Long-term reliable physical health monitoring by sweat pore-inspired perforated electronic skins

Flexible electronics for cardiovascular monitoring on complex physiological skins

Cardiovascular diseases (CVDs) pose a significant global health threat, responsible for a considerable portion of worldwide mortality. Flexible electronics enable continuous, noninvasive, real-time, and portable monitoring, providing an ideal platform for personalized healthcare. Nevertheless, challenges persist in sustaining stable adherence across diverse and intricate skin environments, hindering further advancement toward clinical applications. Strategies such as structural design and chemical modification can significantly enhance the environmental adaptability and monitoring performance of flexible electronics. This review delineates processing techniques, including structural design and chemical modification, to mitigate signal interference from sebaceous skin, motion artifacts from the skin in motion, and infection risks from fragile skin, thereby enabling the accurate monitoring of key cardiovascular indicators in complex physiological environments. Moreover, it delves into the potential for the strategic development and improvement of flexible electronics to ensure their alignment with complex physiological environment requirements, facilitating their transition to clinical applications.

Semi-liquid metal-based highly permeable and adhesive electronic skin inspired by spider web

Soft and stretchable electronics have garnered significant attention in various fields, such as wearable electronics, electronic skins, and soft robotics. However, current wearable electronics made from materials like conductive elastomers, hydrogels, and liquid metals face limitations, including low permeability, poor adhesion, inadequate conductivity, and limited stretchability. These issues hinder their effectiveness in long-term healthcare monitoring and exercise monitoring. To address these challenges, we introduce a novel design of web-droplet-like electronics featuring a semi-liquid metal coating for wearable applications. This innovative design offers high permeability, excellent stretchability, strong adhesion, and good conductivity for the electronic skin. The unique structure, inspired by the architecture of a spider web, significantly enhances air permeability compared to commercial breathable patches. Furthermore, the distribution of polyborosiloxane mimics the adhesive properties of spider web mucus, while the use of semi-liquid metals in this design results in remarkable conductivity (9 × 106 S/m) and tensile performance (up to 850% strain). This advanced electronic skin technology enables long-term monitoring of various physiological parameters and supports machine learning recognition functions with unparalleled advantages. This web-droplet structure design strategy holds great promise for commercial applications in medical health monitoring and disease diagnosis.

Toward an AI Era: Advances in Electronic Skins

Electronic skins (e-skins) have seen intense research and rapid development in the past two decades. To mimic the capabilities of human skin, a multitude of flexible/stretchable sensors that detect physiological and environmental signals have been designed and integrated into functional systems. Recently, researchers have increasingly deployed machine learning and other artificial intelligence (AI) technologies to mimic the human neural system for the processing and analysis of sensory data collected by e-skins. Integrating AI has the potential to enable advanced applications in robotics, healthcare, and human-machine interfaces but also presents challenges such as data diversity and AI model robustness. In this review, we first summarize the functions and features of e-skins, followed by feature extraction of sensory data and different AI models. Next, we discuss the utilization of AI in the design of e-skin sensors and address the key topic of AI implementation in data processing and analysis of e-skins to accomplish a range of different tasks. Subsequently, we explore hardware-layer in-skin intelligence before concluding with an analysis of the challenges and opportunities in the various aspects of AI-enabled e-skins.

Skin-Mountable Functional Electronic Materials for Bio-Integrated Devices

Skin-mountable electronic materials are being intensively evaluated for use in bio-integrated devices that can mutually interact with the human body. Over the past decade, functional electronic materials inspired by the skin are developed with new functionalities to address the limitations of traditional electronic materials for bio-integrated devices. Herein, the recent progress in skin-mountable functional electronic materials for skin-like electronics is introduced with a focus on five perspectives that entail essential functionalities: stretchability, self-healing ability, biocompatibility, breathability, and biodegradability. All functionalities are advanced with each strategy through rational material designs. The skin-mountable functional materials enable the fabrication of bio-integrated electronic devices, which can lead to new paradigms of electronics combining with the human body.

Electronic Skin for Health Monitoring Systems: Properties, Functions, and Applications

Electronic skin (e-skin), a skin-like wearable electronic device, holds great promise in the fields of telemedicine and personalized healthcare because of its good flexibility, biocompatibility, skin conformability, and sensing performance. E-skin can monitor various health indicators of the human body in real time and over the long term, including physical indicators (exercise, respiration, blood pressure, etc.) and chemical indicators (saliva, sweat, urine, etc.). In recent years, the development of various materials, analysis, and manufacturing technologies has promoted significant development of e-skin, laying the foundation for the application of next-generation wearable medical technologies and devices. Herein, the properties required for e-skin health monitoring devices to achieve long-term and precise monitoring and summarize several detectable indicators in the health monitoring field are discussed. Subsequently, the applications of integrated e-skin health monitoring systems are reviewed. Finally, current challenges and future development directions in this field are discussed. This review is expected to generate great interest and inspiration for the development and improvement of e-skin and health monitoring systems.

