A wearable patch for continuous monitoring of sweat electrolytes during exertion

A physiological perspective of the relevance of sweat biomarkers and their detection by wearable microfluidic technology: A review

The great majority of published microfluidic wearable platforms for sweat sensing focus on the development of the technology to fabricate the device, the integration of sensing materials and actuators and the fluidics of sweat within the device. However, very few papers have discussed the physiological relevance of the metabolites measured using these novel approaches. In fact, some of the analytes present in sweat, which serve as biomarkers in blood, do not show a correlation with blood levels. This discrepancy can be attributed to factors such as contamination during measurements, the metabolism of sweat glands, or challenges in obtaining significant samples. The objective of this review is to present a critical and meaningful insight into the real applicability and potential use of wearable technology for improving health and sport performance. It also discusses the current limitations and future challenges of microfluidics, aiming to provide accurate information about the actual needs in this field. This work is expected to contribute to the future development of more suitable wearable microfluidic technology for health and sports science monitoring, using sweat as the biofluid for analysis.

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

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

Flexible/Regenerative Nanosensor with Automatic Sweat Collection for Cytokine Storm Biomarker Detection

The real-time monitoring of low-concentration cytokines such as TNF-α in sweat can aid clinical physicians in assessing the severity of inflammation. The challenges associated with the collection and the presence of impurities can significantly impede the detection of proteins in sweat. This issue is addressed by incorporating a nanosphere array designed for automatic sweat transportation, coupled with a reusable sensor that employs a Nafion/aptamer-modified MoS2 field-effect transistor. The nanosphere array with stepwise wettability enables automatic collection of sweat and blocks impurities from contaminating the detection zone. This device enables direct detection of TNF-α proteins in undiluted sweat, within a detection range of 10 fM to 1 nM. The use of an ultrathin, ultraflexible substrate ensures stable electrical performance, even after up to 30 extreme deformations. The findings indicate that in clinical scenarios, this device could potentially provide real-time evaluation and management of patients' immune status via sweat testing.

Nature-Inspired Superhydrophilic Biosponge as Structural Beneficial Platform for Sweating Analysis Patch

Perspiration plays a pivotal role not only in thermoregulation but also in reflecting the body's internal state and its response to external stimuli. The up-to-date skin-based wearable platforms have facilitated the monitoring and simultaneous analysis of sweat, offering valuable physiological insights. Unlike conventional passive sweating, dynamic normal perspiration, which occurs during various activities and rest periods, necessitates a more reliable method of collection to accurately capture its real-time fluctuations. An innovative microfluidic patch incorporating a hierarchical superhydrophilic biosponge, poise to significantly improve the efficiency capture of dynamic sweat is introduced. The seamlessly integrated biosponge microchannel showcases exceptional absorption capabilities, efficiently capturing non-sensitive sweat exuding from the skin surface, mitigating sample loss and minimizing sweat volatilization. Furthermore, the incorporation of sweat-rate sensors alongside a suite of functional electrochemical sensors endows the patch of uninterrupted monitoring and analysis of dynamic sweat during various activities, stress events, high-energy intake, and other scenarios.

Porous Conductive Textiles for Wearable Electronics

Over the years, researchers have made significant strides in the development of novel flexible/stretchable and conductive materials, enabling the creation of cutting-edge electronic devices for wearable applications. Among these, porous conductive textiles (PCTs) have emerged as an ideal material platform for wearable electronics, owing to their light weight, flexibility, permeability, and wearing comfort. This Review aims to present a comprehensive overview of the progress and state of the art of utilizing PCTs for the design and fabrication of a wide variety of wearable electronic devices and their integrated wearable systems. To begin with, we elucidate how PCTs revolutionize the form factors of wearable electronics. We then discuss the preparation strategies of PCTs, in terms of the raw materials, fabrication processes, and key properties. Afterward, we provide detailed illustrations of how PCTs are used as basic building blocks to design and fabricate a wide variety of intrinsically flexible or stretchable devices, including sensors, actuators, therapeutic devices, energy-harvesting and storage devices, and displays. We further describe the techniques and strategies for wearable electronic systems either by hybridizing conventional off-the-shelf rigid electronic components with PCTs or by integrating multiple fibrous devices made of PCTs. Subsequently, we highlight some important wearable application scenarios in healthcare, sports and training, converging technologies, and professional specialists. At the end of the Review, we discuss the challenges and perspectives on future research directions and give overall conclusions. As the demand for more personalized and interconnected devices continues to grow, PCT-based wearables hold immense potential to redefine the landscape of wearable technology and reshape the way we live, work, and play.

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

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

Measuring the Salt Content of Sweat inside a Sweat-Absorbing Skin Adhesive

Biofluids contain a wealth of different biomarkers, and their concentrations are indicative of the state of the body. As one of those biofluids, sweat is easily accessible, and its composition can, for example, be related to particular diseases or sports performance. Due to the relatively low sweat flow rates, however, adequate sampling is paramount. Here, we aim to explore the potential use of sweat-absorbing skin adhesives as a sweat sampling system for wearable sensors with a simple construction. Upon absorption of sweat, the electrochemical properties of the skin adhesive are determined by the composition of sweat and the amount of sweat within the skin adhesive (i.e., hydration). Through the incorporation of two polarizable electrodes within the skin adhesive, its electrical properties can be monitored using impedance spectroscopy. Here, the double layer capacitance is used as an indicator of hydration, while the conductance depends on both the ion concentration and hydration (the mobility of ions). By evaluating the conductance as a function of hydration, the ion concentration within an electrolyte solution can be estimated. We demonstrate the concept based on a simple model sensor patch, which is exposed to electrolyte solutions containing various concentrations of NaCl and an artificial sweat solution. Finally, we show that ion concentrations in human sweat can be estimated when the model sensor patch is worn during exercise.

