under ultrasonic vibration or heating, XTiO₃ perovskites can induce piezo-catalytic reactions due to the titling of their conduction and valence bands, resulting in the formation of separated charge carriers in the medium. In addition, under light irradiation, XTiO₃ perovskites are considered as a new class of photocatalysts for environmental and energy related applications. Herein, we addressed the recent advances on variously synthesized, doped and formulated XTiO₃ perovskite-type oxides showing piezo- and/or photocatalytic exploitation in environmental remediation and energy conversion. The control of structural crystallite size and phase, conductivity, morphology, oxygen vacancy control, doping agents and ratio has a significant role on the photocatalytic and piezocatalytic activities. The different piezo or/and photocatalytic processes mechanistic pathways towards varying applications were discussed. The current challenges facing these materials and future trends were addressed at the end of the review.

Highly-stable flexible pressure sensor using piezoelectric polymer film on metal oxide TFT

In this study, a flexible pressure sensor with highly stable performance is presented. The pressure sensor was fabricated to work under low voltage conditions by using a high mobility amorphous indium–gallium–zinc oxide (a-IGZO) thin-film transistor (TFT) and a stretched polyvinylidene fluoride (PVDF) film. To prepare a stable sensor suitable for practical use, we designed a device structure that shields ambient noise by grounding the control gate. The shielding structure significantly improves the stability of the device. Moreover, the sensor was fabricated on a flexible substrate and delaminated via a laser lift-off (LLO) technique to meet the urgent needs for flexibility. The pressure sensor showed good sensitivity and reliability over a pressure ranging from 0 to 75 kPa which covers the human touch pressure range. Especially, good linearity over a wide pressure range and high stability over 1000 repeated loadings were realized. Due to the simple structure, the pressure sensor demonstrates the advantage of being inexpensive to be manufactured and holds the potential to be integrated into the display backplane. Therefore, the proposed sensor has great potential in the production of flexible touch screens, human–machine interacting applications, and even electronic skins in the future.

Flexible piezoelectric pressure sensor using a-IGZO TFT was prepared and a shielding structure was proposed to stabilize the response current.

A Self-Powered Optogenetic System for Implantable Blood Glucose Control

Diabetes treatment and rehabilitation are usually a lifetime process. Optogenetic engineered designer cell-therapy holds great promise in regulating blood glucose homeostasis. However, portable, sustainable, and long-term energy supplementation has previously presented a challenge for the use of optogenetic stimulation in vivo. Herein, we purpose a self-powered optogenetic system (SOS) for implantable blood glucose control. The SOS consists of a biocompatible far-red light (FRL) source, FRL-triggered transgene-expressing cells, a power management unit, and a flexible implantable piezoelectric nanogenerator (i-PENG) to supply long-term energy by converting biomechanical energy into electricity. Our results show that this system can harvest energy from body movement and power the FRL source, which then significantly enhanced production of a short variant of human glucagon-like peptide 1 (shGLP-1) in vitro and in vivo. Indeed, diabetic mice equipped with the SOS showed rapid restoration of blood glucose homeostasis, improved glucose, and insulin tolerance. Our results suggest that the SOS is sufficiently effective in self-powering the modulation of therapeutic outputs to control glucose homeostasis and, furthermore, present a new strategy for providing energy in optogenetic-based cell therapy.

Self-assisted wound healing using piezoelectric and triboelectric nanogenerators

The complex process of wound healing depends on the coordinated interaction between various immunological and biological systems, which can be aided by technology. This present review provides a broad overview of the medical applications of piezoelectric and triboelectric nanogenerators, focusing on their role in the development of wound healing technology. Based on the finding that the damaged epithelial layer of the wound generates an endogenous bioelectric field to regulate the wound healing process, development of technological device for providing an exogenous electric field has therefore been paid attention. Authors of this review focus on the design and application of piezoelectric and triboelectric materials to manufacture self-powered nanogenerators, and conclude with an outlook on the current challenges and future potential in meeting medical needs and commercialization.

