An inductively powered implantable blood flow sensor microsystem for vascular grafts

Realtime monitoring of thrombus formation in vivo using a self-reporting vascular access graft

BACKGROUND

Chronic kidney disease (CKD) affects 10% of the global population costing over a hundred billion dollars per annum and leading to increased risk of cardiovascular disease. Many patients with CKD require regular haemodialyses. Synthetic arteriovenous grafts (AVG) are increasingly used to provide rapid vascular connection for dialysis. Initially, they have excellent patency rates but are critically limited by neointimal hyperplasia at the venous anastomosis, which drives subsequent thrombosis, graft failure and death.

METHODS

Here, we describe a system in which electrical impedance spectroscopy sensors are incorporated circumferentially into the wall of a synthetic arteriovenous graft. This is combined with an implantable radiotelemetry system for data transmission outside the patient. The system was tested using monolayers of endothelial and smooth muscle cells as well as swine blood and clots with explanted human carotid artery plaques. Sensor testing was then performed in vitro and the device was implanted in vivo in female swine.

RESULTS

The device can wirelessly report the accumulation of biological material, both cells and blood. Differences are also detected when comparing controls with pathological atheroma. In swine differences between blockage formation in a graft were remotely obtained and wireless reported.

CONCLUSIONS

Combining electrical impedance spectroscopy and an implantable radiotelemetry system enables graft surveillance. This has the potential to be used for early detection of venous stenosis and blood clot formation in real-time in vivo. In principle, the concept could apply to other cardiovascular diseases and vascular implantable devices.

Functionality of Flexible Pressure Sensors in Cardiovascular Health Monitoring: A Review

As the highest percentage of global mortality is caused by several cardiovascular diseases (CVD), maintenance and monitoring of a healthy cardiovascular condition have become the primary concern of each and every individual. Simultaneously, recent progress and advances in wearable pressure sensor technology have provided many pathways to monitor and detect underlying cardiovascular illness in terms of irregularities in heart rate, blood pressure, and blood oxygen saturation. These pressure sensors can be comfortably attached onto human skin or can be implanted on the surface of vascular grafts for uninterrupted monitoring of arterial blood pressure. While the traditional monitoring systems are time-consuming, expensive, and not user-friendly, flexible sensor technology has emerged as a promising and dynamic practice to collect important health information at a comparatively low cost in a reliable and user-friendly way. This Review explores the importance and necessity of cardiovascular health monitoring while emphasizing the role of flexible pressure sensors in monitoring patients' health conditions to avoid adverse effects. A comprehensive discussion on the current research progress along with the real-time impact and accessibility of pressure sensors developed for cardiovascular health monitoring applications has been provided.

Piezoelectric Signals in Vascularized Bone Regeneration

The demand for bone substitutes is increasing in Western countries. Bone graft substitutes aim to provide reconstructive surgeons with off-the-shelf alternatives to the natural bone taken from humans or animal species. Under the tissue engineering paradigm, biomaterial scaffolds can be designed by incorporating bone stem cells to decrease the disadvantages of traditional tissue grafts. However, the effective clinical application of tissue-engineered bone is limited by insufficient neovascularization. As bone is a highly vascularized tissue, new strategies to promote both osteogenesis and vasculogenesis within the scaffolds need to be considered for a successful regeneration. It has been demonstrated that bone and blood vases are piezoelectric, namely, electric signals are locally produced upon mechanical stimulation of these tissues. The specific effects of electric charge generation on different cells are not fully understood, but a substantial amount of evidence has suggested their functional and physiological roles. This review summarizes the special contribution of piezoelectricity as a stimulatory signal for bone and vascular tissue regeneration, including osteogenesis, angiogenesis, vascular repair, and tissue engineering, by considering different stem cell sources entailed with osteogenic and angiogenic potential, aimed at collecting the key findings that may enable the development of successful vascularized bone replacements useful in orthopedic and otologic surgery.

