Recent advances and perspectives in sweat based wearable electrochemical sensors

Pumpless microfluidic sweat sensing yarn

Textile sweat sensors possess immense potential for non-invasive health monitoring. Rapid in-situ sweat capture and prevention of its evaporation are crucial for accurate and stable real-time monitoring. Herein, we introduce a unidirectional, pump-free microfluidic sweat management system to tackle this challenge. A nanofiber sheath layer on micrometer-scale sensing filaments enables this pumpless microfluidic design. Utilizing the capillary effect of the nanofibers allows for the swift capture of sweat, while the differential configuration of the hydrophilic and hydrophobic properties of the sheath and core yarns prevents sweat evaporation. The Laplace pressure difference between the cross-scale fibers facilitates the management system to ultimately expulse sweat. This results in microfluidic control of sweat without the need for external forces, resulting in rapid (<5 s), sensitive (19.8 nA μM-1), and stable (with signal noise and drift suppression) sweat detection. This yarn sensor can be easily integrated into various fabrics, enabling the creation of health monitoring smart garments. The garments maintain good monitoring performance even after 20 washes. This work provides a solution for designing smart yarns for high-precision, stable, and non-invasive health monitoring.

Machine learning-powered wearable interface for distinguishable and predictable sweat sensing

The constrained resources on wearable devices pose a challenge in meeting the demands for comprehensive sensing information, and current wearable non-enzymatic sensors face difficulties in achieving specific detection in biofluids. To address this issue, we have developed a highly selective non-enzymatic sweat sensor that seamlessly integrates with machine learning, ensuring reliable sensing and physiological monitoring of sweat biomarkers during exercise. The sensor consists of two electrodes supported by a microsystem that incorporates signal processing and wireless communication. The device generates four explainable features that can be used to accurately predict tyrosine and tryptophan concentrations, as well as sweat pH. The reliability of this device has been validated through rigorous statistical analysis, and its performance has been tested in subjects with and without supplemental amino acid intake during cycling trials. Notably, a robust linear relationship has been identified between tryptophan and tyrosine concentrations in the collected samples, irrespective of the pH dimension. This innovative sensing platform is highly portable and has significant potential to advance the biomedical applications of non-enzymatic sensors. It can markedly improve accuracy while decreasing costs.

Development of a microfluidic wearable electrochemical sensor for the non-invasive monitoring of oxidative stress biomarkers in human sweat

Oxidative stress is widely recognized as a pivotal factor contributing to numerous Central Nervous System (CNS) ailments. The concentrations of hydrogen peroxide (H2O2) and phosphorylated proteins within the human body serve as crucial indicators of oxidative stress. As such, the real-time monitoring of H2O2 and phosphorylated proteins in sweat is vital for the early identification, diagnosis, and management of diseases linked to oxidative stress. In this context, we present a novel microfluidic wearable electrochemical sensor by modifying the electrode with Prussian blue (PB) and loading sulfur-rich vacancy-containing molybdenum disulfide (MoS2-X) onto Multi-walled carbon nanotube (CNTs) to form coaxially layered CNTs/MoS2-X, which was then synthesized with highly dispersed titanium dioxide nanoparticles (TiO2) to synthesize CNTs/MoS2-X/TiO2 composites for the detection of human sweat H2O2 and phosphorylated proteins, respectively. This structure, with its sulfur vacancies and coaxial layering, significantly improved sensitivity of electrochemical sensors, allowing it to detect H2O2 in a range of 0.01-1 mM with a detection limit of 4.80 μM, and phosphoproteins in a range of 0.01-1 mg/mL with a threshold of 0.917 μg/mL. Furthermore, the miniature sensor demonstrates outstanding performance in detecting analytes in both simulated and real sweat. Comprehensive biosafety assessments have validated the compatibility of the electrode material, underscoring the potential of sensor as a reliable and non-invasive method for tracking biomarkers linked to CNS disorders. This microfluidic wearable electrochemical biosensor with high performance and biosafety features shows great promise for the development of cutting-edge wearable technology devices for tracking CNS disease indicators.

Highly Sensitive Biosensors Based on All-PEDOT:PSS Organic Electrochemical Transistors with Laser-Induced Micropatterning

Recent advances in numerous biological applications have increased the accuracy of monitoring the level of biologically significant analytes in the human body to manage personal nutrition and physiological conditions. However, despite promising reports about costly wearable devices with high sensing performance, there has been a growing demand for inexpensive sensors that can quickly detect biological molecules. Herein, we present highly sensitive biosensors based on organic electrochemical transistors (OECTs), which are types of organic semiconductor-based sensors that operate consistently at low operating voltages in aqueous solutions. Instead of the gold or platinum electrode used in current electrochemical devices, poly(3,4-ethylenedioxythiophene):poly(4-styrenesulfonate) (PEDOT:PSS) was used as both the channel and gate electrodes in the OECT. Additionally, to overcome the patterning resolution limitations of conventional solution processing, we confirmed that the irradiation of a high-power IR laser (λ = 1064 nm) onto the coated PEDOT:PSS film was able to produce spatially resolvable micropatterns in a digital-printing manner. The proposed patterning technique exhibits high suitability for the fabrication of all-PEDOT:PSS OECT devices. The device geometry was optimized by fine-tuning the gate area and the channel-to-gate distance. Consequently, the sensor for detecting ascorbic acid (vitamin C) concentrations in an electrolyte exhibited the best sensitivity of 125 μA dec-1 with a limit of detection of 1.3 μM, which is nearly 2 orders of magnitude higher than previous findings. Subsequently, an all-plastic flexible epidermal biosensor was established by transferring the patterned all-PEDOT:PSS OECT from a glass substrate to a PET substrate, taking full advantage of the flexibility of PEDOT:PSS. The prepared all-plastic sensor device is highly cost-effective and suitable for single-use applications because of its acceptable sensing performance and reliable signal for detecting vitamin C. Additionally, the epidermal sensor successfully obtained the temporal profile of vitamin C in the sweat of a human volunteer after the consumption of vitamin C drinks. We believe that the highly sensitive all-PEDOT:PSS OECT device fabricated using the accurate patterning process exhibits versatile potential as a low-cost and single-use biosensor for emerging bioelectronic applications.

Evaluation of sweat-based biomarkers using wearable biosensors for monitoring stress and fatigue: a systematic review

Objectives. This systematic review aims to report the evaluation of wearable biosensors for the real-time measurement of stress and fatigue using sweat biomarkers. Methods. A thorough search of the literature was carried out in databases such as PubMed, Web of Science and IEEE. A three-step approach for selecting research articles was developed and implemented. Results. Based on a systematic search, a total of 17 articles were included in this review. Lactate, cortisol, glucose and electrolytes were identified as sweat biomarkers. Sweat-based biomarkers are frequently monitored in real time using potentiometric and amperometric biosensors. Wearable biosensors such as an epidermal patch or a sweatband have been widely validated in scientific literature. Conclusions. Sweat is an important biofluid for monitoring general health, including stress and fatigue. It is becoming increasingly common to use biosensors that can measure a wide range of sweat biomarkers to detect fatigue during high-intensity work. Even though wearable biosensors have been validated for monitoring various sweat biomarkers, such biomarkers can only be used to assess stress and fatigue indirectly. In general, this study may serve as a driving force for academics and practitioners to broaden the use of wearable biosensors for the real-time assessment of stress and fatigue.

