Piezoelectric Scaffolds as Smart Materials for Bone Tissue Engineering

Bone repair and regeneration require physiological cues, including mechanical, electrical, and biochemical activity. Many biomaterials have been investigated as bioactive scaffolds with excellent electrical properties. Amongst biomaterials, piezoelectric materials (PMs) are gaining attention in biomedicine, power harvesting, biomedical devices, and structural health monitoring. PMs have unique properties, such as the ability to affect physiological movements and deliver electrical stimuli to damaged bone or cells without an external power source. The crucial bone property is its piezoelectricity. Bones can generate electrical charges and potential in response to mechanical stimuli, as they influence bone growth and regeneration. Piezoelectric materials respond to human microenvironment stimuli and are an important factor in bone regeneration and repair. This manuscript is an overview of the fundamentals of the materials generating the piezoelectric effect and their influence on bone repair and regeneration. This paper focuses on the state of the art of piezoelectric materials, such as polymers, ceramics, and composites, and their application in bone tissue engineering. We present important information from the point of view of bone tissue engineering. We highlight promising upcoming approaches and new generations of piezoelectric materials.

MXene-coated piezoelectric poly-L-lactic acid membrane accelerates wound healing by biomimicking low-voltage electrical pulses

Electrical stimulation therapy is effective in promoting wound healing by rescuing the decreased endogenous electrical field, where self-powered and miniaturized devices such as nanogenerators become the emerging trends. While high-voltage and unidirectional electric field may pose thermal effect and damage to the skin, nanogenerators with lower voltages, pulsed or bidirectional currents, and less invasive electrodes are preferred. Herein, we construct a polydopamine (PDA)-modified poly-L-lactic acid (PLLA) /MXene (PDMP/MXene) nanofibrous composite membrane that generates piezoelectric voltages matching the transepithelial potential (TEP) to accelerate wound healing. PDA coating not only enhances the piezoelectricity of PLLA by dipole attraction and alignment, but also increases its hydrophilicity and facilitates subsequent MXene adhesion for electrical conductivity and stability in physiological environment. When applied as wound dressings in mice, the PDMP/MXene membranes act as a nanogenerators with reduced internal resistances and satisfactory piezoelectric performances that resemble bioelectric potentials (~10 mV) responding to physical activities. The membrane significantly accelerates wound closure by facilitating fibroblast migration, collagen deposition and angiogenesis, and suppressing the expression of inflammatory responses. This piezoelectric fibrous membrane therefore provides a convenient solution for speeding up wound healing by sustained low voltage mimicking bioelectricity, better cell affinity.

A review of recent advances of piezoelectric poly-L-lactic acid for biomedical applications

Poly-L-lactic acid (PLLA), recognized as a piezoelectric material, not only demonstrates exceptional piezoelectric properties but also exhibits commendable biocompatibility and biodegradability. These properties render PLLA highly promising for diverse applications, including sensors, wearable devices, biomedical engineering, and related domains. This review offers a comprehensive overview of the distinctive piezoelectric effect of PLLA-based material and delves into the latest advancements in its preparation strategies as a piezoelectric material. It further presents recent research progress in PLLA-based piezoelectric materials, particularly in the realms of health monitoring, skin repair, nerve regeneration, and tissue repair. The discourse extends to providing insights into potential future trajectories for the development of PLLA-based piezoelectric materials.

Bioelectret Materials and Their Bioelectric Effects for Tissue Repair: A Review

Biophysical and clinical medical studies have confirmed that biological tissue lesions and trauma are related to the damage of an intrinsic electret (i.e., endogenous electric field), such as wound healing, embryonic development, the occurrence of various diseases, immune regulation, tissue regeneration, and cancer metastasis. As exogenous electrical signals, such as conductivity, piezoelectricity, ferroelectricity, and pyroelectricity, bioelectroactives can regulate the endogenous electric field, thus controlling the function of cells and promoting the repair and regeneration of tissues. Materials, once polarized, can harness their inherent polarized static electric fields to generate an electric field through direct stimulation or indirect interactions facilitated by physical signals, such as friction, ultrasound, or mechanical stimulation. The interaction with the biological microenvironment allows for the regulation and compensation of polarized electric signals in damaged tissue microenvironments, leading to tissue regeneration and repair. The technique shows great promise for applications in the field of tissue regeneration. In this paper, the generation and change of the endogenous electric field and the regulation of exogenous electroactive substances are expounded, and the latest research progress of the electret and its biological effects in the field of tissue repair include bone repair, nerve repair, drug penetration promotion, wound healing, etc. Finally, the opportunities and challenges of electret materials in tissue repair were summarized. Exploring the research and development of new polarized materials and the mechanism of regulating endogenous electric field changes may provide new insights and innovative methods for tissue repair and disease treatment in biological applications.

