Printing Flexible and Hybrid Electronics for Human Skin and Eye-Interfaced Health Monitoring Systems

Designs and Applications for the Multimodal Flexible Hybrid Epidermal Electronic Systems

Research on the flexible hybrid epidermal electronic system (FHEES) has attracted considerable attention due to its potential applications in human-machine interaction and healthcare. Through material and structural innovations, FHEES combines the advantages of traditional stiff electronic devices and flexible electronic technology, enabling it to be worn conformally on the skin while retaining complex system functionality. FHEESs use multimodal sensing to enhance the identification accuracy of the wearer's motion modes, intentions, or health status, thus realizing more comprehensive physiological signal acquisition. However, the heterogeneous integration of soft and stiff components makes balancing comfort and performance in designing and implementing multimodal FHEESs challenging. Herein, multimodal FHEESs are first introduced in 2 types based on their different system structure: all-in-one and assembled, reflecting totally different heterogeneous integration strategies. Characteristics and the key design issues (such as interconnect design, interface strategy, substrate selection, etc.) of the 2 multimodal FHEESs are emphasized. Besides, the applications and advantages of the 2 multimodal FHEESs in recent research have been presented, with a focus on the control and medical fields. Finally, the prospects and challenges of the multimodal FHEES are discussed.

Integrating High-Performance Flexible Wires with Strain Sensors for Wearable Human Motion Detection

Flexible electronics have revolutionized the field by overcoming the rigid limitations of traditional devices, offering superior flexibility and adaptability. Conductive ink performance is crucial, directly impacting the stability of flexible electronics. While metal filler-based inks exhibit excellent conductivity, they often lack mechanical stability. To address this challenge, we present a novel conductive ink utilizing a ternary composite filler system: liquid metal and two micron-sized silver morphologies (particles and flakes). We systematically investigated the influence of filler type, mass ratio, and sintering process parameters on the composite ink's conductivity and mechanical stability. Our results demonstrate that flexible wires fabricated with the liquid metal/micron silver particle/micron silver flake composite filler exhibit remarkable conductivity and exceptional bending stability. Interestingly, increasing the liquid metal content results in a trade-off, compromising conductivity while enhancing mechanical performance. After enduring 5000 bending cycles, the resistance change in wires formulated with a 4:1 mass ratio of micron silver particles to flakes is only half that of wires with a 1:1 ratio. This study further investigates the mechanism governing resistance variations during flexible wire bending. Additionally, we observed a positive correlation between sintering temperature and pressure with the conductivity of flexible wires. The significance of the sintering parameters on conductivity follows a descending order: sintering temperature, sintering pressure, and sintering time. Finally, we demonstrate the practical application of this technology by integrating the composite ink-based flexible wires with conductive polymer-based strain sensors. This combination successfully achieved the detection of human movements, including finger and wrist bending.

Eye-Readable and Wearable Colorimetric Sensor Arrays for In Situ Monitoring of Volatile Organic Compounds

Wearable sensors utilize changes in color as a response to physiological stimuli, making them easily recognizable by the naked eye. These colorimetric wearable sensors offer benefits such as easy readability, rapid responsiveness, cost-effectiveness, and straightforward manufacturing techniques. However, their applications in detecting volatile organic compounds (VOCs) in situ have been limited due to the low concentration of complex VOCs and complicated external interferences. Aiming to address these challenges, we introduced readable and wearable colorimetric sensing arrays with a microchannel structure and highly gas-sensitive materials for in situ detection of complex VOCs. The highly gas-sensitive materials were designed by loading gas-sensitive dyes into the porous metal-organic frameworks and further depositing the composites on the electrospun nanofiber membrane. The colorimetric sensor arrays were fabricated using various gas-sensitive composites, including eight dye/MOF composites that respond to various VOCs and two Pd2+/dye/MOF composites that respond to ethylene. This enables the specific recognition of multiple characteristic VOCs. A microfluidic channel made of polydimethylsiloxane (PDMS) was integrated with different colorimetric elements to create a wearable sensor array. It was attached to the surface of fruits to collect and monitor VOCs using the DenseNet classification method. As a proof of concept, we demonstrated the feasibility of the wearable sensing system in monitoring the ripening process of fruits by continuously measuring the VOC emissions from the skin of the fruit.

A Bionic Skin for Health Management: Excellent Breathability, In Situ Sensing, and Big Data Analysis

Developing an intelligent wearable system is of great significance to human health management. An ideal health-monitoring patch should possess key characteristics such as high air permeability, moisture-wicking function, high sensitivity, and a comfortable user experience. However, such a patch that encompasses all these functions is rarely reported. Herein, an intelligent bionic skin patch for health management is developed by integrating bionic structures, nano-welding technology, flexible circuit design, multifunctional sensing functions, and big data analysis using advanced electrospinning technology. By controlling the preparation of nanofibers and constructing bionic secondary structures, the resulting nanofiber membrane closely resembles human skin, exhibiting excellent air/moisture permeability, and one-side sweat-wicking properties. Additionally, the bionic patch is endowed with a high-precision signal acquisition capabilities for sweat metabolites, including glucose, lactic acid, and pH; skin temperature, skin impedance, and electromyographic signals can be precisely measured through the in situ sensing electrodes and flexible circuit design. The achieved intelligent bionic skin patch holds great potential for applications in health management systems and rehabilitation engineering management. The design of the smart bionic patch not only provides high practical value for health management but also has great theoretical value for the development of the new generation of wearable electronic devices.

