Flexible and Stretchable Bioelectronics

Body Surface Potential Mapping: A Perspective on High-Density Cutaneous Electrophysiology

The electrophysiological signals recorded by cutaneous electrodes, known as body surface potentials (BSPs), are widely employed biomarkers in medical diagnosis. Despite their widespread application and success in detecting various conditions, the poor spatial resolution of traditional BSP measurements poses a limit to their diagnostic potential. Advancements in the field of bioelectronics have facilitated the creation of compact, high-quality, high-density recording arrays for cutaneous electrophysiology, allowing detailed spatial information acquisition as BSP maps (BSPMs). Currently, the design of electrode arrays for BSP mapping lacks a standardized framework, leading to customizations for each clinical study, limiting comparability, reproducibility, and transferability. This perspective proposes preliminary design guidelines, drawn from existing literature, rooted solely in the physical properties of electrophysiological signals and mathematical principles of signal processing. These guidelines aim to simplify and generalize the optimization process for electrode array design, fostering more effective and applicable clinical research. Moreover, the increased spatial information obtained from BSPMs introduces interpretation challenges. To mitigate this, two strategies are outlined: observational transformations that reconstruct signal sources for intuitive comprehension, and machine learning-driven diagnostics. BSP mapping offers significant advantages in cutaneous electrophysiology with respect to classic electrophysiological recordings and is expected to expand into broader clinical domains in the future.

Enhancing visual seismocardiography in noisy environments with adaptive bidirectional filtering for Cardiac Health Monitoring

BACKGROUND

Wearable sensors have revolutionized cardiac health monitoring, with Seismocardiography (SCG) at the forefront due to its non-invasive nature. However, the substantial motion artefacts have hindered the translation of SCG-based medical applications, primarily induced by walking. In contrast, our innovative technique, Adaptive Bidirectional Filtering (ABF), surpasses these challenges by refining SCG signals more effectively than any motion-induced noise. ABF leverages a noise-cancellation algorithm, operating on the benefits of the Redundant Multi-Scale Wavelet Decomposition (RMWD) and the bidirectional filtering framework, to achieve optimal signal quality.

METHODOLOGY

The ABF technique is a two-stage process that diminishes the artefacts emanating from motion. The first step by RMWD is the identification of the heart-associated signals and the isolating samples with those related frequencies. Subsequently, the adaptive bidirectional filter operates in two dimensions: it uses Time-Frequency masking that eliminates temporal noise while engaging in non-negative matrix Decomposition to ensure spatial correlation and dorsoventral vibration reduction jointly. The main component that is altered from the other filters is the recursive structure that changes to the motion-adapted filter, which uses vertical axis accelerometer data to differentiate better between accurate SCG signals and motion artefacts.

OUTCOME

Our empirical tests demonstrate exceptional signal improvement with the application of our ABF approach. The accuracy in heart rate estimation reached an impressive r-squared value of 0.95 at - 20 dB SNR, significantly outperforming the baseline value, which ranged from 0.1 to 0.85. The effectiveness of the motion-artifact-reduction methodology is also notable at an SNR of - 22 dB. Consequently, ECG inputs are not required. This method can be seamlessly integrated into noisy environments, enhancing ECG filtering, automatic beat detection, and rhythm interpretation processes, even in highly variable conditions. The ABF method effectively filters out up to 97% of motion-related noise components within the SCG signal from implantable devices. This advancement is poised to become an integral part of routine patient monitoring.

Actuation for flexible and stretchable microdevices

Flexible and stretchable microdevices incorporate highly deformable structures, facilitating precise functionality at the micro- and millimetre scale. Flexible microdevices have showcased extensive utility in the fields of biomedicine, microfluidics, and soft robotics. Actuation plays a critical role in transforming energy between different forms, ensuring the effective operation of devices. However, when it comes to actuating flexible microdevices at the small millimetre or even microscale, translating actuation mechanisms from conventional rigid large-scale devices is not straightforward. The recent development of actuation mechanisms leverages the benefits of device flexibility, particularly in transforming conventional actuation concepts into more efficient approaches for flexible devices. Despite many reviews on soft robotics, flexible electronics, and flexible microfluidics, a specific and systematic review of the actuation mechanisms for flexible and stretchable microdevices is still lacking. Therefore, the present review aims to address this gap by providing a comprehensive overview of state-of-the-art actuation mechanisms for flexible and stretchable microdevices. We elaborate on the different actuation mechanisms based on fluid pressure, electric, magnetic, mechanical, and chemical sources, thoroughly examining and comparing the structure designs, characteristics, performance, advantages, and drawbacks of these diverse actuation mechanisms. Furthermore, the review explores the pivotal role of materials and fabrication techniques in the development of flexible and stretchable microdevices. Finally, we summarise the applications of these devices in biomedicine and soft robotics and provide perspectives on current and future research.