Sensing patches for biomarker identification in skin-derived biofluids

In conventional clinical disease diagnosis and screening based on biomarker detection, most analysis samples are collected from serum, blood. However, these invasive collection methods require specific instruments, professionals, and may lead to infection risks. Additionally, the diagnosis process suffers from untimely results. The identification of skin-related biomarkers plays an unprecedented role in early disease diagnosis. More importantly, these skin-mediated approaches for collecting biomarker-containing biofluid samples are noninvasive or minimally invasive, which is more preferable for point-of-care testing (POCT). Therefore, skin-based biomarker detection patches have been promoted, owing to their unique advantages, such as simple fabrication, desirable transdermal properties and no requirements for professional medical staff. Currently, the skin biomarkers extracted from sweat, interstitial fluid (ISF) and wound exudate, are achieved with wearable sweat patches, transdermal MN patches, and wound patches, respectively. In this review, we detail these three types of skin patches in biofluids collection and diseases-related biomarkers identification. Patch classification and the corresponding manufacturing as well as detection strategies are also summarized. The remaining challenges in clinical applications and current issues in accurate detection are discussed for further advancement of this technology (Scheme 1).

A home-made nanoporous gold microsensor for lead(II) detection in seawater with high sensitivity and anti-interference properties

A nanoporous gold microelectrode (NPG-μE) was fabricated and used for Pb(II) detection in seawater samples via square wave anodic stripping voltammetry (SWASV). The Au microelectrode (Au-μE) was fabricated by embedding a gold microfiber into a Pasteur pipette, and its surface was further modified by an anodization-electrochemical reduction (A-ECR) method, yielding the NPG-μE. The fabricated electrodes were characterized by cyclic voltammetry (CV) and field emission scanning electron microscopy (FE-SEM) for electrochemical and structural morphological investigations. SWASV results show a Pb(II) stripping peak at around -0.05 V vs. Ag/AgCl, sat. KCl, which is unusual for common Pb(II) detection (typically occurring at around -0.40 V) in anodic stripping voltammetry (ASV) analysis. The Pb(II) detection at less negative stripping potential is more beneficial. Hence, it exhibited anti-interference properties with Cd(II), which is attributed to the preferential deposition and stripping of the target analyte on the low-indexed crystal planes of the NPG structure. The calibration plot obtained by SWASV was linear in the concentration range of 0.1-10 μM, and the detection limit was found to be 57 nM (correlation coefficient of 0.9974). The NPG microsensor presented a 15-fold enhanced current response compared to Au-μE, with excellent sensitivity (27.2 μA μM-1 cm-2). The application of the NPG microsensor was examined by detecting Pb(II) in seawater samples, and a satisfactory performance was obtained.

A wearable microfluidic system for efficient sweat collection and real-time detection

Sweat is an important biofluid with rich physiological information that can evaluate human health condition. Wearable sweat sensors have received widespread attention in recent years due to the benefits of non-invasive, continuous, and real-time monitoring. Currently, an efficient device integrating sweat collection and detection is still needed. Here, a wearable sweat microfluidic system was fabricated for real-time collection and analysis of sweat. The fabricated microfluidic system consisted of four layers, including a skin adhesive layer, a microfluidic layer, an electrode layer, and a capping layer. The sweat collection rate was around 0.79 μL/min, which demonstrated efficient sweat sampling, storage, and refreshing capabilities. Simultaneous detection of multiple sweat biomarkers was achieved with a screen-printed sweat sensing array, which could realize high-precision detection of Na+, K+, and glucose. Moreover, the sensing array also showed good repeatability and stability, with a relative standard deviation of sensitivity of less than 5%. Additionally, human testing was conducted to demonstrate that this microfluidic system can continuously monitor Na+, K+, and glucose in subjects' sweat during exercise, which showed high potential for non-invasive human health monitoring.

3D-Printed Flexible Microfluidic Health Monitor for In Situ Sweat Analysis and Biomarker Detection

Wearable sweat biosensors have shown great progress in noninvasive, in situ, and continuous health monitoring to demonstrate individuals' physiological states. Advances in novel nanomaterials and fabrication methods promise to usher in a new era of wearable biosensors. Here, we introduce a three-dimensional (3D)-printed flexible wearable health monitor fabricated through a unique one-step continuous manufacturing process with self-supporting microfluidic channels and novel single-atom catalyst-based bioassays for measuring the sweat rate and concentration of three biomarkers. Direct ink writing is adapted to print the microfluidic device with self-supporting structures to harvest human sweat, which eliminates the need for removing sacrificial supporting materials and addresses the contamination and sweat evaporation issues associated with traditional sampling methods. Additionally, the pick-and-place strategy is employed during the printing process to accurately integrate the bioassays, improving manufacturing efficiency. A single-atom catalyst is developed and utilized in colorimetric bioassays to improve sensitivity and accuracy. A feasibility study on human skin successfully demonstrates the functionality and reliability of our health monitor, generating reliable and quantitative in situ results of sweat rate, glucose, lactate, and uric acid concentrations during physical exercise.

Graphene Oxide-Poly(vinyl alcohol) Hydrogel-Coated Solid-Contact Ion-Selective Electrodes for Wearable Sweat Potassium Ion Sensing

Solid-contact ion-selective electrodes (SC-ISEs) with ionophore-based polymer-sensitive membranes have been the major devices in wearable sweat sensors toward electrolyte analysis. However, the toxicity of ionophores in ion-selective membranes (ISMs), for example, valinomycin (K+ ion carrier), is a significant challenge, since the ISM directly contacts the skin during the tests. Herein, we report coating a hydrogel of graphene oxide-poly(vinyl alcohol) (GO-PVA) on the ISM to fabricate hydrogel-based SC-ISEs. The hydrogen bond interaction between GO sheets and PVA chains could enhance the mechanical strength through the formation of a cross-linking network. Comprehensive electrochemical tests have demonstrated that hydrogel-coated K+-SC-ISE maintains Nernstian response sensitivity, high selectivity, and anti-interference ability compared with uncoated K+-SC-ISE. A flexible hydrogel-based K+ sensing device was further fabricated with the integration of a solid-contact reference electrode, which has realized the monitoring of sweat K+ in real time. This work highlights the possibility of hydrogel coating for fabricating biocompatible wearable potentiometric sweat electrolyte sensors.

Wearable Sensing Device Integrated with Prestored Reagents for Cortisol Detection in Sweat

Wearable sweat sensors have achieved rapid development since they hold great potential in personalized health monitoring. However, a typical difficulty in practical processes is the control of working conditions for biorecognition elements, e.g., pH level and ionic strength in sweat may decrease the affinity between analytes and recognition elements. Here, we developed a wearable sensing device for cortisol detection in sweat using an aptamer as the recognition element. The device integrated functions of sweat collection, reagent prestorage, and signal conversion. Especially, the components of prestored reagents were optimized according to the inherent characteristics of sweat samples and electrodes, which allowed us to keep optimal conditions for aptamers. The sweat samples were transferred from the inlet of the device to the reagent prestored chamber, and the dry preserved reagents were rehydrated with sweat and then arrived at the aptamer-modified electrodes. Sweat samples of volunteers were analyzed by the wearable sensing device, and the results showed a good correlation with those of the ELISA kit. We believe that this convenient and reliable wearable sensing device has significant potential in self-health monitoring.