Screen-Printed Wearable Sweat Sensor for Cost-Effective Assessment of Human Hydration Status through Potassium and Sodium Ion Detection

Human sweat is intricately linked to human health, and unraveling its secrets necessitates a substantial volume of experimental data. However, conventional sensors fabricated via complex processes such as photolithography offer high detection precision at the expense of prohibitive costs. In this study, we presented a cost-effective and high-performance wearable flexible sweat sensor for real-time monitoring of K+ and Na+ concentrations in human sweat, fabricated using screen printing technology. Initially, we evaluated the electrical and electrochemical stability of the screen-printed substrate electrodes, which demonstrated good consistency with a variation within 10% of the relative standard deviation (RSD), meeting the requirements for reliable detection of K+ and Na+ in human sweat. Subsequently, we employed an "ion-electron" transduction layer and an ion-selective membrane to construct the sensors for detecting K+ and Na+. Comprehensive tests were conducted to assess the sensors' sensitivity, linearity, repeatability, resistance to interference, and mechanical deformation capabilities. Furthermore, we evaluated their long-term stability during continuous monitoring and storage. The test results confirmed that the sensor's performance indicators, as mentioned above, met the requirements for analyzing human sweat. In a 10-day continuous and regular monitoring experiment involving volunteers wearing the sensors, a wealth of data revealed a close relationship between K+ and Na+ concentrations in human sweat and hydration status. Notably, we observed that consistent and regular physical exercise effectively enhanced the body's resistance to dehydration. These findings provided a solid foundation for conducting extensive experiments and further exploring the intricate relationship between human sweat and overall health. Our research paved a practical and feasible path for future studies in this domain.

Noninvasive Monitoring to Detect Dehydration: Are We There Yet?

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

Multifunctional Biosensing Platform Based on Nickel-Modified Laser-Induced Graphene

Nickel plating electrolytes prepared by using a simple salt solution can achieve nickel plating on laser-induced graphene (LIG) electrodes, which greatly enhances the electrical conductivity, electrochemical properties, wear resistance, and corrosion resistance of LIG. This makes the LIG-Ni electrodes well suited for electrophysiological, strain, and electrochemical sensing applications. The investigation of the mechanical properties of the LIG-Ni sensor and the monitoring of pulse, respiration, and swallowing confirmed that the sensor can sense insignificant deformations to relatively large conformal strains of skin. Modulation of the nickel-plating process of LIG-Ni, followed by chemical modification, may allow for the introduction of glucose redox catalyst Ni2Fe(CN)6 with interestingly strong catalytic effects, which gives LIG-Ni impressive glucose-sensing properties. Additionally, the chemical modification of LIG-Ni for pH and Na+ monitoring also confirmed its strong electrochemical monitoring potential, which demonstrates application prospects in the development of multiple electrochemical sensors for sweat parameters. A more uniform LIG-Ni multi-physiological sensor preparation process provides a prerequisite for the construction of an integrated multi-physiological sensor system. The sensor was validated to have continuous monitoring performance, and its preparation process is expected to form a system for non-invasive physiological parameter signal monitoring, thus contributing to motion monitoring, disease prevention, and disease diagnosis.

Advances in Integration, Wearable Applications, and Artificial Intelligence of Biomedical Microfluidics Systems

Microfluidics attracts much attention due to its multiple advantages such as high throughput, rapid analysis, low sample volume, and high sensitivity. Microfluidics has profoundly influenced many fields including chemistry, biology, medicine, information technology, and other disciplines. However, some stumbling stones (miniaturization, integration, and intelligence) strain the development of industrialization and commercialization of microchips. The miniaturization of microfluidics means fewer samples and reagents, shorter times to results, and less footprint space consumption, enabling a high throughput and parallelism of sample analysis. Additionally, micro-size channels tend to produce laminar flow, which probably permits some creative applications that are not accessible to traditional fluid-processing platforms. The reasonable integration of biomedical/physical biosensors, semiconductor microelectronics, communications, and other cutting-edge technologies should greatly expand the applications of current microfluidic devices and help develop the next generation of lab-on-a-chip (LOC). At the same time, the evolution of artificial intelligence also gives another strong impetus to the rapid development of microfluidics. Biomedical applications based on microfluidics normally bring a large amount of complex data, so it is a big challenge for researchers and technicians to analyze those huge and complicated data accurately and quickly. To address this problem, machine learning is viewed as an indispensable and powerful tool in processing the data collected from micro-devices. In this review, we mainly focus on discussing the integration, miniaturization, portability, and intelligence of microfluidics technology.

Skin-Interfaced Wearable Sweat Sensors for Precision Medicine

Wearable sensors hold great potential in empowering personalized health monitoring, predictive analytics, and timely intervention toward personalized healthcare. Advances in flexible electronics, materials science, and electrochemistry have spurred the development of wearable sweat sensors that enable the continuous and noninvasive screening of analytes indicative of health status. Existing major challenges in wearable sensors include: improving the sweat extraction and sweat sensing capabilities, improving the form factor of the wearable device for minimal discomfort and reliable measurements when worn, and understanding the clinical value of sweat analytes toward biomarker discovery. This review provides a comprehensive review of wearable sweat sensors and outlines state-of-the-art technologies and research that strive to bridge these gaps. The physiology of sweat, materials, biosensing mechanisms and advances, and approaches for sweat induction and sampling are introduced. Additionally, design considerations for the system-level development of wearable sweat sensing devices, spanning from strategies for prolonged sweat extraction to efficient powering of wearables, are discussed. Furthermore, the applications, data analytics, commercialization efforts, challenges, and prospects of wearable sweat sensors for precision medicine are discussed.