Unlocking the potential of stimuli-responsive biomaterials for bone regeneration

Bone defects caused by tumors, osteoarthritis, and osteoporosis attract great attention. Because of outstanding biocompatibility, osteogenesis promotion, and less secondary infection incidence ratio, stimuli-responsive biomaterials are increasingly used to manage this issue. These biomaterials respond to certain stimuli, changing their mechanical properties, shape, or drug release rate accordingly. Thereafter, the activated materials exert instructive or triggering effects on cells and tissues, match the properties of the original bone tissues, establish tight connection with ambient hard tissue, and provide suitable mechanical strength. In this review, basic definitions of different categories of stimuli-responsive biomaterials are presented. Moreover, possible mechanisms, advanced studies, and pros and cons of each classification are discussed and analyzed. This review aims to provide an outlook on the future developments in stimuli-responsive biomaterials.

Recent advances in wearable flexible electronic skin: types, power supply methods, and development prospects

In recent years, wearable e-skin has emerged as a prominent technology with a wide range of applications in healthcare, health surveillance, human-machine interface, and virtual reality. Inspired by the properties of human skin, arrayed wearable e-skin is a novel technology that offers multifunctional sensing capabilities. It can detect and quantify various stimuli, mimicking the human somatosensory system, and record a wide range of physical and physiological parameters in real time. By combining flexible electronic device units with a data acquisition system, specific functional sensors can be distributed in targeted areas to achieve high sensitivity, resolution, adjustable sensing range, and large-area expandability. This review provides a comprehensive overview of recent advances in wearable e-skin technology, including its development status, types of applications, power supply methods, and prospects for future development. The emphasis of current research is on enhancing the sensitivity and stability of sensors, improving the comfort and reliability of wearable devices, and developing intelligent data processing and application algorithms. This review aims to serve as a scientific reference for the intelligent development of wearable e-skin technology.

Advanced Immunomodulatory Biomaterials for Therapeutic Applications

The multifaceted biological defense system modulating complex immune responses against pathogens and foreign materials plays a critical role in tissue homeostasis and disease progression. Recently developed biomaterials that can specifically regulate immune responses, nanoparticles, graphene, and functional hydrogels have contributed to the advancement of tissue engineering as well as disease treatment. The interaction between innate and adaptive immunity, collectively determining immune responses, can be regulated by mechanobiological recognition and adaptation of immune cells to the extracellular microenvironment. Therefore, applying immunomodulation to tissue regeneration and cancer therapy involves manipulating the properties of biomaterials by tailoring their composition in the context of the immune system. This review provides a comprehensive overview of how the physicochemical attributes of biomaterials determine immune responses, focusing on the physical properties that influence innate and adaptive immunity. This review also underscores the critical aspect of biomaterial-based immune engineering for the development of novel therapeutics and emphasizes the importance of understanding the biomaterials-mediated immunological mechanisms and their role in modulating the immune system.

Revealing an important role of piezoelectric polymers in nervous-tissue regeneration: A review

Nerve injuries pose a drastic threat to nerve mobility and sensitivity and lead to permanent dysfunction due to low regenerative capacity of mature neurons. The electrical stimuli that can be provided by electroactive materials are some of the most effective tools for the formation of soft tissues, including nerves. Electric output can provide a distinctly favorable bioelectrical microenvironment, which is especially relevant for the nervous system. Piezoelectric biomaterials have attracted attention in the field of neural tissue engineering owing to their biocompatibility and ability to generate piezoelectric surface charges. In this review, an outlook of the most recent achievements in the field of piezoelectric biomaterials is described with an emphasis on piezoelectric polymers for neural tissue engineering. First, general recommendations for the design of an optimal nerve scaffold are discussed. Then, specific mechanisms determining nerve regeneration via piezoelectric stimulation are considered. Activation of piezoelectric responses via natural body movements, ultrasound, and magnetic fillers is also examined. The use of magnetoelectric materials in combination with alternating magnetic fields is thought to be the most promising due to controllable reproducible cyclic deformations and deep tissue permeation by magnetic fields without tissue heating. In vitro and in vivo applications of nerve guidance scaffolds and conduits made of various piezopolymers are reviewed too. Finally, challenges and prospective research directions regarding piezoelectric biomaterials promoting nerve regeneration are discussed. Thus, the most relevant scientific findings and strategies in neural tissue engineering are described here, and this review may serve as a guideline both for researchers and clinicians.

Recent advances in smart wearable sensors as electronic skin

Flexible and multifunctional electronic devices and soft robots inspired by human organs, such as skin, have many applications. However, the emergence of electronic skins (e-skins) or textiles in biomedical engineering has made a great revolution in a myriad of people's lives who suffer from different types of diseases and problems in which their skin and muscles lose their appropriate functions. In this review, recent advances in the sensory function of the e-skins are described. Furthermore, we have categorized them from the sensory function perspective and highlighted their advantages and limitations. The categories are tactile sensors (including capacitive, piezoresistive, piezoelectric, triboelectric, and optical), temperature, and multi-sensors. In addition, we summarized the most recent advancements in sensors and their particular features. The role of material selection and structure in sensory function and other features of the e-skins are also discussed. Finally, current challenges and future prospects of these systems towards advanced biomedical applications are elaborated.