Wireless Monitoring of Vascular Pressure Using CB-PDMS Based Flexible Strain Sensor

Rising pressure within a vascular graft can signal impending failure caused by stenosis or thrombosis, and early detection can improve surgical salvage outcomes. To enable regular graft pressure monitoring, we developed a thin flexible pulsation sensor (FPS) with wireless data readout. A conductive polymer sensing layer is attached to a flexible circuit board and then encapsulated by polydimethylsiloxane (PDMS) for biocompatibility. Due to the FPS' outstanding flexibility in comparison to natural arteries, veins, and synthetic vascular grafts, it can be wrapped around target conduits to monitor blood pressure for short-term surgical and long-term implantation purposes. In this study, we analyze the power spectrum of the FPS data to determine the ideal bandwidth of the wireless FPS device to preserve heart rate and hemodynamic waveforms while rejecting noise. The strain response of FPS wrapped around silicone tube, vascular graft and artery was simulated using COMSOL®, showing a linear relationship between pressure and FPS strain. The optimized bandpass filter of 0.2-10 Hz was simulated and implemented on a flexible polyimide circuit board. The circuit board also included a low- power microcontroller for data conversion and transmission via simple 4-MHz on-off keying. The performance of the prototype was evaluated by recording wireless data from a vascular phantom under different pressure and flow settings. The results indicate that the peak-to-peak FPS voltage responds linearly to RMS blood pressure and systolic-diastolic pressure.Clinical Relevance- Early detection of a failing vascular graft could leverage sensors for near real-time monitoring. The presented wireless flexible sensor measures and transmits vessel distension data as a proxy for internal lumen pressure.

Array Integration and Far-Field Detection of Biocompatible Wireless LC Pressure Sensors

In this paper, three configurations of LC (inductor-capacitor) pressure sensors are developed, namely series LC pressure sensors, compact LC pressure sensors, and far-field LC pressure sensor tags. The modified silk protein films have been chosen as substrates due to their good biocompatibility and air/water permeability, which is suitable for continuously pasting such substrates on skin. For series LC pressure sensors, conducting wire is used to connect the flexible capacitor and spiral inductor. It exhibits good cycling stability and high sensitivities, suitable for electronic skin. For compact LC pressure sensors, the spiral coil functions as inductor, antenna, and capacitor electrode simultaneously, minimizing the space cost and is suitable for array integration, while the sensitivities remain the same. By tailoring the turn of the spiral coil, the resonate frequency can be regulated continuously. An annular array of compact LC sensors with ten distinct resonate frequencies ranged from 400 to 1000 MHz is developed to remotely monitor the press of number 0-9. Finally, far-field LC pressure sensor tags with elongated detection distances are developed in which each compact LC sensor acts as a filter. A wireless in-shoe plantar to detect the sole pressure distribution using the far-field LC sensor configuration is developed.

Application of Multi-Branch Cauer Circuits in the Analysis of Electromagnetic Transducers Used in Wireless Transfer Power Systems

In this paper, the feasibility of applying a multi-branch equivalent model employing first- and second-order Cauer circuits for the analysis of electromagnetic transducers used in systems of wireless power transfer is discussed. A method of formulating an equivalent model (EqM) is presented, and an example is shown for a wireless power transfer system (WPTS) consisting of an air transformer with field concentrators. A method is proposed to synthesize the EqM of the considered transducer based on the time-harmonic field model, an optimization algorithm employing the evolution strategy (ES) and the equivalent Cauer circuits. A comparative analysis of the performance of the considered WPTS under high-frequency voltage supply calculated using the proposed EqM and a 3D field model in the time domain using the finite element method (FEM) was carried out. The selected results of the conducted analysis are presented and discussed.