Treefrog-Inspired Flexible Electrode with High Permeability, Stable Adhesion, and Robust Durability

Long-term continuous monitoring (LTCM) of physiological electrical signals is an effective means for detecting several cardiovascular diseases. However, the integrated challenges of stable adhesion, low impedance, and robust durability under different skin conditions significantly hinder the application of flexible electrodes in LTCM. This paper proposes a structured electrode inspired by the treefrog web, comprising dispersed pillars at the bottom and asymmetric cone holes at the top. Attachment structures with a dispersed pillar improve the contact stability (adhesion increases 2.79/13.16 times in dry/wet conditions compared to an electrode without structure). Improved permeable duct structure provides high permeability (12 times compared to cotton). Due to high adhesion and permeability, the electrode's durability is 40 times larger than commercial Ag/AgCl electrodes. The treefrog web-like electrode has great advantages in permeability, adhesion, and durability, resulting in prospects for application in physiological electrical signal detection and a new design idea for LTCM wearable dry electrodes.

Highly Adaptive Kirigami-Metastructure Adhesive with Vertically Self-Aligning Octopus-like 3D Suction Cups for Efficient Wet Adhesion to Complexly Curved Surfaces

An essential requirement for biomedical devices is the capability of conformal adaptability on diverse irregular 3D (three-dimensional) nonflat surfaces in the human body that may be covered with liquids such as mucus or sweat. However, the development of reversible adhesive interface materials for biodevices that function on complex biological surfaces is challenging due to the wet, slippery, smooth, and curved surface properties. Herein, we present an ultra-adaptive bioadhesive for irregular 3D oral cavities covered with saliva by integrating a kirigami-metastructure and vertically self-aligning suction cups. The flared suction cup, inspired by octopus tentacles, allows adhesion to moist surfaces. Additionally, the kirigami-based auxetic metastructure with a negative Poisson's ratio relieves the stress caused by tensile strain, thereby mitigating the stress caused by curved surfaces and enabling conformal contact with the surface. As a result, the adhesive strength of the proposed auxetic adhesive is twice that of adhesives with a flat backbone on highly curved porcine palates. For potential application, the proposed auxetic adhesive is mounted on a denture and performs successfully in human subject feasibility evaluations. An integrated design of these two structures may provide functionality and potential for biomedical applications.

Electronic Skin: Opportunities and Challenges in Convergence with Machine Learning

Recent advancements in soft electronic skin (e-skin) have led to the development of human-like devices that reproduce the skin's functions and physical attributes. These devices are being explored for applications in robotic prostheses as well as for collecting biopotentials for disease diagnosis and treatment, as exemplified by biomedical e-skins. More recently, machine learning (ML) has been utilized to enhance device control accuracy and data processing efficiency. The convergence of e-skin technologies with ML is promoting their translation into clinical practice, especially in healthcare. This review highlights the latest developments in ML-reinforced e-skin devices for robotic prostheses and biomedical instrumentations. We first describe technological breakthroughs in state-of-the-art e-skin devices, emphasizing technologies that achieve skin-like properties. We then introduce ML methods adopted for control optimization and pattern recognition, followed by practical applications that converge the two technologies. Lastly, we briefly discuss the challenges this interdisciplinary research encounters in its clinical and industrial transition.

Ultra-conformal epidermal antenna for multifunctional motion artifact-free sensing and point-of-care monitoring

Accurate acquisition of physiological and physical information from human tissue is essential for health monitoring, disease prevention and treatment. The existing antennas with traditional rigid or flexible substrates are susceptible to motion artifacts in wearable applications due to the miniaturization limitation and lack of proper adhesion and conformal interfaces with the skin. Recent advances in wearable radio frequency (RF) bioelectronics directly drawn on the skin are a promising solution for future skin-interfaced devices. Herein, we present a first-of-its kind epidermal antenna architecture with skin as the antenna substrate, which is ultra-low profile, ultra-conformal, ultra-compact, and simple fabrication without specialized equipment. The radiation unit and ground of antenna are drawn directly on the skin with the strong adhesion and ultra conformality. Therefore, this RF device is highly adaptable to motion. As a proof-of- feasibility, epidermal antenna can be freely drawn on demand at different locations on the skin for the development of temperature sensor, skin hydration sensor, strain sensor, glucose sensor and other devices. An epidermal antenna-based temperature sensor can offer accurate and real-time monitoring of human body temperature changes in the ultra-wideband (UWB) range. The results during the monitoring of hydration level with and without stretching show that the epidermal antenna drawn on the skin is motion artifact-free. We also designed an epidermal antenna array employing a horseshoe-shaped configuration for the precise identification of various gestures. In addition, the non-invasive blood glucose level (BGL) monitoring results during the in-vivo experiments report high correlation between the epidermal antenna responses and BGLs, without any time hysteresis. After the prediction of BGL by BP network, all the predicted BGL values are fallen 100% into the clinically acceptable zones. Together, these results show that epidermal antenna offers a promising new approach for biosensing platform.