Cloth-based microfluidic devices integrated onto the patch as wearable colorimetric sensors for simultaneous sweat analysis

Introduction

In this work, a flexible, and wearable point-of-care (POC) device integrated on a pain relief patch as wearable colorimetric sensors have been developed for sweat analysis, such as lactic acid, sodium ions, and pH simultaneously. Herein, the patch has still functioned as pain relief, while it allows for sweat monitoring during exercise, and in daily activities.

Methods

It was constructed on cotton cloth using wax printing technology (batik stamp) as cloth-based microfluidic devices (CMDs). Here, it uses micro volumes of samples to perform the reaction in the sensing zones, where the sensitive reagents are immobilized so that it can collect and analyze the sweat (lactic acid, sodium ions, and pH) as the model for sweat analytes. The colorimetric analysis was conducted via a smartphone camera by using a free app (Color Grab) for a color image analysis that uses for quantitative analysis or naked eye for semi-qualitative analysis.

Results

The ∆RGB value of the CMDS shows the excellent linear correlation vs analytes concentration, where the coefficient of correlations was found for lactic acid (R2 = 0.994), sodium ion (R2 = 0.998), and pH (R2 = 0.994). The ∆RGB value shows the appropriate color value for the linear correlation of the analyte target concentrations in the sweat samples. Here, the limit of detection (LOD) was found at 45.73 µg/mL for lactic acid and 56.46 µg/mL for sodium ions. The reproducibility was found at 0.79% and 0.89%, for lactic acid and sodium ions respectively.

Conclusion

It was applied for sweat analysis during exercise, and the results show in agreement with the standard methods used in a clinical laboratory.

Hydrovoltaic Nanogenerators for Self-Powered Sweat Electrolyte Analysis

Human sweat comprises various electrolytes that are health status indicators. Conventional potentiometric electrolyte sensors require an electrical power source, which is expensive, bulky, and requires a complex architecture. Herein, this work demonstrates an electric nanogenerator fabricated using silicon nanowire (SiNW) arrays comprising modified carbon nanoparticles. The SiNW arrays platform is demonstrated as an effective self-powered sensor for sweat electrolyte analysis. It has been shown that an evaporation-induced water flow in nanochannels can yield an open-circuit voltage (V_oc ) of 0.45 V and a short-circuit current of 10.2 µA at room temperature as a result of overlapped electric double layers. The electrolyte in the water flow results in a V_oc decrease due to the charge shielding effect. The V_oc is inversely proportional to the electrolyte concentration. The fabricated hydrovoltaic device shows the capability for sensing electrolytes in human sweat, which is useful in evaluating the hydration status of volunteers following intense physical exercise. The device depicts a novel response mechanism compared to conventional electrochemical sensors. Furthermore, the hydrovoltaic device shows a maximum output power of 1.42 µW, and as such has been successfully shown to drive various electronic devices including light-emitting diodes, a calculator, and an electronic timer.

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

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

A Comprehensive Review of the Recent Developments in Wearable Sweat-Sensing Devices

Sweat analysis offers non-invasive real-time on-body measurement for wearable sensors. However, there are still gaps in current developed sweat-sensing devices (SSDs) regarding the concerns of mixing fresh and old sweat and real-time measurement, which are the requirements to ensure accurate the measurement of wearable devices. This review paper discusses these limitations by aiding model designs, features, performance, and the device operation for exploring the SSDs used in different sweat collection tools, focusing on continuous and non-continuous flow sweat analysis. In addition, the paper also comprehensively presents various sweat biomarkers that have been explored by earlier works in order to broaden the use of non-invasive sweat samples in healthcare and related applications. This work also discusses the target analyte's response mechanism for different sweat compositions, categories of sweat collection devices, and recent advances in SSDs regarding optimal design, functionality, and performance.

Point-of-care and self-testing for potassium: recent advances

Potassium is an important bodily electrolyte which is kept within tight limits in health. Many medical conditions as well as commonly-used drugs either raise or lower blood potassium levels, which can be dangerous or even fatal. For at-risk patients, frequent monitoring of potassium can improve safety and lifestyle, but conventional venous blood draws are inconvenient, don't provide a timely result and may be inaccurate. This review summarises current solutions and recent developments in point-of-care and self-testing potassium measurement technologies, which include devices for measurement of potassium in venous blood, devices for home blood collection and remote measurement, devices for rapid home measurement of potassium, wearable sensors for potassium in interstitial fluid, in sweat, in urine, as well as non-invasive potassium detection. We discuss the practical and clinical applicability of these technologies and provide future outlooks.

Wearable Sensor for Continuous Sweat Biomarker Monitoring

In recent years, wearable sensors have enabled the unique mode of real-time and noninvasive monitoring to develop rapidly in medical care, sports, and other fields. Sweat contains a wide range of biomarkers such as metabolites, electrolytes, and various hormones. Combined with wearable technology, sweat can reflect human fatigue, disease, mental stress, dehydration, and so on. This paper comprehensively describes the analysis of sweat components such as glucose, lactic acid, electrolytes, pH, cortisol, vitamins, ethanol, and drugs by wearable sensing technology, and the application of sweat wearable devices in glasses, patches, fabrics, tattoos, and paper. The development trend of sweat wearable devices is prospected. It is believed that if the sweat collection, air permeability, biocompatibility, sensing array construction, continuous monitoring, self-healing technology, power consumption, real-time data transmission, specific recognition, and other problems of the wearable sweat sensor are solved, we can provide the wearer with important information about their health level in the true sense.