Bioelectronic Medicine: a multidisciplinary roadmap from biophysics to precision therapies

Bioelectronic Medicine stands as an emerging field that rapidly evolves and offers distinctive clinical benefits, alongside unique challenges. It consists of the modulation of the nervous system by precise delivery of electrical current for the treatment of clinical conditions, such as post-stroke movement recovery or drug-resistant disorders. The unquestionable clinical impact of Bioelectronic Medicine is underscored by the successful translation to humans in the last decades, and the long list of preclinical studies. Given the emergency of accelerating the progress in new neuromodulation treatments (i.e., drug-resistant hypertension, autoimmune and degenerative diseases), collaboration between multiple fields is imperative. This work intends to foster multidisciplinary work and bring together different fields to provide the fundamental basis underlying Bioelectronic Medicine. In this review we will go from the biophysics of the cell membrane, which we consider the inner core of neuromodulation, to patient care. We will discuss the recently discovered mechanism of neurotransmission switching and how it will impact neuromodulation design, and we will provide an update on neuronal and glial basis in health and disease. The advances in biomedical technology have facilitated the collection of large amounts of data, thereby introducing new challenges in data analysis. We will discuss the current approaches and challenges in high throughput data analysis, encompassing big data, networks, artificial intelligence, and internet of things. Emphasis will be placed on understanding the electrochemical properties of neural interfaces, along with the integration of biocompatible and reliable materials and compliance with biomedical regulations for translational applications. Preclinical validation is foundational to the translational process, and we will discuss the critical aspects of such animal studies. Finally, we will focus on the patient point-of-care and challenges in neuromodulation as the ultimate goal of bioelectronic medicine. This review is a call to scientists from different fields to work together with a common endeavor: accelerate the decoding and modulation of the nervous system in a new era of therapeutic possibilities.

Real-Time Monitoring of Cell Adhesion onto a Soft Substrate by a Graphene Impedance Biosensor

Soft substrates are interesting for many applications, ranging from mimicking the cellular microenvironment to implants. Conductive electrodes on such substrates allow the realization of flexible, elastic, and transparent sensors. Single-layer graphene as a candidate for such electrodes brings the advantage that the active area of the sensor is transparent and conformal to the underlying substrate. Here, we overcome several challenges facing the routine realization of graphene cell sensors on a canonical soft substrate, namely, poly(dimethylsiloxane) (PDMS). We have systematically studied the effect of surface energy before, during, and after the transfer of graphene. Thus, we have identified a suitable support polymer, optimal substrate (pre)treatment, and an appropriate solvent for the removal of the support. Using this procedure, we can reproducibly obtain stable and intact graphene sensors on a millimeter scale on PDMS, which can withstand continuous measurements in cell culture media for several days. From local nanomechanical measurements, we infer that the softness of the substrate is slightly affected after the graphene transfer. However, we can modulate the stiffness using PDMS with differing compositions. Finally, we show that graphene sensors on PDMS can be successfully used as soft electrodes for real-time monitoring of the cell adhesion kinetics. The routine availability of single-layer graphene electrodes on a soft substrate with tunable stiffness will open a new avenue for studies, where the PDMS-liquid interface is made conducting with minimal alteration of the intrinsic material properties such as softness, flexibility, elasticity, and transparency.

