Epidermal devices for noninvasive, precise, and continuous mapping of macrovascular and microvascular blood flow

Wearable ultrasound devices: An emerging era for biomedicine and clinical translation

In recent years, personalized diagnosis and treatment have gained significant recognition and rapid development in the biomedicine and healthcare. Due to the flexibility, portability and excellent compatibility, wearable ultrasound (WUS) devices have become emerging personalized medical devices with great potential for development. Currently, with the development of the ongoing advancements in materials and structural design of the ultrasound transducers, WUS devices have improved performance and are increasingly applied in the medical field. In this review, we provide an overview of the design and structure of WUS devices, focusing on their application for diagnosis and treatment of various diseases from a clinical application perspective, and then explore the issues that need to be addressed before clinical translation. Finally, we summarize the progress made in the development of WUS devices, and discuss the current challenges and the future direction of their development. In conclusion, WUS devices usher an emerging era for biomedicine with great clinical promise.

Nonwoven fiber meshes for oxygen sensing

Accurate oxygen sensing and cost-effective fabrication are crucial for the adoption of wearable devices inside and outside the clinical setting. Here we introduce a simple strategy to create nonwoven polymeric fibrous mats for a notable contribution towards addressing this need. Although morphological manipulation of polymers for cell culture proliferation is commonplace, especially in the field of regenerative medicine, non-woven structures have not been used for oxygen sensing. We used an airbrush spraying, i.e. solution blowing, to obtain nonwoven fiber meshes embedded with a phosphorescent dye. The fibers serve as a polymer host for the phosphorescent dye and are shown to be non-cytotoxic. Different composite fibrous meshes were prepared and favorable mechanical and oxygen-sensing properties were demonstrated. A Young's modulus of 9.8 MPa was achieved and the maximum oxygen sensitivity improved by a factor of ∼2.9 compared to simple drop cast film. The fibers were also coated with silicone rubbers to produce mechanically robust sensing films. This reduced the sensing performance but improved flexibility and mechanical properties. Lastly, we are able to capture oxygen concentration maps via colorimetry using a smartphone camera, which should offer unique advantages in wider usage. Overall, the introduced composite fiber meshes show a potential to significantly improve cell cultures and healthcare monitoring via absolute oxygen sensing.

An Experimental Phototherapy Device for Studying the Effects of Blue Light on Patients with Raynaud's Phenomenon

Raynaud's phenomenon (RP) is a condition that causes decreased blood flow to areas perfused by small blood vessels (e.g., fingers, toes). In severe cases, ulceration, gangrene, and loss of fingers may occur. Most treatments focus on inducing vasorelaxation in affected areas by the way of pharmaceuticals. Recently, animal studies have shown that vasorelaxation can be induced by non-coherent blue light (wavelength ~ 430-460 nm) through the actions of melanopsin, a photoreceptive opsin protein encoded by the OPN4 gene. To study this effect in humans, a reliable phototherapy device (PTD) is needed. We outline the construction of a PTD to be used in studying blue light effects on Raynaud's patients. Our design addresses user safety, calibration, electromagnetic compatibility/interference (EMC/EMI), and techniques for measuring physiological responses (temperature sensors, laser Doppler flow sensors, infrared thermal imaging of the hands). We tested our device to ensure (1) safe operating conditions, (2) predictable, user-controlled irradiance output levels, (3) an ability for measuring physiological responses, and (4) features necessary to enable a double-blinded crossover study for a clinical trial. We also include in the Methods an approved research protocol utilizing our device that may serve as a starting point for clinical study. We introduced a reliable PTD for studying the effects of blue light therapy for patients suffering from Raynaud's phenomenon and showed that our device is safe and reliable and includes the required measurement vectors for tracking treatment effects throughout the duration of a clinical study.

Bioresorbable shape-adaptive structures for ultrasonic monitoring of deep-tissue homeostasis

Monitoring homeostasis is an essential aspect of obtaining pathophysiological insights for treating patients. Accurate, timely assessments of homeostatic dysregulation in deep tissues typically require expensive imaging techniques or invasive biopsies. We introduce a bioresorbable shape-adaptive materials structure that enables real-time monitoring of deep-tissue homeostasis using conventional ultrasound instruments. Collections of small bioresorbable metal disks distributed within thin, pH-responsive hydrogels, deployed by surgical implantation or syringe injection, allow ultrasound-based measurements of spatiotemporal changes in pH for early assessments of anastomotic leaks after gastrointestinal surgeries, and their bioresorption after a recovery period eliminates the need for surgical extraction. Demonstrations in small and large animal models illustrate capabilities in monitoring leakage from the small intestine, the stomach, and the pancreas.

Variations of skin thermal diffusivity on different skin regions

BACKGROUND AND OBJECTIVE

Skin thermal diffusivity plays a crucial role in various applications, including laser therapy and cryogenic skin cooling.This study investigates the correlation between skin thermal diffusivity and two important skin parameters, melanin content and erythema, in a cohort of 102 participants.

METHODS

An in-house developed device based on transient temperature measurement was used to assess thermal diffusivity at different body locations. Melanin content and erythema were measured using a colorimeter. Statistical analysis was performed to examine potential correlations.

RESULTS

The results showed that the measured thermal diffusivity values were consistent with previous reports, with variations observed among subjects. No significant correlation was found between thermal diffusivity and melanin content or erythema. This suggests that other factors, such as skin hydration or epidermis thickness, may have a more dominant influence on skin thermal properties.

CONLCUSION

This research provides valuable insights into the complex interplay between skin thermal properties and physiological parameters, with potential implications for cosmetic and clinical dermatology applications.

Soft Sensors and Actuators for Wearable Human-Machine Interfaces

Haptic human-machine interfaces (HHMIs) combine tactile sensation and haptic feedback to allow humans to interact closely with machines and robots, providing immersive experiences and convenient lifestyles. Significant progress has been made in developing wearable sensors that accurately detect physical and electrophysiological stimuli with improved softness, functionality, reliability, and selectivity. In addition, soft actuating systems have been developed to provide high-quality haptic feedback by precisely controlling force, displacement, frequency, and spatial resolution. In this Review, we discuss the latest technological advances of soft sensors and actuators for the demonstration of wearable HHMIs. We particularly focus on highlighting material and structural approaches that enable desired sensing and feedback properties necessary for effective wearable HHMIs. Furthermore, promising practical applications of current HHMI technology in various areas such as the metaverse, robotics, and user-interactive devices are discussed in detail. Finally, this Review further concludes by discussing the outlook for next-generation HHMI technology.