Long-term in vivo operation of implanted cardiac nanogenerators in swine

Implantable nanogenerators (i-NG) provide power to cardiovascular implantable electronic devices (CIEDs) by harvesting biomechanical energy locally eliminating the need for batteries. However, its long-term operation and biological influences on the heart have not been tested. Here, we evaluate a soft and flexible i-NG system engineered for long-term in vivo cardiac implantation. It consisted of i-NG, leads, and receivers, and was implanted on the epicardium of swine hearts for 2 months. The i-NG system generated electric current throughout the testing period. Biocompatibility and biosafety were established based on normal blood and serum test results and no tissue reactions. Heart function was unchanged over the testing period as validated by normal electrocardiogram (ECG), transthoracic ultrasound, and invasive cardiac functional measures. This research demonstrates the safety, long term operation and therefore the feasibility of using i-NGs to power the next generation CIEDs.

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.

Materials Perspectives for Self-Powered Cardiac Implantable Electronic Devices toward Clinical Translation

Represented by pacemakers, implantable electronic devices (CIEDs) are playing a vital life-saving role in modern society. Although the current CIEDs are evolving quickly in terms of performance, safety, and miniaturization, the bulky and rigid battery creates the largest hurdle toward further development of a soft system that can be attached and conform to tissues without causing undesirable physiologic changes. Over 50% of patients with pacemakers require additional surgery procedures to replace a drained battery. Abrupt battery malfunction and failure contributes up to 2.4% of implanted leadless pacemakers. The battery also has risks of lethal interference with diagnostic magnetic resonance imaging (MRI). Applying the implantable nanogenerators (i-NGs) technology to CIEDs is regarded as a promising solution to the battery challenge and enables self-powering capability. I-NGs based on the principle of either triboelectricity (TENG) or piezoelectricity (PENG) can convert biomechanical energy into electricity effectively. Meanwhile, a complete heartbeat cycle provides a biomechanical energy of ~0.7 J or an average power of 0.93 W, which is sufficient for the operation of CIEDs considering the power consumption of 5-10 μW for a pacemaker and 10-100 μW for a cardiac defibrillator. It is therefore practical to leverage the effective, soft, flexible, lightweight, and biocompatible i-NGs to eliminate the bulky battery component in CIEDs and achieve self-sustainable operation. In this rapidly evolving interdisciplinary field, materials innovation acts as a cornerstone that frames the technology development. Here we bring a few critical perspectives regarding materials design and engineering, which are essential in leading the NG-powered CIEDs toward clinical translations. This Account starts with a brief introduction of the cardiac electrophysiology, as well as its short history to interface the state-of-the-art cardiac NG technologies. Three key components of NG-powered CIEDs are discussed in detail, including the NG device itself, the packaging material, and the stimulation electrodes. Cardiac NG is the essential component that converts heartbeat energy into electricity. It demands high-performance electromechanical coupling materials with long-term dynamic stability. The packaging material is critical to ensure a long-term stable operation of the device on a beating heart. Given the unique operation environment, a few criteria need to be considered in its development, including flexibility, biocompatibility, antifouling, hemocompatibility, and bioadhesion. The stimulation electrodes are the only material interfacing the heart tissue electrically. They should provide capacitive charge injection and mimic the soft and wet intrinsic tissues for the sake of stable biointerfaces. Driven by the rapid materials and device advancement, we envision that the evolution of NG-based CIEDs will quickly move from epicardiac to intracardiac, from single-function to multifunction, and with a minimal-invasive implantation procedure. This trend of development will open many research opportunities in emerging materials science and engineering, which will eventually lead the NG technology to a prevailing strategy for powering future CIEDs.