Permeable Bioelectronics toward Biointegrated Systems

Bioelectronics integrates electronics with biological organs, sustaining the natural functions of the organs. Organs dynamically interact with the external environment, managing internal equilibrium and responding to external stimuli. These interactions are crucial for maintaining homeostasis. Additionally, biological organs possess a soft and stretchable nature; encountering objects with differing properties can disrupt their function. Therefore, when electronic devices come into contact with biological objects, the permeability of these devices, enabling interactions and substance exchanges with the external environment, and the mechanical compliance are crucial for maintaining the inherent functionality of biological organs. This review discusses recent advancements in soft and permeable bioelectronics, emphasizing materials, structures, and a wide range of applications. The review also addresses current challenges and potential solutions, providing insights into the integration of electronics with biological organs.

A three-dimensional liquid diode for soft, integrated permeable electronics

Wearable electronics with great breathability enable a comfortable wearing experience and facilitate continuous biosignal monitoring over extended periods1-3. However, current research on permeable electronics is predominantly at the stage of electrode and substrate development, which is far behind practical applications with comprehensive integration with diverse electronic components (for example, circuitry, electronics, encapsulation)4-8. Achieving permeability and multifunctionality in a singular, integrated wearable electronic system remains a formidable challenge. Here we present a general strategy for integrated moisture-permeable wearable electronics based on three-dimensional liquid diode (3D LD) configurations. By constructing spatially heterogeneous wettability, the 3D LD unidirectionally self-pumps the sweat from the skin to the outlet at a maximum flow rate of 11.6 ml cm-2 min-1, 4,000 times greater than the physiological sweat rate during exercise, presenting exceptional skin-friendliness, user comfort and stable signal-reading behaviour even under sweating conditions. A detachable design incorporating a replaceable vapour/sweat-discharging substrate enables the reuse of soft circuitry/electronics, increasing its sustainability and cost-effectiveness. We demonstrated this fundamental technology in both advanced skin-integrated electronics and textile-integrated electronics, highlighting its potential for scalable, user-friendly wearable devices.

Anti-friction gold-based stretchable electronics enabled by interfacial diffusion-induced cohesion

Stretchable electronics that prevalently adopt chemically inert metals as sensing layers and interconnect wires have enabled high-fidelity signal acquisition for on-skin applications. However, the weak interfacial interaction between inert metals and elastomers limit the tolerance of the device to external friction interferences. Here, we report an interfacial diffusion-induced cohesion strategy that utilizes hydrophilic polyurethane to wet gold (Au) grains and render them wrapped by strong hydrogen bonding, resulting in a high interfacial binding strength of 1017.6 N/m. By further constructing a nanoscale rough configuration of the polyurethane (RPU), the binding strength of Au-RPU device increases to 1243.4 N/m, which is 100 and 4 times higher than that of conventional polydimethylsiloxane and styrene-ethylene-butylene-styrene-based devices, respectively. The stretchable Au-RPU device can remain good electrical conductivity after 1022 frictions at 130 kPa pressure, and reliably record high-fidelity electrophysiological signals. Furthermore, an anti-friction pressure sensor array is constructed based on Au-RPU interconnect wires, demonstrating a superior mechanical durability for concentrated large pressure acquisition. This chemical modification-free approach of interfacial strengthening for chemically inert metal-based stretchable electronics is promising for three-dimensional integration and on-chip interconnection.

Multimodal and flexible hydrogel-based sensors for respiratory monitoring and posture recognition

The accurate monitoring of respiratory events and human motion states holds paramount importance in the realm of health surveillance and disease prognostication. An exquisitely precise, multifaceted, portable, and environmentally resilient sensor designed for health monitoring would undeniably be of utmost desirability, despite its persisting as a formidable challenge. Here, we propose a breath monitoring and posture recognition system that utilizes hydrogel electrolytes based on polyvinyl alcohol, sodium alginate, and starch, suitable for supercapacitors and multimodal wearable sensors. The multimodal smart sensors can independently detect mechanical and thermal changes through the output signals of capacitance and resistance, respectively. Moreover, we have cultivated an artificial neural network to achieve a finger-pressing posture recognition accuracy of up to 99.259%. Our hydrogel sensors have also been successfully employed in the diagnosis of obstructive sleep apnea syndrome. The flexible electronic device derived from this study exhibit a plethora of functionalities, thereby affording a novel perspective for the design and fabrication of advanced flexible electronic contrivances that find applications across diverse domains such as medicine and virtual reality.

Wearable fabric-based ZnO nanogenerator for biomechanical and biothermal monitoring

Wearable devices that can mechanically conform to human skin are a necessity for reliable monitoring and decoding of biomechanical activities through skin. Most inorganic piezoelectrics, however, lack deformability and damage tolerance, impeding stable motion monitoring. Here, we present an air-permeable fabric-based ZnO nanogenerator with mechanical adaptivity to diverse deformations for wearable piezoelectric sensors, collecting biomechanical health data. We fabricate ZnO nanorods incorporated throughout the entire nylon fabric, with a strategically positioned neutral mechanical plane, for bending-sensitive electronics (2.59 μA mm). Its hierarchically interlocked geometry also permits sensitive tactile sensing (0.15 nA kPa-1). Various physiological information about activities, including pulse beating, breathing, saliva swallowing, and coughing, is attained using skin-mounted sensors. Further, the pyroelectric sensing capability of a mask-attached device is demonstrated by identifying specific respiratory patterns. Our wearable healthcare sensors hold great promise for real-time monitoring of health-related vital signs, informing individuals' health status without disrupting their daily lives.