Recent Advances in Bioelectronics for Localized Drug Delivery

The last decade has witnessed remarkable advancements in bioelectronics, ushering in a new era of wearable and implantable devices for drug delivery. By utilizing miniaturized system design and/or flexible materials, bioelectronics illustrates ideal integration with target organs and tissues, making them ideal platforms for localized drug delivery. Furthermore, the development of electrically assisted drug delivery systems has enhanced the efficiency and safety of therapeutic administration, particularly for the macromolecules that encounter additional challenges in penetrating biological barriers. In this review, a concise overview of recent progress in bioelectronic devices for in vivo localized drug delivery, with highlights on the latest trends in device design, working principles, and their corresponding functionalities, is provided. The reported systems based on their targeted delivery locations as wearable systems, ingestible systems, and implantable systems are categorized. Each category is introduced in detail by highlighting the special requirements for devices and the corresponding solutions. The remaining challenges in this field and future directions are also discussed.

A snapshot review on materials enabled multimodal bioelectronics for neurological and cardiac research

Seamless integration of the body and electronics toward the understanding, quantification, and control of disease states remains one of the grand scientific challenges of this era. As such, research efforts have been dedicated to developing bioelectronic devices for chemical, mechanical, and electrical sensing, and cellular and tissue functionality modulation. The technologies developed to achieve these capabilities cross a wide range of materials and scale (and dimensionality), e.g., from micrometer to centimeters (from 2-dimensional (2D) to 3-dimensional (3D) assemblies). The integration into multimodal systems which allow greater insight and control into intrinsically multifaceted biological systems requires careful design and selection. This snapshot review will highlight the state-of-the-art in cellular recording and modulation as well as the material considerations for the design and manufacturing of devices integrating their capabilities.

Multifaceted Shape Memory Polymer Technology for Biomedical Application: Combining Self-Softening and Stretchability Properties

Thiol-ene polymers are a promising class of biomaterials with a wide range of potential applications, including organs-on-a-chip, microfluidics, drug delivery, and wound healing. These polymers offer flexibility, softening, and shape memory properties. However, they often lack the inherent stretchability required for wearable or implantable devices. This study investigated the incorporation of di-acrylate chain extenders to improve the stretchability and conformability of those flexible thiol-ene polymers. Thiol-ene/acrylate polymers were synthesized using 1,3,5-triallyl-1,3,5-triazine-2,4,6(1H,3H,5H)-trione (TATATO), Trimethylolpropanetris (3-mercaptopropionate) (TMTMP), and Polyethylene Glycol Diacrylate (PEGDA) with different molecular weights (Mn 250 and Mn 575). Fourier Transform Infrared (FTIR) spectroscopy confirmed the complete reaction among the monomers. Uniaxial tensile testing demonstrated the softening and stretching capability of the polymers. The Young's Modulus dropped from 1.12 GPa to 260 MPa upon adding 5 wt% PEGDA 575, indicating that the polymer softened. The Young's Modulus was further reduced to 15 MPa under physiologic conditions. The fracture strain, a measure of stretchability, increased from 55% to 92% with the addition of 5 wt% PEGDA 575. A thermomechanical analysis further confirmed that PEGDA could be used to tune the polymer's glass transition temperature (Tg). Moreover, our polymer exhibited shape memory properties. Our results suggested that thiol-ene/acrylate polymers are a promising new class of materials for biomedical applications requiring flexibility, stretchability, and shape memory properties.

Regenerative bioelectronics: A strategic roadmap for precision medicine

In the past few decades, stem cell-based regenerative engineering has demonstrated its significant potential to repair damaged tissues and to restore their functionalities. Despite such advancement in regenerative engineering, the clinical translation remains a major challenge. In the stance of personalized treatment, the recent progress in bioelectronic medicine likewise evolved as another important research domain of larger significance for human healthcare. Over the last several years, our research group has adopted biomaterials-based regenerative engineering strategies using innovative bioelectronic stimulation protocols based on either electric or magnetic stimuli to direct cellular differentiation on engineered biomaterials with a range of elastic stiffness or functional properties (electroactivity/magnetoactivity). In this article, the role of bioelectronics in stem cell-based regenerative engineering has been critically analyzed to stimulate futuristic research in the treatment of degenerative diseases as well as to address some fundamental questions in stem cell biology. Built on the concepts from two independent biomedical research domains (regenerative engineering and bioelectronic medicine), we propose a converging research theme, 'Regenerative Bioelectronics'. Further, a series of recommendations have been put forward to address the current challenges in bridging the gap in stem cell therapy and bioelectronic medicine. Enacting the strategic blueprint of bioelectronic-based regenerative engineering can potentially deliver the unmet clinical needs for treating incurable degenerative diseases.