A smartphone-enabled wireless and batteryless implantable blood flow sensor for remote monitoring of prosthetic heart valve function

Aortic valve disease is one of the leading forms of complications in the cardiovascular system. The failing native aortic valve is routinely surgically replaced with a bioprosthesis. However, insufficient durability of bioprosthetic heart valves often requires reintervention. Valve degradation can be assessed by an analysis of the blood flow characteristics downstream of the valve. This is cost and labor intensive using clinical methodologies and is performed infrequently. The integration of consumer smartphones and implantable blood flow sensors into the data acquisition chain facilitates remote management of patients that is not limited by access to clinical facilities. This article describes the characteristics of an implantable magnetic blood flow sensor which was optimized for small size and low power consumption to allow for batteryless operation. The data is wirelessly transmitted to the patient's smartphone for in-depth processing. Tests using three different experimental setups confirmed that wireless and batteryless blood flow recording using a magnetic flow meter technique is feasible and that the sensor system is capable of monitoring the characteristic flow downstream of the valve.

Vascular Pressure-Flow Measurement Using CB-PDMS Flexible Strain Sensor

Regular monitoring of blood flow and pressure in vascular reconstructions or grafts would provide early warning of graft failure and improve salvage procedures. Based on biocompatible materials, we have developed a new type of thin, flexible pulsation sensor (FPS) which is wrapped around a graft to monitor blood pressure and flow. The FPS uses carbon black (CB) nanoparticles dispersed in polydimethylsiloxane (PDMS) as a piezoresistive sensor layer, which was encapsulated within structural PDMS layers and connected to stainless steel interconnect leads. Because the FPS is more flexible than natural arteries, veins, and synthetic vascular grafts, it can be wrapped around target conduits at the time of surgery and remain implanted for long-term monitoring. In this study, we analyze strain transduction from a blood vessel and characterize the electrical and mechanical response of CB-PDMS from 0-50% strain. An optimum concentration of 14% CB-PDMS was used to fabricate 300-μm thick FPS devices with elastic modulus under 500 kPa, strain range of over 50%, and gauge factor greater than 5. Sensors were tested in vitro on vascular grafts with flows of 0-1,100 mL/min. In vitro testing showed linear output to pulsatile flows and pressures. Cyclic testing demonstrated robust operation over hundreds of cardiac cycles, with ±2.6 mmHg variation in pressure readout. CB-PDMS composite material showed excellent potential in biologic strain sensing applications where a flexible sensor with large maximum strain range is needed.

Design of an adaptive medium access control protocol for wireless body area networks with heterogeneous sensors

The IEEE 802.15.6 standard emerged as the most suitable standard that fits the special requirements of wireless body area networks. It provides flexibility to designers by recommending the use of several medium access control layer techniques, but does not specify how to combine some or all these recommended techniques to form the most efficient wireless body area network medium access control for a specific scenario. Our goal here is to design a wireless body area network medium access control that provides an optimal combination of these basic techniques that are available in the standard, by taking into consideration the variability and heterogeneity of the sensors. The performance of the proposed techniques is evaluated using some of the standard performance measures such as throughput, delay, and energy consumption.

Soft and flexible piezoelectric smart patch for vascular graft monitoring based on Aluminum Nitride thin film

Vascular grafts are artificial conduits properly designed to substitute a diseased blood vessel. However prosthetic fail can occur without premonitory symptoms. Continuous monitoring of the system can provide useful information not only to extend the graft's life but also to optimize the patient's therapy. In this respect, various techniques have been used, but all of them affect the mechanical properties of the artificial vessel. To overcome these drawbacks, an ultrathin and flexible smart patch based on piezoelectric Aluminum Nitride (AlN) integrated on the extraluminal surface of the prosthesis is presented. The sensor can be conformally wrapped around the external surface of the prosthesis. Its design, mechanical properties and dimensions are properly characterized and optimized in order to maximize performances and to avoid any interference with the graft structure during its activity. The sensorized graft is tested in vitro using a pulsatile recirculating flow system that mimics the physiological and pathological blood flow conditions. In this way, the ability of the device to measure real-time variations of the hemodynamics parameters has been tested. The obtained high sensitivity of 0.012 V Pa-1 m-2, joint to the inherent biocompatibility and non-toxicity of the used materials, demonstrates that the device can successfully monitor the prosthesis functioning under different conditions, opening new perspectives for real-time vascular graft surveillance.