Advances in laser speckle imaging: From qualitative to quantitative hemodynamic assessment

Laser speckle imaging (LSI) techniques have emerged as a promising method for visualizing functional blood vessels and tissue perfusion by analyzing the speckle patterns generated by coherent light interacting with living biological tissue. These patterns carry important biophysical tissue information including blood flow dynamics. The noninvasive, label-free, and wide-field attributes along with relatively simple instrumental schematics make it an appealing imaging modality in preclinical and clinical applications. The review outlines the fundamentals of speckle physics and the three categories of LSI techniques based on their degree of quantification: qualitative, semi-quantitative and quantitative. Qualitative LSI produces microvascular maps by capturing speckle contrast variations between blood vessels containing moving red blood cells and the surrounding static tissue. Semi-quantitative techniques provide a more accurate analysis of blood flow dynamics by accounting for the effect of static scattering on spatiotemporal parameters. Quantitative LSI such as optical speckle image velocimetry provides quantitative flow velocity measurements, which is inspired by the particle image velocimetry in fluid mechanics. Additionally, discussions regarding the prospects of future innovations in LSI techniques for optimizing the vascular flow quantification with associated clinical outlook are presented.

Editorial for the Special Issue on Flexible Sensors and Actuators for Biomedicine

Flexible sensors and actuators typically rely on functional materials with low Young's moduli or ultrathin geometries [...].

Laser Direct Writing of Flexible Thermal Flow Sensors

Thin film-based thermal flow sensors afford applications in healthcare and industries owing to their merits in preserving initial flow distributions. However, traditional thermal flow sensors are primarily applied to track flow intensities based on hot-wire or hot-film sensing mechanisms due to their relatively facile device configurations and fabrication strategies. Herein, a calorimetric thermal flow sensor is proposed based on laser direct writing to form laser-induced graphene as heaters and temperature sensors, resulting in monitoring both flow intensities and orientations. Via homogeneously surrounding spiral heaters with multiple temperature sensors, the device exhibits high sensitivity (∼162 K·s/m) at small flows with an extended flow detection range (∼25 m/s). Integrating the device with a data-acquisition board and a dual-mode graphical user interface enables wirelessly and dynamically monitoring respiration and the motion of robotic arms. This versatile flow sensor with facile manufacturing affords potentials in health inspection, remote monitoring, and studying hydrodynamics.

A flexible optoacoustic blood 'stethoscope' for noninvasive multiparametric cardiovascular monitoring

Quantitative and multiparametric blood analysis is of great clinical importance in cardiovascular disease diagnosis. Although there are various methods to extract blood information, they often require invasive procedures, lack continuity, involve bulky instruments, or have complicated testing procedures. Flexible sensors can realize on-skin assessment of several vital signals, but generally exhibit limited function to monitor blood characteristics. Here, we report a flexible optoacoustic blood 'stethoscope' for noninvasive, multiparametric, and continuous cardiovascular monitoring, without requiring complicated procedures. The optoacoustic blood 'stethoscope' features the light delivery elements to illuminate blood and the piezoelectric acoustic elements to capture light-induced acoustic waves. We show that the optoacoustic blood 'stethoscope' can adhere to the skin for continuous and non-invasive in-situ monitoring of multiple cardiovascular biomarkers, including hypoxia, intravascular exogenous agent concentration decay, and hemodynamics, which can be further visualized with a tailored 3D algorithm. Demonstrations on both in-vivo animal trials and human subjects highlight the optoacoustic blood 'stethoscope''s potential for cardiovascular disease diagnosis and prediction.

Skin-interfaced electronics: A promising and intelligent paradigm for personalized healthcare

Skin-interfaced electronics (skintronics) have received considerable attention due to their thinness, skin-like mechanical softness, excellent conformability, and multifunctional integration. Current advancements in skintronics have enabled health monitoring and digital medicine. Particularly, skintronics offer a personalized platform for early-stage disease diagnosis and treatment. In this comprehensive review, we discuss (1) the state-of-the-art skintronic devices, (2) material selections and platform considerations of future skintronics toward intelligent healthcare, (3) device fabrication and system integrations of skintronics, (4) an overview of the skintronic platform for personalized healthcare applications, including biosensing as well as wound healing, sleep monitoring, the assessment of SARS-CoV-2, and the augmented reality-/virtual reality-enhanced human-machine interfaces, and (5) current challenges and future opportunities of skintronics and their potentials in clinical translation and commercialization. The field of skintronics will not only minimize physical and physiological mismatches with the skin but also shift the paradigm in intelligent and personalized healthcare and offer unprecedented promise to revolutionize conventional medical practices.

Spectral analysis of laser speckle contrast imaging and infrared thermography to assess skin microvascular reactive hyperemia

BACKGROUND

Post-occlusive reactive hyperemia (PORH) test with signal spectral analysis coupled provides potential indicators for the assessment of microvascular functions.

OBJECTIVE

The objective of this study is to investigate the variations of skin blood flow and temperature spectra in the PORH test. Furthermore, to quantify the oscillation amplitude response to occlusion within different frequency ranges.

MATERIALS AND METHODS

Ten healthy volunteers participated in the PORH test and their hand skin temperature and blood flow images were captured by infrared thermography (IRT) and laser speckle contrast imaging (LSCI) system, respectively. Extracted signals from selected areas were then transformed into the time-frequency space by continuous wavelet transform for cross-correlation analysis and oscillation amplitude response comparisons.

RESULTS

The LSCI and IRT signals extracted from fingertips showed stronger hyperemia response and larger oscillation amplitude compared with other areas, and their spectral cross-correlations decreased with frequency. According to statistical analysis, their oscillation amplitudes in the PORH stage were obviously larger than the baseline stage within endothelial, neurogenic, and myogenic frequency ranges (p < 0.05), and their quantitative indicators of oscillation amplitude response had high linear correlations within endothelial and neurogenic frequency ranges.

CONCLUSION

Comparisons of IRT and LSCI techniques in recording the reaction to the PORH test were made in both temporal and spectral domains. The larger oscillation amplitudes suggested enhanced endothelial, neurogenic, and myogenic activities in the PORH test. We hope this study is also significant for investigations of response to the PORH test by other non-invasive techniques.