A wearable flexible electrochemical biosensor with CuNi-MOF@rGO modification for simultaneous detection of uric acid and dopamine in sweat

BACKGROUND

In health assessment and personalized medical services, accurate detection of biological markers such as dopamine (DA) and uric acid (UA) in sweat is crucial for providing valuable physiological information. However, there are challenges in detecting sweat biomarkers due to their low concentrations, variations in sweat yield among individuals, and the need for efficient sweat collection.

RESULTS

We synthesized CuNi-MOF@rGO as a high-activity electrocatalyst and investigated its feasibility and electrochemical mechanism for simultaneously detecting low-concentration biomarkers UA and DA. Interaction between the non-coordinating carboxylate group and the sample produces effective separation signals for DA and UA. The wearable biomimetic biosensor has a wide linear range of 1-500 μM, with a detection limit of 9.41 μM and sensitivity of 0.019 μA μM-1 cm-2 for DA, and 10-1000 μM, with a detection limit of 9.09 μM and sensitivity of 0.026 μA μM-1 cm-2 for UA. Thus, our sensor performs excellently in detecting low-concentration biomarkers. To improve sweat collection, we designed a microfluidic-controlled device with hydrophilic modification in the microchannel. Experimental results show optimal ink flow at 2% concentration. Overall, we developed an innovative and highly active electrocatalyst, successfully enabling simultaneous detection of low-concentration biomarkers UA and DA.

SIGNIFICANCE

This study provides a strategy for sweat analysis and health monitoring. Moreover, the sensor also showed good performance in detecting real sweat samples. This study has shown great potential in future advances in sweat analysis and health monitoring.

A photoelectrochemical sensor based on In2O3/In2S3/ZnIn2S4 ternary Z-scheme heterojunction for ultrasensitive detection of dopamine in sweat

A novel ternary heterojunction material In2O3/In2S3/ZnIn2S4 was synthesized, and a photoelectrochemical sensor was fabricated for the non-invasive test of dopamine (DA) in sweat. In2O3 multihollow microtubules were synthesized and then In2S3 was formed on their surface to construct a type-I heterojunction between In2S3 and In2O3. ZnIn2S4 was further introduced to form a Z-scheme heterojunction between In2S3/ZnIn2S4. Under photoexcitation, the photogenerated holes of In2O3 transferred to the valence band of In2S3, superimposed with the holes produced by In2S3, leads to a significantly higher photocatalytic oxidation capacity of In2O3/In2S3/ZnIn2S4 ternary composites than that of In2O3/In2S3. The Z-scheme heterojunction accelerates the transfer of photogenerated electrons accumulated on the type-I heterojunction. In the presence of DA, it is rapidly oxidized into polydopamine (PDA) by In2O3/In2S3, and the benzoquinone groups of PDA compete for the photogenerated electrons to reduce the current in the external circuit, whereby DA determination is achieved. Owing to the combination of type-I and Z-scheme heterojunction, the sensor showed extremely high sensitivity, with a detection limit of 3.94 × 10-12 mol/L. It is one of the most sensitive methods for DA detection reported and has been applied to the determination of DA in human sweat.

Current On-Skin Flexible Sensors, Materials, Manufacturing Approaches, and Study Trends for Health Monitoring: A Review

Due to an ever-increasing amount of the population focusing more on their personal health, thanks to rising living standards, there is a pressing need to improve personal healthcare devices. These devices presently require laborious, time-consuming, and convoluted procedures that heavily rely on cumbersome equipment, causing discomfort and pain for the patients during invasive methods such as sample-gathering, blood sampling, and other traditional benchtop techniques. The solution lies in the development of new flexible sensors with temperature, humidity, strain, pressure, and sweat detection and monitoring capabilities, mimicking some of the sensory capabilities of the skin. In this review, a comprehensive presentation of the themes regarding flexible sensors, chosen materials, manufacturing processes, and trends was made. It was concluded that carbon-based composite materials, along with graphene and its derivates, have garnered significant interest due to their electromechanical stability, extraordinary electrical conductivity, high specific surface area, variety, and relatively low cost.

Biopolymer-protected graphene-Fe3O4 nanocomposite based wearable microneedle sensor: toward real-time continuous monitoring of dopamine

Neurological disorders can occur in the human body as a result of nano-level variations in the neurotransmitter levels. Patients affected by neuropsychiatric disorders, that are chronic require continuous monitoring of these neurotransmitter levels for effective disease management. The current work focus on developing a highly sensitive and personalized sensor for continuous monitoring of dopamine. Here we propose a wearable microneedle-based electrochemical sensor, to continuously monitor dopamine in interstitial fluid (ISF). A chitosan-protected hybrid nanomaterial Fe3O4-GO composite has been used as a chemical recognition element protected by Nafion antifouling coating layer. The morphological and physiochemical characterizations of the nanocomposite were carried out with XRD, XPS, FESEM, EDAX and FT-IR. The principle of the developed sensor relies on orthogonal detection of dopamine with square wave voltammetry and chronoamperometric techniques. The microneedle sensor array exhibited an attractive analytical performance toward detecting dopamine in phosphate buffer and artificial ISF. The limit of detection (LOD) of the developed sensor was observed to be low, 90 nM in square wave voltammetry and 0.6 μM in chronoamperometric analysis. The practical applicability of the microneedle sensor array has been demonstrated on a skin-mimicking phantom gel model. The microneedle sensor also exhibited good long-term storage stability, reproducibility, and sensitivity. All of these promising results suggest that the proposed microneedle sensor array could be reliable for the continuous monitoring of dopamine.

Carbon fiber-based multichannel solid-contact potentiometric ion sensors for real-time sweat electrolyte monitoring

Solid-contact ion-selective electrodes (SC-ISEs) feature miniaturization and integration that have gained extensive attention in non-invasive wearable sweat electrolyte sensors. The state-of-the-art wearable SC-ISEs mainly use polyethylene terephthalate, gold and carbon nanotube fibers as flexible substrates but suffer from uncomfortableness, high cost and biotoxicity. Herein, we report carbon fiber-based SC-ISEs to construct a four-channel wearable potentiometric sensor for sweat electrolytes monitoring (Na+/K+/pH/Cl-). The carbon fibers were extracted from commercial cloth, of which the starting point is addressing the cost and reproducibility issues for flexible SC-ISEs. The bare carbon fiber electrodes exhibited reversible voltammetric and stable impedance performances. Further fabricated SC-ISEs based on corresponding ion-selective membranes disclosed Nernstian sensitivity and anti-interface ability toward both ions and organic species in sweat. Significantly, these carbon fiber-based SC-ISEs revealed high reproducibility of standard potentials between normal and bending states. Finally, a textile-based sensor was integrated with a solid-contact reference electrode, which realized on-body sweat electrolytes analysis. The results displayed high accuracy compared with ex-situ tests by ion chromatography. This work highlights carbon fiber-based multichannel wearable potentiometric ion sensors with low cost, biocompatibility and reproducibility.