Smartphone-based iontophoresis transdermal drug delivery system for cancer treatment

Cancer is a leading cause of the death worldwide. However, the conventional cancer therapy still suffers from several limitations, such as systemic side effects, poor efficacy, and patient compliance due to limited accessibility to the tumor site. To address these issues, the localized drug delivery system has emerged as a promising approach. In this study, we developed an iontophoresis-based transdermal drug delivery system (TDDS) controlled by a smartphone application for cancer treatment. Iontophoresis, a low-intensity electric current-based TDDS, enhances drug permeation across the skin to provide potential for localized drug delivery and minimize systemic side effects. The fundamental mechanism of our system was modeled using finite element analysis and its performance was corroborated through the flow-through skin permeation tests using a plastic-based microfluidic chip. The results of in vitro cell experiments and skin deposition tests successfully demonstrated that our smartphone-controlled iontophoresis system significantly enhanced the drug permeation for cancer treatment. Therefore, this hand-held smartphone-based iontophoresis TDDS could be a powerful tool for self-administrated anticancer drug delivery applications.

Low-temperature growth of MoS2 on polymer and thin glass substrates for flexible electronics

Recent advances in two-dimensional semiconductors, particularly molybdenum disulfide (MoS2), have enabled the fabrication of flexible electronic devices with outstanding mechanical flexibility. Previous approaches typically involved the synthesis of MoS2 on a rigid substrate at a high temperature followed by the transfer to a flexible substrate onto which the device is fabricated. A recurring drawback with this methodology is the fact that flexible substrates have a lower melting temperature than the MoS2 growth process, and that the transfer process degrades the electronic properties of MoS2. Here we report a strategy for directly synthesizing high-quality and high-crystallinity MoS2 monolayers on polymers and ultrathin glass substrates (thickness ~30 µm) at ~150 °C using metal-organic chemical vapour deposition. By avoiding the transfer process, the MoS2 quality is preserved. On flexible field-effect transistors, we achieve a mobility of 9.1 cm2 V-1 s-1 and a positive threshold voltage of +5 V, which is essential for reducing device power consumption. Moreover, under bending conditions, our logic circuits exhibit stable operation while phototransistors can detect light over a wide range of wavelengths from 405 nm to 904 nm.

A Selective-Response Hypersensitive Bio-Inspired Strain Sensor Enabled by Hysteresis Effect and Parallel Through-Slits Structures

Flexible strain sensors are promising in sensing minuscule mechanical signals, and thereby widely used in various advanced fields. However, the effective integration of hypersensitivity and highly selective response into one flexible strain sensor remains a huge challenge. Herein, inspired by the hysteresis strategy of the scorpion slit receptor, a bio-inspired flexible strain sensor (BFSS) with parallel through-slit arrays is designed and fabricated. Specifically, BFSS consists of conductive monolayer graphene and viscoelastic styrene-isoprene-styrene block copolymer. Under the synergistic effect of the bio-inspired slit structures and flexible viscoelastic materials, BFSS can achieve both hypersensitivity and highly selective frequency response. Remarkably, the BFSS exhibits a high gage factor of 657.36, and a precise identification of vibration frequencies at a resolution of 0.2 Hz through undergoing different morphological changes to high-frequency vibration and low-frequency vibration. Moreover, the BFSS possesses a wide frequency detection range (103 Hz) and stable durability (1000 cycles). It can sense and recognize vibration signals with different characteristics, including the frequency, amplitude, and waveform. This work, which turns the hysteresis effect into a "treasure," can provide new design ideas for sensors for potential applications including human-computer interaction and health monitoring of mechanical equipment.

Transparent Electronics for Wearable Electronics Application

Recent advancements in wearable electronics offer seamless integration with the human body for extracting various biophysical and biochemical information for real-time health monitoring, clinical diagnostics, and augmented reality. Enormous efforts have been dedicated to imparting stretchability/flexibility and softness to electronic devices through materials science and structural modifications that enable stable and comfortable integration of these devices with the curvilinear and soft human body. However, the optical properties of these devices are still in the early stages of consideration. By incorporating transparency, visual information from interfacing biological systems can be preserved and utilized for comprehensive clinical diagnosis with image analysis techniques. Additionally, transparency provides optical imperceptibility, alleviating reluctance to wear the device on exposed skin. This review discusses the recent advancement of transparent wearable electronics in a comprehensive way that includes materials, processing, devices, and applications. Materials for transparent wearable electronics are discussed regarding their characteristics, synthesis, and engineering strategies for property enhancements. We also examine bridging techniques for stable integration with the soft human body. Building blocks for wearable electronic systems, including sensors, energy devices, actuators, and displays, are discussed with their mechanisms and performances. Lastly, we summarize the potential applications and conclude with the remaining challenges and prospects.