Graphene-Based Wireless Tube-Shaped Pressure Sensor for In Vivo Blood Pressure Monitoring

We propose a wireless pressure sensor composed of a graphene sheet and a transmitter coil integrated with a polydimethylsiloxane (PDMS) tube. The pressure inside the tube was monitored wirelessly using an external receiver coil. We then monitored the typical blood pressure range, 12–20 kPa, using this fabricated sensor by changing the turn number of the receiver coil and the overlapping length of the coils. Furthermore, we demonstrated wireless blood pressure measurement by connecting our sensor to the blood vessel of a rat. Our results suggested that this sensor can be easily inserted between an implantable medical device and blood vessels for in vivo blood pressure monitoring. The proposed wireless pressure sensor could also be suitable for monitoring in vivo implanted medical systems, such as artificial organs and pump systems.

Design, Analysis and Experiment of a Tactile Force Sensor for Underwater Dexterous Hand Intelligent Grasping

This paper proposes a novel underwater dexterous hand structure whose fingertip is equipped with underwater tactile force sensor (UTFS) array to realize the grasping sample location determination and force perception. The measurement structure, theoretical analysis, prototype development and experimental verification of the UTFS are purposefully studied in order to achieve accurate measurement under huge water pressure influence. The UTFS is designed as capsule shape type with differential pressure structure, and the external water pressure signal is separately transmitted to the silicon cup bottom which is considered to be an elastomer with four strain elements distribution through the upper and lower flexible contacts and the silicone oil filled in the upper and lower cavities of UTFS. The external tactile force information can be obtained by the vector superposition between the upper and lower of silicon cup bottom to counteract the water pressure influence. The analytical solution of deformation and stress of the bottom of the square silicon cup bottom is analyzed with the use of elasticity and shell theory, and compared with the Finite Element Analysis results, which provides theoretical support for the distribution design of four strain elements at the bottom of the silicon cup. At last, the UTFS zero drift experiment without force applying under different water depths, the output of the standard force applying under different water depth and the test of the standard force applying under conditions of different 0 ∘C–30 ∘C temperature with 0.1 m water depth are carried out to verify the performance of the sensor. The experiments show that the UTFS has a high linearity and sensitivity, and which has a regular zero drift and temperature drift which can be eliminated by calibration algorithm.

Vascular Graft Pressure-Flow Monitoring Using 3D Printed MWCNT-PDMS Strain Sensors

Real-time monitoring of arteriovenous graft blood flow would provide early warning of graft failure to permit interventions such as angioplasty or graft replacement to avoid catastrophic failure. We have developed a new type of flexible pulsation sensor (FPS) consisting of a 3D printed elastic cuff wrapped around a graft and thus not in contact with blood. The FPS uses multi-walled carbon nanotubes (MWCNTs) dispersed in polydimethylsiloxane (PDMS) as a piezoresistive sensor layer, which is embedded within structural thixotropic PDMS. These materials were specifically developed to enable sensor additive manufacturing via 3D Bio-plotting, and the resulting strain sensor is more compliant and has a wider maximum strain range than graft materials. Here, we analyze the strain transduction mechanics on a vascular graft and describe the memristive properties of MWCNT-PDMS composites, which may be mitigated using AC biasing. In vitro testing of the FPS on a vascular graft phantom showed a robust, linear sensor output to pulsatile flows (170-650 mL/min) and pressures (62-175 mmHg). The FPS showed an RMS error when measuring pressure and flow of 7.7 mmHg and 29.3 mL/min, with a mean measurement error of 6.5% (pressure) and 8.0% (flow).