MXene-infused bioelectronic interfaces for multiscale electrophysiology and stimulation

Soft bioelectronic interfaces for mapping and modulating excitable networks at high resolution and at large scale can enable paradigm-shifting diagnostics, monitoring, and treatment strategies. Yet, current technologies largely rely on materials and fabrication schemes that are expensive, do not scale, and critically limit the maximum attainable resolution and coverage. Solution processing is a cost-effective manufacturing alternative, but biocompatible conductive inks matching the performance of conventional metals are lacking. Here, we introduce MXtrodes, a class of soft, high-resolution, large-scale bioelectronic interfaces enabled by Ti3C2 MXene (a two-dimensional transition metal carbide nanomaterial) and scalable solution processing. We show that the electrochemical properties of MXtrodes exceed those of conventional materials and do not require conductive gels when used in epidermal electronics. Furthermore, we validate MXtrodes in applications ranging from mapping large-scale neuromuscular networks in humans to cortical neural recording and microstimulation in swine and rodent models. Last, we demonstrate that MXtrodes are compatible with standard clinical neuroimaging modalities.

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.

Hydrogel Ionic Diodes toward Harvesting Ultralow-Frequency Mechanical Energy

Energy harvesting from human motion is regarded as a promising protocol for powering portable electronics, biomedical devices, and smart objects of the Internet of things. However, state-of-the-art mechanical-energy-harvesting devices generally operate at frequencies (>10 Hz) well beyond human activity frequencies. Here, a hydrogel ionic diode formed by the layered structures of anionic and cationic ionomers in hydrogels is presented. As confirmed by finite element analysis, the underlying mechanism of the hydrogel ionic diode involves the formation of the depletion region by mobile cations and anions and the subsequent increase of the built-in potential across the depletion region in response to mechanical pressure. Owing to the enhanced ionic rectification ratio by the embedded carbon nanotube and silver nanowire electrodes, the hydrogel ionic diode exhibits a power density of ≈5 mW cm^-2 and a charge density of ≈4 mC cm^-2 at 0.01 Hz, outperforming the current energy-harvesting devices by several orders of magnitude. The applications of the self-powered hydrogel ionic diode to tactile sensing, pressure imaging, and touchpads are demonstrated, with sensing limitation is as low as 0.01 kPa. This work is expected to open up new opportunities for ionic-current-based ionotronics in electronics and energy devices.

Piezoelectric Materials for Energy Harvesting and Sensing Applications: Roadmap for Future Smart Materials

Piezoelectric materials are widely referred to as "smart" materials because they can transduce mechanical pressure acting on them to electrical signals and vice versa. They are extensively utilized in harvesting mechanical energy from vibrations, human motion, mechanical loads, etc., and converting them into electrical energy for low power devices. Piezoelectric transduction offers high scalability, simple device designs, and high-power densities compared to electro-magnetic/static and triboelectric transducers. This review aims to give a holistic overview of recent developments in piezoelectric nanostructured materials, polymers, polymer nanocomposites, and piezoelectric films for implementation in energy harvesting. The progress in fabrication techniques, morphology, piezoelectric properties, energy harvesting performance, and underpinning fundamental mechanisms for each class of materials, including polymer nanocomposites using conducting, non-conducting, and hybrid fillers are discussed. The emergent application horizon of piezoelectric energy harvesters particularly for wireless devices and self-powered sensors is highlighted, and the current challenges and future prospects are critically discussed.

Biomedical Implants with Charge-Transfer Monitoring and Regulating Abilities

Transmembrane charge (ion/electron) transfer is essential for maintaining cellular homeostasis and is involved in many biological processes, from protein synthesis to embryonic development in organisms. Designing implant devices that can detect or regulate cellular transmembrane charge transfer is expected to sense and modulate the behaviors of host cells and tissues. Thus, charge transfer can be regarded as a bridge connecting living systems and human-made implantable devices. This review describes the mode and mechanism of charge transfer between organisms and nonliving materials, and summarizes the strategies to endow implants with charge-transfer regulating or monitoring abilities. Furthermore, three major charge-transfer controlling systems, including wired, self-activated, and stimuli-responsive biomedical implants, as well as the design principles and pivotal materials are systematically elaborated. The clinical challenges and the prospects for future development of these implant devices are also discussed.