Enhancing the Elasticity of Conjugated Polymers through Precise Control of the Spacing between the Backbone and Siloxane Side-Chains

Intrinsically stretchable conjugated polymers (CPs) have extensively been studied for the development of novel flexible electronic devices. In this work, a method to control the elastic properties of CPs has been proposed via regulation of spacer length between the siloxane side-chain and the backbone. The target polymers were CP films with the structure P(mC-Si) for four different numbers of the spacer methylene groups, namely, m = 5, 6, 7, and 8. The effect of spacer length on the aggregation state as well as on electrical and elastic properties of the prepared films was then investigated. An adjustable lamellar spacing (d_L-L), in addition to improved elastic properties, was achieved as the spacer length was changed in the prepared polymer films. Moreover, P(7C-Si) has a sufficient d_L-L value of 35.77 Å, which provides enough space for inter-chain sliding to dissipate stress. This facilitated the dissipation of stress during the straining process. At a strain value of 100% in the vertical direction, the mobility of the P(7C-Si) film was 0.79 cm² V^-1 s^-1 and reduced to 84.0% of the initial value without any applied strain. The study provides clear evidence that tuning the spacer length between the silicone endgroup and backbone is an effective way to improve the intrinsic stretchability of CPs with siloxane side chains.

Ultra-soft and highly stretchable tissue-adhesive hydrogel based multifunctional implantable sensor for monitoring of overactive bladder

A highly stretchable and tissue-adhesive multifunctional sensor based on structurally engineered islets embedded in ultra-soft hydrogel is reported for monitoring of bladder activity in overactive bladder (OAB) induced rat and anesthetized pig. The use of hydrogel yielded a much lower sensor modulus (1 kPa) compared to that of the bladder (300 kPa), while the strong adhesiveness of the hydrogel (adhesive strength: 260.86 N/m) allowed firm attachment onto the bladder. The change in resistance of printed liquid metal particle thin-film lines under strain were used to detect bladder inflation and deflation; due to the high stretchability and reliability of the lines, surface strains of 200% could be measured repeatedly. Au electrodes coated with Platinum black were used to detect electromyography (EMG). These electrodes were placed on structurally engineered rigid islets so that no interfacial fracture occurs under high strains associated with bladder expansion. On the OAB induced rat, stronger signals (change in resistance and EMG root-mean-square) were detected near intra-bladder pressure maxima, thus showing correlation to bladder activity. Moreover, using robot-assisted laparoscopic surgery, the sensor was placed onto the bladder of an anesthetized pig. Under voiding and filling, bladder strain and EMG were once again monitored. These results confirm that our proposed sensor is a highly feasible, clinically relevant implantable device for continuous monitoring OAB for diagnosis and treatment.

Neuroplasticity as a Foundation for Decision-Making in Space

This is an exploratory review of two very recent, intersecting segments of space science: neuroplasticity in space, and decision-making in space. The high level of neuroplasticity in humans leads to unfortunate neurological and physical deconditioning while the body adjusts to the new space environment. However, neuroplasticity may also allow recovery and continued functioning of decision-making at a level necessary for mission completion. Cosmic radiation, microgravity, heightened levels of carbon dioxide in spacecraft, and other factors are being explored as root causes of neurological and physical deconditioning in space. The goal of this paper is to explore some of the lines of causation that show how these factors affect the capacity of humans to make decisions in space. Either alone or in groups, it remains essential that humans retain an ability to make decisions that will save lives, protect equipment, complete missions, and return safely to Earth. A final section addresses healthcare, medical intervention, and remediation that could help to "harness" neuroplasticity before, during, and after spaceflight. The dual nature of human neuroplasticity renders it both a cause of problems and also potentially the foundation of remediation. The future of research on both neuroplasticity and human decision-making promises to be full of surprises, both welcome and otherwise. It is an exciting time in research on space medicine.