Direct-Ink-Writing 3D-Printed Bioelectronics

The development of wearable and implantable bioelectronics has garnered significant momentum in recent years, driven by the ever-increasing demand for personalized health monitoring, remote patient management, and real-time physiological data collection. The elevated sophistication and advancement of these devices have thus led to the use of many new and unconventional materials which cannot be fulfilled through traditional manufacturing techniques. Three-dimension (3D) printing, also known as additive manufacturing, is an emerging technology that opens new opportunities to fabricate next-generation bioelectronic devices. Some significant advantages include its capacity for material versatility and design freedom, rapid prototyping, and manufacturing efficiency with enhanced capabilities. This review provides an overview of the recent advances in 3D printing of bioelectronics, particularly direct ink writing (DIW), encompassing the methodologies, materials, and applications that have emerged in this rapidly evolving field. This review showcases the broad range of bioelectronic devices fabricated through 3D printing including wearable biophysical sensors, biochemical sensors, electrophysiological sensors, energy devices, multimodal systems, implantable devices, and soft robots. This review will also discuss the advantages, existing challenges, and outlook of applying DIW 3D printing for the development of bioelectronic devices toward healthcare applications.

A Novel Mechanomyography (MMG) Sensor Based on Piezo-Resistance Principle and with a Pyramidic Microarray

Flexible piezoresistive sensors built by printing nanoparticles onto soft substrates are crucial for continuous health monitoring and wearable devices. In this study, a mechanomyography (MMG) sensor was developed using a flexible piezoresistive MMG signal sensor based on a pyramidal polydimethylsiloxane (PDMS) microarray sprayed with carbon nanotubes (CNTs). The experiment was conducted, and the results show that the sensitivity of the sensor can reach 0.4 kPa-1 in the measurement range of 0~1.5 kPa, and the correlation reached 96%. This has further implications for the possibility that muscle activation can be converted into mechanical movement. The integrity of the sensor in terms of its MMG signal acquisition was tested based on five subjects who were performing arm bending and arm extending movements. The results of this test were promising.

Advances in Wearable Piezoelectric Sensors for Hazardous Workplace Environments

Recent advances in wearable energy harvesting technology as solutions to occupational health and safety programs are presented. Workers are often exposed to harmful conditions-especially in the mining and construction industries-where chronic health issues can emerge over time. While wearable sensors technology can aid in early detection and long-term exposure tracking, powering them and the associated risks are often an impediment for their widespread use, such as the need for frequent charging and battery safety. Repetitive vibration exposure is one such hazard, e.g., whole body vibration, yet it can also provide parasitic energy that can be harvested to power wearable sensors and overcome the battery limitations. This review can critically analyze the vibration effect on workers' health, the limitations of currently available devices, explore new options for powering different personal protective equipment devices, and discuss opportunities and directions for future research. The recent progress in self-powered vibration sensors and systems from the perspective of the underlying materials, applications, and fabrication techniques is reviewed. Lastly, the challenges and perspectives are discussed for reference to the researchers who are interested in self-powered vibration sensors.

Effect of interstitial fluid pH on transdermal glucose extraction by reverse iontophoresis

Reverse iontophoresis (RI) is a promising technology in the field of continuous glucose monitoring (CGM), offering significant advantages such as finger-stick-free operation, wearability, and non-invasiveness. In the glucose extraction process based on RI, the pH of the interstitial fluid (ISF) is a critical factor that needs further investigation, as it directly influences the accuracy of transdermal glucose monitoring. In this study, a theoretical analysis was conducted to investigate the mechanism by which pH affects the glucose extraction flux. Modeling and numerical simulations performed at different pH conditions indicated that the zeta potential was significantly impacted by the pH, thereby altering the direction and flux of the glucose iontophoretic extraction. A screen-printed glucose biosensor integrated with RI extraction electrodes was developed for ISF extraction and glucose monitoring. The accuracy and stability of the ISF extraction and glucose detection device were demonstrated with extraction experiments using different subdermal glucose concentrations ranging from 0 to 20 mM. The extraction results for different ISF pH values exhibited that at 5 mM and 10 mM subcutaneous glucose, the extracted glucose concentration was increased by 0.08212 mM and 0.14639 mM for every 1 pH unit increase, respectively. Furthermore, the normalized results for 5 mM and 10 mM glucose demonstrated a linear correlation, indicating considerable potential for incorporating a pH correction factor in the blood glucose prediction model used to calibrate glucose monitoring.

Smart Contact Lenses Keep an Eye on Health

Contact lenses are ideal conduits for continuous health monitoring. They have a long safety record, and they sit on the eye, where they have access to a range of biological signals. Making the transition from vision correction to biological monitoring, however, requires advances in technological development so the lenses not only detect and report signals accurately, but retain the high level of comfort that users have come to expect.

Piezoresistive Free-standing Microfiber Strain Sensor for High-resolution Battery Thickness Monitoring

Highly sensitive microfiber strain sensors are promising for the detection of mechanical deformations in applications where limited space is available. In particular for in situ battery thickness monitoring where high resolution and low detection limit are key requirements. Herein, the realization of a highly sensitive strain sensor for in situ lithium-ion (Li-ion) battery thickness monitoring is presented. The compliant fiber-shaped sensor is fabricated by an upscalable wet-spinning method employing a composite of microspherical core-shell conductive particles embedded in an elastomer. The electrical resistance of the sensor changes under applied strain, exhibiting a high strain sensitivity and extremely low strain detection limit of 0.00005 with high durability of 10 000 cycles. To demonstrate the accuracy and ease of applicability of this sensor, the real-time thickness change of a Li-ion battery pouch cell is monitored during the charge and discharge cycles. This work introduces a promising approach with the least material complexity for soft microfiber strain gauges.