An Ultra-Low-Power RFID/NFC Frontend IC Using 0.18 μm CMOS Technology for Passive Tag Applications

Battery-less passive sensor tags based on RFID or NFC technology have achieved much popularity in recent times. Passive tags are widely used for various applications like inventory control or in biotelemetry. In this paper, we present a new RFID/NFC frontend IC (integrated circuit) for 13.56 MHz passive tag applications. The design of the frontend IC is compatible with the standard ISO 15693/NFC 5. The paper discusses the analog design part in details with a brief overview of the digital interface and some of the critical measured parameters. A novel approach is adopted for the demodulator design, to demodulate the 10% ASK (amplitude shift keying) signal. The demodulator circuit consists of a comparator designed with a preset offset voltage. The comparator circuit design is discussed in detail. The power consumption of the bandgap reference circuit is used as the load for the envelope detection of the ASK modulated signal. The sub-threshold operation and low-supply-voltage are used extensively in the analog design—to keep the power consumption low. The IC was fabricated using 0.18 μ m CMOS technology in a die area of 1.5 mm × 1.5 mm and an effective area of 0.7 m m 2 . The minimum supply voltage desired is 1.2 V, for which the total power consumption is 107 μ W. The analog part of the design consumes only 36 μ W, which is low in comparison to other contemporary passive tags ICs. Eventually, a passive tag is developed using the frontend IC, a microcontroller, a temperature and a pressure sensor. A smart NFC device is used to readout the sensor data from the tag employing an Android-based application software. The measurement results demonstrate the full passive operational capability. The IC is suitable for low-power and low-cost industrial or biomedical battery-less sensor applications. A figure-of-merit (FOM) is proposed in this paper which is taken as a reference for comparison with other related state-of-the-art researches.

A Non-Resonant Kinetic Energy Harvester for Bioimplantable Applications

A linear non-resonant kinetic energy harvester for implantable devices is presented. The design contains a metal platform with permanent magnets, two stators with three-dimensional helical coils for increased power generation, ball bearings, and a polydimethylsiloxane (PDMS) package for biocompatibility. Mechanical excitation of this device within the body due to daily activities leads to a relative motion between the platform and stators, resulting in electromagnetic induction. Initial prototypes without packaging have been fabricated and characterized on a linear shaker. Dynamic tests showed that the friction force acting on the platform is on the order of 0.6 mN. The resistance and the inductance of the coils were measured to be 2.2 Ω and 0.4 µH, respectively. A peak open circuit voltage of 1.05 mV was generated per stator at a platform speed of 5.8 cm/s. Further development of this device offers potential for recharging the batteries of implantable biomedical devices within the body.

Flexible, Structured MWCNT/PDMS Sensor for Chronic Vascular Access Monitoring

Graft wall pulsation amplitude sensing can provide a measure of functional status, e.g. in hemodialysis access grafts. Current implantable graft monitoring sensors require graft modification and direct bloodstream contact. We propose a new class of piezoresistive flexible pulsation sensors which can be wrapped around the graft to measure wall movement. These sensors must be highly flexible to prevent graft constriction; typical strain sensors are too rigid and the strain sensing range is too limited for this application. We describe a novel additive manufacturing (AM) method for printing polydimethylsiloxane (PDMS) with an internal porous structure, such that material compliance may be tuned anisotropically for a given sensor geometry. Prototype flexible pulsation sensors (FPS) consisting of structured PDMS with an embedded conductive PDMS sensor layer were fabricated and tested. Initial tests demonstrated reliable sensor response to 1-Hz cyclic elongation of 20%, and a sensor gauge factor of 1.0.