Wearables in Sports Cardiology

The expanding array and adoption of consumer health wearables is creating a new dynamic to the patient-health-care provider relationship. Providers are increasingly tasked with integrating the biometric data collected from their patients into clinical care. Further, a growing body of evidence is supporting the provider-driven utility of wearables in the screening, diagnosis, and monitoring of cardiovascular disease. Here we highlight existing and emerging wearable health technologies and the potential applications for use within sports cardiology. We additionally highlight how wearables can advance the remote cardiovascular care of patients within the context of the COVID-19 pandemic. Finally, despite these promising advances, we acknowledge some of the significant challenges that remain before wearables can be routinely incorporated into clinical care.

State of the Art in Smart Portable, Wearable, Ingestible and Implantable Devices for Health Status Monitoring and Disease Management

Several illnesses that are chronic and acute are becoming more relevant as the world's aging population expands, and the medical sector is transforming rapidly, as a consequence of which the need for "point-of-care" (POC), identification/detection, and real time management of health issues that have been required for a long time are increasing. Biomarkers are biological markers that help to detect status of health or disease. Biosensors' applications are for screening for early detection, chronic disease treatment, health management, and well-being surveillance. Smart devices that allow continual monitoring of vital biomarkers for physiological health monitoring, medical diagnosis, and assessment are becoming increasingly widespread in a variety of applications, ranging from biomedical to healthcare systems of surveillance and monitoring. The term "smart" is used due to the ability of these devices to extract data with intelligence and in real time. Wearable, implantable, ingestible, and portable devices can all be considered smart devices; this is due to their ability of smart interpretation of data, through their smart sensors or biosensors and indicators. Wearable and portable devices have progressed more and more in the shape of various accessories, integrated clothes, and body attachments and inserts. Moreover, implantable and ingestible devices allow for the medical diagnosis and treatment of patients using tiny sensors and biomedical gadgets or devices have become available, thus increasing the quality and efficacy of medical treatments by a significant margin. This article summarizes the state of the art in portable, wearable, ingestible, and implantable devices for health status monitoring and disease management and their possible applications. It also identifies some new technologies that have the potential to contribute to the development of personalized care. Further, these devices are non-invasive in nature, providing information with accuracy and in given time, thus making these devices important for the future use of humanity.

Advanced wearable biosensors for the detection of body fluids and exhaled breath by graphene

Given the huge economic burden caused by chronic and acute diseases on human beings, it is an urgent requirement of a cost-effective diagnosis and monitoring process to treat and cure the disease in their preliminary stage to avoid severe complications. Wearable biosensors have been developed by using numerous materials for non-invasive, wireless, and consistent human health monitoring. Graphene, a 2D nanomaterial, has received considerable attention for the development of wearable biosensors due to its outstanding physical, chemical, and structural properties. Moreover, the extremely flexible, foldable, and biocompatible nature of graphene provide a wide scope for developing wearable biosensor devices. Therefore, graphene and its derivatives could be trending materials to fabricate wearable biosensor devices for remote human health management in the near future. Various biofluids and exhaled breath contain many relevant biomarkers which can be exploited by wearable biosensors non-invasively to identify diseases. In this article, we have discussed various methodologies and strategies for synthesizing and pattering graphene. Furthermore, general sensing mechanism of biosensors, and graphene-based biosensing devices for tear, sweat, interstitial fluid (ISF), saliva, and exhaled breath have also been explored and discussed thoroughly. Finally, current challenges and future prospective of graphene-based wearable biosensors have been evaluated with conclusion. Graphene is a promising 2D material for the development of wearable sensors. Various biofluids (sweat, tears, saliva and ISF) and exhaled breath contains many relevant biomarkers which facilitate in identify diseases. Biosensor is made up of biological recognition element such as enzyme, antibody, nucleic acid, hormone, organelle, or complete cell and physical (transducer, amplifier), provide fast response without causing organ harm.

Resettable Microfluidics for Broad-Range and Prolonged Sweat Rate Sensing

Wearable sweat sensors are emerging as promising platforms for personalized and real-time tracking of evolving health and fitness parameters. While most wearable sweat sensors focus on tracking biomarker concentration profiles, sweat secretion rate is a key metric with broad implications for assessing hydration, cardiac, and neural conditions. Here we present a wearable microfluidic sensor for continuous sweat rate measurement. A discrete impedimetric sensing scheme relying on interdigitated electrodes within a microfluidic sweat collector allows for precise and selective sweat rate measurement across a broad physiological range. Integration of a manually activated pressure pump to expel sweat from the device prevents sensor saturation and enables continuous sweat rate tracking over hours. By enabling broad range and prolonged sweat rate measurement, this platform tackles a key obstacle to realizing meaningful and actionable sweat sensing for applications in exercise physiology and medicine.

Correlations of Salivary and Blood Glucose Levels among Six Saliva Collection Methods

Background: Saliva has been studied as a better indicator of disorders and diseases than blood. Specifically, the salivary glucose level is considered to be an indicator of diabetes mellitus (DM). However, saliva collection methods can affect the salivary glucose level, thereby affecting the correlation between salivary glucose and blood glucose. Therefore, this study aims to identify an ideal saliva collection method and to use this method to determine the population and individual correlations between salivary glucose and blood glucose levels in DM patients and healthy controls. Finally, an analysis of the stability of the individual correlations is conducted. Methods: This study included 40 age-matched DM patients and 40 healthy controls. In the fasting state, saliva was collected using six saliva collection methods, venous blood was collected simultaneously from each study participant, and both samples were analyzed at the same time using glucose oxidase peroxidase. A total of 20 DM patients and 20 healthy controls were arbitrarily selected from the above participants for one week of daily testing. The correlations between salivary glucose and blood glucose before and after breakfast were analyzed. Finally, 10 DM patients and 10 healthy controls were arbitrarily selected for one month of daily testing to analyze the stability of individual correlations. Results: Salivary glucose levels were higher in DM patients than healthy controls for the six saliva collection methods. Compared with unstimulated saliva, stimulated saliva had decreased glucose level and increased salivary flow. In addition, unstimulated parotid salivary glucose was most correlated with blood glucose level (R² = 0.9153), and the ROC curve area was 0.9316, which could accurately distinguish DM patients. Finally, it was found that the correlations between salivary glucose and blood glucose in different DM patients were quite different. The average correlation before breakfast was 0.83, and the average correlation after breakfast was 0.77. The coefficient of variation of the correlation coefficient before breakfast within 1 month was less than 5%. Conclusion: Unstimulated parotid salivary glucose level is the highest and is most correlated with blood glucose level, which can be accurately used to distinguish DM patients. Meanwhile, the correlation between salivary glucose and blood glucose was found to be relatively high and stable before breakfast. In general, the unstimulated parotid salivary glucose before breakfast presents an ideal saliva collecting method with which to replace blood-glucose use to detect DM, which provides a reference for the prediction of DM.