Recent advances in inkjet-printing technologies for flexible/wearable electronics

The rapid development of flexible/wearable electronics requires novel fabricating strategies. Among the state-of-the-art techniques, inkjet printing has aroused considerable interest due to the possibility of large-scale fabricating flexible electronic devices with good reliability, high time efficiency, a low manufacturing cost, and so on. In this review, based on the working principle, recent advances in the inkjet printing technology in the field of flexible/wearable electronics are summarized, including flexible supercapacitors, transistors, sensors, thermoelectric generators, wearable fabric, and for radio frequency identification. In addition, some current challenges and future opportunities in this area are also addressed. We hope this review article can give positive suggestions to the researchers in the area of flexible electronics.

Designing Hierarchical Soft Network Materials with Developable Lattice Nodes for High Stretchability

Soft network materials (SNMs) represent one of the best candidates for the substrates and the encapsulation layers of stretchable inorganic electronics, because they are capable of precisely customizing the J-shaped stress-strain curves of biological tissues. Although a variety of microstructures and topologies have been exploited to adjust the nonlinear stress-strain responses of SNMs, the stretchability of most SNMs is hard to exceed 100%. Designing novel high-strength SNMs with much larger stretchability (e.g., >200%) than existing SNMs and conventional elastomers remains a challenge. This paper develops a class of hierarchical soft network materials (HSNMs) with developable lattice nodes, which can significantly improve the stretchability of SNMs without any loss of strength. The effects of geometric parameters, lattice topologies, and loading directions on the mechanical properties of HSNMs are systematically discussed by experiments and numerical simulations. The proposed node design strategy for SNMs is also proved to be widely applicable to different constituent materials, including polymers and metals.

A Breathable, Passive-Cooling, Non-Inflammatory, and Biodegradable Aerogel Electronic Skin for Wearable Physical-Electrophysiological-Chemical Analysis

Real-time monitoring of human health can be significantly improved by designing novel electronic skin (E-skin) platforms that mimic the characteristics and sensitivity of human skin. A high-quality E-skin platform that can simultaneously monitor multiple physiological and metabolic biomarkers without introducing skin discomfort or irritation is an unmet medical need. Conventional E-skins are either monofunctional or made from elastomeric films that do not include key synergistic features of natural skin, such as multi-sensing, breathability, and thermal management capabilities in a single patch. Herein, a biocompatible and biodegradable E-skin patch based on flexible gelatin methacryloyl aerogel (FGA) for non-invasive and continuous monitoring of multiple biomarkers of interest is engineered and demonstrated. Taking advantage of cryogenic temperature treatment and slow polymerization, FGA is fabricated with a highly interconnected porous structure that displays good flexibility, passive-cooling capabilities, and ultra-lightweight properties that make it comfortable to wear for long periods of time. It also provides numerous permeable capillary channels for thermal-moisture transfer, ensuring its excellent breathability. Therefore, the engineered FGA-based E-skin can simultaneously monitor body temperature, hydration, and biopotentials via electrophysiological sensors and detect glucose, lactate, and alcohol levels via electrochemical sensors. This work offers a previously unexplored materials strategy for next-generation E-skin platforms with superior practicality.

Smart soft contact lenses for continuous 24-hour monitoring of intraocular pressure in glaucoma care

Continuous monitoring of intraocular pressure, particularly during sleep, remains a grand challenge in glaucoma care. Here we introduce a class of smart soft contact lenses, enabling the continuous 24-hour monitoring of intraocular pressure, even during sleep. Uniquely, the smart soft contact lenses are built upon various commercial brands of soft contact lenses without altering their intrinsic properties such as lens power, biocompatibility, softness, transparency, wettability, oxygen transmissibility, and overnight wearability. We show that the smart soft contact lenses can seamlessly fit across different corneal curvatures and thicknesses in human eyes and therefore accurately measure absolute intraocular pressure under ambulatory conditions. We perform a comprehensive set of in vivo evaluations in rabbit, dog, and human eyes from normal to hypertension to confirm the superior measurement accuracy, within-subject repeatability, and user comfort of the smart soft contact lenses beyond current wearable ocular tonometers. We envision that the smart soft contact lenses will be effective in glaucoma care.

Cuffless Blood Pressure Monitoring: Academic Insights and Perspectives Analysis

In recent decades, cuffless blood pressure monitoring technology has been a point of research in the field of health monitoring and public media. Based on the web of science database, this paper evaluated the publications in the field from 1990 to 2020 using bibliometric analysis, described the developments in recent years, and presented future research prospects in the field. Through the comparative analysis of keywords, citations, H-index, journals, research institutions, national authors and reviews, this paper identified research hotspots and future research trends in the field of cuffless blood pressure monitoring. From the results of the bibliometric analysis, innovative methods such as machine learning technologies related to pulse transmit time and pulse wave analysis have been widely applied in blood pressure monitoring. The 2091 articles related to cuffless blood pressure monitoring technology were published in 1131 journals. In the future, improving the accuracy of monitoring to meet the international medical blood pressure standards, and achieving portability and miniaturization will remain the development goals of cuffless blood pressure measurement technology. The application of flexible electronics and machine learning strategy in the field will be two major development directions to guide the practical applications of cuffless blood pressure monitoring technology.