A Batteryless Sensor ASIC for Implantable Bio-Impedance Applications

The measurement of the biological tissue's electrical impedance is an active research field that has attracted a lot of attention during the last decades. Bio-impedances are closely related to a large variety of physiological conditions; therefore, they are useful for diagnosis and monitoring in many medical applications. Measuring living tissues, however, is a challenging task that poses countless technical and practical problems, in particular if the tissues need to be measured under the skin. This paper presents a bio-impedance sensor ASIC targeting a battery-free, miniature size, implantable device, which performs accurate 4-point complex impedance extraction in the frequency range from 2 kHz to 2 MHz. The ASIC is fabricated in 150 nm CMOS, has a size of 1.22 mm × 1.22 mm and consumes 165 μA from a 1.8 V power supply. The ASIC is embedded in a prototype which communicates with, and is powered by an external reader device through inductive coupling. The prototype is validated by measuring the impedances of different combinations of discrete components, measuring the electrochemical impedance of physiological solution, and performing ex vivo measurements on animal organs. The proposed ASIC is able to extract complex impedances with around 1 Ω resolution; therefore enabling accurate wireless tissue measurements.

An Integrated Wireless Power Management and Data Telemetry IC for High-Compliance-Voltage Electrical Stimulation Applications

This paper describes a 13.56-MHz wireless power recovery system with bidirectional data link for high-compliance-voltage neural/muscle stimulator. The power recovery circuit includes a 2-stage rectifier, 2 LDOs and a high voltage charge pump to provide 3 DC outputs: 1.8 V, 3.3 V and 20 V for the stimulator. A 2-stage time division based rectifier is proposed to provide 3 DC outputs simultaneously. It improves the power efficiency without introducing any impact on the forward data recovery. The 20 V output is generated by a modified low ripple charge pump that reduces the ripple voltage by 40%. The power management system shows 49% peak power efficiency. The data link includes a clock and data recovery (CDR) circuit and a load shift keying (LSK) modulator for bidirectional data telemetry. The forward and backward data rates of the data telemetry are 61.5 kbps and 33.3 kbps, respectively. In addition, a power monitor circuit for closed-loop power control is implemented. The whole system has been fabricated in a 24 V HV LDMOS option 1.8 μ m CMOS process, occupying a core area of around 3.5 mm (2).

Health care sensor--based systems for point of care monitoring and diagnostic applications: a brief survey

Continuous, real-time remote monitoring through medical point--of--care (POC) systems appears to draw the interest of the scientific community for healthcare monitoring and diagnostic applications the last decades. Towards this direction a significant merit has been due to the advancements in several scientific fields. Portable, wearable and implantable apparatus may contribute to the betterment of today's healthcare system which suffers from fundamental hindrances. The number and heterogeneity of such devices and systems regarding both software and hardware components, i.e sensors, antennas, acquisition circuits, as well as the medical applications that are designed for, is impressive. Objective of the current study is to present the major technological advancements that are considered to be the driving forces in the design of such systems, to briefly state the new aspects they can deliver in healthcare and finally, the identification, categorization and a first level evaluation of them.

Self-powered wireless carbohydrate/oxygen sensitive biodevice based on radio signal transmission

Here for the first time, we detail self-contained (wireless and self-powered) biodevices with wireless signal transmission. Specifically, we demonstrate the operation of self-sustained carbohydrate and oxygen sensitive biodevices, consisting of a wireless electronic unit, radio transmitter and separate sensing bioelectrodes, supplied with electrical energy from a combined multi-enzyme fuel cell generating sufficient current at required voltage to power the electronics. A carbohydrate/oxygen enzymatic fuel cell was assembled by comparing the performance of a range of different bioelectrodes followed by selection of the most suitable, stable combination. Carbohydrates (viz. lactose for the demonstration) and oxygen were also chosen as bioanalytes, being important biomarkers, to demonstrate the operation of the self-contained biosensing device, employing enzyme-modified bioelectrodes to enable the actual sensing. A wireless electronic unit, consisting of a micropotentiostat, an energy harvesting module (voltage amplifier together with a capacitor), and a radio microchip, were designed to enable the biofuel cell to be used as a power supply for managing the sensing devices and for wireless data transmission. The electronic system used required current and voltages greater than 44 µA and 0.57 V, respectively to operate; which the biofuel cell was capable of providing, when placed in a carbohydrate and oxygen containing buffer. In addition, a USB based receiver and computer software were employed for proof-of concept tests of the developed biodevices. Operation of bench-top prototypes was demonstrated in buffers containing different concentrations of the analytes, showcasing that the variation in response of both carbohydrate and oxygen biosensors could be monitored wirelessly in real-time as analyte concentrations in buffers were changed, using only an enzymatic fuel cell as a power supply.