Skin-interfaced microfluidic sweat collection devices for personalized hydration management through thermal feedback

Non-electronic wearables that utilize skin-interfaced microfluidic technology have revolutionized the collection and analysis of human sweat, providing valuable biochemical information and indicating body hydration status. However, existing microfluidic devices often require constant monitoring of data during sweat assessment, thereby impeding the user experience and potentially missing anomalous physiological events, such as excessive sweating. Moreover, the complex manufacturing process hampers the scalability and large-scale production of such devices. Herein, we present a self-feedback microfluidic device with a unique dehydration reminder through a cost-effective "CAD-to-3D device" approach. It incorporates two independent systems for sweat collection and thermal feedback, including serpentine microchannels, reservoirs, petal-like bursting valves and heating chambers. The device operates by sequentially collecting sweat in the channels and reservoirs, and then activating thermal stimulators in the heating chambers through breaking the valves, initiating a chemical exothermic reaction. Human trials validate that the devices effectively alert users to potential dehydration by inducing skin thermal sensations triggered by sweat sampling. The proposed device offers facile scalability and customizable fabrication, and holds promise for managing hydration strategies in real-world scenarios, benefiting individuals engaged in sporting activities or exposed to high-temperature settings.

Nanomaterial-based Electrochemical Sensors for Multiplex Medicinal Applications

This review explores the advancements in nanomaterial-based electrochemical sensors for the multiplex detection of medicinal compounds. The growing demand for efficient and selective detection methods in the pharmaceutical field has prompted significant research into the development of electrochemical sensors employing nanomaterials. These materials, defined as functional materials with at least one dimension between 1 and 100 nanometers, encompass metal nanoparticles, polymers, carbon-based nanocomposites, and nano-bioprobes. These sensors are characterized by their enhanced sensitivity and selectivity, playing a crucial role in simultaneous detection and offering a comprehensive analysis of multiple medicinal complexes within a single sample. The review comprehensively examines the design, fabrication, and application of nanomaterial- based electrochemical sensors, focusing on their ability to achieve multiplex detection of various medicinal substances. Insights into the strategies and nanomaterials employed for enhancing sensor performance are discussed. Additionally, the review explores the challenges and future perspectives of this evolving field, highlighting the potential impact of nanomaterial-based electrochemical sensors on the advancement of medicinal detection technologies.

Wearable biosensors for human health: A bibliometric analysis from 2007 to 2022

Objective

This study aimed to determine the status of scientific production on biosensor usage for human health monitoring.

Methods

We used bibliometrics based on the data and metadata retrieved from the Web of Science between 2007 and 2022. Articles unrelated to health and medicine were excluded. The databases were processed using the VOSviewer software and auxiliary spreadsheets. Data extraction yielded 275 articles published in 161 journals, mainly concentrated on 13 journals and 881 keywords plus.

Results

The keywords plus of high occurrences were estimated at 27, with seven to 30 occurrences. From the 1595 identified authors, 125 were consistently connected in the coauthorship network in the total set and were grouped into nine clusters. Using Lotka's law, we identified 24 prolific authors, and Hirsch index analysis revealed that 45 articles were cited more than 45 times. Crosses were identified between 17 articles in the Hirsch index and 17 prolific authors, highlighting the presence of a large set of prolific authors from various interconnected clusters, a triad, and a solitary prolific author.

Conclusion

An exponential trend was observed in biosensor research for health monitoring, identifying areas of innovation, collaboration, and technological challenges that can guide future research on this topic.

Advances in Non-Electrochemical Sensing of Human Sweat Biomarkers: From Sweat Sampling to Signal Reading

Sweat, commonly referred to as the ultrafiltrate of blood plasma, is an essential physiological fluid in the human body. It contains a wide range of metabolites, electrolytes, and other biologically significant markers that are closely linked to human health. Compared to other bodily fluids, such as blood, sweat offers distinct advantages in terms of ease of collection and non-invasive detection. In recent years, considerable attention has been focused on wearable sweat sensors due to their potential for continuous monitoring of biomarkers. Electrochemical methods have been extensively used for in situ sweat biomarker analysis, as thoroughly reviewed by various researchers. This comprehensive review aims to provide an overview of recent advances in non-electrochemical methods for analyzing sweat, including colorimetric methods, fluorescence techniques, surface-enhanced Raman spectroscopy, and more. The review covers multiple aspects of non-electrochemical sweat analysis, encompassing sweat sampling methodologies, detection techniques, signal processing, and diverse applications. Furthermore, it highlights the current bottlenecks and challenges faced by non-electrochemical sensors, such as limitations and interference issues. Finally, the review concludes by offering insights into the prospects for non-electrochemical sensing technologies. By providing a valuable reference and inspiring researchers engaged in the field of sweat sensor development, this paper aspires to foster the creation of innovative and practical advancements in this domain.

A highly sensitive and long-term stable wearable patch for continuous analysis of biomarkers in sweat

Although increasing efforts have been devoted to the development of non-invasive wearable or stretchable electrochemical sweat sensors for monitoring physiological and metabolic information, most of them still suffer from poor stability and specificity over time and fluctuating temperatures. This study reports the design and fabrication of a long-term stable and highly sensitive flexible electrochemical sensor based on nanocomposite-modified porous graphene by simple and facile laser treatment for detecting biomarkers such as glucose in sweat. The laser-reduced and patterned stable conductive nanocomposite on the porous graphene electrode provides the resulting glucose sensor with an excellent sensitivity of 1317.69 μAmM-1cm-2 with an ultra-low limit of detection (LOD) of 0.079 μM. The sensor can also detect pH and exhibit extraordinary stability to maintain more than 91% sensitivity over 21 days in ambient conditions. Taken together with a temperature sensor based on the same material system, the dual glucose and pH sensor integrated with a flexible microfluidic sweat sampling network further results in accurate continuous on-body glucose detection calibrated by the simultaneously measured pH and temperature. The low-cost, highly sensitive, and long-term stable platform could facilitate and pave the way for the early identification and continuous monitoring of different biomarkers for non-invasive disease diagnosis and treatment evaluation.

Sweat Sensor Based on Wearable Janus Textiles for Sweat Collection and Microstructured Optical Fiber for Surface-Enhanced Raman Scattering Analysis

Wearable sweat sensors provide real-time monitoring of biomarkers, enabling individuals to gain real-time insight into their health status. Current sensors primarily rely on electrochemical mechanisms, limiting their capacity for the concurrent detection of multiple analytes. Surface-enhanced Raman scattering spectroscopy offers an alternative approach by providing molecular fingerprint information to facilitate the identification of intricate analytes. In this study, we combine a wearable Janus fabric for efficient sweat collection and a grapefruit optical fiber embedded with Ag nanoparticles as a sensitive SERS probe. The Janus fabric features a superhydrophobic side in contact with the skin and patterned superhydrophilic regions on the opposite surface, facilitating the unidirectional flow of sweat toward these hydrophilic zones. Grapefruit optical fibers feature sharp tips with the ability to penetrate transparent dressings. Its microchannels extract sweat through capillary force, and nanoliter-scale volumes of sweat are sufficient to completely fill them. The Raman signal of sweat components is greatly enhanced by the plasmonic hot spots and accumulates along the fiber length. We demonstrate sensitive detection of sodium lactate and urea in sweat with a detection limit much lower than the physiological concentration levels. Moreover, the platform shows its capability for multicomponent detection and extends to the analysis of real human sweat.

A monolithically integrated in-textile wristband for wireless epidermal biosensing

Textile bioelectronics that allow comfortable epidermal contact hold great promise in noninvasive biosensing. However, their applications are limited mainly because of the large intrinsic electrical resistance and low compatibility for electronics integration. We report an integrated wristband that consists of multifunctional modules in a single piece of textile to realize wireless epidermal biosensing. The in-textile metallic patterning and reliable interconnect encapsulation contribute to the excellent electrical conductivity, mechanical robustness, and waterproofness that are competitive with conventional flexible devices. Moreover, the well-maintained porous textile architectures deliver air permeability of 79 mm s-1 and moisture permeability of 270 g m-2 day-1, which are more than one order of magnitude higher than medical tapes, thus ensuring superior wearing comfort. The integrated in-textile wristband performed continuous sweat potassium monitoring in the range of 0.3 to 40 mM with long-term stability, demonstrating its great potential for wearable fitness monitoring and point-of-care testing.