A Review of Skin-Wearable Sensors for Non-Invasive Health Monitoring Applications

The early detection of fatal diseases is crucial for medical diagnostics and treatment, both of which benefit the individual and society. Portable devices, such as thermometers and blood pressure monitors, and large instruments, such as computed tomography (CT) and X-ray scanners, have already been implemented to collect health-related information. However, collecting health information using conventional medical equipment at home or in a hospital can be inefficient and can potentially affect the timeliness of treatment. Therefore, on-time vital signal collection via healthcare monitoring has received increasing attention. As the largest organ of the human body, skin delivers significant signals reflecting our health condition; thus, receiving vital signals directly from the skin offers the opportunity for accessible and versatile non-invasive monitoring. In particular, emerging flexible and stretchable electronics demonstrate the capability of skin-like devices for on-time and continuous long-term health monitoring. Compared to traditional electronic devices, this type of device has better mechanical properties, such as skin conformal attachment, and maintains compatible detectability. This review divides the health information that can be obtained from skin using the sensor aspect's input energy forms into five categories: thermoelectrical signals, neural electrical signals, photoelectrical signals, electrochemical signals, and mechanical pressure signals. We then summarize current skin-wearable health monitoring devices and provide outlooks on future development.

Stretchable conductors for stretchable field-effect transistors and functional circuits

Stretchable electronics have received intense attention due to their broad application prospects in many areas, and can withstand large deformations and form close contact with curved surfaces. Stretchable conductors are vital components of stretchable electronic devices used in wearables, soft robots, and human-machine interactions. Recent advances in stretchable conductors have motivated basic scientific and technological research efforts. Here, we outline and analyse the development of stretchable conductors in transistors and circuits, and examine advances in materials, device engineering, and preparation technologies. We divide the existing approaches to constructing stretchable transistors with stretchable conductors into the following two types: geometric engineering and intrinsic stretchability engineering. Finally, we consider the challenges and outlook in this field for delivering stretchable electronics.

Comparing Remote Speckle Plethysmography and Finger-Clip Photoplethysmography with Non-Invasive Finger Arterial Pressure Pulse Waves, Regarding Morphology and Arrival Time

OBJECTIVE

The goal was to compare Speckle plethysmography (SPG) and Photoplethysmography (PPG) with non-invasive finger Arterial Pressure (fiAP) regarding Pulse Wave Morphology (PWM) and Pulse Arrival Time (PAT).

METHODS

Healthy volunteers (n = 8) were connected to a Non-Invasive Blood Pressure (NIBP) monitor providing fiAP pulse wave and PPG from a clinical transmission-mode SpO₂ finger clip. Biopac recorded 3-lead ECG. A camera placed at a 25 cm distance recorded a video stream (100 fps) of a finger illuminated by a laser diode at 639 nm. A chest belt (Polar) monitored respiration. All signals were recorded simultaneously during episodes of spontaneous breathing and paced breathing.

ANALYSIS

Post-processing was performed in Matlab to obtain SPG and analyze the SPG, PPG and fiAP mean absolute deviations (MADs) on PWM, plus PAT modulation.

RESULTS

Across 2599 beats, the average fiAP MAD with PPG was 0.17 (0-1) and with SPG 0.09 (0-1). PAT derived from ECG-fiAP correlated as follows: 0.65 for ECG-SPG and 0.67 for ECG-PPG.

CONCLUSION

Compared to the clinical NIBP monitor fiAP reference, PWM from an experimental camera-derived non-contact reflective-mode SPG setup resembled fiAP significantly better than PPG from a simultaneously recorded clinical transmission-mode finger clip. For PAT values, no significant difference was found between ECG-SPG and ECG-PPG compared to ECG-fiAP.

In-ear infrasonic hemodynography with a digital health device for cardiovascular monitoring using the human audiome

Human bodily mechanisms and functions produce low-frequency vibrations. Our ability to perceive these vibrations is limited by our range of hearing. However, in-ear infrasonic hemodynography (IH) can measure low-frequency vibrations (<20 Hz) created by vital organs as an acoustic waveform. This is captured using a technology that can be embedded into wearable devices such as in-ear headphones. IH can acquire sound signals that travel within arteries, fluids, bones, and muscles in proximity to the ear canal, allowing for measurements of an individual's unique audiome. We describe the heart rate and heart rhythm results obtained in time-series analysis of the in-ear IH data taken simultaneously with ECG recordings in two dedicated clinical studies. We demonstrate a high correlation (r = 0.99) between IH and ECG acquired interbeat interval and heart rate measurements and show that IH can continuously monitor physiological changes in heart rate induced by various breathing exercises. We also show that IH can differentiate between atrial fibrillation and sinus rhythm with performance similar to ECG. The results represent a demonstration of IH capabilities to deliver accurate heart rate and heart rhythm measurements comparable to ECG, in a wearable form factor. The development of IH shows promise for monitoring acoustic imprints of the human body that will enable new real-time applications in cardiovascular health that are continuous and noninvasive.

Advanced thermal sensing techniques for characterizing the physical properties of skin

Measurements of the thermal properties of the skin can serve as the basis for a noninvasive, quantitative characterization of dermatological health and physiological status. Applications range from the detection of subtle spatiotemporal changes in skin temperature associated with thermoregulatory processes, to the evaluation of depth-dependent compositional properties and hydration levels, to the assessment of various features of microvascular/macrovascular blood flow. Examples of recent advances for performing such measurements include thin, skin-interfaced systems that enable continuous, real-time monitoring of the intrinsic thermal properties of the skin beyond its superficial layers, with a path to reliable, inexpensive instruments that offer potential for widespread use as diagnostic tools in clinical settings or in the home. This paper reviews the foundational aspects of the latest thermal sensing techniques with applicability to the skin, summarizes the various devices that exploit these concepts, and provides an overview of specific areas of application in the context of skin health. A concluding section presents an outlook on the challenges and prospects for research in this field.