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

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

Biodegradable Piezoelectric Polymers: Recent Advancements in Materials and Applications

Recent materials, microfabrication, and biotechnology improvements have introduced numerous exciting bioelectronic devices based on piezoelectric materials. There is an intriguing evolution from conventional unrecyclable materials to biodegradable, green, and biocompatible functional materials. As a fundamental electromechanical coupling material in numerous applications, novel piezoelectric materials with a feature of degradability and desired electrical and mechanical properties are being developed for future wearable and implantable bioelectronics. These bioelectronics can be easily integrated with biological systems for applications, including sensing physiological signals, diagnosing medical problems, opening the blood-brain barrier, and stimulating healing or tissue growth. Therefore, the generation of piezoelectricity from natural and synthetic bioresorbable polymers has drawn great attention in the research field. Herein, the significant and recent advancements in biodegradable piezoelectric materials, including natural and synthetic polymers, their principles, advanced applications, and challenges for medical uses, are reviewed thoroughly. The degradation methods of these piezoelectric materials through in vitro and in vivo studies are also investigated. These improvements in biodegradable piezoelectric materials and microsystems could enable new applications in the biomedical field. In the end, potential research opportunities regarding the practical applications are pointed out that might be significant for new materials research.

Biodegradable Electroactive Nanofibrous Air Filters for Long-Term Respiratory Healthcare and Self-Powered Monitoring

The concept of triboelectric nanogenerator (TENG)-based fibrous air filters, in which the electroactive fibers are ready to enhance the electrostatic adsorption by sustainable energy harvesting, is appealing for long-term respiratory protection and in vivo real-time monitoring. This effort discloses a self-reinforcing electroactivity strategy to confer extreme alignment and refinement of the electrospun poly(lactic acid) (PLA) nanofibers, significantly facilitating formation of electroactive phases (i.e., β-phase and highly aligned chains and dipoles) and promotion of polarization and electret properties. It endowed the PLA nanofibrous membranes (NFMs) with largely increased surface potential and filtration performance, as exemplified by efficient removal of PM0.3 and PM2.5 (90.68 and 99.82%, respectively) even at the highest airflow capacity of 85 L/min. With high electroactivity and a well-controlled morphology, the PLA NFMs exhibited superior TENG properties triggered by regular respiratory vibrations, enabling 9.21-fold increase of surface potential (-1.43 kV) and nearly 68% increase of PM0.3 capturing (94.3%) compared to those of conventional PLA membranes. The remarkable TENG mechanisms were examined to elaborately monitor the personal respiration characteristics, particularly those triggered large and rapid variations of output voltages like coughing and tachypnea. Featuring desirable biocompatibility and degradability, the self-powered PLA NFMs permit promising applications in the fabrication of ecofriendly air filters toward high-performance purification and intelligent monitoring.

Bioelectrets in Electrospun Bimodal Poly(lactic acid) Fibers: Realization of Multiple Mechanisms for Efficient and Long-Term Filtration of Fine PMs

Despite the great potential in fabrication of biodegradable and eco-friendly air filters by electrospinning poly(lactic acid) (PLA) membranes, the filtering performance is frequently dwarfed by inadequate physical sieving or electrostatic adsorption mechanisms to capture airborne particulate matters (PMs). Here, using the parallel spinning approach, the unique micro/nanoscale architecture was established by conjugation of neighboring PLA nanofibers, creating bimodal fibers in electrospun PLA membranes for the enhanced slip effect to significantly reduce the air resistance. Moreover, the bone-like nanocrystalline hydroxyapatite bioelectret (HABE) was exploited to enhance the dielectric and polarization properties of electrospun PLA, accompanied by the controlled generation of junctions induced by the microaggregation of HABE (10-30 wt %). The incorporated HABE was supposed to orderly align in the applied E-field and largely promote the charging capability and surface potential, gradually increasing to 7.2 kV from the lowest level of 2.5 kV for pure PLA. This was mainly attributed to HABE-induced orientation of PLA backbone chains and C═O dipoles, as well as the interfacial charges trapped at the interphases of HABE-PLA and crystalline region-amorphous PLA. Given the multiple capturing mechanisms, the micro/nanostructured PLA/HABE membranes were characterized by excellent and sustainable filtering performance, e.g., the filtration efficiency of PM_0.3 was promoted from 59.38% for pure PLA to 94.38% after addition of 30 wt % HABE at a moderate airflow capacity of 32 L/min and from 30.78 to 83.75% at the highest level of 85 L/min. It is of interest that the pressure drop was significantly decreased, mainly arising from the slip effect between the ultrafine nanofibers and conjugated microfibers. The proposed combination of the nanostructured electret and the multistructuring strategy offers the function integration of efficient filtration and low resistance that are highly useful to pursue fully biodegradable filters.