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

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

Rapid meniscus-guided printing of stable semi-solid-state liquid metal microgranular-particle for soft electronics

Liquid metal is being regarded as a promising material for soft electronics owing to its distinct combination of high electrical conductivity comparable to that of metals and exceptional deformability derived from its liquid state. However, the applicability of liquid metal is still limited due to the difficulty in simultaneously achieving its mechanical stability and initial conductivity. Furthermore, reliable and rapid patterning of stable liquid metal directly on various soft substrates at high-resolution remains a formidable challenge. In this work, meniscus-guided printing of ink containing polyelectrolyte-attached liquid metal microgranular-particle in an aqueous solvent to generate semi-solid-state liquid metal is presented. Liquid metal microgranular-particle printed in the evaporative regime is mechanically stable, initially conductive, and patternable down to 50 μm on various substrates. Demonstrations of the ultrastretchable (~500% strain) electrical circuit, customized e-skin, and zero-waste ECG sensor validate the simplicity, versatility, and reliability of this manufacturing strategy, enabling broad utility in the development of advanced soft electronics.

In this article, meniscus-guided printing of polyelectrolyte-attached liquid metal particles to simultaneously achieve mechanical stability and initial electrical conductivity at high resolution is introduced.

Smart Electronic Textiles for Wearable Sensing and Display

Increasing demand of using everyday clothing in wearable sensing and display has synergistically advanced the field of electronic textiles, or e-textiles. A variety of types of e-textiles have been formed into stretchy fabrics in a manner that can maintain their intrinsic properties of stretchability, breathability, and wearability to fit comfortably across different sizes and shapes of the human body. These unique features have been leveraged to ensure accuracy in capturing physical, chemical, and electrophysiological signals from the skin under ambulatory conditions, while also displaying the sensing data or other immediate information in daily life. Here, we review the emerging trends and recent advances in e-textiles in wearable sensing and display, with a focus on their materials, constructions, and implementations. We also describe perspectives on the remaining challenges of e-textiles to guide future research directions toward wider adoption in practice.

Multi-Layer Printable Lithium Ion Micro-Batteries with Remarkable Areal Energy Density and Flexibility for Wearable Smart Electronics

Pursuing high areal energy density and developing scalable fabrication strategies of micro-batteries are the key for the progressive printed microelectronics. Herein, the scalable fabrication of multi-layer printable lithium ion micro-batteries (LIMBs) with ultrahigh areal energy density and exceptional flexibility is reported, based on highly conductive and mechanically stable inks by fully incorporating the polyurethane binders in dibasic esters with high-conducting additives of graphene and carbon nanotubes into active materials to construct a cross-linked conductive network. Benefiting from relatively higher electrical conductivity (≈7000 mS cm^-1 ) and stably connected network of microelectrodes, the as-fabricated LIMBs by multi-layer printing display robust areal capacity of 398 µAh cm^-2 , and remarkable areal energy density of 695 μWh cm^-2 , which are much higher than most LIMBs reported. Further, the printed LIMBs show notable capacity retention of 88% after 3000 cycles, and outstanding flexibility without any structure degradation under various torsion states and folding angles. Importantly, a wearable smart bracelet, composed of a serially connected LIMBs pack, a temperature sensor, and a light-emitting diode, is realized for the automatic detection of body temperature. Therefore, this strategy of fabricating highly conductive and mechanically stable printable ink will open a new avenue for developing high-performance printable LIMBs for smart microelectronics.

Ultrahigh Sensitive Au-Doped Silicon Nanomembrane Based Wearable Sensor Arrays for Continuous Skin Temperature Monitoring with High Precision

Monitoring the body temperature with high accuracy provides a fast, facile, yet powerful route about the human body in a wide range of health information standards. Here, the first ever ultrasensitive and stretchable gold-doped silicon nanomembrane (Au-doped SiNM) epidermal temperature sensor array is introduced. The ultrasensitivity is achieved by shifting freeze-out region to intrinsic region in carrier density and modulation of fermi energy level of p-type SiNM through the development of a novel gold-doping strategy. The Au-doped SiNM is readily transferred onto an ultrathin polymer layer with a well-designed serpentine mesh structure, capable of being utilized as an epidermal temperature sensor array. Measurements in vivo and in vitro show temperature coefficient of resistance as high as -37270.72 ppm °C^-1 , 22 times higher than existing metal-based temperature sensors with similar structures, and one of the highest thermal sensitivity among the inorganic material based temperature sensors. Applications in the continuous monitoring of body temperature and respiration rate during exercising are demonstrated with a successful capture of information. This work lays a foundation for monitoring body temperature, potentially useful for precision diagnosis (e.g., continuous monitoring body temperature in coronavirus disease 2019 cases) and management of disease relevance to body temperature in healthcare.

Flexible Plasmonic Biosensors for Healthcare Monitoring: Progress and Prospects

The noble metal nanoparticle has been widely utilized as a plasmonic unit to enhance biosensors, by leveraging its electric and/or optical properties. Integrated with the "flexible" feature, it further enables opportunities in developing healthcare products in a conformal and adaptive fashion, such as wrist pulse tracers, body temperature trackers, blood glucose monitors, etc. In this work, we present a holistic review of the recent advance of flexible plasmonic biosensors for the healthcare sector. The technical spectrum broadly covers the design and selection of a flexible substrate, the process to integrate flexible and plasmonic units, the exploration of different types of flexible plasmonic biosensors to monitor human temperature, blood glucose, ions, gas, and motion indicators, as well as their applications for surface-enhanced Raman scattering (SERS) and colorimetric detections. Their fundamental working principles and structural innovations are scoped and summarized. The challenges and prospects are articulated regarding the critical importance for continued progress of flexible plasmonic biosensors to improve living quality.

