Stretchable, dynamic covalent polymers for soft, long-lived bioresorbable electronic stimulators designed to facilitate neuromuscular regeneration

Bioelectronics hydrogels for implantable cardiac and brain disease medical treatment application

Hydrogel-based bioelectronic systems offer significant benefits for point-of-care diagnosis, treatment of cardiac and cerebral disease, surgical procedures, and other medical applications, ushering in a new era of advancements in medical technology. Progress in hydrogel-based bioelectronics has advanced from basic instrument and sensing capabilities to sophisticated multimodal perceptions and feedback systems. Addressing challenges related to immune responses and inflammation regulation after implantation, physiological dynamic mechanism, biological toxicology as well as device size, power consumption, stability, and signal conversion is crucial for the practical implementation of hydrogel-based bioelectronics in medical implants. Therefore, further exploration of hydrogel-based bioelectronics is imperative, and a comprehensive review is necessary to steer the development of these technologies for use in implantable therapies for cardiac and brain/neural conditions. In this review, a concise overview is provided on the fundamental principles underlying ionic electronic and ionic bioelectronic mechanisms. Additionally, a comprehensive examination is conducted on various bioelectronic materials integrated within hydrogels for applications in implantable medical treatments. The analysis encompasses a detailed discussion on the representative structures and physical attributes of hydrogels. This includes an exploration of their intrinsic properties such as mechanical strength, dynamic capabilities, shape-memory features, stability, stretchability, and water retention characteristics. Moreover, the discussion extends to properties related to interactions with tissues or the environment, such as adhesiveness, responsiveness, and degradability. The intricate relationships between the structure and properties of hydrogels are thoroughly examined, along with an elucidation of how these properties influence their applications in implantable medical treatments. The review also delves into the processing techniques and characterization methods employed for hydrogels. Furthermore, recent breakthroughs in the applications of hydrogels are logically explored, covering aspects such as materials, structure, properties, functions, fabrication procedures, and hybridization with other materials. Finally, the review concludes by outlining the future prospects and challenges associated with hydrogels-based bioelectronics systems.

Wireless, Multisensor Integrated Bioelectronics for Real-Time Monitoring and Assessment of Muscle Atrophy

Real-time monitoring and evaluation of muscle atrophy are vital for efficient treatment and effective diagnosis. Although some systems have been developed to monitor loss of muscle mass or strength, they are bulky and nonspecific, cannot be applied to the body, and cannot assess the degree of muscle atrophy. Our research focuses on developing a wireless multisensor wearable system (WMWS) for on-body monitoring and assessment of atrophy, which utilizes a single-electrode triboelectric nanogenerator (S-TENG) and electrochemical creatinine (CREA) sensor to achieve real-time acquisition of plantar pressure and interstitial fluid (ISF) CREA concentration. In addition, LSTM (long short-term memory) and SVM (support vector machine) machine learning (ML) algorithms also prove that our multisensor strategy can effectively improve the recognition rate of different degrees of atrophy (the highest accuracy reached 92.32%). Overall, our work makes it possible to monitor and grade muscle atrophy remotely in real time.

Advances in wearable electronics for monitoring human organs: Bridging external and internal health assessments

Devices used for diagnosing disease are often large, expensive, and require operation by trained professionals, which can result in delayed diagnosis and missed opportunities for timely treatment. However, wearable devices are being recognized as a new approach to overcoming these difficulties, as they are small, affordable, and easy to use. Recent advancements in wearable technology have made monitoring information possible from the surface of organs like the skin and eyes, enabling accurate diagnosis of the user's internal status. In this review, we categorize the body's organs into external (e.g., eyes, oral cavity, neck, and skin) and internal (e.g., heart, brain, lung, stomach, and bladder) organ systems and introduce recent developments in the materials and designs of wearable electronics, including electrochemical and electrophysiological sensors applied to each organ system. Further, we explore recent innovations in wearable electronics for monitoring of deep internal organs, such as the heart, brain, and nervous system, using ultrasound, electrical impedance tomography, and temporal interference stimulation. The review also addresses the current challenges in wearable technology and explores future directions to enhance the effectiveness and applicability of these devices in medical diagnostics. This paper establishes a framework for correlating the design and functionality of wearable electronics with the physiological characteristics and requirements of various organ systems.

Design High-Performance Stretchable Light-Harvesting Polymers for Organic Solar Cells via Synergistic Effect of Flexible Alkyl Segment and Hydrogen Bond

Stretchable organic solar cells (SOSCs) have great application prospects to serve as energy supply systems, which can be fully incorporated with wearable electronic devices to achieve truly integrated systems that are fully stretchable and wearable. However, the stretchable polymer light-harvesting active layer has not been successfully developed, which limits the development of stretchable organic solar cells. In this regard, a series of stretchable light-harvesting donor and acceptor polymers are designed and synthesized by introducing amide units with flexible alkyl segments and hydrogen bonds as the third component into the PM6 and PY-IT based conjugated polymer backbones. Hydrogen bonds and flexible alkyl segments can dissipate tensile stress for high stretchability. In addition, hydrogen bonds can reduce the impact of flexible alkyl segments on intermolecular stacking, thus maintaining good photovoltaic performance. The obtained results suggest that the incorporation of amide units (5 mol% content) into the donor polymer can efficiently improve the stretchability without compromising the photovoltaic performance. This study provides an understanding of the impact of amide units on properties, offering another entry to the molecular design guidelines for high-performance stretchable light-harvesting polymers, developing high-performance stretchable organic solar cells, and further promoting the development of wearable electronic devices.

Electrically-stimulated cellular and tissue events are coordinated through ion channel-mediated calcium influx and chromatin modifications across the cytosol-nucleus space

Electrical stimulation (ES) through biomaterials and devices has been implicated in activating diverse cell behaviors while facilitating tissue healing process. Despite its significance in modulating biological events, the mechanisms governing ES-activated cellular phenomena remain largely elusive. Here, we demonstrated that millisecond-pulsed temporal ES profoundly impacted a spectrum of cellular events across the membrane-cytosol-nuclear space. These include activated ion channels, intracellular calcium influx, actomyosin contractility, cell migration and proliferation, and secretome release. Such events were coordinated mainly through ES-activated ion channels and calcium oscillation dynamics. Notably, ES increased the chromatin accessibility of genes, particularly those associated with the ES-activated cellular events, underscoring the significance of epigenetic changes in ES-induced behavioral outcomes. We identified histone acetylation (mediated by histone acetyltransferases), among other chromatin modifications, is key in reshaping the chromatin landscape upon ES. These observations were further validated through experiments involving ex vivo skin tissue samples, including activated ion channels and calcium influx, increased cell proliferation and actomyosin contractility, elevated secretome profile, and more accessible chromatin structure following ES. This work provides novel insights into the mechanisms underlying ES-activated cell and tissue events, ultimately guiding design principles for the development of electrical devices and materials effective for tissue repair and wound healing.