Tough, Self-Healing, and Conductive Elastomer ─Ionic PEGgel

Ionically conductive elastomers are necessary for realizing human-machine interfaces, bioelectronic applications, or durable wearable sensors. Current design strategies, however, often suffer from solvent leakage and evaporation, or from poor mechanical properties. Here, we report a strategy to fabricate ionic elastomers (IHPs) demonstrating high conductivity (0.04 S m-1), excellent electrochemical stability (>60,000 cycles), ultra-stretchability (up to 1400%), high toughness (7.16 MJ m-3), and fast self-healing properties, enabling the restoration of ionic conductivity within seconds, as well as no solvent leakage. The ionic elastomer is composed of in situ formed physically cross-linked poly(2-hydroxyethyl methacrylate) networks and poly(ethylene glycol) (PEG). The long molecular chains of PEG serve as a solvent for dissolving electrolytes, improve its long-term stability, reduce solvent leakage, and ensure the outstanding mechanical properties of the IHP. Surprisingly, the incorporation of ions into PEG simultaneously enhances the strength and toughness of the elastomer. The strengthening and toughening mechanisms were further revealed by molecular simulation. We demonstrate an application of the IHPs as (a) flexible sensors for strain or temperature sensing, (b) skin electrodes for recording electrocardiograms, and (c) a tough and sensing material for pneumatic artificial muscles. The proposed strategy is simple and easily scalable and can further inspire the design of novel ionic elastomers for ionotronics applications.

Ultra-Thin Flexible Encapsulating Materials for Soft Bio-Integrated Electronics

Recently, bioelectronic devices extensively researched and developed through the convergence of flexible biocompatible materials and electronics design that enables  more precise diagnostics and therapeutics in human health care and opens up the potential to expand into various fields, such as clinical medicine and biomedical research. To establish an accurate and stable bidirectional bio-interface, protection against the external environment and high mechanical deformation is essential for wearable bioelectronic devices. In the case of implantable bioelectronics, special encapsulation materials and optimized mechanical designs and configurations that provide electronic stability and functionality are required for accommodating various organ properties, lifespans, and functions in the biofluid environment. Here, this study introduces recent developments of ultra-thin encapsulations with novel materials that can preserve or even improve the electrical performance of wearable and implantable bio-integrated electronics by supporting safety and stability for protection from destruction and contamination as well as optimizing the use of bioelectronic systems in physiological environments. In addition, a summary of the materials, methods, and characteristics of the most widely used encapsulation technologies is introduced, thereby providing a strategic selection of appropriate choices of recently developed flexible bioelectronics.

Ultrasound monitoring of microcirculation: An original study from the laboratory bench to the clinic

OBJECTIVE

Monitoring microcirculation and visualizing microvasculature are critical for providing diagnosis to medical professionals and guiding clinical interventions. Ultrasound provides a medium for monitoring and visualization; however, there are challenges due to the complex microscale geometry of the vasculature and difficulties associated with quantifying perfusion. Here, we studied established and state-of-the-art ultrasonic modalities (using six probes) to compare their detection of slow flow in small microvasculature.

METHODS

Five ultrasonic modalities were studied: grayscale, color Doppler, power Doppler, superb microvascular imaging (SMI), and microflow imaging (MFI), using six linear probes across two ultrasound scanners. Image readability was blindly scored by radiologists and quantified for evaluation. Vasculature visualization was investigated both in vitro (resolution and flow characterization) and in vivo (fingertip microvasculature detection).

RESULTS

Superb Microvascular Imaging (SMI) and Micro Flow Imaging (MFI) modalities provided superior images when compared with conventional ultrasound imaging modalities both in vitro and in vivo. The choice of probe played a significant difference in detectability. The slowest flow detected (in the lab) was 0.1885 ml/s and small microvasculature of the fingertip were visualized.

CONCLUSIONS

Our data demonstrated that SMI and MFI used with vascular probes operating at higher frequencies provided resolutions acceptable for microvasculature visualization, paving the path for future development of ultrasound devices for microcirculation monitoring.

Stretchable and Self-Healable Graphene–Polymer Conductive Composite for Wearable EMG Sensor

In bioelectronics, stretchable and self-healable electrodes can reliably measure electrophysiological signals from the human body because they have good modulus matching with tissue and high durability. In particular, the polymer–graphene composite has advantages when it is used as an electrode for bioelectronic sensor devices. However, it has previously been reported that external stimuli such as heat or light are required for the self-healing process of polymer/graphene composites. In this study, we optimized a conducting composite by mixing a self-healing polymer (SHP) and graphene. The composite materials can not only self-heal without external stimulation but also have rapid electrical recovery from repeated mechanical damage such as scratches. In addition, they had stable electrical endurance even when the cyclic test was performed over 200 cycles at 50% strain, so they can be useful for a bioelectronic sensor device with high durability. Finally, we measured the electromyogram signals caused by the movement of arm muscles using our composite, and the measured data were transmitted to a microcontroller to successfully control the movement of the robot’s hand.

Wearable Devices in Veterinary Health Care

Wearables are an up-and-coming tool in veterinary health care. This article reviews the current and prospective wearable technology for veterinary patients and the future of wearables in veterinary medicine. These devices allow veterinarians to monitor a patient's vital signs remotely, in addition to other variables, and push the profession away from a reactive health-care system toward a proactive culture that is able to identify diseases earlier. Advances in this technology have the potential to profoundly change the way veterinarians obtain and use patient data to practice medicine.

A proof-of-concept real-time processing to characterize vascular flow

In dialysis patients, monitoring vascular flow of the surgically created arteriovenous fistula (AVF) is critical to indicate the success of the AVF as a dialysis access site. Current gold standard to quantify vascular flow involves external doppler evaluation which requires frequent visits to the clinic. In this paper, we present a proof-of-concept cost-efficient vascular flow monitoring system towards a wearable and robust blood flow monitoring system. The proposed system captures beat-to-beat blood flow from impedance plethysmography (IPG) signal and performs embedded computing to robustly map the changes in the IPG to peripheral blood flow. We present the proof-of-concept results for the embedded real-time blood flow computing from measurements obtained using a custom electrical bioimpedance hardware presented previously elsewhere. We anticipate the results serving as the first step towards potentially eliminating the need for using expensive and bulky systems that require specialized personnel to operate for peripheral blood flow monitoring. Clinical relevance-The study paves the way to engineering a ubiquitous blood flow monitoring system for patients who have a surgically created Arteriovenous fistula (AVF) for dialysis vascular access.