A Triboelectric Nanocomposite for Sterile Sensing, Energy Harvesting, and Haptic Diagnostics in Interventional Procedures from Surgical Gloves

Advanced interfacial engineering has the potential to enable the successful realization of three features that are particularly important for a variety of healthcare applications: wettability control, antimicrobial activity to reduce infection risks, and sensing of physiological parameters. Here, a sprayable multifunctional triboelectric coating is exploited as a nontoxic, ultrathin tactile sensor that can be integrated directly on the fingertips of surgical gloves. The coating is based on a polymer blend mixed with zinc oxide (ZnO) nanoparticles, which enables antifouling and antibacterial properties. Additionally, the nanocomposite is superhydrophobic (self-cleaning) and is not cytotoxic. The coating is also triboelectric and can be applied directly onto surgical gloves with printed electrodes. The sensorized gloves so obtained enable mechanical energy harvesting, force sensing, and detection of materials stiffness changes directly from fingertip, which may complement proprioceptive feedback for clinicians. Just as importantly, the sensors also work with a second glove on top offering better reassurance regarding sterility in interventional procedures. As a case study of clinical use for stiffness detection, the sensors demonstrate successful detection of pig anal sphincter injury ex vivo. This may lead to improving the accuracy of diagnosing obstetric anal sphincter injury, resulting in prompt repair, fewer complications, and improved quality of life.

Charge transport transition of PEDOT:PSS thin films for temperature-insensitive wearable strain sensors

In this study, a temperature-insensitive strain sensor that detects only the strain without responding to the temperature was designed. The transport mechanism and associated temperature coefficient of resistance (TCR) of a poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) thin film were modified through secondary doping with dimethyl sulfoxide (DMSO). Upon DMSO-doping, the carrier transport mechanism of the PEDOT:PSS thin film transitioned from hopping to band-like transport, with a morphological change. At the DMSO doping level, which caused the critical point of the transport transition, the resistance of the thin film was maintained with a change in temperature. Consequently, the TCR of the optimized PEDOT:PSS thin film was less than 9 × 10^-5 K^-1, which is 10² times lower than that of the as-prepared films. The carrier mobility of the PEDOT:PSS thin film was effectively improved with the morphological change due to DMSO doping and was investigated through combinational analysis. Ultimately, the wearable strain sensor prepared using the optimized PEDOT:PSS thin film responded stably to the applied strain with a gauge factor of 2 and exhibited excellent temperature anti-interference.

Blood-Glucose-Powered Metabolic Fuel Cell for Self-Sufficient Bioelectronics

Currently available bioelectronic devices consume too much power to be continuously operated on rechargeable batteries, and are often powered wirelessly, with attendant issues regarding reliability, convenience, and mobility. Thus, the availability of a robust, self-sufficient, implantable electrical power generator that works under physiological conditions would be transformative for many applications, from driving bioelectronic implants and prostheses to programing cellular behavior and patients' metabolism. Here, capitalizing on a new copper-containing, conductively tuned 3D carbon nanotube composite, an implantable blood-glucose-powered metabolic fuel cell is designed that continuously monitors blood-glucose levels, converts excess glucose into electrical power during hyperglycemia, and produces sufficient energy (0.7 mW cm^-2 , 0.9 V, 50 mm glucose) to drive opto- and electro-genetic regulation of vesicular insulin release from engineered beta cells. It is shown that this integration of blood-glucose monitoring with elimination of excessive blood glucose by combined electro-metabolic conversion and insulin-release-mediated cellular consumption enables the metabolic fuel cell to restore blood-glucose homeostasis in an automatic, self-sufficient, and closed-loop manner in an experimental model of type-1 diabetes.

Toward a new generation of permeable skin electronics

Skin-mountable electronics are considered to be the future of the next generation of portable electronics, due to their softness and seamless integration with human skin. However, impermeable materials limit device comfort and reliability for long-term, continuous usage. The recent emergence of permeable skin-mountable electronics has attracted tremendous attention in the soft electronics field. Herein, we provide a comprehensive and systematic review of permeable skin-mountable electronics. Typical porous materials and structures are first highlighted, followed by discussion of important device properties. Then, we review the latest representative applications of breathable skin-mountable electronics, such as bioelectrical sensors, temperature sensors, humidity and hydration sensors, strain and pressure sensors, and energy harvesting and storage devices. Finally, a conclusion and future directions for permeable skin electronics are provided.

Natural Shaping of Acellular Dermal Matrices for Implant-Based Breast Reconstruction via Expansile Kirigami

To complete a successful and aesthetic breast reconstruction for breast cancer survivors, tissue reinforcing acellular dermal matrices (ADMs) are widely utilized to create slings/pockets to keep breast implants or autologous tissue transfer secured against the chest wall in the desired location. However, ADM sheets are 2D and cannot completely cover the entire implant without wrinkles. Here, guided by finite element modeling, a kirigami strategy is presented to cut the ADM sheets with locally and precisely controlled stretchability, curvature, and elasticity. Upon expansion, a single kirigami ADM sheet can conformably wrap the implant regardless of the shape and size, forming a natural teardrop shape; contour cuts prescribe the topographical height and fractal cuts in the center ensures horizontal expandability and thus conformability. This kirigami ADM can provide support to the reconstructed breast in the desired regions, potentially offering optimal outcomes and patient-specific reconstruction, while minimizing operative time and cost.