How to Assess the Measurement Performance of Mobile/Wearable Point-of-Care Testing Devices? A Systematic Review Addressing Sweat Analysis

Recent advances in technologies for biosensor integration in mobile or wearable devices have highlighted the need for the definition of proper validation procedures and technical standards that enable testing, verification and validation of the overall performance of these solutions. Thus, reliable assessment—in terms of limits of detection/quantitation, linearity, range, analytical and diagnostic sensitivity/specificity, accuracy, repeatability, reproducibility, cross-reactivity, diagnostic efficiency, and positive/negative prediction—still represents the most critical and challenging aspect required to progress beyond the status of feasibility studies. Considering this picture, this work aims to review and discuss the literature referring to the available methods and criteria reported in the assessment of the performance of point-of-care testing (PoCT) devices within their specific applications. In particular, without losing generality, we focused on mobile or wearable systems able to analyze human sweat. In performing this review, the focus was on the main challenges and trends underlined in the literature, in order to provide specific hints that can be used to set shared procedures and improve the overall reliability of the identified solutions, addressing the importance of sample management, the sensing components, and the electronics. This review can contribute to supporting an effective validation of mobile or wearable PoCT devices and thus to spreading the use of reliable approaches outside hospitals and clinical laboratories.

Wearable soft electrochemical microfluidic device integrated with iontophoresis for sweat biosensing

A soft and flexible wearable sweat epidermal microfluidic device capable of simultaneously stimulating, collecting, and electrochemically analyzing sweat is demonstrated. The device represents the first system integrating an iontophoretic pilocarpine delivery system around the inlet channels of epidermal polydimethylsiloxane (PDMS) microfluidic device for sweat collection and analysis. The freshly generated sweat is naturally pumped into the fluidic inlet without the need of exercising. Soft skin-mounted systems, incorporating non-invasive, on-demand sweat sampling/analysis interfaces for tracking target biomarkers, are in urgent need. Existing skin conformal microfluidic-based sensors for continuous monitoring of target sweat biomarkers rely on assays during intense physical exercising. This work demonstrates the first example of combining sweat stimulation, through transdermal pilocarpine delivery, with sample collection through a microfluidic channel for real-time electrochemical monitoring of sweat glucose, in a fully integrated soft and flexible multiplexed device which eliminates the need of exercising. The on-body operational performance and layout of the device were optimized considering the fluid dynamics and evaluated for detecting sweat glucose in several volunteers. Furthermore, the microfluidic monitoring device was integrated with a real-time wireless data transmission system using a flexible electronic board PCB conformal with the body. The new microfluidic platform paves the way to real-time non-invasive monitoring of biomarkers in stimulated sweat samples for diverse healthcare and wellness applications.

Non-invasive electrochemistry-driven metals tracing in human biofluids

Wearable analytical devices represent the future for fast, de-centralized, and human-centered health monitoring. Electrochemistry-based platforms have been highlighted as the role model for future developments amid diverse strategies and transduction technologies. Among the various relevant analytes to be real-time and non-invasively monitored in bodily fluids, we review the latest wearable achievements towards determining essential and toxic metals. On-skin measurements represent an excellent possibility for humankind: real-time monitoring, digital/fast communication with specialists, quick interventions, removing barriers in developing countries. In this review, we discuss the achievements over the last 5 years in non-invasive electrochemical platforms, providing a comprehensive table for quick visualizing the diverse sensing/technological advances. In the final section, challenges and future perspectives about wearables are deeply discussed.

Progress of Wearable and Flexible Electrochemical Biosensors With the Aid of Conductive Nanomaterials

Conductive nanomaterials have recently gained a lot of interest due to their excellent physical, chemical, and electrical properties, as well as their numerous nanoscale morphologies, which enable them to be fabricated into a wide range of modern chemical and biological sensors. This study focuses mainly on current applications based on conductive nanostructured materials. They are the key elements in preparing wearable electrochemical Biosensors, including electrochemical immunosensors and DNA biosensors. Conductive nanomaterials such as carbon (Carbon Nanotubes, Graphene), metals and conductive polymers, which provide a large effective surface area, fast electron transfer rate and high electrical conductivity, are summarized in detail. Conductive polymer nanocomposites in combination with carbon and metal nanoparticles have also been addressed to increase sensor performance. In conclusion, a section on current challenges and opportunities in this growing field is forecasted at the end.