Toward Stretchable Flexible Integrated Sensor Systems

Skin-like flexible sensors hold great potential as the next generation of intelligent electronic devices owing to their broad applications in environmental monitoring, human-machine interfaces, the Internet of Things, and artificial intelligence. Flexible electronics inspired by human skin play a vital role in continuous and real-time health monitoring. This review summarizes recent progress in skin-mountable electronics developed by designing flexible electrodes and substrates into different structures, including serpentine, microcrack, wrinkle, and kirigami. Furthermore, this review briefly discusses advances in wearable integrated sensor systems that mimic the flexibility of human skin, as well as multisensing functions. In the future, innovations in stretchable integrated sensor systems will be crucial to develop next-generation intelligent skin-based sensors for practical applications such as medical diagnosis, treatment, and environment monitoring.

Biofluid-Permeable and Erosion-Resistant Wireless Neural-Electronic Interfaces for Neurohomeostasis Modulation

Neural-electronic interfaces through delivering electroceuticals to lesions and modulating pathological endogenous electrical environments offer exciting opportunities to treat drug-refractory neurological disorders. Such an interface should ideally be compatible with the neural tissue and aggressive biofluid environment. Unfortunately, no interface specifically designed for the biofluid environments is available so far; instead, simply stacking an encapsulation layer on silicon-based substrates makes them susceptible to biofluid leakage, device malfunction, and foreign-body reactions. Here, we developed a biofluid-permeable and erosion-resistant wireless neural-electronic interface (BNEI) that is composed of a flexible 3D interconnected poly(l-lactide) fibrous network with a dense and axially aligned piezoelectrical molecular chain arrangement architecture. The organized molecular chain structure enhances the tortuous pathway and longitudinal piezoelectric coefficient of poly(l-lactide) fibers, improves their water barrier properties, and enables efficient conversion of low-intensity acoustic vibrations transmitted in biofluids into electrical signals, achieving long-term stable and wireless neuromodulation. A 3-month clinical trial demonstrated that the BNEI can effectively accelerate the pathological cascade in peripheral neuropathy for nerve regeneration and transcranially modulate cerebellar-cerebral circuit dynamics, suppressing seizures in temporal lobe epilepsy. The BNEI can be a clinically scalable approach for wireless neuromodulation that is broadly applicable to the modulation of neurohomeostasis in both the peripheral and central nervous systems.

A Body-Temperature-Triggered In Situ Softening Peripheral Nerve Electrode for Chronic Robust Neuromodulation

Implantable peripheral nerve electrodes are crucial for monitoring health and alleviating symptoms of chronic diseases. Advanced compliant electrodes have been developed because of their biomechanical compatibility. However, these mechanically tissue-like electrodes suffer from unmanageable operating forces, leading to high risks of nerve injury and fragile electrode-tissue interfaces. Here, a peripheral nerve electrode is developed that simultaneously fulfills the criteria of body temperature softening and tissue-like modulus (less than 0.8 MPa at 37 °C) after implantation. The central core is altered from the tri-arm crosslinker to the star-branched monomer to kill two birds (close the translation temperature to 37 °C and decrease the modulus after implantation) with one stone. Furthermore, the decreased interfacial impedance (325.1 ± 46.9 Ω at 1 kHz) and increased charge storage capacity (111.2 ± 5.8 mC cm-2) are achieved by an in situ electrografted conductive polymer on the strain-insensitive conductive network of Au nanotubes. The electrodes are readily wrapped around nerves and applied for long-term stimulation in vivo with minimal inflammation. Neuromodulation experiments demonstrate their potential clinical utility, including vagus nerve stimulation in rats to suppress seizures and alleviation of cardiac remodeling in a canine model of myocardial infarction.

Advances in Symbiotic Bioabsorbable Devices

Symbiotic bioabsorbable devices are ideal for temporary treatment. This eliminates the boundaries between the device and organism and develops a symbiotic relationship by degrading nutrients that directly enter the cells, tissues, and body to avoid the hazards of device retention. Symbiotic bioresorbable electronics show great promise for sensing, diagnostics, therapy, and rehabilitation, as underpinned by innovations in materials, devices, and systems. This review focuses on recent advances in bioabsorbable devices. Innovation is focused on the material, device, and system levels. Significant advances in biomedical applications are reviewed, including integrated diagnostics, tissue repair, cardiac pacing, and neurostimulation. In addition to the material, device, and system issues, the challenges and trends in symbiotic bioresorbable electronics are discussed.

3D printable and myoelectrically sensitive hydrogel for smart prosthetic hand control

Surface electromyogram (sEMG) serves as a means to discern human movement intentions, achieved by applying epidermal electrodes to specific body regions. However, it is difficult to obtain high-fidelity sEMG recordings in areas with intricate curved surfaces, such as the body, because regular sEMG electrodes have stiff structures. In this study, we developed myoelectrically sensitive hydrogels via 3D printing and integrated them into a stretchable, flexible, and high-density sEMG electrodes array. This electrode array offered a series of excellent human-machine interface (HMI) features, including conformal adherence to the skin, high electron-to-ion conductivity (and thus lower contact impedance), and sustained stability over extended periods. These attributes render our electrodes more conducive than commercial electrodes for long-term wearing and high-fidelity sEMG recording at complicated skin interfaces. Systematic in vivo studies were used to investigate its efficacy to control a prosthetic hand by decoding sEMG signals from the human hand via a multiple-channel readout circuit and a sophisticated artificial intelligence algorithm. Our findings demonstrate that the 3D printed gel myoelectric sensing system enables real-time and highly precise control of a prosthetic hand.

Ultrathin, Lightweight Materials Enabled Wireless Data and Power Transmission in Chip-Less Flexible Electronics

The surge of flexible, biointegrated electronics has inspired continued research efforts in designing and developing chip-less and wireless devices as soft and mechanically compliant interfaces to the living systems. In recent years, innovations in materials, devices, and systems have been reported to address challenges surrounding this topic to empower their reliable operation for monitoring physiological signals. This perspective provides a brief overview of recent works reporting various chip-less electronics for sensing and actuation in diverse application scenarios. We summarize wireless signal/data/power transmission strategies, key considerations in materials design and selection, as well as successful demonstrations of sensors and actuators in wearable and implantable forms. The final section provides an outlook to the future direction down the road for performance improvement and optimization. These versatile, inexpensive, and low-power device concepts can serve as alternative strategies to existing digital wireless electronics, which will find broad applications as bidirectional biointerfaces in basic biomedical research and clinical practices.

On the longevity and inherent hermeticity of silicon-ICs: evaluation of bare-die and PDMS-coated ICs after accelerated aging and implantation studies

Silicon integrated circuits (ICs) are central to the next-generation miniature active neural implants, whether packaged in soft polymers for flexible bioelectronics or implanted as bare die for neural probes. These emerging applications bring the IC closer to the corrosive body environment, raising reliability concerns, particularly for chronic use. Here, we evaluate the inherent hermeticity of bare die ICs, and examine the potential of polydimethylsiloxane (PDMS), a moisture-permeable elastomer, as a standalone encapsulation material. For this aim, the electrical and material performance of ICs sourced from two foundries was evaluated through one-year accelerated in vitro and in vivo studies. ICs featured custom-designed test structures and were partially PDMS coated, creating two regions on each chip, uncoated "bare die" and "PDMS-coated". During the accelerated in vitro study, ICs were electrically biased and periodically monitored. Results revealed stable electrical performance, indicating the unaffected operation of ICs even when directly exposed to physiological fluids. Despite this, material analysis revealed IC degradation in the bare regions. PDMS-coated regions, however, revealed limited degradation, making PDMS a suitable IC encapsulant for years-long implantation. Based on the new insights, guidelines are proposed that may enhance the longevity of implantable ICs, broadening their applications in the biomedical field.