Finite Element Analysis Model of Electronic Skin Based on Surface Acoustic Wave Sensor

In recent years, with the rapid development of flexible electronic devices, researchers have a great interest in the research of electronic skin (e-skin). Traditional e-skin, which is made of rigid integrated circuit chips, not only limits the overall flexibility, but also consumes a lot of power and poses certain security risks to the human body. In this paper, a wireless passive e-skin is designed based on the surface acoustic wave sensor (SAWS) of lithium niobate piezoelectric film. The e-skin has the advantages of small size, high precision, low power consumption, and good flexibility. With the multi-sensing function of stress, temperature, and sweat ion concentration, etc., the newly designed e-skin is a sensor platform for a wide range of external stimuli, and the measurement results can be directly presented in frequency. In order to explore the characteristic parameters and various application scenarios of the SAWS, finite element analysis is carried out using the simulation software; the relationship between the SAWS and various influencing factors is explored, and the related performance curve is obtained. These simulation results provide important reference and experimental guidance for the design and preparation of SAW e-skin.

Ultrapermeable and Wet-Adhesive Monolayer Porous Film for Stretchable Epidermal Electrode

Noninvasive electrophysiological signal monitoring is significant for health care and scientific research. The simultaneous achievement of wet adhesion, stretchability, breathability, and low contact impedance is highly recommended in the epidermal electrode but still challenging. In this work, a monolayer porous film electrode with a pore size and wall thickness of less than ∼10 μm is fabricated via the breath figure method (BFM) and metal sputtering, and it was subsequently applied using epidermal electrophysiological monitoring. The ultrahigh permeability is comparable to the naked skin because the through holes of the monolayer porous film match well with the pores on human skin. The stretchability of 50% is realized with the combination of Au microcrack and the monolayer porous structure. The wet adhesion of 0.17 N/cm is established on the chemical bonding between the electrode and the epidermis. The contact impedance is comparable with the gold standard Ag/AgCl gel electrode, especially after sweating. Stable and precise electrophysiological signals are measured. Especially, the perspiration resistance of the monolayer porous film outperforms that of the gel electrode. The monolayer porous structure provides a new avenue to improve the breathability of the epidermal electronics.

In Situ Forming Epidermal Bioelectronics for Daily Monitoring and Comprehensive Exercise

Conventional epidermal bioelectronics usually do not conform well with natural skin surfaces and are susceptible to motion artifact interference, due to incompatible dimensions, insufficient adhesion, imperfect compliance, and usually require complex manufacturing and high costs. We propose in situ forming hydrogel electrodes or electronics (ISF-HEs) that can establish highly conformal interfaces on curved biological surfaces without auxiliary adhesions. The ISF-HEs also have favorable flexibility and soft compliance comparable to human skin (≈0.02 kPa^-1), which can stably maintain synchronous movements with deformed skins. Thus, the as-prepared ISF-HEs can accurately monitor large and tiny human motions with short response time (≈180 ms), good biocompatibility, and excellent performance. The as-obtained nongapped hydrogel electrode-skin interfaces achieve ultralow interfacial impedance (≈50 KΩ), nearly an order of magnitude lower than commercial Ag|AgCl electrodes as well as other reported dry and wet electrodes, regardless of the intrinsic micro-obstacles (wrinkles, hair) and skin deformation interference. Therefore, the ISF-HEs can collect high-quality electrocardiography and surface electromyography (sEMG) signals, with high signal-to-noise ratio (SNR ≈ 32.04 dB), reduced signal crosstalk, and minimized motion artifact interference. Simultaneously monitoring human motions and sEMG signals have also been implemented for the general exercise status assessment, such as the shooting competition in the Olympics. The as-prepared ISF-HEs can be considered as supplements/substitutes of conventional electrodes in percutaneously noninvasive monitoring of multifunctional physiological signals for health and exercise status.

Pathway to Developing Permeable Electronics

Permeable electronics possess the capability of permeating gas and/or liquid while performing the device functionality when attached to human bodies. The permeability of wearable electronics can not only minimize the thermophysiological disturbance to the human body but also ensure a biocompatible human-device interface for long-term, continuous, and real-time health monitoring. To date, how to simultaneously acquire high permeability and multifunctionality is the major challenge of wearable electronics. Here, a critical discussion on the future development of wearable electronics toward permeability is presented. In this perspective, the critical metrics of permeable electronics are discussed, and the historical evolution of wearable technologies is reviewed with highlights of representative examples. The materials and structural strategies for developing high-performance permeable electronics are then analyzed.