Cactus-Spine-Inspired Sweat-Collecting Patch for Fast and Continuous Monitoring of Sweat

A sweat sensor is expected to be the most appropriate wearable device for noninvasive healthcare monitoring. However, the practical use of sweat sensors is impeded by irregular and low sweat secretion rates. Here, a sweat-collecting patch that can collect sweat efficiently for fast and continuous healthcare monitoring is demonstrated. The patch uses cactus-spine-inspired wedge-shaped wettability-patterned channels on a hierarchical microstructured/nanostructured surface. The channel shape, in combination with the superhydrophobic/superhydrophilic surface materials, induces a unidirectional Laplace pressure that transports the sweat to the sensing area spontaneously even when the patch is aligned vertically. The patch demonstrates superior sweat-collecting efficiency and reduces the time required to fill the sensing area by transporting sweat almost without leaving it inside the channel. Therefore, a sensor based on the patch responds quickly to biochemicals in sweat, and the patch enables the continuous monitoring of changes in sweat biochemicals according to their changes in the wearer's blood.

Energy Autonomous Sweat-Based Wearable Systems

The continuous operation of wearable electronics demands reliable sources of energy, currently met through Li-ion batteries and various energy harvesters. These solutions are being used out of necessity despite potential safety issues and unsustainable environmental impact. Safe and sustainable energy sources can boost the use of wearables systems in diverse applications such as health monitoring, prosthetics, and sports. In this regard, sweat- and sweat-equivalent-based studies have attracted tremendous attention through the demonstration of energy-generating biofuel cells, promising power densities as high as 3.5 mW cm-2 , storage using sweat-electrolyte-based supercapacitors with energy and power densities of 1.36 Wh kg-1 and 329.70 W kg-1 , respectively, and sweat-activated batteries with an impressive energy density of 67 Ah kg-1 . A combination of these energy generating, and storage devices can lead to fully energy-autonomous wearables capable of providing sustainable power in the µW to mW range, which is sufficient to operate both sensing and communication devices. Here, a comprehensive review covering these advances, addressing future challenges and potential solutions related to fully energy-autonomous wearables is presented, with emphasis on sweat-based energy storage and energy generation elements along with sweat-based sensors as applications.

Bio-inspired fractal textile device for rapid sweat collection and monitoring

In this study, a new design concept in sweat collection was developed to achieve rapid and intact sweat sampling for analytical purposes. Textiles with fast water wicking properties were first selected and laser engraved into tree-like bifurcating channels for sweat collection. The fractal framework of the bifurcating textile channels was theoretically derived to minimize the flow resistance for fast sweat absorption. The optimized collector with designed fractal geometry exhibited thorough coverage of emerging droplets without overflow. Great collection efficiency was achieved with a short induction time (<1 minute after perspiration begins) and a maximum sweat collection flux up to 4.0 μL cm-2 min-1 without leakage. After being combined with printed sensors and microchips, the assembled sweat collection/sensing device can simultaneously provide measurements of salt concentration and sweat rate for wireless hydration state monitoring. The collection/sensing system also exhibited fast response times to abrupt changes in sweat rates or concentrations and thus can be used to detect instant physical conditions in exercise. Finally, field tests were performed to demonstrate the reliability and practicality of the device in real-time sweat monitoring under vigorous activities.

Developments of the Electroactive Materials for Non-Enzymatic Glucose Sensing and Their Mechanisms

A comprehensive review of the electroactive materials for non-enzymatic glucose sensing and sensing devices has been performed in this work. A general introduction for glucose sensing, a facile electrochemical technique for glucose detection, and explanations of fundamental mechanisms for the electro-oxidation of glucose via the electrochemical technique are conducted. The glucose sensing materials are classified into five major systems: (1) mono-metallic materials, (2) bi-metallic materials, (3) metallic-oxide compounds, (4) metallic-hydroxide materials, and (5) metal-metal derivatives. The performances of various systems within this decade have been compared and explained in terms of sensitivity, linear regime, the limit of detection (LOD), and detection potentials. Some promising materials and practicable methodologies for the further developments of glucose sensors have been proposed. Firstly, the atomic deposition of alloys is expected to enhance the selectivity, which is considered to be lacking in non-enzymatic glucose sensing. Secondly, by using the modification of the hydrophilicity of the metallic-oxides, a promoted current response from the electro-oxidation of glucose is expected. Lastly, by taking the advantage of the redistribution phenomenon of the oxide particles, the usage of the noble metals is foreseen to be reduced.

Molecular and physical technologies for monitoring fluid and electrolyte imbalance: A focus on cancer population

Several clinical examinations have shown the essential impact of monitoring (de)hydration (fluid and electrolyte imbalance) in cancer patients. There are multiple risk factors associated with (de)hydration, including aging, excessive or lack of fluid consumption in sports, alcohol consumption, hot weather, diabetes insipidus, vomiting, diarrhea, cancer, radiation, chemotherapy, and use of diuretics. Fluid and electrolyte imbalance mainly involves alterations in the levels of sodium, potassium, calcium, and magnesium in extracellular fluids. Hyponatremia is a common condition among individuals with cancer (62% of cases), along with hypokalemia (40%), hypophosphatemia (32%), hypomagnesemia (17%), hypocalcemia (12%), and hypernatremia (1-5%). Lack of hydration and monitoring of hydration status can lead to severe complications, such as nausea/vomiting, diarrhea, fatigue, seizures, cell swelling or shrinking, kidney failure, shock, coma, and even death. This article aims to review the current (de)hydration (fluid and electrolyte imbalance) monitoring technologies focusing on cancer. First, we discuss the physiological and pathophysiological implications of fluid and electrolyte imbalance in cancer patients. Second, we explore the different molecular and physical monitoring methods used to measure fluid and electrolyte imbalance and the measurement challenges in diverse populations. Hydration status is assessed in various indices; plasma, sweat, tear, saliva, urine, body mass, interstitial fluid, and skin-integration techniques have been extensively investigated. No unified (de)hydration (fluid and electrolyte imbalance) monitoring technology exists for different populations (including sports, elderly, children, and cancer). Establishing novel methods and technologies to facilitate and unify measurements of hydration status represents an excellent opportunity to develop impactful new approaches for patient care.