Engineering the Functional Expansion of Microneedles

Microneedles (MNs), composed of an array of micro-sized needles and a supporting base, have transcended their initial use to replace hypodermic needles in drug delivery and fluid collection, advancing toward multifunctional platforms. In this review, four major areas are summarized in interdisciplinary engineering approaches combined with MNs technology. First, electronics engineering, the most extensively researched field, enables applications in biomonitoring, electrical stimulation, and closed-loop theranostics through the generation, transmission, and transformation of electrical signals. Second, in electromagnetic engineering, the responsiveness of electromagnetic induction offers prospects for remote and programmable therapeutic applications. Third, photonic engineering endows MNs with novel functionalities, such as waveguiding and photonic manipulation to enhance optical therapeutic capabilities and facilitate the visualization of disease progression and treatment processes. Lastly, it reviewed the role of mechanical engineering in conferring shape adaptability and programmable motion features necessary for various MNs applications. This review focuses on the functionalities that emerge from the intersection of MNs with complementary engineering technologies, aiming to inspire further research and innovation in microneedle technology for biomedical applications.

Recent advances in bio-integrated electrochemical sensors for neuroengineering

Detecting and diagnosing neurological diseases in modern healthcare presents substantial challenges that directly impact patient outcomes. The complex nature of these conditions demands precise and quantitative monitoring of disease-associated biomarkers in a continuous, real-time manner. Current chemical sensing strategies exhibit restricted clinical effectiveness due to labor-intensive laboratory analysis prerequisites, dependence on clinician expertise, and prolonged and recurrent interventions. Bio-integrated electronics for chemical sensing is an emerging, multidisciplinary field enabled by rapid advances in electrical engineering, biosensing, materials science, analytical chemistry, and biomedical engineering. This review presents an overview of recent progress in bio-integrated electrochemical sensors, with an emphasis on their relevance to neuroengineering and neuromodulation. It traverses vital neurological biomarkers and explores bio-recognition elements, sensing strategies, transducer designs, and wireless signal transmission methods. The integration of in vivo biochemical sensors is showcased through applications. The review concludes by outlining future trends and advancements in in vivo electrochemical sensing, and highlighting ongoing research and technological innovation, which aims to provide inspiring and practical instructions for future research.

Bioelectronic Medicines-A Novel Approach of Therapeutics in Current Epoch

BACKGROUND

Bioelectronic medicines aim to diagnose and treat a wide range of illnesses and ailments, including cancer, rheumatoid arthritis, inflammatory bowel disease, obesity, diabetes, asthma, paralysis, blindness, bleeding, ischemia, organ transplantation, cardiovascular disease, and neurodegenerative diseases. The focus of bioelectronic medicine is on electrical signaling of the nervous system. Understanding the nervous system's regulatory roles and developing technologies that record, activate, or inhibit neural signaling to influence particular biological pathways.

OBJECTIVE

Bioelectronic medicine is an emerging therapeutic option with the interconnection between molecular medicine, neuroscience, and bioengineering. The creation of nerve stimulating devices that communicate with both the central and peripheral nervous systems has the potential to completely transform how we treat disorders. Although early clinical applications have been largely effective across entire nerves, the ultimate goal is to create implantable, miniature closed-loop systems that can precisely identify and modulate individual nerve fibers to treat a wide range of disorders.

METHODOLOGY

The data bases such as PubMed, and Clinicaltrial.gov.in were searched for scientific research, review and clinical trials on bioelectronic medicine.

CONCLUSION

The field of bioelectronic medicine is trending at present. In recent years, researchers have extended the field's applications, undertaken promising clinical trials, and begun delivering therapies to patients, thus creating the groundwork for significant future advancements. Countries and organizations must collaborate across industries and regions to establish an atmosphere and guidelines that foster the advancement of the field and the fulfillment of its prospective advantages.

Leptin deficiency leads to nerve degeneration and impairs axon remyelination by inducing Schwann cell apoptosis and demyelination in type 2 diabetic peripheral neuropathy in rats

Diabetic peripheral neuropathy, characterized by symptoms such as paresthesia, neuropathic pain, and potential lower limb amputation, poses significant clinical management challenges. Recent studies suggest that chronic hyperglycemia-induced Schwann cells (SCs) apoptosis contributes to neurodegeneration and impaired nerve regeneration, but the detailed mechanisms are still unknown. Our study investigated a mixed-sex type 2 diabetes mellitus (T2DM) rat model using leptin knockout (KO) to simulate obesity and diabetes-related conditions. Through extensive assessments, including mechanical allodynia, electrophysiology, and microcirculation analyses, along with myelin degradation studies in KO versus wild-type rats, we focused on apoptosis, autophagy, and SCs dedifferentiation in the sciatic nerve and examined nerve regeneration in KO rats. KO rats exhibited notable reductions in mechanical withdrawal force, prolonged latency, decreased compound muscle action potential (CMAP) amplitude, reduced microcirculation, myelin sheath damage, and increases in apoptosis, autophagy, and SCs dedifferentiation. Moreover, leptin KO was found to impair peripheral nerve regeneration postinjury, as indicated by reduced muscle weight, lower CMAP amplitude, extended latency, and decreased remyelination and SCs density. These findings underscore the effectiveness of the T2DM rat model in clarifying the impact of leptin KO on SCs apoptosis, dedifferentiation, and demyelination, providing valuable insights into new therapeutic avenues for treating T2DM-induced peripheral neuropathy.

Implantable Passive Sensors for Biomedical Applications

In recent years, implantable sensors have been extensively researched since they allow localized sensing at an area of interest (e.g., within the vicinity of a surgical site or other implant). They allow unobtrusive and potentially continuous sensing, enabling greater specificity, early warning capabilities, and thus timely clinical intervention. Wireless remote interrogation of the implanted sensor is typically achieved using radio frequency (RF), inductive coupling or ultrasound through an external device. Two categories of implantable sensors are available, namely active and passive. Active sensors offer greater capabilities, such as on-node signal and data processing, multiplexing and multimodal sensing, while also allowing lower detection limits, the possibility to encode patient sensitive information and bidirectional communication. However, they require an energy source to operate. Battery implantation, and maintenance, remains a very important constraint in many implantable applications even though energy can be provided wirelessly through the external device, in some cases. On the other hand, passive sensors offer the possibility of detection without the need for a local energy source or active electronics. They also offer significant advantages in the areas of system complexity, cost and size. In this review, implantable passive sensor technologies will be discussed along with their communication and readout schemes. Materials, detection strategies and clinical applications of passive sensors will be described. Advantages over active sensor technologies will be highlighted, as well as critical aspects related to packaging and biocompatibility.