Ultrathin Fiber-Mesh Polymer Thermistors

Flexible sensors enable on-skin and in-body health monitoring, which require flexible thermal protection circuits to prevent overheating and operate the devices safely. Here, ultrathin fiber-mesh polymer positive temperature coefficient (PTC) thermistors via electrospinning are developed. The fiber-type thermistors are composed of acrylate polymer and carbon nanofibers. The fibrous composite materials are coated with a parylene to form a core-sheath structure, which improves the repeatability of temperature characteristics. Approximately 5 µm thick fiber-type thermistors exhibit an increase in the resistance by three orders of magnitude within ≈2 °C and repeatable temperature characteristics for up to 400 cycles. The mesh structure enables the thermistor layer to be ultra-lightweight and transparent; the mesh-type thermistor operates with a fiber density of 16.5 µg cm^-2 , whose fiber layer has a transmittance of more than 90% in the 400-800 nm region. By fabricating the mesh thermistor on a 1.4 µm thick substrate, the thermistor operates without degradation when wrapped around a 280 µm radius needle. Furthermore, the gas-permeable property is demonstrated by fabricating the fibrous thermistor on a mesh substrate. The proposed ultrathin mesh polymer PTC thermistors form the basis for on-skin and implantable devices that are equipped with overheat prevention.

Fluidic enabled bioelectronic implants: opportunities and challenges

Bioelectronic implants are increasingly facilitating novel strategies for clinical diagnosis and treatment. The integration of fluidic technologies into such implants enables new complementary routes for sensing and therapy alongside electrical interaction. Indeed, these two technologies, electrical and fluidic, can work synergistically in a bioelectronics implant towards the fabrication of a complete therapeutic platform. In this perspective article, the leading applications of fluidic enabled bioelectronic implants are highlighted and methods of operation and material choices are discussed. Furthermore, a forward-looking perspective is offered on emerging opportunities as well as critical materials and technological challenges.

A Focused Review on the Flexible Wearable Sensors for Sports: From Kinematics to Physiologies

As an important branch of wearable electronics, highly flexible and wearable sensors are gaining huge attention due to their emerging applications. In recent years, the participation of wearable devices in sports has revolutionized the way to capture the kinematical and physiological status of athletes. This review focuses on the rapid development of flexible and wearable sensor technologies for sports. We identify and discuss the indicators that reveal the performance and physical condition of players. The kinematical indicators are mentioned according to the relevant body parts, and the physiological indicators are classified into vital signs and metabolisms. Additionally, the available wearable devices and their significant applications in monitoring these kinematical and physiological parameters are described with emphasis. The potential challenges and prospects for the future developments of wearable sensors in sports are discussed comprehensively. This review paper will assist both athletic individuals and researchers to have a comprehensive glimpse of the wearable techniques applied in different sports.

Chip-less wireless electronic skins by remote epitaxial freestanding compound semiconductors

Recent advances in flexible and stretchable electronics have led to a surge of electronic skin (e-skin)-based health monitoring platforms. Conventional wireless e-skins rely on rigid integrated circuit chips that compromise the overall flexibility and consume considerable power. Chip-less wireless e-skins based on inductor-capacitor resonators are limited to mechanical sensors with low sensitivities. We report a chip-less wireless e-skin based on surface acoustic wave sensors made of freestanding ultrathin single-crystalline piezoelectric gallium nitride membranes. Surface acoustic wave-based e-skin offers highly sensitive, low-power, and long-term sensing of strain, ultraviolet light, and ion concentrations in sweat. We demonstrate weeklong monitoring of pulse. These results present routes to inexpensive and versatile low-power, high-sensitivity platforms for wireless health monitoring devices.

Breathable Electronic Skins for Daily Physiological Signal Monitoring

With the aging of society and the increase in people's concern for personal health, long-term physiological signal monitoring in daily life is in demand. In recent years, electronic skin (e-skin) for daily health monitoring applications has achieved rapid development due to its advantages in high-quality physiological signals monitoring and suitability for system integrations. Among them, the breathable e-skin has developed rapidly in recent years because it adapts to the long-term and high-comfort wear requirements of monitoring physiological signals in daily life. In this review, the recent achievements of breathable e-skins for daily physiological monitoring are systematically introduced and discussed. By dividing them into breathable e-skin electrodes, breathable e-skin sensors, and breathable e-skin systems, we sort out their design ideas, manufacturing processes, performances, and applications and show their advantages in long-term physiological signal monitoring in daily life. In addition, the development directions and challenges of the breathable e-skin are discussed and prospected.

Surface Wettability for Skin-Interfaced Sensors and Devices

The practical applications of skin-interfaced sensors and devices in daily life hinge on the rational design of surface wettability to maintain device integrity and achieve improved sensing performance under complex hydrated conditions. Various bio-inspired strategies have been implemented to engineer desired surface wettability for varying hydrated conditions. Although the bodily fluids can negatively affect the device performance, they also provide a rich reservoir of health-relevant information and sustained energy for next-generation stretchable self-powered devices. As a result, the design and manipulation of the surface wettability are critical to effectively control the liquid behavior on the device surface for enhanced performance. The sensors and devices with engineered surface wettability can collect and analyze health biomarkers while being minimally affected by bodily fluids or ambient humid environments. The energy harvesters also benefit from surface wettability design to achieve enhanced performance for powering on-body electronics. In this review, we first summarize the commonly used approaches to tune the surface wettability for target applications toward stretchable self-powered devices. By considering the existing challenges, we also discuss the opportunities as a small fraction of potential future developments, which can lead to a new class of skin-interfaced devices for use in digital health and personalized medicine.