Expedient secondary functions of flexible piezoelectrics for biomedical energy harvesting

Flexible piezoelectrics realise the conversion between mechanical movements and electrical power by conformally attaching onto curvilinear surfaces, which are promising for energy harvesting of biomedical devices due to their sustainable body movements and/or deformations. Developing secondary functions of flexible piezoelectric energy harvesters is becoming increasingly significant in recent years via aiming at issues that cannot be addressed or mitigated by merely increasing piezoelectric efficiencies. These issues include loose interfacial contact and pucker generation by stretching, power shortage or instability induced by inadequate mechanical energy, and premature function degeneration or failure caused by fatigue fracture after cyclic deformations. Herein, the expedient secondary functions of flexible piezoelectrics to mitigate above issues are reviewed, including stretchability, hybrid energy harvesting, and self-healing. Efforts have been devoted to understanding the state-of-the-art strategies and their mechanisms of achieving secondary functions based on piezoelectric fundamentals. The link between structural characteristic and function performance is unravelled by providing insights into carefully selected progresses. The remaining challenges of developing secondary functions are proposed in the end with corresponding outlooks. The current work hopes to help and inspire future research in this promising field focusing on developing the secondary functions of flexible piezoelectric energy harvesters.

Surface charge and dynamic mechanoelectrical stimuli improves adhesion, proliferation and differentiation of neuron-like cells

Neuronal diseases and trauma are among the current major health-care problems. Patients frequently develop an irreversible state of neuronal disfunction that lacks treatment, strongly reducing life quality and expectancy. Novel strategies are thus necessary and tissue engineering research is struggling to provide alternatives to current treatments, making use of biomaterials capable to provide cell supports and active stimuli to develop permissive environments for neural regeneration. As neuronal cells are naturally found in electrical microenvironments, the electrically active materials can pave the way for new and effective neuroregenerative therapies. In this work the influence of piezoelectric poly(vinylidene fluoride) with different surface charges and dynamic mechanoelectrical stimuli on neuron-like cells adhesion, proliferation and differentiation was addressed. It is successfully demonstrated that both surface charge and electrically active dynamic microenvironments can be suitable to improve neuron-like cells adhesion, proliferation, and differentiation. These findings provide new knowledge to develop effective approaches for preclinical applications.

Mechanical Sensors for Cardiovascular Monitoring: From Battery-Powered to Self-Powered

Cardiovascular disease is one of the leading causes of death worldwide. Long-term and real-time monitoring of cardiovascular indicators is required to detect abnormalities and conduct early intervention in time. To this end, the development of flexible wearable/implantable sensors for real-time monitoring of various vital signs has aroused extensive interest among researchers. Among the different kinds of sensors, mechanical sensors can reflect the direct information of pressure fluctuations in the cardiovascular system with the advantages of high sensitivity and suitable flexibility. Herein, we first introduce the recent advances of four kinds of mechanical sensors for cardiovascular system monitoring, based on capacitive, piezoresistive, piezoelectric, and triboelectric principles. Then, the physio-mechanical mechanisms in the cardiovascular system and their monitoring are described, including pulse wave, blood pressure, heart rhythm, endocardial pressure, etc. Finally, we emphasize the importance of real-time physiological monitoring in the treatment of cardiovascular disease and discuss its challenges in clinical translation.

Recent Advances in Flexible Sensors and Their Applications

Flexible sensors are low cost, wearable, and lightweight, as well as having a simple structure as per the requirements of engineering applications. Furthermore, for many potential applications, such as human health monitoring, robotics, wearable electronics, and artificial intelligence, flexible sensors require high sensitivity and stretchability. Herein, this paper systematically summarizes the latest progress in the development of flexible sensors. The review briefly presents the state of the art in flexible sensors, including the materials involved, sensing mechanisms, manufacturing methods, and the latest development of flexible sensors in health monitoring and soft robotic applications. Moreover, this paper provides perspectives on the challenges in this field and the prospect of flexible sensors.

Stretchable, breathable, and highly sensitive capacitive and self-powered electronic skin based on core-shell nanofibers

Fiber-based nanostructures are greatly desired for the improvement of wearable/flexible electronics, which are expected to be stretchable, conformable, flexible, and long-term. Herein, an ultra-stretchable, breathable, and highly sensitive flexible capacitive tactile sensor and triboelectric effect core-shell nanofibers are proposed. In particular, core-shell ionic TPU/PVDF-HFP nanofibers are effectively prepared by an electrospinning approach. The core-shell ionic TPU/PVDF-HFP nanofibers exhibit high performance as a capacitive flexible sensor with high sensitivity (0.718 kPa^-1) in a low linear pressure range (0-1.2 kPa), an ultralow detection limit (7 Pa), a rapid response and recovery time, and excellent stability. Moreover, we assembled a self-powered pressure sensor, which has a sensitivity of 0.071 V kPa^-1 in the high linear pressure range of 90 kPa to 400 kPa. The increase in the inductive charges of the nanofiber layer allows it to work as an energy harvester with a high power density (1.6 W m^-2) that can light up 100 LEDs instantly. These remarkable results allow the capacitive flexible devices to be applied in various applications, such as spatial pressure mapping, bending angle detection, soft grabbing, and physiological signal monitoring.