Wearable devices for continuous monitoring of biosignals: Challenges and opportunities

The ability for wearable devices to collect high-fidelity biosignals continuously over weeks and months at a time has become an increasingly sought-after characteristic to provide advanced diagnostic and therapeutic capabilities. Wearable devices for this purpose face a multitude of challenges such as formfactors with long-term user acceptance and power supplies that enable continuous operation without requiring extensive user interaction. This review summarizes design considerations associated with these attributes and summarizes recent advances toward continuous operation with high-fidelity biosignal recording abilities. The review also provides insight into systematic barriers for these device archetypes and outlines most promising technological approaches to expand capabilities. We conclude with a summary of current developments of hardware and approaches for embedded artificial intelligence in this wearable device class, which is pivotal for next generation autonomous diagnostic, therapeutic, and assistive health tools.

Construction of liquid metal-based soft microfluidic sensors via soft lithography

Background

Liquid metal (LM) can be integrated into microfluidic channel, bringing new functionalities of microfluidics and opening a new window for soft microfluidic electronics, due to the superior advantages of the conductivity and deformability of LMs. However, patterning the LMs into microfluidic channels requires either selective surface wetting or complex fabrication process.

Results

In this work, we develop a method to pattern the LMs onto the soft elastomer via soft lithographic process for fabrication of soft microfluidic sensors without the surface modification, bulky facilities, and complicated processes. The combination of the interfacial hydrogen bond and surface tension enables the LM patterns transfer to the soft elastomer. The transferred LM patterns with an ellipse-like cross-section further improve the stability under the mechanical deformation. Three proof-of-concept experiments were conducted to demonstrate the utilization of this method for development of thermochromic sensors, self-powered capacity sensors and flexible biosensor for glucose detection.

Conclusions

In summary, the proposed method offers a new patterning method to obtain soft microfluidic sensors and brings new possibilities for microfluidics-related wearable devices.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12951-022-01471-0.

Ultralight Iontronic Triboelectric Mechanoreceptor with High Specific Outputs for Epidermal Electronics

The pursuit to mimic skin exteroceptive ability has motivated the endeavors for epidermal artificial mechanoreceptors. Artificial mechanoreceptors are required to be highly sensitive to capture imperceptible skin deformations and preferably to be self-powered, breathable, lightweight and deformable to satisfy the prolonged wearing demands. It is still struggling to achieve these traits in single device, as it remains difficult to minimize device architecture without sacrificing the sensitivity or stability. In this article, we present an all-fiber iontronic triboelectric mechanoreceptor (ITM) to fully tackle these challenges, enabled by the high-output mechano-to-electrical energy conversion. The proposed ITM is ultralight, breathable and stretchable and is quite stable under various mechanical deformations. On the one hand, the ITM can achieve a superior instantaneous power density; on the other hand, the ITM shows excellent sensitivity serving as epidermal sensors. Precise health status monitoring is readily implemented by the ITM calibrating by detecting vital signals and physical activities of human bodies. The ITM can also realize acoustic-to-electrical conversion and distinguish voices from different people, and biometric application as a noise dosimeter is demonstrated. The ITM therefore is believed to open new sights in epidermal electronics and skin prosthesis fields.

Biomarkers and Detection Platforms for Human Health and Performance Monitoring: A Review

Human health and performance monitoring (HHPM) is imperative to provide information necessary for protecting, sustaining, evaluating, and improving personnel in various occupational sectors, such as industry, academy, sports, recreation, and military. While various commercially wearable sensors are on the market with their capability of "quantitative assessments" on human health, physical, and psychological states, their sensing is mostly based on physical traits, and thus lacks precision in HHPM. Minimally or noninvasive biomarkers detectable from the human body, such as body fluid (e.g., sweat, tear, urine, and interstitial fluid), exhaled breath, and skin surface, can provide abundant additional information to the HHPM. Detecting these biomarkers with novel or existing sensor technologies is emerging as critical human monitoring research. This review provides a broad perspective on the state of the art biosensor technologies for HHPM, including the list of biomarkers and their physiochemical/physical characteristics, fundamental sensing principles, and high-performance sensing transducers. Further, this paper expands to the additional scope on the key technical challenges in applying the current HHPM system to the real field.

Flexible dual-channel digital auscultation patch with active noise reduction for bowel sound monitoring and application

Bowel sounds (BSs) have important clinical value in the auxiliary diagnosis of digestive diseases, but due to the inconvenience of long-term monitoring and too much interference from environmental noise, they have not been well studied. Most of the current electronic stethoscopes are hard and bulky without the function of noise reduction, and their application for long-term wearable monitoring of BS in noisy clinical environments is very limited. In this paper, a flexible dual-channel digital auscultation patch with active noise reduction is designed and developed, which is wireless, wearable, and conformably attached to abdominal skin to record BS more accurately. The ambient noise can be greatly reduced through active noise reduction based on the adaptive filter. At the same time, some nonstationary noises appearing intermittently (e.g., frictional noise) can also be removed from BS by the cross validation of multichannel simultaneous acquisition. Then, two kinds of typical BS signals are taken as examples, and the feature parameters of the BS in the time domain and frequency domain are extracted through the time-frequency analysis algorithm. Furthermore, based on the short-term energy ratio between the four channels of dual patches, the two-dimensional localization of BS on the abdomen mapping plane is realized. Finally, the continuous wearable monitoring of BS for patients with postoperative ileus (POI) in the noisy ward from pre-operation (POD0) to postoperative Day 7 (POD7) was carried out. The obtained change curve of the occurrence frequency of BS provides guidance for doctors to choose a reasonable feeding time for patients after surgery and accelerate their recovery. Therefore, flexible dual-channel digital auscultation patches with active noise reduction will have promising applications in the clinical auxiliary diagnosis of digestive diseases.

Thermal Analysis of Blood Flow Alterations in Human Hand and Foot Based on Vascular-Porous Media Model

Microvascular and Macrovascular diseases are serious complications of diabetic mellitus, which significantly affect the life quality of diabetic patients. Quantitative description of the relationship between temperature and blood flow is considerably important for non-invasive detection of blood vessel structural and functional lesions. In this study, thermal analysis has been employed to predict blood flow alterations in a foot and a cubic skin model successively by using a discrete vessel-porous media model and further compared the blood flows in 31 diabetic patients. The tissue is regarded as porous media whose liquid phase represents the blood flow in capillaries and solid phase refers to the tissue part. Discrete vascular segments composed of arteries, arterioles, veins, and venules were embedded in the foot model. In the foot thermal analysis, the temperature distributions with different inlet vascular stenosis were simulated. The local temperature area sensitive to the reduction of perfusion was obtained under different inlet blood flow conditions. The discrete vascular-porous media model was further applied in the assessment of the skin blood flow by coupling the measured skin temperatures of diabetic patients and an inverse method. In comparison with the estimated blood flows among the diabetic patients, delayed blood flow regulation was found in some of diabetic patients, implying that there may be some vascular disorders in these patients. The conclusion confirms the one in our previous experiment on diabetic rats. Most of the patients predicted to be with vascular disorders were diagnosed as vascular complication in clinical settings as well, suggesting the potential applications of the vascular-porous media model in health management of diabetic patients.