Nerve-Mimetic Adhesive Hydrogel Electroceuticals: Tailoring In Situ Physically Entangled Domains in Singular Polymers

Implantable electrochemicals stand out as promising candidates for resolving peripheral nerve injuries. However, challenges persist in designing bioelectronic materials that mimic tissue due to modulus matching, conformal adhesion, and immune responses. Herein, we present a nerve-mimicking design rationale for biocompatible hydrogel-based electroceuticals with a tissue-like modulus, robust and conformal tissue adhesion, exceptional mechanical toughness, and efficient stress dissipation. Inspired by the hierarchical structure of the peripheral nerve, the hydrogel substrate features a structurally gradient bilayer transitioning from a dense to a loose polymeric network, utilizing alginate functionalized with either photo-cross-linkable methacrylate or tissue-adhesive phenylborate. Due to the varying water affinity of the tethering groups, a physically entangled interfacial domain is in situ formed during dehydration of the pre-gel film, resulting in enhanced mechanical toughness and strong adhesion. The hydrogel electroceuticals, when integrated with conducting polymeric electrodes, locally stimulate nerve tissue, improving tissue regeneration in a crushed nerve injury model.

Breathable and Stretchable Epidermal Electronics for Health Management: Recent Advances and Challenges

Advanced epidermal electronic devices, capable of real-time monitoring of physical, physiological, and biochemical signals and administering appropriate therapeutics, are revolutionizing personalized healthcare technology. However, conventional portable electronic devices are predominantly constructed from impermeable and rigid materials, which thus leads to the mechanical and biochemical disparities between the devices and human tissues, resulting in skin irritation, tissue damage, compromised signal-to-noise ratio (SNR), and limited operational lifespans. To address these limitations, a new generation of wearable on-skin electronics built on stretchable and porous substrates has emerged. These substrates offer significant advantages including breathability, conformability, biocompatibility, and mechanical robustness, thus providing solutions for the aforementioned challenges. However, given their diverse nature and varying application scenarios, the careful selection and engineering of suitable substrates is paramount when developing high-performance on-skin electronics tailored to specific applications. This comprehensive review begins with an overview of various stretchable porous substrates, specifically focusing on their fundamental design principles, fabrication processes, and practical applications. Subsequently, a concise comparison of various methods is offered to fabricate epidermal electronics by applying these porous substrates. Following these, the latest advancements and applications of these electronics are highlighted. Finally, the current challenges are summarized and potential future directions in this dynamic field are explored.

The use of electrical stimulation to enhance recovery following peripheral nerve injury

Peripheral nerve injury is common and can have devastating consequences. In severe cases, functional recovery is often poor despite surgery. This is primarily due to the exceedingly slow rate of nerve regeneration at only 1-3 mm/day. The local environment in the distal nerve stump supportive of nerve regrowth deteriorates over time and the target end organs become atrophic. To overcome these challenges, investigations into treatments capable of accelerating nerve regrowth are of great clinical relevance and are an active area of research. One intervention that has shown great promise is perioperative electrical stimulation. Postoperative stimulation helps to expedite the Wallerian degeneration process and reduces delays caused by staggered regeneration at the site of nerve injury. By contrast, preoperative "conditioning" stimulation increases the rate of nerve regrowth along the nerve trunk. Over the past two decades, a rich body of literature has emerged that provides molecular insights into the mechanism by which electrical stimulation impacts nerve regeneration. The end result is upregulation of regeneration-associated genes in the neuronal body and accelerated transport to the axon front for regrowth. The efficacy of brief electrical stimulation on patients with peripheral nerve injuries was demonstrated in a number of randomized controlled trials on compressive, transection and traction injuries. As approved equipment to deliver this treatment is becoming available, it may be feasible to deploy this novel treatment in a wide range of clinical settings.

Beyond Flexible: Unveiling the Next Era of Flexible Electronic Systems

Flexible electronics are integral in numerous domains such as wearables, healthcare, physiological monitoring, human-machine interface, and environmental sensing, owing to their inherent flexibility, stretchability, lightweight construction, and low profile. These systems seamlessly conform to curvilinear surfaces, including skin, organs, plants, robots, and marine species, facilitating optimal contact. This capability enables flexible electronic systems to enhance or even supplant the utilization of cumbersome instrumentation across a broad range of monitoring and actuation tasks. Consequently, significant progress has been realized in the development of flexible electronic systems. This study begins by examining the key components of standalone flexible electronic systems-sensors, front-end circuitry, data management, power management and actuators. The next section explores different integration strategies for flexible electronic systems as well as their recent advancements. Flexible hybrid electronics, which is currently the most widely used strategy, is first reviewed to assess their characteristics and applications. Subsequently, transformational electronics, which achieves compact and high-density system integration by leveraging heterogeneous integration of bare-die components, is highlighted as the next era of flexible electronic systems. Finally, the study concludes by suggesting future research directions and outlining critical considerations and challenges for developing and miniaturizing fully integrated standalone flexible electronic systems.

Fully biodegradable and self-powered nerve guidance conduit based on zinc-molybdenum batteries for peripheral nerve repair

Peripheral nerve injury (PNI) poses a significant public health issue, often leading to muscle atrophy and persistent neuropathic pain, which can drastically impact the quality of life for patients. Electrical stimulation represents an effective and non-pharmacological treatment to promote nerve regeneration. Yet, the postoperative application of electrical stimulation remains a challenge. Here, we propose a fully biodegradable, self-powered nerve guidance conduit (NGC) based on dissolvable zinc-molybdenum batteries. The conduit can offer topographic guidance for nerve regeneration and deliver sustained electrical cues between both ends of a transected nerve stump, extending beyond the surgical window. Schwann cell proliferation and adenosine triphosphate (ATP) production are enhanced by the introduction of the zinc-molybdenum batteries. In rodent models with 10-mm sciatic nerve damage, the device effectively enhances nerve regeneration and motor function recovery. This study offers innovative strategies for creating biodegradable and electroactive devices that hold important promise to optimize therapeutic outcomes for nerve regeneration.

Advances in Biointegrated Wearable and Implantable Optoelectronic Devices for Cardiac Healthcare

With the prevalence of cardiovascular disease, it is imperative that medical monitoring and treatment become more instantaneous and comfortable for patients. Recently, wearable and implantable optoelectronic devices can be seamlessly integrated into human body to enable physiological monitoring and treatment in an imperceptible and spatiotemporally unconstrained manner, opening countless possibilities for the intelligent healthcare paradigm. To achieve biointegrated cardiac healthcare, researchers have focused on novel strategies for the construction of flexible/stretchable optoelectronic devices and systems. Here, we overview the progress of biointegrated flexible and stretchable optoelectronics for wearable and implantable cardiac healthcare devices. Firstly, the device design is addressed, including the mechanical design, interface adhesion, and encapsulation strategies. Next, the practical applications of optoelectronic devices for cardiac physiological monitoring, cardiac optogenetics, and nongenetic stimulation are presented. Finally, an outlook on biointegrated flexible and stretchable optoelectronic devices and systems for intelligent cardiac healthcare is discussed.