Wearable and Mobile Sensors for Personalized Nutrition

While wearable and mobile chemical sensors have experienced tremendous growth over the past decade, their potential for tracking and guiding nutrition has emerged only over the past three years. Currently, guidelines from doctors and dietitians represent the most common approach for maintaining optimal nutrition status. However, such recommendations rely on population averages and do not take into account individual variability in responding to nutrients. Precision nutrition has recently emerged to address the large heterogeneity in individuals' responses to diet, by tailoring nutrition based on the specific requirements of each person. It aims at preventing and managing diseases by formulating personalized dietary interventions to individuals on the basis of their metabolic profile, background, and environmental exposure. Recent advances in digital nutrition technology, including calories-counting mobile apps and wearable motion tracking devices, lack the ability of monitoring nutrition at the molecular level. The realization of effective precision nutrition requires synergy from different sensor modalities in order to make timely reliable predictions and efficient feedback. This work reviews key opportunities and challenges toward the successful realization of effective wearable and mobile nutrition monitoring platforms. Non-invasive wearable and mobile electrochemical sensors, capable of monitoring temporal chemical variations upon the intake of food and supplements, are excellent candidates to bridge the gap between digital and biochemical analyses for a successful personalized nutrition approach. By providing timely (previously unavailable) dietary information, such wearable and mobile sensors offer the guidance necessary for supporting dietary behavior change toward a managed nutritional balance. Coupling of the rapidly emerging wearable chemical sensing devices-generating enormous dynamic analytical data-with efficient data-fusion and data-mining methods that identify patterns and make predictions is expected to revolutionize dietary decision-making toward effective precision nutrition.

A thread-based wearable sweat nanobiosensor

Non-invasive wearable biosensors provide an efficient way of continuously quantifying a person's biochemical parameters, and are highly valuable for predicting human physiological status and flagging risks and illness. Commercial wearable sensors are available for tracking a user's physical activities, but few could monitor user's health conditions through sweat analysis. Electronic textile (e-textile) biosensors enable new applications in this scenario because of its high flexibility/wearability, low cost, high level of electronic integration, and unobtrusiveness. However, challenges in developing e-textile sweat biosensors remain in the production of textile-based biosensing materials, skin interfacing design, and embedded data acquisition/transmission. Here, we propose a novel wearable electrochemical sweat biosensor based on conductive threads decorated with zinc-oxide nanowires (ZnO NWs) and apply it to detecting lactate and sodium in perspiration during physical exercise. The sweat biosensor is fully integrated with signal readout and data communication circuits in a wearable headband and is capable of monitoring human sweat accurately and wirelessly. We achieved the detection of lactate and sodium in linear ranges of 0-25 mM and 0.1-100 mM and limits of detection of 3.61 mM and 0.16 mM, respectively, which cover the clinically-relevant ranges of lactate and sodium in human sweat. We demonstrated accurate lactate and sodium measurements in human sweat from a healthy volunteer, and the results are in good agreement with standard test results. We also conducted on-body measurements on the same human volunteer during exercise and confirmed the robustness of the signal readout during body movements and the excellent accuracy of the testing results.

Integrated non-invasive biochemical and biophysical sensing systems for health and performance monitoring: A systems perspective

Advances in materials, bio-recognition elements, transducers, and microfabrication techniques, as well as progress in electronics, signal processing, and wireless communication have generated a new class of skin-interfaced wearable health monitoring systems for applications in personalized medicine and digital health. In comparison to conventional medical devices, these wearable systems are at the cusp of initiating a new era of longitudinal and noninvasive sensing for the prevention, detection, diagnosis, and treatment of diseases at the molecular level. Herein, we provide a review of recent developments in wearable biochemical and biophysical systems. We survey the sweat sampling and collection methods for biochemical systems, followed by an assessment of biochemical and biophysical sensors deployed in current wearable systems with an emphasis on their hardware specifications. Specifically, we address how sweat collection and sample handling platforms may be a rate limiting technology to realizing the clinical translation of wearable health monitoring systems; moreover, we highlight the importance of achieving both longitudinal sensing and assessment of intrapersonal variation in sweat-blood correlations to have the greatest clinical impact. Lastly, we assess a snapshot of integrated wireless wearable systems with multimodal sensing capabilities, and we conclude with our perspective on the state-of-the-art and the required developments to achieve the next-generation of integrated wearable health and performance monitoring systems.

Recent progress, challenges, and opportunities for wearable biochemical sensors for sweat analysis

Sweat is a promising, yet relatively unexplored biofluid containing biochemical information that offers broad insights into the underlying dynamic metabolic activity of the human body. The rich composition of electrolytes, metabolites, hormones, proteins, nucleic acids, micronutrients, and exogenous agents found in sweat dynamically vary in response to the state of health, stress, and diet. Emerging classes of skin-interfaced wearable sensors offer powerful capabilities for the real-time, continuous analysis of sweat produced by the eccrine glands in a manner suitable for use in athletics, consumer wellness, military, and healthcare industries. This perspective examines the rapid and continuous progress of wearable sweat sensors through the most advanced embodiments that address the fundamental challenges currently restricting widespread deployment. It concludes with a discussion of efforts to expand the overall utility of wearable sweat sensors and opportunities for commercialization, in which advances in biochemical sensor technologies will be critically important.