Artificial Sense Technology: Emulating and Extending Biological Senses

Biological senses are critical for the survival of organisms. A great deal of attention has focused on elucidating the underlying physiological mechanisms of the senses, inspiring various sensing techniques. Despite progress in this area, gaps remain between the biological senses and conventional sensing techniques. In this Perspective, we propose the concept of artificial sense technology, which mimics the biological senses but differs in terms of objective sensing and intelligent feedback capabilities. We first summarize recent progress in the use of nanotechnologies to emulate the biological senses and then outline the advantages of artificial sense technology, which extend the capabilities of its biological counterparts. We envision artificial sense technology as a powerful perceptual interface that will play key roles in sensation substitution, digital healthcare, animal interactions, plant electronics, smart robots, and other areas that enrich the connections of the physical and virtual worlds.

Flexible Microwave Biosensor for Skin Abnormality Detection Based on Spoof Surface Plasmon Polaritons

Point-of-care testing plays an important role in the detection of skin abnormalities. The detection of skin abnormalities requires sufficient depth and no harm. A flexible microwave biosensor based on spoof surface plasmon polaritons was designed to meet the requirements of skin abnormalities. The designed biosensor, which works at 11.3 GHz, is small and can be flexibly attached to the skin surface of any part of the human body for measurement. The health status of the skin can be evaluated by the resonant frequency and the magnitude of the reflection coefficient of the sensor. The sensor was tested on pork skin. The experiment results showed that the sensor can detect skin abnormalities such as skin burn, skin tumor, and others. Compared with other sensors, the sensor has sufficient penetration depth because of the strong penetration of microwave electromagnetic waves. It is the first flexible microwave biosensor used for skin, which involves point-of-care testing, and continuous monitoring of skin.

Flexible and Stable Carbon Nanotube Film Strain Sensors with Self-Derived Integrated Electrodes

The development of flexible and wearable electronic devices has put an increasing demand on electrode systems with seamless connection and high compatibility with the main device, in order to accommodate complex deformation conditions and maintain stable performance. Here, we present a carbon nanotube-integrated electrode (CNTIE) by wet-pulling the ends of a carbon nanotube (CNT) film to form condensed thin fibers that resemble conventional conducting wire electrodes. A flexible strain sensor was constructed consisting of the middle CNT film as the main functional part and the CNTIE as self-derived electrodes, with inherent CNT connection between the two parts. The sensor can be transferred to versatile substrates (e.g., balloon surface) or encapsulated in thermoplastic polymers, exhibiting a large linear response range (up to 1000% in tensile strain), excellent durability and repeatability over 5000 cycles, and the ability to detect small- to large-degree human body motions. In addition, the strain sensor based on the CNTIE hybrid film (MXene/CNT and graphene/CNT) also shows superior linearity and stability at a strain range of 0-800%. Compared with the sensors using traditional silver wire electrodes and separately fabricated CNT fiber electrodes, our CNTIE plays an important role in achieving highly stable performance in the strain cycles. Our self-derived integrated electrodes provide a potential route to solve the incompatibility issues of conventional electrodes and to develop high-performance flexible and wearable systems based on CNTs and other nanomaterials.

2D Materials for Skin-Mountable Electronic Devices

Skin-mountable devices that can directly measure various biosignals and external stimuli and communicate the information to the users have been actively studied owing to increasing demand for wearable electronics and newer healthcare systems. Research on skin-mountable devices is mainly focused on those materials and mechanical design aspects that satisfy the device fabrication requirements on unusual substrates like skin and also for achieving good sensing capabilities and stable device operation in high-strain conditions. 2D materials that are atomically thin and possess unique electrical and optical properties offer several important features that can address the challenging needs in wearable, skin-mountable electronic devices. Herein, recent research progress on skin-mountable devices based on 2D materials that exhibit a variety of device functions including information input and output and in vitro and in vivo healthcare and diagnosis is reviewed. The challenges, potential solutions, and perspectives on trends for future work are also discussed.

Multifunctional Dressing for Wound Diagnosis and Rehabilitation

A wound dressing is a sterile pad or compress that is used in direct contact with a wound to help it heal and prevent further issues or complications. Though wound healing is an intricate dynamic process that involves multiple biomolecular species, conventional wound dressings have a limited ability to provide timely information of abnormal conditions, missing the best time for early treatment. The current perspective presents and discusses the design and development of smart wound dressings that are integrated with multifunctional materials, wearable sensors and drug delivery systems as well as their application ranging from wound monitoring to timely application of therapeutics. The perspective also discusses the ongoing challenges and exciting opportunities associated with the development of wearable sensor-based smart wound dressing and provide critical insights into wound healing monitoring and management.