Piezoelectric nanogenerators for personalized healthcare

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

Quaternized chitin/tannic acid bilayers layer-by-layer deposited poly(lactic acid)/polyurethane nanofibrous mats decorated with photoresponsive complex and silver nanoparticles for antibacterial activity

Chronic wounding treatment based on bacterially infected diabetes suffers an essential limitation in persistent skin injuries due to the resistance of progressive antibiotics, which inhibits the process of healing with wound tissue. Therefore, biologically friendly and nontoxic bio-based mats without antibiotics are taken for granted as a versatile platform for biomedical dressing, but urgently necessitates further functional diversification. Herein, a novel tannic acid (TA)/silver (Ag)-modified poly(lactic acid) (PLA)/Polyurethane (PU) antibacterial hybrid nanofibers were successfully constructed by electrospinning technology. Layer-by-layer (LBL) self-assembly technique was utilized to produce membranes via deposited biocompatible quaternized chitin (QC) and TA. The mats are enabled with outstanding flexibility, antibacterial activity, great hemocompatibility, and good ROS-scavenger in a wounding environment. Consequently, the basis of morphology and structure of electrospun membranes was verified by SEM and FT-IR. Besides, the LBL-structured surface was proved to impart improved wettability and hydrophilic via the test of water contact angle. Additionally, antimicrobial experiments demonstrate the effective broad-spectrum antibacterial ability of as-prepared hybrids, inhibiting infection of gram-positive microbial (S. aureus) as well as gram-negative microbial. Finally, the anti-oxidation performance holds great promise in conducive to the formation favorable physiological environment for wound healing. In conclusion, this work establishes a feasible but effective pathway to construct a multifunctional antibacterial dressing for the skin infection.

Poly-l-Lactic Acid (PLLA)-Based Biomaterials for Regenerative Medicine: A Review on Processing and Applications

Synthetic biopolymers are effective cues to replace damaged tissue in the tissue engineering (TE) field, both for in vitro and in vivo application. Among them, poly-l-lactic acid (PLLA) has been highlighted as a biomaterial with tunable mechanical properties and biodegradability that allows for the fabrication of porous scaffolds with different micro/nanostructures via various approaches. In this review, we discuss the structure of PLLA, its main properties, and the most recent advances in overcoming its hydrophobic, synthetic nature, which limits biological signaling and protein absorption. With this aim, PLLA-based scaffolds can be exposed to surface modification or combined with other biomaterials, such as natural or synthetic polymers and bioceramics. Further, various fabrication technologies, such as phase separation, electrospinning, and 3D printing, of PLLA-based scaffolds are scrutinized along with the in vitro and in vivo applications employed in various tissue repair strategies. Overall, this review focuses on the properties and applications of PLLA in the TE field, finally affording an insight into future directions and challenges to address an effective improvement of scaffold properties.

Integrated osteochondral differentiation of mesenchymal stem cells on biomimetic nanofibrous mats with cell adhesion-generated piezopotential gradients

Biomimetic piezoelectric scaffolds provide a noninvasive method for in vivo cell regulation and tissue regeneration. Herein, considering the gradually varied piezoelectric properties of native cartilage and bone tissues, we fabricated biomimetic electrospun poly(L-lactic acid) (PLLA) nanofibrous mats with gradient piezoelectric properties to induce the integrated osteochondral differentiation of rat mesenchymal stem cells (MSCs). Nanofibrous mats are polarized under electric fields with linear variation of strength to generate gradient piezoelectricity, and cell adhesion-derived contraction forces could produce gradient piezoelectric potential on the scaffolds. Our results demonstrated that the piezoelectric potential could positively modulate cell adhesion, intracellular calcium transients, Ca²⁺ binding proteins, and differentiation-related genes. In addition, the differentiation of MSCs into osteogenic and chondrogenic lineages was integrated on a single scaffold at different areas with relatively high and low piezoelectricity values, respectively. The continuous gradient scaffold exhibited the potential to provide a smooth transition between the cartilage and bone, offering new insights to probe the regeneration mechanisms of the osteochondral tissue in a single scaffold and inspiring a future efficient and rational design of piezoelectric smart biomaterials for tissue engineering.

Powering Implantable and Ingestible Electronics

Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.