Mechanical sensors based on two-dimensional materials: Sensing mechanisms, structural designs and wearable applications

Compared with bulk materials, atomically thin two-dimensional (2D) crystals possess a range of unique mechanical properties, including relatively high in-plane stiffness and large bending flexibility. The atomic 2D building blocks can be reassembled into precisely designed heterogeneous composite structures of various geometries with customized mechanical sensing behaviors. Due to their small specific density, high flexibility, and environmental adaptability, mechanical sensors based on 2D materials can conform to soft and curved surfaces, thus providing suitable solutions for functional applications in future wearable devices. In this review, we summarize the latest developments in mechanical sensors based on 2D materials from the perspective of function-oriented applications. First, typical mechanical sensing mechanisms are introduced. Second, we attempt to establish a correspondence between typical structure designs and the performance/multi-functions of the devices. Afterward, several particularly promising areas for potential applications are discussed, following which we present perspectives on current challenges and future opportunities

A wireless optoelectronic skin patch for light delivery and thermal monitoring

Wearable optoelectronic devices can interface with the skin for applications in continuous health monitoring and light-based therapy. Measurement of the thermal effect of light on skin is often critical to track physiological parameters and control light delivery. However, accurate measurement of light-induced thermal effects is challenging because conventional sensors cannot be placed on the skin without obstructing light delivery. Here, we report a wearable optoelectronic patch integrated with a transparent nanowire sensor that provides light delivery and thermal monitoring at the same location. We achieve fabrication of a transparent silver nanowire network with >92% optical transmission that provides thermoresistive sensing of skin temperature. By integrating the sensor in a wireless optoelectronic patch, we demonstrate closed-loop regulation of light delivery as well as thermal characterization of blood flow. This light delivery and thermal monitoring approach may open opportunities for wearable devices in light-based diagnostics and therapies.

Flexible Doppler ultrasound device for the monitoring of blood flow velocity

Thrombosis and restenosis after vascular reconstruction procedures may cause complications such as stroke, but a clinical means to continuously monitor vascular conditions is lacking. Conventional ultrasound probes are rigid, particularly for postoperative patients with fragile skin. Techniques based on photoplethysmography or thermal analysis provide only relative changes in flow volume and have a shallow detection depth. Here, we introduce a flexible Doppler ultrasound device for the continuous monitoring of the absolute velocity of blood flow in deeply embedded arteries based on the Doppler effect. The device is thin (1 mm), lightweight (0.75 g), and skin conforming. When the dual-beam Doppler method is used, the influence of the Doppler angle on the velocity measurement is avoided. Experimental studies on ultrasound phantoms and human subjects demonstrate accurate measurement of the flow velocity. The wearable Doppler device has the potential to enhance the quality of care of patients after reconstruction surgery.

A Molecular Communications System for the Detection of Inflammatory Levels Related to COVID-19 Disease

A recent and extensive research activity highlighted the process behind the attack and spread of COVID-19 in the human body. What emerged is that the SARS-CoV-2 virus makes use of both the ACE2 receptor, expressed by pneumocytes in the ephitelial alveolar lining, and by the endothelium to spread the disease and to replicate itself. Since the endothelium is an extended tissue lying in the circulatory system, this may lead to a large state of diffuse endothelial inflammation with serious clinical consequences. This situation may be further compromised by the immune system, that may generate pro-inflammatory cytokines (IL-6) as a consequence of the infection. In this paper we propose and analyze a molecular communication system, designed for the detection of excessive IL-6 level, that allows monitoring its evolution in the blood vessels. The proposed analysis was performed by using the BiNS2 simulator, which is suitable for the numerical analysis of flow-based molecular communications in blood vessels, as well as Markov models of the endothelium.

Continuous monitoring of deep-tissue haemodynamics with stretchable ultrasonic phased arrays

Stretchable wearable devices for the continuous monitoring of physiological signals from deep tissues are constrained by the depth of signal penetration and by difficulties in resolving signals from specific tissues. Here, we report the development and testing of a prototype skin-conformal ultrasonic phased array for the monitoring of haemodynamic signals from tissues up to 14 cm beneath the skin. The device allows for active focusing and steering of ultrasound beams over a range of incident angles so as to target regions of interest. In healthy volunteers, we show that the phased array can be used to monitor Doppler spectra from cardiac tissues, record central blood flow waveforms and estimate cerebral blood supply in real time. Stretchable and conformal skin-worn ultrasonic phased arrays may open up opportunities for wearable diagnostics.

High Precision Human Skin Temperature Fluctuations Measuring Instrument

This paper describes the experimental results of testing a prototype of a high precision human skin rapid temperature fluctuations measuring instrument. Based on the author’s work, an original circuit solution on a miniature semiconductor diode sensor has been designed. The proposed circuitry provides operation in the full voltage range with automatic setting and holding the operating point, as well as the necessary slope of the conversion coefficient (up to 2300 mV/°C), which makes it possible to register fast temperature oscillations from the surface of the human body and other biological objects. Simulation results in the Microcap 12 software and laboratory tests have confirmed all declared design specifications: temperature resolution of 0.01 °C, transducer thermal time constant of 0.05 s. An original thermostat and an experimental setup for the simultaneous registration of the electrocardiogram, pulse wave signals from the Biopac polygraph MP36 and a signal of temperature oscillations from the prototype thermometer have been designed for further investigations. The preliminary test results indicates that using the designed measuring instrument gives a possibility to provide an in-depth study of the relationship between micro- and macro-blood circulations manifested in skin temperature fluctuations.