Preparation of β-Cyclodextrin Functionalized Platform for Monitoring Changes in Potassium Content in Perspiration

The monitoring of potassium ion (K+) levels in human sweat can provide valuable insights into electrolyte balance and muscle fatigue non-invasively. However, existing laboratory techniques for sweat testing are complex, while wearable sensors face limitations like drift, fouling and interference from ions such as Na+. This work develops printed electrodes using β-cyclodextrin functionalized reduced graphene oxide (β-CD-RGO) for selective K+ quantification in sweat. The β-CD prevents the aggregation of RGO sheets while also providing selective binding sites for K+ capture. Electrodes were fabricated by screen printing the β-CD-RGO ink onto conductive carbon substrates. Material characterization confirmed the successful functionalization of RGO with β-CD. Cyclic voltammetry (CV) showed enhanced electrochemical behavior for β-CD-RGO-printed electrodes compared with bare carbon and RGO. Sensor optimization resulted in a formulation with 30% β-CD-RGO loading. The printed electrodes were drop-casted with an ion-selective polyvinyl chloride (PVC) membrane. A linear range from 10 μM to 100 mM was obtained along with a sensitivity of 54.7 mV/decade. The sensor showed good reproducibility over 10 cycles in 10 mM KCl. Minimal interference from 100 mM Na+ and other common sweat constituents validated the sensor's selectivity. On-body trials were performed by mounting the printed electrodes on human subjects during exercise. The K+ levels measured in sweat were found to correlate well with serum analysis, demonstrating the sensor's ability for non-invasive electrolyte monitoring. Overall, the facile synthesis of stable β-CD-RGO inks enables the scalable fabrication of wearable sensors for sweat potassium detection.

Sweat analysis for urea sensing: trends and challenges

With increasing population there is a rise in pathological diseases that the healthcare facilities are grappling with. Sweat-based wearable technologies for continuous monitoring have overcome the demerits associated with sweat sampling and sensing. Hence, sweat as an alternative biofluid holds great promise for the quantification of a host of biomarkers and understanding the functioning of the body, thereby deducing ailments quickly and economically. This comprehensive review accounts for recent advances in sweat-based LOCs (Lab-On-Chips), which are a likely alternative to the existing blood-urea sample testing that is invasive and time-consuming. The present review is focused on the advancements in sweat-based Lab-On-Chips (LOCs) as an alternative to invasive and time-consuming blood-urea sample testing. In addition, different sweat collection methods (direct skin, near skin and microfluidic) and their mechanism for urea sensing are explained in detail. The mechanism of urea in biofluids in protein metabolism, balancing nitrogen levels and a crucial factor of kidney function is described. In the end, research and technological advancements are explained to address current challenges and enable its widespread implementation.

Electrochemical Wearable Biosensors and Bioelectronic Devices Based on Hydrogels: Mechanical Properties and Electrochemical Behavior

Hydrogel-based wearable electrochemical biosensors (HWEBs) are emerging biomedical devices that have recently received immense interest. The exceptional properties of HWEBs include excellent biocompatibility with hydrophilic nature, high porosity, tailorable permeability, the capability of reliable and accurate detection of disease biomarkers, suitable device-human interface, facile adjustability, and stimuli responsive to the nanofiller materials. Although the biomimetic three-dimensional hydrogels can immobilize bioreceptors, such as enzymes and aptamers, without any loss in their activities. However, most HWEBs suffer from low mechanical strength and electrical conductivity. Many studies have been performed on emerging electroactive nanofillers, including biomacromolecules, carbon-based materials, and inorganic and organic nanomaterials, to tackle these issues. Non-conductive hydrogels and even conductive hydrogels may be modified by nanofillers, as well as redox species. All these modifications have led to the design and development of efficient nanocomposites as electrochemical biosensors. In this review, both conductive-based and non-conductive-based hydrogels derived from natural and synthetic polymers are systematically reviewed. The main synthesis methods and characterization techniques are addressed. The mechanical properties and electrochemical behavior of HWEBs are discussed in detail. Finally, the prospects and potential applications of HWEBs in biosensing, healthcare monitoring, and clinical diagnostics are highlighted.

Application of Intelligent Medical Sensing Technology

With the popularization of intelligent sensing and the improvement of modern medical technology, intelligent medical sensing technology has emerged as the times require. This technology combines basic disciplines such as physics, mathematics, and materials with modern technologies such as semiconductors, integrated circuits, and artificial intelligence, and has become one of the most promising in the medical field. The core of intelligent medical sensor technology is to make existing medical sensors intelligent, portable, and wearable with full consideration of ergonomics and sensor power consumption issues in order to conform to the current trends in cloud medicine, personalized medicine, and health monitoring. With the development of automation and intelligence in measurement and control systems, it is required that sensors have high accuracy, reliability, and stability, as well as certain data processing capabilities, self-checking, self-calibration, and self-compensation, while traditional medical sensors cannot meet such requirements. In addition, to manufacture high-performance sensors, it is also difficult to improve the material process alone, and it is necessary to combine computer technology with sensor technology to make up for its performance shortcomings. Intelligent medical sensing technology combines medical sensors with microprocessors to produce powerful intelligent medical sensors. Based on the original sensor functions, intelligent medical sensors also have functions such as self-compensation, self-calibration, self-diagnosis, numerical processing, two-way communication, information storage, and digital output. This review focuses on the application of intelligent medical sensing technology in biomedical sensing detection from three aspects: physical sensor, chemical sensor, and biosensor.

A highly sensitive electrochemical sensor by growing Ag nanoparticles on the surface of PPy@PEDOT:PSS film for detecting sodium hydroxymethanesulfinate molecules

A high-sensitivity electrochemical sensor was fabricated via in situ growth of Ag nanoparticles (AgNPs) on the surface of a polypyrrole@poly(3,4-ethylenedioxythiophene):polystyrene sulfonic acid (PPy@PEDOT:PSS) film for detecting sodium hydroxymethanesulfinate (SHF) molecules in milk and rice flour samples. The sensor fabrication process involved randomly decorating Ag seed points on the porous PPy@PEDOT:PSS film via a chemical reduction process using a AgNO₃ solution. Next, AgNPs were anchored on the PPy@PEDOT:PSS film surface using an electrochemical deposition method to prepare a sensor electrode. Under optimal conditions, the sensor exhibits a good linear relation within a range of 1-130 ng/mL for real milk and rice flour samples and its limit-of-detection values were up to 0.58 and 0.29 ng/mL, respectively. Additionally, Raman spectroscopy was used to identify the byproducts of the chemical reaction, such as formaldehyde. This AgNP/PPy@PEDOT:PSS film-based electrochemical sensor offers a simple and rapid method for detecting SHF molecules in food products.

Noninvasive Monitoring to Detect Dehydration: Are We There Yet?