Ultrathin crystalline silicon-based omnidirectional strain gauges for implantable/wearable characterization of soft tissue biomechanics

Monitoring soft-tissue biomechanics is of interest in biomedical research and clinical treatment of diseases. An important focus is biointegrated strain gauges that track time-dependent mechanics of targeted tissues with deforming surfaces over multidirections. Existing methods provide limited gauge factors, tailored for sensing within specific directions under quasi-static conditions. We present development and applicability of implantable/wearable strain gauges that integrate multiple ultrathin monocrystalline silicon-based sensors aligned with different directions, in stretchable formats for dynamically monitoring direction angle-sensitive strain. We experimentally and computationally establish operational principles, with theoretical systems that enable determination of intensities and direction of applied strains at an omnidirectional scale. Wearable evaluations range from cardiac pulse to intraocular pressure monitoring of eyeballs. The device can evaluate cardiac disorders of myocardial infarction and hypoxia of living rats and locate the pathological orientation associated with infarction, in designs with possibilities as biodegradable implants for stable operation. These findings create clinical significance of the devices for monitoring complex dynamic biomechanics.

Nanoscale Strategies for Enhancing the Performance of Adhesive Dry Electrodes for the Skin

High-quality electrophysiological monitoring requires electrodes to maintain a compliant and stable skin contact. This necessitates low impedance, good skin compliance, and strong adhesion to ensure continuous and stable contact under dynamic conditions. In this context, adhesive epidermal dry electrodes are advancing rapidly, which is promising for long-term applications in clinical diagnosis, wearable health monitoring, and human-machine interfaces. However, challenges persist, as conventional technologies usually fall short of meeting the high standards required for electrophysiological electrodes. This Perspective discusses four key aspects for high-performance epidermal electrodes from an adhesive perspective: initial adhesion, water resistance, dynamic stability, and removal simplicity. We review recent nanoscale strategies addressing these issues, providing a comprehensive guideline to enhance the application performance of epidermal dry electrodes. Additionally, we explore key nanoscale strategies and their associated functions, future technology roadmaps, and prospects for dry adhesive epidermal electrodes.

A bioabsorbable mechanoelectric fiber as electrical stimulation suture

In surgical medicine, suturing is the standard treatment for large incisions, yet traditional sutures are limited in functionality. Electrical stimulation is a non-pharmacological therapy that promotes wound healing. In this context, we designed a passive and biodegradable mechanoelectric suture. The suture consists of multi-layer coaxial structure composed of (poly(lactic-co-glycolic acid), polycaprolactone) and magnesium to allow safe degradation. In addition to the excellent mechanical properties, the mechanoelectrical nature of the suture grants the generation of electric fields in response to movement and stretching. This is shown to speed up wound healing by 50% and reduce the risk of infection. This work presents an evolution of the conventional wound closure procedures, using a safe and degradable device ready to be translated into clinical practice.

Recent advances in soft, implantable electronics for dynamic organs

Unlike conventional rigid counterparts, soft and stretchable electronics forms crack- or defect-free conformal interfaces with biological tissues, enabling precise and reliable interventions in diagnosis and treatment of human diseases. Intrinsically soft and elastic materials, and device designs of innovative configurations and structures leads to the emergence of such features, particularly, the mechanical compliance provides seamless integration into continuous movements and deformations of dynamic organs such as the bladder and heart, without disrupting natural physiological functions. This review introduces the development of soft, implantable electronics tailored for dynamic organs, covering various materials, mechanical design strategies, and representative applications for the bladder and heart, and concludes with insights into future directions toward clinically relevant tools.

Self-Adhesive and Self-Sustainable Bioelectronic Patch for Physiological Feedback Electronic Modulation of Soft Organs

Bionic electrical stimulation (Bio-ES) aims to achieve personalized therapy and proprioceptive adaptation by mimicking natural neural signatures of the body, while current Bio-ES devices are reliant on complex sensing and computational simulation systems, thus often limited by the low-fidelity of simulated electrical signals, and failure of interface information interaction due to the mechanical mismatch between soft tissues and rigid electrodes. Here, the study presents a flexible and ultrathin self-sustainable bioelectronic patch (Bio-patch), which can self-adhere to the lesion area of organs and generate bionic electrical signals synchronized vagal nerve envelope in situ to implement Bio-ES. It allows adaptive adjustment of intensity, frequency, and waveform of the Bio-ES to fully meet personalized needs of tissue regeneration based on real-time feedback from the vagal neural controlled organs. With this foundation, the Bio-patch can effectively intervene with excessive fibrosis and microvascular stasis during the natural healing process by regulating the polarization time of macrophages, promoting the reconstruction of the tissue-engineered structure, and accelerating the repair of damaged liver and kidney. This work develops a practical approach to realize biomimetic electronic modulation of the growth and development of soft organs only using a multifunctional Bio-patch, which establishes a new paradigm for precise bioelectronic medicine.

Wirelessly steerable bioelectronic neuromuscular robots adapting neurocardiac junctions

Biological motions of native muscle tissues rely on the nervous system to interface movement with the surrounding environment. The neural innervation of muscles, crucial for regulating movement, is the fundamental infrastructure for swiftly responding to changes in body tissue requirements. This study introduces a bioelectronic neuromuscular robot integrated with the motor nervous system through electrical synapses to evoke cardiac muscle activities and steer robotic motion. Serving as an artificial brain and wirelessly regulating selective neural activation to initiate robot fin motion, a wireless frequency multiplexing bioelectronic device is used to control the robot. Frequency multiplexing bioelectronics enables the control of the robot locomotion speed and direction by modulating the flapping of the robot fins through the wireless motor innervation of cardiac muscles. The robots demonstrated an average locomotion speed of ~0.52 ± 0.22 millimeters per second, fin-flapping frequency up to 2.0 hertz, and turning locomotion path curvature of ~0.11 ± 0.04 radians per millimeter. These systems will contribute to the expansion of biohybrid machines into the brain-to-motor frontier for developing autonomous biohybrid systems capable of advanced adaptive motor control and learning.

Maglev-fabricated long and biodegradable stent for interventional treatment of peripheral vessels

While chronic limb-threatening ischemia is a serious peripheral artery disease, the lack of an appropriate stent significantly limits the potential of interventional treatment. In spite of much progress in coronary stents, little is towards peripheral stents, which are expected to be both long and biodegradable and thus require a breakthrough in core techniques. Herein, we develop a long and biodegradable stent with a length of up to 118 mm based on a metal-polymer composite material. To achieve a well-prepared homogeneous coating on a long stent during ultrasonic spraying, a magnetic levitation is employed. In vivo degradation of the stent is investigated in rabbit abdominal aorta/iliac arteries, and its preclinical safety is evaluated in canine infrapopliteal arteries. First-in-man implantation of the stent is carried out in the below-the-knee artery. The 13 months' follow-ups demonstrate the feasibility of the long and biodegradable stent in clinical applications.

Wireless breathable face mask sensor for spatiotemporal 2D respiration profiling and respiratory diagnosis

Owing to air pollution and the pandemic outbreak, the need for quantitative pulmonary monitoring has greatly increased. The COVID-19 outbreak has aroused attention for comfortable wireless monitoring of respiratory profiles and more real-time diagnosis of respiratory diseases. Although respiration sensors have been investigated extensively with single-pixel sensors, 2D respiration profiling with a pixelated array sensor has not been demonstrated for both exhaling and inhaling. Since the pixelated array sensor allowed for simultaneous profiling of the nasal breathing and oral breathing, it provides essential respiratory information such as breathing patterns, respiration habit, breathing disorders. In this study, we introduced an air-permeable, stretchable, and a pixelated pressure sensor that can be integrated into a commercial face mask. The mask sensor showed a strain-independent pressure-sensing performance, providing 2D pressure profiles for exhalation and inhalation. Real-time 2D respiration profiles could monitor various respiratory behaviors, such as oral/nasal breathing, clogged nose, out-of-breath, and coughing. Furthermore, they could detect respiratory diseases, such as rhinitis, sleep apnea, and pneumonia. The 2D respiratory profiling mask sensor is expected to be employed for remote respiration monitoring and timely patient treatment.