A wearable patch for continuous analysis of thermoregulatory sweat at rest

The body naturally and continuously secretes sweat for thermoregulation during sedentary and routine activities at rates that can reflect underlying health conditions, including nerve damage, autonomic and metabolic disorders, and chronic stress. However, low secretion rates and evaporation pose challenges for collecting resting thermoregulatory sweat for non-invasive analysis of body physiology. Here we present wearable patches for continuous sweat monitoring at rest, using microfluidics to combat evaporation and enable selective monitoring of secretion rate. We integrate hydrophilic fillers for rapid sweat uptake into the sensing channel, reducing required sweat accumulation time towards real-time measurement. Along with sweat rate sensors, we integrate electrochemical sensors for pH, Cl-, and levodopa monitoring. We demonstrate patch functionality for dynamic sweat analysis related to routine activities, stress events, hypoglycemia-induced sweating, and Parkinson's disease. By enabling sweat analysis compatible with sedentary, routine, and daily activities, these patches enable continuous, autonomous monitoring of body physiology at rest.

Highly Concentrated, Conductive, Defect-free Graphene Ink for Screen-Printed Sensor Application

Ultrathin and defect-free graphene ink is prepared through a high-throughput fluid dynamics process, resulting in a high exfoliation yield (53.5%) and a high concentration (47.5 mg mL^-1). A screen-printed graphene conductor exhibits a high electrical conductivity of 1.49 × 10⁴ S m^-1 and good mechanical flexibility. An electrochemical sodium ion sensor based on graphene ink exhibits an excellent potentiometric sensing performance in a mechanically bent state. Real-time monitoring of sodium ion concentration in sweat is demonstrated. Conductive inks based on graphene materials have received significant attention for the fabrication of a wide range of printed and flexible devices. However, the application of graphene fillers is limited by their restricted mass production and the low concentration of their suspensions. In this study, a highly concentrated and conductive ink based on defect-free graphene was developed by a scalable fluid dynamics process. A high shear exfoliation and mixing process enabled the production of graphene at a high concentration of 47.5 mg mL^-1 for graphene ink. The screen-printed graphene conductor exhibits a high electrical conductivity of 1.49 × 10⁴ S m^-1 and maintains high conductivity under mechanical bending, compressing, and fatigue tests. Based on the as-prepared graphene ink, a printed electrochemical sodium ion (Na⁺) sensor that shows high potentiometric sensing performance was fabricated. Further, by integrating a wireless electronic module, a prototype Na⁺-sensing watch is demonstrated for the real-time monitoring of the sodium ion concentration in human sweat during the indoor exercise of a volunteer. The scalable and efficient procedure for the preparation of graphene ink presented in this work is very promising for the low-cost, reproducible, and large-scale printing of flexible and wearable electronic devices.

A wearable battery-free wireless and skin-interfaced microfluidics integrated electrochemical sensing patch for on-site biomarkers monitoring in human perspiration

In this study, an ultra-high sensitive, flexible, wireless, battery-free, and fully integrated (no external analysis equipment) electrochemical sensing patch system, including a microfluidic-sweat collecting unit, was newly developed for the on-site monitoring of the [K⁺] concentration in human sweat. Multiwalled carbon nanotube (MWCNT) and MXene-Ti₃C₂T_X based hybrid multi-dimensional networks were applied to obtain a high surface activation area and faster charge transfer rate, strongly adsorbing the valinomycin membrane to protect the ionophore for effective transshipment and immobilization of the [K⁺]. Furthermore, the controllable porosity of carbon-based materials can accelerate the kinetic process of ion diffusion. This hybrid nanonetwork structure effectively enhanced electrochemical stability and sensitivity, addressing the noise and signal drifting problems experienced with low concentration detection. The fabricated sensor exhibited a high ion concentration sensitivity of 63 mV/dec with excellent selectivity, amplified to 173 mV/dec with the integrated amplification system. The Near Field Communication (NFC) is used to transmit measurements to a smartphone wirelessly. A microfluidic channel was integrated with the electrochemical sensor patch to efficiently collect sweat on the human skin surface and mitigate the sensor surface contamination problem. Furthermore, the developed sensing patch can also be applied to other biomarkers on-site detection after modifying the working electrode with the corresponding selective membranes.

Wearable Osmotic-Capillary Patch for Prolonged Sweat Harvesting and Sensing

Biomarkers in sweat are a largely untapped source of health information. Most of the currently available sweat harvesting and testing devices are incapable of operating under low-sweat rates such as those experienced by humans at rest. Here we analyze the in vitro and in vivo sampling of sweat through osmosis via the use of a hydrogel interfaced with the skin, without need for active perspiration. The hydrogel also interfaces with paper-based microfluidics to transport the fluid via capillary forces toward a testing zone and then evaporation pad. We show that the hydrogel solute content and area of the evaporation pad regulate the long-term extraction of sweat and its associated biomarkers. The results indicate that the platform can sample biomarkers from a model skin system continuously for approximately 12 h. On-skin testing of the platform on both resting and exercising human subjects confirms that it can sample sweat lactate directly from the surface of skin. The results highlight that lactate in sweat increases with exercise and as a direct result of muscle activity. Implementation of such new principles for sweat fluid harvesting and management via wearable patch devices can contribute toward the advancement of next generation wearables.

Wearable Sweat Biosensors Refresh Personalized Health/Medical Diagnostics

Sweat contains a broad range of critical biomarkers including ions, small molecules, and macromolecules that may indirectly or directly reflect the health status of the human body and thereby help track disease progression. Wearable sweat biosensors enable the collection and analysis of sweat in situ, achieving real-time, continuous, and noninvasive monitoring of human biochemical parameters at the molecular level. This review summarizes the physiological/pathological information of sweat and wearable sweat biosensors. First, the production of sweat pertaining to various electrolytes, metabolites, and proteins is described. Then, the compositions of the wearable sweat biosensors are summarized, and the design of each subsystem is introduced in detail. The latest applications of wearable sweat biosensors for outdoor, hospital, and family monitoring are highlighted. Finally, the review provides a summary and an outlook on the future developments and challenges of wearable sweat biosensors with the aim of advancing the field of wearable sweat monitoring technology.