The need for hydration monitoring is significant, especially for the very young and elderly populations who are more vulnerable to becoming dehydrated and suffering from the effects that dehydration brings. This need has been among the drivers of considerable effort in the academic and commercial sectors to provide a means for monitoring hydration status, with a special interest in doing so outside the hospital or clinical setting. This review of emerging technologies provides an overview of many technology approaches that, on a theoretical basis, have sensitivity to water and are feasible as a routine measurement. We review the evidence of technical validation and of their use in humans. Finally, we highlight the essential need for these technologies to be rigorously evaluated for their diagnostic potential, as a necessary step to meet the need for hydration monitoring outside of the clinical environment.

Recent Advances in Two-Dimensional MXene-Based Electrochemical Biosensors for Sweat Analysis

Sweat, a biofluid secreted naturally from the eccrine glands of the human body, is rich in several electrolytes, metabolites, biomolecules, and even xenobiotics that enter the body through other means. Recent studies indicate a high correlation between the analytes' concentrations in the sweat and the blood, opening up sweat as a medium for disease diagnosis and other general health monitoring applications. However, low concentration of analytes in sweat is a significant limitation, requiring high-performing sensors for this application. Electrochemical sensors, due to their high sensitivity, low cost, and miniaturization, play a crucial role in realizing the potential of sweat as a key sensing medium. MXenes, recently developed anisotropic two-dimensional atomic-layered nanomaterials composed of early transition metal carbides or nitrides, are currently being explored as a material of choice for electrochemical sensors. Their large surface area, tunable electrical properties, excellent mechanical strength, good dispersibility, and biocompatibility make them attractive for bio-electrochemical sensing platforms. This review presents the recent progress made in MXene-based bio-electrochemical sensors such as wearable, implantable, and microfluidic sensors and their applications in disease diagnosis and developing point-of-care sensing platforms. Finally, the paper discusses the challenges and limitations of MXenes as a material of choice in bio-electrochemical sensors and future perspectives on this exciting material for sweat-sensing applications.

A wearable sensor based on multifunctional conductive hydrogel for simultaneous accurate pH and tyrosine monitoring in sweat

Flexible and wearable sweat sensors have drawn extensive attention by virtue of their continuous and real-time monitoring of molecular level information. However, current sweat-based sensors still pose several challenges, such as low accuracy for analytes detection, susceptibility to microorganism and poor mechanical performance. Herein, we demonstrated a noninvasive wearable sweat sensing patch composed of an electrochemical sensing system, and a pilocarpine-based iontophoretic system to stimulate sweat secretion. The electrochemical sensor based on tannic acid-Ag-carbon nanotube-polyaniline (TA-Ag-CNT-PANI) composite hydrogel was designed for on-body detection of pH and tyrosine (Tyr), a disease marker associated with multiple disorders, such as tyrosinemia and bulimia nervosa. The wearable sweat sensor can not only monitor the pH and Tyr in sweat simultaneously, but also further calibrate Tyr detection results with the measured pH value, so as to eliminate the effect of Tyr response variance at different pH and enhance the accuracy of the sensor. Furthermore, the presence of tannic acid chelated-Ag nanoparticles (TA-Ag NPs) and carbon nanotubes (CNTs) significantly improved the conductivity and flexibility of the hydrogel and endowed the composite hydrogel with antibacterial capability. Of note, the constructed wearable sensor was capable of monitoring Tyr with enhanced accuracy in various sweats.

Research Progress on Biomimetic Nanomaterials for Electrochemical Glucose Sensors

Diabetes has become a chronic disease that necessitates timely and accurate detection. Among various detection methods, electrochemical glucose sensors have attracted much attention because of low cost, real-time detection, and simple and easy operation. Nonenzymatic biomimetic nanomaterials are the vital part in electrochemical glucose sensors. This review article summarizes the methods to enhance the glucose sensing performance of noble metal, transition metal oxides, and carbon-based materials and introduces biomimetic nanomaterials used in noninvasive glucose detection in sweat, tear, urine, and saliva. Based on these, this review provides the foundation for noninvasive determination of trace glucose for diabetic patients in the future.

Insight into continuous glucose monitoring: from medical basics to commercialized devices

According to the latest statistics, more than 537 million people around the world struggle with diabetes and its adverse consequences. As well as acute risks of hypo- or hyper- glycemia, long-term vascular complications may occur, including coronary heart disease or stroke, as well as diabetic nephropathy leading to end-stage disease, neuropathy or retinopathy. Therefore, there is an urgent need to improve diabetes management to reduce the risk of complications but also to improve patient's quality life. The impact of continuous glucose monitoring (CGM) is well recognized, in this regard. The current review aims at introducing the basic principles of glucose sensing, including electrochemical and optical detection, summarizing CGM technology, its requirements, advantages, and disadvantages. The role of CGM systems in the clinical diagnostics/personal testing, difficulties in their utilization, and recommendations are also discussed. In the end, challenges and prospects in future CGM systems are discussed and non-invasive, wearable glucose biosensors are introduced. Though the scope of this review is CGMs and provides information about medical issues and analytical principles, consideration of broader use will be critical in future if the right systems are to be selected for effective diabetes management.

Reshaping healthcare with wearable biosensors

Wearable health sensors could monitor the wearer's health and surrounding environment in real-time. With the development of sensor and operating system hardware technology, the functions of wearable devices have been gradually enriched with more diversified forms and more accurate physiological indicators. These sensors are moving towards high precision, continuity, and comfort, making great contributions to improving personalized health care. At the same time, in the context of the rapid development of the Internet of Things, the ubiquitous regulatory capabilities have been released. Some sensor chips are equipped with data readout and signal conditioning circuits, and a wireless communication module for transmitting data to computer equipment. At the same time, for data analysis of wearable health sensors, most companies use artificial neural networks (ANN). In addition, artificial neural networks could help users effectively get relevant health feedback. Through the physiological response of the human body, various sensors worn could effectively transmit data to the control unit, which analyzes the data and provides feedback of the health value to the user through the computer. This is the working principle of wearable sensors for health. This article focuses on wearable biosensors used for healthcare monitoring in different situations, as well as the development, technology, business, ethics, and future of wearable sensors for health monitoring.

Directly Using Ti3C2Tx MXene for a Solid-Contact Potentiometric pH Sensor toward Wearable Sweat pH Monitoring

The level of hydrogen ions in sweat is one of the most important physiological indexes for the health state of the human body. As a type of two-dimensional (2D) material, MXene has the advantages of superior electrical conductivity, a large surface area, and rich functional groups on the surface. Herein, we report a type of Ti₃C₂T_x-based potentiometric pH sensor for wearable sweat pH analysis. The Ti₃C₂T_x was prepared by two etching methods, including a mild LiF/HCl mixture and HF solution, which was directly used as the pH-sensitive materials. Both etched Ti₃C₂T_x showed a typical lamellar structure and exhibited enhanced potentiometric pH responses compared with a pristine precursor of Ti₃AlC₂. The HF-Ti₃C₂T_x disclosed the sensitivities of -43.51 ± 0.53 mV pH^-1 (pH 1-11) and -42.73 ± 0.61 mV pH^-1 (pH 11-1). A series of electrochemical tests demonstrated that HF-Ti₃C₂T_x exhibited better analytical performances, including sensitivity, selectivity, and reversibility, owing to deep etching. The HF-Ti₃C₂T_x was thus further fabricated as a flexible potentiometric pH sensor by virtue of its 2D characteristic. Upon integrating with a solid-contact Ag/AgCl reference electrode, the flexible sensor realized real-time monitoring of pH level in human sweat. The result disclosed a relatively stable pH value of ~6.5 after perspiration, which was consistent with the ex situ sweat pH test. This work offers a type of MXene-based potentiometric pH sensor for wearable sweat pH monitoring.