Bitter Flavored, Soft Composites for Wearables Designed to Reduce Risks of Choking in Infants

Wireless, skin-integrated devices for continuous, clinical-quality monitoring of vital signs have the potential to greatly improve the care of patients in neonatal and pediatric intensive-care units. These same technologies can also be used in the home, across a broad spectrum of ages, from beginning to end of life. Although miniaturized forms of such devices minimize patient burden and improve compliance, they represent life-threatening choking hazards for infants. A materials strategy is presented here to address this concern. Specifically, composite materials are introduced as soft encapsulating layers and gentle adhesives that release chemical compounds designed to elicit an intense bitter taste when placed in the mouth. Reflexive reactions to this sensation strongly reduce the potential for ingestion, as a safety feature. The materials systems described involve a non-toxic bitterant (denatonium benzoate) as a dopant in an elastomeric (poly(dimethylsiloxane)) or hydrogel matrix. Experimental and computational studies of these composite materials and the kinetics of release of the bitterant define the key properties. Incorporation into various wireless skin-integrated sensors demonstrates their utility in functional systems. This simple strategy offers valuable protective capabilities, with broad practical relevance to the welfare of children monitored with wearable devices.

Printable Smart Materials and Devices: Strategies and Applications

Smart materials are a kind of functional materials which can sense and response to environmental conditions or stimuli from optical, electrical, magnetic mechanical, thermal, and chemical signals, etc. Patterning of smart materials is the key to achieving large-scale arrays of functional devices. Over the last decades, printing methods including inkjet printing, template-assisted printing, and 3D printing are extensively investigated and utilized in fabricating intelligent micro/nano devices, as printing strategies allow for constructing multidimensional and multimaterial architectures. Great strides in printable smart materials are opening new possibilities for functional devices to better serve human beings, such as wearable sensors, integrated optoelectronics, artificial neurons, and so on. However, there are still many challenges and drawbacks that need to be overcome in order to achieve the controllable modulation between smart materials and device performance. In this review, we give an overview on printable smart materials, printing strategies, and applications of printed functional devices. In addition, the advantages in actual practices of printing smart materials-based devices are discussed, and the current limitations and future opportunities are proposed. This review aims to summarize the recent progress and provide reference for novel smart materials and printing strategies as well as applications of intelligent devices.

A Soft Pressure Sensor Array Based on a Conducting Nanomembrane

Although skin-like pressure sensors exhibit high sensitivity with a high performance over a wide area, they have limitations owing to the critical issue of being linear only in a narrow strain range. Various strategies have been proposed to improve the performance of soft pressure sensors, but such a nonlinearity issue still exists and the sensors are only effective within a very narrow strain range. Herein, we fabricated a highly sensitive multi-channel pressure sensor array by using a simple thermal evaporation process of conducting nanomembranes onto a stretchable substrate. A rigid-island structure capable of dissipating accumulated strain energy induced by external mechanical stimuli was adopted for the sensor. The performance of the sensor was precisely controlled by optimizing the thickness of the stretchable substrate and the number of serpentines of an Au membrane. The fabricated sensor exhibited a sensitivity of 0.675 kPa^-1 in the broad pressure range of 2.3-50 kPa with linearity (~0.990), and good stability (>300 Cycles). Finally, we successfully demonstrated a mapping of pressure distribution.

Advanced Flexible Skin-Like Pressure and Strain Sensors for Human Health Monitoring

Recently, owing to their excellent flexibility and adaptability, skin-like pressure and strain sensors integrated with the human body have the potential for great prospects in healthcare. This review mainly focuses on the representative advances of the flexible pressure and strain sensors for health monitoring in recent years. The review consists of five sections. Firstly, we give a brief introduction of flexible skin-like sensors and their primary demands, and we comprehensively outline the two categories of design strategies for flexible sensors. Secondly, combining the typical sensor structures and their applications in human body monitoring, we summarize the recent development of flexible pressure sensors based on perceptual mechanism, the sensing component, elastic substrate, sensitivity and detection range. Thirdly, the main structure principles and performance characteristic parameters of noteworthy flexible strain sensors are summed up, namely the sensing mechanism, sensitive element, substrate, gauge factor, stretchability, and representative applications for human monitoring. Furthermore, the representations of flexible sensors with the favorable biocompatibility and self-driven properties are introduced. Finally, in conclusion, besides continuously researching how to enhance the flexibility and sensitivity of flexible sensors, their biocompatibility, versatility and durability should also be given sufficient attention, especially for implantable bioelectronics. In addition, the discussion emphasizes the challenges and opportunities of the above highlighted characteristics of novel flexible skin-like sensors.

Biodegradable Flexible Electronic Device with Controlled Drug Release for Cancer Treatment

Nowadays, controllable drug release is a vitally important strategy for cancer treatment and usually realized using implanting biocompatible devices. However, these devices need to be removed by another surgery after the function fails, which brings the risks of inflammation or potential death. In this article, a biodegradable flexible electronic device with controllable drug (paclitaxel) release was proposed for cancer treatment. The device is powered by an external alternating magnetic field to generate internal resistance heat and promote drug release loaded on the substrate. Moreover, the device temperature can even reach to 65 °C, which was sufficient for controllable drug release. This device also has similar mechanical properties to human tissues and can autonomously degrade due to the structure design of the circuit and degradable compositions. Finally, it is confirmed that the device has a good inhibitory effect on the proliferation of breast cancer cells (MCF-7) and could be completely degraded in vitro. Thus, its great biodegradability and conformity can relieve patients of second operation, and the device proposed in this paper provides a promising solution to complete conquest of cancer in situ.