Controllable Graphene Wrinkle for a High-Performance Flexible Pressure Sensor

Flexible pressure sensors have aroused tremendous attention, owing to their broad applications in healthcare, robotics, and prosthetics. So far, it remains a critical challenge to develop low-cost and controllable microstructures for flexible pressure sensors. Herein, a high-sensitivity and low-cost flexible piezoresistive sensor was developed by combining a controllable graphene-nanowalls (GNWs) wrinkle and a polydimethylsiloxane (PDMS) elastomer. For the GNWs-PDMS bilayer, the vertically grown GNWs film can effectively improve the interface strength and form delamination-free conformal wrinkles. More importantly, a controllable microstructure can be easily tuned through the thermal wrinkling method. The wrinkled graphene-nanowalls (WG) piezoresistive sensor has a high sensitivity (S = 59.0 kPa^-1 for the 0-2 kPa region and S = 4.8 kPa^-1 for the 2-20 kPa region), a fast response speed (<6.9 ms), and a low limit of detection (LOD) of 2 mg (∼0.2 Pa). The finite element method was used to analyze the working mechanism of the sensor, which revealed that the periods of the wrinkles play a dominant role in the performances of the sensors. These prominent merits enable wrinkled graphene sensors to successfully detect various signals from a weak stimulus to large pressures, for example, the detection of weak gas and plantar pressure. Furthermore, object manipulation, tactile imaging, and braille recognition applications have been demonstrated, showing their great potential in prosthetics limbs and intelligent robotics.

Cohabiting Plant-Wearable Sensor In Situ Monitors Water Transport in Plant

The boom of plant phenotype highlights the need to measure the physiological characteristics of an individual plant. However, continuous real-time monitoring of a plant's internal physiological status remains challenging using traditional silicon-based sensor technology, due to the fundamental mismatch between rigid sensors and soft and curved plant surfaces. Here, the first flexible electronic sensing device is reported that can harmlessly cohabitate with the plant and continuously monitor its stem sap flow, a critical plant physiological characteristic for analyzing plant health, water consumption, and nutrient distribution. Due to a special design and the materials chosen, the realized plant-wearable sensor is thin, soft, lightweight, air/water/light-permeable, and shows excellent biocompatibility, therefore enabling the sap flow detection in a continuous and non-destructive manner. The sensor can serve as a noninvasive, high-throughput, low-cost toolbox, and holds excellent potentials in phenotyping. Furthermore, the real-time investigation on stem flow insides watermelon reveals a previously unknown day/night shift pattern of water allocation between fruit and its adjacent branch, which has not been reported before.

Micro-Actuated Tunable Hierarchical Silver Nanostructures to Measure Tensile Force for Biomedical Wearable Sensing Applications

Commercially available biomedical wearable sensors to measure tensile force/strain still struggle with miniaturization in terms of weight, size, and conformability. Flexible and epidermal electronic devices have been utilized in these applications to overcome these issues. However, current sensors still require a power supply and some form of powered data transfer, which present challenges to miniaturization and to applications. Here, we report on the development of flexible, passive (thus zero power consumption), and biocompatible nanostructured photonic devices that can measure tensile strain in real time by providing an optical readout instead of an electronic readout. Hierarchical silver (Ag) nanostructures in various thicknesses of 20–60 nm were fabricated and embedded on a stretchable substrate using e-beam lithography and a low-temperature dewetting process. The hierarchical Ag nanostructures offer more design flexibility through a two-level design approach. A tensional force applied in one lateral (x- or y-) direction of the stretchable substrate causes a Poisson contraction in the other, and as a result, a shift in the reflected light of the nanostructures. A clear blue shift of more than 100 nm in peak reflectance in the visible spectrum was observed in the reflected color, making the devices applicable in a variety of biomedical photonic sensing applications.

Wireless and battery-free platforms for collection of biosignals

Recent progress in biosensors have quantitively expanded current capabilities in exploratory research tools, diagnostics and therapeutics. This rapid pace in sensor development has been accentuated by vast improvements in data analysis methods in the form of machine learning and artificial intelligence that, together, promise fantastic opportunities in chronic sensing of biosignals to enable preventative screening, automated diagnosis, and tools for personalized treatment strategies. At the same time, the importance of widely accessible personal monitoring has become evident by recent events such as the COVID-19 pandemic. Progress in fully integrated and chronic sensing solutions is therefore increasingly important. Chronic operation, however, is not truly possible with tethered approaches or bulky, battery-powered systems that require frequent user interaction. A solution for this integration challenge is offered by wireless and battery-free platforms that enable continuous collection of biosignals. This review summarizes current approaches to realize such device architectures and discusses their building blocks. Specifically, power supplies, wireless communication methods and compatible sensing modalities in the context of most prevalent implementations in target organ systems. Additionally, we highlight examples of current embodiments that quantitively expand sensing capabilities because of their use of wireless and battery-free architectures.

Wireless, implantable catheter-type oximeter designed for cardiac oxygen saturation

Accurate, real-time monitoring of intravascular oxygen levels is important in tracking the cardiopulmonary health of patients after cardiothoracic surgery. Existing technologies use intravascular placement of glass fiber-optic catheters that pose risks of blood vessel damage, thrombosis, and infection. In addition, physical tethers to power supply systems and data acquisition hardware limit freedom of movement and add clutter to the intensive care unit. This report introduces a wireless, miniaturized, implantable optoelectronic catheter system incorporating optical components on the probe, encapsulated by soft biocompatible materials, as alternative technology that avoids these disadvantages. The absence of physical tethers and the flexible, biocompatible construction of the probe represent key defining features, resulting in a high-performance, patient-friendly implantable oximeter that can monitor localized tissue oxygenation, heart rate, and respiratory activity with wireless, real-time, continuous operation. In vitro and in vivo testing shows that this platform offers measurement accuracy and precision equivalent to those of existing clinical standards.

Material innovation and mechanics design for substrates and encapsulation of flexible electronics: a review

Advances in materials and mechanics designs have led to the development of flexible electronics, which have important applications to human healthcare due to their good biocompatibility and conformal integration with biological tissue. Material innovation and mechanics design have played a key role in designing the substrates and encapsulations of flexible electronics for various bio-integrated systems. This review first introduces the inorganic materials and novel organic materials used for the substrates and encapsulation of flexible electronics, and summarizes their mechanics properties, permeability and optical transmission properties. The structural designs of the substrates are then introduced to ensure the reliability of flexible electronics, including the patterned and pre-strained designs to improve the stretchability, and the strain-isolation and -limiting substrates to reduce the deformation. Some emerging encapsulations are presented to protect the flexible electronics from degradation, environmental erosion or contamination, though they may slightly reduce the stretchability of flexible electronics.