Highly Stretchable and Robust Electrochemical Sensor Based on 3D Graphene Oxide-CNT Composite for Detecting Ammonium in Sweat

Wearable electrochemical sensors have attracted tremendous attention and have been experiencing rapid growth in recent years. Sweat, one of the most suitable biological fluids for non-invasive monitoring, contains various chemical elements relating abundant information about human health conditions. In this work, a new type of non-invasive and highly stretchable potentiometric sweat sensor was developed based on all-solid-state ion-selective electrode (ISE) coupled with poly(dimethylsiloxane; PDMS) and polyurethane (PU). This highly stretchable composite of PDMS-PU allows the sensor to be robust, with the PDMS providing a flexible backbone and the PU enhancing the adhesion between the electrodes and the substrate. In addition, graphene-carbon nanotube (CNT) network 3D nanomaterials were introduced to modify the ion selective membrane (ISM) in order to increase the charge transfer activity of the ISEs, which also could minimize the formation of water layers on the electrode surface, as such nanomaterials are highly hydrophobic. As a result, the sensor demonstrated a wide detection range of NH₄⁺ from 10^-6 M to 10^-1 M with high stability and sensitivity-showing a high sensitivity of 59.6 ± 1.5 mV/log [NH₄⁺] and an LOD lower than 10^-6 M. Under a strain of 40%, the sensor still showed a sensitivity of 42.7 ± 3.1 mV/log [NH₄⁺]. The proposed highly stretchable and robust electrochemical sweat sensor provides a new choice for wearable-device-based personal daily healthcare management beyond hospital-centric healthcare monitoring.

Microneedle-Coupled Epidermal Sensors for In-Situ-Multiplexed Ion Detection in Interstitial Fluids

Maintaining the concentrations of various ions in body fluids is critical to all living organisms. In this contribution, we designed a flexible microneedle patch coupled electrode array (MNP-EA) for the in situ multiplexed detection of ion species (Na⁺, K⁺, Ca²⁺, and H⁺) in tissue interstitial fluid (ISF). The microneedles (MNs) are mechanically robust for skin or cuticle penetration (0.21 N/needle) and highly swellable to quickly extract sufficient ISF onto the ion-selective electrochemical electrodes (∼6.87 μL/needle in 5 min). The potentiometric sensor can simultaneously detect these ion species with nearly Nernstian response in the ranges wider enough for diagnosis purposes (Na⁺: 0.75-200 mM, K⁺: 1-128 mM, Ca²⁺: 0.25-4.25 mM, pH: 5.5-8.5). The in vivo experiments on mice, humans, and plants demonstrate the feasibility of MNP-EA for timely and convenient diagnosis of ion imbalances with minimal invasiveness. This transdermal sensing platform shall be instrumental to home-based diagnosis and health monitoring of chronic diseases and is also promising for smart agriculture and the study of plant biology.

3D Printed Hydrogel Microneedle Arrays for Interstitial Fluid Biomarker Extraction and Colorimetric Detection

To treat and manage chronic diseases, it is necessary to continuously monitor relevant biomarkers and modify treatment as the disease state changes. Compared to other bodily fluids, interstitial skin fluid (ISF) is a good choice for identifying biomarkers because it has a molecular composition most similar to blood plasma. Herein, a microneedle array (MNA) is presented to extract ISF painlessly and bloodlessly. The MNA is made of crosslinked poly(ethylene glycol) diacrylate (PEGDA), and an optimal balance of mechanical properties and absorption capability is suggested. Besides, the effect of needles’ cross-section shape on skin penetration is studied. The MNA is integrated with a multiplexed sensor that provides a color change in a biomarker concentration-dependent manner based on the relevant reactions for colorimetric detection of pH and glucose biomarkers. The developed device enables diagnosis by visual inspection or quantitative red, green, and blue (RGB) analysis. The outcomes of this study show that MNA can successfully identify biomarkers in interstitial skin fluid in a matter of minutes. The home-based long-term monitoring and management of metabolic diseases will benefit from such practical and self-administrable biomarker detection.

Flexible electrochemical sensor with Fe/Co bimetallic oxides for sensitive analysis of glucose in human tears

The construction of uniformly dispersed structure with abundant active sites is crucial for fast electron transport and advancing electrocatalytic reactions. Herein, Fe_xCo_yO₄-rGO was prepared by depositing Fe and Co bimetallic oxides in-situ on reduced graphene oxide through a simple process combined hydrothermal reaction and calcination. Fe was elaborately introduced into the synthesis of metal oxides to alleviate the aggregation of cobalt oxides and obtain nanocomposites with homogeneously structured and abundant redox sites, and the bimetallic oxides nanomaterials had enhanced electrocatalysis under the synergistic effect. The flexible electrode prepared from Fe_xCo_yO₄-rGO exhibited excellent detection performance for glucose with a detection limit down low to 0.07 μM and a sensitivity of 1510 μM cm^-2 mA^-1. The adoption of flexible substrates improved the wearability of the electrode and broadened its practicality for detecting biomarkers on the skin surface. The constructed sensor was successfully used in the dynamic analysis of glucose content in tears, and the results were highly consistent with the test outcome of a commercial test kit, demonstrating its application prospects in non-invasive epidermal diabetes mellitus diagnosis.

Real-time multiple signal amplification self-powered biosensing platform for ultrasensitive detection of MicroRNA

A real-time self-powered biosensor is designed for ultrasensitive detection of microRNA-21 based on electrochemical energy device capacitor and target-induced recycling double amplification strategy, which greatly improves the output signal by converting a small number of targets into two glucose oxidase labeled output strand DNAs, and the squeezed-out output strand is recycled by the cathode to fix more signal [Ru(NH₃)₆]³⁺ to further improve the detection signal. A digital multimeter (DMM) is connected to computer for real-time displaying the output signal of the self-powered biosensing system, which improves the accuracy of the sensing platform. The sensitivity of the proposed biosensor is 116.15 μA/pM for target microRNA-21, which is 32.26 times higher than that of pure EBFC (3.6 μA/pM). The target concentration is proportional to the open-circuit voltage value in a wide linear range of 0.1-10000 fM with a low detection limit of 0.04 fM (S/N = 3). The method shows high sensitivity and excellent selectivity, and can be applied to detect tumor marker microRNA-21 in biological matrix.

Electrochemical-based remote biomarker monitoring: Toward Internet of Wearable Things in telemedicine

Internet of Wearable Things (IoWT) will be a major breakthrough for remote medical monitoring. In this scenario, wearable biomarker sensors have been developing not only to diagnose point-of-care (POC) of diseases, but also to continuously manage them. On-body tracking of biomarkers in biofluids is regarded as a proper substitution of conventional biomarker sensors for dynamic sampling and analyzing due to their high sensitivity, conformability, and affordability, creating ever-rising the market demand for them. In a wireless body area network (WBAN), data is captured from all sensors on the body to a smartphone/laptop, and sent the sensed data to a cloud for storing, processing, and retrieving, and ultimately displayed the data on custom applications (Apps). Wearable IoT biomarker sensors are used for early diseases diagnosis and continuous monitoring in developing countries in which people hardly access to healthcare systems. In this review, we aim to highlight a wide range of wearable electrochemical biomarker sensors, accompanied by microfluidics for continuous sampling, which will pave the way toward developing wearable IoT biomarker sensors to track health status. The current challenges and future perspective in skin-conformal biomarker sensors will be discussing their potential applicability for IoWT in cloud-based telemedicine.