Artificial Intelligence in Medical Sensors for Clinical Decisions

Due to the limited ability of conventional methods and the limited perspective of human diagnostics, patients are often diagnosed incorrectly or at a late stage as their disease condition progresses. They may then undergo unnecessary treatments due to inaccurate diagnoses. In this Perspective, we offer a brief overview on the integration of nanotechnology-based medical sensors and artificial intelligence (AI) for advanced clinical decision support systems to help decision-makers and healthcare systems improve how they approach information, insights, and the surrounding contexts, as well as to promote the uptake of personalized medicine on an individualized basis. Relying on these milestones, wearable sensing devices could enable interactive and evolving clinical decisions that could be used for evidence-based analysis and recommendations as well as for personalized monitoring of disease progress and treatment. We present and discuss the ongoing challenges and future opportunities associated with AI-enabled medical sensors in clinical decisions.

Wearable and Implantable Intraocular Pressure Biosensors: Recent Progress and Future Prospects

Biosensors worn on or implanted in eyes have been garnering substantial attention since being proven to be an effective means to acquire critical biomarkers for monitoring the states of ophthalmic disease, diabetes. Among these disorders, glaucoma, the second leading cause of blindness globally, usually results in irreversible blindness. Continuous intraocular pressure (IOP) monitoring is considered as an effective measure, which provides a comprehensive view of IOP changes that is beyond reach for the "snapshots" measurements by clinical tonometry. However, to satisfy the applications in ophthalmology, the development of IOP sensors are required to be prepared with biocompatible, miniature, transparent, wireless and battery-free features, which are still challenging with many current fabrication processes. In this work, the recent advances in this field are reviewed by categorizing these devices into wearable and implantable IOP sensors. The materials and structures exploited for engineering these IOP devices are presented. Additionally, their working principle, performance, and the potential risk that materials and device architectures may pose to ocular tissue are discussed. This review should be valuable for preferable structure design, device fabrication, performance optimization, and reducing potential risk of these devices. It is significant for the development of future practical IOP sensors.

Knittable and Sewable Spandex Yarn with Nacre-Mimetic Composite Coating for Wearable Health Monitoring and Thermo- and Antibacterial Therapies

The emerging personal healthcare has significantly propelled the development of advanced wearable electronics with novel functions of providing diagnostic information and point-of-care therapies for specific diseases. However, it is still challenging to simultaneously achieve high sensitivity for health biomonitoring and multifunction integration for point-of-care therapies in a one single flexible, lightweight yet robust fiber-based device. Here, a knittable and sewable spandex yarn with conductive nacre-mimetic composite coating has been developed through an alternant dip-coating method employing MXene nanosheets as the "brick" and polydopamine (PDA)/Ni²⁺ as the "mortar". The resultant spandex yarn coating with MXene/PDA/Ni²⁺ (MPNi@Spandex) can be assembled as a strain sensor with high sensitivity (up to 5.7 × 10⁴ for the gauge factor), wide sensing range (∼61.2%), and low detection limit (0.11%) to monitor the biological activities of the human body. Furthermore, MPNi@Spandex displays great potential to give on-demand thermotherapy by virtue of the fast response to near-infrared irradiation, controllable surface temperature, and applicability even under sewing conditions. In addition, MPNi@Spandex knitted textiles demonstrate a strong antibacterial effect due to the sharp edges, anionic, and hydrophilic nature of MXene nanosheets. Remarkably, near-infrared irradiation further improves the bacteria-killing efficiency of an MPNi@Spandex knitted textile to more than 99.9%. This work paves the way for the design of multifunctional wearable electronics with an all-in-one theranostic platform for personal healthcare.

Integration of interstitial fluid extraction and glucose detection in one device for wearable non-invasive blood glucose sensors

Wearable non-invasive glucose sensors that can provide human a painless and portable means to monitor their blood glucose and manage their health condition draw great attentions, recently. Non-invasive human glucose sensors by detecting glucose in interstitial fluid (ISF) extracted through a reverse iontophoresis (RI) approach have been widely investigated, but the current challenges are their complex structure and instability for continuous monitor. Herein, we demonstrate a simple two-electrode non-invasive blood glucose sensor, which is fabricated by using graphene/carbon nanotubes/glucose oxidase composite textile and graphene/carbon nanotube/silver/silver chloride composite textile as the working electrode and counter electrode, respectively. By using one single device, extraction of ISF through RI process is firstly conducted by loading a certain electric current between two electrodes, then the glucose concentration in the ISF is detected through an amperometric approach by using the same two electrodes. The feasibility of these non-invasive glucose sensors is validated on porcine skin, nude mice and human. The blood glucose concentration calculated according to the response currents of the two-electrode sensors is highly consistent with that measured by commercial glucose meter. Furthermore, the used textile-like electrodes provide the non-invasive blood glucose sensors with excellent flexible and wearable properties, which make them promising to be integrated with other electronic units for monitor and management of human health.

Wearable Circuits Sintered at Room Temperature Directly on the Skin Surface for Health Monitoring

A soft body area sensor network presents a promising direction in wearable devices to integrate on-body sensors for physiological signal monitoring and flexible printed circuit boards (FPCBs) for signal conditioning/readout and wireless transmission. However, its realization currently relies on various sophisticated fabrication approaches such as lithography or direct printing on a carrier substrate before attaching to the body. Here, we report a universal fabrication scheme to enable printing and room-temperature sintering of the metal nanoparticle on paper/fabric for FPCBs and directly on the human skin for on-body sensors with a novel sintering aid layer. Consisting of polyvinyl alcohol (PVA) paste and nanoadditives in the water, the sintering aid layer reduces the sintering temperature. Together with the significantly decreased surface roughness, it allows for the integration of a submicron-thick conductive pattern with enhanced electromechanical performance. Various on-body sensors integrated with an FPCB to detect health conditions illustrate a system-level example.