Ultra-Flexible Organic Solar Cell Based on Indium-Zinc-Tin Oxide Transparent Electrode for Power Source of Wearable Devices

We have developed a novel structure of ultra-flexible organic photovoltaics (UFOPVs) for application as a power source for wearable devices with excellent biocompatibility and flexibility. Parylene was applied as an ultra-flexible substrate through chemical vapor deposition. Indium-zinc-tin oxide (IZTO) thin film was used as a transparent electrode. The sputtering target composed of 70 at.% In₂O₃-15 at.% ZnO-15 at.% SnO₂ was used. It was fabricated at room temperature, using pulsed DC magnetron sputtering, with an amorphous structure. UFOPVs, in which a 1D grating pattern was introduced into the hole-transport and photoactive layers were fabricated, showed a 13.6% improvement (maximum power conversion efficiency (PCE): 8.35%) compared to the reference device, thereby minimizing reliance on the incident angle of the light. In addition, after 1000 compression/relaxation tests with a compression strain of 33%, the PCE of the UFOPVs maintained a maximum of 93.3% of their initial value.

Stimuli-Responsive Electrospun Piezoelectric Mats of Ethylene-co-vinyl Acetate-Millable Polyurethane-Nanohydroxyapatite Composites

Piezoelectric materials have gained interest among materials scientists as body motion sensors and energy harvesters on account of their fast responsiveness and substantial output signals. In this work, piezoelectric polymer mats have been fabricated from ethylene-co-vinyl acetate-millable polyurethane/nanohydroxyapatite (EVA-MPU/nHA) composite systems by employing the electrospinning technique. The ferro-piezoelectric features of the samples were confirmed from the butterfly loops of electrostatic force microscopy (EFM) amplitude signals as well as through the hysteresis curves of the EFM phase recorded with the assistance of dynamic-contact EFM. Piezoelectric responses of the samples to random finger tapping were evaluated after fabricating a simple device prototype connected to an oscilloscope. The efficacy of the mats to generate a voltage in response to activities such as mechanical bending, movement of throat muscles while drinking, movement of elbow joints, air blowing, and so forth has also been investigated. The results suggest the promising possibility of fabricating user-friendly piezoelectric mats out of the EVA-MPU/nHA system for physiological motion-sensing applications.

Fabrication of piezoelectric poly(L-lactic acid)/BaTiO3 fibre by the melt-spinning process

Poly(l-lactic acid) (PLLA) based piezoelectric polymers are gradually becoming the substitute for the conventional piezoelectric ceramic and polymeric materials due to their low cost and biodegradable, non-toxic, piezoelectric and non-pyroelectric nature. To improve the piezoelectric properties of melt-spun poly(l-lactic acid) (PLLA)/BaTiO₃, we optimized the post-processing conditions to increase the proportion of the β crystalline phase. The α → β phase transition behaviour was determined by two-dimensional wide-angle x-ray diffraction and differential scanning calorimetry. The piezoelectric properties of PLLA/BaTiO₃ fibres were characterised in their yarn and textile form through a tapping method. From these results, we confirmed that the crystalline phase transition of PLLA/BaTiO₃ fibres was significantly enhanced under the optimised post-processing conditions at a draw ratio of 3 and temperature of 120 °C during the melt-spinning process. The results indicated that PLLA/BaTiO₃ fibres could be a one of the material for organic-based piezoelectric sensors for application in textile-based wearable piezoelectric devices.

Transduction Mechanisms, Micro-Structuring Techniques, and Applications of Electronic Skin Pressure Sensors: A Review of Recent Advances

Electronic skin (e-skin), which is an electronic surrogate of human skin, aims to recreate the multifunctionality of skin by using sensing units to detect multiple stimuli, while keeping key features of skin such as low thickness, stretchability, flexibility, and conformability. One of the most important stimuli to be detected is pressure due to its relevance in a plethora of applications, from health monitoring to functional prosthesis, robotics, and human-machine-interfaces (HMI). The performance of these e-skin pressure sensors is tailored, typically through micro-structuring techniques (such as photolithography, unconventional molds, incorporation of naturally micro-structured materials, laser engraving, amongst others) to achieve high sensitivities (commonly above 1 kPa⁻¹), which is mostly relevant for health monitoring applications, or to extend the linearity of the behavior over a larger pressure range (from few Pa to 100 kPa), an important feature for functional prosthesis. Hence, this review intends to give a generalized view over the most relevant highlights in the development and micro-structuring of e-skin pressure sensors, while contributing to update the field with the most recent research. A special emphasis is devoted to the most employed pressure transduction mechanisms, namely capacitance, piezoelectricity, piezoresistivity, and triboelectricity, as well as to materials and novel techniques more recently explored to innovate the field and bring it a step closer to general adoption by society.