Soft Bioelectronics for Neuroengineering: New Horizons in the Treatment of Brain Tumor and Epilepsy

Soft bioelectronic technologies for neuroengineering have shown remarkable progress, which include novel soft material technologies and device design strategies. Such technological advances that are initiated from fundamental brain science are applied to clinical neuroscience and provided meaningful promises for significant improvement in the diagnosis efficiency and therapeutic efficacy of various brain diseases recently. System-level integration strategies in consideration of specific disease circumstances can enhance treatment effects further. Here, recent advances in soft implantable bioelectronics for neuroengineering, focusing on materials and device designs optimized for the treatment of intracranial disease environments, are reviewed. Various types of soft bioelectronics for neuroengineering are categorized and exemplified first, and then details for the sensing and stimulating device components are explained. Next, application examples of soft implantable bioelectronics to clinical neuroscience, particularly focusing on the treatment of brain tumor and epilepsy are reviewed. Finally, an ideal system of soft intracranial bioelectronics such as closed-loop-type fully-integrated systems is presented, and the remaining challenges for their clinical translation are discussed.

Advanced nerve regeneration enabled by neural conformal electronic stimulators enhancing mitochondrial transport

Addressing peripheral nerve defects remains a significant challenge in regenerative neurobiology. Autografts emerged as the gold-standard management, however, are hindered by limited availability and potential neuroma formation. Numerous recent studies report the potential of wireless electronic system for nerve defects repair. Unfortunately, few has met clinical needs for inadequate electrode precision, poor nerve entrapment and insufficient bioactivity of the matrix material. Herein, we present an advanced wireless electrical nerve stimulator, based on water-responsive self-curling silk membrane with excellent bioabsorbable and biocompatible properties. We constructed a unique bilayer structure with an oriented pre-stretched inner layer and a general silk membrane as outer layer. After wetting, the simultaneous contraction of inner layer and expansion of outer layer achieved controllable super-contraction from 2D flat surface to 3D structural reconfiguration. It enables shape-adaptive wrapping to cover around nerves, overcomes the technical obstacle of preparing electrodes on the inner wall of the conduit, and prevents electrode breakage caused by material expansion in water. The use of fork capacitor-like metal interface increases the contact points between the metal and the regenerating nerve, solving the challenge of inefficient and rough electrical stimulation methods in the past. Newly developed electronic stimulator is effective in restoring 10 mm rat sciatic nerve defects comparable to autologous grafts. The underlying mechanism involves that electric stimulation enhances anterograde mitochondrial transport to match energy demands. This newly introduced device thereby demonstrated the potential as a viable and efficacious alternative to autografts for enhancing peripheral nerve repair and functional recovery.

Bioelectronics for electrical stimulation: materials, devices and biomedical applications

Bioelectronics is a hot research topic, yet an important tool, as it facilitates the creation of advanced medical devices that interact with biological systems to effectively diagnose, monitor and treat a broad spectrum of health conditions. Electrical stimulation (ES) is a pivotal technique in bioelectronics, offering a precise, non-pharmacological means to modulate and control biological processes across molecular, cellular, tissue, and organ levels. This method holds the potential to restore or enhance physiological functions compromised by diseases or injuries by integrating sophisticated electrical signals, device interfaces, and designs tailored to specific biological mechanisms. This review explains the mechanisms by which ES influences cellular behaviors, introduces the essential stimulation principles, discusses the performance requirements for optimal ES systems, and highlights the representative applications. From this review, we can realize the potential of ES based bioelectronics in therapy, regenerative medicine and rehabilitation engineering technologies, ranging from tissue engineering to neurological technologies, and the modulation of cardiovascular and cognitive functions. This review underscores the versatility of ES in various biomedical contexts and emphasizes the need to adapt to complex biological and clinical landscapes it addresses.

Stretchable Electrodes for Interconnects in Soft Electronics

Soft electronics have significantly enhanced user convenience and data accuracy in wearable devices, implantable devices, and human-machine interfaces. However, a persistent challenge in their development has been the disconnection between the rigid and soft components of devices due to the substantial difference in modulus and stretchability. To address this issue, establishing a durable and flexible connection that smoothly links components of varying stiffness to signal-capturing sections with a lower stiffness is essential. In this study, we developed a novel stretchable interconnect that strongly adheres to various materials, facilitating electrical connections effortlessly by applying minimal finger pressure. Capable of stretching up to 1000% while maintaining electrical integrity, this interconnect proves its applicability across multiple domains, including electrocardiogram (ECG), electromyography (EMG), and stretchable light-emitting diode (LED) circuits. Its versatility is further demonstrated through its compatibility with various manufacturing techniques such as 3D printing, painting, and spin coating, highlighting its adaptability in soft electronics.

Biohacking Nerve Repair: Novel Biomaterials, Local Drug Delivery, Electrical Stimulation, and Allografts to Aid Surgical Repair

The regenerative capacity of the peripheral nervous system is limited, and peripheral nerve injuries often result in incomplete healing and poor outcomes even after repair. Transection injuries that induce a nerve gap necessitate microsurgical intervention; however, even the current gold standard of repair, autologous nerve graft, frequently results in poor functional recovery. Several interventions have been developed to augment the surgical repair of peripheral nerves, and the application of functional biomaterials, local delivery of bioactive substances, electrical stimulation, and allografts are among the most promising approaches to enhance innate healing across a nerve gap. Biocompatible polymers with optimized degradation rates, topographic features, and other functions provided by their composition have been incorporated into novel nerve conduits (NCs). Many of these allow for the delivery of drugs, neurotrophic factors, and whole cells locally to nerve repair sites, mitigating adverse effects that limit their systemic use. The electrical stimulation of repaired nerves in the perioperative period has shown benefits to healing and recovery in human trials, and novel biomaterials to enhance these effects show promise in preclinical models. The use of acellular nerve allografts (ANAs) circumvents the morbidity of donor nerve harvest necessitated by the use of autografts, and improvements in tissue-processing techniques may allow for more readily available and cost-effective options. Each of these interventions aid in neural regeneration after repair when applied independently, and their differing forms, benefits, and methods of application present ample opportunity for synergistic effects when applied in combination.

Unveiling Trends: Nanoscale Materials Shaping Emerging Biomedical Applications

The realm of biomedical materials continues to evolve rapidly, driven by innovative research across interdisciplinary domains. Leveraging big data from the CAS Content Collection, this study employs quantitative analysis through natural language processing (NLP) to identify six emerging areas within nanoscale materials for biomedical applications. These areas encompass self-healing, bioelectronic, programmable, lipid-based, protein-based, and antibacterial materials. Our Nano Focus delves into the multifaceted utilization of nanoscale materials in these domains, spanning from augmenting physical and electronic properties for interfacing with human tissue to facilitating intricate functionalities like programmable drug delivery.