Inkjet-Printed Electronics on Paper for RF Identification (RFID) and Sensing

The newly developed research area of inkjet-printed radio frequency (RF) electronics on cellulose-based and synthetic paper substrates is introduced in this paper. This review paper presents the electrical properties of the paper substrates, the printed silver nanoparticle-based thin films, the dielectric layers, and the catalyst-based metallization process. Numerous inkjet-printed microwave passive/ative systems on paper, such as a printed radio frequency identification (RFID) tag, an RFID-enabled sensor utilizing carbon nanotubes (CNTs), a substrate-integrated waveguide (SIW), fully printed vias, an autonomous solar-powered beacon oscillator (active antenna), and artificial magnetic conductors (AMC), are discussed. The reported technology could potentially act as the foundation for true “green” low-cost scalable wireless topologies for autonomous Internet-of-Things (IoT), bio-monitoring, and “smart skin” applications.

Surface and Interface Designs in Copper-Based Conductive Inks for Printed/Flexible Electronics

Silver (Ag), gold (Au), and copper (Cu) have been utilized as metals for fabricating metal-based inks/pastes for printed/flexible electronics. Among them, Cu is the most promising candidate for metal-based inks/pastes. Cu has high intrinsic electrical/thermal conductivity, which is more cost-effective and abundant, as compared to Ag. Moreover, the migration tendency of Cu is less than that of Ag. Thus, recently, Cu-based inks/pastes have gained increasing attention as conductive inks/pastes for printed/flexible electronics. However, the disadvantages of Cu-based inks/pastes are their instability against oxidation under an ambient condition and tendency to form insulating layers of Cu oxide, such as cuprous oxide (Cu2O) and cupric oxide (CuO). The formation of the Cu oxidation causes a low conductivity in sintered Cu films and interferes with the sintering of Cu particles. In this review, we summarize the surface and interface designs for Cu-based conductive inks/pastes, in which the strategies for the oxidation resistance of Cu and low-temperature sintering are applied to produce highly conductive Cu patterns/electrodes on flexible substrates. First, we classify the Cu-based inks/pastes and briefly describe the surface oxidation behaviors of Cu. Next, we describe various surface control approaches for Cu-based inks/pastes to achieve both the oxidation resistance and low-temperature sintering to produce highly conductive Cu patterns/electrodes on flexible substrates. These surface control approaches include surface designs by polymers, small ligands, core-shell structures, and surface activation. Recently developed Cu-based mixed inks/pastes are also described, and the synergy effect in the mixed inks/pastes offers improved performances compared with the single use of each component. Finally, we offer our perspectives on Cu-based inks/pastes for future efforts.

All 3D-Printed Flexible ZnO UV Photodetector on an Ultraflat Substrate

An all three-dimensional (3D)-printed flexible ZnO ultraviolet (UV) photodetector is demonstrated, where the 3D-printing method is used not only for the electrode and photosensitive material but also for creating a substrate. An ultraflat and flexible substrate capable of serving as the backbone layer is developed using a water-dissolvable polymer layer for surface planarization. A two-layered printing followed by surface treatment is demonstrated for the substrate preparation. As mechanical support but flexible, a thick and sparse thermoplastic polyurethane layer is printed. On its surface, a thin and dense poly(vinyl alcohol) (PVA) is then printed. A precise control of PVA reflow using a microwater droplet results in a flexible and extremely uniform substrate. A Cu-Ag nanowire network is directly 3D printed on the flexible substrate for the conducting layer, followed by ZnO for the photosensitive material. Unlike the planar two-dimensional printing that provides thin films, 3D printing allows the electrode to have a step height, which can be made like a dam to accommodate a thick film of ZnO. Photosensitivity as a function of various ZnO thickness values was investigated to establish an optimal thickness for UV response. The device was also tested in natural sunlight along with stability and reliability.

Recent advances of tissue-interfaced chemical biosensors

This review discusses recent advances of tissue interfaced chemical biosensors, highlights current challenges and gives an outlook on future possibilities.

Toward Imperfection-Insensitive Soft Network Materials for Applications in Stretchable Electronics

Development of stretchable devices with mechanical responses that mimic those of biological tissues/organs is of particular importance for the long-term biointegration, as the discomfort induced by the mechanical mismatch can be minimized. Recent works have established the bioinspired designs of soft network materials that can precisely reproduce the unconventional J-shaped stress-strain curves of human skin at different regions. Existing studies mostly focused on the design, fabrication, and modeling of perfect soft network materials. When utilized as the substrates of biointegrated electronics, the soft network designs, however, often need to incorporate deterministic holes, a type of imperfection, to accommodate hard, inorganic electronic components. Understanding of the effect of hole imperfections on the mechanical properties of soft network materials is thereby essential in practical applications. This paper presents a combined experimental and computational study of the stretchability and elastic modulus of imperfect soft network materials consisting of circular holes with a variety of diameters. Both the size and location of the circular-hole imperfections are shown to have profound influences on the stretchability. Based on these results, design guidelines of imperfection-insensitive network materials are introduced. For the imperfections that result in an evident reduction of stretchability, an effective reinforcement approach is presented by enlarging the width of horseshoe microstructures at strategic locations, which can enhance the stretchability considerably. A stretchable and imperfection-insensitive integrated device with a light-emitting diode embedded in the network material serves a demonstrative application.