[Analysis of endothelial dysfunction in the context of pleural effusions of various origins using skin thermometry]

OBJECTIVE

To analyze the mechanisms and severity of endothelial dysfunction in patients with pleural effusion of various origins using skin thermometry.

MATERIAL AND METHODS

We studied microcirculation in 135 patients with pleural effusions of various origins. Local skin thermometry and computer wavelet analysis were performed in 3-5 days after thoracoscopy with pleural biopsy using Microtest-100WF device with a temperature measuring resolution of 0.001°C. We estimated endothelial, myogenic and neurogenic indices using spectral analysis of skin temperature fluctuations in a range 0.0095-2 Hz. The control group comprised 40 healthy participants aged 23-36 years.

RESULTS

Three groups of patients were distinguished depending on the cause of effusion: malignant pleural effusions (n=65, 48.1%); inflammatory pleural effusions (para-pneumonic, post-traumatic, pancreatogenic, tuberculous) (n=58, 43%); transudates (hepatogenic, cardiogenic, and nephrogenic) (n=12, 8.9%). There were no significant differences in vascular tone in response to local heating of the second finger of the hand up to 40°C. Measurements were carried out within 10 min in all groups. Patients with diabetes mellitus and cardiovascular diseases (n=48, 35.6%) had significant decrease of thermal vasodilation index in endothelial range up to 2.93±1.77, in the control group - up to 4.21±2.40 (p=0.041).

CONCLUSION

Endothelial dysfunction is a universal non-specific aspect in pathogenesis of various diseases. This process is essential in pleural effusion. Local thermometry and computer wavelet analysis revealed no significant differences between patients with malignant, inflammatory and transudative pleural effusions. Pleural effusions in the context of cardiovascular pathology and/or diabetes mellitus occur due to impaired vasodilatation mechanisms in endothelial range.

In vivo skin thermophysical property testing technology using flexible thermosensor-based 3ω method

Thermophysical properties of human skin surface and subsurface can reflect the hydration state of the skin and the blood flow rate in the near surface microvessels, which reveals important physiological information related to dermatology and overall health status of human body. Although a few techniques have been developed to measure these signs, complicated devices are required and the subjects need to be completely fixed during the test period. Here, a flexible thermosensor-based 3ω technology was used to monitor thermal conductivity of human skins at different states. Through the analysis of these characteristics, the corresponding physiological state can be established, which can provide a new detection method for the evaluation or prediction of human health status.

Highly Stretchable Fiber-Based Potentiometric Ion Sensors for Multichannel Real-Time Analysis of Human Sweat

Wearable potentiometric ion sensors are attracting attention for real-time ion monitoring in biological fluids. One of the key challenges lies in keeping the analytical performances under a stretchable state. Herein, we report a highly stretchable fiber-based ion-selective electrode (ISE) prepared by coating an ion-selective membrane (ISM) on a stretchable gold fiber electrode. The fiber ISE ensures high stretchability up to 200% strain with only 2.1% increase in resistance of the fiber electrode. Owing to a strong attachment between the ISM and gold fiber electrode substrate, the ISE discloses favorable stability and potential repeatability. The Nernst slope of the ion response fluctuates from 59.2 to 57.4 mV/dec between 0 and 200% strain. Minor fluctuation of the intercept (E⁰) (±4.97 mV) also results. The ISE can endure 1000 cycles at the maximum stretch. Sodium, chloride, and pH fiber sensors were fabricated and integrated into a hairband for real-time analysis of human sweat. The result displays a high accuracy compared with ex situ analysis. The integrated sensors were calibrated before and just after on-body measurements, and they offer reliable results for sweat analysis.

Vibration Analysis of Post-Buckled Thin Film on Compliant Substrates

Buckling stability of thin films on compliant substrates is universal and essential in stretchable electronics. The dynamic behaviors of this special system are unavoidable when the stretchable electronics are in real applications. In this paper, an analytical model is established to investigate the vibration of post-buckled thin films on a compliant substrate by accounting for the substrate as an elastic foundation. The analytical predictions of natural frequencies and vibration modes of the system are systematically investigated. The results may serve as guidance for the dynamic design of the thin film on compliant substrates to avoid resonance in the noise environment.

In Vivo Optofluidic Switch for Controlling Blood Microflow

Control of blood microflow is crucial for the prevention and therapy of blood disorders, such as cardiovascular diseases and their complications. Conventional control strategies generally implant exogenous synthetic materials into blood vessels as labeling markers or actuating sources, which are invasive and incompatible with biological systems. Here, a label-free, noninvasive, and biocompatible device constructed from natural red blood cells (RBCs) for controlling blood microflow in vivo is reported. The RBCs, optically manipulated, arranged, and rotated using scanning optical tweezers, can function as an optofluidic switch for targeted switching, directional enrichment, dynamic redirecting, and rotary actuation of blood microflow inside zebrafish. The regulation precision of the switch is determined to be at the single-cell level, and the response time is measured as ≈200 ms using a streamline tracking method. This in vivo optofluidic switch may provide a biofriendly device for exploring blood microenvironments in a noncontact and noninvasive manner.

Physiological and Behavior Monitoring Systems for Smart Healthcare Environments: A Review

Healthcare optimization has become increasingly important in the current era, where numerous challenges are posed by population ageing phenomena and the demand for higher quality of the healthcare services. The implementation of Internet of Things (IoT) in the healthcare ecosystem has been one of the best solutions to address these challenges and therefore to prevent and diagnose possible health impairments in people. The remote monitoring of environmental parameters and how they can cause or mediate any disease, and the monitoring of human daily activities and physiological parameters are among the vast applications of IoT in healthcare, which has brought extensive attention of academia and industry. Assisted and smart tailored environments are possible with the implementation of such technologies that bring personal healthcare to any individual, while living in their preferred environments. In this paper we address several requirements for the development of such environments, namely the deployment of physiological signs monitoring systems, daily activity recognition techniques, as well as indoor air quality monitoring solutions. The machine learning methods that are most used in the literature for activity recognition and body motion analysis are also referred. Furthermore, the importance of physical and cognitive training of the elderly population through the implementation of exergames and immersive environments is also addressed.