Paper-Based Sandwich-Structured Wearable Sensor with Sebum Filtering for Continuous Detection of Sweat pH

Wearable sweat sensors, a product of the development of flexible electronics and microfluidic technologies, can continuously and noninvasively monitor abundant biomarkers in human sweat; however, sweat interferences, such as sebum, can reduce sensor reliability and accuracy. Herein, for the first time, the influence of sebum on the potentiometric response of an all-solid-state pH sensor was studied, and the obtained experimental results show that sebum mixed in sweat can decrease the potential response of the sensor and the slope of its calibration curve. A paper-based sandwich-structured pH sensor that can filter the sebum mixed in sweat was proposed based on commonly used oil-control sheets. Moreover, the hydrophilic properties, microstructure, and microfluidic performance of the sensor were investigated. The detection performance of the paper-based sandwich-structured pH sensor was comprehensively evaluated in terms of calibration in the presence of sebum and potentiometric response upon the addition of sebum. Furthermore, the anti-interference ability of the sensor was evaluated using different analytes under various deformation conditions. On-body trials were conducted to verify the performance, and their results showed that the proposed sensor can filter over 90% of the sebum in sweat, significantly enhancing sensor reliability and accuracy. Additionally, microfluidic channels could be simply fabricated using a scissor and paper, obviating the need for complex micromachining processes, such as photolithography and laser engraving. Overall, this work illustrates the influence of sebum on the detection performance of traditional potentiometric wearable sensors and paves the way for their development for real-world applications.

Flexible Textile-Based Sweat Sensors for Wearable Applications

The current physical health care system has gradually evolved into a form of virtual hospitals communicating with sensors, which can not only save time but can also diagnose a patient's physical condition in real time. Textile-based wearable sensors have recently been identified as detection platforms with high potential. They are developed for the real-time noninvasive detection of human physiological information to comprehensively analyze the health status of the human body. Sweat comprises various chemical compositions, which can be used as biomarkers to reflect the relevant information of the human physiology, thus providing references for health conditions. Combined together, textile-based sweat sensors are more flexible and comfortable than other conventional sensors, making them easily integrated into the wearable field. In this short review, the research progress of textile-based flexible sweat sensors was reviewed. Three mechanisms commonly used for textile-based sweat sensors were firstly contrasted with an introduction to their materials and preparation processes. The components of textile-based sweat sensors, which mainly consist of a sweat transportation channel and collector, a signal-selection unit, sensing elements and sensor integration and communication technologies, were reviewed. The applications of textile-based sweat sensors with different mechanisms were also presented. Finally, the existing problems and challenges of sweat sensors were summarized, which may contribute to promote their further development.

SWEAT BIOSENSORS FOR SPORTS MONITORING

ABSTRACT Introduction: Biometric sweat monitoring is an important tool for optimizing sports training. The possibility of developing a wearable amperometric lactate biosensor using a screen-printed carbon electrode (SPCE) impregnated by Ag nanoparticles (Ag NPs) for sweat determination in sports monitoring is questioned. Objective: To develop a sensor with GCE substrate coated on Ag NPs/SPCE. Methods: FESEM and XRD analysis were used for the morphological and structural characterizations of Ag and SPCE NPs, respectively. Results: FESEM, EDS, and XRD revealed that Ag NPs were uniformly dispersed in SPCE. The electrochemical biosensor responded linearly to lactate in phosphate buffer solutions, with detection and sensitivity limits of 1.2 µM and 14.2 mAcm-2 mM-1, respectively. Conclusion: The results suggest that Ag NPs/SPCE can be used to continuously monitor lactate levels in sweat as a practical and reliable biosensor for use. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

A Solid-Contact Reference Electrode Based on Silver/Silver Organic Insoluble Salt for Potentiometric Ion Sensing

Solid-contact ion-selective electrodes are a type of ion measurement devices that have been focused in wearable biotechnology based on the features of miniaturization and integration. However, the solid-contact reference electrodes (SC-REs) remain relatively less focused compared with numerous working (or indicator) electrodes. Most SC-REs in wearable sensors rely on Ag/AgCl reference electrodes with solid electrolytes, for example, the hydrophilic electrolyte salts in polymer matrix, but face the risk of electrolyte leakage. Herein, we report a type of SC-REs based on the silver/silver tetraphenylborate (Ag/AgTPB) organic insoluble electrode. The SC-RE consists of a Ag substrate, a solid contact (AgTPB), and a plasticized poly(vinyl chloride) (PVC) membrane containing the hydrophobic organic salt of tetrabutylammonium tetraphenylborate (TBATPB). The potentiometric measurements demonstrated that the SC-RE of Ag/AgTPB/PVC-TBATPB showed a reproducible standard potential in various electrolytes and disclosed high long-term stability. This SC-RE was further fabricated on a flexible substrate and integrated into all-solid-state wearable potentiometric ion sensor for sweat Cl- monitoring.

A new 3D, microfluidic-oriented, multi-functional, and highly stretchable soft wearable sensor

Increasing demand for wearable devices has resulted in the development of soft sensors; however, an excellent soft sensor for measuring stretch, twist, and pressure simultaneously has not been proposed yet. This paper presents a novel, fully 3D, microfluidic-oriented, gel-based, and highly stretchable resistive soft sensor. The proposed sensor is multi-functional and could be used to measure stretch, twist, and pressure, which is the potential of using a fully 3D structure in the sensor. Unlike previous methods, in which almost all of them used EGaIn as the conductive material, in this case, we used a low-cost, safe (biocompatible), and ubiquitous conductive gel instead. To show the functionality of the proposed sensor, FEM simulations and a set of designed experiments were done, which show linear (99%), accurate (> 94.9%), and durable (tested for a whole of four hours) response of the proposed sensor. Then, the sensor was put through its paces on a female test subject's knee, elbow, and wrist to show the potential application of the sensor as a body motion sensor. Also, a fully 3D active foot insole was developed, fabricated, and evaluated to evaluate the pressure functionality of the sensor. The result shows good discrimination and pressure measurement for different foot sole areas. The proposed sensor has the potential to be used in real-world applications like rehabilitation, wearable devices, soft robotics, smart clothing, gait analysis, AR/VR, etc.

Wearable chemical sensors for biomarker discovery in the omics era

Biomarkers are crucial biological indicators in medical diagnostics and therapy. However, the process of biomarker discovery and validation is hindered by a lack of standardized protocols for analytical studies, storage and sample collection. Wearable chemical sensors provide a real-time, non-invasive alternative to typical laboratory blood analysis, and are an effective tool for exploring novel biomarkers in alternative body fluids, such as sweat, saliva, tears and interstitial fluid. These devices may enable remote at-home personalized health monitoring and substantially reduce the healthcare costs. This Review introduces criteria, strategies and technologies involved in biomarker discovery using wearable chemical sensors. Electrochemical and optical detection techniques are discussed, along with the materials and system-level considerations for wearable chemical sensors. Lastly, this Review describes how the large sets of temporal data collected by wearable sensors, coupled with modern data analysis approaches, would open the door for discovering new biomarkers towards precision medicine.