An Encapsulation-Free and Hierarchical Porous Triboelectric Scaffold with Dynamic Hydrophilicity for Efficient Cartilage Regeneration

Tissue engineering and electrotherapy are two promising methods to promote tissue repair. However, their integration remains an underexplored area, because their requirements on devices are usually distinct. Triboelectric nanogenerators (TENGs) have shown great potential to develop self-powered devices. However, due to their susceptibility to moisture, TENGs have to be encapsulated in vivo. Therefore, existing TENGs cannot be employed as tissue engineering scaffolds, which require direct interaction with surrounding cells. Here, the concept of triboelectric scaffolds (TESs) is proposed. Poly(glycerol sebacate), a biodegradable and relatively hydrophobic elastomer, is selected as the matrix of TESs. Each hydrophobic micropore in multi-hierarchical porous TESs efficiently serves as a moisture-resistant working unit of TENGs. Integration of tons of micropores ensures the electrotherapy ability of TESs in vivo without encapsulation. Originally hydrophobic TESs are degraded by surface erosion and transformed into hydrophilic surfaces, facilitating their role as tissue engineering scaffolds. Notably, TESs seeded with chondrocytes obtain dense and large matured cartilages after subcutaneous implantation in nude mice. Importantly, rabbits with osteochondral defects receiving TES implantation show favorable hyaline cartilage regeneration and complete cartilage healing. This work provides a promising electronic biomedical device and will inspire a series of new in vivo applications.

Evolution of Musculoskeletal Electronics

The musculoskeletal system, constituting the largest human physiological system, plays a critical role in providing structural support to the body, facilitating intricate movements, and safeguarding internal organs. By virtue of advancements in revolutionized materials and devices, particularly in the realms of motion capture, health monitoring, and postoperative rehabilitation, "musculoskeletal electronics" has actually emerged as an infancy area, but has not yet been explicitly proposed. In this review, the concept of musculoskeletal electronics is elucidated, and the evolution history, representative progress, and key strategies of the involved materials and state-of-the-art devices are summarized. Therefore, the fundamentals of musculoskeletal electronics and key functionality categories are introduced. Subsequently, recent advances in musculoskeletal electronics are presented from the perspectives of "in vitro" to "in vivo" signal detection, interactive modulation, and therapeutic interventions for healing and recovery. Additionally, nine strategy avenues for the development of advanced musculoskeletal electronic materials and devices are proposed. Finally, concise summaries and perspectives are proposed to highlight the directions that deserve focused attention in this booming field.

Synthesis of shape-programmable elastomer for a bioresorbable, wireless nerve stimulator

Materials that have the ability to manipulate shapes in response to stimuli such as heat, light, humidity and magnetism offer a means for versatile, sophisticated functions in soft robotics or biomedical implants, while such a reactive transformation has certain drawbacks including high operating temperatures, inherent rigidity and biological hazard. Herein, we introduce biodegradable, self-adhesive, shape-transformable poly (L-lactide-co-ε-caprolactone) (BSS-PLCL) that can be triggered via thermal stimulation near physiological temperature (∼38 °C). Chemical inspections confirm the fundamental properties of the synthetic materials in diverse aspects, and study on mechanical and biochemical characteristics validates exceptional stretchability up to 800 % and tunable dissolution behaviors under biological conditions. The integration of the functional polymer with a bioresorbable electronic system highlights potential for a wide range of biomedical applications.

A biodegradable and flexible neural interface for transdermal optoelectronic modulation and regeneration of peripheral nerves

Optoelectronic neural interfaces can leverage the photovoltaic effect to convert light into electrical current, inducing charge redistribution and enabling nerve stimulation. This method offers a non-genetic and remote approach for neuromodulation. Developing biodegradable and efficient optoelectronic neural interfaces is important for achieving transdermal stimulation while minimizing infection risks associated with device retrieval, thereby maximizing therapeutic outcomes. We propose a biodegradable, flexible, and miniaturized silicon-based neural interface capable of transdermal optoelectronic stimulation for neural modulation and nerve regeneration. Enhancing the device interface with thin-film molybdenum significantly improves the efficacy of neural stimulation. Our study demonstrates successful activation of the sciatic nerve in rodents and the facial nerve in rabbits. Moreover, transdermal optoelectronic stimulation accelerates the functional recovery of injured facial nerves.

Flexible, biodegradable ultrasonic wireless electrotherapy device based on highly self-aligned piezoelectric biofilms

Biodegradable piezoelectric devices hold great promise in on-demand transient bioelectronics. Existing piezoelectric biomaterials, however, remain obstacles to the development of such devices due to difficulties in large-scale crystal orientation alignment and weak piezoelectricity. Here, we present a strategy for the synthesis of optimally orientated, self-aligned piezoelectric γ-glycine/polyvinyl alcohol (γ-glycine/PVA) films via an ultrasound-assisted process, guided by density functional theory. The first-principles calculations reveal that the negative piezoelectric effect of γ-glycine originates from the stretching and compression of glycine molecules induced by hydrogen bonding interactions. The synthetic γ-glycine/PVA films exhibit a piezoelectricity of 10.4 picocoulombs per newton and an ultrahigh piezoelectric voltage coefficient of 324 × 10-3 volt meters per newton. The biofilms are further developed into flexible, bioresorbable, wireless piezo-ultrasound electrotherapy devices, which are demonstrated to shorten wound healing by ~40% and self-degrade in preclinical wound models. These encouraging results offer reliable approaches for engineering piezoelectric biofilms and developing transient bioelectronics.

Stereoscopic artificial compound eyes for spatiotemporal perception in three-dimensional space

Arthropods' eyes are effective biological vision systems for object tracking and wide field of view because of their structural uniqueness; however, unlike mammalian eyes, they can hardly acquire the depth information of a static object because of their monocular cues. Therefore, most arthropods rely on motion parallax to track the object in three-dimensional (3D) space. Uniquely, the praying mantis (Mantodea) uses both compound structured eyes and a form of stereopsis and is capable of achieving object recognition in 3D space. Here, by mimicking the vision system of the praying mantis using stereoscopically coupled artificial compound eyes, we demonstrated spatiotemporal object sensing and tracking in 3D space with a wide field of view. Furthermore, to achieve a fast response with minimal latency, data storage/transportation, and power consumption, we processed the visual information at the edge of the system using a synaptic device and a federated split learning algorithm. The designed and fabricated stereoscopic artificial compound eye provides energy-efficient and accurate spatiotemporal object sensing and optical flow tracking. It exhibits a root mean square error of 0.3 centimeter, consuming only approximately 4 millijoules for sensing and tracking. These results are more than 400 times lower than conventional complementary metal-oxide semiconductor-based imaging systems. Our biomimetic imager shows the potential of integrating nature's unique design using hardware and software codesigned technology toward capabilities of edge computing and sensing.