Skin bioelectronics towards long-term, continuous health monitoring

Skin bioelectronics are considered as an ideal platform for personalised healthcare because of their unique characteristics, such as thinness, light weight, good biocompatibility, excellent mechanical robustness, and great skin conformability. Recent advances in skin-interfaced bioelectronics have promoted various applications in healthcare and precision medicine. Particularly, skin bioelectronics for long-term, continuous health monitoring offer powerful analysis of a broad spectrum of health statuses, providing a route to early disease diagnosis and treatment. In this review, we discuss (1) representative healthcare sensing devices, (2) material and structure selection, device properties, and wireless technologies of skin bioelectronics towards long-term, continuous health monitoring, (3) healthcare applications: acquisition and analysis of electrophysiological, biophysical, and biochemical signals, and comprehensive monitoring, and (4) rational guidelines for the design of future skin bioelectronics for long-term, continuous health monitoring. Long-term, continuous health monitoring of advanced skin bioelectronics will open unprecedented opportunities for timely disease prevention, screening, diagnosis, and treatment, demonstrating great promise to revolutionise traditional medical practices.

Flexible Electronics and Devices as Human-Machine Interfaces for Medical Robotics

Medical robots are invaluable players in non-pharmaceutical treatment of disabilities. Particularly, using prosthetic and rehabilitation devices with human-machine interfaces can greatly improve the quality of life for impaired patients. In recent years, flexible electronic interfaces and soft robotics have attracted tremendous attention in this field due to their high biocompatibility, functionality, conformability, and low-cost. Flexible human-machine interfaces on soft robotics will make a promising alternative to conventional rigid devices, which can potentially revolutionize the paradigm and future direction of medical robotics in terms of rehabilitation feedback and user experience. In this review, the fundamental components of the materials, structures, and mechanisms in flexible human-machine interfaces are summarized by recent and renowned applications in five primary areas: physical and chemical sensing, physiological recording, information processing and communication, soft robotic actuation, and feedback stimulation. This review further concludes by discussing the outlook and current challenges of these technologies as a human-machine interface in medical robotics.

All-Nanofiber-Based Janus Epidermal Electrode with Directional Sweat Permeability for Artifact-Free Biopotential Monitoring

Epidermal electronics have been developed with gas/sweat permeability for long-term wearable electrophysiological monitoring. However, the state-of-the-art breathable epidermal electronics ignore the sweat accumulation and immersion at the skin/device interface, resulting in serious degradation of the interfacial conformality and adhesion, leading to signal artifacts with unstable and inaccurate biopotential measurements. Here, the authors present an all-nanofiber-based Janus epidermal electrode endowed with directional sweat transport properties for artifact-free biopotential monitoring. The designed Janus multilayered membrane (≈15 µm) of superhydrophilic-hydrolyzed-polyacrylonitrile (HPAN)/polyurethane (PU)/Ag nanowire (AgNW) can quickly (less than 5 s) drive sweat away from the skin/electrode interface while resisting its penetration in the reverse direction. Along with the medical adhesive (MA)-reinforced junction-nodes, the adhesion strength among the heterogeneous interfaces can be greatly enhanced for robust mechanical-electrical stability. Therefore, their measured on-body electromyography (EMG) and electrocardiography (ECG) signals are free of sweat artifacts with negligible degradation and baseline drift compared to commercial Ag/AgCl gel electrodes and hydrophilic textile electrodes. This work paves a way to design novel directional-sweat-permeable epidermal electronics that can be conformally attached under sweaty conditions for long-term biopotential monitoring and shows the potential to apply epidermal electronics to many challenging conditions.

A Selective-Response Bioinspired Strain Sensor Using Viscoelastic Material as Middle Layer

Flexible strain sensors have an irreplaceable role in critical and emerging fields, such as electronic skins, flexible robots, and prosthetics. Although numerous efforts have been made to improve sensor sensitivity to meet specific application scenarios, the signal-to-noise ratio (SNR) is an extremely critical and non-negligible indicator, which takes into account higher sensitivity, meaning that they can also detect the noise signals with high sensitivity. Coincidentally, scorpions with ultrasensitive vibration sensilla also face such a dilemma. Here, it is found that the scorpion ingeniously uses the viscoelastic material in front of its slit sensilla to realize efficient preprocessing of the signal. Its mechanism is that the loss factor of materials changes with frequency, affecting energy storage and transmission. Inspired by this ingenious strategy, a bioinspired strain sensor insensitive to a low strain rate was designed using a two-step template transfer method. As a result, its relative change in resistance reached 110% under the same strain (0.3197%) but with different strain rates (0.1 Hz and ∼20 Hz). The noncontact vibration experiments also show different responses to low-frequency vibration and high-frequency impact. Moreover, it can also be used as a typical flexible strain sensor. Under the tensile state, it has a gauge factor (GF) as high as 4596 upon 0.6% strain, and the response time is 140 ms. Therefore, it is expected that this strain sensor will be used in many important ultraprecision measurement fields, especially when the measured signal is small.