On the Nanoscale Mapping of the Mechanical and Piezoelectric Properties of Poly (L-Lactic Acid) Electrospun Nanofibers

The effect of the post-annealing process on different properties of poly (L-lactic acid) (PLLA) nanofibers has been investigated in view of their use in energy-harvesting devices. Polymeric PLLA nanofibers were prepared by using electrospinning and then were thermally treated above their glass transition. A detailed comparison between as-spun (amorphous) and annealed (semi-crystalline) samples was performed in terms of the crystallinity, morphology and mechanical as well as piezoelectric properties using a multi-technique approach combining DSC, XRD, FTIR, and AFM measurements. A significant increase in the crystallinity of PLLA nanofibers has been observed after the post-annealing process, together with a major improvement of the mechanical and piezoelectric properties.

Recent Advances in Organic Piezoelectric Biomaterials for Energy and Biomedical Applications

The past decade has witnessed significant advances in medically implantable and wearable devices technologies as a promising personal healthcare platform. Organic piezoelectric biomaterials have attracted widespread attention as the functional materials in the biomedical devices due to their advantages of excellent biocompatibility and environmental friendliness. Biomedical devices featuring the biocompatible piezoelectric materials involve energy harvesting devices, sensors, and scaffolds for cell and tissue engineering. This paper offers a comprehensive review of the principles, properties, and applications of organic piezoelectric biomaterials. How to tackle issues relating to the better integration of the organic piezoelectric biomaterials into the biomedical devices is discussed. Further developments in biocompatible piezoelectric materials can spark a new age in the field of biomedical technologies.

Biodegradable nanofiber-based piezoelectric transducer

Piezoelectric materials, a type of "smart" material that generates electricity while deforming and vice versa, have been used extensively for many important implantable medical devices such as sensors, transducers, and actuators. However, commonly utilized piezoelectric materials are either toxic or nondegradable. Thus, implanted devices employing these materials raise a significant concern in terms of safety issues and often require an invasive removal surgery, which can damage directly interfaced tissues/organs. Here, we present a strategy for materials processing, device assembly, and electronic integration to 1) create biodegradable and biocompatible piezoelectric PLLA [poly(l-lactic acid)] nanofibers with a highly controllable, efficient, and stable piezoelectric performance, and 2) demonstrate device applications of this nanomaterial, including a highly sensitive biodegradable pressure sensor for monitoring vital physiological pressures and a biodegradable ultrasonic transducer for blood-brain barrier opening that can be used to facilitate the delivery of drugs into the brain. These significant applications, which have not been achieved so far by conventional piezoelectric materials and bulk piezoelectric PLLA, demonstrate the PLLA nanofibers as a powerful material platform that offers a profound impact on various medical fields including drug delivery, tissue engineering, and implanted medical devices.

Wearable Sensors for Monitoring Human Motion: A Review on Mechanisms, Materials, and Challenges

The emergence of flexible wearable electronics as a new platform for accurate, unobtrusive, user-friendly, and longitudinal sensing has opened new horizons for personalized assistive tools for monitoring human locomotion and physiological signals. Herein, we survey recent advances in methodologies and materials involved in unobtrusively sensing a medium to large range of applied pressures and motions, such as those encountered in large-scale body and limb movements or posture detection. We discuss three commonly used methodologies in human gait studies: inertial, optical, and angular sensors. Next, we survey the various kinds of electromechanical devices (piezoresistive, piezoelectric, capacitive, triboelectric, and transistive) that are incorporated into these sensor systems; define the key metrics used to quantitate, compare, and optimize the efficiency of these technologies; and highlight state-of-the-art examples. In the end, we provide the readers with guidelines and perspectives to address the current challenges of the field.

One-component waterborne in vivo cross-linkable polysiloxane coatings for artificial skin

Polysiloxane-based artificial skins are able to emulate the mechanical and barrier performance of human skin. However, they are usually fabricated in vitro, restricting their diverse applications on human body. Herein, we presented one-component waterborne cross-linkable polysiloxane coatings prepared from emulsified vinyl dimethicone, emulsified hydrogen dimethicone, and Karstedt catalyst capsules that were first synthesized by solvent evaporation method. The coating had good storage stability and meanwhile could form an elastic film quickly through merging of silicone oil droplets and subsequent hydrosilylation reaction. It was found that the mass ratio of vinyl dimethicone emulsion/hydrogen dimethicone emulsion (V/H), and the dosage of Karstedt catalyst capsules (K/(V + H)) were critical to the curing time, morphology, and mechanical properties of the coatings. With appropriate values of V/H and K/(V + H), the polysiloxane film had the mechanical performance comparable to that from solvent-based one. The coating could be topically applied to human skin in vivo and in situ turned into an elastic, invisible thin film with good water resistance. In contrast to those reported polysiloxane materials, the one-component waterborne polysiloxane coating was nontoxic and convenient for in vivo application on human body, making it be a promising candidate as artificial skin in the fields of cosmetics, medical treatment, and E-skin.