Continuous wireless pressure monitoring and mapping with ultra-small passive sensors for health monitoring and critical care

Continuous monitoring of internal physiological parameters is essential for critical care patients, but currently can only be practically achieved via tethered solutions. Here we report a wireless, real-time pressure monitoring system with passive, flexible, millimetre-scale sensors, scaled down to unprecedented dimensions of 1 × 1 × 0.1 cubic millimeters. This level of dimensional scaling is enabled by novel sensor design and detection schemes, which overcome the operating frequency limits of traditional strategies and exhibit insensitivity to lossy tissue environments. We demonstrate the use of this system to capture human pulse waveforms wirelessly in real time as well as to monitor in vivo intracranial pressure continuously in proof-of-concept mice studies using sensors down to 2.5 × 2.5 × 0.1 cubic millimeters. We further introduce printable wireless sensor arrays and show their use in real-time spatial pressure mapping. Looking forward, this technology has broader applications in continuous wireless monitoring of multiple physiological parameters for biomedical research and patient care.

Monitoring systems and quantitative measurement of biomolecules for the management of trauma

Continued high morbidity and complications due to trauma related hemorrhage underscores the fact that our understanding of the detailed molecular events of trauma are inadequate to bring life-saving changes to practice. The current state of efficacy and advances in biomedical microdevice technology for trauma diagnostics concerning hemorrhage and hemorrhagic shock was considered with respect to vital signs and metabolic biomarkers. Tachycardia and hypotension are markers of hemorrhagic shock in decompensated trauma patients. Base deficit has been predicative of injury severity at hospital admission. Tissue oxygen saturation has been predicative of onset of multiple organ dysfunction syndrome. Blood potassium levels increase with onset of hemorrhagic shock. Lactate is a surrogate for tissue hypoxia and its clearance predicts mortality. Triage glucose measurements have been shown to be specific in predicting major injuries. No vital sign has yet to be proven effective as an independent predictor of trauma severity. Point of care (POC) devices allow for rapid results, easy sample preparation and processing, small sample volumes, small footprint, multifunctional analysis, and low cost. Advances in the field of in-vivo biosensors has provided a much needed platform by which trauma related metabolites can be monitored easily, rapidly and continuously. Multi-analyte monitoring biosensors have the potential to explore areas still undiscovered in the realm of trauma physiology.

Microelectromechanical systems and nephrology: the next frontier in renal replacement technology

Microelectromechanical systems (MEMS) are playing a prominent role in the development of many new and innovative biomedical devices, but they remain a relatively underused technology in nephrology. The future landscape of clinical medicine and research will only see further expansion of MEMS-based technologies in device designs and applications. This enthusiasm stems from the ability to create small-scale device features with high precision in a cost-effective manner. MEMS also offers the possibility to integrate multiple components into a single device. The adoption of MEMS has the potential to revolutionize how nephrologists manage kidney disease by improving the delivery of renal replacement therapies and enhancing the monitoring of physiologic parameters. To introduce nephrologists to MEMS, this review will first define relevant terms and describe the basic processes used to fabricate devices. Next, a survey of MEMS devices being developed for various biomedical applications will be illustrated with current examples. Finally, MEMS technology specific to nephrology will be highlighted and future applications will be examined. The adoption of MEMS offers novel avenues to improve the care of kidney disease patients and assist nephrologists in clinical practice. This review will serve as an introduction for nephrologists to the exciting world of MEMS.