Flexible, Biodegradable, and Wireless Magnetoelectric Paper for Simple In Situ Personalization of Bioelectric Implants

Bioelectronic implants delivering electrical stimulation offer an attractive alternative to traditional pharmaceuticals in electrotherapy. However, achieving simple, rapid, and cost-effective personalization of these implants for customized treatment in unique clinical and physical scenarios presents a substantial challenge. This challenge is further compounded by the need to ensure safety and minimal invasiveness, requiring essential attributes such as flexibility, biocompatibility, lightness, biodegradability, and wireless stimulation capability. Here, a flexible, biodegradable bioelectronic paper with homogeneously distributed wireless stimulation functionality for simple personalization of bioelectronic implants is introduced. The bioelectronic paper synergistically combines i) lead-free magnetoelectric nanoparticles (MENs) that facilitate electrical stimulation in response to external magnetic field and ii) flexible and biodegradable nanofibers (NFs) that enable localization of MENs for high-selectivity stimulation, oxygen/nutrient permeation, cell orientation modulation, and biodegradation rate control. The effectiveness of wireless electrical stimulation in vitro through enhanced neuronal differentiation of neuron-like PC12 cells and the controllability of their microstructural orientation are shown. Also, scalability, design flexibility, and rapid customizability of the bioelectronic paper are shown by creating various 3D macrostructures using simple paper crafting techniques such as cutting and folding. This platform holds promise for simple and rapid personalization of temporary bioelectronic implants for minimally invasive wireless stimulation therapies.

Closed-Loop Wearable Device Network of Intrinsically-Controlled, Bilateral Coordinated Functional Electrical Stimulation for Stroke

Innovative functional electrical stimulation has demonstrated effectiveness in enhancing daily walking and rehabilitating stroke patients with foot drop. However, its lack of precision in stimulating timing, individual adaptivity, and bilateral symmetry, resulted in diminished clinical efficacy. Therefore, a closed-loop wearable device network of intrinsically controlled functional electrical stimulation (CI-FES) system is proposed, which utilizes the personal surface myoelectricity, derived from the intrinsic neuro signal, as the switch to activate/deactivate the stimulation on the affected side. Simultaneously, it decodes the myoelectricity signal of the patient's healthy side to adjust the stimulation intensity, forming an intrinsically controlled loop with the inertial measurement units. With CI-FES assistance, patients' walking ability significantly improved, evidenced by the shift in ankle joint angle mean and variance from 105.53° and 28.84 to 102.81° and 17.71, and the oxyhemoglobin concentration tested by the functional near-infrared spectroscopy. In long-term CI-FES-assisted clinical testing, the discriminability in machine learning classification between patients and healthy individuals gradually decreased from 100% to 92.5%, suggesting a remarkable recovery tendency, further substantiated by performance on the functional movement scales. The developed CI-FES system is crucial for contralateral-hemiplegic stroke recovery, paving the way for future closed-loop stimulation systems in stroke rehabilitation is anticipated.

Capacitive-Coupling-Responsive Hydrogel Scaffolds Offering Wireless In Situ Electrical Stimulation Promotes Nerve Regeneration

Electrical stimulation (ES) has shown beneficial effects in repairing injured tissues. However, current ES techniques that use tissue-traversing leads and bulky external power suppliers have significant limitations in translational medicine. Hence, exploring noninvasive in vivo ES to provide controllable electrical cues in tissue engineering is an imminent necessity. Herein, a conductive hydrogel with in situ electrical generation capability as a biodegradable regeneration scaffold and wireless ES platform for spinal cord injury (SCI) repair is demonstrated. When a soft insulated metal plate is placed on top of the injury site as a wireless power transmitter, the conductive hydrogel implanted at the injury site can serve as a wireless power receiver, and the capacitive coupling between the receiver and transmitter can generate an alternating current in the hydrogel scaffold owing to electrostatic induction effect. In a complete transection model of SCI rats, the implanted conductive hydrogels with capacitive-coupling in situ ES enhance functional recovery and neural tissue repair by promoting remyelination, accelerating axon regeneration, and facilitating endogenous neural stem cell differentiation. This facile wireless-powered electroactive-hydrogel strategy thus offers on-demand in vivo ES with an adjustable timeline, duration, and strength and holds great promise in translational medicine.

Wireless Battery-free and Fully Implantable Organ Interfaces

Advances in soft materials, miniaturized electronics, sensors, stimulators, radios, and battery-free power supplies are resulting in a new generation of fully implantable organ interfaces that leverage volumetric reduction and soft mechanics by eliminating electrochemical power storage. This device class offers the ability to provide high-fidelity readouts of physiological processes, enables stimulation, and allows control over organs to realize new therapeutic and diagnostic paradigms. Driven by seamless integration with connected infrastructure, these devices enable personalized digital medicine. Key to advances are carefully designed material, electrophysical, electrochemical, and electromagnetic systems that form implantables with mechanical properties closely matched to the target organ to deliver functionality that supports high-fidelity sensors and stimulators. The elimination of electrochemical power supplies enables control over device operation, anywhere from acute, to lifetimes matching the target subject with physical dimensions that supports imperceptible operation. This review provides a comprehensive overview of the basic building blocks of battery-free organ interfaces and related topics such as implantation, delivery, sterilization, and user acceptance. State of the art examples categorized by organ system and an outlook of interconnection and advanced strategies for computation leveraging the consistent power influx to elevate functionality of this device class over current battery-powered strategies is highlighted.

Stretchable Electronics with Strain-Resistive Performance

Stretchable electronics have attracted tremendous attention amongst academic and industrial communities due to their prospective applications in personal healthcare, human-activity monitoring, artificial skins, wearable displays, human-machine interfaces, etc. Other than mechanical robustness, stable performances under complex strains in these devices that are not for strain sensing are equally important for practical applications. Here, a comprehensive summarization of recent advances in stretchable electronics with strain-resistive performance is presented. First, detailed overviews of intrinsically strain-resistive stretchable materials, including conductors, semiconductors, and insulators, are given. Then, systematic representations of advanced structures, including helical, serpentine, meshy, wrinkled, and kirigami-based structures, for strain-resistive performance are summarized. Next, stretchable arrays and circuits with strain-resistive performance, that integrate multiple functionalities and enable complex behaviors, are introduced. This review presents a detailed overview of recent progress in stretchable electronics with strain-resistive performances and provides a guideline for the future development of stretchable electronics.

Soft, Long-Lived, Bioresorbable Electronic Surgical Mesh with Wireless Pressure Monitor and On-Demand Drug Delivery

Current research in the area of surgical mesh implants is somewhat limited to traditional designs and synthesis of various mesh materials, whereas meshes with multiple functions may be an effective approach to address long-standing challenges including postoperative complications. Herein, a bioresorbable electronic surgical mesh is presented that offers high mechanical strength over extended timeframes, wireless post-operative pressure monitoring, and on-demand drug delivery for the restoration of tissue structure and function. The study of materials and mesh layouts provides a wide range of tunability of mechanical and biochemical properties. Dissolvable dielectric composite with porous structure in a pyramidal shape enhances sensitivity of a wireless capacitive pressure sensor, and resistive microheaters integrated with inductive coils provide thermo-responsive drug delivery system for an antibacterial agent. In vivo evaluations demonstrate reliable, long-lived operation, and effective treatment for abdominal hernia defects, by clear evidence of suppressed complications such as adhesion formation and infections.

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

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