Methylammonium Lead Iodide Incorporated Poly(vinylidene fluoride) Nanofibers for Flexible Piezoelectric-Pyroelectric Nanogenerator

This work introduces a piezoelectric-pyroelectric nanogenerator (P-PNG) based on methylammonium lead iodide (CH₃NH₃PbI₃) incorporated electrospun poly(vinylidene fluoride) (PVDF) nanofibers that are able to harvest mechanical and thermal energies. During the application of a periodic compressive contact force at a frequency of 4 Hz, an output voltage of ∼220 mV is generated. The P-PNG has a piezoelectric coefficient (d₃₃) of ∼19.7 pC/N coupled with a high durability (60 000 cycles) and quick response time (∼1 ms). The maximum generated output power density (∼0.8 mW/m²) is sufficient to charge up a variety of capacitors, with the potential to replace an external power supply to drive portable devices. In addition, upon exposure to cyclic heating and cooling at a temperature of 38 K, a pyroelectric output current of 18.2 pA and a voltage of 41.78 mV were achieved. The fast response time of 1.14 s, reset time of 1.25 s, and pyroelectric coefficient of ∼44 pC/m² K demonstrate a self-powered temperature sensing capability of the P-PNG. These characteristics make the P-PNG suitable for flexible piezoelectric-pyroelectric energy harvesting for self-powered electronic devices.

Application of piezoelectric cells printing on three-dimensional porous bioceramic scaffold for bone regeneration

In recent years, the additive manufacture was popularly used in tissue engineering, as the various technologies for this field of research can be used. The most common method is extrusion, which is commonly used in many bioprinting applications, such as skin. In this study, we combined the two printing techniques; first, we use the extrusion technology to form the ceramic scaffold. Then, the stem cells were printed directly on the surface of the ceramic scaffold through a piezoelectric nozzle. We also evaluated the effects of polydopamine (PDA)-coated ceramic scaffolds for cell attachment after printing on the surface of the scaffold. In addition, we used fluorescein isothiocyanate to simulate the cell adhered on the scaffold surface after ejected by a piezoelectric nozzle. Finally, the attachment, growth, and differentiation behaviors of stem cell after printing on calcium silicate/polycaprolactone (CS/PCL) and PDACS/PCL surfaces were also evaluated. The PDACS/PCL scaffold is more hydrophilic than the original CS/PCL scaffold that provided for better cellular adhesion and proliferation. Moreover, the cell printing technology using the piezoelectric nozzle, the different cells can be accurately printed on the surface of the scaffold that provided and analyzed more information of the interaction between different cells on the material. We believe that this method may serve as a useful and effective approach for the regeneration of defective complex hard tissues in deep bone structures.

Piezoelectric Biomaterials for Sensors and Actuators

Recent advances in materials, manufacturing, biotechnology, and microelectromechanical systems (MEMS) have fostered many exciting biosensors and bioactuators that are based on biocompatible piezoelectric materials. These biodevices can be safely integrated with biological systems for applications such as sensing biological forces, stimulating tissue growth and healing, as well as diagnosing medical problems. Herein, the principles, applications, future opportunities, and challenges of piezoelectric biomaterials for medical uses are reviewed thoroughly. Modern piezoelectric biosensors/bioactuators are developed with new materials and advanced methods in microfabrication/encapsulation to avoid the toxicity of conventional lead-based piezoelectric materials. Intriguingly, some piezoelectric materials are biodegradable in nature, which eliminates the need for invasive implant extraction. Together, these advancements in the field of piezoelectric materials and microsystems can spark a new age in the field of medicine.

Self-Powered Wearable Pressure Sensors with Enhanced Piezoelectric Properties of Aligned P(VDF-TrFE)/MWCNT Composites for Monitoring Human Physiological and Muscle Motion Signs

Self-powered operation, flexibility, excellent mechanical properties, and ultra-high sensitivity are highly desired properties for pressure sensors in human health monitoring and anthropomorphic robotic systems. Piezoelectric pressure sensors, with enhanced electromechanical performance to effectively distinguish multiple mechanical stimuli (including pressing, stretching, bending, and twisting), have attracted interest to precisely acquire the weak signals of the human body. In this work, we prepared a poly(vinylidene fluoride-trifluoroethylene)/ multi-walled carbon nanotube (P(VDF-TrFE)/MWCNT) composite by an electrospinning process and stretched it to achieve alignment of the polymer chains. The composite membrane demonstrated excellent piezoelectricy, favorable mechanical strength, and high sensitivity. The piezoelectric coefficient d33 value was approximately 50 pm/V, the Young's modulus was ~0.986 GPa, and the sensitivity was ~540 mV/N. The resulting composite membrane was employed as a piezoelectric pressure sensor to monitor small physiological signals including pulse, breath, and small motions of muscle and joints such as swallowing, chewing, and finger and wrist movements. Moderate doping with carbon nanotubes had a positive impact on the formation of the β phase of the piezoelectric device, and the piezoelectric pressure sensor has the potential for application in health care systems and smart wearable devices.